VA-BC Patient Assessment 5 — Questions and Answers
Question 1: A nurse is assessing a patient who will receive long-term home IV therapy. Which factor is MOST important to assess when selecting a vascular access device for discharge planning?
- Patient's insurance coverage for device type
- Patient's and caregiver's ability to manage and maintain the device (Correct answer)
- Proximity of the patient's home to the hospital
- Patient's preference for the smallest possible device
Correct answer: Patient's and caregiver's ability to manage and maintain the device
The patient's and caregiver's ability to safely manage the device at home is the primary safety consideration for device selection in home infusion therapy.
Question 2: Which vein characteristic found on ultrasound assessment would MOST indicate suitability for PICC insertion?
- Vein collapses completely with light probe pressure
- Vein is compressible, anechoic, and measures at least 4 mm in diameter (Correct answer)
- Vein shows increased echogenicity (bright appearance)
- Vein is located within 1 cm of the brachial artery
Correct 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.
Question 3: A patient's medical history documents prior radiation therapy to the right chest and axilla. How should this information influence vascular access assessment?
- Radiation has no impact on vascular access decisions
- Avoid the right upper extremity and right-sided central access due to fibrosis and poor healing (Correct answer)
- Radiation improves vein visibility and makes placement easier
- Place the central line on the right to stay away from the heart
Correct answer: Avoid the right upper extremity and right-sided central access due to fibrosis and poor healing
Prior radiation causes tissue fibrosis, vascular damage, and impaired healing, making the radiated area unsuitable for vascular access.
Question 4: During assessment of a pediatric patient requiring IV access, the nurse notes the child is highly anxious and crying. Which action should the nurse prioritize BEFORE attempting IV insertion?
- Restrain the child immediately to ensure safety during insertion
- Use age-appropriate distraction techniques and allow a parent to be present (Correct answer)
- Administer oral sedation without waiting for parent consent
- Proceed quickly to minimize time the child is upset
Correct answer: Use age-appropriate distraction techniques and allow a parent to be present
Child life techniques such as distraction and parental presence reduce procedure-related anxiety and improve cooperation and safety during venipuncture.
Question 5: A nurse assesses an elderly patient's veins and notes they are visible but roll when touched and the skin is extremely fragile. Which technique modification is MOST appropriate?
- Apply tourniquet tighter to stabilize veins
- Use a smaller gauge needle, anchor the vein with traction, and avoid excessive tourniquet pressure (Correct answer)
- Skip the tourniquet entirely and rely on vein visualization
- Select a larger gauge to complete the procedure faster
Correct answer: Use a smaller gauge needle, anchor the vein with traction, and avoid excessive tourniquet pressure
In elderly patients, stabilizing rolling veins with traction and using a small gauge with minimal tourniquet pressure reduces vessel trauma and skin tearing.
Question 6: When assessing catheter function in a patient with an implanted port, the nurse notes resistance when flushing and inability to withdraw blood. After repositioning fails, the next appropriate step is to:
- Force flush to clear the occlusion
- Administer a fibrinolytic agent per protocol and reassess patency (Correct answer)
- Remove the port immediately
- Document and continue using for medication administration only
Correct answer: Administer a fibrinolytic agent per protocol and reassess patency
When repositioning does not restore patency, a fibrinolytic agent such as alteplase is indicated per protocol to clear a suspected thrombus.
Question 7: Which assessment finding in a patient with a long-term tunneled catheter should prompt the nurse to withhold use of the device and notify the provider IMMEDIATELY?
- Patient reports mild discomfort during flushing
- Visible purulent drainage and fever of 39.2°C (102.6°F) (Correct answer)
- Dressing due for routine change today
- Slightly prolonged blood return time compared to last week
Correct answer: Visible purulent drainage and fever of 39.2°C (102.6°F)
Purulent drainage at the catheter site combined with fever are signs of catheter-related infection requiring urgent provider notification and possible catheter removal.
VA-BC Patient Assessment 5
A nurse is assessing a patient who will receive long-term home IV therapy.
Which factor is MOST important to assess when selecting a vascular access device for discharge planning?