VA-BC Pediatric Access 3 — Questions and Answers
Question 1: A child with a PICC line develops fever, chills, and hypotension 48 hours after insertion. The FIRST priority nursing action is:
- Remove the PICC line immediately
- Obtain blood cultures from the PICC and a peripheral site before antibiotics (Correct answer)
- Administer broad-spectrum antibiotics through the PICC
- Apply warm compresses to the insertion site
Correct answer: Obtain blood cultures from the PICC and a peripheral site before antibiotics
Blood cultures should be drawn from both the PICC and a peripheral site before starting antibiotics to properly identify a catheter-related bloodstream infection (CRBSI).
Question 2: Which pH range is considered SAFE for peripheral IV administration in pediatric patients to minimize risk of phlebitis?
- 3.0–5.0
- 5.0–9.0 (Correct answer)
- 9.0–11.0
- 2.0–4.0
Correct answer: 5.0–9.0
Solutions with a pH of 5.0–9.0 are considered safe for peripheral infusion, as extremes of pH cause chemical irritation and phlebitis of the vessel wall.
Question 3: When using a transilluminator device to locate veins in a premature infant, the nurse should be aware of which RISK?
- Electromagnetic interference with monitoring equipment
- Thermal injury to fragile neonatal skin from prolonged light exposure (Correct answer)
- Dye absorption through immature skin
- Increased infection risk from device contact
Correct answer: Thermal injury to fragile neonatal skin from prolonged light exposure
Prolonged transilluminator contact with fragile premature skin can cause thermal burns, so the device must be moved continuously and contact time minimized.
Question 4: A 10-year-old child has a tunneled central venous catheter for long-term chemotherapy. The nurse notes the catheter has migrated 2 cm externally. The BEST action is:
- Advance the catheter back to original position and secure
- Flush the catheter and continue use as positional change is expected
- Do not reposition; notify the provider and obtain a chest X-ray to verify tip position (Correct answer)
- Remove the catheter and place a new one
Correct answer: Do not reposition; notify the provider and obtain a chest X-ray to verify tip position
A migrated catheter should never be advanced back in; the provider must be notified and tip position verified radiologically before resuming use.
Question 5: In pediatric patients, which condition MOST increases the risk of catheter-associated thrombosis in a central venous catheter?
- Type 1 diabetes mellitus
- Congenital heart disease with polycythemia (Correct answer)
- Mild dehydration
- Seasonal allergies
Correct answer: Congenital heart disease with polycythemia
Polycythemia in congenital heart disease increases blood viscosity, significantly raising the risk of thrombosis around central venous catheters.
Question 6: Which dressing change interval is recommended by INS standards for a PICC site covered with a transparent semipermeable membrane (TSM) dressing in a pediatric patient?
- Every 24 hours
- Every 48 hours
- Every 5–7 days or when soiled/lifting (Correct answer)
- Every 14 days
Correct answer: Every 5–7 days or when soiled/lifting
INS standards recommend changing TSM dressings every 5–7 days or immediately when the dressing is soiled, wet, or no longer intact.
Question 7: A nurse is preparing to insert a peripheral IV in a toddler who is extremely anxious. Which non-pharmacologic distraction technique is MOST evidence-based for this age group?
- Showing the child a detailed video of the procedure beforehand
- Using a buzzy device (vibration + cold) at the site during insertion (Correct answer)
- Telling the child to count to 100
- Having the parent leave the room to reduce stimulation
Correct answer: Using a buzzy device (vibration + cold) at the site during insertion
A Buzzy device combines cold and vibration using gate-control theory to reduce pain perception and is well-supported by evidence for toddlers during IV insertion.
VA-BC Pediatric Access 3
A child with a PICC line develops fever, chills, and hypotension 48 hours after insertion.
The FIRST priority nursing action is: