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

Question 1

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?

A)Clean the port of the lumen with alcohol and allow it to dry.
B)Flush blood out of the pigtail or cap following the procedure.
C)Turn off infusates containing glucose or electrolyte for a full 1 minute prior to the blood draw.
D)Flush the lumen with sodium chloride after the sample is obtained.

Answer 1

C

Question 2

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:

A)1 mL.
B)3 mL.
C)5 mL.
D)10 mL.

Answer 2

C

Question 3

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:

A)make PICC insertion easier.
B)prevent thrombus formation.
C)prevent air from entering the circulation.
D)prevent malposition of the catheter during insertion.

Answer 3

D

Question 4

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.

A)Change the dressing after the first 24 hours.
B)Change the dressing every 10 days.
C)Inspect the catheter insertion site for redness, swelling, and drainage.
D)Use care not to dislodge the catheter during the dressing change.
E)Place a recommended transparent dressing after the first 24 hours.

Question 5

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.

A)Peritoneum
B)Intra-arterial
C)Right subclavian
D)Right atrium

Question 6

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

A)bleeding, malposition of the catheter, and nerve damage.
B)phlebitis, infection, and SVC syndrome.
C)thrombosis, pinch-off syndrome, and infection.
D)septicemia, twiddler's syndrome, and thrombosis.

Question 7

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?

A)Any universal repair kit
B)A blunt-end needle and an injection cap system
C)The manufacturer's repair kit
D)None.The nurse should notify the physician, because nurses do not repair central venous catheters.

Question 8

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:

A)have an open-ended tip with a three-position valve that stays open all the time.
B)have a chemical makeup that allows for minimal use of heparin for flushing.
C)have a closed-end tip with a three-position pressure-sensitive valve that stays closed when not in use.
D)are available only in single-lumen type.

Question 9

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:

A)keep a repair kit in the home, if needed.
B)wear a medical identification tag or bracelet.
C)protect the insertion site when he or she is bathing.
D)keep his or her activity level to a minimum while the catheter is in place.

Question 10

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:

A)no more frequently than every 72 hours.
B)at the change of each shift.
C)after administration of each medication.
D)whenever blood was drawn from the lumen.

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.

A)It is associated with more complications including occlusions from clots or fibrin.
B)It operates by a pressure-activated two- or three-way slit.
C)Its tip decreases adherence of platelets or fibrin.
D)It does not require clamping.

Question 12

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

A)Basilic vein
B)Innominate vein
C)Subclavian vein
D)Internal jugular vein

Question 13

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?

A)Hold the connector above the client's heart and change the cap.
B)Hold the connector below the client's heart and change the cap.
C)Hold the connector below the client's heart, clamp, and change the cap.
D)Hold the connector above the client's heart, have the client hold his or her arms up, and change the cap.

Question 14

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?

A)Laser
B)Breakaway needle
C)Surgical cutdown
D)Fluoroscopy

Question 15

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

A)distal to the proximal edge.
B)proximal to the distal edge.
C)side first, then from top to bottom.
D)side first, then from bottom to top.

Question 16

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

A)The PICC is very reliable.
B)The PICC is cost effective.
C)The PICC is ideal for short-term use.
D)The PICC involves less pain and discomfort because of its multiple uses.Chapter 8: Techniques for Initiation and Maintenance of Central Vascular Access

Question 17

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:

A)phlebitis.
B)vasospasm.
C)thrombophlebitis.
D)a catheter tear or rupture.

Question 18

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:

A)hold a current license from the state.
B)be trained in a state-approved agency and show proficiency in catheter insertion and maintenance.
C)be a registered nurse (RN), meet minimal educational requirements, have employer-granted certification, and demonstrate evidence of competency.
D)be an RN or licensed practical nurse and meet minimum state-approved educational requirements.