Certified Registered Nurse Infusion (CRNI®) Examination Study Guide

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A patient takes a deep breath while a central catheter is being removed in a seated position. Identify the pressure gradient as the concern and prepare a safer removal plan before opening the tract.

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A cooperative adult is scheduled for internal jugular catheter removal. Before withdrawing the catheter, the nurse positions the patient appropriately, rehearses the respiratory maneuver, and places the materials for immediate tract occlusion within reach.

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After removing gloves, a nurse notices visible blood on a finger before preparing another patient's infusion. The nurse washes with soap and water rather than relying only on alcohol hand rub for this episode.

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A nurse empties a drainage container while wearing gloves, then reaches toward a vascular access connector. The nurse stops, removes the gloves, performs hand hygiene, and uses appropriate clean supplies before the aseptic task.

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After preparing a peripheral insertion site, a nurse wants to feel the vein again with a nonsterile fingertip. The nurse recognizes that the intended puncture area must remain protected and restores an aseptic approach.

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An operator prepares a central insertion site with the selected chlorhexidine-alcohol product and immediately reaches for the needle. The nurse pauses the procedure until the antiseptic has dried according to its instructions.

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A PICC insertion tray contains sterile gloves and a small fenestrated drape, but the operator has no sterile gown. The nurse obtains the missing maximal barrier components before allowing the insertion to proceed.

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A patient reports no infectious illnesses before a blood draw. The nurse still performs hand hygiene and selects protective equipment for anticipated blood exposure rather than using the history to relax routine infection prevention.

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An inpatient has completed intravenous therapy and is taking all medications orally, yet a central catheter remains for convenience. The nurse raises removal during the daily review because no current essential indication is identified.

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A peripheral antibiotic infusion is flowing, but the patient reports tenderness and the nurse finds erythema along the vein. The nurse removes the affected catheter and arranges appropriate access for the remaining treatment.

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A patient with a central catheter develops rigors while the exit site remains dry and unremarkable. The nurse promptly initiates clinical assessment and ordered diagnostic collection instead of dismissing infection because the skin appears normal.

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Two patients require blood cultures on the same unit. Before each draw, the nurse verifies the patient's identifiers and labels the collected bottles for that patient, preserving the collection site and time information.

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An adult culture bottle contains much less blood than the collection system recommends. The nurse identifies this as a diagnostic-yield problem and follows the collection process to obtain an adequate specimen without compromising asepsis.

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An adult with suspected bloodstream infection has only one set collected. The nurse recognizes the need for the additional indicated set from a separate collection rather than simply adding another bottle to the first draw.

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A collector prepares the patient's skin but plans to inoculate bottles immediately after removing their caps. The nurse disinfects the bottle septa and allows the required drying before inoculation to address the second contamination route.

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A patient receiving phlebotomy has improving iron measures but a substantial hemoglobin decline. The nurse checks the preprocedure hemoglobin or hematocrit and raises the trend for reassessment before another collection.

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A patient with a midline is prescribed a solution that requires central venous administration. The nurse identifies the mismatch and obtains an appropriate access plan instead of assuming an upper-arm catheter provides central dilution.

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A handover describes an arm catheter as “probably a midline.” Before administering a central-only infusion, the nurse checks the device record and placement information rather than assigning the access type from its external appearance.

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A patient needs one continuous infusion and no identified simultaneous incompatible therapy. The nurse questions a proposed multilumen central catheter and asks whether a simpler device can meet the documented treatment requirements safely.

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A pump displays the correct drug name, but its selected concentration differs from the bag label. The nurse resolves the concentration mismatch before starting therapy instead of relying on the absence of a limit alert.

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A pump reports normal operation, but a bag has barely emptied during the expected interval. The nurse compares expected and actual volume, traces the line, and assesses the patient instead of documenting delivery from the screen alone.

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A prescribed 180 mL infusion must run over 90 minutes. Converting 90 minutes to 1.5 hours gives 180 divided by 1.5, or 120 mL/hour, which the nurse checks against the order before programming.

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A replacement tubing set fits into a pump channel but is not identified as compatible with that model. The nurse obtains the approved set and checks its loading rather than treating physical fit as sufficient verification.

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An operator obtains venous access under ultrasound while placing a PICC. The nurse recognizes that successful vessel entry does not by itself document final tip position and checks completion of the device's placement verification process.

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A midline's securement has loosened and more catheter is visible externally than previously documented. The nurse protects the device from further movement and arranges assessment instead of advancing the exposed segment back into the arm.

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A patient returns from washing with a central catheter dressing wet and lifting at one edge. The nurse replaces it using the appropriate aseptic process now rather than waiting until its scheduled change tomorrow.

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An older adult with cognitive impairment has a peripheral infusion and cannot describe discomfort reliably. The nurse directly assesses the site and surrounding tissue during care instead of accepting a lack of complaints as evidence of safety.

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A tunnelled catheter that flushed easily yesterday now resists a gentle attempt. The nurse stops, checks clamps and visible tubing, and seeks further assessment instead of selecting a smaller syringe to push harder.

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A pump alarms for occlusion shortly after a patient transfers to a chair. The nurse traces the line and finds tubing compressed beneath the armrest, corrects that problem, and reassesses delivery and the access site.

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A patient with advanced chronic kidney disease needs central therapy. When subclavian placement is proposed for infection reduction, the nurse raises the risk of stenosis and future dialysis access loss during the access-planning discussion.

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A premature neonate needs central line care, and an adult chlorhexidine-impregnated dressing is proposed. The nurse identifies the neonatal skin-risk boundary and selects an appropriate neonatal approach rather than copying the adult dressing routine.

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An oncology patient has a functioning PICC without evidence of infection or malfunction. A proposal to replace it weekly solely because the patient is immunocompromised is reconsidered in favor of careful maintenance and ongoing necessity assessment.

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A patient develops swelling during an infusion. Before choosing a compress or removing the catheter, the nurse stops delivery and identifies the solution's tissue-injury potential so the event follows the correct management pathway.

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Burning and swelling develop during a peripheral antineoplastic vesicant infusion. The nurse stops delivery, calls for help, retains the cannula, disconnects the tubing, and attempts aspiration without flushing before peripheral cannula removal and drug-specific treatment.

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After the immediate response, a doxorubicin leak prompts the cold-and-antidote pathway, whereas a vincristine leak prompts warmth and hyaluronidase. The nurse documents the injury and arranges follow-up because damage can evolve.

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After nutrition restarts, a depleted patient's serum potassium falls despite no new gastrointestinal loss. The nurse considers an intracellular shift rather than assuming the result measures a new external loss of the same magnitude.

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A patient on maintenance fluid develops substantial drain output and falling urine output. The nurse quantifies the loss and verifies actual delivery, then obtains reassessment of replacement needs rather than assuming the maintenance rate covers the additional loss.

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A spouse offers to press the PCA button while the patient sleeps so pain will not return. The nurse explains that only the patient should press and assesses comfort and sedation before addressing further analgesia needs.

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Two patients develop hypoxemia after transfusion. One has hypertension and elevated venous pressure; the other has hypotension without overload evidence. The nurse recognizes why a diuretic may fit the first pattern but could worsen the second.

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During an antineoplastic infusion through a central device, a patient reports new discomfort and swelling near the access area. The nurse stops delivery and initiates assessment instead of continuing because the treatment uses central access.

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A staff member proposes preparing a hazardous drug outside the designated containment area because a closed-system transfer device is available. The nurse retains the required primary engineering controls and uses the transfer device as an additional safeguard.

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A hazardous infusion has finished, and a worker prepares to disconnect and discard the tubing without the designated protective equipment. The nurse identifies disconnection and waste handling as exposure tasks requiring the facility's assessed controls.

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During a first rituximab infusion, a patient develops wheezing, falling oxygen saturation, and hypotension. The nurse stops delivery and activates immediate clinical management rather than attributing the findings to anxiety or waiting for the scheduled assessment.

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A patient scheduled for rituximab has a negative HBsAg result but no anti-HBc result. The nurse identifies incomplete label-specified screening instead of treating the single negative marker as sufficient evidence that reactivation risk is absent.

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A patient improves on broad empiric therapy, and cultures identify an organism susceptible to a narrower option. The nurse brings the result to the treatment review so continued breadth is justified or appropriately reduced.

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A recovering patient can take oral medications and is preparing for discharge with a central catheter. The nurse requests review of the antibiotic's route and planned stop date before assuming that outpatient intravenous treatment remains necessary.

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A patient develops rigors and breathlessness shortly after a transfusion begins. The nurse stops the transfusion, performs immediate assessment, maintains appropriate access, and starts the identification and notification process rather than simply reducing the rate.

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After transfusion, a patient develops dyspnea, rising blood pressure, crackles, and a markedly positive fluid balance. The nurse identifies circulatory overload as a leading concern while stopping exposure and obtaining urgent assessment for a transfusion reaction.

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A vial of potassium chloride concentrate arrives for a replacement order. The nurse verifies that a correctly diluted infusion will be prepared and administered, preventing the stock vial from being treated as an intravenous push dose.

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A patient prescribed potassium replacement develops markedly reduced urine output before the next infusion. The nurse checks current laboratory and renal information and obtains reassessment instead of administering automatically because potassium was low the previous day.

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A patient with cardiac impairment receives maintenance fluid, several medication infusions, and a transfusion. When breathlessness develops, the nurse reviews the combined fluid history rather than judging safety only from the current blood component's hourly rate.

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A severely undernourished patient begins nutrition and develops falling phosphate and potassium over the next two days. The nurse recognizes the timing and electrolyte pattern as possible refeeding effects rather than assuming the solution simply lacks enough electrolytes.

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An adult has had negligible intake for eight days but normal initial electrolytes. The nurse recognizes a significant-risk criterion and arranges baseline assessment and early serial monitoring rather than using the normal panel to justify unrestricted feeding.

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Phosphorus falls from 4.0 to 2.8 mg/dL within three days of restarting calories. The nurse calculates a 30% decrease and recognizes the moderate biochemical range while also assessing symptoms and other possible explanations for the decline.

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A patient has central access but can use the gastrointestinal tract effectively. The nurse distinguishes having a route available from having an indication for PN and asks how the proposed nutrition plan addresses a documented nutritional limitation.

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A patient receiving intravenous dextrose is described as already receiving complete nutrition. The nurse explains that carbohydrate alone does not supply amino acids, essential fats, vitamins, trace elements, and the other components of an individualized PN prescription.

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A concentrated central PN formulation is delivered for a patient whose only device is a midline. The nurse withholds connection and obtains a compatible formulation-and-access plan instead of assuming that any long catheter is adequate.

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A patient receiving PN develops rigors while the bag and pump appear normal. The nurse assesses the patient and catheter-related infection possibilities rather than treating correct formulation and normal pump operation as evidence that the nutrition system is safe.

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An undernourished patient is about to receive dextrose-containing support. The nurse identifies the need for the prescribed thiamine prevention plan before carbohydrate delivery rather than assuming electrolyte replacement alone covers the patient's refeeding risks.

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The day after initial rituximab, a patient with bulky disease develops rising potassium, phosphate, uric acid, and creatinine. The nurse recognizes possible tumor lysis and escalates the findings despite an uneventful infusion the previous day.