CRNI CRNI Central Venous Access Devices Practice Test 4 — Questions and Answers
Question 1: A patient with a newly placed PICC line develops upper extremity swelling and pain 48 hours post-insertion. Which complication should the nurse suspect first?
- Catheter-associated deep vein thrombosis (Correct answer)
- Catheter tip malposition
- Air embolism
- Catheter occlusion
Correct answer: Catheter-associated deep vein thrombosis
Upper extremity swelling and pain after PICC insertion are classic signs of catheter-associated deep vein thrombosis (CADVT), which is a known complication of PICC lines.
Question 2: When performing a blood draw from a central venous access device, how much blood should be discarded before obtaining the sample?
- 1–2 mL
- 3–5 mL (Correct answer)
- 10–15 mL
- No discard is needed
Correct answer: 3–5 mL
Current INS standards recommend discarding 3–5 mL of blood (or the dead-space volume plus 1 mL) before obtaining a blood sample from a CVAD to avoid dilution or contamination.
Question 3: A nurse is assessing a tunneled CVC and notes the cuff is visible outside the skin. What is the most appropriate action?
- Reposition the cuff manually under the skin
- Notify the provider, as the catheter may be migrating out (Correct answer)
- Apply a sterile dressing over the exposed cuff
- Continue routine care; this is expected
Correct answer: Notify the provider, as the catheter may be migrating out
An externalized cuff indicates the tunneled catheter is migrating out of its tunnel, which requires provider notification and evaluation for possible replacement.
Question 4: Which gauge needle is recommended for accessing an implanted port to minimize damage to the port septum?
- 18-gauge straight needle
- 20-gauge angiocatheter
- Non-coring (Huber) needle (Correct answer)
- Butterfly needle of any gauge
Correct answer: Non-coring (Huber) needle
A non-coring (Huber) needle must be used to access an implanted port because its angled bevel cuts through the septum without removing a core of silicone material.
Question 5: A patient receiving TPN through a CVAD develops sudden fever, chills, and hypotension. Blood cultures are drawn. While waiting for results, which intervention is the highest priority?
- Remove the CVAD immediately
- Administer empiric broad-spectrum antibiotics per protocol (Correct answer)
- Increase the TPN infusion rate
- Apply warm compresses to the insertion site
Correct answer: Administer empiric broad-spectrum antibiotics per protocol
Suspected CLABSI with hemodynamic instability requires prompt empiric antibiotic therapy while awaiting culture results, as delayed treatment increases mortality.
Question 6: What is the primary advantage of a valved CVAD (e.g., PASV or Groshong) over an open-ended catheter?
- Lower infection rate
- Eliminates the need for heparin flushing (Correct answer)
- Allows higher flow rates
- Requires less frequent dressing changes
Correct answer: Eliminates the need for heparin flushing
Valved catheters have internal pressure-sensitive valves that prevent backflow of blood, eliminating or reducing the need for heparin flushes compared to open-ended catheters.
Question 7: Which finding during a central line dressing change requires immediate nursing intervention?
- Clear, intact skin under the dressing
- Transparent dressing with condensation inside
- Purulent drainage at the catheter exit site (Correct answer)
- Slight redness that resolves with dressing removal
Correct answer: Purulent drainage at the catheter exit site
Purulent drainage at the catheter exit site is a sign of local infection and requires immediate intervention including provider notification and possible catheter removal.
CRNI CRNI Central Venous Access Devices Practice Test 4
A patient with a newly placed PICC line develops upper extremity swelling and pain 48 hours post-insertion.
Which complication should the nurse suspect first?