D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
1. Which finding indicates that a patient with an indwelling urinary catheter may be developing a catheter-associated urinary tract infection (CAUTI)?
- Clear, straw-colored urine
- Complaints of lower abdominal pain and cloudy urine
- Urine output of 30 mL/hour
- Absence of odor in urine
Explanation
Lower abdominal pain, cloudy urine, and foul odor suggest bacterial growth in the urinary tract, a hallmark of CAUTI. Normal urine should be clear and pale yellow, without discomfort.
2. Which action is the most effective in minimizing the risk of contamination when using sterile liquids during a sterile procedure?
- Touch only the outer 1½ -inch margin of the sterile field unless you are wearing sterile gloves
- Avoid splashing when pouring sterile liquids onto the sterile field
- Compare the label of the solution with the specific solution necessary for the procedure
- Assess the patient for any known allergies to the sterile solution
Explanation
Avoiding splashing when pouring sterile liquids is crucial to maintain the integrity of the sterile field. Splashing can carry microorganisms from the liquid container or the surrounding environment onto sterile surfaces, directly increasing the risk of contamination. While touching only the outer margin with sterile gloves, verifying the solution label, and assessing for allergies are important safety measures, they do not specifically prevent contamination from the liquid itself. Careful pouring technique is the most direct and effective method to maintain sterility during the procedure.
3. The nurse suspects a urinary tract infection in a patient with an indwelling catheter. Which action should the nurse perform before starting antibiotics?
- Obtain a sterile urine specimen from the catheter port.
- Drain all urine from the collection bag.
- Replace the existing catheter immediately.
- Administer a single dose of prophylactic antibiotic.
Explanation
A sterile urine sample should be obtained from the sampling port using aseptic technique before antibiotic administration. This ensures that laboratory results accurately reflect the infecting organism. Collecting from the bag or starting antibiotics prematurely can skew results.
4. When pouring a sterile liquid into a container on a sterile field, why does the nurse hold the bottle with the label facing the palm of the hand?
- The label is not sterile and will contaminate the field if it is splashed.
- The label may become illegible if it is splashed.
- The pour spout faces down when the bottle is held with the label facing the palm.
- The hand grips on the bottle are molded to fit correctly when the label is facing the palm.
Explanation
The label on a sterile solution bottle is considered non-sterile and could contaminate the sterile field if it comes into contact with sterile surfaces. By holding the bottle with the label facing the palm, the nurse positions the non-sterile part away from the field, reducing the risk of contamination. This practice is part of standard sterile technique and ensures that only the sterile contents of the bottle are introduced to the sterile field. Other considerations, such as readability of the label or ergonomics, are secondary to maintaining sterility.
5. The nurse is caring for a patient with a closed wound drain (Jackson-Pratt). Which observation requires immediate intervention?
- Drain reservoir compressed and secured below wound level
- Drain reservoir expanded and full of bright red fluid
- Small amount of serosanguineous fluid in the tubing
- 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.
6. Which statement best illustrates the nurse's understanding of the role of nursing assistive personnel (NAP) when inserting an indwelling urinary catheter in a female patient?
- "Please direct the light to better illuminate the patient's perineal area."
- "You need to be comfortable inserting a catheter in a patient of her size."
- "See if a size 14-French catheter is big enough."
- "Find out if the patient has any allergies to latex or iodine."
Explanation
NAP can assist with tasks that do not require clinical judgment or sterile technique, such as positioning the light to improve visibility during catheter insertion. This support helps the nurse perform the procedure safely and efficiently without breaching sterile technique. Tasks such as selecting catheter size, assessing allergies, or performing the insertion require nursing judgment and are outside the scope of NAP responsibilities. The nurse’s direction reflects an appropriate delegation of supportive duties while maintaining patient safety.
7. Which action(s) would minimize the patient's risk for injury during insertion of an indwelling urinary catheter?
- Assessing the patient for allergies related to latex, antiseptic, tape, and/or iodine-based substances.
- Thoroughly cleansing the patient's perineal area with povidone-iodine solution before inserting the catheter
- Performing proper hand hygiene and applying gloves before inserting the catheter
- Terminating the insertion if the patient reports pain at any time during the procedure
Explanation
Assessing the patient for allergies related to latex, antiseptic, tape, and iodine-based substances is crucial to prevent allergic reactions, which could cause injury or complications during catheter insertion. This precaution ensures the materials used are safe for the patient. While proper hand hygiene, perineal cleansing, and responding to pain are important for infection control and patient comfort, assessing for allergies directly prevents potentially serious injuries and adverse reactions during the procedure.
8. A patient with a new indwelling catheter complains of suprapubic discomfort and bladder distention. The nurse notes no urine output for two hours. What should the nurse do first?
- Irrigate the catheter with sterile saline.
- Reposition the patient and check for kinks in the tubing.
- Remove and replace the catheter.
- Notify the provider for a bladder scan order.
Explanation
The most common cause of lack of drainage is mechanical obstruction, such as kinking or dependent loops in the tubing. The nurse should first inspect and reposition the tubing before initiating irrigation or replacement.
9. The nurse has completed the initial inspection of the patient's perineum and is preparing to insert an indwelling urinary catheter. Which action would the nurse complete next?
- Begin to establish a sterile field.
- Open and assemble the urine drainage bag.
- Remove soiled gloves, and perform hand hygiene.
- Center the drape over the patient's labia.
Explanation
After inspecting the perineum, the next step is to perform hand hygiene and establish a sterile field to prepare for catheter insertion. This ensures that all supplies remain sterile and the risk of infection is minimized. Establishing the sterile field is a prerequisite to opening and assembling the urine drainage bag or centering the drape, which are steps that occur after the sterile environment is prepared. Hand hygiene is performed immediately before setting up the sterile field to maintain asepsis.
10. Which finding indicates that enteral tube feeding is being tolerated well?
- No gastric residual volume on aspiration
- Presence of diarrhea and cramping
- Abdominal distention and rigidity
- Low serum albumin level
Explanation
Absence of residual volume, nausea, or distention suggests that the feeding is being digested and absorbed effectively. The presence of diarrhea, cramping, or distention indicates intolerance or rapid feeding rate, requiring adjustment.
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