VA-BC Patient Assessment 4 — Questions and Answers
Question 1: A patient presents with a port-a-cath that has not been accessed in 8 months. Prior to drawing blood from the port, the nurse should FIRST:
- Access the port and immediately withdraw 10 mL of blood for labs
- Assess port patency by injecting 10 mL normal saline and feeling for resistance (Correct answer)
- Obtain a chest X-ray to verify tip position before any use
- Flush with heparin and leave for 30 minutes before withdrawing blood
Correct answer: Assess port patency by injecting 10 mL normal saline and feeling for resistance
Assessing for patency by evaluating resistance to flush with normal saline determines whether the port and catheter are functional before blood withdrawal.
Question 2: When assessing a patient for appropriateness of a midline catheter, which therapy would be a contraindication for midline use?
- IV antibiotics for 10 days
- Continuous vesicant chemotherapy infusion (Correct answer)
- Normal saline hydration for 5 days
- Intermittent analgesic infusion
Correct answer: Continuous vesicant chemotherapy infusion
Vesicant chemotherapy must be administered through a central venous catheter because extravasation from a midline can cause severe tissue necrosis.
Question 3: A nurse assesses a patient's arm after peripheral IV insertion and notes the infusion is flowing by gravity but the site is cool, pale, and slightly swollen. This presentation is MOST consistent with:
- Phlebitis
- Infiltration (Correct answer)
- Occlusion
- Infection
Correct answer: Infiltration
Coolness, pallor, and swelling at the IV site indicate infiltration, where fluid is leaking into the surrounding subcutaneous tissue rather than the vein.
Question 4: Which assessment finding in a patient with a femoral central venous catheter would prompt the nurse to immediately notify the physician?
- A transparent dressing that is intact and dated
- Hematoma formation and expanding bruising at the groin insertion site (Correct answer)
- Patient ambulating with catheter in place
- Blood return confirmed with aspiration
Correct answer: Hematoma formation and expanding bruising at the groin insertion site
Expanding hematoma at a femoral CVC site suggests vascular injury or inadequate hemostasis and requires urgent physician notification.
Question 5: When assessing a patient's PICC for a blood draw, the nurse aspirates and obtains no blood return. Which intervention should be attempted FIRST?
- Forcefully flush with 20 mL normal saline
- Reposition the patient's arm and have them take a deep breath, then reattempt (Correct answer)
- Immediately request a catheter exchange
- Declare the catheter non-functional and discontinue it
Correct answer: Reposition the patient's arm and have them take a deep breath, then reattempt
Repositioning the arm and changing intrathoracic pressure can relieve tip malposition against the vessel wall, restoring blood return.
Question 6: A nurse is assessing a patient for vascular access device selection. The patient needs IV therapy for an expected 3 weeks and has a documented latex allergy. Which consideration is MOST important during device assessment?
- Select only glass IV bottles
- Verify all components of the vascular access system are latex-free (Correct answer)
- Administer antihistamines prophylactically prior to insertion
- Use a smaller gauge catheter to minimize contact reactions
Correct answer: Verify all components of the vascular access system are latex-free
All IV equipment, including tubing, injection caps, and gloves, must be confirmed latex-free to prevent allergic reaction in patients with latex allergy.
Question 7: During assessment of a patient with a subclavian central line, the nurse notes the patient's oxygen saturation has dropped to 89% and he is complaining of sudden chest pain and shortness of breath following the recent line insertion. The nurse should FIRST suspect:
- Catheter occlusion
- Pneumothorax (Correct answer)
- Air embolism from tubing disconnect
- Cardiac arrhythmia from catheter tip movement
Correct answer: Pneumothorax
Sudden respiratory distress and chest pain following subclavian CVC insertion are classic signs of pneumothorax, a known complication of subclavian access.
VA-BC Patient Assessment 4
A patient presents with a port-a-cath that has not been accessed in 8 months.
Prior to drawing blood from the port, the nurse should FIRST: