VA-BC Patient Assessment 2 — Questions and Answers
Question 1: When assessing a patient's arm for peripheral IV placement, which finding would be MOST concerning and warrant selecting an alternate site?
- Visible antecubital vein
- Edematous extremity on the affected side post-mastectomy (Correct answer)
- Slight hair on the forearm
- Warm skin temperature
Correct 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.
Question 2: A patient reports a history of 'difficult veins' and multiple failed IV attempts. Which assessment technique is BEST to perform first?
- Immediately request ultrasound-guided placement
- Apply a tourniquet and assess veins after 60 seconds of dependency
- Review prior access documentation and ask about past successful sites (Correct answer)
- Begin with a 22-gauge needle in the hand
Correct 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.
Question 3: Which lab value should be reviewed BEFORE placing a central venous catheter to assess bleeding risk?
- Serum potassium
- International Normalized Ratio (INR) (Correct answer)
- Blood urea nitrogen (BUN)
- Serum albumin
Correct answer: International Normalized Ratio (INR)
INR reflects coagulation status; elevated INR indicates coagulopathy and increases procedural bleeding risk.
Question 4: 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?
- Place the PICC in the fistula arm distally
- Use the fistula arm only if veins are more prominent
- Select the contralateral arm for PICC placement (Correct answer)
- Proceed with placement above the fistula site
Correct 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.
Question 5: 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?
- Patient's blood pressure
- Visibility of veins without tourniquet
- Presence of subcutaneous tissue obscuring veins (Correct answer)
- Patient's oxygen saturation
Correct answer: Presence of subcutaneous tissue obscuring veins
Obesity increases subcutaneous tissue depth, making veins difficult to palpate and visualize, often necessitating ultrasound guidance.
Question 6: 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?
- Short peripheral IV catheter
- Midline catheter
- Central venous catheter (Correct answer)
- Arterial line
Correct 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.
Question 7: 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?
- Left cephalic vein due to longer path to the SVC
- Right basilic vein due to larger diameter (Correct answer)
- Either vein; size does not matter for PICC
- Neither; veins must be at least 5 mm for PICC
Correct 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.
VA-BC Patient Assessment 2
When assessing a patient's arm for peripheral IV placement, which finding would be MOST concerning and warrant selecting an alternate site?