D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
1. The nurse prepares to collect a sterile urine specimen from a patient’s indwelling catheter. Which step ensures sterility of the specimen?
- A) Collect urine from the drainage bag
- B) Clamp the tubing below the port for 15–30 minutes before collection
- C) Open the drainage system at the catheter connection
- D) 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.
2. A nurse is preparing to perform tracheostomy suctioning on a patient with copious secretions. Which action should be performed first?
- Hyperoxygenate the patient with 100% oxygen.
- Insert the suction catheter into the tracheostomy without applying suction.
- Sterilize the catheter before use.
- Ask the patient to take several deep breaths.
Explanation
Hyperoxygenation before suctioning is essential to prevent hypoxemia during the procedure. Suctioning removes oxygen along with secretions, so preoxygenation minimizes desaturation and potential cardiac complications.
3. Which action would the nurse take to manage continuous urinary catheter irrigation for a patient whose urine is bright red and contains clots?
- Increase the irrigation drip rate.
- Notify the patient's health care provider of the blood and clots in the urine.
- Encourage the patient to increase fluid intake.
- Apply ice to the patient's lower abdominal area.
Explanation
Bright red urine with clots during continuous urinary catheter irrigation can indicate significant bleeding or obstruction. The nurse’s priority action is to notify the healthcare provider promptly, as this may require medical intervention or adjustment of therapy. Increasing the irrigation rate, encouraging fluids, or applying ice may support care but do not address the potentially serious complication. Early notification ensures timely assessment and management to prevent further complications.
4. While opening a prepackaged sterile kit, a package of sterile 4 x 4s falls to the floor. What will the nurse ask ancillary staff to do to ensure the quality of the sterile field?
- "I will have to set up another sterile field; please take these items away."
- "Please go to the clean utility room and get me a package of sterile 4 x 4s."
- "Please watch that nothing contaminates this sterile field while I go and get a replacement item."
- "Explain to the patient the importance of remaining still during this procedure so no other items are contaminated."
Explanation
If an item falls to the floor, it is considered contaminated, and the sterile field may also be compromised. The nurse should instruct ancillary staff to ensure that nothing contaminates the sterile field while a replacement item is obtained. This preserves the sterility of the existing field and prevents accidental contamination. Asking staff to remove the dropped item or instructing the patient on stillness does not directly address maintaining sterility while acquiring a replacement.
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?
- A) “You may place the drainage spout on the bed for convenience.”
- B) “Be sure to wipe the drainage spout with an alcohol pad after emptying.”
- C) “Clamp the tubing above the bag while emptying.”
- D) “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 removing an indwelling urinary catheter. The patient reports resistance when the nurse begins to withdraw the catheter. What should the nurse do first?
- Stop pulling and ensure the balloon is completely deflated.
- Continue pulling with steady pressure.
- Ask another nurse to assist with removal.
- Cut the inflation port to release fluid.
Explanation
Resistance during catheter removal suggests that the balloon is not fully deflated. The nurse should stop immediately and verify that all fluid has been aspirated from the balloon port before proceeding. Forcing removal can cause urethral trauma.
7. Which statement might the nurse make to nursing assistive personnel (NAP) caring for a patient who has just had an indwelling urinary catheter removed?
- "Teach the patient the signs of a urinary tract infection."
- "Tell me when and how much the patient first voids."
- "Explain that voiding might be uncomfortable for 4 to 5 days."
- "Assess the patient for a distended bladder before the end of the shift."
Explanation
NAP can assist by observing and reporting the patient’s first voiding after catheter removal, including timing and urine output. This information helps the nurse assess bladder function and detect retention or complications. Teaching signs of infection, explaining discomfort, or assessing for bladder distention require nursing judgment and are outside the scope of NAP responsibilities. Delegating observation and reporting ensures accurate monitoring while maintaining appropriate scope of practice.
8. When adding a sterile liquid to a sterile field, which action will contaminate the field?
- Extending your arm over the sterile field to pour the liquid into the receptacle
- Holding the bottle with the label facing the palm
- Adding a liquid with a usable period that expires in 2 days
- 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.
9. A newly inserted suprapubic catheter becomes dislodged. What action should the nurse perform first?
- Notify the health care provider
- Apply pressure over the site
- Cover the site with a sterile dressing
- Help the patient into a side-lying position
Explanation
If a newly inserted suprapubic catheter becomes dislodged, the first and most important action is to apply gentle pressure over the site to control any bleeding and prevent urine leakage into surrounding tissues. The tract from the bladder to the abdominal wall closes very quickly, especially when the catheter is newly placed, so it is critical to stabilize the area immediately. After applying pressure, the nurse should notify the health care provider so that reinsertion can be performed as soon as possible to prevent closure of the tract and potential complications such as infection or leakage.
10. When cleansing the perineal area before catheterization, how should the nurse proceed?
- A) Wipe in a circular motion from the center outward
- B) Wipe from the urethral opening toward the rectum
- C) Wipe from the rectum toward the urethral opening
- D) 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.
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