Caring for Central Vascular Access Devices (CVAD) –
EXAM Questions With Correct Answers
The |nurse |is |unable |to |aspirate |a |blood |return |from |the |distal |port |of |a |triple-lumen |CVAD |and
|suspects |an |occlusion. |What |should |the |nurse |do |first?
1. |Reposition |the |patient |and |have |her |raise |her |hand |above |her |head; |reattempt.
2. |Use |a |smaller |syringe |and |attempt |again.
3. |Insert |a |10-mL |syringe |of |preservative-free |sterile |normal |saline |and |attempt |to |flush |and |
aspirate |rapidly |and |repeatedly.
4. |Attach |a |label |to |the |port |indicating |it |is |occluded, |and |use |a |different |port |of |the |triple- |
lumen |CVAD.
1
(The |nurse |should |first |reposition |the |patient, |have |her |take |a |deep |breath |and |cough, |and/or |
have |her |raise |her |hand |above |her |head |then |reattempt. |A |syringe |smaller |than |10 |mL |should |
not |be |used |because |this |could |damage |the |catheter |as |a |result |of |the |high |psi. |Rapidly |and |
repeatedly |flushing |and |aspirating |could |cause |dislodgment |of |a |thrombus. |The |nurse |should |
first |attempt |measures |to |improve |patency |of |the |port |before |determining |it |is |no |longer |able |
to |be |used. |The |health |care |provider |may |order |an |antithrombolytic |if |these |measures |are |
unsuccessful.)
A |patient |has |been |receiving |chemotherapy |via |a |percutaneous |CVAD |located |in |the |right |
subclavian |vein. |The |patient |is |complaining |of |pain |and |burning |at |the |insertion |site |of |the |
CVAD. |The |nurse |notes |erythema, |edema, |and |a |spongy |feeling |around |the |patient’s |right |
upper |chest |and |neck |area. |Which |actions |would |be |appropriate |for |the |nurse |to |take |at |this |
time? |(Select |all |that |apply.)
1. |Prepare |to |obtain |electrocardiogram.
2. |Stop |chemotherapy |administration.
3. |Administer |antidote |per |protocol.
4. |Provide |emotional |support.
5. |Turn |patient |onto |left |side |with |head |down.
2,3,4
, (The |patient |is |demonstrating |symptoms |of |extravasation. |Appropriate |actions |of |the |nurse |
include |immediately |stopping |the |vesicant |administration, |administering |the |appropriate |
antidote |per |protocol, |and |applying |cold/warm |compresses |according |to |specific |vesicant |
protocol. |An |electrocardiogram |would |be |in |order |if |the |CVAD |is |placed |incorrectly, |resulting |in
|cardiac |dysrhythmias. |Turning |the |patient |onto |the |left |side |with |head |down |would |be |
appropriate |if |an |air |embolism |was |suspected, |not |for |extravasation.)
The |nurse |is |reviewing |the |sequence |for |performing |a |dressing |change |on |a |vascular |access |
device. |Which |statement, |by |the |nurse, |indicates |further |instruction |is |needed?
1. |"I |will |wear |clean |gloves |to |remove |the |previous |dressing, |and |I |will |remove |it |in |the |
direction |the |catheter |was |inserted."
2. |"I |should |avoid |touching |the |Dacron |cuff |in |a |subcutaneous |tunnel |because |this |may |cause |
dislodgement."
3. |"I |will |wear |sterile |gloves |to |clean |and |apply |the |new |dressing."
4. |"I |should |allow |the |antiseptic |to |dry |completely |before |applying |the |transparent |dressing."
2
(The |nurse |should |palpate |the |Dacron |cuff |in |the |subcutaneous |tunnel |to |determine |if |it |is |
stable |and |in |the |anticipated |location |and |that |there |are |no |signs |of |infection |such |as |
tenderness |or |warmth |at |the |site.)
The |nurse |is |preparing |to |administer |continuous |fluids |through |a |central |venous |catheter, |
leaving |the |injection |caps |in |place. |Which |step |in |the |procedure |requires |correction?
1. |Perform |hand |hygiene; |apply |gloves |and |mask(s). |Prepare |a |syringe |with |10 |mL |normal |
saline.
2. |Use |chlorhexidine |and/or |alcohol |preparation |swabs |to |cleanse |injection |cap. |Insert |
needleless |access |device |of |syringe |containing |10 |mL |normal |saline, |unclamp, |and |flush.
3. |Reclamp. |Connect |IV |tubing |to |injection |cap |of |catheter |using |needleless |access |device. |(IV |
tubing |should |already |be |flushed |with |IV |fluid.) |Tape |tubing |connections.
4. |Flush |with |10 |mL |heparin |flush |solution |and |clamp. |Regulate |IV |infusion. |Dispose |of |soiled |
equipment. |Remove |gloves |and |document.
4
(It |is |unnecessary |to |flush |with |heparin |because |continuous |fluids |are |going |to |be |
administered. |It |would |be |necessary |to |unclamp |the |port |before |regulating |the |IV |infusion. |
Hand |hygiene |should |be |performed |after |removing |gloves.)
EXAM Questions With Correct Answers
The |nurse |is |unable |to |aspirate |a |blood |return |from |the |distal |port |of |a |triple-lumen |CVAD |and
|suspects |an |occlusion. |What |should |the |nurse |do |first?
1. |Reposition |the |patient |and |have |her |raise |her |hand |above |her |head; |reattempt.
2. |Use |a |smaller |syringe |and |attempt |again.
3. |Insert |a |10-mL |syringe |of |preservative-free |sterile |normal |saline |and |attempt |to |flush |and |
aspirate |rapidly |and |repeatedly.
4. |Attach |a |label |to |the |port |indicating |it |is |occluded, |and |use |a |different |port |of |the |triple- |
lumen |CVAD.
1
(The |nurse |should |first |reposition |the |patient, |have |her |take |a |deep |breath |and |cough, |and/or |
have |her |raise |her |hand |above |her |head |then |reattempt. |A |syringe |smaller |than |10 |mL |should |
not |be |used |because |this |could |damage |the |catheter |as |a |result |of |the |high |psi. |Rapidly |and |
repeatedly |flushing |and |aspirating |could |cause |dislodgment |of |a |thrombus. |The |nurse |should |
first |attempt |measures |to |improve |patency |of |the |port |before |determining |it |is |no |longer |able |
to |be |used. |The |health |care |provider |may |order |an |antithrombolytic |if |these |measures |are |
unsuccessful.)
A |patient |has |been |receiving |chemotherapy |via |a |percutaneous |CVAD |located |in |the |right |
subclavian |vein. |The |patient |is |complaining |of |pain |and |burning |at |the |insertion |site |of |the |
CVAD. |The |nurse |notes |erythema, |edema, |and |a |spongy |feeling |around |the |patient’s |right |
upper |chest |and |neck |area. |Which |actions |would |be |appropriate |for |the |nurse |to |take |at |this |
time? |(Select |all |that |apply.)
1. |Prepare |to |obtain |electrocardiogram.
2. |Stop |chemotherapy |administration.
3. |Administer |antidote |per |protocol.
4. |Provide |emotional |support.
5. |Turn |patient |onto |left |side |with |head |down.
2,3,4
, (The |patient |is |demonstrating |symptoms |of |extravasation. |Appropriate |actions |of |the |nurse |
include |immediately |stopping |the |vesicant |administration, |administering |the |appropriate |
antidote |per |protocol, |and |applying |cold/warm |compresses |according |to |specific |vesicant |
protocol. |An |electrocardiogram |would |be |in |order |if |the |CVAD |is |placed |incorrectly, |resulting |in
|cardiac |dysrhythmias. |Turning |the |patient |onto |the |left |side |with |head |down |would |be |
appropriate |if |an |air |embolism |was |suspected, |not |for |extravasation.)
The |nurse |is |reviewing |the |sequence |for |performing |a |dressing |change |on |a |vascular |access |
device. |Which |statement, |by |the |nurse, |indicates |further |instruction |is |needed?
1. |"I |will |wear |clean |gloves |to |remove |the |previous |dressing, |and |I |will |remove |it |in |the |
direction |the |catheter |was |inserted."
2. |"I |should |avoid |touching |the |Dacron |cuff |in |a |subcutaneous |tunnel |because |this |may |cause |
dislodgement."
3. |"I |will |wear |sterile |gloves |to |clean |and |apply |the |new |dressing."
4. |"I |should |allow |the |antiseptic |to |dry |completely |before |applying |the |transparent |dressing."
2
(The |nurse |should |palpate |the |Dacron |cuff |in |the |subcutaneous |tunnel |to |determine |if |it |is |
stable |and |in |the |anticipated |location |and |that |there |are |no |signs |of |infection |such |as |
tenderness |or |warmth |at |the |site.)
The |nurse |is |preparing |to |administer |continuous |fluids |through |a |central |venous |catheter, |
leaving |the |injection |caps |in |place. |Which |step |in |the |procedure |requires |correction?
1. |Perform |hand |hygiene; |apply |gloves |and |mask(s). |Prepare |a |syringe |with |10 |mL |normal |
saline.
2. |Use |chlorhexidine |and/or |alcohol |preparation |swabs |to |cleanse |injection |cap. |Insert |
needleless |access |device |of |syringe |containing |10 |mL |normal |saline, |unclamp, |and |flush.
3. |Reclamp. |Connect |IV |tubing |to |injection |cap |of |catheter |using |needleless |access |device. |(IV |
tubing |should |already |be |flushed |with |IV |fluid.) |Tape |tubing |connections.
4. |Flush |with |10 |mL |heparin |flush |solution |and |clamp. |Regulate |IV |infusion. |Dispose |of |soiled |
equipment. |Remove |gloves |and |document.
4
(It |is |unnecessary |to |flush |with |heparin |because |continuous |fluids |are |going |to |be |
administered. |It |would |be |necessary |to |unclamp |the |port |before |regulating |the |IV |infusion. |
Hand |hygiene |should |be |performed |after |removing |gloves.)
