VACC Vascular Access Board Certified (VA-BC) Practice Test

VACC Exam Format | Course Contents | Course Outline | Exam Syllabus | Exam Objectives

DOMAIN CATEGORY I: Clinical Knowledge and Application
A. Device Assessment and Selection
1. Central venous access devices
2. Peripheral intravenous devices
3. Dialysis, apheresis and aquapheresis catheters
4. Intraosseous devices
5. Arterial catheters
6. Pulmonary artery catheters
7. Device characteristics (e.g., single versus multi-lumen devices, optimal insertion and tip location)
B. Patient Assessment
1. Vascular pathology (e.g., impact of disease processes on vascular access)
2. Device selection (e.g., infusion therapy, alternative to IV placement, vesicants and osmolality)
3. Patient specific characteristics (e.g., compromised skin integrity, product reaction) and resources to maintain vascular access devices
4. Imaging technology (e.g., ultrasound, transillumination, fluoroscopy / venogram, chest x-ray)
C. Preparation
1. Infection prevention procedures, concepts and principles (e.g., sterile field, aseptic non-touch technique [ANTT], common pathogens)
2. Anatomy and physiology
3. Growth and development implications
DOMAIN CATEGORY I (continued): Clinical Knowledge and Application
D. Insertion
1. Vascular access device and insertion components
2. Insertion techniques (e.g., Modified Seldinger)
3. Flushing and locking solutions / procedures
4. Imaging technology (e.g., ultrasound, infra-red, transillumination)
5. Laboratory values relevant to device placement and maintenance
6. Tip location and confirmation systems
7. Engineered securement devices
8. Complications and emergency interventions (e.g., inadvertent arterial puncture, pneumothorax, catheter tip malposition, nerve injury)
E. Care and Maintenance of Vascular Access
1. Insertion / exit site assessment
2. Lumen patency and catheter clearance (e.g., flushing protocol, occlusion therapy)
3. Infusion equipment and add-on supplies (e.g., needleless connector)
4. Dressing change procedure
5. Patient / caregiver education
6. Care plan throughout the healthcare continuum (e.g., catheter insertion information, care and maintenance instructions, patient restrictions)
7. Vascular access device removal (e.g., removal length of PICC, removal complications, patient tolerance of removal procedure)
F. Troubleshooting, Complications, and Interventions
1. Post-insertion risks and complications (e.g., extravasation, thrombosis, infection, catheter tip migration, occlusion, nerve damage, phlebitis)
2. Pharmacologic interventions (e.g., catheter clearance, antibiotic lock, ethanol lock, extravasation treatment)
3. Catheter repair / exchange
4. Other complications (e.g., central vein occlusion, internal fracture, compromised skin integrity)
DOMAIN CATEGORY II: Interpersonal and Communication Skills
A. Interpersonal Communication
1. Communication with patient / caregiver (e.g., risks, benefits and alternatives; device care; infection prevention)
2. Communication with patient / caregiver with additional needs (e.g., developmental/ cognitive deficit, psychosocial concerns)
3. Cultural competency (e.g., cultural and religious differences, family involvement, language barrier)
4. Collaboration with patient's care team
B. Mentoring and education
1. Educational / staff development opportunities (e.g., quality improvement, hospital committees, early assessment for vessel preservation)
2. Infection control measures and techniques
DOMAIN CATEGORY III: Professional Development
A. Evidence-based Practice and Continuing Education
1. Evidence-based practice guidelines (e.g., AVA, INS, MAGIC, KDOQI, ACCP, SHEA)
2. Process improvement initiatives and outcome evaluation (e.g., implementation of new techniques and / or products)
3. Professional practice and development (e.g., seminars, webinars, conferences, certification)
4. Critical analysis of published research (e.g., research methodologies)
DOMAIN CATEGORY IV: Legal and Ethical Considerations
A. Legal Considerations
1. Professional codes of conduct, professional guidelines, scope of practice and standards of care
2. Legal principles in the practice of vascular access (e.g., consent, liability, HIPAA)
3. Documentation requirements
4. Manufacturer's guidelines for product use (e.g., Instructions for Use [IFUs], expiration dates, off-label use)
B. Ethical Considerations
1. Patient advocacy (e.g., patient preferences, end of life care)
2. Reporting requirements (e.g., MAUDE database, Joint Commission [JC], state health department)
3. Fiscal responsibility (e.g., accurate recording of charges, use of supplies and equipment, use of time)

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Question: 75
The nurse is gathering equipment for an arterial puncture. She has gathered the
following equipment: heparin solution of 1,000 IU per ml, sterile gauze, betadine
wipes, sterile needle, and syringe. What has the nurse forgotten?
A. Container of ice water.
B. Alcohol wipes.
C. Tourniquet.
D. Requisition form.
Answer: A
The urse has forgotten to gather a container for ice water. An arterial blood
sample is placed in a container of ice water to keep blood gasses from escaping.
The sample should be transported to the lab in the container of ice water and
analyzed within ten minutes of being collected. A tourniquet is not required for
arterial punctures, because of arterial pressure. Tincture of iodine is used to
cleanse the puncture site.
Question: 76
The nurse is aware that their hospital has a policy that allows nursing aides to
remove intravenous lines while on the surgical unit. The nurse delegates this task
to the aide and the intravenous catheter is removed incorrectly. Who is
responsible for this mistake?
A. The hospital, because the policy allowed the procedure.
B. The nurse, because they supervised the procedure.
C. The aide, because they performed the procedure.
D. Both B and C
Answer: B
In this situation, the nurse is responsible for the aides actions, because they
supervised the procedure. Tasks delegated to unlicensed personnel are ultimately
the responsibility of the nurse. Although the hospital may have a policy allowing
unlicensed personnel to perform certain tasks, this cannot override the states
nurse practice act.
Question: 77
The nurse is preparing to insert an intravenous catheter to administer fluids for a
patient who will have surgery. What is the most important factor that affects the
nurses choice of location for this site?
A. The type of cannula to be used
B. The duration of the infusion
C. The condition of the vein for use
D. Both B and C
Answer: D
When preparing to insert a catheter for intravenous fluids during surgery, factors
that influence the site location choice include the infusion duration and the
condition of the vein for use. An infusion that will run over a long period requires
a vein that will tolerate the instillation of large amounts of fluid over time, rather
than a short injection of fluid or medication. Additionally, veins that are in poor
condition may be difficult to cannulate and may not tolerate a fluid infusion.
Question: 78
What special precaution should be observed when collecting a specimen for blood
cultures?
A. Maintaining aseptic technique.
B. Maintaining postural position.
C. Maintaining calmness.
Answer: A
A special precaution when collecting a specimen for blood cultures is
establishing and maintaining aseptic technique during the collection process.
Bacteria are found on the skin surface and are considered normal. Without using
special precautions, the normal skin bacteria may contaminate the specimen. The
puncture site and rubber stopper on collection bottles are prepared using tincture
of iodine. After area has been prepared, the nurse should take care not to
contaminate the site by inadvertently touching or allowing the tourniquet to touch
the area.
Question: 79
A patient is admitted with severe burns over 50 percent of their body. The nurse
inserts an IV to begin fluid administration and for medications. What is the
typical process of fluid shift for this type of patient within the first 48 hours?
A. Fluid is pulled out of the blood vessels and into the tissues.
B. Fluid is pulled out of the tissues and into the blood vessels.
C. Fluid maintains equilibrium between the blood vessels and the tissues.
D. Fluid movement depends on the type of burn and the patients electrolyte
status.
Answer: A
During the first 48 hours following a burn, fluid is pulled out of the blood vessels
and into the tissues. The nurse must administer adequate fluids to prevent
hypovolemia and subsequent hypotension. The tissues will swell with the excess
fluid, but after approximately two to three days, the shift reverses and the fluid
returns to circulation.
Question: 80
Which statement is a requirement when managing exposure to blood borne
pathogens?
A. Nurses should receive training in handling occupational exposure if there is a
risk of coming in contact with blood borne pathogens.
B. Food and drink should be kept on a separate table in the operating suite, away
from the patient.
C. A contaminated needle should be carefully recapped before placing it in a
biohazard container.
D. Employers are required to provide measures for hand hygiene practices.
Answer: D
Employers are required to provide measures for hand hygiene practices. If
employees are expected to wash their hands to protect themselves from blood
borne pathogens, employers are mandated to provide materials for them,
according to the Occupational Safety and Health Administration. Food and drink
should be separate from operative procedures and not in the same room, and
contaminated needles should never be recapped to reduce risk of injury. All
healthcare personnel should receive training on exposure to blood borne
pathogens.
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