Deck 13: Central Venous Access

Question 1

What does the nurse understand about a Hickman catheter?

A) Surgically inserted tunneled catheter
B) Placed in the cephalic or basilic vein
C) Exits the client through the subclavian vein
D) Must be replaced every 2 months

Answer 1

Surgically inserted tunneled catheter

Question 2

The student is learning about PICC lines. Which statement by the student indicates the need to review the material?

A) They are less expensive than central venous catheters (CVCs).
B) Nurses are not allowed to insert PICC lines.
C) PICCs have a lower rate of complications than CVCs.
D) PICCs can have double or triple lumens.

Answer 2

Nurses are not allowed to insert PICC lines.

Question 3

A client has a PICC line in the right cephalic vein. What action by the student nurse requires the faculty to intervene?

A) Uses the double-lumen PICC to administer two incompatible medications simultaneously.
B) Collects a peripheral venous blood specimen from the left arm.
C) Takes blood pressures on the right arm.
D) Measures the circumference of the client's arm above and below the antecubital fossa with dressing changes.

Answer 3

Takes blood pressures on the right arm.

Question 4

The nurse understands the advantage of the pulsating flushing with a central venous access device is which of the following?

A) Creates positive pressure to decrease blood backup
B) Very effective at preventing fibrin formation
C) Forces small blood clots out of the tubing
D) Clears old solution that may harbor bacteria

Question 5

The nurse is caring for a client who has a central venous catheter (CVC). What action by the nurse demonstrates the need for further education when caring for this client's CVC?

A) Uses sterile scissors when changing the dressing
B) Applies antimicrobial disc at the insertion site
C) Applies a sterile transparent dressing over the site
D) Changes the CVC dressing if wet, loose, or soiled

Question 6

The nurse is drawing blood from a client's CVC. The spouse asks why the nurse discarded the first few milliliters of blood. What response by the nurse is best?

A) "The flush solution is incompatible with blood tube additives."
B) "The first part of the tubing has flush solution that dilutes the blood."
C) "That first bit of blood is usually contaminated with microbes."
D) "There may be medication backed up into the tubing."

Question 7

When caring for a client with an implanted port, what action does the nurse take?

A) Changes the noncoring needle and dressing every 7 days
B) Uses only heparin to flush the port after an infusion is complete
C) Accesses the port and flushes it with normal saline daily
D) Flushes the port every 2 weeks if not being used

Question 8

What does the nurse understand about IV tubing being used on central venous access devices?

A) All tubing is changed every 72 hours.
B) TPN tubing is changed every 24 hours.
C) Lipid tubing is changed with each bottle.
D) Intermittent infusion tubing is changed every 96 hours.

Question 9

After assisting the provider with inserting a CVC in a client, what action by the nurse is most important?

A) Documenting the procedure and client tolerance
B) Alerting lab the client is now a "line draw"
C) Assessing the client's pain
D) Facilitating a chest x-ray

Question 10

The nurse is discontinuing an internal jugular central line. What action by the nurse demonstrates the need to review the policy?

A) Places the client in reverse Trendelenburg position
B) Applies a mask to own face and to the client's face
C) Pulls old dressing off toward the insertion site
D) Cleans insertion site with chlorhexidine for 30 seconds

Question 11

A client is receiving TPN through a CVC. Which activity does the nurse include in the client's care?

A) Assess blood glucose three times a day.
B) Have another RN double check new TPN bags.
C) Monitor client's weight gain weekly.
D) Use secondary tubing for antibiotics.

Question 12

A client has a nontunneled central venous catheter. What action by the nurse is most important in caring for this client?

A) Change IV tubing every 72 to 96 hours.
B) Use needleless connection ports.
C) Adhere to strict aseptic techniques.
D) Use chlorhexidine skin prep.

Question 13

A client is having a long term central venous access device implanted which may need to stay in place for years. Which type of line does the nurse educate the client on?

A) Triple lumen subclavian line
B) Broviac catheter
C) PICC line
D) Power-PICC line

Question 14

A client who has a Hickman catheter calls the home care nurse to report being unable to flush the line. What does the nurse tell the client?

A) "Change positions then try to flush it again."
B) "I will come right out to try flushing it myself."
C) "You may need to have the catheter removed."
D) "Try pulling back and forth on the syringe plunger."

Question 15

A client has a central line associated blood stream infection and the spouse asks where the infection came from. What response from the nurse is most appropriate?

A) "It probably came from the bladder catheter."
B) "It started right here with the central line site."
C) "It could have been picked up from anywhere."
D) "There is no way of telling where it came from."

Question 16

A client has a central venous access device. What assessment data indicates that a goal for the priority nursing diagnosis has been met?

A) Can demonstrate home care of the catheter
B) Pain controlled with ordered analgesia
C) White blood cell count within parameters
D) Able to list signs of infection

Question 17

The nurse is changing the dressing on a central venous catheter. The client refuses to wear a mask. What action by the nurse is best?

A) Drape a sterile towel over the client's face.
B) Tell the client the mask must be worn.
C) Have the client turn his or her head away.
D) Inform the provider the dressing cannot be changed.

Question 18

A client has been admitted for a bone marrow transplant. On which type of central venous access device will the nurse provide teaching?

A) Broviac
B) Triple-lumen subclavian
C) Hickman
D) Groshong

Question 19

The nurse teaching a client about an implanted port includes what information? (Select all that apply.)

A) Must be surgically implanted and removed.
B) They have a lower risk of bloodstream infections.
C) They are high maintenance.
D) Swimming and bathing are allowed.
E) Used for blood draws and infusions.

Question 20

The nurse is flushing an implanted port. What actions by the nurse are appropriate? (Select all that apply.)

A) Uses a 10 mL or larger syringe
B) Flushes after use with 0.9% normal saline
C) Uses 30 mL of 0.9% normal saline after blood draws
D) Flushes prior to use with sterile water
E) Clamps the lumen after the final flush

Question 21

A nurse is caring for a client who has a central venous access device (CVAD). What actions does the nurse take as part of the care bundle for this client? (Select all that apply.)

A) Good hand hygiene prior to insertion
B) Using alcohol for skin prep
C) Using sterile barrier precautions
D) Changing a gauze dressing every 2 days
E) Applying a chlorhexidine impregnated sponge disc

Question 22

The nurse is assisting with insertion of a central venous catheter and needs to use maximal sterile barrier. What items does this include? (Select all that apply.)

A) Mask
B) Sterile gloves
C) Full body drape
D) Sterile gown
E) Cap

Question 23

What information does the nurse utilize when caring for a client who has a triple-lumen central venous access device? (Select all that apply.)

A) Blood samples are drawn from the proximal lumen.
B) Medications are administered in the distal lumen.
C) TPN is infused through the distal lumen.
D) IV solutions run through the proximal lumen.
E) The distal lumen is reserved for transfusions.

Question 24

The nurse caring for a client with a central venous access device (CVAD) plans care to prevent the two most serious complications that arise from this catheter. Which of these are included? (Select all that apply.)

A) Thrombus
B) Catheter rupture
C) Line migration
D) Infection
E) Rejection

Question 25

Which of the following acceptable flush methods for central venous access devices are matched with a correct statement? (Select all that apply.)

A) Positive pressure flush: decreases blood backup in the tubing
B) Pulsing flush: removes fibrin that has formed in the tubing
C) Continuous flush: evidence-based practice for heparinization
D) Pulsing flush: need to check with manufacturer instructions
E) Positive pressure flush: clamp the catheter before syringe is empty