D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
1. The wound bed of a patient's pressure ulcer is red. What does this finding indicate to the nurse?
- Necrotic tissue
- Presence of slough
- Granulation tissue
- Development of an infection
Explanation
A red wound bed indicates the presence of granulation tissue, which is a positive sign of healing. Granulation tissue is composed of new connective tissue and microscopic blood vessels that form on the surfaces of a wound during the healing process. It appears red and moist, signaling that the wound is progressing toward closure. In contrast, necrotic tissue is black or brown, slough appears yellow or white, and redness alone does not necessarily indicate infection unless accompanied by other signs such as swelling, warmth, or purulent drainage.
2. Which wound would be allowed to heal by secondary intention?
- Cleft lip repair
- Infected hysterectomy incision
- Exploratory laparoscopy incision
- Facial laceration caused by a pocket knife
Explanation
Wounds that are infected or have significant tissue loss are typically allowed to heal by secondary intention. Secondary intention involves the wound healing naturally from the bottom up, forming granulation tissue, rather than being closed surgically. An infected hysterectomy incision requires this approach because primary closure could trap bacteria inside, increasing the risk of complications. In contrast, clean surgical wounds, facial lacerations, and cleft lip repairs are generally closed primarily to promote faster and more controlled healing with minimal scarring.
3. The nurse is caring for a patient with a closed wound drain (Jackson-Pratt). Which observation requires immediate intervention?
- A) Drain reservoir compressed and secured below wound level
- B) Drain reservoir expanded and full of bright red fluid
- C) Small amount of serosanguineous fluid in the tubing
- D) Drain site covered with a sterile dressing
Explanation
An expanded drain full of bright red fluid indicates active bleeding or failure of suction. The nurse should immediately assess the wound site, check drain patency, and notify the provider.
4. A patient with a suprapubic catheter is complaining of pain. What will the nurse do first to help this patient?
- Ensure that the patient is not lying on the drainage tubing
- Instruct the patient to increase his or her oral fluid intake
- Observe the rate of drainage in the urine collection bag
- Notify the health care provider
Explanation
The first action is to ensure that the patient is not lying on the drainage tubing, as this can cause discomfort, obstruction, and backflow of urine, which may lead to pain or potential infection. Addressing mechanical or positioning issues is the immediate and simplest intervention to relieve discomfort. Monitoring drainage, increasing fluid intake, or notifying the healthcare provider may follow if pain persists, but resolving potential tubing obstruction is the priority.
5. What direction would the nurse provide to nursing assistive personnel (NAP) while establishing and maintaining a sterile field?
- "This work surface is too low. Choose a surface that's above your waist."
- "Begin to establish the sterile field here on the overbed table."
- "Be careful to touch only the outer 1-inch edge of the sterile drape."
- "Remember, reaching over the sterile field constitutes a break in sterile technique."
Explanation
Maintaining a sterile field requires precise actions and awareness of contamination risks. Instructing NAP to touch only the outer 1-inch edge of the sterile drape ensures that they handle the sterile field correctly without contaminating the inner sterile area. This is critical because the edges of the drape are considered non-sterile, and proper handling prevents unintentional contamination of sterile supplies. While surface height, starting location, and avoiding reaching over the field are important considerations, the most direct guidance that safeguards the sterile field during handling is focusing on proper drape manipulation.
6. While preparing a sterile field, the nurse notes that a portion of the sterile drape has come into contact with the patient's gown. Which action is most appropriate in this situation?
- Place the sterile supplies only on the portion of the drape that did not touch the gown.
- Collect the supplies necessary and establish a new sterile field.
- Determine if the contact occurred within the outer 1-inch perimeter of the drape.
- Establish the sterile field on the opposite side of the drape
Explanation
Any contact between a sterile drape and a non-sterile surface, such as the patient’s gown, contaminates the drape. To maintain sterility, the entire field must be considered compromised once contamination occurs. The safest and most appropriate action is to discard the contaminated drape and establish a new sterile field with the necessary supplies. Attempting to use only the uncontaminated portion or working around the contamination increases the risk of infection and violates sterile technique principles. Ensuring a completely sterile field protects patient safety and prevents potential procedural infections.
7. What is the best reason for a nurse to select a prepackaged sterile kit for a sterile procedure?
- Sterile prepackaged kits do not have expiration dates.
- The wrapper of the sterile kit can be used as a sterile field.
- Adding supplies to the sterile field takes less time than using a prepackaged kit.
- The prepackaged sterile kit will take up less space on the bedside table.
Explanation
Prepackaged sterile kits are designed to contain all necessary supplies in a single, sterile package, which minimizes preparation time and reduces the risk of contamination when setting up a sterile field. Using a prepackaged kit ensures that all items are sterile and ready for immediate use, promoting efficiency and patient safety. While other options may seem practical, they do not address the primary reason for selecting a prepackaged kit: to maintain sterility and streamline the procedure.
8. During intermittent open bladder irrigation, a patient complains of pain. Which action would the nurse take first?
- Examine the drainage tubing for clots, sediment, and kinks.
- Notify the health care provider.
- Leave the irrigation drip wide open.
- Monitor the patient's vital signs.
Explanation
When a patient reports pain during intermittent bladder irrigation, the nurse’s first action is to assess the drainage tubing for clots, sediment, or kinks that could be obstructing urine flow. Obstructions can cause discomfort and increase the risk of bladder distention or injury. Notifying the healthcare provider or monitoring vital signs may follow, but identifying and resolving mechanical obstructions immediately is the priority to relieve pain and prevent complications. Leaving the irrigation wide open without assessment could worsen the problem.
9. A patient receiving a blood transfusion develops chills, fever, and flank pain 10 minutes after initiation. Which action should the nurse take first?
- Stop the transfusion and keep the IV line open with normal saline.
- Notify the health care provider immediately.
- Administer acetaminophen for fever.
- Check the patient’s identification band and blood unit label.
Explanation
These symptoms suggest an acute hemolytic transfusion reaction, a life-threatening emergency. The nurse must immediately stop the transfusion and maintain IV access with normal saline using new tubing to prevent further hemolysis and maintain circulation. Verifying identification or notifying the provider occurs after stopping the transfusion and ensuring patient safety.
10. A postoperative patient with a wound drain reports increased pain and swelling at the surgical site. What should the nurse do first?
- A) Notify the health care provider
- B) Assess the amount and characteristics of drainage
- C) Remove the drain to relieve pressure
- D) Reinforce the dressing
Explanation
Pain and swelling could indicate obstruction or infection. The nurse should assess the drainage system first to determine if it is functioning and to collect data before notifying the provider.
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