VA-BC Pediatric Access 2 — Questions and Answers
Question 1: When assessing a neonate for peripheral IV placement, which vein is considered the LAST resort due to risk of tissue necrosis?
- Antecubital fossa vein
- Scalp vein
- Dorsal foot vein
- Femoral vein (Correct answer)
Correct answer: Femoral vein
The femoral vein is a last-resort site in neonates because extravasation in this area can cause severe tissue necrosis and limb-threatening complications.
Question 2: A 3-year-old requires a PICC line. The nurse measures from the insertion site to which landmark to estimate catheter tip position?
- Xiphoid process
- Right sternoclavicular joint
- Manubriosternal junction (angle of Louis) (Correct answer)
- Midclavicular line at the 3rd rib
Correct answer: Manubriosternal junction (angle of Louis)
The manubriosternal junction (angle of Louis) is used as the external landmark to estimate the catheter tip position at the cavoatrial junction in pediatric PICC placement.
Question 3: Which gauge peripheral IV catheter is most appropriate for a stable 6-month-old infant requiring maintenance fluids?
- 18 gauge
- 20 gauge
- 24 gauge (Correct answer)
- 16 gauge
Correct answer: 24 gauge
A 24-gauge catheter is the most appropriate size for infants, as it fits the small caliber of infant veins while minimizing trauma.
Question 4: In a pediatric patient, the MOST reliable indicator of IV infiltration is:
- Elevated blood pressure at the site
- Slowed infusion rate on the pump alarm
- Swelling, pallor, and coolness at the insertion site (Correct answer)
- Patient complaint of burning sensation alone
Correct answer: Swelling, pallor, and coolness at the insertion site
Swelling, pallor, and coolness are the most reliable clinical signs of infiltration because they reflect fluid accumulation in surrounding tissue.
Question 5: An intraosseous (IO) needle is placed in a 2-year-old during cardiac arrest. Which is the preferred primary site?
- Distal femur
- Proximal tibia (Correct answer)
- Humeral head
- Iliac crest
Correct answer: Proximal tibia
The proximal tibia is the preferred primary IO site in children because it has a large, flat surface that is easy to palpate and access during resuscitation.
Question 6: Which topical anesthetic agent has a maximum safe application time of 60 minutes for pediatric IV insertion preparation?
- EMLA cream (lidocaine/prilocaine)
- LMX4 (4% lidocaine) (Correct answer)
- Ethyl chloride spray
- Benzocaine gel
Correct answer: LMX4 (4% lidocaine)
LMX4 (4% liposomal lidocaine) achieves adequate analgesia in 30 minutes and has a maximum recommended application time of 60 minutes.
Question 7: When calculating the maximum safe dose of normal saline flush for a 4 kg neonate, the nurse should use which principle?
- Use adult standard 10 mL flush protocol
- Weight-based dosing, typically 1-3 mL per flush (Correct answer)
- Use 5 mL regardless of weight
- Flush volume equals twice the catheter dead space only
Correct answer: Weight-based dosing, typically 1-3 mL per flush
Neonates require weight-based flush volumes (typically 1-3 mL) to prevent fluid overload, as their circulating volumes are very small.
VA-BC Pediatric Access 2
When assessing a neonate for peripheral IV placement, which vein is considered the LAST resort due to risk of tissue necrosis?