NORCET 7 Prelims -2024
Medical Surgical Nursing
Hard
A nurse notices swelling and a hematoma during jugular vein catheterization. What is the most appropriate initial action?
Appeared in: NORCET 7 Prelims -2024
Explanation
- Swelling and hematoma formation during catheter insertion are hallmark signs of vessel injury, such as vein perforation or arterial puncture.
- The immediate priority in any iatrogenic injury is to remove the source of the trauma to prevent further harm.
- Stopping the procedure and removing the catheter allows for the application of direct pressure to control bleeding and minimize the size of the hematoma.
- This action directly addresses the cause of the problem and is the first step in managing the complication safely.
Why Other Options Were Wrong
- Option A: Continuing the procedure would worsen the vessel injury, increase the amount of bleeding, and lead to a larger, more dangerous hematoma.
- Option B: While documenting the event and notifying the doctor are essential nursing responsibilities, they are not the initial action. The immediate threat to the patient (active bleeding) must be managed first.
- Option C: Applying ice is a secondary intervention used to reduce swelling and provide comfort after the bleeding has been controlled. It is not the priority action to stop active bleeding from a punctured vessel.
Related Visual
- Visual 1: Illustration - A diagram showing the anatomy of the neck, highlighting the close proximity of the internal jugular vein and the carotid artery, to explain the risk of arterial puncture.
- Visual 2: Flowchart - A simple flowchart outlining the priority of actions for a CVC insertion complication: 1. Stop & Remove Catheter → 2. Apply Direct Pressure → 3. Assess Patient (especially airway) → 4. Notify Provider.
Clinical Relevance
- Nursing practice connection: Knowing Complications of Central Venous Catheterization helps nurses interpret findings accurately and avoid errors in routine assessment, medication administration, and patient teaching.
- The primary nursing principle is patient safety. In this scenario, the immediate priority is to prevent further harm from an active complication.
- A large or rapidly expanding hematoma in the neck is a medical emergency as it can compress the trachea and compromise the patient's airway.
- Nurses must be able to recognize signs of CVC complications immediately and initiate the correct sequence of actions to ensure patient safety.
How to Approach the Question
- First, identify the question type. This is a clinical priority question asking for the 'most appropriate initial action'.
- Next, analyze the clinical situation presented in the stem. 'Swelling and a hematoma' during a procedure are critical signs of an active complication, specifically vessel injury.
- Evaluate the options based on the principle of 'first, do no harm'. The initial action must be the one that stops the harmful process.
- Option A (Continue) actively causes more harm.
- Options B (Document/Notify) and C (Apply ice) are correct actions, but they are performed after the immediate danger is controlled.
- Option D (Remove/Stop) is the only action that directly stops the cause of the complication.
Concept Tested & Keywords
- Concept Tested: Complications of Central Venous Catheterization
- Stem keywords: jugular vein catheterization, swelling, hematoma
- Lead-in keywords: most appropriate initial action
- Clinical cues: The combination of swelling and hematoma during the procedure is a critical cue for vessel injury.
Question ID
QS3KQuvp8hIYSn5qTCAqOk
Practise the full NORCET 7 Prelims -2024
Attempt every question from this paper in a timed mock, then review the full solution for each one.
More Critical Care Nursing Questions
- What is the procedure shown in the image?
- A nurse at ICU setting is doing suctioning for a client to remove excessive secretions from the mouth. She should know that the maximum time for suct…
- In ATLS algorithm E stands for?
- Most common late complication of central venous line or PICC?
- The low-pressure alarm sounds on the ventilator. The nurse checks the client and then attempts to determine the cause of the alarm but is unsuccessfu…
- Selective digestive decontamination is used to prevent?
- While giving ET tube suctioning, the patient suddenly goes on tachycardia. What will the nurse do?
- An unconscious patient admitted in ICU, what is the first priority for this patient?
- A client with chest tube drainage system. During the morning rounds, the on-duty nurse observes that there is no oscillation in the drainage system.…
- A nurse is doing endotracheal suctioning. During the procedure, the nurse notes decreasing heart rate on the monitor. What should be the first priori…
More NORCET 7 Prelims -2024 Questions
- A patient with kidney failure has been found to have 4+ protein in their urine. The nurse recognizes this finding as indicating:
- Which of the following is a true statement regarding breast milk?
- Based on the image showing the placement of ECG electrodes, where should the V1 lead be placed?
- Which of the following conditions is most likely associated with macroblastic RBC?
- A nurse is caring for a patient with Chronic Obstructive Pulmonary Disease (COPD) and notices that the patient is using a CPAP machine. The nurse und…
- If a tracheostomy tube becomes dislodged, the nurse should:
- A nurse is assessing an endotracheal tube and needs to press the cricoid. This technique is known as:
- Which vaccine is typically given at the 6-week immunization visit?
- A patient is being administered general anesthesia. The nurse should assess the patient for:
- A nurse is using a non-rebreather mask on a patient, but the bag is not inflating. What should the nurse do next?