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VA BC EXAM 2024 ACTUAL Exam 2 VERSIONS (VERSION A AND B) COMPLETE QUESTIONS WITH DETAILED ANSWERS
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VA BC EXAM 2024 ACTUAL Exam 2 VERSIONS (VERSION A AND B) COMPLETE QUESTIONS WITH DETAILED ANSWERS
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VA BC EXAM 2024 ACTUAL Exam 2 VERSIONS(VERSION A AND B) COMPLETE QUESTIONS WITH
DETAILED ANSWERS
Version 1
Cognitive Impairment patient considerations - ANSWERthe decision making ability of a
person under the influence of drugs, alcohol, or anesthetic is altered and therefore they
are not able to consent while impaired; verify patient and family healthcare literacy
mental illness patient considerations - ANSWERdecision making ability is determined by
the person's ability to understand information, decision capacity, and voluntarism;
determination made on a case-by-case basis; formal psychiatric evaluation or
consultation may be needed as part of the consent process
limited language proficiency patient considerations - ANSWERcan create disparities in
the informed consent process; professional interpreters are necessary when
communicating with patients with a language barrier; patient's family or friends should
not be used; when possible, informed consent forms are provided in patient's first
language regardless of proficiency in non-primary language; when professional
translators unavailable, consult facilities policy on using staff members are translators
religious objections to medical care patient considerations - ANSWERindividuals can
sometimes decline care for themselves or their children on the basis of religious beliefs,
clinicians need to be sensitive to religious beliefs and practices of patients and their
families
cultural differences for patient considerations - ANSWERassess cultural needs with
admission to healthcare, clinicians should attempt to make collaborative decisions
whenever possible, taking care when considering authority to override personal or
parental preferences
vulnerable populations patient considerations - ANSWERvulnerable populations leave
patient at risk for skewed power dynamics in interpersonal relationships creating an
environment prone to coercion; situations in which patients have multiple sources of
vulnerability that impact the process of informed consent
-pediatric, aging, prison, behavioral/mentally challenged
,informed consent with CVAD placement - ANSWER-is a patient educational process
involving shared decision making
-selection of the most appropriate vascular access device occurs as a collaborative
process among the interprofessional team, the patient, and the patients caregivers
-patient preference must also be considered in VAD site selection, yet has not been
considered a high priority
Recommendations for facilitating informed consent process include: - ANSWER-provide
education material and a consent form at the educational level between the fourth and
sixth grades
-use a medical interpreter for non-english speaking patients
-use appropriate resources for those with visual and hearing deficits
-allow adequate time and opportunity for questions and answers
-use the most appropriate method to deliver the information
-validate understanding using the teach back method
-collaborate with the provider if confusion or need for further explanation expressed
What size syringe to use for flushing central line - ANSWERuse a 10mL or larger
syringe to minimize pressure on the catheter
How often do you change securement device? - ANSWER-transparent semipermeable
membrane (TSM) dressing: every 7 days or when soiled and loose
-gauze dressing: every 2 days or when soiled and loose
cause of arrhythmia during catheter placement - ANSWERcatheter or wire annoying
cardiac conduction
prevention of arrhythmia during catheter placement - ANSWER-ensure optimal tip
positioning
-careful measurement and documentation of external anatomic landmarks
-adequate stabilization and proper dressing management
-consider left sided insertion for patients with cardiac conditions to allow for more space
before reaching sensitive areas of the heart
treatment of arrhythmias during catheter placement - ANSWER-if catheter is tunneled or
implanted, refer to IR
-retract any catheter that CXR has indicated is in the R atrium
Infant (0-18mo) considerations - ANSWER-trust vs mistrust
-fears: separation anxiety, fear of strangers >6 mo, communicates by crying, object
permanence by 9mo
-support parents, encourage presence if beneficial, provide calm environment preferably
not in patients bed, limit # of providers
-child life specialist when available, oral sucrose, pacifier, comfort item, topical
anesthetics, cold and vibration, comfort positioning
, early childhood (18mo-3yr) considerations - ANSWER-autonomy vs shame and doubt
-fears: separation anxiety, loss of control, egocentric
-support parents and encourage presence if beneficial, provide a calm environment,
simple instructions using non threatening words, limit # of providers
-child life specialist when available, pacifier, comfort item, topical anesthetics, cold and
vibration, comfort position, distraction, mild sedation/anxiolytic, moderate sedation with
monitoring
Preschool (3-5yr) considerations - ANSWER-initiative vs guilt
-fears: bodily injury/mutilation, loss of control, fear of the unknown, the dark, being
alone, follows directions but has short attention span
-support parents and encourage presence if beneficial, provide a calm environment,
offer two choices when possible and let the child decide, simple instructions using non
threatening words, praise often for cooperation, limit # of providers needed
-child life specialist when available, pacifier, comfort item, topical anesthetics, cold and
vibration, comfort position, distraction, mild sedation/anxiolytic, moderate sedation with
monitoring
School Age (6-12yr) considerations - ANSWER-Industry vs inferiority
-fears: bodily injury or mutilation, loss of control, not being able to live up to expectations
of important others, death, capable of following directions and can be involved in
treatment
-support parents and encourage presence if beneficial, provide a calm environment,
offer choices when possible and let the child decide, simple instructions using non
threatening words, praise often for cooperation, limit # of providers needed
-child life specialist when available, topical anesthetics, cold and vibration, distraction,
massage/acupressure, mild sedation/anxiolytics, moderate sedation with monitoring
Adolescence (13-18yrs) considerations - ANSWER-identity vs role confusion
-fears: very conscious of body image and appearance, fearful of something happening
that will make them different from their peers, increasingly capable of abstract thought
and reasoning, taking more responsibility for decisions, striving for independence but
may have difficulty accepting new authority figures and resist compliance with
procedures
-prepare ahead of time with accurate information, provide and guard privacy, include
and encourage to participate in discussion regarding care, answer questions honestly
and explain consequences of decisions or procedures
-child life specialist when available, topical anesthetics, cold and vibration, distraction,
massage/acupressure, mild sedation/anxiolytics, moderate sedation with monitoring
Best place for IJ placement - ANSWER-preferred place of access for patients with CKD
-access using a small diameter (<8 Fr) intended for long term use (>1 week) should be
inserted via subcutaneous tunnel
-has been show to decrease the risk of CLASBI
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