Question 1

A nurse is preparing to assist a physician with the insertion of an implanted catheter. Which are acceptable sites for insertion of an implantable catheter? SELECT ALL THAT APPLY.

Accepted Answer

The right subclavian vein is an acceptable site for the insertion of an implanted catheter. The peritoneum and intra-arterial sites are not appropriate for catheter insertion. The right atrium is not typically used as a catheter insertion site but can be considered in certain cases. However, the right subclavian is generally considered the best choice due to its accessibility and low complication rate.

Question 2

A nurse is preparing to assist with the insertion of a Groshong catheter. The nurse refers to the instructions regarding the use of Groshong catheters in a nursing reference book. The nurse learns that Groshong catheters differ from other central venous catheters in that they:

Accepted Answer

Groshong catheters have a closed-end tip with a three-position pressure-sensitive valve that stays closed when not in use, which reduces the risk of infection and thrombosis. This also means that they do not require heparin flushes to maintain patency. Groshong catheters are available in both single and multiple lumen types.

Question 3

A nurse is to change the needleless injection cap of a multiple-lumen central line. Which techniques should be used by the nurse to change the injection cap?

Accepted Answer

To prevent air embolism, the nurse should hold the connector below the client's heart, clamp the line, and change the cap. This will ensure that any air in the line will ascend toward the client's heart, preventing it from entering the bloodstream.

Question 4

The PICC team is scheduled to remove a PICC before client discharge. Assessment of the catheter indicates the PICC and determines that the PICC is "stuck." The most common cause of a stuck PICC is:

Accepted Answer

Thrombophlebitis is the most common cause of a stuck PICC. It occurs when a blood clot forms around the catheter, causing it to adhere to the vein wall. This can make removal difficult or even impossible without causing injury or further complications to the patient. It is important to address thrombophlebitis promptly and follow proper removal procedures to minimize risks to the patient.

Question 5

Which statements should a nurse include when explaining the advantages of a PICC to a client? SELECT ALL THAT APPLY.

Accepted Answer

The answer of Which statements should a nurse include when...

Question 6

A nurse, assisting a physician with the insertion of a central venous catheter, instructs a client to perform the Valsalva maneuver during the insertion of the catheter. The purpose of instructing the client to perform the Valsalva maneuver is to:

Accepted Answer

The Valsalva maneuver involves holding one's breath and straining, which increases intra-abdominal pressure and can help prevent air from entering the circulation during central venous catheter insertion. This is important to avoid an air embolism, which can be a serious complication. The maneuver does not specifically help with PICC insertion, prevent thrombus formation, or prevent malposition of the catheter.

Question 7

A nurse is to draw a blood sample for laboratory analysis from a multilumen central venous catheter. When performing this procedure, which step should the nurse take first?

Accepted Answer

Turning off infusates containing glucose or electrolytes for a full 1 minute prior to the blood draw is crucial to avoid contamination of the blood sample with these substances, which could lead to inaccurate laboratory results.

Question 8

A nurse is changing a client's PICC dressing. When changing a PICC dressing, the old dressing should be detached from the:

Accepted Answer

When changing a PICC dressing, the old dressing should be detached from the proximal to the distal edge. This helps to prevent the risk of introducing microorganisms into the client's bloodstream.

Question 9

A nurse is preparing to assist a physician with the insertion of a peripherally inserted central catheter (PICC). The physician intends to use a guidewire insertion technique to insert the catheter. Which is an adjunct to guidewire insertion technique for a PICC?

Accepted Answer

The answer of A nurse is preparing to assist a...

Question 10

A nurse has given instructions to a client being discharged home with a PICC, but evaluates that the client does not fully understand the instructions when the client states that he or she will:

Accepted Answer

Keeping activity level to a minimum while the catheter is in place is not an appropriate response and indicates a misunderstanding of the instructions given by the nurse. The other options are appropriate measures to take when caring for a PICC line.

Question 11

A nurse is preparing to assist with the insertion of a valved nontunneled central venous catheter (CVC). Which facts about a valved CVC should the nurse understand? SELECT ALL THAT APPLY.

Accepted Answer

The answer of A nurse is preparing to assist with...

Question 12

A nurse aspires to be able to use and manage peripherally inserted central catheters (PICCs) in the home-care environment. For the nurse to safely and legally perform this function, the nurse must:

Accepted Answer

To safely and legally perform the function of using and managing PICCs in the home-care environment, the nurse must be an RN, meet minimal educational requirements, have employer-granted certification, and demonstrate evidence of competency. This is the most comprehensive option that takes into account the necessary education, certification, and competency demonstrations required for this specialized skill. Option A only covers the requirement for a current license which is a general requirement for nursing practice, but not specific to this skill. Option B implies some level of training and proficiency in catheter insertion and maintenance, but does not cover the requirements for education, certification, and competency. Option D does not require any employer-granted certification or evidence of competency, which is a crucial component of safely and legally performing this function.

Question 13

A nurse specialist is preparing to insert a peripherally inserted central catheter (PICC). Complications related to the insertion of PICCs include:

Accepted Answer

The answer of A nurse specialist is preparing to insert...

Question 14

An oncology nurse prepares to flush a central venous catheter (CVC) prior to the administration of chemotherapy. When irrigating a CVC, the barrel capacity of the syringe should be a minimum of:

Accepted Answer

The barrel capacity of the syringe should be a minimum of 5 mL to effectively flush a central venous catheter prior to the administration of chemotherapy. This allows for adequate force and volume to clear any occlusions or debris in the catheter, reducing the risk of infection or other complications.

Question 15

A nurse specialist is preparing to insert a peripherally inserted central catheter (PICC).Which site is best for the insertion of the PICC?

Accepted Answer

The basilic vein is often the preferred site for PICC insertion as it is the least likely to cause complications such as pneumothorax or arterial puncture. The innominate vein, subclavian vein, and internal jugular vein are all larger veins that can be used for PICC insertion, but they carry a higher risk of complications. Ultimately, the best site for PICC insertion depends on the individual patient's anatomy and medical history.

Question 16

A nurse is discharging a client with a new PICC. Which instructions should the nurse provide to the client regarding the management of the PICC dressing? SELECT ALL THAT APPLY.

Accepted Answer

The answer of A nurse is discharging a client with...

Question 17

A nurse using a pair of scissors to remove a dressing over a tunneled catheter cuts into the catheter. Which should the nurse use to repair the catheter?

Accepted Answer

The manufacturer's repair kit should be used to repair the catheter as it is specifically designed for the type of catheter being used and will ensure proper repair and function of the catheter. Using any other repair kit could potentially cause further damage or malfunction of the catheter. The physician should also be notified of the incident.

Question 18

A nurse attends a class on the care of multilumen central venous catheters. The nurse clearly understands the information presented in the class when, on performance evaluation, the nurse discards and replaces the injection cap on a multilumen catheter:

Accepted Answer

According to CDC guidelines, injection caps on multilumen central venous catheters should be replaced no more frequently than every 72 hours, unless they become visibly soiled or are accidentally removed. Option B is not recommended as it is not necessary to replace the injection cap at every shift change. Option C is not practical as many medications may be administered through the same port, and replacing the injection cap after each medication administration would increase the risk of contamination. Option D is not recommended as simply drawing blood from a lumen does not necessitate replacement of the injection cap.

Quiz 8: Techniques for Initiation and Maintenance of Central Vascular Access