Question 1

The most common site for central line catheterization?

Accepted Answer

Answer reason: Among common central venous access sites, the internal jugular vein is most frequently used due to easy ultrasound-guided access and a favorable safety profile; the radial and brachial veins are peripheral sites.

Question 2

What is the most common site for central line catheterization?

Accepted Answer

Answer reason: The internal jugular vein is the most commonly used site for central venous catheterization due to its straight path to the SVC, ease of ultrasound-guided access, and lower complication rates compared with alternatives. Femoral is used in emergencies but has higher infection risk; radial and brachial veins are not typical central line sites.

Question 3

Which syringe is used for flushing a PICC?

Accepted Answer

Answer reason: For PICC lines, smaller syringes generate higher pressure and risk catheter damage. Use the largest available size; while best practice is a 10 mL syringe, among these options 5 mL is the safest choice.

Question 4

A client with a stroke and malnutrition has been placed on Total Parenteral Nutrition (TPN). The nurse notes air entering the client via the central line. Which initial action is most appropriate?

Accepted Answer

Answer reason: Suspected venous air embolism from a central line requires immediate left lateral positioning (Durant maneuver) to trap air in the right atrium and prevent pulmonary embolization, then notify provider. Elevating the head may worsen it; stopping TPN is not the first priority.

Question 5

Which of the following is a purpose of inserting central venous catheters?

Accepted Answer

Answer reason: Central lines are used to monitor CVP, allow rapid infusion of large fluid volumes, and provide durable long-term venous access (e.g., TPN, chemo). Therefore all listed purposes are correct.

Question 6

The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to?

Accepted Answer

Answer reason: During central venous catheter removal, the client should perform the Valsalva maneuver (bear down/hold breath) to increase intrathoracic pressure and prevent air embolism. Options about head turning or taking slow deep breaths do not reduce the risk of air entry.

Question 7

How often should site care and dressing changes be performed for a patient with TPN?

Accepted Answer

Answer reason: For TPN via a central line, transparent semipermeable dressings are changed every 7 days (or sooner if soiled/loose) to prevent infection; daily or more frequent changes are unnecessary, and every other week is too infrequent.

Question 8

The nurse is caring for a client following the removal of a central line catheter when the client suddenly develops dyspnea and complains of substernal chest pain. The client is noticeably confused and fearful. Based on the client's symptoms, the nurse should suspect which complication of central line use?

Accepted Answer

Answer reason: Sudden dyspnea, substernal chest pain, and acute confusion immediately after central line removal are classic signs of venous air embolism.

Question 9

The physician is preparing to remove a central line. The nurse should tell the client to?

Accepted Answer

Answer reason: Having the client hold a deep breath (Valsalva maneuver) during central line removal increases intrathoracic pressure and helps prevent air embolism.

Question 10

If a very active 2 year-old client pulls his tunneled central venous catheter out, what INITIAL nursing action is appropriate?

Accepted Answer

Answer reason: Immediate priority is to control bleeding and prevent air embolism by applying direct pressure to the venous entry site. The other actions are secondary.

Question 11

What is the most common site for central line catheterization?

Accepted Answer

Answer reason: Among common central venous access sites, the internal jugular vein is most frequently used due to reliable ultrasound guidance and favorable complication profile; radial and brachial are peripheral veins.

Question 12

A client is receiving Total Parenteral Nutrition (TPN) via Hickman catheter. The catheter accidentally becomes dislodged from the site. Which of the following actions by the nurse should take priority?

Accepted Answer

Answer reason: A dislodged central venous catheter creates immediate risk of bleeding and air embolus; the priority is to occlude the site with a pressure dressing to prevent air entry and hemorrhage.

Question 13

The tip position of a PICC is usually confirmed by?

Accepted Answer

Answer reason: After PICC insertion, tip location is most commonly verified with a chest radiograph to ensure the catheter terminates in the lower SVC/cavoatrial junction and to detect malposition. Palpation or auscultation cannot reliably determine intravascular catheter tip position. CT can show the tip but is not the usual/standard confirmation method due to cost and radiation compared with routine X-ray.

Question 14

Best position for a client during insertion of a central venous catheter (e.g., subclavian line)?

Accepted Answer

Answer reason: This position distends the central veins, improving access and reducing the chance of venous air entry during catheter insertion. Head-down positioning also decreases the risk of air embolism by increasing central venous pressure relative to atmospheric pressure. High Fowler’s can increase air-embolism risk, and prone/left lateral are not standard positioning for subclavian CVC insertion.

Question 15

The nurse is verifying the placement of a left subclavian central venous catheter (CVC) with radiology department prior to using the catheter. Where should the tip of the CVC be located?

Accepted Answer

Answer reason: The safe target for a central venous catheter tip is the distal superior vena cava near the cavoatrial junction to allow rapid hemodilution of infusates and reliable central venous access. Placement in the right atrium increases the risk of dysrhythmias and cardiac perforation/tamponade from endocardial irritation. A tip in the internal jugular suggests malposition and can lead to inaccurate CVP readings and thrombosis. Arterial placement (e.g., subclavian artery) is a dangerous complication associated with hematoma, stroke risk, and inappropriate delivery of vesicant medications.

Question 16

When drawing blood from a central venous access device, how many milliliters of blood should the nurse discard before drawing the laboratory specimen?

Accepted Answer

Answer reason: A waste (discard) volume is required when drawing from a central venous access device to clear residual flush solution (e.g., normal saline) and any heparin or diluted blood in the catheter lumen so the sample reflects circulating blood. Discarding 10 mL is a commonly taught standard for adult central line draws and is sufficient to remove the dead-space contents for accurate lab results. Smaller volumes risk dilution and inaccurate values, particularly for coagulation studies and drug levels. Larger discard volumes are generally unnecessary and can contribute to avoidable blood loss, especially with frequent draws.

Question 17

A client receives an implanted port. After insertion, an x-ray is performed to determine proper positioning. The tip of the catheter should be located in which vascular structure?

Accepted Answer

Answer reason: Central venous access devices (including implanted ports) are intended to deliver infusates into a high-flow central vein to rapidly dilute medications and reduce the risk of vessel irritation and thrombosis. Proper tip placement is at the cavoatrial junction/low superior vena cava, which is why a post-insertion chest x-ray is used to confirm position. Placement in the left atrium would be malposition with serious risks such as arrhythmias, perforation, and systemic embolization. The aortic arch is an arterial structure and indicates incorrect placement, and the inferior vena cava is not the expected location for a typical chest-inserted port catheter.

Question 18

A client complains of pain at the insertion site of an implanted venous port device during infusion of a medication. Which is the most likely explanation for this problem?

Accepted Answer

Answer reason: Pain or burning at the port site during an infusion most strongly suggests infiltration of the infusate into surrounding tissue due to nonpatent access or needle displacement from the port septum. This local tissue exposure is typical of extravasation and can occur even with an implanted port if the noncoring needle is not correctly seated. An occlusion more often presents as resistance to flushing or inability to infuse rather than immediate local pain with infusion. A malpositioned catheter typically causes poor blood return, difficulty infusing, or chest/neck symptoms, while chylothorax would not present as isolated insertion-site pain during medication administration.

Question 19

The nurse is assisting the physician with the placement of a central line. Which catheter, when properly positioned, is in the superior vena cava?

Accepted Answer

Answer reason: Central venous catheters are intended to terminate in a large central vein to allow reliable hemodilution and accurate central venous pressure measurement. Proper tip placement is at the cavoatrial junction, typically within the lower superior vena cava just above the right atrium. A pulmonary artery catheter must pass through the right heart into the pulmonary artery, so its tip is not in the superior vena cava. Left atrial and right atrial catheter placements terminate in their respective chambers rather than in the superior vena cava, increasing different risks and not matching standard central line tip location.

Question 20

The nurse gathers supplies needed to access an implanted port in a client. Which equipment is appropriate for use in this client?

Accepted Answer

Answer reason: Implanted ports have a self-sealing silicone septum that must be accessed with a noncoring (Huber) needle to avoid cutting and coring the septum, which can cause leakage, extravasation, and device failure. The noncoring design distributes pressure and creates a “deflected” tip that enters the port without punching out a plug of silicone. Standard straight needles or butterfly needles can damage the septum and are not recommended for port access. An over-the-needle peripheral catheter is designed for peripheral venipuncture and is inappropriate for accessing a port reservoir.

Question 21

The nurse who is accessing a client’s central line notices the infusion rate is difficult to maintain. The nurse notes the rate is affected when the client raises an arm or moves a shoulder. The nurse should be concerned with which possible complication?

Accepted Answer

Answer reason: Mechanical obstruction of a central venous catheter that varies with arm/shoulder movement strongly suggests intermittent catheter compression between the clavicle and first rib. This positional occlusion causes inconsistent flow and can progress to catheter damage or fracture with risk of embolization. In contrast, extravasation and phlebitis are more associated with local site pain, swelling, erythema, and tissue irritation rather than a purely position-dependent change in infusion rate. Central vein thrombosis more often causes persistent resistance to infusion/aspiration and extremity/neck swelling rather than a problem that predictably changes with shoulder motion.

Question 22

A client has a Groshong central venous access device. The nurse prepares to flush the device. Which information is correct regarding the flushing?

Accepted Answer

Answer reason: Groshong catheters have a pressure-activated valve at the distal tip that helps reduce backflow and generally allows maintenance with normal saline rather than routine heparin. Using an adequate saline volume helps clear the lumen and reduce occlusion risk, and weekly flushing is a common maintenance interval when the line is not in frequent use (per facility policy). A very small flush volume (e.g., 2 mL) is typically insufficient to reliably clear a central catheter. Daily high-concentration heparin (1000 units/mL) is unnecessary for this device and increases bleeding/medication-risk without added benefit for routine maintenance.

Question 23

The nurse finds the client with a disconnected central venous access device. The client complains of chest pain and dyspnea. The client’s blood pressure is 84/52 mm Hg and pulse is 150 beats/minute. Which nursing action takes priority?

Accepted Answer

Answer reason: A disconnected central venous access device creates high risk for venous air embolism, suggested here by sudden dyspnea/chest pain with hypotension and marked tachycardia. The immediate priority is to prevent further air movement into the pulmonary circulation by positioning the patient in left lateral decubitus (Durant maneuver) to help trap air in the right atrium/ventricle. This is a rapid bedside action that can be initiated without delay while additional emergency measures are prepared. Calling the provider and monitoring oxygenation are important, but they do not address the immediate life-threatening mechanism and must follow the first stabilizing intervention.

Question 24

When accessing a Groshong tunneled venous access device, the nurse notes there is no clamp on the end. Which action should the nurse take?

Accepted Answer

Answer reason: Groshong catheters have a pressure-activated valve at the distal tip that remains closed when not in use, which helps prevent air entry and blood reflux, so an external clamp is not required. The appropriate nursing action is to recognize this as a normal device feature and proceed using correct central-line access technique (asepsis, proper flushing). Applying a clamp or improvised occlusion can damage the catheter or create flow obstruction and is not indicated. Notifying the inserter is unnecessary in the absence of a device malfunction or complication.

Question 25

A peripherally inserted central catheter (PICC) line is ordered for a client. Which statement made by the nurse indicates an understanding of the proper insertion information for this intravenous access device?

Accepted Answer

Answer reason: Once I get this line in, it will need to be checked with an x-ray. The line should be in the superior vena cava. The key principle is that a PICC is a central venous catheter inserted peripherally, and safe use requires confirmation of the catheter tip location before infusing prescribed therapies. Post-insertion radiographic verification is standard to ensure the tip terminates in the lower superior vena cava/cavoatrial junction, reducing risks such as malposition, thrombosis, and infusion-related complications. It also demonstrates understanding that tip position—not just successful cannulation—determines whether the device is appropriate for central infusions. In contrast, restricting the line only to antibiotics is incorrect because PICCs can be used for multiple compatible infusions, and the typical dwell time is longer than 2 weeks when maintained correctly.

Question 26

A client receiving total parenteral nutrition (TPN) through a central venous catheter is noted to have a damp, partially detached occlusive dressing at the insertion site. The client denies shortness of breath, and lung sounds are clear bilaterally. What is the nurse’s priority action?

Accepted Answer

Answer reason: A moist, loosened occlusive dressing indicates loss of a sterile barrier at the central venous catheter site, increasing the risk of catheter-related infection. The priority is to immediately restore site integrity by changing the dressing using sterile technique. There are no signs of respiratory compromise to suggest air embolism. Obtaining a culture and notifying the provider may be necessary but are secondary to securing the site.

Question 27

The client has a tunneled Groshong catheter for intermittent medication administration. After administering the medication, the nurse prepares to do which of the following?

Accepted Answer

Answer reason: The key principle is maintaining central line patency while preventing occlusion and infection using the device-specific protocol. Groshong catheters have a pressure-activated valve, so they are typically flushed with normal saline before/after intermittent medications to clear the lumen and reduce clot/medication residue. Routine heparin locking is generally not required with a Groshong because the valve design helps prevent blood reflux, making scheduled heparin an unnecessary risk (e.g., bleeding, medication error) unless agency policy specifically indicates otherwise. Clamping is not the primary post-med step for this valved catheter, and instructing a Valsalva maneuver is more relevant to catheter removal or preventing air embolism during certain line manipulations, not routine medication tubing disconnection with a closed system.

Question 28

The client has a percutaneous jugular central venous line that is capped and used for intermittent infusions. After administering the medication, the best method to maintain patency is to do which of the following?

Accepted Answer

Answer reason: Patency of a capped intermittent central venous catheter is best maintained by clearing medication from the lumen first, then locking the catheter to prevent clot formation during the dwell time. Normal saline flushes residual drug from the catheter and reduces incompatibility/precipitation risk before any locking solution is instilled. A heparinized saline lock after the saline flush helps reduce intraluminal thrombus and occlusion between intermittent uses. Using only saline may be insufficient for some intermittent central lines depending on facility policy, and instilling heparin before clearing the medication increases the risk of drug–heparin incompatibility within the lumen.

Train with a large NCLEX question bank and jump into a full exam-style simulator

Central Venous Access Devices Practice Test 1

Central Venous Access Devices NCLEX Practice Test

Continue Learning

The most common site for central line catheterization?

What is the most common site for central line catheterization?

Which syringe is used for flushing a PICC?

A client with a stroke and malnutrition has been placed on Total Parenteral Nutrition (TPN). The nurse notes air entering the client via the central line. Which initial action is most appropriate?

Which of the following is a purpose of inserting central venous catheters?

The nurse is assisting the physician with removal of a central venous catheter. To facilitate removal, the nurse should instruct the client to?

How often should site care and dressing changes be performed for a patient with TPN?

The physician is preparing to remove a central line. The nurse should tell the client to?

If a very active 2 year-old client pulls his tunneled central venous catheter out, what INITIAL nursing action is appropriate?

What is the most common site for central line catheterization?

A client is receiving Total Parenteral Nutrition (TPN) via Hickman catheter. The catheter accidentally becomes dislodged from the site. Which of the following actions by the nurse should take priority?

The tip position of a PICC is usually confirmed by?

Best position for a client during insertion of a central venous catheter (e.g., subclavian line)?

The nurse is verifying the placement of a left subclavian central venous catheter (CVC) with radiology department prior to using the catheter. Where should the tip of the CVC be located?

When drawing blood from a central venous access device, how many milliliters of blood should the nurse discard before drawing the laboratory specimen?

A client receives an implanted port. After insertion, an x-ray is performed to determine proper positioning. The tip of the catheter should be located in which vascular structure?

A client complains of pain at the insertion site of an implanted venous port device during infusion of a medication. Which is the most likely explanation for this problem?

The nurse is assisting the physician with the placement of a central line. Which catheter, when properly positioned, is in the superior vena cava?

The nurse gathers supplies needed to access an implanted port in a client. Which equipment is appropriate for use in this client?

The nurse who is accessing a client’s central line notices the infusion rate is difficult to maintain. The nurse notes the rate is affected when the client raises an arm or moves a shoulder. The nurse should be concerned with which possible complication?

A client has a Groshong central venous access device. The nurse prepares to flush the device. Which information is correct regarding the flushing?

The nurse finds the client with a disconnected central venous access device. The client complains of chest pain and dyspnea. The client’s blood pressure is 84/52 mm Hg and pulse is 150 beats/minute. Which nursing action takes priority?

When accessing a Groshong tunneled venous access device, the nurse notes there is no clamp on the end. Which action should the nurse take?

A peripherally inserted central catheter (PICC) line is ordered for a client. Which statement made by the nurse indicates an understanding of the proper insertion information for this intravenous access device?

A client receiving total parenteral nutrition (TPN) through a central venous catheter is noted to have a damp, partially detached occlusive dressing at the insertion site. The client denies shortness of breath, and lung sounds are clear bilaterally. What is the nurse’s priority action?

The client has a tunneled Groshong catheter for intermittent medication administration. After administering the medication, the nurse prepares to do which of the following?

The client has a percutaneous jugular central venous line that is capped and used for intermittent infusions. After administering the medication, the best method to maintain patency is to do which of the following?

Think you’re ready for the NCLEX?

Leave a Reply Cancel reply

Practice Questions

Study Cards

Flashcards