VA-BC Certification Exam 2024/2025 with 100% Accurate Solutions, Exams of Nursing

Download VA-BC Certification Exam 2024/2025 with 100% Accurate Solutions and more Exams Nursing in PDF only on Docsity! VA-BC CERTIFICATION EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS List indications for Vascular Access: - Precise Answer ✔✔1. Total parenteral nutrition (TPN) 2. Partial parenteral nutrition 3. I.V. fluids and medications 4. Blood and blood components 5. Chemotherapeutic agents 6. Cardiac monitoring 7. Plasmapheresis 8. Aquapherisis 9. Hemodialysis a. Diagnostic testing b. Frequent blood sampling What is the French Scale? - Precise Answer ✔✔Measurement of the outside size (diameter) of a catheter What is the range of Central venous catheter French sizes? - Precise Answer ✔✔1.2fr for Neonates up to 15fr for dialysis catheters As the French size increases, what does the diameter of the catheter do? - Precise Answer ✔✔It increases What is the gauge scale? - Precise Answer ✔✔Measurement of the outside size(diameter) of a catheter As the gauge number gets larger, what happens to the catheter size? - Precise Answer ✔✔It gets smaller. What is the gauge range of IV catheters? - Precise Answer ✔✔24ga to 12 ga Why are all I.V. devices manufactured in the USA are required to be radiopaque? - Precise Answer ✔✔To facilitate location of catheter emboli in the event of shearing or fracture Why should a PICC device NOT be used for midline placement? - Precise Answer ✔✔Using a PICC device for midline placement will risk confusion related to the type of access device a patient has; places the catheter tip outside the SVC, which is contrary to the manufacturers' DFU related to the intention of the product and risks potential liability for the nurse. What is optimal tip location for a midline catheter? - Precise Answer ✔✔One inch below the axillary area For midline placement, what alternative veins can be considered in pediatric patients? - Precise Answer ✔✔Scalp veins Popliteal veins Saphenous veins What are the indications for non-tunneled catheters? - Precise Answer ✔✔Short term central vein access Emergency central vein access What are the contraindications for non-tunneled catheters? - Precise Answer ✔✔Neck or chest sites may be excluded for patients with tracheostomies, radical neck dissection, and cervical fracture instability, or unstable airway Inability to position patient, insert or stabilize catheter Avoid insertion on same side as a PICC that passes through the subclavian vein What are the potential vessels for non-tunneled catheters? - Precise Answer ✔✔A. Jugular veins, external and/or internal B. Subclavian veins C. Femoral veins (least preferred) In patients at greater risk for catheter associated bloodstream infections (CABSI) what typed of PICC or non-tunneled catheters should be considered? - Precise Answer ✔✔Anti-microbial catheters What type of barrier precautions are required for non-tunneled catheter placement? - Precise Answer ✔✔Maximun sterile How should a patient be positioned for non-tunneled catheter placement? - Precise Answer ✔✔slight Trendelenburg position Why is a patient placed in slight Trendelenburg position for non- tunneled catheter placement? - Precise Answer ✔✔to avoid the possibility of air emboli during the placement procedure In non-tunneled catheter or PICC placement., what should always be avoided when accessing veins? - Precise Answer ✔✔Blind-stick attempts. Prior to any infusion of non-tunneled catheters, how should tip location be confirmed? - Precise Answer ✔✔ECG technology or radiograph What must be obtained prior to ANY infusion of a non-tunneled catheter or a PICC line? - Precise Answer ✔✔A free flowing blood return What is the optimal tip location for a non-tunneled and PICC catheters? - Precise Answer ✔✔Cavoatrial juncture (CAJ) If inserted through the femoral vein, what the optimal tip location for a non-tunneled and PICC catheters? - Precise Answer ✔✔Inferior vena cava (IVC) above the level of the diaphragm Why is the femoral vein is commonly used in pediatric critical care units for non-tunneled catheter placement? - Precise Answer ✔✔Due to ease of insertion in young patients Why may the jugular vein be the preferred point of insertion in very young children for non-tunneled catheters? - Precise Answer ✔✔To avoid a pneumothorax What are the indications for placement of a PICC line? - Precise Answer ✔✔-Patients who require central venous access when the duration of the infusions are unknown Where might tunneled catheter exits sites be located? - Precise Answer ✔✔The chest, upper back, top of thigh, or lower torso What attached to the catheter, will be positioned in the tissue track to secure the catheter? - Precise Answer ✔✔A stabilizing Dacron cuff After a tunneled catheter placement, how long until the exit site heals? - Precise Answer ✔✔Two to three weeks. When (upon physician approval) may a tunneled catheter be maintained without a dressing? - Precise Answer ✔✔Once the cuff has developed tissue attachment and the exit site is healed, In pediatric pts. with tunneled catheters, why do we assess/verify internal catheter tip location as the child grows? - Precise Answer ✔✔To maintain internal tip in the SVC What are the indications for an implanted port? - Precise Answer ✔✔Infusions that are projected to continue for months to years What are the contraindications for an implanted port? - Precise Answer ✔✔-Severe coagulopathy -Severe, uncontrolled sepsis -Burns or cellulitis (affecting the intended insertion site) -Patient who is cachectic, below ideal body weight, or lacking subcutaneous tissue for port implantation What vessels are selected for a "peripheral" implanted port? - Precise Answer ✔✔Basilic or cephalic vein What vessels are selected for a "central" implanted port? - Precise Answer ✔✔Subclavian vein Jugular vein Femoral vein Name two things considered when placing an implanted port. - Precise Answer ✔✔-Comfort related to the location of the implanted venous port -Depth of the implanted port must be shallow enough for the clinician to palpate and insert a non-coring access needle safely to maintain access into the port septum Depending on the vein accessed, where might the port implantation site be located? - Precise Answer ✔✔Port implantation site may be upper chest or lower abdominal side area How is the port secured inside the patient? - Precise Answer ✔✔Port is sutured into a subcutaneous pocket under the skin Accessing an implanted port is always what type of procedure? - Precise Answer ✔✔Sterile procedure What type of needle is used to access an implanted port? - Precise Answer ✔✔Non-coring needle What are power-injectable catheters? - Precise Answer ✔✔Power- injectable catheters are made of polyurethane and engineered to withstand high pressure >300 pounds per square inch (PSI) What are power injection catheters used for? - Precise Answer ✔✔Used for power injection of I.V. contrast media for a computerized tomography (CT) or magnetic resonance imaging (MRI) scan What are indications for an intraosseous device? - Precise Answer ✔✔As an alternative to venous access in emergency situations What are contraindications for intraosseous placement? - Precise Answer ✔✔-Trauma or fracture in the area of access -Bone disease In which type of catheter placement is cardiac monitoring used during insertion? - Precise Answer ✔✔Pulmonary Artery catheters. What is the indication for an Aquapheresis catheter? - Precise Answer ✔✔Diuretic resistant CHF (ultrafiltration to remove excess fluid/sodium) What is the contraindication for an aquapheresis catheter? - Precise Answer ✔✔Lack of an accessible basilic vein in upper arm What vessel is selected for an aquapheresis catheter? - Precise Answer ✔✔Basilic vein above the antecubital bend For what things are Aquapheresis catheters are not recommended? - Precise Answer ✔✔Not recommended for infusions of fluids or medications What is the optimal tip location for an aquapheresis catheter? - Precise Answer ✔✔1 -2 centimeters below the axilla What vessels are available to use with pediatric umbilical catheters? - Precise Answer ✔✔2 umbilical arteries 1 umbilical vein During what time frame may umbilical vessels be accessed? - Precise Answer ✔✔Up to the 4th day of life. What are appropriate uses of an umbilical catheter located in a VEIN? - Precise Answer ✔✔-Blood sampling -All infusates What are appropriate uses of an umbilical catheter located in an ARTERY? - Precise Answer ✔✔-Blood sampling -No TPN or vesicant infusions Site Determination: In evaluating potential sites, what is an important but an often overlooked portion of the CVAD pre-procedural assessment? - Precise Answer ✔✔Physical exam Site Determination: Prominent superficial veins in the area of planned CVAD may indicate what? - Precise Answer ✔✔Neighboring or central vein stenosis or thrombosis Site Determination: What should you assess upon physical exam when determining potential CVAD sites? - Precise Answer ✔✔-Skin turgor with emphasis on skin condition at the planned insertion site -Presence of any skin lesions, scars, edema, ecchymosis, or grafts -Presence or absence of collateral veins -Swelling of the arm, chest, face or neck -Prominent superficial veins Site Determination: Why should you avoid non-compressible or partially compressible target veins? - Precise Answer ✔✔They denote probable thrombosis Site Determination: What might variance in the vein diameter along the vein pathway do? - Precise Answer ✔✔Variance in the vein diameter along the vein pathway which may interfere with catheter advancement Site Determination: When assessing to patient for potential CVAD sites why should you look at a recent CXR? - Precise Answer ✔✔To check for pacemakers or Automatic Implantable Cardioverter Defibrillator (AICD), spinal rods or other implanted devices Skin Preparation: What are the recommended prep agents? - Precise Answer ✔✔a. Chlorhexidine gluconate b. Iodophors c. Alcohol d. Surface disinfectant e. Adhesive remover f. Skin protectant Site Preparation: How is Chlorhexidine gluconate applied? - Precise Answer ✔✔In a back-and-forth motion for a minimum of 30 seconds Site preparation: Against what type of organisms is Chlorhexidine gluconate effective? - Precise Answer ✔✔gram positive and gram negative Site preparation: With it's strong skin binding properties, what is the residual effect of Chlorhexidine? - Precise Answer ✔✔Up to 48 hours residual activity Site preparation:: What is a pediatric consideration of Chlorhexidine? - Precise Answer ✔✔USE WITH CAUTION FOR PREMATURE INFANTS AND CHILDREN < 2 MONTHS OF AGE Site preparation: What are iodophors? - Precise Answer ✔✔Solutions of iodine in complexes that contain a low amount of free iodine Site preparation: What solutions contain up to l0% of an iodine complex, and provide up to 1% free iodine for skin antisepsis - Precise Answer ✔✔Povidone iodine (e.g. Betadine™) Site preparation: After the application of povidone iodine, what should NOT be applied? - Precise Answer ✔✔Alcohol Site preparation: What is effective against gram-positive and gram-negative bacteria, fungi, and viruses; but has minimal effect on bacterial spores? - Precise Answer ✔✔Tincture of iodine Site preparation: For an antiseptic effect to occur with Iodophors, what must happen? - Precise Answer ✔✔The antiseptic must have contact with the skin for two minutes or more to release free iodine Site preparation: Once applied, how long is the residual effect of Iodophors? - Precise Answer ✔✔Approximately two hours Site preparation: if iodine comes into contact with organic matter, such as blood, what happens? - Precise Answer ✔✔It is neutralized and no longer effective Site preparation: What solutions contain 1% to 2% iodine in an alcohol base? - Precise Answer ✔✔Tincture of Iodine