D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
1. While caring for a postoperative patient with a Jackson-Pratt (JP) drain, the nurse notes that the drainage has become thick, cloudy, and foul-smelling. What is the nurse’s best action?
- Empty the drain and continue monitoring output.
- Irrigate the drain with sterile saline.
- Notify the health care provider of the findings.
- Compress the bulb to re-establish suction.
Explanation
A change in drainage character to thick, cloudy, or foul-smelling indicates possible infection at the surgical site. Continuing to monitor without reporting or attempting irrigation would delay intervention. The nurse must promptly notify the healthcare provider for assessment, potential culture, and antibiotic therapy. Compressing the bulb or irrigating without an order could spread infection or disrupt the system.
2. After inserting an indwelling catheter in a male patient, the nurse inflates the balloon but observes leakage of urine around the urethral meatus. What should the nurse do next?
- Deflate the balloon, advance the catheter further, and reinflate.
- Apply tape to secure the catheter.
- Replace the catheter with a smaller size.
- Notify the provider that the balloon is defective.
Explanation
Leakage may occur if the balloon was inflated before the catheter was advanced fully into the bladder. Deflating the balloon and advancing the catheter ensures correct placement before reinflation.
3. 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.
4. When preparing a sterile field, the nurse notices that one of the sterile drapes has a small tear near the edge. What should the nurse do?
- Place the torn drape so the tear is outside the sterile field
- Cover the tear with another sterile drape
- Discard the drape and replace it with a new sterile one
- Use the drape as long as the tear does not touch sterile items
Explanation
A torn sterile drape compromises sterility because microorganisms can enter through the tear. To maintain asepsis, any item that is damaged, wet, or torn must be considered contaminated. Using or covering the tear does not restore sterility.
5. Prior to setting up a sterile field for a sterile procedure in a patient's room, why would the nurse ask any visitors to please leave the patient's bedside?
- Ensures that no unnecessary movement occurs that could contaminate the sterile field
- Limits distractions while setting up the sterile field
- Ensures a quiet environment during the procedure
- Provides privacy for the patient
Explanation
Visitors at the bedside can inadvertently increase the risk of contamination by moving around or reaching near the sterile field. Asking visitors to leave ensures that unnecessary movement is minimized, protecting the sterility of the environment. While limiting distractions, providing quiet, and maintaining privacy are important considerations, the primary reason for asking visitors to step away is to maintain the sterile field and prevent potential contamination that could compromise patient safety.
6. Before performing a wound assessment, which nursing action would reduce the patient's risk for infection?
- Taking the patient's temperature
- Applying clean gloves
- Assessing the wound for drainage
- Assessing the dressing for drainage
Explanation
Applying clean gloves before performing a wound assessment is a critical infection-prevention measure. Gloves act as a barrier between the nurse’s hands and potentially infectious material, reducing the risk of introducing pathogens to the wound or the nurse. While taking the patient’s temperature and assessing the wound or dressing are important parts of the overall assessment, they do not directly prevent infection. Using clean gloves is a standard precaution to maintain a safe and aseptic environment.
7. When providing perineal care to a female patient with an indwelling catheter, what is the correct cleaning technique?
- Clean from front to back around the catheter insertion site.
- Clean from the rectum toward the meatus.
- Wipe circularly around the catheter with one cloth.
- Clean from the urethra outward toward the thighs.
Explanation
Cleaning from front to back prevents the transfer of bacteria from the anal region to the urethra, which reduces infection risk. Each wipe should be done with a clean section of the cloth to maintain asepsis.
8. Which action demonstrates proper use of sterile gloves?
- Adjusting the gloves after both are applied
- Touching only sterile items after both gloves are on
- Pulling the first glove over the wrist cuff of the gown
- Applying lotion to the hands before gloving
Explanation
Once sterile gloves are donned, only sterile objects should be touched to maintain asepsis. Adjusting or touching non-sterile items contaminates the gloves.
9. Which protocol does not vary among institutions?
- Acceptability of wearing artificial nails in patient care areas
- Use of impervious transparent dressings to cover open lesions on nurse's hands during sterile procedures
- Use of sterile gloves for sterile procedures
- Sterile gloves are only available in "one size fits all"
Explanation
The use of sterile gloves for sterile procedures is a standard practice that does not vary among institutions. Sterile gloves are universally required for any sterile procedure to prevent infection and maintain patient safety. Policies such as artificial nail use, covering open lesions, and glove sizing can vary depending on institutional regulations or manufacturer guidelines, but the need for sterile gloves during sterile procedures is consistent across all healthcare settings.
10. Which nursing action minimizes a patient's risk for injury during removal of an indwelling urinary catheter?
- Using a 5-mL syringe to deflate the balloon
- Using sterile scissors to cut the valve to deflate the balloon
- Tugging gently on the catheter to pull the balloon through the urethra
- Checking the documentation for the volume of fluid used to inflate the balloon
Explanation
Using a syringe to deflate the balloon is the correct method for safely removing an indwelling urinary catheter. Fully deflating the balloon prevents trauma to the urethra and bladder during removal. Cutting the valve or tugging on the catheter can cause urethral injury, and simply checking the documentation does not prevent physical harm. Following proper deflation technique is critical to minimize the risk of injury during catheter removal.
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