Week 1 Clinical Skills

Question 1

Which action would the nurse perform to best ensure effective insertion of a venous access device into a patient’s arm?

A. Anchor the vein by placing a thumb 1 to 2 inches below the site.
B. Insert the device tip at a 45-degree angle distal to the proposed site.
C. Place the patient’s left arm in a dependent position for 5 minutes before assessment.
D. Apply a tourniquet to the left antecubital fossa 8 to 12 inches above the proposed site.

Answer 1

A. Anchor the vein by placing a thumb 1 to 2 inches below the site.

Question 2

How might the nurse prepare a patient to anticipate some discomfort when inserting a venous access device?

A. Instruct the patient to expect a sharp, quick stick.
B. Insert the access device as quickly as possible.
C. Apply a topical anesthetic to the area before inserting the device.
D. Promise that the procedure will not hurt once the device has been inserted.

Answer 2

A. Instruct the patient to expect a sharp, quick stick.

Question 3

Which of the following technique(s) is/are best for minimizing a patient’s risk for injury when inserting a venous access device?

A. Inserting the needle with the bevel up
B. Using a vein on the dorsal surface of the arm
C. Holding the skin taut directly below the site
D. All of the above

Answer 3

D. All of the above

Question 4

The nurse is inserting an over-the-needle catheter into a newly admitted patient. What will the nurse do after confirming blood return?

A. Loosen or remove the tourniquet.
B. Advance the catheter 1 inch into the vein.
C. Lower the catheter until it is flush with the skin.
D. Thread the catheter into the vein up to the hub.

Answer 4

C. Lower the catheter until it is flush with the skin.

Question 5

Which instruction might the nurse give to nursing assistive personnel (NAP) regarding the care of a patient with an intravenous access device?

A. “Assess the IV site frequently for signs of inflammation.”
B. “Be sure not to obscure the insertion site with the dressing.”
C. “Let me know when you notice that the IV bag contains less than 100 milliliters.”
D. “Explain the symptoms of infection to the patient.”

Answer 5

C. “Let me know when you notice that the IV bag contains less than 100 milliliters.”

Question 6

Which technique is most accurate in identifying an appropriate vein site for IV catheter insertion into the arm?

A. Remove any clothing that is covering the arm.
B. Apply a warm washcloth to the arm at the proposed site.
C. Elevate the selected arm on a pillow for 2 to 3 minutes.
D. Apply a tourniquet to the selected arm 4 to 6 inches above the proposed site.

Answer 6

D. Apply a tourniquet to the selected arm 4 to 6 inches above the proposed site.

Question 7

When preparing to insert a venous access device, how can the nurse encourage patient compliance with the procedure?

A. Assess the patient’s understanding of the placement of the device.
B. Insert the access device as quickly as possible.
C. Ask the patient to select the arm preferred for access.
D. Apply a topical anesthetic to the area before inserting the device.

Answer 7

A. Assess the patient’s understanding of the placement of the device.

Question 8

Which action minimizes the patient’s risk for injury when inserting a venous access device into the arm?

A. Wearing clean gloves during the procedure
B. Using a larger vein found on the palmar (ventral) side of the wrist
C. Checking for a radial pulse once the tourniquet has been applied
D. Priming the extension tubing after attaching it to the newly placed venous access device

Answer 8

C. Checking for a radial pulse once the tourniquet has been applied

Question 9

The nurse is preparing to insert a venous access device into a newly admitted 75-year-old patient. Which vein is an inappropriate choice for IV insertion in this patient?

A. Basilic vein
B. Cephalic vein
C. Superficial dorsal vein
D. Median cubital vein

Answer 9

C. Superficial dorsal vein

Question 10

The nurse is using chlorhexidine to prepare the site before inserting a venous access device into the median cubital vein of a 60-year-old patient. Which action is correct?

A. Wash the site with soap and water.
B. Allow the site to dry 1 to 2 minutes after cleansing it with chlorhexidine.
C. Cleanse the site using a circular motion, starting at the insertion site and working outward.
D. Cleanse the area by first swabbing horizontally, then vertically with the applicator for about 30 seconds.

Answer 10

D. Cleanse the area by first swabbing horizontally, then vertically with the applicator for about 30 seconds.

Question 11

Which statement might a nurse make to nursing assistive personnel (NAP) when caring for a patient prescribed an intravenous (IV) bolus of analgesic medication?

A. “Assess the IV site frequently for signs of inflammation.”
B. “Let me know immediately if the patient complains of pain at the insertion site.”
C. “Make sure the patient knows what results to expect from the medication.”
D. “Observe the IV site for sudden swelling when the IV bolus is administered.”

Answer 11

B. “Let me know immediately if the patient complains of pain at the insertion site.”

Question 12

Which patient safety issue is specific to administration of medication by IV bolus?

A. Determining that the medication is compatible with the IV solution
B. Checking for patient allergies before giving the medication
C. Identifying the patient using two identifiers
D. Checking the medication against the medication administration record (MAR) three times

Answer 12

A. Determining that the medication is compatible with the IV solution

Question 13

What is the most important action the nurse can take to protect the patient when administering a narcotic analgesic by IV bolus?

A. Injecting the medication at the prescribed rate
B. Observing the insertion site after giving the medication
C. Instructing the patient about side effects to report to the nurse
D. Using an alcohol swab to wipe the insertion port on the primary tubing

Answer 13

A. Injecting the medication at the prescribed rate

Question 14

How can the nurse best minimize the patient’s risk for infection when administering an IV bolus of an analgesic?

A. Use the injection port closest to the patient.
B. Assess the IV insertion site for signs of infiltration.
C. Follow aseptic technique during the entire process.
D. Instruct the patient to report any adverse medication reactions.

Answer 14

C. Follow aseptic technique during the entire process.

Question 15

If the nurse does not see blood return when aspirating the saline lock in preparation for an IV bolus medication, what is the next step?

A. Attempt to aspirate the site again.
B. Prepare to access another IV site.
C. Assess the saline lock site for signs of phlebitis.
D. Assess the site for swelling or coolness while flushing the saline lock with normal saline.

Answer 15

D. Assess the site for swelling or coolness while flushing the saline lock with normal saline.

Question 16

Which response might the nurse give to nursing assistive personnel (NAP) who reports that the alarm is sounding on a patient’s electronic infusion device (EID)?

A. “Assess the IV site for signs of inflammation.”
B. “Be sure to change the dressing on the IV site.”
C. “I’ll check the IV site and pump.”
D. “Turn off the alarm.”

Answer 16

C. “I’ll check the IV site and pump.”

Question 17

How would the infusion of the IV fluids be affected if the tubing were unintentionally dislodged from the chamber of the control mechanism of the EID?

A. The infusion would slow to a “keep vein open” rate.
B. The patient would receive a bolus of fluid.
C. The infusion would continue at the prescribed rate.
D. The flow of fluid would stop.

Answer 17

D. The flow of fluid would stop.

Question 18

A patient is prescribed 1000 mL of intravenous (IV) normal saline to run over 8 hours. The initial fluid is hung at 0800. How many milliliters of fluid will have infused by 1200?

A. 125 mL
B. 250 mL
C. 500 mL
D. 625 mL

Answer 18

C. 500 mL

Question 19

The nurse calculates that the patient is to receive 125 mL of intravenous (IV) normal saline per hour. After programming the infusion pump to deliver at that rate, how would the nurse ensure accurate fluid administration?

A. First verify that the fluid is dripping, and then check the level of fluid remaining in the container every hour.
B. Ask another nurse to assess the programming of the pump.
C. Set the pump alarm to sound when half of the fluid has infused.
D. Check the IV site for complications.

Answer 19

A. First verify that the fluid is dripping, and then check the level of fluid remaining in the container every hour.

Question 20

Which information is not necessary for the nurse to include when documenting the use of an EID for an intravenous infusion?

A. Location of the insertion site
B. Time at which the infusion began
C. Patient’s pulse and heart rate
D. Hourly volume flow rate of the infusion

Answer 20

C. Patient’s pulse and heart rate

Question 21

Which instruction reflects the nurse’s correct understanding of the role of nursing assistive personnel (NAP) in caring for a patient receiving an intravenous (IV) antibiotic medication by piggyback?

A. “Assess the IV site frequently for signs of infiltration.”
B. “Let me know immediately if the patient complains of pain at the IV site.”
C. “Notify the physician that the patient is allergic to the medication prescribed.”
D. “Remember to hang the piggyback medication higher than the primary solution.”

Answer 21

B. “Let me know immediately if the patient complains of pain at the IV site.”

Question 22

When administering an IV piggyback medication to infuse by gravity, how can the nurse ensure that the medication will flow properly?

A. Use an infusion pump to regulate the flow rate of the piggyback medication.
B. Hang the piggyback medication higher than the primary fluid.
C. Attach the piggyback medication to the most proximal insertion port on the primary tubing.
D. Use a secondary infusion set for the piggyback tubing.

Answer 22

B. Hang the piggyback medication higher than the primary fluid.

Question 23

What is the best way to protect a patient from an IV site injury when giving an antibiotic medication by piggyback?

A. Use a site into which a primary solution is already infusing.
B. Assess the IV site before initiating the IV piggyback medication.
C. Select a relatively small vein to infuse the IV medication.
D. Instruct NAP to notify you immediately if the insertion site appears swollen.

Answer 23

B. Assess the IV site before initiating the IV piggyback medication.

Question 24

What is the best way to prevent infection and conserve resources when terminating an IV piggyback medication infusion in a patient who also has a primary fluid infusion?

A. Remove the tubing from the primary line Y-site port, and cap the end.
B. Leave both the piggyback tubing and the bag attached to the primary line Y-site port until the next scheduled dose.
C. Place an unopened secondary setup at the bedside, and discard the used one.
D. Change both the primary and secondary tubing upon terminating the piggyback infusion.

Answer 24

B. Leave both the piggyback tubing and the bag attached to the primary line Y-site port until the next scheduled dose.

Question 25

Which nursing intervention is most important in ensuring safe infusion of a medication delivered by IV piggyback through a saline lock?

A. Use the most proximal insertion port on the primary tubing.
B. Hang the piggyback solution higher than the primary infusion solution.
C. Use a pump to regulate the infusion rate of the piggyback medication.
D. Flush the saline lock with sodium chloride solution before initiating the infusion.

Answer 25

D. Flush the saline lock with sodium chloride solution before initiating the infusion.

Question 26

Which instruction might the nurse give to nursing assistive personnel (NAP) regarding the care of a patient with an intravenous (IV) site dressing?

A. “Assess the IV site frequently for signs of inflammation.”
B. “Be sure not to obscure the insertion site with the dressing.”
C. “If the gauze dressing looks damp, replace it with a dry 4 × 4 gauze.”
D. “Be sure to notify me if the patient reports that the IV site is painful or swollen.”

Answer 26

D. “Be sure to notify me if the patient reports that the IV site is painful or swollen.”

Question 27

How will the nurse minimize the risk for infection when changing a patient’s IV catheter site dressing?

A. Use aseptic technique throughout the process.
B. Pull the tape toward the insertion site.
C. Remove both the gauze dressing and the tape one layer at a time.
D. Explain the process to the patient.

Answer 27

A. Use aseptic technique throughout the process.

Question 28

The nurse is concerned that a confused patient’s erratic movements may compromise the intravenous (IV) insertion site. Which action can the nurse take to protect the patient and the site from injury?

A. Apply an IV site-protection device over the site.
B. Apply restraints to the patient.
C. Check the patient frequently.
D. Instruct the patient to avoid dislodging the IV catheter.

Answer 28

A. Apply an IV site-protection device over the site.

Question 29

Which action would the nurse take if an intravenous (IV) insertion site appeared red, warm, and swollen?

A. Assess for blood return.
B. Discontinue the infusion.
C. Change the existing dressing.
D. Secure the tubing with more tape.

Answer 29

B. Discontinue the infusion.

Question 30

How can the nurse ensure that a patient’s IV tubing will not tug on the infusion catheter after a transparent dressing is applied to an infusion site on the arm?

A. Encircle the arm with tape.
B. Secure the tubing and catheter hub with tape.
C. Secure the tubing in two different locations on the arm.
D. Label the dressing with the date and time of application.

Answer 30

C. Secure the tubing in two different locations on the arm.

Question 31

After changing the intravenous (IV) tubing on a patient’s primary infusion, the nurse notes air bubbles in the tubing. How would the nurse remove them?

A. Begin the process again.
B. Add more fluid to the drip chamber.
C. Inject a syringe of saline into the tubing to vent the air bubbles.
D. Close the clamp, stretch the tubing downward, and flick the tubing.

Answer 31

D. Close the clamp, stretch the tubing downward, and flick the tubing.

Question 32

Which action can the nurse take to minimize the patient’s risk for infection when applying new tubing to a primary IV infusion?

A. Using aseptic technique throughout the process
B. Changing the tubing each shift
C. Changing the tubing at the same time a new primary fluid bag is hung when possible
D. Using aseptic technique and changing the tubing at the same time a new primary fluid bag is hung are both appropriate to minimize the patient’s risk for infection

Answer 32

D. Using aseptic technique and changing the tubing at the same time a new primary fluid bag is hung are both appropriate to minimize the patient’s risk for infection

Question 33

While changing a patient’s hospital gown, the extension set on the IV infusion becomes disconnected and ends up on the bed linens. What would the nurse do?

A. Reconnect the extension set.
B. Clean the end with an alcohol swab and reconnect it.
C. Pull the IV from the site and insert a new catheter.
D. Change the extension set tubing.

Answer 33

D. Change the extension set tubing.

Question 34

What would the nurse do to ensure the correct administration of gravity drip intravenous (IV) fluid after changing the tubing on a patient’s primary infusion?

A. Change the tubing with each new infusion bag.
B. Wear clean treatment gloves when changing the tubing.
C. Recheck the drip rate by counting the drops for 1 full minute.
D. Assess the condition of the patient’s insertion site for possible infiltration.

Answer 34

C. Recheck the drip rate by counting the drops for 1 full minute.

Question 35

Which instruction would the nurse give to nursing assistive personnel (NAP) when caring for a patient who is receiving IV fluids?

A. “If the IV tubing gets disconnected, quickly reconnect it for me and let me know.”
B. “It’s okay for you to turn off the pump alarm when it beeps.”
C. “Let me know when the IV bag is almost empty.”
D. “Please check the IV site for me and let me know if it’s tender.”

Answer 35

C. “Let me know when the IV bag is almost empty.”

Question 36

When drawing blood from a patient’s peripherally inserted central catheter (PICC), what can the nurse do to minimize pressure on the device during flushing?

A. Clamp the device.
B. Use a 3-ml syringe for the flush.
C. Use a 10-ml syringe for the flush.
D. Cleanse the catheter hub with an alcohol swab.

Answer 36

C. Use a 10-ml syringe for the flush.

Question 37

When drawing blood from a peripherally inserted central catheter (PICC) in which all ports are patent, it is recommended that the nurse select which lumen?

A. The shortest
B. The longest
C. The proximal port
D. The largest

Answer 37

D. The largest

Question 38

Which action can the nurse take to ensure a quality blood sample when drawing blood from a patient’s peripherally inserted central catheter (PICC) site?

A. Allow fluid infusions to continue to flow right up to the time of the sample.
B. Flush the catheter after aspirating for blood return.
C. Ensure that the patient has been resting quietly for at least 15 minutes before taking the sample.
D. Discard the first 6 to 9 ml of blood drawn.

Answer 38

D. Discard the first 6 to 9 ml of blood drawn.

Question 39

After drawing blood from a patient’s peripherally inserted central catheter (PICC), what would the nurse do to ensure that the device resumes proper functioning?

A. Discard the initial 6 ml of aspirated blood.
B. Apply an antiseptic to the injection cap.
C. Wear clean treatment gloves during the procedure.
D. Flush the catheter with preservative-free 0.9% sodium chloride, per agency policy.

Answer 39

D. Flush the catheter with preservative-free 0.9% sodium chloride, per agency policy.

Question 40

After drawing blood from a peripherally inserted central catheter (PICC), which action would minimize the patient’s risk for infection when reconnecting prescribed intravenous fluids?

A. Wearing clean gloves
B. Changing the IV tubing
C. Disinfecting the IV needleless connector and the end of the IV tubing
D. Aspirating for blood return before flushing the catheter

Answer 40

C. Disinfecting the IV needleless connector and the end of the IV tubing

Question 41

Why is it important to label the gauze dressing covering the site of an intravenous access device with the date, time, and nurse’s initials?

A. Reminds the nurse to document the insertion of the device
B. Proves that the access site was assessed
C. Informs the nurse and other staff when the next dressing change is due
D. Reminds the nurse when to change the infusion tubing

Answer 41

C. Informs the nurse and other staff when the next dressing change is due

Question 42

Which action will the nurse take to minimize a patient’s risk for injury when applying a dressing to an infusion site?

A. Use aseptic technique throughout the process.
B. Apply a skin protectant to the skin before the intervention.
C. Apply a transparent dressing that allows for visualization of the site.
D. Explain the process to the patient before implementation.

Answer 42

A. Use aseptic technique throughout the process.

Question 43

The nursing assistive personnel (NAP) reports to the nurse that a patient’s intravenous access device dressing is wet. What would the nurse do first?

A. Assess the site.
B. Instruct the NAP on how to change the dressing.
C. Remove the device, and insert a new one.
D. Reinforce the dressing with more gauze.

Answer 43

A. Assess the site.

Question 44

When applying a dressing to an infusion site on a patient’s left forearm, what will the nurse do to ensure proper maintenance of the tubing?

A. Apply a transparent dressing to the insertion site.
B. Use a catheter stabilizing device when applying the dressing.
C. Apply the dressing distal to the tubing and catheter hub connector.
D. Secure the tubing to the patient’s dressing with 1-inch tape.

Answer 44

A. Apply a transparent dressing to the insertion site.

Question 45

Which action will the nurse take to minimize a patient’s risk for injury when applying a gauze dressing to an infusion site?

A. Avoid encircling the arm with tape
B. Not secure the tubing and catheter hub with tape
C. Secure the tubing in two different locations on the arm
D. Label the dressing with the date and time of application

Answer 45

A. Avoid encircling the arm with tape

Question 46

While checking a blood product prior to administration, the nurse is called away to assist with another procedure. What should the nurse do with the blood product?

A. Return it to the blood bank until it can be administered.
B. Ask another nurse to administer it to the patient.
C. Ask nursing assistive personnel (NAP) to place it in the unit refrigerator if you expect to be gone less than 30 minutes.
D. Leave it in the patient’s room.

Answer 46

A. Return it to the blood bank until it can be administered.

Question 47

While checking a blood product prior to administration, the nurse notices that the birth date on the blood bag and requisition do not match the birth date on the patient’s identification bracelet. Which is the correct action for the nurse to take?

A. Be especially vigilant for adverse reactions during the infusion.
B. Ask the patient to state his or her birth date.
C. Correct the birth date on the blood bag and requisition.
D. Return the blood to the blood bank.

Answer 47

D. Return the blood to the blood bank.

Question 48

An adult patient is prescribed to receive a unit of packed red blood cells. Which size intravenous catheter does the patient need to safely receive this blood?

A. 30-gauge
B. 25-gauge
C. 18-gauge
D. 10-gauge

Answer 48

C. 18-gauge

Question 49

The nurse is preparing to administer a unit of blood to a patient in the emergency department and discovers that he is not wearing an identification bracelet. What should the nurse do?

A. Identify the patient by asking him to produce a photo ID, such as a driver’s license.
B. Administer the blood only if you have been caring for the patient and can be certain of his identity.
C. Return the unit to the blood bank.
D. Identify the patient by asking a family member to identify him.

Answer 49

C. Return the unit to the blood bank.

Question 50

While checking a blood bag prior to infusion, the nurse notes that the patient’s blood type is A+ and the donor’s blood type is O+. Which action would the nurse take?

A. Administer the blood.
B. Return the blood to the blood bank.
C. Notify the physician.
D. Ask the patient if anyone in the family has blood type A+.

Answer 50

A. Administer the blood.

Question 51

A patient prescribed to receive two units of packed red blood cells is to receive a dose of intravenous medication between the two units. How would the nurse administer the medication?

A. In the IV line for the blood product during the transfusion
B. In the IV line for the blood product when the line is flushed with normal saline
C. In oral form
D. Through another IV line

Answer 51

D. Through another IV line

Question 52

The nurse is preparing equipment to administer a unit of blood to a patient. Which type of fluid would the nurse piggyback with the blood transfusion?

A. 0.45% normal saline
B. 0.9% normal saline
C. Dextrose 5% and 0.45% normal saline
D. Dextrose 5% and 0.9% normal saline

Answer 52

B. 0.9% normal saline

Question 53

A patient is to receive one unit of packed red blood cells over 2 hours. Which rate is the usual flow rate for the first 15 minutes of a blood transfusion?

A. 1 mL/min
B. 2 mL/min
C. 10 mL/min
D. 25 mL/min

Answer 53

B. 2 mL/min

Question 54

A patient is to receive 3 units of packed red blood cells over 8 hours. What will the nurse do to maintain the patency of the patient’s IV access line after each of the first two units of blood has transfused?

A. Infuse 0.9% normal saline at 100 mL/hour.
B. Infuse dextrose 5% and 0.9% normal saline at the KVO (keep-vein-open) rate.
C. Infuse 0.9% normal saline at the KVO rate.
D. Cap the intravenous line.

Answer 54

C. Infuse 0.9% normal saline at the KVO rate.

Question 55

A patient received two 300-mL units of packed red blood cells, and the line was flushed with 25 mL of solution between the units. What is the total amount of fluid the nurse will document having provided to the patient?

A. 675 mL
B. 650 mL
C. 625 mL
D. 600 mL

Answer 55

C. 625 mL

Question 56

What would the nurse do to assess a patient’s risk for embolus when removing a venous access device?

A. Inspect the site for redness.
B. Visualize the tip of the IV device.
C. Palpate the site for possible edema.
D. Ask the patient to rate any pain at the site.

Answer 56

B. Visualize the tip of the IV device.

Question 57

Which instruction might the nurse give to nursing assistive personnel (NAP) when caring for a patient whose IV access device is to be removed?

A. “Remember to wear gloves to minimize the risk for infection.”
B. “Be sure to keep pressure on the site for at least 2 to 3 minutes.”
C. “Let me know if you notice any bleeding on the site dressing.”
D. “Make sure the patient knows to notify me if the IV site becomes painful.”

Answer 57

C. “Let me know if you notice any bleeding on the site dressing.”

Question 58

What might the nurse do to improve a patient’s cooperation during the removal of an IV access device?

A. Describe the entire procedure to the patient.
B. Assure the patient that you will remove the IV catheter quickly.
C. Assure the patient that the procedure will take only about 5 minutes.
D. Tell the patient that the procedure will cause only a slight burning sensation.

Answer 58

A. Describe the entire procedure to the patient.

Question 59

Which action will best minimize the patient’s risk for vein injury when removing an IV access device from a patient’s arm?

A. Keep the hub parallel to the skin.
B. Cleanse the site with an antibacterial swab.
C. Cut the dressing to facilitate its removal.
D. Turn the IV tubing roller clamp to the “off” position.

Answer 59

A. Keep the hub parallel to the skin.

Question 60

What will the nurse do to prevent possible complications after removing an IV access device in a patient on anticoagulant therapy?

A. Instruct the patient to report immediately any sign of bleeding on the site dressing.
B. Perform hand hygiene and wear clean gloves while removing the device.
C. Encourage the patient to keep a cold compress on the site for 15 minutes.
D. Apply firm pressure to the site with sterile gauze for 10 minutes.

Answer 60

D. Apply firm pressure to the site with sterile gauze for 10 minutes.