PPNC 2024 exam 2 questions with
complete solutions
Describe the considerations for choosing an IV site - ANSWERS-Ideal site: most distal vein of upper
extremity
-Upper extremity = large & forearm creates natural splint
-Lower extremities should be avoided due to insufficient peripheral circulation (increases risk for
thrombus formation)
-Ease of access (straight vein)
-Non-dominant hand
-Avoid joint areas
-Utilize vein finder if available
-May "pop-out" as it engorges with blood or may feel springing
nursing care & IV insertion - ANSWERS-Advance needle at 30-45 degree angle (flashback confirms entry
into vein)
-Avoid placing the tourniquet too tight (there should not be an absence of the radial pulse
-Clean site for 30 seconds
-Assess pain
-Document: date, time, initials, placement site, # of attempts, length and gauge of catheter, assessment
of site, patency, patient tolerance
infiltration - ANSWERS-The seepage of non-vesicant solution or medication into surrounding tissues.
-Treatment: Stop the infusion, restart the infusion in a different vein, and elevate the affected arm on a
pillow to promote absorption of excess fluid
thrombosis - ANSWERS-Local coagulation or clotting of the blood surrounding the IV site
-Treatment: Discontinue the IV infusion and restart in the opposite extremity using new equipment.
Apply warm, moist compresses. Consult the primary care provider.
,infection - ANSWERS-Microbial contamination of the cannula or IV site.
-Treatment: Remove the IV line, apply a sterile dressing over the site, and administer antibiotics if
necessary
phlebitis - ANSWERS-redness, pain, & warmth at injection site (inflammation of vein)
-Treatment: Discontinue the IV infusion and restart in a new location, apply cold compresses to the site if
the site is warm and tender, warm compresses after, assess for circulatory impairment
IV complications - ANSWERS-minor bleeding, infection (localized, cellulitis, phlebitis), infiltration, abscess
formation
-Inserting an IV catheter breaks the body's first line of defense and provides a portal of entry of
microorganisms which can cause infection
-trauma roughness to the vein wall predisposes the person to platelet clumping and thrombus formation
indications for CVCs - ANSWERSAutoimmune disorders, blood sampling, blood transfusions, heart failure,
hemodynamic monitoring, medication administration (cancer, contrast media, infection, pain, etc),
nutritional replacement, renal failure, shock, burns
types of CVCs - ANSWERS-Peripherally inserted central catheter: intermediate to long-term use; not
routinely replaced
-Nontunneled central catheter: shorter use (6 weeks); not routinely replaced
-Tunneled central catheter: long-term
-Implanted ports: long-term
complications of CVCs - ANSWERSCatheter migration, catheter-related infection, catheter occlusion,
embolism, pneumothorax
nursing management of CVCs - ANSWERS-Aseptic technique
-Dressing changes
-IV management (flow rates, pumps, etc)
-Administering blood transfusions/blood products
, -Managing reactions
-Injection cap changes
-Maintenance of catheter patency
rationale for CVC placement - ANSWERS-prolonged IV antibiotic therapy, parenteral nutrition,
chemotherapy, diagnostics (blood draws)
-Infection prevention (ex. Tunneled catheters)
infection prevention of CVCs - ANSWERS-Hand hygiene
-Full barrier precautions (sterile drape, gown, gloves)
-Chlorhexidine skin antisepsis
-Optimal site selection
-Type of catheter (fewest number of ports/lumens = better)
-Daily review of lines
IV insertion procedure - ANSWERS-Apply a tourniquet 10-20 cm (4-8in) above selected site
-Palpate the vein & make sure it rebounds quickly
-Prime w/ NS at injection port
-Swab site w/ chlorhexidine or 70% alcohol for 10 seconds (allow to dry, do not fan)
-After flashback, advance catheter 1/4 inch
-Do not cover tubing with dressing-\
-When removing, hold pressure w/ gauze over site for 1-3 min
CVL dressing change procedure - ANSWERS-Sterile equipment (wear mask)
-Patient in semi-fowlers
-Remove soiled dressing with clean nonsterile gloves and dispose
-Scrub site with antiseptic swab
-Chlorhexidine products for 30 seconds
-Apply chlorhexidine gluconate sponge (biopatch) as part of dressing
