EAQ #1 Peripheral & Central IV Therapy
Which gauge size of peripheral IV catheter is preferred for adults undergoing routine surgery? A) 14 gauge B) 18 gauge C) 22 gauge D) 24 gauge
18 gauge is the preferred peripheral IV catheter size for adults undergoing routine surgery.
Which central vascular access device (CVAD) can be placed for access to arteries, the epidural space, and the peritoneal cavity? A) Implanted port B) Tunneled central venous catheter C) Peripherally inserted central catheter D) Nontunneled percutaneous central venous catheter
Implanted ports are central vascular access devices (CVADs) that can be placed for access to arteries, the epidural space, and the peritoneal cavity. Tunneled/nontunneled catheters and PICCs are not CVADs.
Which PICC complication is rare? A) Infiltration B) Phlebitis C) Thrombophlebitis D) DVT
Infiltration (A) is a rare complication of PICC lines.
Which complication of peripherally inserted central catheters happens rarely? A) Phlebitis B) Infiltration C) Thrombophlebitis D) DVT
Infiltration is a rare complication of peripherally inserted central catheters (PICCs).
What is the maximum flow rate of contrast injection for a "Power PICC"?
5 mL/sec is the maximum flow rate of contrast injection for a "Power PICC". A "Power PICC" can be used for contrast injection at max flow rate of 5 mL/sec & max pressure of 300 psi. It can also be used for monitoring central venous pressure.
A 14-gauge peripheral catheter is appropriate for A) trauma & surgical patients needing rapid fluid resuscitation B) routine surgery C) blood transfusion D) PPN
A 14-gauge peripheral catheter is appropriate for trauma & surgical patients needing rapid fluid (A).
A patient is admitted to the ICU and expected to remain for about 2 weeks. Which vascular access device would be most appropriate? A) Midline catheter B) Peripherally inserted central catheter C) Short peripheral catheter D) Tunneled central catheter
A patient is admitted to the ICU and expected to remain for about 2 weeks. A midline catheter (A) would be the most appropriate vascular access device. Midline caths are good for 1-2 weeks.
Which central vascular access device (CVAD) is indicated in patients who require IV therapy for more than a year? A) Implanted port B) Tunneled central venous catheter C) Peripherally inserted central catheter D) Nontunneled percutaneous central venous catheter
An implanted port (A) is a central vascular access device (CVAD) appropriate for patients who require IV therapy for more than a year. Tunneled caths are appropriate for weeks to months of infusion or nutrition. Nontunneled caths are used short-term for trauma, critical care, and surgery. PICCs aren't suitable for more than a few months.
Attaching a catheter to an implanted port requires the patient to be in which position? A) Trendelenburg B) Reverse Trendelenberg C) High-Fowler's D) Semi-Fowler's
Attaching a catheter to an implanted port requires the patient to be in semi-Fowler's position (D). This helps prevent nausea caused by the infusion.
Which factor would the nurse take into account before selecting an insertion site for a short peripheral venous catheter? A) Type of therapy B) Length of therapy C) History of mastectomy D) Presence of dialysis fistula E) Axillary lymph node dissection
Before selecting an insertion site for a short peripheral venous catheter, the nurse will consider: A) Type of therapy C) History of mastectomy D) Presence of dialysis fistula E) Axillary lymph node dissection Length of therapy (B) affect the type of access, but not necessarily the location.
Which situations may cause phlebitis? (Select all that apply). A) Traumatic vein puncture B) Obstruction of blood flow C) Improper antiseptic technique D) Improper catheter securement device E) High osmolarity of the medication infused
Improper antiseptic technique (C), improper catheter securement device (D), and high osmolarity of the medication infused (E) may cause phlebitis. Traumatic vein puncture (A) may cause thrombosis, and obstruction of blood flow (B) may cause infiltration or extravasation.
Which device(s) allow(s) the visualization of a superficial vein on a patient who is prescribed infusion therapy? A) X-ray B) Drugs C) Infrared D) Laser beam E) Transilluminator
Infrared (C) and laser beam transilluminators (D & E) allow visualization of a superficial vein on a patient who is prescribed infusion therapy?
Which catheter type is rarely used for IV therapy in older adults due to risk for adverse effects and difficulty with correct placement? A) Implanted ports B) Peripherally inserted central catheters C) Tunneled catheters D) Nontunneled percutaneous central catheters
Nontunneled percutaneous central catheters (D) are rarely used for IV therapy in older adults due to risk for adverse effects and difficulty with correct placement. Midline catheters & PICC lines are preferred. Tunneled caths & implanted ports may be used in some cases.
Which central catheter insertion procedure requires the patient to be in the Trendelenburg position? A) Implanted port B) Tunneled central venous catheter C) Peripherally inserted central catheter D) Nontunneled percutaneous central venous catheter
Nontunneled percutaneous central venous catheter (D) insertion procedure requires the patient to be in the Trendelenburg position. Trendelenberg helps ensure the Nontunneled CVC exist site is at or below heart level.
Peripherally inserted central catheters (PICCs) are placed in... (select all that apply) A) The antecubital fossa B) The middle of the upper arm B) The anterior forearm C) The dorsa of the hand
Peripherally inserted central catheters (PICCs) are placed in the antecubital fossa (A) or the middle of the upper arm (B).
Which is the preferred site for inserting a PICC line? A) Brachial vein in the upper arm B) Basilic vein in the upper arm C) Cephalic vein in the upper arm D) Median vein in the forearm
The basilic vein in the upper arm (B) is the preferred site for inserting a PICC line. The cephalic vein may also be used as a second-choice (C). Brachial & median veins are not recommended (A&D)
Which situation(s) are indications for placing a nontunneled percutaneous central venous catheter (CVC) in a patient? A) Impending surgery B) Trauma situations C) Renal failure D) Administration of IV fluids E) Prolonged parenteral nutrition
The follow are indications for placing a nontunneled percutaneous central venous catheter (CVC): A) Impending surgery B) Trauma situations D) Administration of IV fluids HD catheters may be placed for renal failure. Prolonged parenteral nutrition requires a tunneled CVC.
Which action would the nurse take to ensure skin antisepsis before veinipuncture in an older adult? A) Apply chlorhexidine for maximum antiseptic action B) Apply vigorous friction when cleaning the skin C) Do not let the skin dry after application of the antiseptic D) Allow a contact time of 1 minute when using iodophors
The nurse will apply chlorhexidine (A) for maximum antiseptic action before veinipuncture in an older adult.
The smallest gauge that is preferred in PIV catheters is _____ gauge.
The smallest gauge that is preferred in PIV catheters is 22 (or 20) gauge.
Which findings at an IV insertion site may indicate phlebitis? (Select all that apply) A) Swelling B) Bruising C) Blistering D) Skin coolness E) Erythema F) Palpable cord
These findings at an IV insertion site may indicate phlebitis: A) Swelling B) Bruising D) Skin coolness E) Erythema F) Palpable cord Blistering may occur with extravasation, not infiltration.
A patient reports tingling, feeling pins and needles in the extremity, and numbness during insertion of a peripheral IV catheter. Which action would the nurse take? A) Remove the catheter B) Continue inserting the catheter C) Inform the primary healthcare provider D) Choose a new site for the catheter insertion E) Stop the IV catheter insertion
Tingling, feeling pins and needles, and numbness during catheter insertion indicates nerve puncture. The nurse should stop the IV catheter insertion (E) and remove the catheter (A). Nurse should also choose a new site for catheter insertion (D). There is no need to notify the primary healthcare provider (C).
Which technique is used to confirm the location of the catheter tip after insertion of a peripherally inserted central catheter (PICC)? A) X-ray B) laser C) surgery D) infrared
X-ray (A) is used to confirm the location of the catheter tip after insertion of a peripherally inserted central catheter (PICC)?
A 18-gauge catheter has a flow-rate of _____ mL/min. A) 24 mL/min B) 38 mL/min C) 65 mL/min D) 110 mL/min
A 22-gauge catheter has a flow-rate of 110 mL/min.
A patient is admitted to the hospital for postsurgical observation, and expected to be discharged within 2 days. Which vascular access device would be most appropriate? A) Midline catheter B) Peripherally inserted central catheter C) Short peripheral catheter D) Tunneled central catheter
A patient is admitted to the hospital for postsurgical observation, and expected to be discharged within 2 days. A short peripheral catheter (C) would be the most appropriate vascular access device. Short peripheral catheters may stay in place for 72-96 hours.
A solution with an osmolarity of ______ mOsm/L is hypertonic and can be administered through a peripheral IV catheter. A) 250 mOsm/L B) 280 mOsm/L C) 400 mOsm/L D) 600 mOsm/L
A solution with an osmolarity of 400 mOsm/L (C) is hypertonic and can be administered through a peripheral IV catheter. 250 mOsm/L is hypotonic, 280 mOsm/L is isotonic, and 600 mOsm/L is very hypertonic and not appropriate for a peripheral line.
Which condition indicates infiltration? A) Inflammation of the vein B) Blood clot inside the vein C) Leakage of nonvesicant IV solution into extracellular fluid D) Leakage of vesicant IV solution into extravascular fluid
Leakage of nonvesicant IV solution into extracellular fluid (C) indicates infiltration.
Which IV catheter would the nurse choose to insert a short peripheral catheter into a patient who is scheduled for surgery? A) 18 gauge B) 20 gauge C) 22 gauge D) 24 gauge
The nurse would use an 18-gauge to insert a short peripheral catheter into a patient who is scheduled for surgery.
A 20-gauge catheter has a flow-rate of _____ mL/min. A) 24 mL/min B) 38 mL/min C) 65 mL/min D) 110 mL/min
A 20-gauge catheter has a flow-rate of 65 mL/min.
What is the smallest gauge of peripheral IV catheter the nurse would use to infuse a blood transfusion? A) 16-gauge B) 18-gauge C) 20-gauge D) 22-gauge
A 22-gauge (D) is the smallest PIV catheter a nurse may use to infuse blood without damage blood cells.
A 22-gauge catheter has a flow-rate of _____ mL/min. A) 24 mL/min B) 38 mL/min C) 65 mL/min D) 110 mL/min
A 22-gauge catheter has a flow-rate of 38 mL/min (B).
A 26-gauge catheter has a flow-rate of _____ mL/min. A) 24 mL/min B) 38 mL/min C) 65 mL/min D) 110 mL/min
A 26-gauge catheter has a flow-rate of 24 mL/min (A).
A chemotherapy nurse is planning to give a patient the next dose of a chemotherapeutic agent through the implanted BARD PowerPort. Which technique would the nurse use to identify the location of the port and the site for puncture? A) Palpate a dull ridge that encircles the septum B) Inspect the rise in the spin where the port is implanted C) Palpate three bumps that indicate the location of the septum D) Percuss the port to identify the location of the hollow reservoir
A chemotherapy nurse is planning to give a patient the next dose of a chemotherapeutic agent through the implanted BARD PowerPort. The nurse would palpate three bumps that indicate the location of the septum (C) to identify the location of the port and site for puncture.
Which action would the nurse include in the plan of care to prevent the lumens of a central venous catheter from occluding? A) Use smaller syringes B) Flush with normal saline C) Apply a transparent dressing D) Administer infusions slowly
A nurse may flush a CVC with normal saline (B) to prevent its lumens from occluding. Using smaller syringes would increase the pressure inside the line. Applying a transparent dressing would help prevent infection. Slow administration may prevent circulatory overload.
Which gauges of PIV catheter would the nurse use for rapid fluid resuscitation in a patient with severe blood loss after a MVC? (Select all that apply) A) 14-gauge B) 16-gauge C) 18-gauge D) 20-gauge E) 22-gauge
A nurse may use a 14-gauge or 16-gauge (A&B) PIV catheter for rapid fluid resuscitation in a patient with severe blood loss after a MVC. Lumens smaller than 16-gauge do not facilitate rapid, large-volume fluid infusion.
A patient has an arterial catheter in the right wrist. Which assessment would the nurse make to determine patency of the patient's radial artery? A) Blood pressure B) Capillary refill C) Neurologic function D) Pain level at the site
A patient has an arterial catheter in the right wrist. The nurse may check his capillary refill (B) to assess patency of the patient's radial artery.
A patient in the ED with acute RLQ abdominal pain, nausea, and rebound tenderness is scheduled for urgent surgery. Which gauge catheter would the nurse choose when starting this patient's IV solution? A) 24 gauge B) 22 gauge C) 18 gauge D) 14 gauge
A patient in the ED with acute RLQ abdominal pain, nausea, and rebound tenderness is scheduled for urgent surgery. The nurse will choose an 18-gauge (C) catheter for this patient's IV.
A patient is admitted to the ICU and expected to remain for several months. Which vascular access device would be most appropriate? A) Midline catheter B) Peripherally inserted central catheter C) Short peripheral catheter D) Tunneled central catheter
A patient is admitted to the ICU and expected to remain for several months. A peripherally inserted central catheter (B) would be the most appropriate vascular access device.
A patient reports pain at the peripheral IV site. The nurse finds redness at the side and inflammation along the length of the vein. The nurse suspects ______________. A) Infiltration B) Extravasation C) Phlebitis
A patient reports pain at the peripheral IV site. The nurse finds redness at the side and inflammation along the length of the vein. The nurse suspects phlebitis (C).
A patient requires peripheral infusion therapy. Which factor(s) would the nurse consider in planning for the type of access device? A) Age of the patient B) Gender of the patient C) Diagnosis of the patient D) Duration of the therapy E) Patient preference
A patient requires peripheral infusion therapy. Which factor(s) would the nurse consider in planning for the type of access device? A) Age of the patient C) Diagnosis of the patient D) Duration of the therapy E) Patient preference Gender (B) does not affect the type of infusion therapy.
A patient with a history of cancer is prescribed IV chemotherapy via PICC line. Which solution would the nurse use to flush the PICC? A) 5 mL heparin B) 10 mL heparin C) 10 mL sterile saline D) 20 mL sterile saline
A patient with a history of cancer is prescribed IV chemotherapy via PICC line. The nurse will flush the PICC with 10 mL sterile saline (C) before and after chemo infusion. 5 mL heparin may be used to flush a PICC line that is not actively used. 20 mL of sterile saline is used to flush a catheter after drawing blood. 10 mL of heparin isn't recommended for flushing.
A patient with severe hyponatremia has been prescribed 3% hypertonic saline. Which information would the nurse clarify with the prescribing provider before administering the IV infusion? A) Rate of infusion B) Length of infusion C) Purpose of infusion D) Time of administration E) Route of administration
A patient with severe hyponatremia has been prescribed 3% hypertonic saline. Which information would the nurse clarify with the prescribing provider before administering the IV infusion? A) Rate of infusion B) Length of infusion E) Route of administration We already know the purpose (hyponatremia). The time of admin will be known after it is administered.
Based on the Infusion Nurses Society (INS) infiltration scale, which findings are associated with a grade 2 infiltration? (Select all that apply) A) The infiltration site is cool to the touch B) The infiltration site is with or without pain C) The skin is tight and leaking at the infiltration site D) Edema occurs 1-6" in any direction at the infiltration site.
Based on the Infusion Nurses Society (INS) infiltration scale, infiltration with or without pain (B) that is cool to the touch (A) and edema that occurs 1-6" in any direction (D) are associated with a grade 2 infiltration.
Based on the Infusion Nurses Society (INS) infiltration scale, which finding is associated with a grade 4 infiltration? A) The infiltration site is cool to the touch B) The infiltration site is with or without pain C) The skin is tight and leaking at the infiltration site D) Edema occurs 1-6" in any direction at the infiltration site.
Based on the Infusion Nurses Society (INS) infiltration scale, skin that is tight & leaking at the infiltration site (C) is associated with a grade 4 infiltration.
(T/F) Tunneled central catheters are suitable for long-term use and may be inserted by RNs.
FALSE: Tunneled central catheters are suitable for long-term use but must be inserted by healthcare providers (MD, DO, ARNP, PA).
The nurse attempting a venipuncture on a patient accidentally sticks the used needle into the nurse's own fingertip. Which action is required by OSHA? A) Tell the nurse supervisor for that shift B) Email the hospital's safety administrator C) Record the incident in the sharps injury log D) Call the CDC
The nurse attempting a venipuncture on a patient accidentally sticks the used needle into the nurse's own fingertip. OSHA requires the nurse to record the incident in the sharps injury log (C). Telling a nurse supervisor, safety administrator, or the CDC may be required, but it depends on the facility.
The nurse determines the patient has an infection from the short PIV catheter used for treatment. Which action wold the nurse take to determine the offending organism? A) Cleaning the exit site with alcohol B) Remove the peripheral catheter C) Send the catheter tip for culture D) Apply cold compresses to the site
The nurse determines the patient has an infection from the short PIV catheter used for treatment. The nurse would send the catheter tip for culture (C) to determine the offending organism.
The nurse enters the room of a patient who is receiving a blood transfusion. Which finding(s) would require the nurse to intervene? A) Administration set with filter B) 24-gauge IV catheter C) Luer-Loc connections on tubing D) Extension set attached to catheter E) Electronic infusion device use
The nurse enters the room of a patient who is receiving a blood transfusion. The nurse would intervene if (s)he noticed a 24-gauge IV catheter being used. The 24-gauge is too small and can damage RBCs. It is appropriate to use filters, electronic infusion devices, Luer-Lok connections, and extension sets.
The nurse is caring for a patient admitted with dehydration secondary to influenza who is prescribed 0.9% NaCl. Which vascular access device would be most appropriate? A) Midline catheter B) Short peripheral catheter C) Tunneled central catheter D) Peripherally inserted central catheter
The nurse is caring for a patient admitted with dehydration secondary to influenza who is prescribed 0.9% NaCl. A short peripheral catheter(B) would be most appropriate. A midline cath could be used if the patient had poor skin or veins. Tunneled central caths and PICCs are reserved for long-term treatment.
The nurse is caring for a patient receiving IV vancomycin. Which action would the nurse take after noticing swelling & coolness around the insertion site? A) Remove the catheter B) Apply warm compresses C) Apply cold compresses D) Discontinue the infusion D) Flush the catheter with saline E) Notify the healthcare provider
The nurse is caring for a patient receiving IV vancomycin. After noticing swelling & coolness around the insertion site, the nurse suspects infiltration. (S)he will discontinue the infusion (D), remove the catheter (A), and apply cold compresses (C). Flushing would aggravate the infiltration, and notifying the provider is unnecessary because infiltration will resolve on its own.
The nurse is preparing to flush a peripherally inserted central catheter (PICC) line to maintain patency. Which size syringe would the nurse use to prevent complications? A) 1 mL B) 3 mL C) 5 mL D) 10 mL
The nurse is preparing to flush a peripherally inserted central catheter (PICC) line to maintain patency. The nurse would use a 10 mL (D) syringe to prevent complications. Smaller syringes exert too much pressure & could rupture the PICC line.
The nurse is teaching a patient about activity recommendations with a peripherally inserted central catheter. Which information needs correcting when the patient repeats the directions? A) I must avoid driving B) I must avoid lifting heavy weights C) I can have a shower on my own D) I can jog or run for exercise
The nurse is teaching a patient about activity recommendations with a peripherally inserted central catheter. The patient must not jog or run for exercise (D), as these activities may occlude the lumen of the PICC line.
The nurse is providing discharge instructions to a patient who is being sent home with an ambulatory pump to dispense IV pain medication. Which teaching point with the nurse include for this device that may not apply to other types of IV pumps? A) How to respond to alarms B) How to replace or recharge the battery C) What type of information should be recorded D) How to program the infusion device
The nurse will teach the patient with an ambulatory IV pump how to replace or recharge the batteries (B), which may not apply to other types of IV pumps. For any type of IV pump, the patient should be taught how to program the pump, respond to alarms, and record relevant information.
Which IV insertion site would the nurse choose for an older adult being admitted to a same-day surgery unit? (Select all that apply) A) Dorsa of the hand B) Basilic vein C) Cephalic vein D) Subclavian vein E) Arm on the side of a radical mastectomy
The nurse would chose the basilic vein or cephalic vein as an IV insertion site for an older adult on a same-day surgery unit. The veins of the hand (A) are brittle in older adults and a poor choice. Insertions should be avoided on the side of a radical mastectomy, since they interfere with already limited circulation. Subclavian IVs (D) may only be placed by the healthcare provider.
Which of the following would the nurse include in the documentation for a patient's peripheral venous catheter insertion? (Select all that apply). A) Patient's name & MRN # B) Patient's response to the insertion C) Type and size of device D) Date & time inserted E) Type of dressing applied F) Vein used for insertion
The nurse would document all of the following for a patient's peripheral venous catheter insertion: (B, C, D, E, F) Response to the insertion, type and size of device, type of dressing applied, vein used for insertion, and date & time inserted.
Which parameter of IV therapy would the nurse document? A) Vein that was used for insertion B) Blood pressure of the patient C) The body temperature of the patient D) Date and time of the device insertion E) Name of the nurse who inserted the device
The nurse would document: A) Vein that was used for insertion D) Date and time of the device insertion E) Name of the nurse who inserted the device
Which condition is a common & serious complication of PICCs? A) Infiltration B) Phlebitis C) Thrombophlebitis D) DVT
Thrombophlebitis is a common & serious complication of PICCs. Phlebitis & thrombosis are common but not very serious. Infiltration is rare.
Which action(s) would the nurse take to ensure skin antisepsis before veinipuncture in an older adult? (Select all that apply) A) Apply chlorhexidine for maximum antiseptic action B) Apply some friction when cleaning the skin C) Do not let the skin dry after application of the antiseptic D) Allow a contact time of 2 minutes when using iodophors
To ensure skin antisepsis before veinipuncture in an older adult, the nurse may: A) Apply chlorhexidine for maximum antiseptic action B) Apply some friction when cleaning the skin D) Allow a contact time of 2 minutes when using iodophors The nurse would also allow the skin to dry after applying antiseptic solution.
What should the nurse do to relieve the pain of a patient who has phlebitis? (Select all that apply) A) Remove the catheter B) Provide antimicrobial therapy C) Apply warm compresses to the area D) Inform the primary healthcare provider E) Reinsert a new catheter in the opposite extremity
What should the nurse do to relieve the pain of a patient who has phlebitis? A) Remove the catheter B) Provide antimicrobial therapy C) Apply warm compresses to the area E) Reinsert a new catheter in the opposite extremity It is unnecessary to inform the primary healthcare provider prior to removing the catheter.
Which IV insertion site would the nurse choose for an older adult being admitted to a same-day surgery unit? A) Back of the hand B) Arm on the side of a radical mastectomy C) Cephalic vein of the forearm D) Subclavian vein
Which IV insertion site would the nurse choose for an older adult being admitted to a same-day surgery unit? C) Cephalic vein of the forearm
Which action would the nurse perform before insertion of a PIV catheter? (Select all that apply) A) Apply providone-iodine to clean skin and let dry for 2 minutes B) Clean the skin around the site with soap and water, if soiled C) Choose the IV based on the expected purpose D) Shave the air around the area of insertion E) Wear clean gloves and touch the site only with fingertips after applying antiseptics
Which action would the nurse perform before insertion of a PIV catheter? A) Apply providone-iodine to clean skin and let dry for 2 minutes B) Clean the skin around the site with soap and water, if soiled C) Choose the IV based on the expected purpose Clipping (not shaving) may be appropriate. The insertion site should not be touched, even with gloves, after asepsis.
Which catheter type is usually chosen for IV therapy in older adults? A) implanted ports B) midline catheters C) tunneled catheters D) nontunneled percutaneous central catheters
Which catheter type is usually chosen for IV therapy in older adults? B) midline catheters Midline caths or PICC lines are commonly used. Nontunnelled percutaneous central caths are risky and difficult. Implanted ports & tunneled caths may be used after considering surgery.
Which statement made by the nurse about IV peripheral catheters needs correction? A) Small-gauge peripheral catheters pose an increased risk for phlebitis B) Dwell time of peripheral catheters does not include a specific time frame C) The preferred site of insertion of a peripheral catheter is an upper extremity D) The smallest-gauge catheter that suits the prescribed therapy should be chosen
Which statement made by the nurse about IV peripheral catheters needs correction? A) Small-gauge peripheral catheters pose an increased risk for phlebitis Actually, large-gauge catheters pose an increased risk for phlebitis.
Which device is used to confirm catheter placement? A) X-ray B) Drugs C) Infrared D) Transilluminator
X-ray (A) may be used to confirm catheter placement.