A nurse in the emergency department is inserting a 20-gauge peripheral catheter into the cephalic vein about 3 cm above the lateral wrist. As the needle advances, the patient cries out and describes a sharp, electric pain shooting into the back of the thumb. What should the nurse do FIRST?

Stop and withdraw the catheter at once, then assess sensation and movement of the hand

Apply a cold pack above the site and reassure the patient that the pain will fade shortly

Finish threading the catheter quickly so the needle no longer contacts surrounding tissue

Withdraw the needle slightly and redirect it more medially to stay within the cephalic vein

An ambulatory infusion suite treats a patient colonized with MRSA who receives weekly IV iron in an open bay shared with other patients. Which action is MOST appropriate?

Use dedicated or disinfected equipment and wear gown and gloves for contact with the patient

Place the patient at the end of the day so no precautions are needed during care

Cancel the infusion until three consecutive nasal swabs are negative for MRSA

Have staff wear an N95 respirator and keep the bay curtain closed for the entire infusion

A nurse assesses a patient with a right basilic PICC placed for 6 weeks of antibiotics. The data compare insertion values with today's assessment, measured 10 cm above the antecubital fossa. Measure At insertion Today Upper-arm circumference 27.0 cm 30.5 cm External catheter length 2 cm 2 cm Flush and blood return Brisk Brisk Symptoms None Arm aching, mild hand edema Based on the data, which action is MOST appropriate?

Report the findings and anticipate a duplex ultrasound of the arm

Flush the PICC forcefully to clear any thrombus from the tip

Remove the PICC now, since thrombus around it requires removal

Apply warm packs and recheck the arm circumference in 3 days

A nurse prepares for an ultrasound-guided peripheral catheter insertion in a patient with difficult venous access. Which approach to the ultrasound equipment is MOST appropriate?

Use a sterile probe cover and sterile single-use gel during insertion

Use a transparent dressing over the probe and the nonsterile bottle gel

Use alcohol on the probe face in place of a cover or gel

Use a clean probe with nonsterile gel from the multi-use bottle

A patient's only vascular access is a tunneled hemodialysis catheter locked with heparin 5,000 units/mL. The provider orders an urgent IV antibiotic through it per policy. After disinfecting the hub, what should the nurse do FIRST?

Aspirate and discard the heparin lock from the lumen before flushing

Flush the lock into the patient with 10 mL of 0.9% sodium chloride

Give the antibiotic first, then flush the lumen with 20 mL of saline

Inject the antibiotic directly, since the heparin dose is too small to matter

A patient with a known IgA deficiency and anti-IgA antibodies developed wheezing, generalized hives and hypotension within minutes of a plasma transfusion last month and was treated with epinephrine. She now needs red blood cells. Which product request is MOST appropriate?

Washed red blood cells or red cells from an IgA-deficient donor

Leukoreduced red blood cells infused slowly over the full 4-hour limit

Irradiated red blood cells given after an antihistamine premedication

Standard red blood cells with acetaminophen and hydrocortisone premedication

CRNI Exam

Free CRNI Practice Questions

10 sample questions for the CRNI Exam, with the correct answer and an explanation for each. No account needed. Try each one before you open the answer.

Sections covered on the exam: Anatomy and Physiology for Infusion Practice, Infection Prevention and Control, Phlebotomy and Blood Sampling, Anti-Infective Therapy, Special Populations, Fluid and Electrolyte Balance, Therapy-Related Complications and Hazardous Drug Safety, Device-Related Complications, Antineoplastic and Biologic Therapies, Transfusion Therapy and Blood Products, Parenteral Nutrition.

Question 1 · Anatomy and Physiology for Infusion Practice
A nurse in the emergency department is inserting a 20-gauge peripheral catheter into the cephalic vein about 3 cm above the lateral wrist. As the needle advances, the patient cries out and describes a sharp, electric pain shooting into the back of the thumb. What should the nurse do FIRST?
- A.Apply a cold pack above the site and reassure the patient that the pain will fade shortly
- B.Finish threading the catheter quickly so the needle no longer contacts surrounding tissue
- C.Stop and withdraw the catheter at once, then assess sensation and movement of the hand
- D.Withdraw the needle slightly and redirect it more medially to stay within the cephalic vein
Show answer and explanation
Answer: C. Stop and withdraw the catheter at once, then assess sensation and movement of the hand
Sudden electric or radiating pain during venipuncture at the lateral wrist signals contact with the superficial radial nerve, which runs beside the cephalic vein there; the catheter is removed immediately and the hand assessed and documented. Redirecting or finishing the insertion prolongs nerve contact and risks permanent injury. This is why the cephalic vein at the lateral wrist is avoided.
Question 2 · Infection Prevention and Control
An ambulatory infusion suite treats a patient colonized with MRSA who receives weekly IV iron in an open bay shared with other patients. Which action is MOST appropriate?
- A.Place the patient at the end of the day so no precautions are needed during care
- B.Cancel the infusion until three consecutive nasal swabs are negative for MRSA
- C.Use dedicated or disinfected equipment and wear gown and gloves for contact with the patient
- D.Have staff wear an N95 respirator and keep the bay curtain closed for the entire infusion
Show answer and explanation
Answer: C. Use dedicated or disinfected equipment and wear gown and gloves for contact with the patient
MRSA is spread by contact, so contact precautions apply: gown and gloves for patient contact and dedicated or properly disinfected equipment such as blood pressure cuffs and stethoscopes. Colonization is not a reason to delay needed therapy. Respirators are for airborne diseases, and scheduling does not replace precautions.
Question 3 · Phlebotomy and Blood Sampling
An ICU team must place a nontunneled central venous catheter in an adult with septic shock. The patient has no coagulopathy, and the operator is skilled with ultrasound at all sites. Which site carries the LOWEST risk of catheter-related infection?
- A.Subclavian vein
- B.Internal jugular vein
- C.External jugular vein
- D.Femoral vein
Show answer and explanation
Answer: A. Subclavian vein
In adults, the subclavian site is associated with the lowest infection risk for nontunneled CVADs compared with the jugular and femoral sites. The femoral site has the highest infection and thrombosis risk. The jugular site is often chosen for ease of compression but carries higher infection risk than the subclavian site.
Question 4 · Therapy-Related Complications and Hazardous Drug Safety
A nurse assesses a patient with a right basilic PICC placed for 6 weeks of antibiotics. The data compare insertion values with today's assessment, measured 10 cm above the antecubital fossa.
Measure At insertion Today
Upper-arm circumference 27.0 cm 30.5 cm
External catheter length 2 cm 2 cm
Flush and blood return Brisk Brisk
Symptoms None Arm aching, mild hand edema
Based on the data, which action is MOST appropriate?
- A.Flush the PICC forcefully to clear any thrombus from the tip
- B.Remove the PICC now, since thrombus around it requires removal
- C.Apply warm packs and recheck the arm circumference in 3 days
- D.Report the findings and anticipate a duplex ultrasound of the arm
Show answer and explanation
Answer: D. Report the findings and anticipate a duplex ultrasound of the arm
The upper-arm circumference has increased by 30.5 - 27.0 = 3.5 cm, and with arm pain and edema this suggests catheter-associated deep vein thrombosis, which should be reported and evaluated by duplex ultrasound. A functioning, needed PICC is not removed just because of thrombosis; treatment is anticoagulation per the provider. Forceful flushing can dislodge thrombus.
Question 5 · Transfusion Therapy and Blood Products
A 68-kg adult with chronic gastrointestinal blood loss has a hemoglobin of 6.6 g/dL and no active bleeding. The provider orders 2 units of red blood cells. Assuming the typical adult response, which post-transfusion hemoglobin should the nurse expect?
- A.About 8.6 g/dL
- B.About 9.6 g/dL
- C.About 10.6 g/dL
- D.About 7.6 g/dL
Show answer and explanation
Answer: A. About 8.6 g/dL
Each unit of red blood cells raises hemoglobin about 1 g/dL in an average adult who is not bleeding, so 6.6 + (2 x 1) = 8.6 g/dL. A value of 7.6 g/dL reflects only one unit, and 9.6 or 10.6 g/dL assumes 1.5 to 2 g/dL per unit, which overestimates the response. A smaller than expected rise should prompt assessment for ongoing loss or hemolysis.
Question 6 · Anatomy and Physiology for Infusion Practice
During an ultrasound-guided PICC insertion into the right brachial vein, the patient suddenly reports tingling and burning that radiate into the thumb, index and middle fingers. Which structure is MOST likely being irritated?
- A.Ulnar nerve
- B.Median nerve
- C.Musculocutaneous nerve
- D.Superficial radial nerve
Show answer and explanation
Answer: B. Median nerve
The paired brachial veins run with the brachial artery and lie close to the median nerve, which supplies sensation to the thumb, index and middle fingers. Paresthesia means the needle or introducer is near the nerve, so the clinician stops and withdraws. The ulnar nerve supplies the little finger side, and the superficial radial nerve is the concern at the lateral wrist.
Question 7 · Infection Prevention and Control
A nurse prepares for an ultrasound-guided peripheral catheter insertion in a patient with difficult venous access. Which approach to the ultrasound equipment is MOST appropriate?
- A.Use a transparent dressing over the probe and the nonsterile bottle gel
- B.Use alcohol on the probe face in place of a cover or gel
- C.Use a sterile probe cover and sterile single-use gel during insertion
- D.Use a clean probe with nonsterile gel from the multi-use bottle
Show answer and explanation
Answer: C. Use a sterile probe cover and sterile single-use gel during insertion
For ultrasound-guided insertion, the probe is covered with a sterile sheath and sterile single-use gel is used so the transducer does not contaminate the prepared site. Multi-use nonsterile gel has been linked to outbreaks, and a dressing is not a validated probe barrier. Alcohol on the probe face damages the transducer and does not substitute for a sterile cover.
Question 8 · Phlebotomy and Blood Sampling
A patient's only vascular access is a tunneled hemodialysis catheter locked with heparin 5,000 units/mL. The provider orders an urgent IV antibiotic through it per policy. After disinfecting the hub, what should the nurse do FIRST?
- A.Flush the lock into the patient with 10 mL of 0.9% sodium chloride
- B.Give the antibiotic first, then flush the lumen with 20 mL of saline
- C.Inject the antibiotic directly, since the heparin dose is too small to matter
- D.Aspirate and discard the heparin lock from the lumen before flushing
Show answer and explanation
Answer: D. Aspirate and discard the heparin lock from the lumen before flushing
Hemodialysis catheters are often locked with high-concentration heparin or citrate that fills each lumen. Before the lumen is used for anything else, the lock is aspirated and discarded per policy, and only then is the catheter flushed and used, with an order and per organizational policy. Flushing the lock into the patient or pushing the antibiotic through it delivers thousands of units of heparin, which can cause bleeding, and heparin is incompatible with some drugs.
Question 9 · Therapy-Related Complications and Hazardous Drug Safety
On day 2, an 18 gauge catheter in the antecubital fossa that is infusing lactated Ringer's at 75 mL/h shows pain, redness, and a palpable cord along the vein. The patient bends the arm frequently. Which type of phlebitis is MOST likely?
- A.Bacterial phlebitis
- B.Chemical phlebitis
- C.Mechanical phlebitis
- D.Postinfusion phlebitis
Show answer and explanation
Answer: C. Mechanical phlebitis
A large catheter in an area of flexion that moves with arm bending irritates the vein wall, causing mechanical phlebitis. Lactated Ringer's is near-isotonic, making chemical phlebitis unlikely, and there is no drainage or fever to suggest bacterial phlebitis. Postinfusion phlebitis appears after removal. The catheter should be removed and a standardized phlebitis scale used.
Question 10 · Transfusion Therapy and Blood Products
A patient with a known IgA deficiency and anti-IgA antibodies developed wheezing, generalized hives and hypotension within minutes of a plasma transfusion last month and was treated with epinephrine. She now needs red blood cells. Which product request is MOST appropriate?
- A.Washed red blood cells or red cells from an IgA-deficient donor
- B.Leukoreduced red blood cells infused slowly over the full 4-hour limit
- C.Irradiated red blood cells given after an antihistamine premedication
- D.Standard red blood cells with acetaminophen and hydrocortisone premedication
Show answer and explanation
Answer: A. Washed red blood cells or red cells from an IgA-deficient donor
Anaphylaxis in an IgA-deficient recipient with anti-IgA antibodies is triggered by IgA in donor plasma, so future cellular components should be washed to remove plasma or come from IgA-deficient donors. Premedication and slow infusion do not prevent anaphylaxis. Irradiation prevents graft-versus-host disease and leukoreduction reduces febrile reactions; neither removes plasma proteins.

Measure	At insertion	Today
Upper-arm circumference	27.0 cm	30.5 cm
External catheter length	2 cm	2 cm
Flush and blood return	Brisk	Brisk
Symptoms	None	Arm aching, mild hand edema

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