VA-BC Infection Prevention & Complication Management 3 — Questions and Answers
Question 1: A patient reports pain, swelling, and a palpable cord along the arm where a peripheral IV was inserted 3 days ago. This presentation is MOST consistent with:
- Catheter-related deep vein thrombosis
- Superficial thrombophlebitis (Correct answer)
- Hematoma formation
- Phlebitis grade 1
Correct answer: Superficial thrombophlebitis
Pain, edema, erythema, and a palpable cord along the vein tract are classic signs of superficial thrombophlebitis associated with peripheral IV catheters.
Question 2: Which of the following BEST describes the Phlebitis Scale score of 3?
- Pain at access site with no erythema
- Pain with erythema and/or edema
- Pain with erythema, streak formation, and palpable cord ≤1 inch (Correct answer)
- Pain with erythema, streak formation, palpable cord >1 inch, and purulent drainage
Correct answer: Pain with erythema, streak formation, and palpable cord ≤1 inch
A phlebitis scale score of 3 includes pain, erythema, streak formation, and a palpable cord up to 1 inch in length, indicating moderate-to-severe phlebitis.
Question 3: When using antimicrobial-impregnated catheters, which situation MOST justifies their use according to CDC guidelines?
- All adult patients requiring central venous access
- ICU patients in facilities with CLABSI rates above the institutional goal despite bundle compliance (Correct answer)
- Pediatric patients with immunodeficiency
- Any patient requiring catheterization for more than 24 hours
Correct answer: ICU patients in facilities with CLABSI rates above the institutional goal despite bundle compliance
CDC guidelines support antimicrobial-impregnated catheters for adult patients in units where CLABSI rates remain elevated despite adherence to standard prevention bundles.
Question 4: A nurse suspects air embolism in a patient with a central venous catheter. What is the PRIORITY nursing intervention?
- Clamp the catheter and place patient in Trendelenburg position on the left side (Correct answer)
- Remove the catheter immediately and apply pressure
- Administer 100% oxygen via non-rebreather mask without repositioning
- Obtain an ECG and call a rapid response
Correct answer: Clamp the catheter and place patient in Trendelenburg position on the left side
Clamping the catheter stops air entry; left lateral Trendelenburg (Durant's maneuver) traps air in the right ventricle apex, preventing pulmonary outflow obstruction.
Question 5: Which of the following is the MOST appropriate management for a catheter-associated thrombosis confirmed by ultrasound in a patient who still requires venous access?
- Immediately remove the catheter and initiate anticoagulation
- Continue using the catheter and initiate anticoagulation therapy (Correct answer)
- Flush the catheter aggressively with normal saline and monitor
- Replace the catheter at the same site after thrombus resolution
Correct answer: Continue using the catheter and initiate anticoagulation therapy
Current guidelines support anticoagulation with catheter preservation when the device is still needed and functioning, provided there are no contraindications to anticoagulation.
Question 6: A patient receiving parenteral nutrition through a PICC develops a fever of 38.5°C with chills. Blood cultures are ordered. What is the CORRECT sampling method for diagnosing CRBSI?
- One culture from the central line only
- Two peripheral cultures from different sites
- One culture drawn through the line and one peripheral culture from a separate site (Correct answer)
- Three cultures: two peripheral and one from the line
Correct answer: One culture drawn through the line and one peripheral culture from a separate site
Paired blood cultures—one drawn through the catheter and one from a peripheral vein—allow differential time-to-positivity analysis to diagnose CRBSI.
Question 7: Which of the following dressing types is PREFERRED for central venous catheter insertion sites in adult patients without skin sensitivity?
- Dry gauze changed every 24 hours
- Transparent semipermeable membrane (TSM) dressing changed every 7 days (Correct answer)
- Hydrocolloid dressing changed every 3 days
- Non-adherent foam dressing changed every 48 hours
Correct answer: Transparent semipermeable membrane (TSM) dressing changed every 7 days
TSM dressings allow continuous site visualization without disruption and are recommended for routine use with a change interval of up to 7 days or immediately when soiled or loosened.
VA-BC Infection Prevention & Complication Management 3
A patient reports pain, swelling, and a palpable cord along the arm where a peripheral IV was inserted 3 days ago.
This presentation is MOST consistent with: