CRNI Infection Prevention and Control 4 — Questions and Answers
Question 1: A CRNI is preparing to access a central venous catheter. Which action is the highest priority before accessing the catheter hub?
- Flush the catheter with normal saline
- Scrub the hub with chlorhexidine wipe for at least 15 seconds (Correct answer)
- Apply a sterile dressing to the insertion site
- Verify catheter placement with a chest X-ray
Correct answer: Scrub the hub with chlorhexidine wipe for at least 15 seconds
Scrubbing the hub ('scrub the hub') with an appropriate antiseptic such as chlorhexidine for at least 15 seconds and allowing it to dry is the evidence-based practice to prevent CLABSI.
Question 2: Which type of isolation is required for a patient diagnosed with pulmonary tuberculosis?
- Contact precautions in a standard room
- Droplet precautions with a surgical mask
- Airborne precautions in a negative-pressure room (Correct answer)
- Protective environment with HEPA filtration
Correct answer: Airborne precautions in a negative-pressure room
Pulmonary TB is transmitted via airborne nuclei (<5 microns), requiring airborne precautions in an airborne infection isolation room (AIIR) with negative pressure.
Question 3: A nurse notices a patient's peripheral IV site has signs of phlebitis. What is the FIRST action the CRNI should take?
- Apply a warm compress and continue the infusion
- Discontinue the IV and restart at a new site (Correct answer)
- Increase the infusion rate to flush the vein
- Apply topical antibiotic ointment to the site
Correct answer: Discontinue the IV and restart at a new site
Phlebitis requires immediate discontinuation of the IV catheter and insertion at a new site to prevent progression to thrombophlebitis or infection.
Question 4: Which hand hygiene product is LEAST effective against Clostridioides difficile spores?
- Soap and water with vigorous friction for 20 seconds
- 70% isopropyl alcohol hand rub (Correct answer)
- Chlorhexidine-based hand sanitizer
- Povidone-iodine hand scrub
Correct answer: 70% isopropyl alcohol hand rub
Alcohol-based hand sanitizers are ineffective against C. difficile spores; soap and water with mechanical friction is required to physically remove spores from hands.
Question 5: A patient receiving TPN through a PICC line develops fever, chills, and positive blood cultures. What does this scenario most likely represent?
- Catheter-related bloodstream infection (CRBSI) (Correct answer)
- Infusion-related phlebitis
- Tunnel infection at the exit site
- Septic thrombophlebitis of a peripheral vein
Correct answer: Catheter-related bloodstream infection (CRBSI)
Fever, rigors, and positive blood cultures in a patient with a central line and TPN are classic signs of a catheter-related bloodstream infection (CRBSI).
Question 6: When changing IV tubing for continuous lipid infusions, how frequently should tubing be replaced according to INS standards?
- Every 24 hours (Correct answer)
- Every 48 hours
- Every 72 hours
- Every 96 hours
Correct answer: Every 24 hours
Per INS standards, administration sets used for lipid emulsions (including TPN with lipids) should be changed every 24 hours due to the risk of microbial growth.
Question 7: A CRNI is caring for an immunocompromised patient post-stem cell transplant. Which isolation precaution is designed to PROTECT this patient from environmental pathogens?
- Contact precautions
- Droplet precautions
- Airborne precautions
- Protective environment (PE) (Correct answer)
Correct answer: Protective environment (PE)
Protective environment (PE) uses positive-pressure rooms with HEPA filtration to protect severely immunocompromised patients from environmental fungi and other pathogens.
CRNI Infection Prevention and Control 4
A CRNI is preparing to access a central venous catheter.
Which action is the highest priority before accessing the catheter hub?