CRNI Managing Infusion Complications Questions and Answers

Question 1

A patient with a newly placed non-tunneled central venous catheter in the subclavian vein suddenly becomes dyspneic, hypotensive, and tachycardic during an IV tubing change. The CRNI suspects an air embolism. What is the PRIORITY nursing intervention?

Accepted Answer

Place the patient in the Trendelenburg position on their left side.

Answer

The immediate priority for a suspected venous air embolism is to trap the air in the apex of the right ventricle to prevent it from moving into the pulmonary artery and obstructing outflow. Placing the patient on their left side in the Trendelenburg position (Durant's maneuver) accomplishes this. While administering oxygen and obtaining imaging are important subsequent actions, initial life-saving positioning is the first priority.

Question 2

A CRNI is assessing a peripheral IV site and notes pain at the access site, erythema, streak formation, and a palpable venous cord measuring approximately 1 inch. According to the Infusion Nurses Society (INS) Phlebitis Scale, how should the nurse grade this finding?

Accepted Answer

Grade 3

Answer

The INS Phlebitis Scale grades severity based on specific clinical signs. The presence of pain, erythema, streak formation, AND a palpable venous cord corresponds to a Grade 3 finding. Grade 2 involves pain, erythema, and/or edema but lacks the palpable cord or streak. Grade 4 includes all the signs of Grade 3 plus purulent drainage.

Question 3

A nurse is administering an IV push medication rapidly. The patient suddenly complains of a severe headache, dizziness, and a 'fluttering' feeling in their chest. The patient appears flushed and becomes hypotensive. The CRNI should recognize these symptoms as characteristic of which systemic infusion complication?

Accepted Answer

Speed shock

Answer

Speed shock is a systemic reaction caused by the rapid infusion of a substance into the circulation, leading to toxic plasma levels. Classic symptoms include dizziness, headache, facial flushing, irregular pulse (fluttering), and can progress to hypotension, shock, and cardiac arrest. It is directly related to the rate of administration.

Question 4

During a routine dressing change for a patient's PICC line, the CRNI notes that the external catheter length has increased by 4 cm compared to the documented insertion length. The patient also reports occasionally hearing a 'gurgling' sound in their ear on the side of the catheter insertion. Which of the following is the most likely complication?

Accepted Answer

Catheter migration

Answer

An increase in the measured external length of a central line is a primary indicator of catheter migration. Symptoms such as a gurgling sound in the ear can suggest that the catheter tip has moved into the jugular vein. The infusion should be stopped and tip position must be confirmed via chest x-ray before further use.

Question 5

A patient with a peripheral IV complains of sudden, sharp pain radiating up their arm during the infusion of a room-temperature antibiotic. The infusion has slowed significantly despite no signs of infiltration or phlebitis. Which action is most appropriate to manage a suspected venous spasm?

Accepted Answer

Apply a warm compress to the vein above the insertion site.

Answer

A venous spasm is a sudden constriction of the vein, often caused by the administration of cold infusates, irritating solutions, or a rapid flow rate. The primary management is to decrease the flow rate and apply a warm compress to the area to promote vasodilation and relieve the spasm. Applying a cold compress would worsen vasoconstriction.

CRNI Exam Practice Test

CRNI Exam Practice Test

CRNI Managing Infusion Complications Questions and Answers