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NCLEX-RN Central venous access practice questions

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These are original practice items written to the NCLEX-RN blueprint (4 options, no penalty for wrong answers), not actual exam questions. Try each one before you open the answer.

What this topic covers

Central venous access sits inside the Pharmacological and Parenteral Therapies category of the NCLEX-RN. Our bank holds 33 verified items tagged to it, and the 4 below are a fixed sample so the page stays the same every time you open it. Each one shows the reasoning, not just the letter.

The topic tag comes from our own items rather than from a published syllabus, so treat it as a map of what we cover. For the official category breakdown see the NCLEX-RN page.

Central venous access sample questions

Question 1

A 60-year-old client in the intensive care unit has a right subclavian central venous catheter. The nurse notes that the catheter insertion site is red, warm, and has purulent drainage. The client's temperature is 38.9°C (102°F). Which action should the nurse take first?

  1. A Obtain a blood culture from the catheter and from a peripheral vein as ordered.
  2. B Remove the central venous catheter immediately and send the tip for culture.
  3. C Apply a topical antibiotic ointment to the insertion site and cover with a new dressing.
  4. D Increase the IV fluid rate to treat potential sepsis and notify the provider.
Show the answer and explanation

Correct answer: A

Redness, warmth, purulent drainage, and a fever of 38.9°C suggest a catheter-related bloodstream infection. Paired blood cultures, one drawn through the catheter and one from a peripheral vein, should be obtained as ordered before antibiotics are started or the line is removed, so the organism and source can be identified.

Why the other options are wrong:
B: The catheter will likely be removed, but cultures should be drawn first, and removal requires a provider order.
C: Topical antibiotic ointment does not treat a bloodstream infection and is not recommended on central line sites.
D: Changing the IV rate requires an order, and extra fluid does not identify or treat the infection.

Question 2

A 63-year-old client with a newly inserted tunneled central venous catheter in the medical-surgical unit has a prescription for a continuous heparin infusion. The nurse notices that the catheter's distal lumen has a blood return but the proximal lumen does not. What is the nurse's best action?

  1. A Administer the heparin infusion through the distal lumen and document the finding.
  2. B Flush the proximal lumen with 10 mL of 0.9% sodium chloride using a 10-mL syringe.
  3. C Notify the provider and prepare for a thrombolytic instillation into the proximal lumen.
  4. D Apply gentle negative pressure to the proximal lumen with a 5-mL syringe to restore patency.
Show the answer and explanation

Correct answer: B

A lumen without blood return may be partially occluded by a clot, a fibrin sheath, or the catheter's position. After checking for clamps or kinks, the nurse can gently flush with 10 mL of normal saline in a 10-mL syringe, which generates low pressure and protects the catheter, stopping if resistance is felt.

Why the other options are wrong:
A: Using only the working lumen ignores the problem and lets a partial occlusion worsen.
C: A thrombolytic is considered only after simple measures, such as repositioning and gentle flushing, fail.
D: A smaller syringe generates higher pressure that can damage the catheter, and aspiration alone may not restore patency.

Question 3

A 58-year-old client in the intensive care unit has a newly inserted right subclavian central venous catheter. The nurse notes that the pressure waveform from the distal lumen is dampened and blood return is sluggish. Which action should the nurse take first?

  1. A Place the client in Trendelenburg position and turn the head to the left.
  2. B Increase the IV infusion rate to 150 mL/hr for 15 minutes.
  3. C Flush the lumen with 3 mL of 0.9% sodium chloride using a 10-mL syringe.
  4. D Apply a sterile occlusive dressing and notify the healthcare provider.
Show the answer and explanation

Correct answer: C

The correct first action is to flush the lumen gently with a 10-mL syringe of 0.9% sodium chloride; a dampened waveform with sluggish blood return often indicates a small clot or fibrin tail at the tip, and a gentle flush can restore patency. Placing the client in Trendelenburg and turning the head (the option "Place the client in Trendelenburg position and turn the head to the left." is appropriate during catheter insertion, not for troubleshooting a dampened waveform. Applying an occlusive dressing and notifying the provider (the option "Apply a sterile occlusive dressing and notify the healthcare provider." is premature before attempting a simple flush. Increasing the IV rate (the option "Increase the IV infusion rate to 150 mL/hr for 15 minutes." will not resolve a mechanical obstruction and may cause fluid overload.

Question 4

A 55-year-old female in the intensive care unit has a triple-lumen central venous catheter in the right internal jugular vein. The nurse notes that the catheter is intact, but the cap on the distal lumen is cracked and leaking. Which action should the nurse take first?

  1. A Replace the cracked cap with a new sterile cap and perform a push-pause flush
  2. B Cover the cracked cap with sterile gauze and tape it securely
  3. C Clamp the distal lumen and notify the provider for a catheter change
  4. D Remove the entire central line and apply a sterile dressing to the insertion site
Show the answer and explanation

Correct answer: A

Only the cap is damaged, so the nurse clamps the lumen, replaces the cracked cap with a new sterile one using aseptic technique and flushes to confirm patency. This restores a closed system and prevents air embolism and infection.

Why the other options are wrong:
B: Gauze over a cracked cap leaves the system open to air and contamination.
C: The catheter itself is intact, so a catheter change is unnecessary.
D: Removing a functioning central line is not needed for a cap that can simply be replaced.

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