, Question 1
A patient requires 6 months of daily IV antibiotics with an infusate pH of 3.0
and osmolarity of 720 mOsm/L. Which vascular access device is most
appropriate?
A. Short peripheral catheter
B. Midline catheter
C. Peripherally inserted central catheter (PICC)
D. Non-tunneled central venous catheter
Correct Answer: C - Peripherally inserted central catheter
(PICC)
RATIONALE
PICCs are indicated for therapy >6 days with non-peripherally
compatible infusates (pH <5 or >9, osmolarity >900 mOsm/L) and for
prolonged courses. A PICC provides central placement with lower
infection risk than non-tunneled CVCs for extended outpatient
therapy. Short peripheral and midlines cannot safely deliver this
infusate.
Question 2
Which mechanism best explains why a catheter tip located at the cavoatrial
junction reduces the risk of central venous stenosis compared with a tip in the
upper SVC?
A. Higher blood flow velocity at the cavoatrial junction reduces
endothelial irritation
B. The cavoatrial junction has a larger vessel diameter, reducing
catheter-to-vessel ratio
C. Infusate is diluted more rapidly in the right atrium, reducing chemical
phlebitis
D. The cavoatrial junction lacks valves, preventing turbulent reflux
Correct Answer: A - Higher blood flow velocity at the cavoatrial
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,junction reduces endothelial irritation
RATIONALE
High laminar flow at the cavoatrial junction rapidly dilutes infusates
and minimizes endothelial contact time, reducing mechanical and
chemical injury that drives stenosis. Vessel diameter (B) is not the
primary factor; dilution (C) is a consequence of flow, and valve
absence (D) is not the mechanism.
Question 3
A hemodialysis patient with a mature AV fistula has a dialysis access flow
(QA) of 350 mL/min and a recirculation rate of 18%. Which intervention is
most appropriate?
A. Continue monitoring; repeat in 3 months
B. Refer for fistulography to evaluate for stenosis
C. Increase dialysis pump speed to improve clearance
D. Convert to an AV graft to improve flow
Correct Answer: B - Refer for fistulography to evaluate for
stenosis
RATIONALE
A recirculation rate >10% with low QA (<400 mL/min) suggests
hemodynamically significant stenosis, warranting fistulography.
Continuing to monitor would delay intervention; increasing pump
speed worsens recirculation; converting to a graft is premature and not
indicated.
Question 4
Which statement best distinguishes the pathophysiology of catheter-related
bloodstream infection (CRBSI) from central line-associated bloodstream
infection (CLABSI)?
A. CRBSI requires microbiological confirmation of the catheter as the
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, source; CLABSI is a surveillance definition without source confirmation
B. CLABSI requires positive cultures from the catheter tip; CRBSI uses
only peripheral cultures
C. CRBSI is defined by clinical signs alone; CLABSI requires imaging
D. CLABSI applies only to PICCs; CRBSI applies only to central
catheters
Correct Answer: A - CRBSI requires microbiological
confirmation of the catheter as the source; CLABSI is a
surveillance definition without source confirmation
RATIONALE
CRBSI is a clinical diagnosis requiring specific microbiological
evidence (e.g., differential time to positivity) linking the catheter to
the bloodstream infection. CLABSI is a surveillance definition used
by NHSN that does not require source confirmation. The other options
misstate the definitions.
Question 5
A patient with an implanted port presents with pain and swelling at the port site
2 days after access. Which complication is most likely?
A. Pinch-off syndrome
B. Port pocket infection
C. Extravasation
D. Catheter fracture with embolization
Correct Answer: C - Extravasation
RATIONALE
Extravasation presents acutely with pain, swelling, and burning at the
site during or shortly after infusion, caused by needle dislodgement or
catheter damage. Pinch-off and fracture are mechanical complications
with different presentations; infection typically presents later with
fever and erythema.
Page 4
A patient requires 6 months of daily IV antibiotics with an infusate pH of 3.0
and osmolarity of 720 mOsm/L. Which vascular access device is most
appropriate?
A. Short peripheral catheter
B. Midline catheter
C. Peripherally inserted central catheter (PICC)
D. Non-tunneled central venous catheter
Correct Answer: C - Peripherally inserted central catheter
(PICC)
RATIONALE
PICCs are indicated for therapy >6 days with non-peripherally
compatible infusates (pH <5 or >9, osmolarity >900 mOsm/L) and for
prolonged courses. A PICC provides central placement with lower
infection risk than non-tunneled CVCs for extended outpatient
therapy. Short peripheral and midlines cannot safely deliver this
infusate.
Question 2
Which mechanism best explains why a catheter tip located at the cavoatrial
junction reduces the risk of central venous stenosis compared with a tip in the
upper SVC?
A. Higher blood flow velocity at the cavoatrial junction reduces
endothelial irritation
B. The cavoatrial junction has a larger vessel diameter, reducing
catheter-to-vessel ratio
C. Infusate is diluted more rapidly in the right atrium, reducing chemical
phlebitis
D. The cavoatrial junction lacks valves, preventing turbulent reflux
Correct Answer: A - Higher blood flow velocity at the cavoatrial
Page 2
,junction reduces endothelial irritation
RATIONALE
High laminar flow at the cavoatrial junction rapidly dilutes infusates
and minimizes endothelial contact time, reducing mechanical and
chemical injury that drives stenosis. Vessel diameter (B) is not the
primary factor; dilution (C) is a consequence of flow, and valve
absence (D) is not the mechanism.
Question 3
A hemodialysis patient with a mature AV fistula has a dialysis access flow
(QA) of 350 mL/min and a recirculation rate of 18%. Which intervention is
most appropriate?
A. Continue monitoring; repeat in 3 months
B. Refer for fistulography to evaluate for stenosis
C. Increase dialysis pump speed to improve clearance
D. Convert to an AV graft to improve flow
Correct Answer: B - Refer for fistulography to evaluate for
stenosis
RATIONALE
A recirculation rate >10% with low QA (<400 mL/min) suggests
hemodynamically significant stenosis, warranting fistulography.
Continuing to monitor would delay intervention; increasing pump
speed worsens recirculation; converting to a graft is premature and not
indicated.
Question 4
Which statement best distinguishes the pathophysiology of catheter-related
bloodstream infection (CRBSI) from central line-associated bloodstream
infection (CLABSI)?
A. CRBSI requires microbiological confirmation of the catheter as the
Page 3
, source; CLABSI is a surveillance definition without source confirmation
B. CLABSI requires positive cultures from the catheter tip; CRBSI uses
only peripheral cultures
C. CRBSI is defined by clinical signs alone; CLABSI requires imaging
D. CLABSI applies only to PICCs; CRBSI applies only to central
catheters
Correct Answer: A - CRBSI requires microbiological
confirmation of the catheter as the source; CLABSI is a
surveillance definition without source confirmation
RATIONALE
CRBSI is a clinical diagnosis requiring specific microbiological
evidence (e.g., differential time to positivity) linking the catheter to
the bloodstream infection. CLABSI is a surveillance definition used
by NHSN that does not require source confirmation. The other options
misstate the definitions.
Question 5
A patient with an implanted port presents with pain and swelling at the port site
2 days after access. Which complication is most likely?
A. Pinch-off syndrome
B. Port pocket infection
C. Extravasation
D. Catheter fracture with embolization
Correct Answer: C - Extravasation
RATIONALE
Extravasation presents acutely with pain, swelling, and burning at the
site during or shortly after infusion, caused by needle dislodgement or
catheter damage. Pinch-off and fracture are mechanical complications
with different presentations; infection typically presents later with
fever and erythema.
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