D445 Intermediate Nursing Skills
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Free D445 Intermediate Nursing Skills Questions
1. 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.
2. What is the primary reason the nurse applies sterile gloves rather than clean ones when caring for a patient with a newly inserted suprapubic catheter?
- To protect the nurse and other patients from pathogens
- To collect a sterile urine sample
- To reduce the patient's risk of infection
- To reduce the patient's risk of injury
Explanation
Sterile gloves are used to reduce the patient’s risk of infection when caring for a newly inserted suprapubic catheter. The catheter insertion site is considered a sterile area, and using sterile gloves prevents the introduction of microorganisms that could cause a urinary tract or site infection. Clean gloves provide basic protection but do not maintain sterility required for newly inserted catheters, making sterile gloves essential for patient safety.
3. 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.
4. Which nursing action is most effective in preventing pressure injuries in an immobile patient?
- A) Increasing dietary protein
- B) Turning the patient every 2 hours
- C) Applying sterile dressings daily
- D) Changing the bed linens each shift
Explanation
Regular repositioning redistributes pressure and improves circulation, preventing tissue ischemia. While nutrition and hygiene are important, repositioning is the most direct preventive measure.
5. The nurse is preparing to insert a urinary catheter for a female patient who has severe arthritis and cannot maintain the dorsal recumbent position. Which alternative position is most appropriate?
- A) High-Fowler’s position
- B) Side-lying (Sim’s) position with the upper leg flexed
- C) Supine position with knees extended
- D) Lithotomy position
Explanation
In patients unable to tolerate the dorsal recumbent position, the side-lying (Sim’s) position allows access to the urinary meatus while maintaining comfort. The upper leg is flexed to expose the perineal area without causing joint strain.
6. A nurse is preparing to irrigate a patient’s indwelling urinary catheter. Which action should the nurse take first?
- Verify the health care provider’s prescription for irrigation.
- Clamp the drainage tubing below the port.
- Don sterile gloves and prepare the irrigation solution.
- Insert the syringe into the port and slowly inject the solution.
Explanation
Before performing a catheter irrigation, the nurse must first verify the provider’s prescription. Catheter irrigation is an invasive procedure that could introduce pathogens or cause trauma if not properly indicated. Verification ensures it is medically ordered and that the prescribed volume and solution are appropriate.
7. Which practice protects the nurse from infection when changing the dressing on an infected pressure ulcer?
- Begin antibiotic therapy before the dressing change.
- Use appropriate personal protective equipment.
- Adhere to sterile technique during the intervention.
- Complete the dressing change in an effective, efficient manner.
Explanation
Using appropriate personal protective equipment (PPE) is the primary practice that protects the nurse from infection when caring for an infected wound. PPE, such as gloves, gowns, and masks, creates a barrier between the nurse and infectious material, reducing the risk of pathogen transmission. While sterile technique helps protect the patient, and completing the procedure efficiently is good practice, PPE specifically safeguards the nurse from exposure. Antibiotic therapy protects the patient, not the nurse.
8. Which nursing action is most appropriate when administering a rectal suppository?
- Lubricate the suppository and insert it past the internal sphincter.
- Insert the suppository 1 inch into the rectum regardless of age.
- Ask the patient to ambulate immediately after insertion.
- Avoid using gloves to maintain dexterity.
Explanation
A rectal suppository should be lubricated and inserted past the internal sphincter to ensure absorption and retention. Insertion depth depends on patient age — 4 inches for adults and 2 inches for children. Gloves must be worn for infection control.
9. Which action should the nurse take to ensure accurate measurement of urine output from a closed drainage system?
- Drain the entire bag contents into a calibrated container at the end of each shift.
- Estimate the amount by visually inspecting the drainage bag.
- Disconnect the tubing to pour urine directly into a measuring cup.
- 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.
10. Which action would minimize the risk of infection when placing prepackaged supplies on an established sterile field?
- Wear clean treatment gloves.
- Collect supplies with sterile gloves to avoid contamination.
- Do not allow the wrapper to touch the sterile field.
- Place the supplies in the 1-inch perimeter of the sterile field.
Explanation
When adding prepackaged supplies to a sterile field, it is essential to prevent contamination from the packaging. The wrapper is considered non-sterile and should not touch the sterile field, as contact could transfer pathogens. By carefully opening the package and placing only the sterile contents onto the field, the nurse ensures that sterility is maintained. Wearing gloves or touching the 1-inch perimeter incorrectly could compromise the field, so focusing on proper handling of the package is the key measure to reduce infection risk.
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