Patient Assessment Flashcards

When assessing a patient's arm for peripheral IV placement, which finding would be MOST concerning and warrant selecting an alternate site?

Answer: Edematous extremity on the affected side post-mastectomy

An edematous extremity on the post-mastectomy side is contraindicated for IV placement due to impaired lymphatic drainage and risk of lymphedema exacerbation.

A patient reports a history of 'difficult veins' and multiple failed IV attempts. Which assessment technique is BEST to perform first?

Answer: Review prior access documentation and ask about past successful sites

Reviewing prior documentation and asking the patient about previously successful sites guides site selection and reduces unnecessary attempts.

Which lab value should be reviewed BEFORE placing a central venous catheter to assess bleeding risk?

Answer: International Normalized Ratio (INR)

INR reflects coagulation status; elevated INR indicates coagulopathy and increases procedural bleeding risk.

During a pre-procedure assessment for PICC placement, the nurse notes the patient's dominant arm has an arteriovenous fistula for dialysis. What is the correct action?

Answer: Select the contralateral arm for PICC placement

The contralateral (opposite) arm must be used to protect the AV fistula from damage or thrombosis that could compromise dialysis access.

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 assessing catheter need, a patient is ordered total parenteral nutrition (TPN) with a final osmolarity of 1,200 mOsm/L. Which access type is indicated?

Answer: Central venous catheter

Solutions with osmolarity greater than 900 mOsm/L must be administered through a central venous catheter to prevent peripheral vein damage.

A patient scheduled for PICC insertion has a bilateral upper extremity assessment. The right basilic vein measures 4 mm on ultrasound and the left cephalic vein measures 3 mm. Which is the preferred site?

Answer: Right basilic vein due to larger diameter

The basilic vein is preferred over the cephalic due to its larger diameter, straighter path, and lower risk of malposition or catheter compression.