Editing Nursing Skills and Procedures – RN Practice Questions (section)

==Question 6==
A registered nurse is performing a dressing change on a client's nontunneled central venous catheter. Which actions are appropriate? '''Select all that apply.'''
# Apply a mask to self and the client, or have the client turn the head away.
# Cleanse the site with chlorhexidine using friction and allow it to air dry completely.
# Fan the site with a sterile gauze to speed drying time.
# Change the transparent dressing sooner than scheduled if it becomes damp, loose, or soiled.
# Measure the external catheter length and compare it with the documented length.
# Use a 3 mL syringe to forcefully flush a catheter with no blood return.

'''Answer:''' 1, 2, 4, and 5 (A, B, D, E).

''Rationale:'' Masking or turning the client's head protects the sterile field from respiratory droplets. Chlorhexidine kills organisms during its drying time, so full air drying is essential and fanning in option 3 both contaminates the field and defeats the antisepsis. Dressings are changed on a schedule or immediately when integrity is lost. Comparing external catheter length detects migration. Option 6 is dangerous: a small barrel generates very high pressure and can rupture the catheter or dislodge a thrombus. Absent blood return is assessed and reported, never forced.