CRNI - Certified Registered Nurse Infusion Exam — Questions and Answers

Question 1: Which electrolyte imbalance can be caused by excessive use of intravenous fluids?

Hypercalcemia.
Hyperkalemia.
Hypocalcemia.
Hyponatremia (Correct answer)

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

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

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

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

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 4: When infusing lipid emulsions as part of TPN, the tubing must be changed every how many hours?

Every 4 hours
72 hours
48 hours
24 hours (Correct answer)

Correct answer: 24 hours

Lipid-containing IV solutions support microbial growth; CDC guidelines require administration set changes every 24 hours for lipid-containing TPN.

Question 5: Which assessment finding is most consistent with speed shock during rapid IV infusion?

Erythema and warmth at the IV site
Pallor, cool extremities, and slow capillary refill
Flushing, headache, and loss of consciousness (Correct answer)
Peripheral edema and crackles

Correct answer: Flushing, headache, and loss of consciousness

Speed shock presents with flushing, tight chest, headache, and potential loss of consciousness due to too-rapid introduction of medication or fluid.

Question 6: Lactated Ringer's solution most closely resembles which body fluid?

Urine
Cerebrospinal fluid
Intracellular fluid
Plasma (Correct answer)

Correct answer: Plasma

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

Question 7: A patient's urine specific gravity is 1.030. What does this suggest?

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

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

Hematoma at the neck
Pneumothorax
Phlebitis at the antecubital fossa
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 9: A dialysis catheter (permcath) differs from a standard tunneled CVC primarily because it:

Does not require a cuff for anchoring
Is inserted in the antecubital fossa
Has two large-bore lumens to allow high blood flow rates required for hemodialysis (Correct answer)
Is changed every 7 days

Correct answer: Has two large-bore lumens to allow high blood flow rates required for hemodialysis

Dialysis catheters have large lumens (typically 12–14 Fr) to support the high blood flow rates (300–500 mL/min) required for hemodialysis.

Question 10: A patient has an order for 2 units of fresh frozen plasma (FFP). The nurse knows that FFP must be transfused within how many hours of thawing?

72 hours
4 hours
1 hour
24 hours (Correct answer)

Correct answer: 24 hours

Thawed FFP must be transfused within 24 hours (some institutions allow thawed plasma within 5 days) to preserve coagulation factor activity.

Question 11: What is the recommended minimum internal diameter (bore) of IV tubing for blood product administration?

Blood administration tubing with minimum 2.5–3 mm ID to prevent RBC trauma (Correct answer)
Microbore tubing (0.5 mm ID)
Any tubing gauge is acceptable for blood products
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 12: A patient is receiving IV tPA (alteplase) for acute ischemic stroke. Which nursing intervention is contraindicated during the infusion?

Performing non-invasive blood pressure monitoring every 15 minutes
Obtaining IV access in a non-compressible site
Monitoring neurological status every 15 minutes
Administering IM injections during the infusion period (Correct answer)

Correct answer: Administering IM injections during the infusion period

IM injections are contraindicated during and for 24 hours after tPA infusion because the thrombolytic agent prevents clot formation, causing uncontrollable bleeding at injection sites.

Question 13: How should a nurse manage a patient who is experiencing an allergic reaction to an IV medication?

Continue the medication infusion at a slower rate.
Increase the medication dosage to improve the effect.
Ignore the reaction if it’s mild.
Discontinue the medication and notify the healthcare provider. (Correct answer)

Correct answer: Discontinue the medication and notify the healthcare provider.

If a patient shows signs of an allergic reaction to an IV medication, the nurse's immediate action is to stop the infusion to prevent further exposure to the allergen. After discontinuing the medication, the nurse must promptly notify the healthcare provider to assess the patient's condition and initiate appropriate medical interventions, such as administering antihistamines or epinephrine.

Question 14: An elderly patient with difficult venous access has a midline catheter inserted. Which medication class is contraindicated for midline administration?

Continuous vesicant infusions or parenteral nutrition (Correct answer)
Pre-operative isotonic fluids
Isotonic antibiotics
Normal saline flushes

Correct answer: Continuous vesicant infusions or parenteral nutrition

Midline catheters terminate in the basilic or cephalic vein, not a central vein, so continuous vesicants, TPN, and hyperosmolar solutions are contraindicated due to phlebitis risk.

Question 15: 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?

35 mL/hour (Correct answer)
17.5 mL/hour
175 mL/hour
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 16: A patient has a PICC line in the left basilic vein. Before administering a vesicant, you flush with 10 mL normal saline and note resistance. What is the most appropriate next step?

Apply warm compress to increase flow
Remove the PICC and place a new peripheral IV
Attempt to aspirate blood return before proceeding (Correct answer)
Administer the medication slowly despite resistance

Correct answer: Attempt to aspirate blood return before proceeding

Confirming blood return before vesicant administration is essential; resistance without blood return suggests catheter occlusion or malposition.

Question 17: What is the role of the nurse when administering high-alert medications intravenously?

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

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 18: 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?

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

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

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

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 20: 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)
In-line 0.2-micron filter to prevent particulate infusion
Use of a blood warmer set only
No modifications required; standard blood tubing is acceptable

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

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

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 22: Which laboratory finding is MOST associated with catheter tip malposition in the right atrium rather than the SVC?

Elevated serum potassium
Decreased platelet count
Cardiac arrhythmias noted on telemetry (Correct answer)
Elevated BUN and creatinine

Correct answer: Cardiac arrhythmias noted on telemetry

A catheter tip positioned in the right atrium can irritate the cardiac conduction system, causing arrhythmias such as PACs or PVCs.

Question 23: A patient's serum potassium is 6.2 mEq/L. Which IV fluid should be avoided?

Potassium Chloride in D5W (Correct answer)
Lactated Ringer's
0.9% Normal Saline
0.45% Half Normal Saline

Correct answer: Potassium Chloride in D5W

Administering potassium-containing IV fluids to a hyperkalemic patient worsens the dangerous electrolyte imbalance.

Question 24: Which type of dressing is recommended for central venous access device (CVAD) sites in patients with diaphoresis or when TSM dressings will not adhere?

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

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

It adds heparin to every flush automatically
It prevents any fluid from entering the catheter between uses
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)

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 26: 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?

Administer protamine sulfate immediately without an order
Continue the current rate and recheck in 6 hours
Hold the infusion per protocol and notify the prescriber (Correct answer)
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 27: What is the recommended position of the drip chamber when setting up a primary IV infusion set?

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

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 28: The maximum dwell time recommended for a peripheral IV catheter in adults according to INS standards is:

72–96 hours or when clinically indicated (Correct answer)
24 hours
7 days
48 hours

Correct answer: 72–96 hours or when clinically indicated

INS standards recommend changing peripheral IVs every 72–96 hours or based on clinical assessment rather than on a strict schedule.

Question 29: Which of the following correctly describes the 'SASH' flush protocol for peripheral IV catheters?

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

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

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
It eliminates the need for manual pump programming
It calculates patient weight and adjusts doses automatically

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.

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.

Questions

35 min

Time Limit

70%

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