The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of catheter-related bloodstream infection (CRBSI)?

Review daily the necessity of the central venous catheter.

Maintain a pressure of 300 mm Hg on the flush bag.

Cleanse the insertion site daily with isopropyl alcohol.

Change the pressurized tubing system and flush bag daily.

Answer and Explanation

The Correct Answer is A

A. Review daily the necessity of the central venous catheter: One of the most effective strategies to reduce the risk of catheter-related bloodstream infections is to remove the central line as soon as it is no longer needed. Daily evaluation of necessity prevents prolonged catheter use, which significantly increases infection risk. Removing the source of potential infection is the ultimate preventative action.

B. Maintain a pressure of 300 mm Hg on the flush bag: While maintaining appropriate flush pressure is important for catheter patency and preventing blood clots, it does not play a direct role in preventing bloodstream infections. This action is more related to ensuring adequate line function rather than infection control.

C. Cleanse the insertion site daily with isopropyl alcohol: Current guidelines recommend using chlorhexidine-based solutions rather than isopropyl alcohol for skin antisepsis due to better antimicrobial efficacy. Daily site care is important, but the choice of antiseptic is critical in reducing infection risk.

D. Change the pressurized tubing system and flush bag daily: Tubing and flush systems should be changed typically every 72–96 hours unless contamination is suspected. Changing them daily is not recommended and does not provide added protection against infection it may even increase risk with unnecessary manipulation.

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Correct Answer is E

Explanation

A. contact the prescriber to decrease the rate of the D51/2NS during the blood transfusion: There's no need to alter the rate of maintenance fluids unless there's a fluid volume concern. Additionally, decreasing the rate would not address the need for a dedicated blood transfusion line if another lumen is available.

B. stop the D51/2NS, check the client's vitals & notify the prescriber: Stopping necessary fluids without cause may compromise fluid balance. Unless there's a compatibility issue or no other lumen, stopping the infusion is not the safest or most efficient action.

C. Fluids cannot be given through a CVC: Central venous catheters are routinely used for administering fluids, medications, and blood products, especially in critical care settings.

D. Insert a 22 gauge peripheral IV to administer the transfusion: While blood can be given through a peripheral IV, using an existing central venous catheter is safer and more efficient, especially when multiple lumens are available. Inserting a new IV unnecessarily increases infection and complication risks.

E. transfuse the unit of packed red blood cells through a separate lumen of the CVC: This is the safest and most appropriate action. Triple-lumen CVCs allow for simultaneous infusions through separate channels without mixing. Blood should be transfused through a dedicated lumen to avoid incompatibility or dilution by other fluids.

A. Presence of fine tremors B. Heart rate 50 per minute C. +1 peripheral edema D. Increased confusion

Correct Answer is D

Explanation

A. Presence of fine tremors: Fine tremors are not a typical sign of worsening heart failure. They may be associated with medications (like bronchodilators or lithium), metabolic issues, or neurologic disorders, but not directly with heart failure decompensation.

B. Heart rate 50 per minute: Bradycardia may be notable, especially in the context of beta-blocker therapy, but a heart rate of 50 bpm in a stable patient is not necessarily a sign of worsening heart failure unless accompanied by symptoms like dizziness or hypotension.

C. +1 peripheral edema: Mild peripheral edema is often chronic and common in older adults with heart failure. It does not reliably indicate worsening status unless there is a significant increase in edema or associated weight gain and pulmonary symptoms.

D. Increased confusion: Older adults are more susceptible to changes in cognitive function due to decreased cardiac output in worsening heart failure. New or worsening confusion in older adults is a key sign of decreased cerebral perfusion and may signal worsening heart failure. It can also indicate hypoxia or electrolyte imbalance, making it a critical finding that warrants immediate evaluation.

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The nurse is caring for a patient following insertion of a left subclavian central venous catheter (CVC). Which action by the nurse best reduces the risk of catheter-related bloodstream infection (CRBSI)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client has a triple lumen subclavian central venous catheter (CVC) with D51/2NS infusing through one lumen (port) at 75 mL per hour. The nurse has an order to transfuse one unit of packed red blood cells (PRBCs). The nurse's safest action is to:

Correct Answer is E

Explanation

Which clinical manifestation would the nurse use to indicate that the status of an older adult patient (greater than age 75) with chronic heart failure condition is worsening?

Correct Answer is D

Explanation

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