Chapter.8 Test Bank Docx Central Vascular Access Techniques

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

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. 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. Micropuncture needle

C. Surgical cutdown

D. Fluoroscopy

2. 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. have infusion therapy education, training, and validated competency

D. be an RN or licensed practical nurse and meet minimum state-approved educational requirements.

3. 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. A sterile 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.

4. 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

5. A nurse specialist is precepting a newly certified infusion nurse who is preparing to insert a peripherally inserted central catheter (PICC). Which complications related to the insertion of PICCs does the nurse include in her teaching:

A. malposition of the catheter and nerve damage.

B. phlebitis and infection.

C. thrombosis and infection.

D. septicemia and thrombosis.

6. 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.

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?

A. Clean the port of the lumen with 70% alcohol for at least 15 seconds and allow it to dry.

B. Use an alcohol disinfection cap to reduce contamination and elimination of human factors.

C. Turn off infusates containing glucose or electrolyte for one full minute prior to the blood draw.

D. Flush the lumen with sodium chloride after the sample is obtained.

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

A. are inserted directly through the skin, usually via the subclavian or internal jugular vein.

B. are surgically placed and consist of a catheter attached to a reservoir (port) and placed completely underneath the skin and accessed using a noncoring needle.

C. are threaded into the superior vena cava via the cephalic, basilica, or median veins.

D. are inserted into the central circulation for infusion therapy, with the tip located in the lower 1/3 of the superior vena cava.

9. A nurse is changing a client’s PICC dressing. When changing a PICC dressing, the old dressing should be detached by:

A. moving toward insertion site.

B. moving away from the insertion site.

C. removing left side first, then from top to bottom.

D. removing right side first, then from bottom to top.

10. The PICC team is scheduled to remove a PICC before client discharge. Assessment of the catheter determines that the PICC is “stuck.” The most common cause of a “stuck” PICC is:

A. phlebitis

B. venospasm

C. thrombophlebitis

D. a catheter tear or rupture

11. A nurse is to remove a multiple-lumen central line. Which techniques should be used by the nurse to remove the vascular device?

A. Hold the skin taut and pull line in one smooth motion.

B. Discontinue the infusion first and use gauze to remove the line.

C. Position the client in the Trendelenburg position during removal.

D. Open the central line kit, and then wash hands with soap and water

12. 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.

13. 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.

14. 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 pulls blood for blood sampling from:

A. the proximal port.

B. the distal port.

C. the fourth port.

D. the medial port.

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

1. A nurse is preparing to assist with the insertion of a valved nontunneled central venous access device (CVAD). Which facts about a valved CVAD should the nurse understand? (Select all that apply.)

A. It is associated with more complications including occlusions from clots or fibrin.

B. It reduces the risk for blood reflux.

C. It reduces the risk for catheter occlusion.

D. It does not require clamping.

E. It requires clamping.

2. 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. Hepatic artery

C. Right subclavian

D. Right atrium

E. Peripheral vein

3. 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.

4. 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.

E. The PICC is best for clients with local skin infections.

5. The nurse is taking care of a client diagnosed with sepsis. The client has a multilumen CVAD. Which port/s are for blood or blood component administration? (Select all that apply.)

A. Distal port

B. Medial port

C. Proximal port

D. Fourth port

E. Peripheral port

6. Prior to PICC or CVAD insertion the nurse must have maximal sterile barrier precautions by: (Select all that apply.)

A. Wearing a mask

B. Wearing a sterile gown

C. Washing his/her hands

D. Increasing access to chlorhexidine

E. Using silicone elastomers

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

Multiple Choice

Identify the choice that best completes the statement or answers the question.

1. 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. Micropuncture needle

C. Surgical cutdown

D. Fluoroscopy