D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
1. 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.
2. 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.
3. When cleansing the perineal area before catheterization, how should the nurse proceed?
- Wipe in a circular motion from the center outward
- Wipe from the urethral opening toward the rectum
- Wipe from the rectum toward the urethral opening
- Clean the area with dry sterile gauze
Explanation
Cleaning from the urethral opening toward the rectum reduces the risk of transferring microorganisms from the anal region to the urethra, preventing infection.
4. When preparing to insert an indwelling urinary catheter in a male patient, it is important for the nurse to do what?
- Remove the cotton balls from the kit for later use.
- Advance the catheter 10 to 12 inches or until urine flows.
- Lubricate the first 5 to 7 inches of the catheter.
- Hold the penis at a 45-degree angle during insertion.
Explanation
Lubricating the first 5 to 7 inches of the catheter before insertion helps reduce friction and trauma to the urethra, making the procedure safer and more comfortable for the male patient. Proper lubrication minimizes the risk of urethral injury and facilitates smooth advancement of the catheter. Other actions, such as removing cotton balls, advancing the catheter a set distance without observing urine flow, or holding the penis at a 45-degree angle, do not follow recommended sterile technique and proper anatomical positioning for catheter insertion.
5. While teaching a nursing assistive personnel (NAP) about emptying a patient’s urinary drainage bag, which statement by the nurse ensures understanding of infection control?
- “You may place the drainage spout on the bed for convenience.”
- “Be sure to wipe the drainage spout with an alcohol pad after emptying.”
- “Clamp the tubing above the bag while emptying.”
- “Disconnect the tubing if the bag is full.”
Explanation
Wiping the drainage spout with an alcohol pad prevents microorganisms from entering the closed drainage system after emptying. The tubing should never be disconnected, and the spout should never touch surfaces.
6. A nurse is caring for a patient with a nasogastric tube connected to low continuous suction. Which assessment finding requires immediate intervention?
- Greenish drainage from the NG tube
- Abdominal distention and absence of drainage
- Occasional nausea after turning
- Slight nasal irritation
Explanation
Abdominal distention and absence of drainage suggest that the NG tube may be obstructed or displaced, preventing decompression. This increases the risk for aspiration and gastric rupture, requiring prompt nursing action.
7. During insertion of a nasogastric tube, the patient suddenly starts coughing and becomes cyanotic. What is the nurse’s immediate action?
- Withdraw the tube completely and allow the patient to recover.
- Continue advancing the tube while reassuring the patient.
- Ask the patient to take sips of water to help with swallowing.
- Check for placement by auscultating air over the stomach.
Explanation
Coughing and cyanosis during nasogastric tube insertion indicate accidental placement into the airway. The nurse must immediately withdraw the tube to prevent aspiration or airway obstruction. Continuing advancement or checking placement before removing the tube increases the risk of respiratory distress or hypoxia.
8. A nurse notes that urine is leaking around a patient’s indwelling catheter. What is the nurse’s best action?
- Assess for obstruction and ensure the catheter is not kinked.
- Inflate the balloon with an additional 5 mL of sterile water.
- Replace the catheter with a larger-sized one immediately.
- 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.
9. Which observation indicates that instruction given to nursing assistive personnel (NAP) in caring for a patient with an indwelling urinary catheter has been effective?
- The collection bag has been placed on the side rail of the bed.
- The excess catheter tubing has been coiled beside the patient's inner thigh.
- The collection bag has been placed on the bed.
- The collection bag is held above the level of the bladder while ambulating the patient.
Explanation
Proper catheter care requires that the collection bag always be positioned below the level of the bladder to prevent backflow of urine, which can lead to infection. Observation of NAP maintaining the collection bag below the bladder while ambulating the patient indicates understanding of this critical principle. Placing the bag on the side rail or bed, or coiling excess tubing beside the thigh, can compromise drainage and increase the risk of catheter-associated urinary tract infections, demonstrating ineffective instruction.
10. While preparing supplies on a sterile field, a gauze pad falls off the sterile field. What should the nurse do?
- Nothing
- Create a new sterile field
- Use sterile forceps to move the gauze pad toward the center of the sterile field
- Dispose of the gauze before continuing the procedure
Explanation
If a sterile item falls off the sterile field, it is considered contaminated and cannot be safely used. Using the item or attempting to reposition it, even with sterile forceps, risks introducing pathogens to the sterile environment and compromising patient safety. The proper action is to discard the contaminated gauze and replace it with a new sterile item, maintaining the integrity of the sterile field throughout the procedure.
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