CRNI - Certified Registered Nurse Infusion Exam — Questions and Answers

Question 1: When titrating a vasopressor infusion, a nurse should primarily adjust the rate based on which parameter?

Mean arterial pressure (MAP) per the prescribed target (Correct answer)
Patient-reported comfort level
Urine output alone
Heart rate only

Correct answer: Mean arterial pressure (MAP) per the prescribed target

Vasopressor titration is guided by achieving the prescribed MAP target, as MAP reflects end-organ perfusion pressure and is the primary hemodynamic goal.

Question 2: After applying chlorhexidine for skin antisepsis prior to IV insertion, what must the nurse do before proceeding?

Rinse with sterile water
Wipe off excess with sterile gauze
Allow the area to air-dry completely (Correct answer)
Blot dry with a sterile towel

Correct answer: Allow the area to air-dry completely

Chlorhexidine must be allowed to air-dry completely before catheter insertion to achieve full antimicrobial efficacy and prevent skin irritation.

Question 3: 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?

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

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 4: 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
Syringe pump (Correct answer)
Elastomeric pump

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

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

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

Increase the alarm volume and continue infusing
Immediately clamp the administration set and remove the tubing from the pump for inspection (Correct answer)
Document the incident and continue monitoring
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 7: 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)
Leave the dressing and schedule a routine change for day 7
Remove the PICC and insert a new peripheral catheter
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 8: What is the first step in preparing a medication for intravenous administration?

Reading the medication order. (Correct answer)
Mixing the medication with saline.
Verifying the patient's identity.
Preparing the IV equipment.

Correct answer: Reading the medication order.

The very first and most critical step in preparing any medication, especially for IV administration, is to accurately read and interpret the medication order. This ensures the correct drug, dose, route, time, and patient are identified, preventing potential errors before any physical preparation begins and adhering to the 'five rights' of medication administration.

Question 9: Which sign differentiates transfusion-related acute lung injury (TRALI) from TACO?

TRALI always involves fever and rigors
Both present identically; differentiation requires chest X-ray only
TACO occurs only in pediatric patients
TRALI presents within 6 hours with non-cardiogenic pulmonary edema and normal/low CVP, while TACO has elevated CVP and responds to diuretics (Correct answer)

Correct answer: TRALI presents within 6 hours with non-cardiogenic pulmonary edema and normal/low CVP, while TACO has elevated CVP and responds to diuretics

TRALI is non-cardiogenic pulmonary edema caused by donor antibodies activating neutrophils in the recipient's lungs, presenting with low CVP, while TACO involves fluid overload with elevated CVP.

Question 10: What is the primary purpose of fluid and electrolyte balance in intravenous therapy?

To maintain proper hydration and electrolyte levels (Correct answer)
To dilute the bloodstream.
To reduce the volume of fluid in the body.
To speed up the metabolic process.

Correct answer: To maintain proper hydration and electrolyte levels

The primary purpose of fluid and electrolyte balance in intravenous therapy is to restore and maintain the body's essential hydration and electrolyte levels. IV fluids are administered to correct imbalances caused by dehydration, illness, or surgery, ensuring cells and organs function optimally. This delicate balance is crucial for supporting vital bodily processes and overall patient health.

Question 11: Which complication is specifically associated with PICC line insertion and results from catheter tip malposition?

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

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 12: 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:

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

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

Hypernatremia
Hypercalcemia
Hypermagnesemia
Hypophosphatemia (Correct answer)

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

Increase the infusion rate to flush the reaction
Stop the transfusion and keep the IV line open with normal saline (Correct answer)
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 15: Which antiseptic solution is preferred for skin antisepsis prior to peripheral IV insertion in adults?

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

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

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

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

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

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

Deep vein thrombosis
Air embolism
Pneumothorax (Correct answer)
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 19: Febrile non-hemolytic transfusion reaction (FNHTR) is caused by which mechanism?

Recipient antibodies reacting against donor leukocytes and cytokines in the blood product (Correct answer)
Bacterial contamination of the blood product
ABO incompatibility between donor and recipient
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 20: What differentiates extravasation from infiltration at an IV site?

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

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 21: When comparing isotonic, hypotonic, and hypertonic solutions, which statement is correct?

Hypotonic solutions cause cells to swell (Correct answer)
Isotonic solutions cause cells to swell
Isotonic solutions shift fluid out of cells
Hypertonic solutions pull fluid into cells

Correct answer: Hypotonic solutions cause cells to swell

Hypotonic solutions have lower osmolality than intracellular fluid, so water moves into cells by osmosis, causing them to swell.

Question 22: Third-spacing of fluid refers to fluid that accumulates:

In the intravascular compartment
In the lymphatic system only
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 23: 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)
Wipe once with an alcohol swab and access immediately
Spray with antiseptic and access immediately without drying
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 24: Which action by a nurse demonstrates correct technique when using a needleless connector on an IV line?

Wiping the connector with an alcohol swab for 2 seconds before access
Rinsing the connector with sterile water before each use
Changing the connector only when it appears visibly contaminated
Scrubbing the connector vigorously with an alcohol swab for 15 seconds and allowing to dry (Correct answer)

Correct answer: Scrubbing the connector vigorously with an alcohol swab for 15 seconds and allowing to dry

The 'scrub the hub' technique requires vigorous mechanical scrubbing with 70% alcohol for a minimum of 15 seconds followed by air drying to effectively decontaminate needleless connectors.

Question 25: To confirm PICC line tip placement prior to initiating infusion, the nurse should review:

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

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

To regulate the rate of the secondary infusion
To filter particulate matter from the piggyback medication
To prevent backflow of blood into the IV tubing
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 27: 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
Is changed every 7 days
Has two large-bore lumens to allow high blood flow rates required for hemodialysis (Correct answer)

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 28: During assessment of a tunneled central venous catheter, the nurse notes subcutaneous swelling and crepitus around the exit site. These findings suggest:

Subcutaneous emphysema or possible pneumothorax complication (Correct answer)
Local cellulitis
Normal healing response
Catheter tip malposition into the right atrium

Correct answer: Subcutaneous emphysema or possible pneumothorax complication

Crepitus and subcutaneous swelling near a central catheter exit site may indicate subcutaneous emphysema, possibly from a pneumothorax complication.

Question 29: A patient has a serum phosphate of 1.5 mg/dL. Which condition is most likely contributing?

Hypoparathyroidism
Renal failure
Vitamin D toxicity
Prolonged malnutrition or refeeding syndrome (Correct answer)

Correct answer: Prolonged malnutrition or refeeding syndrome

Hypophosphatemia commonly results from refeeding syndrome or prolonged malnutrition, as insulin release drives phosphate into cells.

Question 30: When should administration tubing used to infuse blood or blood components be changed?

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

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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