D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
When adding a sterile liquid to a sterile field, which action will contaminate the field?
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Extending your arm over the sterile field to pour the liquid into the receptacle
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Holding the bottle with the label facing the palm
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Adding a liquid with a usable period that expires in 2 days
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Placing the receptacle 1 inch (about 2.5 cm) from the edge of the sterile field
Explanation
Contamination of a sterile field can occur if a non-sterile object or body part crosses over the sterile area. Extending your arm over the sterile field increases the risk of airborne contamination and accidental contact with sterile items, directly compromising sterility. Proper technique requires keeping hands and arms away from the sterile field unless sterile gloves are worn and maintaining a safe distance when pouring liquids. Other actions, such as holding the label correctly, checking expiration dates, and positioning the receptacle near the edge, do not inherently contaminate the field when done appropriately.
What direction would the nurse provide to nursing assistive personnel (NAP) while establishing and maintaining a sterile field?
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"This work surface is too low. Choose a surface that's above your waist."
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"Begin to establish the sterile field here on the overbed table."
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"Be careful to touch only the outer 1-inch edge of the sterile drape."
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"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.
How would the nurse safely apply an enzyme debridement ointment?
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Daub ointment on dead tissue at the wound edges.
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Put ointment on a tongue blade, and gently spread it on the center of the wound.
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Apply ointment to necrotic tissue in the wound while avoiding contact with surrounding skin.
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Apply a gauze dressing to ensure contact with the ointment.
Explanation
Enzyme debridement ointments are used to break down necrotic tissue within a wound while sparing healthy tissue. The nurse should apply the ointment directly to necrotic tissue, carefully avoiding contact with surrounding healthy skin to prevent irritation or damage. Proper application ensures that the debriding enzymes target only the dead tissue, promoting safe and effective wound healing. Using a tongue blade to spread the ointment on the center or daubing the edges may not adequately cover all necrotic tissue and could harm healthy tissue, while applying a gauze dressing alone does not address precise placement.
The nurse prepares to collect a sterile urine specimen from a patient’s indwelling catheter. Which step ensures sterility of the specimen?
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Collect urine from the drainage bag
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Clamp the tubing below the port for 15–30 minutes before collection
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Open the drainage system at the catheter connection
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Disconnect the catheter from the drainage bag to collect urine
Explanation
Clamping the tubing allows fresh urine to collect in the tubing above the port. The sample is then drawn from the sampling port using aseptic technique to prevent contamination.
Which action by the nurse best ensures accurate blood pressure measurement using a manual sphygmomanometer?
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Selecting a cuff that covers two-thirds of the upper arm length
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Placing the cuff 1 inch below the antecubital fossa
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Positioning the patient’s arm below heart level
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Using the diaphragm of the stethoscope over the ulnar artery
Explanation
Accuracy in blood pressure measurement depends on using a cuff that covers approximately two-thirds of the upper arm length and encircles 40% of the arm’s circumference. The cuff should be placed 1 inch above the antecubital fossa with the arm supported at heart level. Deviations from these principles can cause falsely high or low readings.
A nurse notes that urine is leaking around a patient’s indwelling catheter. What is the nurse’s best action?
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Assess for obstruction and ensure the catheter is not kinked.
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Inflate the balloon with an additional 5 mL of sterile water.
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Replace the catheter with a larger-sized one immediately.
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Notify the provider to initiate antibiotics.
Explanation
Leakage around a catheter may indicate blockage or kinking of the tubing, which leads to backpressure. The nurse should first assess and correct any mechanical issues before taking other steps. Increasing balloon size or changing catheter size without assessment can cause trauma or worsen leakage.
Which action should the nurse take to ensure accurate measurement of urine output from a closed drainage system?
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Drain the entire bag contents into a calibrated container at the end of each shift.
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Estimate the amount by visually inspecting the drainage bag.
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Disconnect the tubing to pour urine directly into a measuring cup.
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Record the total drainage without emptying the bag.
Explanation
Accurate urine measurement requires draining the contents into a calibrated container without contaminating the system. Disconnecting the tubing increases infection risk, and estimation is unreliable. The procedure should maintain a closed system to prevent infection.
What is the best reason for a nurse to select a prepackaged sterile kit for a sterile procedure?
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Sterile prepackaged kits do not have expiration dates.
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The wrapper of the sterile kit can be used as a sterile field.
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Adding supplies to the sterile field takes less time than using a prepackaged kit.
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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.
A patient is receiving oxygen through a nasal cannula at 4 L/min. Which nursing action is most important?
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Assess for dryness and irritation of the nasal mucosa.
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Encourage the patient to remove the cannula during meals.
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Switch the patient to a face mask if oxygen saturation is 97%.
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Apply petroleum jelly around the nostrils for comfort.
Explanation
Oxygen therapy via nasal cannula can dry the mucosa. The nurse should assess for irritation and use water-based lubricants if needed. Petroleum jelly is contraindicated because it can cause combustion in an oxygen-rich environment.
Why might the nurse offer the patient a bedpan before establishing a sterile field?
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Anticipating what the patient might need during a lengthy sterile procedure will minimize patient movement.
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A patient's becoming incontinent constitutes a breach in sterile technique.
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Refocusing the patient's attention on a task decreases anxiety.
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Assessing the patient's ability to follow instructions will help the nurse maintain the sterile field.
Explanation
Offering a bedpan before starting a sterile procedure is a proactive measure to prevent patient movement during the procedure. Movement or repositioning can compromise the sterile field and increase the risk of contamination. By anticipating the patient’s needs, the nurse minimizes disruptions, maintains sterility, and ensures a smoother procedure. This action is part of patient-centered care and infection control, addressing practical needs that support maintaining the integrity of the sterile environment.
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