Mixed Deck — All VA-BC Topics Flashcards

Which IV solution is considered isotonic and most closely approximates the osmolarity of human blood (approximately 285–295 mOsm/L)?

Answer: 0.9% Normal Saline

0.9% Normal Saline has an osmolarity of approximately 308 mOsm/L, making it isotonic and safe for peripheral infusion.

In VA-BC practice, reliability in assessment refers to:

Answer: The consistency and reproducibility of results

Reliability refers to the consistency and reproducibility of assessment results when the test is repeated under similar conditions.

What is the most important factor in effective communication with patients regarding maintenance and care?

Answer: Using clear, understandable language and confirming understanding

Clear communication in understandable language, with confirmation of understanding, improves patient compliance and outcomes.

A 3-year-old requires a PICC line. The nurse measures from the insertion site to which landmark to estimate catheter tip position?

Answer: Manubriosternal junction (angle of Louis)

The manubriosternal junction (angle of Louis) is used as the external landmark to estimate the catheter tip position at the cavoatrial junction in pediatric PICC placement.

A patient with a PICC in the right arm asks about restrictions. Which instruction is correct?

Answer: Avoid blood pressure cuffs and heavy lifting with the PICC arm, but normal daily activity is encouraged

Patients should avoid BP measurements, tourniquets, and heavy lifting or repetitive strenuous activity on the PICC arm while maintaining normal mobility.

Which vein characteristic found on ultrasound assessment would MOST indicate suitability for PICC insertion?

Answer: Vein is compressible, anechoic, and measures at least 4 mm in diameter

A compressible, anechoic (fluid-filled) vein of at least 4 mm diameter is considered ideal for PICC insertion via ultrasound guidance.

Which action BEST demonstrates the ethical principle of veracity in vascular access nursing?

Answer: Accurately informing the patient of all known risks, benefits, and alternatives before the procedure

Veracity requires truthfulness, meaning the nurse must fully and honestly disclose procedure-related information to the patient.

Which entity defines the legal scope of practice for a registered nurse inserting midline catheters?

Answer: The state Nurse Practice Act and board of nursing

Scope of practice is defined by each state's Nurse Practice Act and board of nursing; professional standards inform but do not grant legal authority.

In an electronic health record, a nurse leaves the workstation logged in and another clinician charts under her credentials. Which principle was violated?

Answer: Individual accountability and security of electronic signatures

Electronic signatures and logins are personal; sharing or leaving them accessible compromises authorship authenticity and record integrity.

What is an air embolism?

Answer: Air in bloodstream

An air embolism occurs when air enters the bloodstream, typically through an open central venous catheter lumen or during insertion/removal. This can lead to serious and potentially life-threatening complications as the air bubble travels to the heart and lungs, obstructing blood flow and oxygen exchange.

The catheter-to-vein ratio for PICC placement, assessed via ultrasound, should ideally not exceed:

Answer: 33%

A catheter-to-vein ratio of ≤33% is recommended to minimize thrombosis risk by allowing adequate blood flow around the catheter.

A nurse is assessing a patient for a peripherally inserted central catheter. The patient's BMI is 42. Which assessment finding is MOST relevant to site selection?

Answer: Presence of subcutaneous tissue obscuring veins

Obesity increases subcutaneous tissue depth, making veins difficult to palpate and visualize, often necessitating ultrasound guidance.

When an IV infusate is changed from a hyperosmolar solution to a standard isotonic solution via a PICC, what must be documented?

Answer: Previous infusate, new infusate, rate change if applicable, flush performed between infusates, and time of change

Documenting the transition between infusates—including any flush performed—ensures the record reflects actual therapy delivered and supports accurate medication reconciliation.

Which patient factor MOST increases the risk of catheter-related bloodstream infection (CRBSI) and should be documented during assessment?

Answer: Immunocompromised status (e.g., neutropenia, HIV)

Immunocompromised patients have impaired defenses against pathogens, significantly elevating their risk for CRBSI.

What is the primary function of venous valves?

Answer: Prevent retrograde blood flow

Venous valves are bicuspid structures that prevent retrograde (backward) flow of blood, aiding venous return against gravity.

Which of the following best describes a 'power-injectable' PICC?

Answer: A PICC rated to withstand contrast injection at up to 300 psi

Power-injectable PICCs are constructed to tolerate high-pressure contrast media injection (typically up to 300 psi) required for CT imaging.

To prevent bacterial proliferation, a unit of packed red blood cells (PRBCs) must be infused within what maximum time frame from initiation?

Answer: 4 hours

Blood products must be infused within 4 hours of initiation per AABB and INS standards to prevent bacterial growth at room temperature.

Which practice is recommended to reduce the risk of CLABSI according to the central line maintenance bundle?

Answer: Daily review of catheter necessity and prompt removal when no longer needed

Daily assessment and prompt removal when the CVC is no longer clinically necessary is a core component of the CLABSI prevention maintenance bundle.

Where should baseline upper-arm circumference be measured before PICC insertion?

Answer: 10 cm above the antecubital fossa

Measuring 10 cm above the antecubital fossa gives a consistent reference for detecting edema or DVT later.

Povidone-iodine is used for skin antisepsis because a patient cannot use chlorhexidine. How long should it be left to dry before puncture?

Answer: At least 1.5 to 2 minutes

Povidone-iodine has to stay on the skin and dry fully, at least 1.5 to 2 minutes, to work as an antiseptic.