VABC Patient Assessment & Evaluation 5

Question 1

A patient on warfarin with an INR of 3.8 requires urgent central venous access. Which assessment information is MOST critical when selecting the insertion site?

Accepted Answer

The insertion site's compressibility in case of arterial puncture

Answer

In anticoagulated patients, choosing a compressible site (subclavian is non-compressible) is critical to allow hemostasis in case of inadvertent arterial puncture.

Question 2

During a vascular access assessment, the nurse notes that a patient receiving peripheral parenteral nutrition (PPN) has a VAS (Visual Analog Scale) pain rating of 4/10 at the IV site. What is the PRIORITY assessment?

Accepted Answer

Inspect and palpate the IV site for signs of infiltration or phlebitis

Answer

Pain at a PPN infusion site warrants immediate site inspection and palpation to rule out infiltration or phlebitis before any other intervention.

Question 3

A patient with a history of superior vena cava (SVC) syndrome is referred for long-term venous access. Which assessment finding would most directly influence the access strategy?

Accepted Answer

Degree of SVC stenosis or occlusion and availability of alternative venous pathways

Answer

The degree of SVC obstruction determines whether standard PICC or CVC placement is feasible or if alternative routes such as femoral access must be considered.

Question 4

When assessing a patient for a midline catheter versus a PICC, which clinical factor most clearly favors a PICC over a midline?

Accepted Answer

Need for infusion of a vesicant chemotherapy agent

Answer

Vesicant chemotherapy requires central venous tip placement to ensure adequate hemodilution, making a PICC necessary over a midline catheter.

Question 5

A patient's nursing history reveals previous bilateral subclavian vein thromboses. Which vascular access assessment finding is MOST important to obtain before selecting an alternative central access route?

Accepted Answer

Patency of jugular, femoral, or translumbar venous alternatives via imaging review

Answer

Bilateral subclavian thromboses eliminate those routes; venous mapping of remaining patent vessels is essential before selecting an alternative central access site.

(VABC) Vascular Access Board Certification Practice Test

(VABC) Vascular Access Board Certification Practice Test

VABC Patient Assessment & Evaluation 5