CRNI Infection Control 5 — Questions and Answers
Question 1: According to the CDC and INS guidelines, how frequently should administration sets used for continuous infusions be changed in the absence of lipids, blood, or propofol?
- Every 24 hours
- Every 48 hours
- No more frequently than every 96 hours, unless clinically indicated (Correct answer)
- Every 7 days
Correct answer: No more frequently than every 96 hours, unless clinically indicated
Current evidence supports changing standard IV administration sets no more often than every 96 hours (4 days) unless the line is compromised or used for blood, lipids, or propofol.
Question 2: A nurse is caring for a neutropenic oncology patient with a tunneled CVC. Which infection control measure is MOST critical in this population?
- Using standard precautions only, as neutropenia does not increase CRBSI risk
- Strict aseptic technique with every catheter access due to severely impaired host defenses (Correct answer)
- Changing the CVC every 3 days prophylactically
- Applying antibiotic ointment to the exit site daily
Correct answer: Strict aseptic technique with every catheter access due to severely impaired host defenses
Neutropenic patients lack adequate immune response, making strict aseptic technique during every catheter access essential to prevent life-threatening CRBSI.
Question 3: When a blood culture confirms a CRBSI, the provider orders catheter removal. After removal of a short-term CVC, what should the nurse do with the catheter tip?
- Dispose of it in a biohazard bag without culturing
- Send the tip for semiquantitative (roll-plate) culture per facility protocol (Correct answer)
- Wipe the tip with alcohol before sending it to the lab
- Reinsert a new catheter over a guidewire at the same site
Correct answer: Send the tip for semiquantitative (roll-plate) culture per facility protocol
Semiquantitative culture of the catheter tip (roll-plate method) is the standard technique to confirm catheter-related infection and identify the causative organism.
Question 4: A nurse applies a chlorhexidine-impregnated sponge dressing to a central line insertion site. What is the PRIMARY purpose of this dressing?
- To absorb excess blood at the insertion site
- To provide continuous antimicrobial action to reduce catheter colonization and CRBSI (Correct answer)
- To prevent accidental dislodgment of the catheter
- To improve patient comfort by reducing skin irritation
Correct answer: To provide continuous antimicrobial action to reduce catheter colonization and CRBSI
Chlorhexidine-impregnated dressings provide sustained local antimicrobial activity that has been shown to reduce catheter colonization and CRBSI rates in high-risk patients.
Question 5: Which finding on assessment of a peripheral IV site would indicate phlebitis that requires catheter removal?
- Slight pallor around the insertion site
- A streak of redness extending along the vein with induration and pain (Correct answer)
- A small bruise at the insertion point with no swelling
- Sluggish flow rate without any local skin changes
Correct answer: A streak of redness extending along the vein with induration and pain
A red streak extending along the vein (tracking) with induration and pain indicates phlebitis, requiring immediate catheter removal and documentation per INS standards.
Question 6: A nurse enters isolation to hang IV medications for a patient on contact precautions for MRSA. In what order should personal protective equipment (PPE) be donned?
- Gown, gloves, mask, eye protection
- Mask, gown, eye protection, gloves (Correct answer)
- Gloves, gown, mask, eye protection
- Eye protection, mask, gown, gloves
Correct answer: Mask, gown, eye protection, gloves
The recommended sequence is mask/respirator first, then eye protection, gown, and gloves last so that gloves cover the gown cuffs and provide the final barrier before contact.
Question 7: A CRNI is evaluating a patient's implanted port before accessing it. Which assessment finding would CONTRAINDICATE accessing the port?
- A faint outline of the port septum under the skin
- Skin breakdown, erythema, or warmth overlying the port (Correct answer)
- Slight resistance when palpating the port body
- Mild bruising at the last access site that has resolved
Correct answer: Skin breakdown, erythema, or warmth overlying the port
Skin breakdown, erythema, or warmth over an implanted port suggests infection or erosion, which contraindicates access until the issue is evaluated by the provider.
CRNI Infection Control 5
According to the CDC and INS guidelines, how frequently should administration sets used for continuous infusions be changed in the absence of lipids, blood, or propofol?