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ACVNU practice questions

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Question 1Patient Assessment and Monitoring

Which finding is the best single indicator of effective spontaneous circulation during resuscitation of an adult patient?

  1. Palpable carotid pulse with a consistent waveform on the monitor
  2. Constriction of the pupils to light
  3. A rising end-tidal carbon dioxide value Correct answer.
  4. Warmth of the extremities

Explanation

End-tidal carbon dioxide reflects pulmonary blood flow, so a sudden sustained rise during CPR suggests return of spontaneous circulation. Pulse checks are unreliable and are minimized during compressions. Pupillary and skin findings change too slowly to guide immediate decisions.

Question 2Patient Assessment and Monitoring

A patient's blood pressure is 118/76 mmHg with a heart rate of 72 beats/min. What is the mean arterial pressure?

  1. 84 mmHg
  2. 90 mmHg Correct answer.
  3. 76 mmHg
  4. 98 mmHg

Explanation

Mean arterial pressure is calculated as diastolic pressure plus one-third of the pulse pressure. Here the pulse pressure is 42 mmHg, one-third is 14, added to 76 gives 90 mmHg. A value near 65 mmHg or higher is generally needed for adequate organ perfusion.

Question 3Patient Assessment and Monitoring

Which parameter is most directly affected by the position of the transducer when measuring invasive arterial pressure?

  1. The displayed mean pressure
  2. The diastolic pressure only
  3. The systolic pressure only
  4. The zero reference level Correct answer.

Explanation

Invasive pressure is referenced to a zero point, typically the phlebostatic axis at the fourth intercostal space midaxillary line. If the transducer is above or below this level, hydrostatic effects distort all displayed values. Correct leveling is therefore the key step before interpreting the waveform.

Question 4Patient Assessment and Monitoring

An adult patient has a respiratory rate of 24 breaths/min, oxygen saturation of 91% on room air, and is speaking in full sentences. Which classification best fits this presentation?

  1. Adequate ventilation with no concern
  2. Hypoxemia with compensatory tachypnea Correct answer.
  3. Normal oxygenation with isolated tachypnea
  4. Hyperventilation due to anxiety

Explanation

An oxygen saturation of 91% on room air indicates hypoxemia, and the elevated respiratory rate is a compensatory response. Speaking in full sentences suggests the patient is not yet in immediate respiratory failure but still requires intervention and reassessment.

Question 5Patient Assessment and Monitoring

Which finding on a 12-lead ECG most strongly suggests acute myocardial ischemia in a patient with chest pain?

  1. Peaked T waves in a single lead
  2. Premature ventricular contractions
  3. Sinus tachycardia at 110 beats/min
  4. ST-segment elevation in contiguous leads Correct answer.

Explanation

ST-segment elevation in anatomically contiguous leads is the hallmark of acute transmural injury and prompts urgent reperfusion evaluation. Isolated peaked T waves, tachycardia, and occasional ectopy are nonspecific and have many causes.

Question 6Patient Assessment and Monitoring

During a focused neurologic assessment, a patient opens the eyes to voice, is confused in conversation, and moves all extremities to command. What is the Glasgow Coma Scale score?

  1. 13
  2. 11
  3. 14 Correct answer.
  4. 12

Explanation

Eye opening to voice scores 3, confused conversation scores 4, and obeying commands scores 6, for a total of 13. Rechecking the arithmetic: 3 plus 4 plus 6 equals 13.

Question 7Patient Assessment and Monitoring

Which assessment finding is most consistent with early hypovolemic shock in an adult?

  1. Widened pulse pressure with bradycardia
  2. Bradycardia with hypertension
  3. Narrowed pulse pressure with tachycardia Correct answer.
  4. Warm flushed skin with normal heart rate

Explanation

Early volume loss produces compensatory tachycardia and peripheral vasoconstriction, which raises diastolic pressure and narrows the pulse pressure. Blood pressure may remain normal until compensation fails. Bradycardia with hypertension suggests a different cause such as raised intracranial pressure.

Question 8Patient Assessment and Monitoring

A patient reports sudden onset of sharp chest pain and breathlessness after prolonged bed rest. Which monitoring priority is most appropriate while awaiting imaging?

  1. Serial blood glucose measurements
  2. Hourly urine specific gravity
  3. Daily weight measurement
  4. Continuous pulse oximetry with frequent vital signs Correct answer.

Explanation

The presentation raises concern for pulmonary embolism, in which oxygenation can deteriorate abruptly. Continuous oximetry and frequent vital signs allow early detection of decompensation. The other measures do not address acute respiratory or hemodynamic instability.

Question 9Patient Assessment and Monitoring

Which statement about pulse oximetry is most accurate?

  1. It measures arterial oxygen content directly.
  2. It reliably detects hypoventilation before desaturation.
  3. It is unaffected by poor peripheral perfusion.
  4. It estimates oxygen saturation from light absorbance. Correct answer.

Explanation

Pulse oximetry estimates the percentage of hemoglobin saturated with oxygen by comparing light absorbance of oxygenated and deoxygenated hemoglobin. It does not measure content, ventilation, or perfusion directly. Poor perfusion, motion, and abnormal hemoglobin can all distort readings.

Question 10Patient Assessment and Monitoring

A patient has a blood glucose of 54 mg/dL and is alert and able to swallow. What is the most appropriate initial action?

  1. Start a continuous insulin infusion
  2. Administer oral glucose and recheck in 15 minutes Correct answer.
  3. Give nothing by mouth and observe
  4. Withhold treatment and recheck in one hour

Explanation

Symptomatic hypoglycemia in a patient who can swallow safely is treated with fast-acting oral carbohydrate followed by rechecking the glucose. Reassessment confirms resolution and guides further treatment. Withholding treatment risks worsening neurologic status.

Question 11Patient Assessment and Monitoring

Which waveform finding on an arterial line suggests an over-damped system?

  1. An elevated mean pressure relative to the systolic
  2. Loss of the dicrotic notch with a slurred upstroke Correct answer.
  3. A systolic pressure that reads higher than the cuff pressure
  4. Exaggerated systolic peaks with a low diastolic trough

Explanation

Over-damping blunts the high-frequency components of the pressure wave, producing a slurred upstroke and loss of the dicrotic notch. It tends to underestimate systolic and overestimate diastolic pressure. Under-damping instead exaggerates the systolic peak.

Question 12Patient Assessment and Monitoring

Which finding best distinguishes an absence seizure from a complex partial seizure on observation?

  1. A preceding aura of foul odor
  2. Unilateral jerking of one limb
  3. Brief staring with immediate return to baseline Correct answer.
  4. Postictal confusion lasting many minutes

Explanation

Absence seizures are brief episodes of impaired awareness with staring and an abrupt return to normal activity, often without a postictal phase. Complex partial seizures typically include automatisms and a period of postictal confusion.

Question 13Patient Assessment and Monitoring

Which parameter is most useful for detecting a trend of rising intracranial pressure before herniation occurs?

  1. Grip strength alone
  2. Serial pupillary size and reactivity
  3. Frequency of yawning
  4. Level of consciousness using a standardized scale Correct answer.

Explanation

A declining level of consciousness is often the earliest reliable sign of worsening intracranial pressure. Pupillary changes tend to appear later and can be affected by medications. Standardized scales allow consistent trending across observers.

Question 14Patient Assessment and Monitoring

A patient's temperature is 39.4 degrees Celsius with rigors and a heart rate of 118 beats/min. Which initial monitoring action is most important?

  1. Obtain blood cultures and assess perfusion Correct answer.
  2. Restrict oral fluids
  3. Repeat the temperature in four hours
  4. Apply a cooling blanket immediately

Explanation

High fever with rigors and tachycardia suggests possible sepsis, so cultures before antibiotics and assessment of perfusion are priorities. Rapid identification of the source guides antimicrobial therapy. Cooling measures do not replace source evaluation.

Question 15Patient Assessment and Monitoring

Which finding on a capnography waveform indicates that the endotracheal tube has been displaced into the esophagus?

  1. A widened alveolar plateau
  2. A sudden loss of the waveform to near zero Correct answer.
  3. A gradual rise in the end-tidal value
  4. A sustained waveform with a plateau

Explanation

Esophageal placement produces little or no exhaled carbon dioxide, so the waveform drops to near zero. A sustained plateau confirms tracheal placement. Any sudden loss of the waveform should prompt immediate verification of tube position.

Question 16Patient Assessment and Monitoring

Which assessment finding is most characteristic of anaphylaxis rather than a simple allergic reaction?

  1. Itchy watery eyes
  2. Localized urticaria at the exposure site
  3. A mild rash that resolves with an antihistamine
  4. Hypotension with airway swelling Correct answer.

Explanation

Anaphylaxis involves multisystem involvement, typically with hemodynamic compromise or airway compromise in addition to skin findings. Localized symptoms alone suggest a milder reaction. Hypotension with airway swelling requires immediate epinephrine.

Question 17Patient Assessment and Monitoring

A patient with a history of heart failure reports increasing orthopnea and a weight gain of 3 kg over four days. Which assessment finding would most support a fluid overload state?

  1. Decreased jugular venous pressure
  2. Bibasilar crackles with an S3 gallop Correct answer.
  3. Clear lungs with a soft S1
  4. Flat neck veins when sitting upright

Explanation

Crackles and an S3 gallop reflect pulmonary congestion and volume overload in heart failure. Rapid weight gain supports fluid accumulation. Neck vein assessment and lung sounds together help confirm the volume state.

Question 18Patient Assessment and Monitoring

Which value represents a normal adult resting oxygen saturation measured by pulse oximetry at sea level?

  1. 86%
  2. 78%
  3. 92%
  4. 97% Correct answer.

Explanation

Normal resting oxygen saturation in a healthy adult at sea level is generally 95% to 100%. Values below 90% represent hypoxemia requiring evaluation. Trending values against the patient's baseline is more useful than a single threshold.

Question 19Patient Assessment and Monitoring

A patient's pain is described as burning and shooting down the leg with a positive straight-leg raise. Which pain mechanism is most likely?

  1. Neuropathic pain from nerve root irritation Correct answer.
  2. Referred pain from a visceral source
  3. Nociceptive pain from muscle strain
  4. Psychogenic pain without a physiologic basis

Explanation

Burning, shooting pain in a dermatomal distribution with a positive straight-leg raise suggests nerve root irritation and a neuropathic component. Nociceptive musculoskeletal pain is typically aching and localized. Accurate characterization guides analgesic selection.

Question 20Patient Assessment and Monitoring

Which monitoring approach best detects opioid-induced respiratory depression in a postoperative patient receiving patient-controlled analgesia?

  1. Continuous capnography with sedation scoring Correct answer.
  2. Daily arterial blood gas sampling
  3. Routine chest radiography
  4. Intermittent vital signs every four hours

Explanation

Opioids depress respiratory drive before oxygenation falls, so capnography detects rising carbon dioxide earlier than oximetry alone. Sedation scoring adds a clinical marker of accumulating opioid effect. Together they allow early intervention.

Question 21Patient Assessment and Monitoring

A patient's rhythm strip shows a regular narrow-complex tachycardia at 180 beats/min with no visible P waves. Which term best describes this rhythm?

  1. Sinus tachycardia
  2. Supraventricular tachycardia Correct answer.
  3. Ventricular fibrillation
  4. Ventricular tachycardia

Explanation

A regular narrow-complex tachycardia without discernible P waves is characteristic of supraventricular tachycardia. Ventricular rhythms are typically wide-complex. Sinus tachycardia usually shows P waves and rarely exceeds roughly 150 beats/min at rest.

Question 22Patient Assessment and Monitoring

A patient's urine output has been 15 mL per hour for the past three hours. Which interpretation is most appropriate?

  1. This is expected after any surgery.
  2. This suggests oliguria requiring evaluation. Correct answer.
  3. This indicates polyuria from diabetes insipidus.
  4. This is adequate output for an adult.

Explanation

Urine output below roughly 0.5 mL/kg per hour in an adult indicates oliguria and warrants assessment of volume status and renal perfusion. Sustained low output can precede acute kidney injury. Trending output over time is more informative than a single measurement.

Question 23Patient Assessment and Monitoring

Which physical assessment technique is most appropriate for estimating central venous pressure at the bedside?

  1. Measuring jugular venous pulsation height with the patient at 30 to 45 degrees Correct answer.
  2. Palpating the radial pulse amplitude
  3. Auscultating the carotid arteries for bruits
  4. Measuring calf circumference

Explanation

Jugular venous pressure is estimated by observing the height of the venous pulsation above the sternal angle with the head of the bed elevated. This provides a noninvasive estimate of right atrial pressure. Carotid and radial assessments do not reflect central pressures.

Question 24Patient Assessment and Monitoring

A patient with a new tracheostomy has an oxygen saturation of 88% and audible stridor. What is the most appropriate immediate action?

  1. Assess and secure the airway while calling for help Correct answer.
  2. Document the finding and continue monitoring
  3. Reposition the patient and wait for the next round
  4. Increase the oxygen flow and reassess in ten minutes

Explanation

Stridor with hypoxemia suggests airway obstruction, which is an emergency. The priority is to assess and secure the airway with additional help. Simply increasing oxygen does not relieve a mechanical obstruction.

Question 25Patient Assessment and Monitoring

Which finding on a chest assessment most strongly suggests a tension pneumothorax?

  1. Tracheal deviation away from the affected side with hypotension Correct answer.
  2. Fine crackles at both bases
  3. Prolonged expiratory phase with wheezing
  4. Dullness to percussion at the affected base

Explanation

Tension pneumothorax produces progressive air accumulation that shifts mediastinal structures and impairs venous return, causing hypotension. Tracheal deviation away from the affected side is a late but classic sign. Immediate decompression is required.

Question 26Patient Assessment and Monitoring

A patient is admitted with a suspected acute coronary syndrome. Which assessment finding is most concerning for ongoing myocardial ischemia?

  1. Chest discomfort that resolves with rest
  2. Blood pressure of 138/86 mm Hg
  3. Heart rate of 88 beats/min with occasional premature beats
  4. New onset of dyspnea with crackles at the lung bases Correct answer.

Explanation

New dyspnea with basilar crackles suggests left ventricular dysfunction and pulmonary congestion, which can indicate ongoing ischemia or impending heart failure. The other findings are either expected or less specific for acute ischemia.

Question 27Patient Assessment and Monitoring

During assessment of a patient with a suspected stroke, which finding is most indicative of a posterior circulation stroke?

  1. Unilateral facial droop
  2. Vertigo with diplopia Correct answer.
  3. Homonymous hemianopia
  4. Expressive aphasia

Explanation

Posterior circulation strokes often present with vertigo, diplopia, ataxia, and other cranial nerve deficits due to involvement of the brainstem or cerebellum. Facial droop and aphasia are more typical of anterior circulation strokes.

Question 28Patient Assessment and Monitoring

A patient with a head injury has a Glasgow Coma Scale score of 13. Which component of the GCS is most predictive of early deterioration?

  1. Best pupil reaction
  2. Verbal response
  3. Motor response Correct answer.
  4. Eye opening

Explanation

The motor response is the most reliable and predictive component of the GCS for assessing severity of brain injury and risk of deterioration. Pupillary reaction is not part of the GCS.

Question 29Patient Assessment and Monitoring

A patient is receiving mechanical ventilation. The peak airway pressure has suddenly increased from 25 to 45 cm H2O. Which action should the nurse take first?

  1. Assess for breath sounds and chest wall movement Correct answer.
  2. Administer a prescribed bronchodilator
  3. Increase the tidal volume setting
  4. Obtain an arterial blood gas sample

Explanation

A sudden rise in peak airway pressure requires immediate assessment for causes such as pneumothorax, mucus plugging, or tube displacement. Auscultation and observation of chest movement are the first steps to identify the problem.

Question 30Patient Assessment and Monitoring

Which finding on a 12-lead ECG is most specific for acute myocardial infarction?

  1. T-wave inversion in a single lead
  2. Sinus tachycardia
  3. ST-segment elevation in two contiguous leads Correct answer.
  4. Premature ventricular contractions

Explanation

ST-segment elevation in two contiguous leads is a hallmark of acute myocardial infarction and is more specific than other ECG changes. T-wave inversion and arrhythmias can occur in many conditions.

Question 31Patient Assessment and Monitoring

A patient with sepsis has a lactate level of 4 mmol/L. Which additional assessment finding best indicates inadequate tissue perfusion?

  1. Mottled skin on the knees Correct answer.
  2. Warm extremities
  3. Capillary refill of 2 seconds
  4. Urine output of 0.8 mL/kg/hr

Explanation

Mottled skin is a sign of poor peripheral perfusion and is associated with inadequate tissue oxygenation in sepsis. The other findings are within normal limits or suggest adequate perfusion.

Question 32Patient Assessment and Monitoring

Which assessment finding is most indicative of a tension pneumothorax in a patient receiving positive-pressure ventilation?

  1. Tracheal deviation toward the affected side
  2. Crackles at the lung bases
  3. Sudden decrease in oxygen saturation with absent breath sounds on one side Correct answer.
  4. Bradycardia with hypertension

Explanation

Tension pneumothorax in a ventilated patient typically presents with sudden hypoxemia and absent breath sounds on the affected side due to air trapping and lung collapse. Tracheal deviation is a late and less common sign.

Question 33Patient Assessment and Monitoring

A patient has a pulmonary artery catheter in place. Which finding indicates that the catheter has migrated into the pulmonary artery wedge position?

  1. A persistent wedge pressure tracing without balloon inflation Correct answer.
  2. Loss of the dicrotic notch on the waveform
  3. A change from pulsatile to nonpulsatile waveform
  4. A sudden increase in pulmonary artery systolic pressure

Explanation

If the catheter migrates distally, it can spontaneously wedge, producing a wedge pressure waveform without balloon inflation. This can cause pulmonary infarction and requires immediate repositioning.

Question 34Patient Assessment and Monitoring

A patient is being assessed for orthostatic hypotension. Which finding is most consistent with this condition?

  1. An increase in heart rate of 5 beats/min upon standing
  2. A drop in diastolic blood pressure of 5 mm Hg upon standing
  3. A drop in systolic blood pressure of 25 mm Hg upon standing Correct answer.
  4. A drop in systolic blood pressure of 10 mm Hg upon standing

Explanation

Orthostatic hypotension is defined as a decrease in systolic blood pressure of at least 20 mm Hg or diastolic of at least 10 mm Hg within 3 minutes of standing. A 25 mm Hg drop meets this criterion.

Question 35Patient Assessment and Monitoring

A patient is reporting pain. Which assessment tool is most appropriate for evaluating pain in an adult who is unable to verbalize?

  1. Wong-Baker FACES scale
  2. Critical-Care Pain Observation Tool (CPOT) Correct answer.
  3. Numeric rating scale
  4. Visual analog scale

Explanation

The CPOT is designed for patients who cannot self-report pain, such as those who are critically ill or unable to communicate. It assesses facial expressions, body movements, muscle tension, and ventilator compliance.

Question 36Patient Assessment and Monitoring

A patient with a spinal cord injury at T6 suddenly develops a severe headache, hypertension, and bradycardia. Which assessment finding is most likely to accompany this syndrome?

  1. Flaccid paralysis of the lower extremities
  2. Loss of pain sensation below the injury
  3. Hypotension and tachycardia
  4. Profuse sweating above the level of injury Correct answer.

Explanation

Autonomic dysreflexia is characterized by severe hypertension, bradycardia, headache, and sweating above the level of the spinal cord injury. It is a medical emergency triggered by noxious stimuli below the injury level.

Question 37Patient Assessment and Monitoring

Which parameter is most sensitive for early detection of increased intracranial pressure in a patient with a traumatic brain injury?

  1. Blood pressure
  2. Level of consciousness Correct answer.
  3. Respiratory rate
  4. Pupillary reaction

Explanation

A change in level of consciousness is often the earliest indicator of increasing intracranial pressure. Pupillary changes and vital sign alterations tend to occur later.

Question 38Patient Assessment and Monitoring

A patient is being monitored with a pulmonary artery catheter. Which value represents a normal pulmonary artery wedge pressure (PAWP)?

  1. 2 mm Hg
  2. 8 mm Hg Correct answer.
  3. 25 mm Hg
  4. 18 mm Hg

Explanation

A normal pulmonary artery wedge pressure is typically 6-12 mm Hg. A value of 8 mm Hg falls within this range and suggests adequate left ventricular filling.

Question 39Patient Assessment and Monitoring

A patient is admitted with a suspected opioid overdose. Which assessment finding is most characteristic of this condition?

  1. Hyperactive bowel sounds and diarrhea
  2. Dilated pupils and hypertension
  3. Tachycardia and agitation
  4. Pinpoint pupils and respiratory depression Correct answer.

Explanation

Opioid overdose classically presents with miosis (pinpoint pupils), respiratory depression, and decreased level of consciousness. These findings help distinguish it from other toxidromes.

Question 40Patient Assessment and Monitoring

A patient with a history of heart failure is being assessed. Which finding best indicates fluid overload?

  1. Flat neck veins when supine
  2. Jugular venous distension at 45 degrees Correct answer.
  3. Clear breath sounds bilaterally
  4. Weight loss of 1 kg over two days

Explanation

Jugular venous distension at 45 degrees is a sign of increased right-sided filling pressures and fluid overload. It reflects volume expansion and is commonly seen in heart failure exacerbation.

Question 41Vascular Access and Catheter Management

Which type of central venous catheter is inserted through the skin of the chest or neck and tunneled under the skin before entering a central vein?

  1. Implanted port
  2. Tunneled central catheter Correct answer.
  3. Peripherally inserted central catheter
  4. Non-tunneled central catheter

Explanation

Tunneled catheters travel subcutaneously from the insertion site to a separate exit point, which helps anchor the device and reduce infection risk. PICCs are inserted via a peripheral arm vein, ports are fully implanted under the skin, and non-tunneled catheters enter directly into a central vein without a subcutaneous tunnel.

Question 42Vascular Access and Catheter Management

What is the primary purpose of flushing a central venous catheter with normal saline after medication administration?

  1. To sterilize the catheter surface
  2. To prevent phlebitis at the exit site
  3. To increase the catheter's dwell time
  4. To maintain patency of the lumen Correct answer.

Explanation

Flushing clears residual medication and blood from the lumen, which keeps the catheter patent and prevents occlusion. Flushing does not sterilize the device, alter dwell time, or prevent exit-site phlebitis.

Question 43Vascular Access and Catheter Management

A nurse is selecting a vein for a peripheral IV in an adult. Which site is generally preferred?

  1. Antecubital fossa
  2. Ventral wrist over the radial artery
  3. Dorsal venous network of the hand Correct answer.
  4. Lower extremity saphenous vein

Explanation

The dorsal veins of the hand are distal, well supported, and preserve proximal veins for future access, making them a preferred starting site. Antecubital veins are often reserved, lower-extremity veins carry higher thrombophlebitis risk in adults, and the ventral wrist overlies the radial artery.

Question 44Vascular Access and Catheter Management

Which organism is the most common cause of catheter-related bloodstream infections?

  1. Coagulase-negative staphylococci Correct answer.
  2. Candida albicans
  3. Escherichia coli
  4. Pseudomonas aeruginosa

Explanation

Coagulase-negative staphylococci, especially Staphylococcus epidermidis, are the most frequently isolated organisms in catheter-related bloodstream infections because they colonize skin and adhere to catheter surfaces. The other organisms cause CRBSI less commonly.

Question 45Vascular Access and Catheter Management

What is the recommended maximum dwell time for a peripheral IV catheter in an adult when there is no clinical indication for removal?

  1. 24 hours
  2. 7 days
  3. 72 to 96 hours Correct answer.
  4. 48 hours

Explanation

Peripheral IV catheters are generally replaced every 72 to 96 hours or sooner if complications occur, per standard infusion therapy guidance. Shorter intervals increase unnecessary venipuncture, and 7 days exceeds recommended peripheral dwell time.

Question 46Vascular Access and Catheter Management

Which action is required before accessing an implanted port with a non-coring needle?

  1. Confirm needle placement and blood return Correct answer.
  2. Apply a warm compress to the port site
  3. Palpate the septum with a gloved finger
  4. Flush with heparin only

Explanation

After inserting the non-coring needle, the nurse verifies placement by obtaining a blood return and flushing per protocol before infusing. Warm compresses, heparin-only flushes, and palpating the septum with a gloved finger are not standard access requirements.

Question 47Vascular Access and Catheter Management

Which catheter type is most appropriate for a patient who needs several weeks of intravenous antibiotics and has poor peripheral veins?

  1. Peripherally inserted central catheter Correct answer.
  2. Midline catheter
  3. Peripheral IV catheter
  4. Non-tunneled subclavian catheter

Explanation

A PICC provides central access suitable for weeks of therapy and is placed through a peripheral vein, making it ideal when peripheral access is poor. A peripheral IV is too short-term, a midline does not reach central circulation for certain therapies, and a non-tunneled central catheter is typically for shorter acute use.

Question 48Vascular Access and Catheter Management

Which sign at a peripheral IV site should prompt immediate catheter removal?

  1. A dry, intact dressing
  2. Mild coolness of the skin
  3. Blanching with pressure
  4. Redness, warmth, and purulent drainage Correct answer.

Explanation

Redness, warmth, and purulent drainage indicate infection or phlebitis and require immediate removal and further assessment. Cool skin, blanching, and a dry intact dressing are not indications for removal.

Question 49Vascular Access and Catheter Management

When drawing blood from a central venous catheter, which action helps prevent hemolysis of the sample?

  1. Flushing with sterile water before drawing
  2. Using a small syringe with strong suction
  3. Shaking the tube vigorously after collection
  4. Drawing the sample slowly and gently Correct answer.

Explanation

Gentle aspiration and slow draw reduce shear stress on red blood cells and prevent hemolysis. Strong suction, vigorous shaking, and non-isotonic flushes can damage cells or alter results.

Question 50Vascular Access and Catheter Management

What is the purpose of using a pulsatile flush technique on a central venous catheter?

  1. To create turbulence that clears the catheter wall Correct answer.
  2. To reduce biofilm formation within the lumen
  3. To increase the catheter's internal diameter
  4. To prevent air embolism during insertion

Explanation

Pulsatile flushing produces turbulence that helps dislodge material adhering to the lumen wall and maintains patency. It does not reduce biofilm formation directly, change catheter dimensions, or prevent air embolism during insertion.