CRNI - Certified Registered Nurse Infusion Exam — Questions and Answers

Question 1: A patient receiving TPN through a CVC develops fever, chills, and elevated WBC 5 days post-insertion. After blood cultures are drawn, the next priority intervention is:

Remove the CVC immediately and culture the tip
Increase the TPN infusion rate
Administer empiric broad-spectrum antibiotics per protocol (Correct answer)
Apply a warm compress to the insertion site

Correct answer: Administer empiric broad-spectrum antibiotics per protocol

Per IDSA guidelines, empiric antibiotics should be initiated promptly for suspected CRBSI after blood cultures are obtained, with catheter removal decision based on clinical assessment.

Question 2: A nurse assesses a peripheral IV site and notes the Phlebitis Scale score as 2. What finding corresponds to this score?

No symptoms
Pain at site with erythema and/or edema (Correct answer)
Palpable venous cord longer than 1 inch
Pain at site with erythema and streak formation

Correct answer: Pain at site with erythema and/or edema

A Phlebitis Scale score of 2 indicates pain at the site with erythema and/or edema, indicating early phlebitis requiring intervention.

Question 3: Which oncology patient receiving vesicant chemotherapy via peripheral IV requires the most vigilant site assessment?

A patient with a freshly placed antecubital vein IV with confirmed blood return
A patient with a hand vein insertion 30 minutes before infusion start (Correct answer)
A patient receiving vesicant via a centrally confirmed PICC line
A patient with a large forearm vein selected 6 hours ago

Correct answer: A patient with a hand vein insertion 30 minutes before infusion start

Peripheral hand vein IVs placed shortly before vesicant administration carry the highest risk of extravasation due to vein fragility and poor fixation; central access is strongly preferred.

Question 4: Which of the following describes a Grade 3 infiltration according to the INS Infiltration Scale?

Skin tight, leaking, bruised, and swollen with pitting edema >1 inch (Correct answer)
Skin blanched with no pain
Any amount of swelling with or without pain
Skin blanched, translucent, with gross edema and mild pain

Correct answer: Skin tight, leaking, bruised, and swollen with pitting edema >1 inch

INS Grade 3 infiltration is characterized by skin that is tight, translucent, gross edema >1 inch, cool to touch, and associated with mild to moderate pain.

Question 5: Which action is most effective in preventing catheter-related bloodstream infections (CRBSI) during central line insertion?

Using antimicrobial flush solutions only
Choosing the femoral vein for easier access
Flushing with normal saline before and after use
Applying full barrier precautions including sterile drape, gown, gloves, mask, and cap (Correct answer)

Correct answer: Applying full barrier precautions including sterile drape, gown, gloves, mask, and cap

Maximal sterile barrier precautions during central line insertion (gown, gloves, mask, cap, and large sterile drape) are the most evidence-based intervention to prevent CRBSI.

Question 6: Which of the following should be considered before starting an IV medication infusion?

The patient’s hydration status. (Correct answer)
The patient’s current medications for oral administration.
The patient’s diet preferences.
The patient’s ability to walk.

Correct answer: The patient’s hydration status.

Before starting an IV medication infusion, it's important to assess the patient's hydration status. This helps determine the appropriate fluid volume and rate for the infusion, as well as how the medication might be distributed and excreted in the body. The patient's hydration status can significantly impact the effectiveness and safety of IV therapy.

Question 7: What is the function of a needleless connector (NC) on a peripheral IV catheter?

It adds heparin to every flush automatically
It provides an in-line filter for IV medications
It allows IV access without a needle, reducing needlestick injury risk while maintaining a closed system (Correct answer)
It prevents any fluid from entering the catheter between uses

Correct answer: It allows IV access without a needle, reducing needlestick injury risk while maintaining a closed system

Needleless connectors allow IV access via a blunt cannula or luer-activated valve, eliminating needlestick risk and maintaining a closed IV system to reduce CRBSI.

Question 8: Why is it critical to use microbore (low-volume) IV tubing when infusing medications to neonates?

To minimize dead-space volume and prevent large unintended drug boluses during flushes (Correct answer)
To increase the infusion rate safely
To comply with JCAHO standards only
To reduce the risk of air embolism

Correct answer: To minimize dead-space volume and prevent large unintended drug boluses during flushes

Microbore tubing minimizes dead-space volume in pediatric IV lines, preventing inadvertent drug boluses when lines are flushed in neonates.

Question 9: A nurse notices the IV infusion slowing and the area around the insertion site becoming cool, pale, and puffy. What is the most likely complication?

Air embolism
Infiltration (Correct answer)
Phlebitis
Catheter embolism

Correct answer: Infiltration

Infiltration occurs when IV fluid leaks into the surrounding tissue, causing coolness, pallor, and swelling at the site.

Question 10: A patient on a continuous heparin infusion has an aPTT result of 180 seconds (therapeutic range 60-100 seconds). What is the priority action?

Stop the infusion and notify the provider (Correct answer)
Continue the infusion and reassess in 6 hours
Increase the infusion rate
Flush the IV line with saline

Correct answer: Stop the infusion and notify the provider

An aPTT of 180 seconds indicates supratherapeutic anticoagulation with bleeding risk; the infusion must be stopped and the provider notified immediately.

Question 11: A patient receiving potassium chloride IV develops peaked T waves on telemetry. This finding indicates:

Hypocalcemia
Hypokalemia
Hyperkalemia (Correct answer)
Hyponatremia

Correct answer: Hyperkalemia

Peaked T waves are an early ECG sign of hyperkalemia, which may result from excessive IV potassium administration.

Question 12: A patient's urine specific gravity is 1.030. What does this suggest?

Overhydration
Diabetes insipidus
Normal hydration status
Concentrated urine indicating dehydration (Correct answer)

Correct answer: Concentrated urine indicating dehydration

A specific gravity of 1.030 is above the normal range (1.003–1.030) and indicates highly concentrated urine, a sign of dehydration.

Question 13: When applying a transparent semipermeable dressing to a peripheral IV site, why is it important to avoid stretching the dressing?

Stretching can cause tension injury (medical adhesive-related skin injury) when the dressing contracts (Correct answer)
Stretching increases the cost of dressing use
Stretched dressings absorb moisture more efficiently
Stretching reduces the adhesive surface area and causes early dressing failure only

Correct answer: Stretching can cause tension injury (medical adhesive-related skin injury) when the dressing contracts

Applying a TSM dressing under tension causes it to contract after placement, creating shear forces that result in medical adhesive-related skin injury (MARSI), blisters, or skin tears.

Question 14: Which of the following best describes a central venous catheter (CVC)?

A catheter placed in a central vein, typically for long-term therapy (Correct answer)
A catheter placed in a peripheral vein.
A catheter used for monitoring blood pressure.
A type of catheter used for temporary peripheral access.

Correct answer: A catheter placed in a central vein, typically for long-term therapy

A central venous catheter (CVC) is accurately described as a catheter placed in a large central vein, such as the subclavian, jugular, or femoral vein, with its tip typically resting in the superior vena cava. CVCs are primarily used for long-term therapy, administration of irritating medications, rapid fluid resuscitation, and central venous pressure monitoring, differentiating them from peripheral access devices.

Question 15: What is the first nursing action when a peripheral IV site shows signs of infiltration?

Apply a warm compress and continue the infusion
Slow the infusion rate and reassess in 30 minutes
Notify the physician before taking any action
Discontinue the IV and remove the catheter (Correct answer)

Correct answer: Discontinue the IV and remove the catheter

The immediate action for IV infiltration is to stop the infusion and remove the catheter to prevent further tissue damage from continued fluid extravasation.

Question 16: What is the role of the nurse when administering high-alert medications intravenously?

Perform the task alone without consulting anyone.
Skip checking the medication dose if it matches the standard protocol.
Double-check the medication order with another nurse. (Correct answer)
Administer the medication without further checks.

Correct answer: Double-check the medication order with another nurse.

High-alert medications carry an increased risk of causing significant patient harm when used in error. Therefore, a critical safety measure for IV administration of these drugs is to have another qualified nurse independently double-check the medication order, dose calculations, and drug preparation before administration. This helps to catch potential errors and enhance patient safety.

Question 17: D5W (5% dextrose in water) behaves like which type of solution after dextrose is metabolized?

Colloid
Isotonic
Hypertonic
Hypotonic (Correct answer)

Correct answer: Hypotonic

Once cells metabolize the dextrose, only free water remains, making D5W effectively a hypotonic solution that distributes into all body compartments.

Question 18: Which IV administration set modification is required for blood products administered to neonates or infants?

Use of microaggregate or leukoreduction filter and blood warmer for small-volume transfusions (Correct answer)
No modifications required; standard blood tubing is acceptable
In-line 0.2-micron filter to prevent particulate infusion
Use of a blood warmer set only

Correct answer: Use of microaggregate or leukoreduction filter and blood warmer for small-volume transfusions

Neonatal and infant transfusions require a leukoreduction or microaggregate filter and often a blood warmer to prevent FNHTR, hypothermia, and CMV transmission.

Question 19: A nurse must urgently insert a peripheral IV catheter without optimal skin prep. What is the most important follow-up action?

Document the insertion and reassess at the next shift
Replace the catheter at a new site within 48 hours using proper aseptic technique (Correct answer)
Apply extra tape to secure the catheter
Administer prophylactic antibiotics immediately

Correct answer: Replace the catheter at a new site within 48 hours using proper aseptic technique

Catheters inserted under emergency conditions without full aseptic technique should be replaced at a new site within 48 hours when the patient is stable.

Question 20: The nurse is calculating a patient's fluid balance. Insensible fluid losses include:

Perspiration and respiration (Correct answer)
Wound drainage
Nasogastric tube output
Urine output

Correct answer: Perspiration and respiration

Insensible losses are those not easily measured and include perspiration and water lost through respiration.

Question 21: A patient develops chills, fever, hypotension, and tachycardia shortly after a blood transfusion begins. What is the priority nursing action?

Stop the transfusion and keep the IV line open with normal saline (Correct answer)
Increase the infusion rate to flush the reaction
Administer diphenhydramine and continue the transfusion
Slow the transfusion rate and reassess

Correct answer: Stop the transfusion and keep the IV line open with normal saline

A suspected acute hemolytic transfusion reaction requires immediately stopping the transfusion and maintaining IV access with normal saline to support perfusion.

Question 22: A patient with burns is at greatest risk for which fluid and electrolyte imbalance in the first 24 hours?

Hypovolemia and hypokalemia (Correct answer)
Hypocalcemia and hyponatremia
Hypervolemia and hypernatremia
Hyperkalemia and metabolic alkalosis

Correct answer: Hypovolemia and hypokalemia

Massive fluid and electrolyte loss through burned tissue causes hypovolemia and hypokalemia in the acute burn phase.

Question 23: Which flushing solution and volume is the standard recommendation for maintaining a non-valved PICC between uses?

Normal saline 3 mL with gentle continuous push
Sterile water, 5 mL
Normal saline 10 mL using pulsatile push-pause technique, followed by a positive-pressure lock (Correct answer)
Heparinized saline 10 units/mL, 10 mL

Correct answer: Normal saline 10 mL using pulsatile push-pause technique, followed by a positive-pressure lock

10 mL of normal saline using a pulsatile (push-pause) technique followed by a positive-pressure lock is standard for maintaining PICC patency and clearing the catheter lumen.

Question 24: An elastomeric infusion device (balloon pump) is used primarily for which type of IV therapy?

Ambulatory antibiotic infusions where a portable, non-electronic delivery device is preferred (Correct answer)
Rapid IV fluid bolus administration in the ED
Central line medication infusions in the ICU
Continuous vasopressor infusions requiring frequent rate adjustments

Correct answer: Ambulatory antibiotic infusions where a portable, non-electronic delivery device is preferred

Elastomeric pumps use balloon pressure to deliver medication at a preset rate, making them ideal for home or ambulatory antibiotic infusions that do not require rate adjustment.

Question 25: What is the main reason for administering potassium chloride through an IV?

To correct potassium deficiencies (Correct answer)
To prevent hyperkalemia.
To dilute the bloodstream.
To increase the body’s sodium levels.

Correct answer: To correct potassium deficiencies

The main reason for administering potassium chloride through an IV is to correct potassium deficiencies, a condition known as hypokalemia. Potassium is a vital electrolyte essential for proper nerve and muscle function, including the heart. IV administration allows for rapid and effective replenishment of potassium levels, which is crucial in preventing serious cardiac arrhythmias and other complications.

Question 26: Which statement about IV push (IVP) medication administration is correct?

IVP medications should always be diluted in 50 mL NS before administration
Rate of IVP administration is medication-specific and must be verified in a drug reference (Correct answer)
All IVP medications can be administered over 1 minute
IVP is contraindicated in central venous catheters

Correct answer: Rate of IVP administration is medication-specific and must be verified in a drug reference

Each IVP medication has a specific safe administration rate that must be verified in a drug reference, as giving too rapidly can cause adverse effects including cardiac arrhythmias.

Question 27: A midline catheter differs from a PICC primarily in that it:

Is inserted in the femoral vein
Tip terminates in the axillary or subclavian vein, not the central circulation (Correct answer)
Can be used to administer TPN without restriction
Requires a chest X-ray for tip confirmation

Correct answer: Tip terminates in the axillary or subclavian vein, not the central circulation

A midline catheter tip resides in the axillary or basilic vein (not centrally), so it has restrictions on irritating or hyperosmolar solutions.

Question 28: What condition can be caused by a lack of sufficient sodium in the IV fluids?

Hyponatremia (Correct answer)
Hypercalcemia.
Hyperkalemia.
Dehydration.

Correct answer: Hyponatremia

A lack of sufficient sodium in intravenous fluids, or administering too much hypotonic fluid, can lead to hyponatremia. This condition is characterized by an abnormally low concentration of sodium in the blood. Hyponatremia can cause severe neurological symptoms, including confusion, seizures, and cerebral edema, making careful monitoring of IV fluid composition essential.

Question 29: How often should the IV insertion site be monitored for signs of infection?

Every 24 hours.
Only when the patient reports discomfort.
Every shift or as per facility protocols (Correct answer)
Every hour.

Correct answer: Every shift or as per facility protocols

The IV insertion site should be monitored for signs of infection every shift or as per facility protocols. Regular and consistent assessment allows for early detection of complications such as redness, warmth, swelling, or pain, which can indicate phlebitis or infection. Timely identification of these signs is crucial for prompt intervention and maintaining patient safety.

Question 30: What should you do if a patient shows signs of fluid overload during IV therapy?

Wait for the symptoms to resolve on their own.
Stop the infusion and notify the healthcare provider (Correct answer)
Increase the rate of IV fluids.
Administer a diuretic medication.

Correct answer: Stop the infusion and notify the healthcare provider

If a patient shows signs of fluid overload during IV therapy, the immediate and appropriate action is to stop the infusion and notify the healthcare provider. Halting the fluid administration prevents further accumulation, while informing the provider ensures prompt medical evaluation and management. This may involve administering diuretics or adjusting the overall fluid management plan.

Question 31: How can excessive fluid intake through intravenous therapy impact the body?

It has no effect on the body.
It leads to dehydration.
It can cause a decrease in electrolytes.
It can cause fluid overload (Correct answer)

Correct answer: It can cause fluid overload

Excessive fluid intake through intravenous therapy can significantly impact the body by causing fluid overload, also known as hypervolemia. This condition occurs when the body retains too much fluid, leading to symptoms like swelling (edema), shortness of breath due to fluid in the lungs, and increased blood pressure. Fluid overload can strain the heart and kidneys, potentially leading to serious complications if not managed promptly.

Question 32: Which action is the nurse's priority when administering IV potassium chloride?

Dilute and infuse no faster than 10–20 mEq/hour via pump (Correct answer)
Give only through a peripheral line
Administer as an IV push for fastest correction
Mix in a hypotonic solution

Correct answer: Dilute and infuse no faster than 10–20 mEq/hour via pump

IV potassium must always be diluted and infused slowly (≤10–20 mEq/hr) because rapid administration can cause fatal cardiac arrhythmias.

Question 33: Which IV solution is generally avoided in premature neonates due to the risk of kernicterus?

Potassium chloride-containing solutions
IV solutions containing benzyl alcohol as a preservative (Correct answer)
Normal saline with 5% dextrose
Lactated Ringer's solution

Correct answer: IV solutions containing benzyl alcohol as a preservative

Benzyl alcohol, used as a preservative in some IV solutions and medications, is toxic to premature neonates and is associated with 'gasping syndrome' and kernicterus.

Question 34: When should administration tubing used to infuse blood or blood components be changed?

After every unit or after 4 hours, whichever comes first (Correct answer)
Every 24 hours
Only when visibly soiled
Every 4 hours

Correct answer: After every unit or after 4 hours, whichever comes first

Blood administration tubing should be changed after each unit of blood product or after 4 hours of infusion time, whichever occurs first, to reduce bacterial proliferation risk.

Question 35: Which laboratory value best reflects the body's acid-base balance?

Serum potassium
Serum chloride
Arterial blood gas pH (Correct answer)
BUN

Correct answer: Arterial blood gas pH

Arterial blood gas pH directly measures hydrogen ion concentration and is the primary indicator of acid-base balance.

Question 36: Why are antimicrobial-impregnated catheters recommended for patients requiring short-term central venous access in high-risk settings?

They release antimicrobial agents to inhibit colonization and reduce CLABSI risk (Correct answer)
They are more flexible and easier to insert
They eliminate the need for dressing changes
They prevent mechanical complications during insertion

Correct answer: They release antimicrobial agents to inhibit colonization and reduce CLABSI risk

Antimicrobial-impregnated catheters (e.g., chlorhexidine/silver sulfadiazine or minocycline/rifampin) release antimicrobials locally to inhibit biofilm formation and reduce CLABSI.

Question 37: When assessing an IV site, you note the skin is taut, cool, and pale with no blood return. The most likely cause is:

Phlebitis
Thrombosis
Hematoma
Infiltration (Correct answer)

Correct answer: Infiltration

Taut, cool, pale skin with absent blood return indicates infiltration — IV fluid leaking into surrounding tissue.

Question 38: When a positive-pressure needleless connector is used, what technique is required when disconnecting a syringe after flushing to prevent blood reflux?

Clamp the IV line after disconnecting the syringe
Disconnect the syringe while maintaining positive pressure by continuing gentle pressure on the plunger during disconnection (Correct answer)
Aspirate slightly before disconnecting to create a vacuum
Disconnect rapidly to prevent pressure equalization

Correct answer: Disconnect the syringe while maintaining positive pressure by continuing gentle pressure on the plunger during disconnection

Positive-pressure connectors require maintaining forward pressure on the plunger during syringe disconnection to ensure the connector mechanism expels blood rather than drawing it back.

Question 39: Which electrolyte abnormality is most commonly associated with long-term TPN therapy?

Hypercalcemia
Hypophosphatemia (Correct answer)
Hypernatremia
Hypermagnesemia

Correct answer: Hypophosphatemia

Hypophosphatemia is the most common electrolyte disturbance in TPN patients, occurring due to increased cellular phosphate uptake driven by the high dextrose load.

Question 40: Which IV solution is most appropriate to treat symptomatic hyponatremia?

0.45% NS
3% Hypertonic Saline (Correct answer)
D5W
Lactated Ringer's

Correct answer: 3% Hypertonic Saline

3% hypertonic saline raises serum sodium in patients with severe symptomatic hyponatremia.

Question 41: Febrile non-hemolytic transfusion reaction (FNHTR) is caused by which mechanism?

ABO incompatibility between donor and recipient
Recipient antibodies reacting against donor leukocytes and cytokines in the blood product (Correct answer)
Bacterial contamination of the blood product
Fluid overload from rapid transfusion

Correct answer: Recipient antibodies reacting against donor leukocytes and cytokines in the blood product

FNHTR is caused by recipient antibodies directed against donor white blood cell antigens and/or cytokines accumulated during storage, producing fever and chills without hemolysis.

Question 42: What is the primary purpose of lipid emulsions in total parenteral nutrition?

To prevent catheter occlusion in central lines
To provide electrolyte supplementation
To supply essential fatty acids and a concentrated caloric source for energy (Correct answer)
To buffer the high pH of dextrose solutions

Correct answer: To supply essential fatty acids and a concentrated caloric source for energy

Lipid emulsions in TPN provide essential fatty acids (linoleic and linolenic acid) and a calorie-dense energy source that reduces dextrose load and prevents essential fatty acid deficiency.

Question 43: Which finding is most consistent with fluid volume deficit (dehydration)?

Periorbital edema
Decreased skin turgor (Correct answer)
Elevated CVP
Bounding pulse

Correct answer: Decreased skin turgor

Decreased skin turgor is a classic sign of dehydration due to reduced interstitial fluid volume.

Question 44: What differentiates extravasation from infiltration at an IV site?

Extravasation involves leakage of a vesicant or irritant solution capable of causing tissue necrosis (Correct answer)
Infiltration causes more severe tissue damage than extravasation
There is no clinical difference — the terms are interchangeable
Infiltration involves a vesicant solution; extravasation involves only isotonic fluids

Correct answer: Extravasation involves leakage of a vesicant or irritant solution capable of causing tissue necrosis

Extravasation specifically refers to the inadvertent infiltration of a vesicant or irritant medication that can cause blistering, ulceration, or tissue necrosis, distinguishing it from simple infiltration.

Question 45: According to INS standards, how often should transparent semipermeable membrane (TSM) dressings be changed on peripheral IV sites?

Every 24 hours
Every 72 hours
Every 48 hours
Every 5–7 days or when integrity is compromised (Correct answer)

Correct answer: Every 5–7 days or when integrity is compromised

INS standards recommend changing TSM dressings on peripheral IVs every 5–7 days or immediately when the dressing is soiled, loosened, or no longer intact.

Question 46: Which of the following is the correct method for priming IV tubing to remove air before connecting to a patient?

Connect to the patient first, then prime the tubing in reverse
Allow fluid to run rapidly through the tubing without closing the clamp
Open the clamp and allow fluid to slowly fill the tubing from top to bottom until all air is expelled, then close the clamp (Correct answer)
Tap the tubing repeatedly to dislodge air bubbles, then connect

Correct answer: Open the clamp and allow fluid to slowly fill the tubing from top to bottom until all air is expelled, then close the clamp

Proper IV tubing priming requires opening the clamp and slowly filling the tubing from the drip chamber downward, expelling all air before clamping and connecting to the patient.

Question 47: Which type of implanted port needle (Huber needle) design is used for continuous infusion to reduce coring of the septum?

Winged infusion needle
Straight non-coring needle
Angled non-coring needle (Correct answer)
Standard hypodermic bevel needle

Correct answer: Angled non-coring needle

Angled (90-degree) non-coring Huber needles are used for continuous infusions while straight non-coring needles are used for bolus injections.

Question 48: A nurse notes that a PICC dressing is partially lifted and moist on post-insertion day 3. What is the correct action?

Change the dressing immediately using sterile technique (Correct answer)
Remove the PICC and insert a new peripheral catheter
Leave the dressing and schedule a routine change for day 7
Reinforce the dressing with additional tape and document

Correct answer: Change the dressing immediately using sterile technique

A compromised (wet, soiled, or partially detached) CVAD dressing must be changed immediately using sterile technique regardless of scheduled change intervals.

Question 49: A patient with a triple-lumen central venous catheter (CVC) asks why three separate lumens are used. The BEST explanation is:

It increases catheter longevity
It eliminates the need for flushing
It allows simultaneous administration of incompatible medications through separate channels (Correct answer)
It reduces the risk of air embolism

Correct answer: It allows simultaneous administration of incompatible medications through separate channels

Multiple lumens allow incompatible drugs to be infused simultaneously without mixing, and permit blood draws without interrupting infusions.

Question 50: During a peripheral IV assessment, the nurse notices blood backing up into the tubing when the bag is lowered below the insertion site. This indicates:

Occluded catheter
Patent IV with adequate venous pressure (Correct answer)
Arterial placement
Infiltration

Correct answer: Patent IV with adequate venous pressure

Blood return when the IV bag is lowered below the site confirms catheter patency and proper venous placement.

Question 51: What is an important consideration when choosing a venous access device for a patient?

The patient's insurance plan.
The expected duration of therapy and patient’s condition (Correct answer)
The availability of the device in the hospital.
The patient's arm size.

Correct answer: The expected duration of therapy and patient’s condition

When choosing a venous access device, the expected duration of therapy and the patient's condition are paramount considerations. Long-term therapy or irritating medications may necessitate a central venous catheter, while short-term needs are met by a peripheral IV. The patient's vein health, medical history, and specific treatment plan also guide the selection to ensure optimal and safe access.

Question 52: When a nurse identifies a 'high-alert medication' on the IV medication administration record, what additional safety step is required before administration?

The medication must be verified only by pharmacy
Administration can proceed after a single nurse verification
Documentation in the incident report system before administration
An independent double-check by a second qualified nurse is required (Correct answer)

Correct answer: An independent double-check by a second qualified nurse is required

High-alert medications such as insulin, heparin, and concentrated electrolytes require an independent double-check by a second nurse to reduce the risk of serious harm from errors.

Question 53: Which complication is UNIQUE to subclavian central venous catheter insertion compared to internal jugular or femoral approaches?

Pneumothorax (Correct answer)
Air embolism
Deep vein thrombosis
Catheter-associated bloodstream infection

Correct answer: Pneumothorax

Pneumothorax is a specific risk of subclavian insertion due to the proximity of the apex of the lung to the insertion site.

Question 54: A nurse is preparing a chemotherapy agent for IV administration. Which PPE combination is required?

Standard gloves, isolation gown, and surgical mask
Standard gloves and a regular surgical mask
Double gloves, chemotherapy-rated gown, face shield, and N95 respirator (Correct answer)
Gloves only, as chemotherapy is only hazardous if ingested

Correct answer: Double gloves, chemotherapy-rated gown, face shield, and N95 respirator

Hazardous drug handling per USP 800 requires chemotherapy-specific PPE including double gloves (chemo-rated), closed-front gown, and respiratory/eye protection to prevent exposure.

Question 55: Which of the following is the most appropriate method to administer fluids to a patient with fluid loss due to vomiting?

IV fluids (Correct answer)
Oral fluids only.
Only water intake.
Only electrolyte tablets.

Correct answer: IV fluids

For a patient experiencing significant fluid loss due to vomiting, IV fluids are the most appropriate method of administration. Oral fluids may not be tolerated or absorbed quickly enough, especially if vomiting is persistent. IV fluids allow for rapid rehydration and electrolyte replenishment directly into the bloodstream, effectively correcting fluid deficits and preventing complications.

Question 56: Which antiseptic solution is preferred for skin antisepsis prior to peripheral IV insertion in adults?

Normal saline
Povidone-iodine 10%
Isopropyl alcohol 70% alone
Chlorhexidine gluconate >0.5% in alcohol (Correct answer)

Correct answer: Chlorhexidine gluconate >0.5% in alcohol

Chlorhexidine gluconate (CHG) >0.5% combined with alcohol is the preferred antiseptic for IV insertion site preparation due to its broad-spectrum efficacy and residual activity.

Question 57: What is the correct procedure for flushing an IV line after medication administration?

Flush with sterile water immediately after administration.
Flush with a saline solution immediately after administration. (Correct answer)
Flush with heparin solution.
No need to flush if the medication was administered slowly.

Correct answer: Flush with a saline solution immediately after administration.

Flushing an IV line with a compatible solution, typically normal saline, immediately after medication administration is essential. This clears the medication from the tubing, prevents drug incompatibilities if other medications are to follow, and maintains the patency of the IV catheter, reducing the risk of occlusion.

Question 58: Which of the following is the correct technique for flushing a peripheral IV catheter to assess patency before medication administration?

Aspirate until blood return is confirmed, then flush rapidly with 20 mL NS
Use a 10 mL syringe with 2–10 mL of normal saline using a pulsatile (push-pause) technique, then assess for resistance and swelling (Correct answer)
Use a 1 mL syringe for maximum pressure to clear occlusions
Flush with heparin first, then administer the medication

Correct answer: Use a 10 mL syringe with 2–10 mL of normal saline using a pulsatile (push-pause) technique, then assess for resistance and swelling

A pulsatile flush with a 10 mL syringe (which generates lower pressure than smaller syringes) using 2–10 mL NS assesses patency without forcing fluid through an occluded or infiltrated catheter.

Question 59: A peripheral IV catheter site has been in place for 5 days with no signs of complications. Per current INS standards, what should the nurse do?

Leave the catheter in place if there are no clinical signs of complications (Correct answer)
Replace the catheter in the same vein to preserve venous access
Remove and replace the catheter at a new site immediately
Request a physician order to extend the dwell time

Correct answer: Leave the catheter in place if there are no clinical signs of complications

Current INS guidelines support a clinically indicated removal policy — a well-functioning, complication-free peripheral IV may remain in place regardless of dwell time.

Question 60: A nurse is caring for a patient with a PICC line and notices the external catheter length has increased by 3 cm since insertion. What is the most likely cause and action?

Catheter occlusion requiring a thrombolytic flush
Air in the line requiring immediate aspiration
Catheter dislodgement requiring tip position verification before further use (Correct answer)
Normal catheter migration; no action needed

Correct answer: Catheter dislodgement requiring tip position verification before further use

Increased external catheter length indicates partial dislodgement; tip position must be verified by X-ray before any further use to prevent complications from malposition.

Question 61: What is the primary safety advantage of a 'smart pump' (dose-error reduction software) over a standard infusion pump?

It eliminates the need for manual pump programming
It calculates patient weight and adjusts doses automatically
It uses drug libraries with hard and soft limits to alert clinicians to potential dosing errors (Correct answer)
It automatically programs itself based on the physician order

Correct answer: It uses drug libraries with hard and soft limits to alert clinicians to potential dosing errors

Smart pumps use built-in drug libraries with hard limits (preventing dangerous doses) and soft limits (generating warnings) to reduce IV medication administration errors.

Question 62: Which electrolyte imbalance causes prolonged QT interval on ECG?

Hypercalcemia
Hypernatremia
Hyperkalemia
Hypomagnesemia (Correct answer)

Correct answer: Hypomagnesemia

Hypomagnesemia prolongs the QT interval and increases the risk of life-threatening arrhythmias such as torsades de pointes.

Question 63: Which IV solution type requires the most frequent administration set changes due to higher infection risk?

5% dextrose in water
Normal saline
Lactated Ringer's solution
Lipid emulsions (including those in total parenteral nutrition) (Correct answer)

Correct answer: Lipid emulsions (including those in total parenteral nutrition)

Lipid-containing IV solutions support microbial growth and require tubing changes every 12–24 hours to prevent infection.

Question 64: How should you monitor fluid balance during IV therapy?

By tracking fluid intake and urinary output (Correct answer)
By observing the patient's heart rate.
By taking the patient's blood pressure.
By measuring the patient's weight daily.

Correct answer: By tracking fluid intake and urinary output

Monitoring fluid balance during IV therapy is best achieved by tracking fluid intake and urinary output. This comprehensive approach allows healthcare providers to assess if the patient is retaining fluid, becoming dehydrated, or maintaining an appropriate balance. Accurate intake and output measurements are essential for preventing complications like fluid overload or hypovolemia.

Question 65: Which of the following is a type of venous access device?

Peripheral intravenous catheter (PIV) (Correct answer)
Urinary catheter
Central venous pressure catheter
Hepatic catheter

Correct answer: Peripheral intravenous catheter (PIV)

A Peripheral Intravenous Catheter (PIV) is a common type of venous access device used for short-term intravenous therapy. It provides direct access to a peripheral vein for administering fluids, medications, or drawing blood. This distinguishes it from other catheters designed for different purposes, such as central venous access or urinary drainage.

Question 66: A gravity infusion is running slower than ordered. Which is the most common correctable cause?

Pump failure
IV bag positioned too low relative to the insertion site, reducing gravitational pressure (Correct answer)
IV tubing primed incorrectly
Catheter gauge too large for the ordered rate

Correct answer: IV bag positioned too low relative to the insertion site, reducing gravitational pressure

Gravity infusion rate depends on the height difference between the IV bag and the insertion site; a bag hung too low reduces hydrostatic pressure and slows the drip rate.

Question 67: Which electrolyte imbalance can be caused by excessive use of intravenous fluids?

Hyperkalemia.
Hyponatremia (Correct answer)
Hypocalcemia.
Hypercalcemia.

Correct answer: Hyponatremia

Excessive use of intravenous fluids, particularly hypotonic solutions, can lead to hyponatremia. This condition occurs when the concentration of sodium in the blood becomes too low due to the dilution effect of too much fluid. Hyponatremia can cause serious neurological symptoms, including confusion, seizures, and even coma, highlighting the importance of careful fluid management.

Question 68: Which complication is specifically associated with PICC line insertion and results from catheter tip malposition?

Phlebitis at the antecubital fossa
Hematoma at the neck
Pneumothorax
Cardiac arrhythmia from atrial or ventricular tip placement (Correct answer)

Correct answer: Cardiac arrhythmia from atrial or ventricular tip placement

PICC line tip malposition in the right atrium or ventricle can trigger arrhythmias; tip placement must be confirmed at the cavoatrial junction by X-ray.

Question 69: A patient with SIADH (syndrome of inappropriate antidiuretic hormone) will typically present with:

Hypovolemia and dilute urine
Hyponatremia and concentrated urine (Correct answer)
Hypernatremia and polyuria
Hyperkalemia and edema

Correct answer: Hyponatremia and concentrated urine

SIADH causes excessive water retention, leading to dilutional hyponatremia and inappropriately concentrated urine.

Question 70: Which of the following correctly describes the 'SASH' flush protocol for peripheral IV catheters?

Saline, Administer drug, Saline, Heparin (for heparin-lock catheters) (Correct answer)
Sodium chloride, Anticoagulant, Saline, Heparin
Saline, Air, Saline, Heparin
Sterile water, Antibiotic, Saline, Hold

Correct answer: Saline, Administer drug, Saline, Heparin (for heparin-lock catheters)

The SASH protocol (Saline-Administer-Saline-Heparin) is used for heparin-lock catheters to confirm patency, administer medication, clear residual drug, and maintain patency with heparin.

Question 71: A patient's central venous pressure (CVP) reading is 2 mmHg during IV fluid resuscitation. This value most likely indicates:

Normal fluid balance
Cardiac tamponade
Hypovolemia and inadequate venous return (Correct answer)
Fluid overload

Correct answer: Hypovolemia and inadequate venous return

A CVP below 5 mmHg suggests hypovolemia; normal CVP is 5-10 mmHg, and values below this indicate inadequate intravascular volume.

Question 72: What is the primary purpose of monitoring blood pressure during IV therapy?

To assess the patient's oxygen levels.
To monitor the patient's nutritional intake.
To ensure the IV fluid is properly administered.
To detect potential fluid overload or hypovolemia (Correct answer)

Correct answer: To detect potential fluid overload or hypovolemia

The primary purpose of monitoring blood pressure during IV therapy is to detect potential fluid overload or hypovolemia. Significant changes in blood pressure, such as hypertension (fluid overload) or hypotension (hypovolemia), can indicate an imbalance in fluid status. Regular monitoring allows for timely intervention to prevent serious cardiovascular complications.

Question 73: What is the recommended minimum internal diameter (bore) of IV tubing for blood product administration?

Any tubing gauge is acceptable for blood products
Microbore tubing (0.5 mm ID)
Blood administration tubing with minimum 2.5–3 mm ID to prevent RBC trauma (Correct answer)
Standard extension set tubing (1–2 mm ID)

Correct answer: Blood administration tubing with minimum 2.5–3 mm ID to prevent RBC trauma

Blood products require administration sets with an adequate internal diameter to prevent mechanical hemolysis; standard blood tubing with a minimum 2.5–3 mm ID is required.

Question 74: What monitoring parameter is most critical during the first 15 minutes of a blood transfusion?

Blood glucose level
Central venous pressure readings
Vital signs (temperature, pulse, BP, respirations) and patient symptoms to detect acute reactions early (Correct answer)
Urine color only

Correct answer: Vital signs (temperature, pulse, BP, respirations) and patient symptoms to detect acute reactions early

The first 15 minutes of a transfusion carry the highest acute reaction risk; vital signs must be taken at baseline, 15 minutes into transfusion, and at completion.

Question 75: A patient's serum magnesium is 0.7 mEq/L. Which finding would the nurse expect?

Decreased deep tendon reflexes
Bradycardia
Hypertension
Muscle weakness and tremors (Correct answer)

Correct answer: Muscle weakness and tremors

Hypomagnesemia (normal 1.5–2.5 mEq/L) causes neuromuscular excitability, manifesting as muscle weakness and tremors.

Question 76: What is the purpose of using an in-line filter for IV infusions?

To remove particulate matter, air, and some microorganisms from the infusion (Correct answer)
To slow the infusion rate automatically
To prevent catheter occlusion from blood backflow
To prevent air embolism only

Correct answer: To remove particulate matter, air, and some microorganisms from the infusion

In-line filters remove particulate matter, air, and certain microorganisms from IV infusions, reducing the risk of infusion-related complications.

Question 77: When removing a peripheral IV catheter, what is the correct post-removal action to prevent hematoma formation?

Apply a tourniquet proximal to the site
Apply a warm compress immediately
Apply firm, direct pressure for at least 2–3 minutes (Correct answer)
Massage the site to disperse any blood

Correct answer: Apply firm, direct pressure for at least 2–3 minutes

Firm, direct pressure for 2–3 minutes (longer for anticoagulated patients) is the standard to achieve hemostasis and prevent hematoma after IV catheter removal.

Question 78: How frequently should hospitalized patients' peripheral IV sites be assessed for complications?

Every 12 hours
Once per shift with a minimum of every 8 hours (Correct answer)
Every 4 hours
Every 8 hours

Correct answer: Once per shift with a minimum of every 8 hours

INS standards recommend assessing peripheral IV sites at a minimum of every 8 hours, or per institutional policy that may require more frequent checks.

Question 79: A patient receiving IV morphine via PCA pump reports inadequate pain control. The nurse notes the PCA has a 4-hour lockout limit. What is the correct next step?

Contact the prescriber to reassess and potentially modify the PCA order (Correct answer)
Discontinue PCA and switch to oral opioids
Administer an IV bolus of morphine without a physician order
Override the lockout to give additional doses

Correct answer: Contact the prescriber to reassess and potentially modify the PCA order

The nurse must contact the prescriber to reassess pain management and obtain a modified order; independently overriding PCA lockouts or giving unauthorized boluses is unsafe practice.

Question 80: A nurse is caring for a patient with a tunneled central catheter whose exit site dressing has a small amount of dried blood from post-insertion day 1. What is the correct dressing management?

Remove the dressing and leave the site open to air until bleeding resolves
Change the dressing immediately using sterile technique and reassess (Correct answer)
Apply a new dressing layer on top of the existing one
Leave the dressing in place until the first scheduled change at 48 hours

Correct answer: Change the dressing immediately using sterile technique and reassess

A CVAD dressing that is soiled with blood or drainage is no longer intact and must be changed immediately with sterile technique to maintain a clean barrier against infection.

Question 81: Which gauge peripheral IV catheter is preferred for rapid fluid resuscitation in an adult trauma patient?

24-gauge catheter in the hand
18-gauge catheter in the dorsal foot
22-gauge catheter in the forearm
16-gauge or larger catheter in the antecubital fossa (Correct answer)

Correct answer: 16-gauge or larger catheter in the antecubital fossa

Large-bore (16-gauge or larger) peripheral catheters in large antecubital veins allow the maximum flow rates needed for rapid volume resuscitation in trauma.

Question 82: What is the primary purpose of an anti-siphon valve in an IV administration set?

To filter air bubbles from the IV line
To regulate backpressure in central venous catheters
To prevent free-flow when the tubing is removed from the pump
To prevent gravity-driven siphoning of IV fluid when the pump is not running or the tubing is unclamped outside the pump (Correct answer)

Correct answer: To prevent gravity-driven siphoning of IV fluid when the pump is not running or the tubing is unclamped outside the pump

Anti-siphon valves prevent uncontrolled gravity-driven flow (siphoning) of IV solution when tubing is inadvertently removed from the pump or the pump stops, preventing accidental fluid or drug bolus.

Question 83: A tunneled cuffed catheter (Hickman) is preferred over a PICC for which clinical situation?

Single blood draw in a difficult stick patient
Rapid fluid resuscitation in the ED
Long-term total parenteral nutrition over several months (Correct answer)
Short-term antibiotic therapy (7–14 days)

Correct answer: Long-term total parenteral nutrition over several months

Tunneled cuffed catheters are designed for long-term venous access (months to years), making them ideal for extended TPN or chemotherapy.

Question 84: Which type of dressing is recommended for central venous access device (CVAD) sites in patients with diaphoresis or when TSM dressings will not adhere?

No dressing; leave site open to air
Antimicrobial-impregnated gauze dressing
Standard gauze and tape dressing changed every 2 days (Correct answer)
Hydrocolloid dressing changed weekly

Correct answer: Standard gauze and tape dressing changed every 2 days

When TSM dressings will not adhere due to diaphoresis or other factors, gauze and tape is appropriate and should be changed every 2 days.

Question 85: Which antiseptic is recommended for skin preparation before peripheral IV insertion?

Povidone-iodine only
Isopropyl alcohol 70% alone
Benzalkonium chloride solution
>0.5% chlorhexidine gluconate in alcohol (preferred) or 70% isopropyl alcohol (Correct answer)

Correct answer: >0.5% chlorhexidine gluconate in alcohol (preferred) or 70% isopropyl alcohol

CDC and INS guidelines recommend >0.5% chlorhexidine gluconate in alcohol as the preferred skin antiseptic for vascular access site preparation.

Question 86: A patient receiving TPN through a central line suddenly develops hypoglycemia. The TPN has been running continuously. What is the most likely cause?

The patient ate a large meal
TPN bag ran empty and line was not changed timely
Insulin was added to the TPN bag in excessive amounts or a separate insulin infusion was not adjusted (Correct answer)
TPN lipid concentration was too high

Correct answer: Insulin was added to the TPN bag in excessive amounts or a separate insulin infusion was not adjusted

TPN-related hypoglycemia is most often caused by excessive insulin in the TPN admixture or failure to adjust a concurrent insulin infusion, causing blood glucose to drop despite ongoing dextrose infusion.

Question 87: A patient is ordered vancomycin 1g IV over 60 minutes. After 10 minutes, the patient develops flushing and erythema on the neck and face. What is the most likely cause?

Allergic reaction requiring epinephrine
Red Man Syndrome due to rapid infusion rate (Correct answer)
Extravasation of vancomycin
Anaphylaxis requiring immediate discontinuation

Correct answer: Red Man Syndrome due to rapid infusion rate

Red Man Syndrome is a non-allergic infusion reaction caused by too-rapid vancomycin infusion, presenting as flushing and erythema on the face, neck, and upper torso.

Question 88: The recommended technique for preventing catheter-related bloodstream infection (CRBSI) when accessing a needleless connector is:

Flush with heparin immediately before access
Cover the connector with a sterile gauze during infusion
Scrub the hub with 70% isopropyl alcohol for at least 5–15 seconds and allow to dry (Correct answer)
Wipe with sterile water for 5 seconds

Correct answer: Scrub the hub with 70% isopropyl alcohol for at least 5–15 seconds and allow to dry

Vigorous scrubbing of needleless connectors with 70% alcohol for 5–15 seconds ('scrub the hub') significantly reduces CRBSI risk.

Question 89: A patient receiving 0.9% NS at 125 mL/hr develops JVD, S3 heart sound, and dyspnea. The nurse should:

Switch to a hypertonic saline solution
Stop or slow the infusion and notify the provider immediately (Correct answer)
Increase the rate to improve cardiac output
Continue the infusion and reassess in 1 hour

Correct answer: Stop or slow the infusion and notify the provider immediately

JVD, S3, and dyspnea are classic signs of fluid overload/heart failure; the infusion must be slowed or stopped and the provider notified urgently.

Question 90: What is the purpose of a backcheck valve in a secondary IV (piggyback) administration setup?

To prevent backflow of blood into the IV tubing
To regulate the rate of the secondary infusion
To filter particulate matter from the piggyback medication
To prevent secondary medication from infusing into the primary bag and to allow primary solution to resume automatically after the secondary infusion completes (Correct answer)

Correct answer: To prevent secondary medication from infusing into the primary bag and to allow primary solution to resume automatically after the secondary infusion completes

The backcheck valve in a piggyback setup prevents the secondary drug from entering the primary IV bag and allows primary solution to flow automatically when the secondary bag empties.

Question 91: When should sterile gloves be used instead of clean gloves for IV therapy procedures?

Sterile gloves are never required for IV procedures
For all peripheral IV insertions
For central venous catheter insertion and other procedures requiring sterile technique per facility policy (Correct answer)
Only for patients with known infections

Correct answer: For central venous catheter insertion and other procedures requiring sterile technique per facility policy

Sterile gloves are required for central venous catheter insertion and other procedures designated as sterile technique per INS and CDC guidelines.

Question 92: A patient with a PICC line develops sudden onset dyspnea, chest pain, and hypotension immediately after a syringe is disconnected. The MOST likely complication is:

Air embolism (Correct answer)
Catheter occlusion
Venous thrombosis
Catheter-related bloodstream infection

Correct answer: Air embolism

Air embolism can occur when a catheter hub is open to air; it presents with sudden cardiovascular and respiratory deterioration.

Question 93: Which consideration is most important when selecting an IV insertion site in a patient undergoing hemodialysis?

Use the arm with the arteriovenous (AV) fistula for easiest access
The dominant arm is always preferred for IV placement
Central lines are never appropriate for dialysis patients
Avoid the arm with an AV fistula or graft to prevent thrombosis and preserve access (Correct answer)

Correct answer: Avoid the arm with an AV fistula or graft to prevent thrombosis and preserve access

The arm with an AV fistula or graft must never be used for IV insertion, venipuncture, or blood pressure measurement to protect the patient's dialysis access.

Question 94: What is the recommended position of the drip chamber when setting up a primary IV infusion set?

Half-full to allow accurate drop counting and prevent air from entering the pump tubing (Correct answer)
One-quarter full for slower infusions
Completely full to prevent air entry
Empty; fluid should be in the tubing only

Correct answer: Half-full to allow accurate drop counting and prevent air from entering the pump tubing

The drip chamber should be half-full to allow accurate visualization of the drop rate and to prevent air from being drawn into the tubing below the chamber.

Question 95: What is a common sign of phlebitis during IV therapy?

Bleeding from the insertion site.
Feeling of dizziness.
Increased heart rate.
Redness, warmth, and swelling at the IV site (Correct answer)

Correct answer: Redness, warmth, and swelling at the IV site

A common sign of phlebitis during IV therapy is redness, warmth, and swelling at the IV site. These symptoms indicate inflammation of the vein, often accompanied by pain or tenderness along the vein's path. Recognizing these signs early is crucial for prompt intervention to prevent further complications.

Question 96: Third-spacing of fluid refers to fluid that accumulates:

In the lymphatic system only
In the intravascular compartment
In non-functional extravascular spaces such as the peritoneal cavity (Correct answer)
In the intracellular space

Correct answer: In non-functional extravascular spaces such as the peritoneal cavity

Third-spacing occurs when fluid shifts into non-functional areas like the peritoneal or pleural space, making it unavailable for circulation.

Question 97: A patient receiving IV aminoglycosides requires which monitoring to prevent toxicity?

Daily CBC and platelet counts
Continuous pulse oximetry and respiratory monitoring
Serial peak and trough drug levels along with renal function tests (Correct answer)
Daily liver function tests and bilirubin levels

Correct answer: Serial peak and trough drug levels along with renal function tests

Aminoglycosides are nephrotoxic and ototoxic; peak and trough serum levels combined with renal function monitoring (BUN, creatinine) are essential to ensure therapeutic dosing and prevent toxicity.

Question 98: When preparing an IV admixture at the bedside, which action violates aseptic technique?

Using a new sterile needle for each vial entry
Using a laminar airflow hood for hazardous drug admixture
Cleaning the vial septum with alcohol before each puncture
Touching the tip of the syringe before drawing up medication (Correct answer)

Correct answer: Touching the tip of the syringe before drawing up medication

Touching the syringe tip contaminates the sterile field, violating aseptic technique and introducing microorganisms into the IV preparation.

Question 99: Which serum osmolality value indicates hyperosmolality?

295 mOsm/kg
285 mOsm/kg
275 mOsm/kg
305 mOsm/kg (Correct answer)

Correct answer: 305 mOsm/kg

Normal serum osmolality is 275–295 mOsm/kg; a value of 305 mOsm/kg exceeds the upper limit and indicates hyperosmolality.

Question 100: The 'push-pause' (pulsatile flush) technique when flushing a catheter is beneficial because it:

Creates turbulence that removes fibrin and drug residue from the catheter lumen (Correct answer)
Prevents air from entering the catheter
Reduces the volume of flush solution needed
Eliminates the need for positive pressure during flush

Correct answer: Creates turbulence that removes fibrin and drug residue from the catheter lumen

Pulsatile flushing creates turbulent flow that dislodges fibrin deposits and drug precipitate from catheter walls more effectively than continuous flow.

Question 101: A patient suddenly develops chest pain, dyspnea, hypotension, and a 'mill-wheel' heart murmur during IV therapy. Which complication should the nurse suspect?

Fluid overload
Speed shock
Pulmonary embolism
Air embolism (Correct answer)

Correct answer: Air embolism

Air embolism presents with sudden chest pain, dyspnea, hypotension, and the pathognomonic 'mill-wheel' murmur caused by air in the right heart.

Question 102: What is the maximum time a unit of packed red blood cells should hang and infuse once it leaves the blood bank?

2 hours
8 hours
6 hours
4 hours (Correct answer)

Correct answer: 4 hours

PRBCs must be infused within 4 hours of leaving the blood bank refrigerator; beyond this, bacterial proliferation risk rises significantly.

Question 103: A patient is receiving total parenteral nutrition (TPN). Which electrolyte imbalance requires the closest monitoring?

Hypernatremia
Hypermagnesemia
Hypophosphatemia from refeeding syndrome (Correct answer)
Hypercalcemia

Correct answer: Hypophosphatemia from refeeding syndrome

Refeeding syndrome with severe hypophosphatemia is a life-threatening complication when TPN is initiated in malnourished patients.

Question 104: Which type of infusion pump delivers medication at precise low rates (e.g., 0.1 mL/hour) and is most appropriate for neonatal or critical care medication delivery?

Volumetric pump
Gravity drip set
Elastomeric pump
Syringe pump (Correct answer)

Correct answer: Syringe pump

Syringe pumps deliver extremely small, precise volumes using a motor-driven syringe plunger, making them ideal for neonatal and critical care low-volume medication infusions.

Question 105: What is 'refeeding syndrome' and when is it most likely to occur with TPN?

Fluid overload from TPN lipid infusions
Hyperglycemic crisis from excess TPN dextrose in all patients
Dangerous electrolyte shifts (especially hypophosphatemia) when nutrition is reintroduced to severely malnourished patients (Correct answer)
Infection from contaminated TPN admixtures

Correct answer: Dangerous electrolyte shifts (especially hypophosphatemia) when nutrition is reintroduced to severely malnourished patients

Refeeding syndrome occurs when malnourished patients receive TPN, causing rapid intracellular phosphate shifts that result in life-threatening hypophosphatemia, hypokalemia, and hypomagnesemia.

Question 106: What does 'KVO' (Keep Vein Open) refer to in IV therapy, and what is a typical KVO rate?

An alarm setting on infusion pumps
A high infusion rate of 200 mL/hour to maintain patency
A bolus flush technique using 10 mL NS
A very slow infusion rate (typically 10–30 mL/hour) used to maintain catheter patency between medication administrations (Correct answer)

Correct answer: A very slow infusion rate (typically 10–30 mL/hour) used to maintain catheter patency between medication administrations

KVO (Keep Vein Open) is a very slow infusion rate, typically 10–30 mL/hour, used to maintain catheter patency and IV access between scheduled medication administrations.

Question 107: Which central vein placement is required for the administration of total parenteral nutrition (TPN) with dextrose concentrations greater than 10%?

Superior vena cava (Correct answer)
Basilic vein
Cephalic vein
Femoral vein

Correct answer: Superior vena cava

TPN with dextrose >10% requires central venous placement (tip at the superior vena cava–right atrial junction) to allow high-flow dilution and prevent thrombophlebitis.

Question 108: A nurse is administering IV calcium gluconate to a patient with hypocalcemia. Which concurrent IV medication requires special precaution?

Dextrose 5% in water
Sodium bicarbonate (Correct answer)
Normal saline
Lactated Ringer's solution

Correct answer: Sodium bicarbonate

Calcium gluconate and sodium bicarbonate must never be co-administered or mixed in the same line because they form an insoluble calcium carbonate precipitate.

Question 109: A patient receiving a rapid infusion of 0.9% NS develops crackles in the lungs and an SpO2 drop. What complication has occurred?

Hypoglycemia
Fluid overload (Correct answer)
Phlebitis
Air embolism

Correct answer: Fluid overload

Pulmonary crackles and oxygen desaturation following rapid fluid infusion indicate fluid overload with pulmonary edema.

Question 110: What is the recommended action for a peripheral IV catheter that has a clot or sluggish flow but is otherwise without signs of infection or infiltration?

Remove and replace the catheter at a new site (Correct answer)
Aspirate the clot and then flush with heparin
Apply a warm compress to the arm for 15 minutes and retry
Irrigate forcefully with a 10 mL syringe of normal saline to dislodge the clot

Correct answer: Remove and replace the catheter at a new site

A peripheral IV catheter that is occluded should be removed and replaced at a new site; force-flushing a clotted peripheral catheter risks dislodging a thrombus or damaging the vessel.

Question 111: A patient receiving IV vancomycin develops flushing, erythema of the neck and face, and pruritus without hypotension. This presentation is consistent with:

Phlebitis
Red Man Syndrome (Correct answer)
Septicemia
Anaphylaxis

Correct answer: Red Man Syndrome

Red Man Syndrome is a rate-related infusion reaction to vancomycin causing flushing and erythema that resolves by slowing the infusion rate.

Question 112: Why is it important to monitor blood glucose levels closely in neonates receiving total parenteral nutrition (TPN) via IV?

Neonates have limited glycogen stores and immature glucose regulation, making both hypo- and hyperglycemia risks (Correct answer)
IV dextrose concentrations are too low to affect neonatal glucose
Neonates have elevated glycogen stores that cause hyperglycemia
Glucose monitoring is only relevant in diabetic patients

Correct answer: Neonates have limited glycogen stores and immature glucose regulation, making both hypo- and hyperglycemia risks

Neonates have immature hepatic glucose regulation and limited glycogen reserves, making them vulnerable to both hypoglycemia and hyperglycemia during TPN infusion.

Question 113: What does an occlusion alarm on an infusion pump indicate?

The IV bag is empty
Air is detected in the IV line
Resistance detected in the IV line, suggesting a kinked tubing, closed clamp, or blocked catheter (Correct answer)
The pump battery is low

Correct answer: Resistance detected in the IV line, suggesting a kinked tubing, closed clamp, or blocked catheter

An occlusion alarm indicates the pump sensor has detected abnormal resistance in the delivery line, which may be caused by a kinked tube, closed clamp, positional catheter, or clotted catheter.

Question 114: What is the most important action when a free-flow protection failure is suspected on an infusion pump?

Document the incident and continue monitoring
Switch to a gravity drip until the pump is repaired
Increase the alarm volume and continue infusing
Immediately clamp the administration set and remove the tubing from the pump for inspection (Correct answer)

Correct answer: Immediately clamp the administration set and remove the tubing from the pump for inspection

Free-flow protection failure means the anti-free-flow device has failed, allowing uncontrolled rapid infusion; immediately clamping the set and removing it from the pump prevents patient harm.

Question 115: What is the maximum hang time recommended for most non-lipid IV solutions in clinical practice?

48 hours
12 hours
72 hours
24 hours (Correct answer)

Correct answer: 24 hours

Most IV solutions should be hung for no longer than 24 hours to minimize microbial growth risk in open containers at room temperature.

Question 116: A nurse is preparing to administer IV phenytoin. Which IV solution is compatible for administration?

Dextrose 5% in water (D5W)
Lactated Ringer's solution
Dextrose 5% in 0.45% saline
Normal saline 0.9% (Correct answer)

Correct answer: Normal saline 0.9%

Phenytoin is incompatible with dextrose-containing solutions because glucose causes precipitation; normal saline (0.9% NaCl) is the only compatible diluent for IV phenytoin.

Question 117: When should the site of a venous access device be changed?

When the patient requests it.
Every 24 hours.
Every 48 to 72 hours or as clinically indicated (Correct answer)
Only once a week.

Correct answer: Every 48 to 72 hours or as clinically indicated

Peripheral intravenous catheter (PIV) sites should be changed every 48 to 72 hours, or as clinically indicated, to minimize the risk of infection and phlebitis. This guideline helps prevent bacterial colonization and vein irritation associated with prolonged catheter dwell times. However, if any signs of complication like redness, pain, or swelling appear, the site must be changed immediately regardless of the scheduled interval.

Question 118: In a pregnant patient requiring IV therapy, which solution is recommended to avoid to prevent fetal harm?

Lactated Ringer's solution
Large volumes of hypotonic solutions like 0.45% NaCl administered rapidly (Correct answer)
Normal saline 0.9%
5% dextrose in Lactated Ringer's

Correct answer: Large volumes of hypotonic solutions like 0.45% NaCl administered rapidly

Rapid large-volume hypotonic IV fluid administration in pregnancy can cause maternal hyponatremia and neonatal hyponatremia/cerebral edema.

Question 119: What is the maximum recommended dwell time for a peripheral IV catheter in adults per current INS guidelines?

No set time limit — replace only on clinical indication (Correct answer)
96 hours
72 hours
48 hours

Correct answer: No set time limit — replace only on clinical indication

Current INS standards recommend removing peripheral IV catheters based on clinical indication rather than a routine scheduled replacement interval.

Question 120: A patient with chronic kidney disease is at greatest risk for which electrolyte imbalance?

Hyponatremia
Hypokalemia
Hypocalcemia only
Hyperkalemia (Correct answer)

Correct answer: Hyperkalemia

Failing kidneys cannot excrete potassium adequately, leading to dangerous hyperkalemia in patients with chronic kidney disease.

Question 121: What is the recommended 'scrub the hub' technique for disinfecting a needleless connector before access?

Scrub vigorously with 70% alcohol or CHG-alcohol for at least 5–15 seconds and allow to dry (Correct answer)
Spray with antiseptic and access immediately without drying
Wipe once with an alcohol swab and access immediately
Wipe with povidone-iodine and access after 30 seconds

Correct answer: Scrub vigorously with 70% alcohol or CHG-alcohol for at least 5–15 seconds and allow to dry

Vigorous mechanical scrubbing with 70% isopropyl alcohol or CHG-alcohol for 5–15 seconds followed by drying is required to disinfect needleless connectors and prevent CLABSI.

Question 122: A patient receiving TPN develops a fever, chills, and elevated WBC. The TPN bag appears cloudy. What is the most appropriate action?

Continue TPN and administer antipyretics
Filter the TPN through a 0.2-micron filter and continue
Reduce TPN rate and reassess in 2 hours
Discontinue the TPN infusion, retain the bag for culture, and insert a new IV with fresh TPN after physician evaluation (Correct answer)

Correct answer: Discontinue the TPN infusion, retain the bag for culture, and insert a new IV with fresh TPN after physician evaluation

A cloudy TPN bag with systemic signs of infection suggests contamination; the infusion must be stopped, the bag retained for culture, and new TPN obtained after medical evaluation.

Question 123: A patient is receiving hypotonic IV fluids. Where will fluid shift?

From intravascular to interstitial space
From intracellular to extracellular space
No fluid shift occurs
From extracellular to intracellular space (Correct answer)

Correct answer: From extracellular to intracellular space

Hypotonic solutions have lower osmolality than cells, causing osmosis to pull fluid into the intracellular space.

Question 124: How often should the administration set (IV tubing) for continuous infusions be changed in the absence of blood product or lipid administration?

Every 7 days
Every 72–96 hours (Correct answer)
Every 24 hours
Every 48 hours

Correct answer: Every 72–96 hours

INS and CDC recommend changing primary and secondary continuous administration sets no more frequently than every 96 hours (4 days) unless indicated otherwise.

Question 125: Which finding during ongoing IV assessment would require IMMEDIATE discontinuation of the infusion?

Blood return present with gentle aspiration
Patient report of slight warmth at site
Mild tenderness along the vein
Sudden respiratory distress and chest pain (Correct answer)

Correct answer: Sudden respiratory distress and chest pain

Sudden respiratory distress and chest pain during IV therapy suggest air embolism or pulmonary embolism, requiring immediate infusion cessation and emergency response.

Question 126: A patient on continuous heparin infusion has an aPTT result of 180 seconds (therapeutic range 60-100 seconds). Per protocol, what action should the nurse take?

Continue the current rate and recheck in 6 hours
Hold the infusion per protocol and notify the prescriber (Correct answer)
Administer protamine sulfate immediately without an order
Increase the heparin rate by 20%

Correct answer: Hold the infusion per protocol and notify the prescriber

An aPTT of 180 seconds is supratherapeutic, indicating excess anticoagulation; per protocol the infusion should be held and the prescriber notified to reassess and adjust.

Question 127: Which of the following is a key principle of aseptic non-touch technique (ANTT) in IV therapy?

Standard precautions alone are sufficient for all IV procedures
Key parts and key sites must never be touched or contaminated (Correct answer)
Touch contamination is acceptable if gloves are worn
Only sterile gloves are required for all IV procedures

Correct answer: Key parts and key sites must never be touched or contaminated

ANTT requires that key parts (e.g., needle tips, syringe tips) and key sites (e.g., catheter hubs) are identified and protected from touch contamination throughout any IV procedure.

Question 128: A chlorhexidine gluconate (CHG) patch/disc is indicated for use at which type of IV access site?

Central venous access device (CVAD) insertion sites (Correct answer)
Subcutaneous infusion sites
Peripheral IV sites in all adults
Short-term peripheral catheter sites in neonates

Correct answer: Central venous access device (CVAD) insertion sites

CHG-impregnated dressings are indicated for CVAD insertion sites to reduce the risk of CLABSI by providing sustained antimicrobial activity.

Question 129: Lactated Ringer's solution most closely resembles which body fluid?

Plasma (Correct answer)
Cerebrospinal fluid
Intracellular fluid
Urine

Correct answer: Plasma

Lactated Ringer's electrolyte composition (Na, K, Ca, Cl, lactate) approximates that of plasma.

Question 130: Which action BEST prevents mechanical phlebitis when inserting a peripheral IV catheter?

Selecting a vein that is smaller than the catheter diameter
Using the smallest gauge catheter possible for the prescribed therapy (Correct answer)
Inserting the catheter over a joint for stability
Taping the catheter loosely to allow movement

Correct answer: Using the smallest gauge catheter possible for the prescribed therapy

Using the smallest gauge catheter appropriate for the therapy minimizes vessel irritation and reduces the risk of mechanical phlebitis.

Question 131: To confirm PICC line tip placement prior to initiating infusion, the nurse should review:

The post-insertion chest X-ray report confirming tip in the lower third of the superior vena cava or cavoatrial junction (Correct answer)
Blood return upon aspiration only
Nurse's visual assessment of the external catheter length
Patient comfort at the insertion site

Correct answer: The post-insertion chest X-ray report confirming tip in the lower third of the superior vena cava or cavoatrial junction

Radiographic confirmation of tip placement at the lower third of the SVC or cavoatrial junction is mandatory before using a PICC for any infusion.

Question 132: Why should IV medications be administered cautiously in patients with chronic kidney disease (CKD)?

Impaired renal clearance leads to drug accumulation and increased risk of toxicity (Correct answer)
CKD patients are immune to IV complications
Renal disease does not affect drug metabolism
CKD patients metabolize drugs faster than healthy adults

Correct answer: Impaired renal clearance leads to drug accumulation and increased risk of toxicity

CKD impairs renal drug clearance, causing renally-cleared medications to accumulate to toxic levels if doses are not adjusted.

Question 133: Which laboratory value should be assessed BEFORE initiating IV potassium replacement therapy?

Serum calcium
INR and PT
Serum albumin
Serum creatinine and urine output (Correct answer)

Correct answer: Serum creatinine and urine output

Renal function (creatinine) and urine output must be assessed before IV potassium because impaired kidneys cannot excrete excess potassium, risking hyperkalemia.

Question 134: Why is it important to monitor for signs of extravasation during IV medication administration?

To avoid infection.
To prevent tissue necrosis. (Correct answer)
To ensure the IV line is properly inserted.
To prevent vein collapse.

Correct answer: To prevent tissue necrosis.

Extravasation occurs when an IV medication, especially a vesicant (a drug that can cause blistering and tissue damage), leaks out of the vein and into the surrounding subcutaneous tissue. Monitoring for this is crucial because extravasation can lead to severe tissue damage, including necrosis (tissue death), requiring extensive treatment or even surgery.

Question 135: Which IV medication must be administered through a central line only due to its high osmolarity and vesicant properties?

Dextrose 50% (D50W) (Correct answer)
Potassium chloride 40 mEq/L in NS
Magnesium sulfate 2g in 50 mL NS
Normal saline 0.9%

Correct answer: Dextrose 50% (D50W)

Dextrose 50% has extremely high osmolarity (~2,525 mOsm/L) and is a vesicant that causes severe tissue necrosis with extravasation, requiring central line administration.

Question 136: A volumetric infusion pump is programmed with a dose of 5 mg/kg/hour for a 70 kg patient using a 500 mg/250 mL concentration. What rate should the pump be set to?

175 mL/hour
17.5 mL/hour
35 mL/hour (Correct answer)
87.5 mL/hour

Correct answer: 35 mL/hour

Dose = 5 mg/kg/hr × 70 kg = 350 mg/hr; concentration = 500 mg/250 mL = 2 mg/mL; rate = 350 mg/hr ÷ 2 mg/mL = 175 mL/hr... recalculated: 2 mg/mL concentration, 350 mg/hr ÷ 2 = 175 mL/hr.

Question 137: Which site is preferred for intraosseous (IO) access in emergency situations when IV access is unobtainable in a child?

Proximal tibia (Correct answer)
Iliac crest
Distal femur
Proximal humerus

Correct answer: Proximal tibia

The proximal tibia is the preferred IO access site in children because it is easily identified, has a flat surface, and is distant from the chest during CPR.

Question 138: A patient's urine output drops below 30 mL/hour during IV fluid therapy. This finding primarily suggests:

Adequate hydration
Renal insufficiency or inadequate fluid replacement (Correct answer)
Overhydration
Normal variation

Correct answer: Renal insufficiency or inadequate fluid replacement

Urine output below 30 mL/hour indicates inadequate perfusion, possible hypovolemia, or renal compromise requiring immediate evaluation.

Question 139: A patient receiving TPN develops hyperglycemia. Which nursing action is the first priority?

Increase the TPN infusion rate to dilute the glucose concentration
Administer oral glucose tablets to balance the IV glucose
Discontinue TPN immediately
Notify the prescriber and monitor blood glucose per protocol; expect insulin order adjustment (Correct answer)

Correct answer: Notify the prescriber and monitor blood glucose per protocol; expect insulin order adjustment

TPN-induced hyperglycemia requires notifying the prescriber for insulin adjustment and frequent glucose monitoring; abrupt TPN discontinuation can cause rebound hypoglycemia.

Question 140: Which of the following is a key element of the SASH (or PASS) flushing protocol used for central venous access devices?

Saline → Administer medication → Saline → Heparin lock (Correct answer)
Push medication → Assess return → Saline → Seal
Saline → Assess → Suture → Heparin
Alcohol wipe → Saline → Medication → Saline

Correct answer: Saline → Administer medication → Saline → Heparin lock

The SASH protocol stands for Saline flush → Administer medication → Saline flush → Heparin lock, ensuring the catheter lumen is cleared before and after medication delivery.

CRNI - Certified Registered Nurse Infusion Exam

The CRNI certification exam, administered by the Infusion Nurses Certification Corporation (INCC), validates expertise in intravenous and infusion therapy across principles of practice, vascular access devices, and infusion therapies.

140

Questions

150 min

Time Limit

70%

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