CRNI Practice Questions (2026) — Free Sample Questions with Answers

Answer: B

Povidone-iodine 10% solution: Povidone-iodine is an acceptable alternative when chlorhexidine is contraindicated, but it is not the preferred agent and needs a longer dry time.

Chlorhexidine above 0.5% in alcohol: Correct. Chlorhexidine gluconate above 0.5% in alcohol is preferred for skin antisepsis because it acts quickly and has residual activity. It must dry completely before insertion or dressing application.

Hydrogen peroxide 3% solution: Hydrogen peroxide is not a recommended skin antiseptic for vascular access and can damage tissue.

Aqueous benzalkonium chloride: Benzalkonium chloride (a quaternary ammonium compound) is not recommended for vascular access skin antisepsis because it can become contaminated.

Skin antisepsis order of preference: CHG above 0.5% in alcohol, then povidone-iodine or 70% alcohol if CHG is contraindicated. Let it dry completely; do not blot or fan.

Answer: C

Sitting upright at 90 degrees with the head turned away: Upright positioning lowers venous pressure at the insertion site, so air is more likely to be drawn in when the catheter is withdrawn.

Semi-Fowler's at 45 degrees with the head in midline: With the head elevated, the site is above the heart, so central venous pressure there may be lower than atmospheric pressure and air can enter.

Supine or in Trendelenburg, with the site below the heart: Correct. INS recommends supine or Trendelenburg positioning (if tolerated) so the site is at or below heart level, raising venous pressure. A Valsalva maneuver at withdrawal and an air-occlusive dressing complete the precautions.

Left lateral decubitus with the knees drawn to the chest: Left lateral positioning is used to trap air in the right atrium after a suspected air embolism, not as the standard position for removal.

CVAD removal: supine or Trendelenburg, Valsalva (or breath-hold) during withdrawal, pressure until hemostasis, and an air-occlusive dressing left in place for at least 24 hours.

Answer: A

Instill alteplase per protocol and allow it to dwell: Correct. Once mechanical and positional causes are ruled out, the likely cause is thrombotic occlusion, treated by instilling alteplase (e.g., 2 mg/2 mL for adults) and letting it dwell for 30 to 120 minutes before reassessing.

Clear the occlusion with forceful flushing through a 3-mL syringe: Small syringes create high pressure that can rupture the catheter, and forcing a clot may cause embolization.

Remove the catheter right away and place a new PICC in the other arm: Many thrombotic occlusions can be cleared, saving the device and the patient's veins; removal is premature.

Pass a guidewire through the PICC at the bedside to clear the lumen: Bedside guidewire clearance by nursing is not a standard occlusion treatment and risks catheter damage and vessel injury.

Occlusion: check for mechanical causes first (clamps, kinks, dressing, position), then think about thrombotic (alteplase) or precipitate (pH- or lipid-specific agents) causes. Never force a flush; use 10-mL-diameter syringes.

Answer: C

In the axillary vein at the level of the axilla: A tip at the axilla is the expected location of a midline catheter, which is a peripheral device, not a CVAD.

In the subclavian vein near the clavicle: A subclavian tip position is non-central and carries a higher risk of thrombosis and catheter dysfunction.

Lower third of the SVC near the cavoatrial junction: Correct. The optimal tip position for CVADs inserted from the upper body is the lower third of the SVC, at or near the cavoatrial junction, confirmed by ECG-based tip location, fluoroscopy or chest x-ray.

Deep in the right ventricle beyond the tricuspid valve: A tip in the right ventricle can cause dysrhythmias, valve damage and perforation; it must be pulled back.

CVAD tip: lower third of the SVC at or near the cavoatrial junction (upper-body insertion); IVC above the diaphragm for lower-body insertion. Confirm before first use.

Answer: A

0.9% sodium chloride: Correct. 0.9% sodium chloride is the standard compatible solution with red blood cells; it does not cause hemolysis or clotting.

5% dextrose in water: Dextrose solutions are hypotonic once metabolized and can cause red cell clumping and hemolysis.

Lactated Ringer's solution: LR contains calcium, which can overcome the citrate anticoagulant and cause clots in the set.

0.45% sodium chloride: Hypotonic saline causes red cells to swell and hemolyze.

Run only 0.9% NaCl with blood components (or other FDA-approved solutions per AABB). Use a blood administration set with a 170- to 260-micron filter and complete each unit within 4 hours of spiking.

Answer: A

32.4 mL/hour: Correct. 18 units/kg/hr x 90 kg = 1,620 units/hr. Concentration = 25,000 units / 500 mL = 50 units/mL. 1,620 / 50 = 32.4 mL/hr.

16.2 mL/hour: This assumes 100 units/mL (e.g., 25,000 units in 250 mL) and would deliver half the ordered dose.

64.8 mL/hour: This doubles the correct rate (e.g., assuming 25 units/mL), delivering 3,240 units/hr and risking bleeding.

18 mL/hour: This programs the units/kg value as mL/hr, ignoring both weight and concentration.

Rate (mL/hr) = (dose per kg per hr x weight) / concentration (units/mL). Have a second nurse independently double-check high-alert infusions.