HEALTH STREAM

CVAD1. Your patient has an order fro a blood draw from the CVAD. After

completing the blood draw, you know that you must? Change the clave/injection cap

2. You are completing a routine blood draw for a CBC from the CVAD of a 4 month old afebrile patient. The child was particularly active during the porcedure and it took you approximately 2 minutes to obtain the blood sample. According to HSC's policy, the first blood sample that you drew off before taking the lab sample should be: Discarded

3. You meet resistance giving a saline flush after repositioning the patient twice. You should: Notify the MD/NP

4. When applying a transparent dressing or gauze dressing to a CVAD site, you should: Loop the catheter before applying the dressing

5. You are caring for a 6 month old infant with a CVAD. Keeping in mind the developmental needs of a child this age, a developmentally appropriate nursing action to help prevent line infection in this child is: Placing a spandage over the CVAD and dressing in a "onsie"

6. According to HSC policy, an MD/NP order is required to re-infuse the initial "discard" blood sample drawn off of a central line. TRUE

7. You are about to complete a CVAD dressing change. Central supply is out of dressing change kits. Three items of equipment that you need to gather to correctly complete the dressing change according to HSC policy would include: Mask, clean gloves, sterile gloves, Chloroprep, Sorbaview

8. You changed your patient's transparent PICC dressing three day ago. Today, during AM care, you notice the edges of the transparent dressing have started to markedly peel up around the entire dressing. According to HSC's policy, your next action is to: Change the dressing as described in HSC's policy and procedures

9. Prior to re-dressing a patient's CVAD, you should cleanse the area with Chloroprep swabs. You know that to enhance this product's antimicrobial activity it is important to: Scrub the exit site in a back and forth motion with Chloroprep swab for 30 seconds

10. As you prepare to do a dressing change on your patient's CVAD exit site, you notice that the chest wall near the site is covered with a dark blue, superficial venous pattern. You know that this finding most likely signifies that the patient has developed: A deep vein thrombosis

11. A patient, age 3 years, was recently transferred to HSC. A single lumen Broviac was inserted forTPN infusion one week ago. An infection control measure that would be important to implement with this patient includes: Securing a finger cot around the tail of the Broviac catheter

12.The rate of infections in patients with a CVAD in place is directly related to: The knowledge and skill level of the nurses caring for the

patient's catheter13. A patient was admitted to HSC five days ago after having a Broviac

placed for TPN. You notice the PCA is taking him to the bathing area. You remind the PCA that she: Should only give the patient a sponge bath while the Broviac is in place

14. As you begin to change the transparent dressing on your patient's CVAD, you notice a small amount of greenish, purulent drainage around the site. An appriate action according to HSC policy would be to: Obtain a culture of the drainage, complete the dressing change and report to MD/NP

15. Before accessing or doing a dressing change for a CVAD, hand washing should be done using: Alcohol based hand rub

16. Sara's transparent CVAD dressing is peeling up and soiled with emesis. Her 8am temp is 38.5 degrees Celcius. In the past, Sara has been somewhat uncooperative during CVAD dressing changes. The most appropriate nursing action in this situation is to: Ask a child life specialist and fellow nurse to help you do a CVAD dressing change today

17. HSC policy regarding PICC line maintenance includes: Measuring/documenting the patient's upper arm circumference between the insertion site and the axilla daily

18. The nurse is unable to withdraw a blood sample from her patient's CVAD. Before calling the MD/NP, the nurse should: Reposition the patient and attempt the blood draw again

19. When cleansing the hub of a CVAD before accessing it, it is important to: Use scrubbing and friction while cleansing the hub with a Chloroprep swab for at least 30 seconds

20. When performing a saline flush on a CVAD, you should use a 1 ml syringe to minimize teh pressure being exerted on the line during the procedure. FALSE

21. According to HSC policy, an important nursing action that helps minimize the chance of infection of a CVAD is: Scrub the injection cap for at least 30 seconds with a Chloroprep swab before opening the system

22. You are caring for an adolescent who recently had his Broviac removed. Shortly after this, he begins to complain of chest pain and SOB. You quickly take his pulse and his heart rate is 120. You notice that he is not responding appropriately to your questions. You suspect that this patient is suffering from: Air embolism

23. Your 5 year old patient has a PICC line in his right arm. During morning report you remind the PCA who is helping you care for the child to: Use his left arm to take the blood pressure

24. An appropriate nursing action to take to help PREVENT the chance of introducing bacteria through a central venous access device (CVAD) is: Limiting blood draws from the CVAD to 2 times per day

CODE BLUE

1. When giving IV Dopamine, you should: Administer thru a secure line2. The most important and first drug to administer in any pediatric

resuscitation effort is: OXYGEN3. A child who is in Compensatory Stage of shock usually manifests the

following sign: tachycardia4. The most commonly used solution for fluid volume replacement in a child is:

normal saline5. Safety measures that should be taken when defibrillating or cardioversion is

taking place include: Maintaining a dry environment when charge is being given

6. A safe, first defibrillation dose for a child is: 2 j/kg7. A procedure which puts the child at risk for a vagal response resulting in

bradycardia is: Performing oral suctioning8. New guidelines recommend that epinephrine given IV or IO during pediatric

resuscitation should be at least a concentration of: 1/10,0009. An important role of RN team member #5 is to: Remind the code team

members of timing of assessment procedures10. A sign of increased work of breathing in infants is: nasal flaring11. The 4.5cm diameter defibrillation paddles should be selected when

defibrillating or cardioverting: infant12. During shift report, the nurse reports that a patient, age 6, who is recovering

from a VP shunt revision "doesn't seem like his usual self." During your initial assessment, you note he responds to his name and says "good morning", but seems indifferent to your usual joking and falls quickly back to sleep. This patient's LOC at this time would be best described as: lethargic

13. When used during cardiopulmonary resuscitation, Lidocaine may be given intravenously, intraosseously or: endotrachealy

14. In addition to documenting information during a code, RN Team Member #5 also has the responsibility to: Remind the team about timing for vital signs and neuro checks

15. Vital sign changes and instability in children are generally: a LATE sign of impending shock in this age group

16. The role of the "first responder" to a potential cardio-pulmonary arrest event includes: Initiating CPR if indicated

17. Adenosine: Should be administered in a port as close to the patient as possible, due to its short half life

18.An important assessment that should be performed BEFORE administration of atropine during resuscitation is: Checking pupillary size

19. The most appropriate nursing action to be taken when a child's status changes is quickly deteriorating includes: Remaining with the child and observing him closely

20.Cardiac arrest in children usually: Results from respiratory difficulty or arrest

21. A common precursor to cardio-pulmonary arrest in children is: shock22. During a code, you notice that over the past 90 seconds that three attempts

to gain peripheral IV access to the patient have failed. You should: Set up equipment needed for IO insertion

23.Endotracheal emergency medications must always: Be followed by a flush of 3-5 mls of normal saline

24. Cushing's triad consists of: A widened pulse pressure, decreased heart rate and respiratory pattern changes

25.Cardiac arrythmias in the pediatric population are: Commonly associated with surgical repairs of congenital heart defects