VA-BC EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS, Exams of Nursing

Download VA-BC EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS and more Exams Nursing in PDF only on Docsity! VA-BC EXAM 2024/2025 WITH 100% ACCURATE SOLUTIONS What size needle do you need for blood? How do you know if you cannulated an artery? You have a 16 year old patient and the PICC appears to be on the left side, how do you determine its in the vein and not artery? - Precise Answer ✔✔20-24 Bright red blood Preform ABG Patient needs one dose of vanco what would you recommend? How do you determine IO position placement? - Precise Answer ✔✔Midline across abdomen If patient states NO IV what do you? What body position do you do for PICC removal? What arm position for PICC removal? When should dressing be changed? - Precise Answer ✔✔Recommend IV upward arm below 2 days with gauze, 7 days without gauze The left SVC dumps into what? When should the arterial line set up be changed? How often do you change arterial lines? - Precise Answer ✔✔coronary sinus 96 hrs as needed Best way to keep the pulmonary artery catheter free of infection? How often do you change IV setups? What does the Swan (Pulmonary artery catheter) measures? - Precise Answer ✔✔put in sleeve 96 Hrs CO (cardiac output) CDC guideline for max barrier include what? Should you cut a PICC with a distal valve? What is optimal placement for a MIDLINE? - Precise Answer ✔✔Sterile gloves, cap, gown, full body sterile drape. NO 1 inch below axilla Which line has the less incidence of infection? What are the contraindications for a MIDLINE? - Precise Answer ✔✔Placement in arm with fracture, trauma, infection, AV fistula, or compromised circulation. Chronic kidney disease patients. What is the vessel selection for Midline? - Precise Answer ✔✔Basilic or cephalic vein in antecubital fossa What is the insertion procedures for MIDLINE? - Precise Answer ✔✔Follow guidelines, sterile technique, max sterile barrier precautions, 2 attempts per provider, PICC for midline risks liability as its against midline DFU. What are the supplies and the optimal tip location for MIDLINE? - Precise Answer ✔✔Midline device, sterile insertion tray, ultrasound, normal saline flush, dressing supplies. One inch below the axillary area. What are the Pediatric considerations for MIDLINE? - Precise Answer ✔✔alternative vein selection like the scalp, popliteal, and saphenous veins. What are the indications and Contraindications for Non-Tunneled Catheters? - Precise Answer ✔✔Short term and emergency central vein access. neck and chest sites excluded for trach patients, neck dissection, cervical fracture, or unstable airway. unable to position, insert, or stabilize catheter. Avoid same side as PICC. What is the vessel selection for Non-tunneled catheters? - Precise Answer ✔✔Jugular, Subclavian, or femoral veins What are the insertion procedures for non-tunneled catheters? - Precise Answer ✔✔Antimicrobial catheters for high risk patients, Follow guidelines, maximum sterile barrier precautions, put in slight trendelenburg to avoid air emboli, avoid blind stick, use ECG for tip location, check for blood return prior to infusion. What are the supplies for a non-tunneled catheters? - Precise Answer ✔✔Non-tunneled percutaneous venous catheter, sterile procedural insertion tray, max sterile barrier precautions, Ultrasound, normal saline flush, Heparin flush, dressing What is the Optimal tip location for non-tunneled catheters? - Precise Answer ✔✔Cavoatrial juncture, inferior vena cava at diaphragm if inserted in femoral vein. What are the indications for a PICC? - Precise Answer ✔✔Patients who require a central venous access when duration is unknown. irritating and vesicant agents. What are the Contraindications for a PICC? - Precise Answer ✔✔Placement in arm with fracture, trauma, infection, amputation, paralyzed (thrombosis risk), compromised circulation. Chronic kidney disease patients. What is the vessel selection for a PICC? - Precise Answer ✔✔Basilic, brachial, cephalic vein. What are the insertion procedures for a PICC? - Precise Answer ✔✔Antimicrobial catheters for high risk patients, follow guidelines, Max sterile barrier precautions, Avoid blind stick, avoid catheter tip in upper SVC or midclavicular, Confirm with ECG or radiograph, check for blood return prior to infusion What are the supplies for a PICC and what is the Optimal tip location? - Precise Answer ✔✔PICC device, Sterile insertion tray, Ultrasound, ECG system, normal saline flush, heparin flush. Caval atrial juncture What are the Pediatric considerations for a PICC? - Precise Answer ✔✔Alternative vein selection like scalp and popliteal vein. Heparin may decrease catheter occlusion. What are the indications for a Tunneled Catheters? - Precise Answer ✔✔Infusions for months or years, Apheresis, What is the insertion procedures and supplies for the Intraosseous Devices? - Precise Answer ✔✔Follow manufactures directions, site disinfection, aseptic technique, IV fluids, blood and meds may be administered. Supplies are interosseous access needle device, disinfecting agent, numbing agent, transparent dressing. What are the indications and contraindications for dialysis or apheresis Catheters? - Precise Answer ✔✔Indications are hemodialysis, apheresis for plasma or platelets. Contraindications is that its rarely used for infusion What is the site and vessel selection for Dialysis or Apheresis Catheters? - Precise Answer ✔✔Jugular, Subclavian or femoral vein. What is the Insertion procedures and Supplies for Dialysis or Apheresis Catheters? - Precise Answer ✔✔Follow manufactures directions, may be scheduled as operative procedure or interventional radiology procedure, catheter lumen is 13-16 gauge size, catheter ridged for rapid blood flow, avoid blind stink. Supplies are Dialysis or Apheresis catheter device, sterile insertion tray, ultrasound equipment, surgical equipment. What is the Optimal Tip Location for Dialysis or Apheresis Catheters? - Precise Answer ✔✔Upper right atrium What are the indications and contraindications for pulmonary artery catheters? - Precise Answer ✔✔Indications is assessment of cardiac function specifically to monitor Cardiac output. Contraindications is mitral stenosis, right heart mass, tricuspid or pulmonary mechanical valves. What is the site for pulmonary artery catheters? - Precise Answer ✔✔right subclavian or IJ What are the indication and contraindications for Aquapheresis Catheters? - Precise Answer ✔✔Indications is diuretic resistant CHF and contraindications is lack of accessible basilic vein in upper arm. What is the Optimal tip location for Aquapheresis Catheters? - Precise Answer ✔✔1-2 centimeters below the axilla Describe the things you need to know about Pediatric Umbilical catheters? - Precise Answer ✔✔The available vessels include 2 umbilical arteries and 1 umbilical vein. may access up to the 4th day and can use up until the 14th day. What are the different types of Skin preparation? - Precise Answer ✔✔Antiseptic: Chemical agent the inhibits microorganisms on skin to prevent infection. Disinfectant: Chemical agent that destroys microorganisms on objects. Aseptic Technique: Steps designed to reduce and minimize risk of transmission of pathogens to patient. No touch technique: type of aseptic technique where key areas of items for infusion are not to be touched prior to insertion. Describe what you should know about Chlorhexidine gluconate? - Precise Answer ✔✔Apply back and fourth for 30 seconds. Effective against gram positive and negative organisms. 48hrs of residual activity. caution with peds under 2 months of age. Describe what you should know about Alcohol? - Precise Answer ✔✔70% concentration and still used in skin antisepsis. denaturing the cell proteins and dissolving the cell lipids. bactericidal effect on gram positive and negative bacteria. has good fungicidal and virocidal activity. lacks residual once evaporates. Describe what you should know about surface disinfectant? - Precise Answer ✔✔Solution wipe that kill bacteria, viruses, and fungi on inanimate objects. Used on hard nonporous surfaces and equipmen betweent patient uses and prior to setting up sterile field. Describe what you should know about adhesive remover? - Precise Answer ✔✔Removes sticky residue, dressings, stitches. decrease skin trauma and tears. do not use on insertion site. What kind of precautions should you use during CVAD and peripheral midline insertion? - Precise Answer ✔✔MSBP (maximal sterile barrier precautions) What is the site and device selection in CKD stage 3 or greater or serum creatinine level greater than 2.0 mg/dl? - Precise Answer ✔✔Dorsal vein of dominant hand for venipunture because veins in forearm, upper arm, and subclavian are critical for possible hemodialysis fistula. What is the normal International normalized ratio normal range and what values are for anticoagulant therapy and for high intensity anticoagulant therapy? - Precise Answer ✔✔0.8-1.2 2.00-3.00 2.50-3.50 What is the frequency, hertz, attenuation, and resolution of ultrasound physics? - Precise Answer ✔✔frequency is number of times a phenomena occurs in one second hertz is cycle per second of sound energy attenuation is loss of us energy as it travels through a material or medium. resolution is quality of image with ability to differentiate anatomic structures. Can a patient family or friend translate for procedure? - Precise Answer ✔✔NO. Professional interpreters must be used. What are the different vascular access competencies? - Precise Answer ✔✔Competency: Demonstration of knowledge, skills, and abilities at a defined level of expertise. Clinical competency in nursing: Five levels have been identified being novice, advanced beginner, competent, proficient, and expert. Clinical competency in medicine: specialty area including knowledge, skills, attitudes, and ability to translate. Competency assessment: evaluation measuring a set of skills and knowledge in the right way and right time. What is Interdisciplinary Collaboration? - Precise Answer ✔✔the process in which individuals from different disciplines collaborate to set goals, plan of care, make decisions, and solve problems. What is Cultural diversity? - Precise Answer ✔✔The learned, shared, and transmitted values, beliefs, norms, and life ways of a group that guides their thinking, decisions, and actions. What is a mentor? - Precise Answer ✔✔Person who teaches, guides, coaches, gives advice, and assistance to colleague creating a trusting relationship. What is Incidence, Incidence proportion, incidence rate, prevalence, morbidity, mortality? - Precise Answer ✔✔Incidence: Occurrence of new cases of disease or injury in a population over a certain time period. Incidence proportion: Proportion of an initially disease-free population that develops disease, becomes injured, or dies during a certain time period like attach rate, risk, a probability of getting disease. Incidence rate: Incidence rate or person time rate is a measure of incidence that incorporates time like the number of infections in a year. Prevalence: The number of cases, both old and new, present at a point in time in a defined population like how 10% of patients in the ICU have positive blood cultures during their stay. Morbidity: Rate at which an illness or abnormality occurs like morbidity of diabetes is 30% among hospital patients. Mortality: Death rate. What are the Ethical Principles? - Precise Answer ✔✔Beneficence: The obligation to do no harm. Justice:Fair and unbiased actions Autonomy:The right of a person to make independent decisions. Veracity:The obligation to tell the truth. What should you know about informed consent? - Precise Answer ✔✔Consent is freely given and is verified by patient signature on correct form. 1. Device selection may be limited in pediatric patients due to small size of vessel or patient activity. T or F 2. Do pediatric patients have more or less venous options to choose from? 11. T 12. Interferes with crawling and ambulating 13. Non-vesicants, >900 mOsm/L 14. Polyurethane 15. How much pressure are power injectable ports rated to withstand? 16. Patients with known septicemia, neutropenia or thrombocytopenia may benefit from what specific type of VAD? 17. IVAD is indicated for complex chemo or infusion therapy > than? 18. What type of CVAD is recommended for patients with acute leukemia and other cancers and blood and bone marrow transplants? 19. Who are tunneled CVADs used more frequently with? - Precise Answer ✔✔15. >300 pounds per square inch (PSI) 16. PICC with antimicrobial properties 17. 3 months 18. Tunneled CVAD 19. Infants and younger children 20. IVADs are used less frequently with pediatric population. Why? 21. Chemotherapy/biotherapy: CVAD required for tx > how long, for vesicant tx > how long, or continuous tx > than how long? 22. Chemo/biotherapy: A blood return is not needed prior to infusion therapy. T or F 23. Why should chemotherapy lines and infusions not be interrupted if at all possible? 24. What are the recommended devices for chemotherapy? 25. When administering TPN, any CVAD is acceptable to use. T or F 26. For infants and toddlers receiving TPN, what access devices is recommended? - Precise Answer ✔✔20. Size of patient, fear of needle, increased risk of dislodgement 21. 3 months, 1 hour, 24-96 hours 22. F 23. Increased patient risk of infection, increased exposure risk to clinician 24. Tunneled CVAD or PICC 25. T 26. Tunneled CVAD 27. Intravenous infusion of multiple and/or simultaneous medication sand solutions may require a multi-lumen catheter. Is if best to check for compatibilities prior to choosing the number of lumens? 28. For medications such as Remodulin, or Prostacylin, what type of access device is best? 29. For Stem Cell Apheresis and Plasmapheresis a large bore catheter is required for flow rates of? 30. Hemodialysis devices are temporary or long term. What flow rates are required for HD? 31. Aquapheresis is designated to do what? 32. What devices is recommended for Aquaphoresis? 33. There are multiple contraindications for placement of VAD on Ipsilateral side. Name some potential contraindications. - Precise Answer ✔✔27. Yes 45. For PICCs placed in arm, how should you position the arm ideally? 46. When measuring for PICC placement in upper extremities, what order should you do the measurements? a. Planned insertion site, right clavicular head, 3rd intercostal space b. 3rd intercostal space, left clavicular head, planned insertion site c. Planned insertion site, left clavicular head, 3rd intercostal space - Precise Answer ✔✔41. False 42. Skin turgor, cuts, edema, ecchymosis, grafts, swelling 43. Neighboring or central vein stenosis or occlusion 44. Distal stenosis or occlusion 45. 90 degrees 46. A 47. Studies are reported that landmark based measurements have as much as a % failure rate? a. 30% b. 50% c. 10% 48. For PICCs inserted in the scalp, how do you measure? a. Planned insertion site, along the jugular vein, right clavicular head, 3rd intercostal space b. Planned insertion site, along jugular artery, left clavicular head, 3rd intercostal space 49. For PICCs inserted in lower extremities, how do you measure? a. Planned insertion site, up leg to umbilicus, continue to the Xyphoid process b. From 3rd clavicular space, along body, down to planned insertion site 50. Veins transport deoxygenated blood from tissues to the right side of the heart. T or F 51. Arteries transport oxygenated blood from left heart to organs and tissues. T or F 52. Veins have thicker vascular walls than arteries. T or F 53. Arteries collapse under pressure. T or F 54. The color of venous blood is bright red. T or F 55. The color of ar - Precise Answer ✔✔47. A 48. A 49. A 50. True 51. True 52. False 53. False 54. False 55. False 56. Arteries contain valves. T or F 57. The function of the pulmonary vein is the transport of oxygenated blood to the left side of the heart. T or F 58. The pulmonary artery transports blood through the capillary bed of the lungs. What occurs next? 59. The inner most layer of a vessel is? 60. The outer most layer of a vessel is? 61. The middle layer of a vessel is? 62. What layer of a vein or artery, if damaged, can cause a thrombus? 63. The tunica media contains nerve fibers for vasoconstriction and dilation. T or F 64. What layer of an artery vasoconstricts with pain and anxiety? - Precise Answer ✔✔56. False 57. True 58. O2 and CO2 exchange 59. Tunica intima/endothelium 60. Tunica adventitia 61. Tunica media 62. Tunica intima 63. True 80. Although subclavian entrance is lower risk for infection, why is the IJ the vein of choice for tunneled implanted ports? - Precise Answer ✔✔72. Axillary 73. Nephrologist 74. False- 1st rib 75. Brachiocephalic 76. True 77. Brachiocephalic 78. 90 degrees 79. IJ 80. Direct route to brachiocephalic; helps avoid pinch off syndrome 81. What vessel is the easiest to access for an emergency short term IV access? 82. What vessel forms from the confluence of the left and right brachiocephalic veins? 83. Does the SVC have valves? 84. What portion of the SVC is ideal for CVAD tip placement? 85. The SVC allows for 2 liters of blood flow per minute. T or F 86. This vessel forms from the confluence of the iliac veins and is located below the diaphragm. 87. CVADS that are placed in the lower extremities should have their catheter tip above or below the level of the diaphragm? 88. This vessel lies within the femoral triangle in the inguinal femoral area. - Precise Answer ✔✔81. EJ 82. SVC 83. No 84. Lower third 85. True 86. IVC 87. Above 88. Femoral 89. Locating the femoral vein is done by palpating the point of maximal pulsation of the femoral artery, immediately below the level of the inguinal ligament and marking a point approximately 0.5 cm medial to the pulsation. T or F 90. Ambulatory patients are an absolute contraindication of femoral central venous access due to risk of catheter fracture or migration. T or F 91. Relative contraindications of femoral central venous access include presence of bleeding disorders, distortion of anatomy due to injury or deformity, previous long-term venous catheterization, absence of a clearly palpable femoral artery, history of vasculitis, previous injection of sclerosis agents, or previous radiation therapy. T or F 92. The six alternative veins for difficult access are: Hepatic, Azygos, Posterior auricular, Saphenous, Popiteal, and Umbilical. T or F 93. The umbilical vein can be accessed after 1 week of birth. T or F 94. T - Precise Answer ✔✔89. True 90. True 91. True 92. True 93. False 94. True 95. Azygos 96. Saphenous 97. Radial 98. Unlike pediatric patients on unmonitored specialty units, PICCs in NICU, ICU and PICU are often placed at the bedside. T or F 99. What positions are optimal for PICC insertion? 100. Can you use CHG as a prep on a child under the age of 2 months? 110. True 111. 48 hours 112. 5 to 7 days 113. True 114. 2 days 115. True 116. False 117. Re-advancing the wire back into the catheter 118. Document a dressing change along with site condition and patient response according to policy. T or F 119. What should you do if the needleless connect is disconnected? 120. It there is blood or debris within the needless connector, prior to drawing blood culture sample from catheter, upon contaminations, or according to policy or manufacturer's directions. What is this an example of? 121. What types of products are acceptable for disinfecting the hub prior to each access? 122. Heparin lock solution of how many units/mL is used before removal of an access needle from an implanted port and/or for periodic access and flushing? 123. The recommended and preferred heparin lock solution is how many units/mL? 124. Heparin lock solution for hemodialysis catheters is how many units/mL after each use? 125. What is an anti-infective central vascular access device? 126. A 3-port temporary catheter placed at bedside - Precise Answer ✔✔118. True 119. Clamp the catheter 120. Removal or changing of needleless connector 121. Alcohol, tincture or iodine, or chlorhexidine gluconate/alcohol combination prior to each access 122. 100 123. 10 124. 1000 125. Devices coated or impregnated with chlorhexidine and silver sulfadiazine, minocycline and rifampin, and silver ion. Make sure they are not used on patients with allergies to the item. 126. Triple lumen catheter 127. True 128. What are Hickman catheters used for? 129. Access implantable ports using aseptic technique with a non-coring needle called? 130. How do you determine the length of the Huber needle for insertion? 131. Power injectable ports can withstand 5 mL/sec and 300 psi when using a power injectable Huber needle. T or F 132. It is acceptable to access a power port with a non-power injectable non-coring needle. T or F 133. Fracturing of a non-power injectable port is possible if misidentified as a power port and receives injectable contrast from CT. T or F 134. If a central line becomes clotted, the physician may order fibrinolytic therapy. What would be an example of one? 135. It takes approximately how many hours for the site of a central line to be healed? 136. When culturing the tip of a catheter, what needs to be used to clip the tip? 137. Considerations to be made when selecting site for IVs. What are they? 140. 70% alcohol, tincture of iodine, or alcohol-chlorhexidine gluconate solution 141. A 142. A 143. A 144. A 145. A 146. A 147. Bloodborne Pathogen Rule and hazardous waste rule comes from what governing body? a. OSHA b. FDA c. FBI d. CDC 148. Accreditation Standards and Quality core measures is by: a. Joint Commission (JCAHO) or DNV b. CDC c. OSHA 149. The attempt or threat to do bodily injury to another is: a. Assault b. Battery c. Force d. Harm 150. Actual physical contact that causes harm and physical contact without consent is: a. Battery b. Assault c. Force 151. The legal structure that deal with the rights of an individual person or corporation is: a. Civil Law b. Federal law c. Courts and Judges 152. The legal structure that deals with an offense against the general public or society as a whole. Actions by licensed persons against medical practice acts or nurse practice acts are considered criminal offenses. a. Criminal Law b. Courts and Judges c. Civil Law 153. Professional misconduct, unreasonable lack of skill, and/or not acti - Precise Answer ✔✔147. A 148. A 149. A 150. A 151. A 152. A 153. A 154. A 155. Each person is responsible for his/her own "wrong doing". No other person may assume responsibility for another. a. Rule of personal liability b. Negligence c. Malpractice d. Sentinel event 156. Serious, undesirable outcome of care that requires investigation. a. Sentinel event b. Negligence c. Malpractice d. Criminal law 157. Level "A" type of evidence based practice is based on randomized control trials (rct). T or F 158. Well-designed control trials without randomization are less strong in validity due to the lack of control of variable at the initiation of the trial. Some concerns or problems with this type of trial include intentional or unintentional bias in participant enrollment is evidence based practice level: a. B b. C c. D d. A 177. Saphenous vein provides an alternative site for lower extremity CVC, but should not be considered for a crawling patient. T or F 178. Umbilical vein is patent for 1 week post birth and can have a single or double lumen catheter inserted; the catheter tip must reside ab - Precise Answer ✔✔171. True 172. True 173. True 174. True 175. True 176. True 177. True 178. True 179. True 180. True 181. True 182. True 183. Collagen and platelet activation occurs when catheter tip is infusing against the vein wall, or catheter movement causes damage or trauma to vein endothelium. T or F 184. Cystic fibrosis patients can have venous stenosis due to frequent IV therapy. T or F 185. Age 0-18 month child has separation anxiety and should have encouragement of parent and calm environment. T or F 186. 18 month-3 year old toddler is egocentric, may need mild to moderate sedation and a comfort item during procedure. T or F 187. You should reassure a child that he/she hasn't done anything wrong and that the procedure is not a form of punishment for what age group? a. 3-5 year old preschooler b. 18 months-3 years toddler c. 6-12 years school age 188. What are the purposes of IV placement? a. NPO b. Fluid loss c. Blood loss d. Drug administration e. All of the above 189. What are types of IV fluids? a. Crystalloid b. Colloid c. Blood products - Precise Answer ✔✔183. True 184. True 185. True 186. True 187. A 188. E 189. D 190. A 191. A 192. D 193. A 194. Colloids are for: a. Maintaining oncotic pressure; aqueous solution of high molecular weight b. Improve O2 carrying capacity c. Low molecular weight; fluid resuscitation 195. Blood products are given to: A. Improve O2 carrying capacity B. Fluid resuscitate C. Maintain hemoglobin D. A and C E. A and B 196. The ulnar artery provides the majority of blood flow to the hand in 90% of patients. T or F 197. Indications for arterial lines are BP monitoring, blood sampling, and deliberate hypotension. T or F 198. A central line is any catheter that the tip resides beyond the axillary vein, into the thorax. T or F 199. Catheter size should NOT take up more than 1/3 of the vessel size to allow adequate blood flow around catheter. T or F