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CRNI practice questions

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Question 1Assessment, Planning, and Patient Education

A peripheral IV site shows erythema at the access site with no pain, edema, induration, or palpable cord. How is this phlebitis graded?

  1. Grade 3
  2. Grade 1 Correct answer.
  3. Grade 2
  4. Grade 4

Explanation

Phlebitis scales run from 1 to 4: grade 1 is erythema at the access site with or without pain; grade 2 adds pain and/or edema; grade 3 adds induration or a red streak; grade 4 involves a palpable cord with severe pain. Erythema alone therefore places this site at grade 1.

Question 2Assessment, Planning, and Patient Education

Which statement best distinguishes extravasation from infiltration?

  1. Extravasation involves a vesicant; infiltration does not. Correct answer.
  2. Both terms describe blood leaking from the vessel into surrounding tissue.
  3. Infiltration involves a vesicant; extravasation does not.
  4. Infiltration occurs only with central catheters and extravasation only with peripheral ones.

Explanation

Infiltration is leakage of a nonvesicant solution into surrounding tissue, while extravasation is leakage of a vesicant or irritant capable of causing tissue injury. The distinction drives management, because extravasation triggers drug-specific antidote and escalation protocols.

Question 3Assessment, Planning, and Patient Education

A patient is receiving a vesicant through a peripheral IV. Which teaching point is most important to give before the infusion starts?

  1. Mild burning at the site is expected and need not be reported.
  2. Warm compresses should be applied to the arm during the infusion.
  3. Report burning, stinging, or swelling at the site immediately. Correct answer.
  4. Call the clinic the next day if any redness appears.

Explanation

Vesicants cause severe tissue injury if they leak, so any burning, stinging, pain, or swelling must be reported the moment it begins so the infusion can be stopped and the site evaluated. Discomfort during a vesicant infusion is never treated as expected.

Question 4Assessment, Planning, and Patient Education

Before administering a vesicant through a central venous catheter, the nurse cannot obtain a blood return. What is the most appropriate action?

  1. Hold the vesicant and evaluate catheter patency before infusing. Correct answer.
  2. Proceed, because central catheters do not require a blood return.
  3. Infuse the vesicant at a slower rate and monitor the site closely.
  4. Flush forcefully with 10 mL of saline and then infuse.

Explanation

Absence of blood return may indicate tip migration, abutment against the vessel wall, or a fibrin sheath, and a vesicant given in that situation can extravasate. Patency must be re-established or the catheter evaluated before the drug is given; forceful flushing is never appropriate.

Question 5Assessment, Planning, and Patient Education

According to infusion nursing standards, how often should a peripheral IV site with a continuous infusion be assessed in a stable adult patient?

  1. At least every 4 hours Correct answer.
  2. Once every 12 hours
  3. Once every 24 hours
  4. At least every 8 hours

Explanation

Standards direct that a peripheral site with a continuous infusion be assessed at least every 4 hours, and more often when vesicants, irritants, or unstable patients are involved. Sites used for intermittent therapy are assessed with each dose.

Question 6Assessment, Planning, and Patient Education

A patient with a tunneled central catheter has purulent drainage, erythema, and warmth at the exit site. Which action is indicated?

  1. Notify the provider and obtain a culture of the drainage. Correct answer.
  2. A small amount of dried blood under the dressing is an equivalent finding.
  3. Cleanse the site and reapply the dressing without further action.
  4. Document the finding and reassess at the next dressing change.

Explanation

Purulent drainage with erythema and warmth suggests a localized exit-site infection, which warrants provider notification and culture so that appropriate therapy can be started. Benign findings such as a small amount of dried blood or mild adhesive itching do not require the same escalation.

Question 7Assessment, Planning, and Patient Education

Which assessment is most important to complete before giving the first dose of an IV medication?

  1. The patient's documented allergy history Correct answer.
  2. The patient's most recent serum electrolyte values
  3. The patient's weight trend over the past month
  4. The patient's preferred arm for venipuncture

Explanation

Allergy history is verified before the first dose of any IV medication so that a hypersensitivity reaction can be prevented. A prior reaction may change the drug selected, the premedication regimen, or the setting in which the drug is given.

Question 8Assessment, Planning, and Patient Education

Which set of findings during an infusion best indicates anaphylaxis rather than a mild allergic reaction?

  1. Hypotension, wheezing, and laryngeal edema Correct answer.
  2. A single episode of sneezing
  3. Localized urticaria on the forearm alone
  4. Mild itching with no visible rash

Explanation

Anaphylaxis is a multisystem reaction with airway, breathing, or circulatory compromise, such as hypotension, wheezing, stridor, or laryngeal edema. Urticaria, itching, or sneezing alone indicate a milder reaction that still requires monitoring but not emergent resuscitation.

Question 9Assessment, Planning, and Patient Education

Ten minutes into a blood transfusion, a patient develops fever, chills, and low back pain. What is the nurse's first action?

  1. Flush the administration set with the blood unit to check patency.
  2. Slow the transfusion and reassess in 15 minutes.
  3. Give the ordered antipyretic and continue the transfusion.
  4. Stop the transfusion and maintain IV access. Correct answer.

Explanation

Fever, chills, and back pain suggest an acute hemolytic or febrile transfusion reaction, and the transfusion must be stopped at once while IV access is preserved with 0.9% sodium chloride. The unit and tubing are returned to the blood bank per policy and the provider is notified.

Question 10Assessment, Planning, and Patient Education

Extravasation of a vesicant is suspected at a peripheral IV site. Which action is correct?

  1. Stop the infusion and aspirate residual drug before removal. Correct answer.
  2. Remove the catheter at once and then apply a warm compress to the site.
  3. Continue the infusion while arranging for central access.
  4. Flush the catheter with 10 mL of saline to dilute the drug.

Explanation

For suspected vesicant extravasation through a peripheral catheter, the infusion is stopped but the catheter is left in place briefly so that residual drug can be aspirated before removal. Flushing pushes additional drug into tissue; compresses and antidotes then follow the drug-specific protocol.

Question 11Assessment, Planning, and Patient Education

During a vancomycin infusion, a patient develops flushing of the face, neck, and upper chest with itching but a normal blood pressure. What is the best interpretation?

  1. An acute hemolytic transfusion reaction
  2. A rate-related histamine infusion reaction Correct answer.
  3. Sepsis originating from the catheter
  4. Anaphylaxis requiring intramuscular epinephrine

Explanation

Flushing of the face, neck, and upper chest with or without itching during vancomycin is a rate-related histamine reaction, not a true allergy. It is managed by slowing the infusion, and antihistamine premedication may be used for subsequent doses.

Question 12Assessment, Planning, and Patient Education

A patient will need daily IV antibiotics at home for about 6 weeks. Which vascular access device is most appropriate?

  1. A peripherally inserted central catheter Correct answer.
  2. A midline catheter
  3. A short peripheral catheter replaced every 72 to 96 hours
  4. A steel-winged butterfly set

Explanation

A PICC is designed to support weeks to months of therapy, including daily antibiotics. Short peripheral catheters and steel-winged needles are limited to brief use, and a midline is not intended for therapy expected to extend well beyond a few weeks.

Question 13Assessment, Planning, and Patient Education

What is the primary purpose of the teach-back method in patient education?

  1. To measure the patient's reading level
  2. To document that printed materials were provided
  3. To confirm understanding by having the patient restate it Correct answer.
  4. To shorten the amount of time needed for discharge teaching

Explanation

Teach-back asks the patient to explain or demonstrate the information in their own words, which exposes gaps in comprehension more reliably than asking whether they understand. It is a check of learning, not of reading level or paperwork.

Question 14Assessment, Planning, and Patient Education

Which statement by a patient learning to give home IV antibiotics shows correct understanding?

  1. I can store the antibiotic vials in direct sunlight on the counter.
  2. I will reuse the same administration tubing for a week to save supplies.
  3. I will wash my hands and disinfect the hub before each connection. Correct answer.
  4. I will skip a dose whenever I start to feel better.

Explanation

Hand hygiene and hub disinfection are core aseptic steps that prevent bloodstream infection in home infusion. Supplies are not reused beyond manufacturer or policy limits, drugs are stored per labeling, and doses are not skipped.

Question 15Assessment, Planning, and Patient Education

Which assessment findings best indicate fluid volume overload during a rapid infusion?

  1. Bradycardia with hypotension
  2. Decreased urine output with dark concentrated urine
  3. Dyspnea, crackles, and jugular venous distention Correct answer.
  4. Dry mucous membranes with poor skin turgor and weight loss

Explanation

Dyspnea, crackles, jugular venous distention, and rapid weight gain reflect fluid accumulating faster than the body can excrete. Dry mucous membranes, hypotension, and oliguria point toward a fluid deficit instead.

Question 16Assessment, Planning, and Patient Education

A severely malnourished patient is starting total parenteral nutrition. Which electrolyte should the nurse monitor most closely for refeeding syndrome?

  1. Sodium
  2. Phosphorus Correct answer.
  3. Chloride
  4. Calcium

Explanation

Refeeding syndrome is driven by an insulin surge that shifts phosphate, potassium, and magnesium into cells after nutrition is reintroduced. Hypophosphatemia is the hallmark abnormality and can precipitate cardiac and respiratory failure.

Question 17Assessment, Planning, and Patient Education

Which element is essential in the written plan of care for a patient receiving infusion therapy?

  1. Measurable expected outcomes with a target timeframe Correct answer.
  2. The patient's insurance authorization number
  3. A list of all prior hospitalizations
  4. The pharmacy's delivery schedule for supplies

Explanation

A plan of care is built around measurable, time-bound expected outcomes that let the team judge whether therapy is achieving its goal and revise the approach if it is not. Administrative and historical data may be recorded elsewhere but do not direct care.

Question 18Assessment, Planning, and Patient Education

The nurse must obtain a blood sample from a central venous catheter that is infusing a continuous medication. What is the most appropriate action?

  1. Stop the infusion, flush, discard waste, then draw the sample. Correct answer.
  2. Use the syringe that was used for flushing to collect the sample.
  3. Draw the sample from the distal lumen without stopping the infusion.
  4. Draw the sample from the port while the infusion continues.

Explanation

A sample drawn from an infusing catheter will be contaminated by the infusate, so the infusion is paused, the lumen flushed, and a discard volume withdrawn per policy before collection. The discard volume clears drug and flush solution from the catheter dead space.

Question 19Assessment, Planning, and Patient Education

Thirty minutes into a first rituximab infusion, a patient develops chills, fever, and mild dyspnea. What is the most appropriate initial management?

  1. Increase the rate to finish the infusion more quickly.
  2. Continue the infusion at the same rate and give an antipyretic.
  3. Stop the infusion permanently and document a drug allergy.
  4. Stop the infusion, treat symptoms, then resume at a slower rate. Correct answer.

Explanation

Infusion-related reactions during a first rituximab dose are managed by interrupting the infusion, treating the symptoms, and resuming at a reduced rate once they resolve, since most patients tolerate the slower infusion. Permanently labeling the patient allergic would deprive them of needed therapy.

Question 20Assessment, Planning, and Patient Education

When assessing a peripheral IV by flushing, which finding indicates the catheter should be removed?

  1. The patient reports no discomfort during the flush.
  2. Resistance is met and the site swells during the flush. Correct answer.
  3. The flush flows easily with no resistance.
  4. A blood return is obtained before the flush begins.

Explanation

Resistance to flushing together with swelling indicates the catheter tip is no longer within the vein and fluid is entering tissue, so the catheter is removed and not flushed again. Free-flowing flush, comfort, and blood return all indicate a patent, well-positioned catheter.

Question 21Assessment, Planning, and Patient Education

A patient scheduled for a vesicant regimen has a peripheral IV in the forearm with brisk blood return. What is the most appropriate action?

  1. Use the existing site but check blood return every 5 minutes.
  2. Proceed, because blood return confirms the catheter is in the vein.
  3. Dilute the vesicant and give it by slow IV push through the site.
  4. Request central vascular access before the vesicant is given. Correct answer.

Explanation

Vesicants are given through central venous access because leakage into tissue causes severe injury, and brisk blood return does not guarantee that the tip sits safely in a large vessel. Peripheral administration of a vesicant is reserved for situations in which central access cannot be obtained and the plan is approved by protocol.

Question 22Assessment, Planning, and Patient Education

Which information must be documented after insertion of a peripheral IV catheter?

  1. The brand name of the IV solution being infused
  2. The patient's dietary preferences and food allergies
  3. Date, time, site, catheter gauge, and number of attempts Correct answer.
  4. The date of the patient's next scheduled appointment

Explanation

Documentation of a new catheter includes the date and time of insertion, the site and catheter gauge or type, the number of attempts, and who placed it. This record supports later evaluation of dwell time and detection of complications.

Question 23Vascular Access Device Selection, Insertion, and Care

Which peripheral catheter gauge provides the highest flow rate for rapid large-volume resuscitation in an adult?

  1. 24-gauge
  2. 20-gauge
  3. 14-gauge Correct answer.
  4. 22-gauge

Explanation

Gauge and flow rate are inversely related: a smaller gauge number means a larger internal diameter and faster flow. A 14-gauge catheter delivers far more volume per minute than a 20-, 22-, or 24-gauge device and is chosen when rapid resuscitation is needed and the vein can accommodate it.

Question 24Vascular Access Device Selection, Insertion, and Care

Which principle guides selection of a peripheral catheter gauge for an adult who needs intermittent IV antibiotics?

  1. Use the largest gauge the vein will accept, regardless of the therapy prescribed
  2. Choose the gauge according to the patient's age rather than the prescribed therapy
  3. Use a 22-gauge catheter for every adult patient
  4. Use the smallest gauge that will accommodate the prescribed therapy Correct answer.

Explanation

Gauge is matched to the prescribed therapy using the smallest catheter that meets the need, because larger catheters cause more phlebitis and mechanical vein injury. Viscosity, flow rate, and anticipated duration of therapy drive the decision rather than habit or a single default size.

Question 25Vascular Access Device Selection, Insertion, and Care

Which skin antiseptic is preferred for preparing intact skin before vascular access device insertion in an adult?

  1. Chlorhexidine gluconate greater than 0.5% in alcohol Correct answer.
  2. 3% hydrogen peroxide
  3. 10% povidone-iodine alone
  4. 70% isopropyl alcohol alone applied with friction

Explanation

Chlorhexidine gluconate in alcohol has broader and more persistent residual activity than alcohol or povidone-iodine alone and is the preferred agent for skin preparation before VAD insertion. It is applied with friction and allowed to dry completely before puncture.

Question 26Vascular Access Device Selection, Insertion, and Care

How often should a clean, dry, intact transparent semipermeable dressing over a central venous access device site be replaced?

  1. Every 72 hours
  2. Every 5 to 7 days Correct answer.
  3. Every 48 hours
  4. Once per shift (every 8 to 12 hours)

Explanation

Transparent semipermeable dressings are changed every 5 to 7 days when they remain clean, dry, and intact, since they permit site visualization and require less frequent manipulation. Any dressing that becomes damp, loose, soiled, or nonadherent must be changed immediately.

Question 27Vascular Access Device Selection, Insertion, and Care

Which needle must be used to access an implanted venous port?

  1. Butterfly needle with a steel bevel
  2. Standard beveled hypodermic needle
  3. Non-coring (Huber) needle Correct answer.
  4. Introducer needle with a splittable sheath

Explanation

The port septum is a self-sealing silicone membrane that must be punctured with a non-coring (Huber) needle, which displaces rather than cuts the material. A beveled needle cores the septum, causing leakage and premature port failure.

Question 28Vascular Access Device Selection, Insertion, and Care

Where does the tip of a midline catheter terminate?

  1. At the cavoatrial junction in the lower superior vena cava
  2. In the brachial vein below the axilla Correct answer.
  3. At the right atrial inlet
  4. In the distal superior vena cava

Explanation

A midline catheter is inserted in an arm vein and its tip terminates in the basilic, cephalic, or brachial vein at or below the level of the axilla, so it is not a central device. Devices whose tips reach the lower superior vena cava or cavoatrial junction are central catheters.

Question 29Vascular Access Device Selection, Insertion, and Care

At what angle is a peripheral IV catheter typically inserted into a vein in an adult?

  1. 45 to 60 degrees
  2. 30 to 45 degrees
  3. 15 to 30 degrees Correct answer.
  4. 5 to 10 degrees

Explanation

A 15- to 30-degree angle allows the needle to enter the vein without piercing the posterior wall, after which the angle is lowered to advance the catheter. Angles that are too shallow or too steep increase the risk of infiltration and failed cannulation.

Question 30Vascular Access Device Selection, Insertion, and Care

Which solution is recommended to lock a peripheral IV catheter in an adult after each use?

  1. Preservative-free 0.9% sodium chloride Correct answer.
  2. Heparin 100 units per mL, instilled after every flush
  3. Dextrose 5% in water
  4. Sterile water for injection

Explanation

Preservative-free 0.9% sodium chloride is the standard locking solution for peripheral catheters, and routine heparin locks are not required. Saline avoids heparin-associated risks such as bleeding and heparin-induced thrombocytopenia.

Question 31Vascular Access Device Selection, Insertion, and Care

A patient is scheduled for six months of daily vesicant chemotherapy. Which vascular access device is most appropriate?

  1. Peripheral IV catheter in the antecubital fossa
  2. 24-gauge peripheral IV catheter
  3. Midline catheter
  4. Implanted venous port Correct answer.

Explanation

Vesicants require a central catheter with its tip in the lower superior vena cava or cavoatrial junction so the drug is rapidly diluted and extravasation injury is avoided. For months of therapy an implanted port is a common choice because it is low-maintenance and has a low infection rate.

Question 32Vascular Access Device Selection, Insertion, and Care

A patient needs about two weeks of IV antibiotics, has poor peripheral veins, and has no indication for central access. Which device is most appropriate?

  1. Midline catheter Correct answer.
  2. Nontunneled central venous catheter
  3. Peripheral IV catheter replaced every 72 hours
  4. Implanted venous port

Explanation

A midline catheter is designed for peripheral therapy lasting roughly one to four weeks when the medications are nonvesicant and not hypertonic. It preserves the central veins and avoids the risks associated with central catheter insertion.

Question 33Vascular Access Device Selection, Insertion, and Care

On a chest radiograph obtained after central catheter insertion, where should the catheter tip be located?

  1. In the mid superior vena cava, approximately 4 cm above the carina
  2. In the proximal brachiocephalic vein on the side of insertion
  3. At the cavoatrial junction Correct answer.
  4. In the right atrium, just beyond the tricuspid valve

Explanation

The optimal tip position is the lower third of the superior vena cava at the cavoatrial junction, where blood flow is high and the risk of thrombosis and arrhythmia is lowest. Tip position must be confirmed before the catheter is used for infusion.

Question 34Vascular Access Device Selection, Insertion, and Care

Which combination constitutes maximal sterile barrier precautions for insertion of a central venous catheter?

  1. Clean gloves, a mask, and a small fenestrated drape with eye protection
  2. Cap, mask, and sterile gloves only
  3. Sterile gloves and a small fenestrated drape only
  4. Cap, mask, sterile gown, sterile gloves, and a full-body sterile drape Correct answer.

Explanation

Maximal sterile barrier precautions combine a cap, mask, sterile gown, sterile gloves, and a full-body sterile drape, and they lower central line-associated bloodstream infections when paired with appropriate skin antisepsis. A small fenestrated drape is adequate only for peripheral venipuncture.

Question 35Vascular Access Device Selection, Insertion, and Care

Which syringe size should be used to flush a PICC?

  1. 10 mL or larger Correct answer.
  2. 5 mL
  3. 3 mL
  4. 1 mL

Explanation

Flushing with a 10 mL or larger syringe generates less pressure per unit area and reduces the risk of catheter rupture, so small syringes are avoided for routine flushes. A push-pause technique with a 10 mL syringe is also used to clear fibrin and debris.

Question 36Vascular Access Device Selection, Insertion, and Care

What is the correct sequence for administering an intermittent medication through a central venous access device that will be locked with heparin?

  1. Saline, heparin, saline, administer
  2. Heparin, saline, administer, heparin
  3. Saline, administer, saline, heparin Correct answer.
  4. Administer, saline, heparin, saline

Explanation

The SASH sequence - saline flush, administer the medication, saline flush, heparin lock - keeps incompatible medications separated and confirms patency before and after administration. Heparin is instilled last so it remains in the lumen as the locking solution.

Question 37Vascular Access Device Selection, Insertion, and Care

A coagulation panel is to be drawn from a central venous access device. What should the nurse do before collecting the specimen?

  1. Flush the lumen with heparin and draw the sample immediately
  2. Stop the infusion, flush with saline, and discard the first 5 mL of blood Correct answer.
  3. Aspirate 1 mL and send it as the specimen
  4. Draw the sample from the side port while the maintenance infusion continues running

Explanation

Stopping the infusion, flushing with saline, and discarding a volume that exceeds the catheter dead space several times over (commonly about 5 mL in adults) removes infusate and diluted blood from the sample. Heparin must never be flushed into the lumen before a coagulation specimen is obtained.

Question 38Vascular Access Device Selection, Insertion, and Care

A central catheter lumen resists flushing and there are no signs of infection. Which action is appropriate after other causes have been assessed?

  1. Instill sodium bicarbonate and then flush forcefully with a 10 mL syringe
  2. Force-flush the lumen with a 3 mL syringe to clear the occlusion
  3. Stop and instill alteplase according to protocol Correct answer.
  4. Use a smaller syringe to increase pressure

Explanation

Persistent occlusion is treated by instilling a thrombolytic such as alteplase to dwell in the lumen, because forceful flushing can rupture the catheter or dislodge a clot. Mechanical causes, catheter damage, and drug precipitate should be considered before instillation.

Question 39Vascular Access Device Selection, Insertion, and Care

A patient with a peripheral IV has erythema, warmth, and tenderness extending along the vein for about 3 cm. What is the priority action?

  1. Discontinue the catheter and apply a warm compress Correct answer.
  2. Slow the infusion rate and reassess in 4 hours
  3. Flush the catheter with saline and continue the infusion
  4. Apply a cold compress and continue the infusion

Explanation

These findings represent phlebitis, which calls for prompt catheter removal and a warm compress, along with documentation and reassessment. Continuing to infuse through an inflamed vein worsens endothelial injury and may progress to thrombosis or infection.

Question 40Vascular Access Device Selection, Insertion, and Care

During infusion of a vesicant through a peripheral IV, the patient reports burning and the site is swollen. What should the nurse do first?

  1. Flush the catheter with 10 mL of saline
  2. Aspirate the vesicant through the catheter and then remove it promptly
  3. Remove the catheter immediately and apply heat
  4. Stop the infusion immediately and leave the catheter in place Correct answer.

Explanation

Extravasation management begins by stopping the infusion at once to limit the amount of vesicant that escapes into tissue while leaving the catheter in place so residual drug can be aspirated and any antidote instilled. Aspiration, antidote administration, and removal then proceed according to the specific agent's protocol.

Question 41Vascular Access Device Selection, Insertion, and Care

A patient becomes suddenly dyspneic and hypotensive during removal of a central venous catheter. Which position should the nurse place the patient in?

  1. Right lateral decubitus with the head flat
  2. Trendelenburg with left lateral decubitus Correct answer.
  3. High Fowler position
  4. Supine with the legs elevated

Explanation

These findings suggest air embolism, so the patient is placed in Trendelenburg with the left lateral decubitus position to trap air at the right ventricular apex away from the pulmonary outflow tract while 100% oxygen is administered. The catheter site is occluded and the patient is assessed for cardiovascular collapse.

Question 42Vascular Access Device Selection, Insertion, and Care

How often should a gauze dressing covering a central venous access device site be changed?

  1. Every 5 days
  2. Every 24 hours
  3. Every 7 days, or whenever the dressing is changed for another reason
  4. Every 2 days or sooner if damp, loose, or soiled Correct answer.

Explanation

Gauze dressings are changed every 2 days because they obscure the site and retain moisture, which promotes microbial growth. Any dressing that becomes damp, loose, or soiled is changed immediately regardless of the schedule.

Question 43Vascular Access Device Selection, Insertion, and Care

A PICC flushes without resistance but no blood return can be obtained. Which cause is most likely?

  1. Air embolism
  2. Fibrin sheath or tip against the vessel wall Correct answer.
  3. Phlebitis of the arm
  4. Catheter-related bloodstream infection with bacteremia

Explanation

Persistent withdrawal occlusion - easy flushing without blood return - usually reflects a fibrin sheath acting as a one-way valve or a tip lying against the vessel wall. Management includes repositioning the patient, having the patient cough or raise the arm, and instilling a thrombolytic if a fibrin sheath persists.

Question 44Vascular Access Device Selection, Insertion, and Care

An implanted port resists flushing, and the chest radiograph shows the catheter compressed between the clavicle and first rib. What is the appropriate action?

  1. Instill alteplase and resume use
  2. Flush the port forcefully with a 10 mL syringe to clear the kink
  3. Reposition the patient's arm, then resume infusions if blood return is obtained
  4. Stop using the port and notify the provider for evaluation of pinch-off syndrome Correct answer.

Explanation

Compression between the clavicle and first rib is pinch-off syndrome, which can progress to catheter fracture with embolization of a catheter fragment. The device must be taken out of use and referred for evaluation and possible removal or replacement.

Question 45Vascular Access Device Selection, Insertion, and Care

Which finding requires removal of a central venous catheter rather than salvage with antibiotic lock therapy?

  1. Fever with negative blood cultures
  2. Candidemia Correct answer.
  3. Uncomplicated exit-site infection
  4. Coagulase-negative staphylococcal bacteremia in a stable patient with a tunneled catheter

Explanation

Candidemia and infections caused by Staphylococcus aureus or Pseudomonas aeruginosa generally require catheter removal because biofilm-associated infection is rarely eradicated by lock therapy. Selected uncomplicated coagulase-negative staphylococcal infections in stable patients may sometimes be managed with lock therapy.

Question 46Vascular Access Device Selection, Insertion, and Care

A patient with a PICC develops swelling of the arm, hand, and neck on the catheter side. Which complication should the nurse suspect?

  1. Air embolism
  2. Superficial phlebitis tracking along the upper arm
  3. Catheter-related venous thrombosis Correct answer.
  4. Catheter fracture at the clavicle

Explanation

Unilateral arm, hand, or neck swelling on the side of a central catheter suggests venous thrombosis obstructing drainage. It is confirmed by ultrasound and managed with anticoagulation, with catheter removal considered if the device is no longer needed or fails.

Question 47Vascular Access Device Selection, Insertion, and Care

After right subclavian catheter insertion, a patient develops increasing dyspnea and tachycardia, with absent breath sounds and hyperresonance to percussion on the right. Which complication should the nurse suspect?

  1. Catheter fracture
  2. Hemothorax from subclavian artery puncture
  3. Air embolism
  4. Pneumothorax on the side of insertion Correct answer.

Explanation

Absent breath sounds with hyperresonance, dyspnea, and tachycardia after a subclavian or internal jugular attempt suggests pneumothorax from pleural puncture, confirmed by chest radiograph. Oxygen is applied and the provider notified immediately while the patient is monitored.

Question 48Vascular Access Device Selection, Insertion, and Care

An adult with intact circulation and no contraindications requires a peripheral IV catheter for a short course of IV antibiotics. Which site is the most appropriate choice for the initial cannulation?

  1. The saphenous vein at the ankle
  2. The arm that contains an arteriovenous fistula
  3. The dorsal venous network of the hand Correct answer.
  4. The antecubital fossa of the dominant arm

Explanation

Peripheral cannulation starts distally so that more proximal sites remain available if the catheter fails, and sites that cross a joint are avoided because flexion dislodges catheters and irritates the vein. Lower-extremity veins in adults carry a higher risk of phlebitis and thrombosis and are generally reserved for situations where no upper-extremity site exists. An arm with an arteriovenous fistula is permanently protected from cannulation.

Question 49Vascular Access Device Selection, Insertion, and Care

Which needle is required to access an implanted venous port?

  1. A butterfly needle with a plastic hub
  2. A standard introducer needle
  3. A beveled hypodermic needle
  4. A non-coring (Huber) needle Correct answer.

Explanation

The port septum is a self-sealing silicone dome that is damaged by repeated puncture with a sharp, coring needle, which can create a permanent leak. A Huber needle has a deflected, non-coring tip that slices the septum cleanly so it reseals after removal. Standard hypodermic and introducer needles are designed for other purposes and are not used on ports.

Question 50Vascular Access Device Selection, Insertion, and Care

A patient with end-stage kidney disease has a maturing arteriovenous fistula in the right forearm and needs a PICC for three weeks of IV antibiotics. Which insertion site is appropriate?

  1. The right basilic vein proximal to the fistula
  2. The right internal jugular vein on the same side
  3. The left basilic vein Correct answer.
  4. The right cephalic vein distal to the fistula

Explanation

The limb that holds a functioning or maturing dialysis fistula, and the limb on the side of a mastectomy with axillary lymph node dissection or lymphedema, is protected from venipuncture and catheter placement. Access is obtained in the opposite arm to preserve the fistula and avoid ischemic or infectious complications. Distal or proximal positions within the fistula arm do not make the limb safe for cannulation.