RPN Clinical Skills 3 — Questions and Answers
Question 1: Which sign indicates that a wound is healing by primary intention?
- Wound edges are open with granulation tissue visible
- Wound edges are approximated with minimal scar formation (Correct answer)
- Wound edges are separated and draining purulent fluid
- Wound is left open and packed with gauze
Correct answer: Wound edges are approximated with minimal scar formation
Primary intention healing occurs when wound edges are closed and approximated, resulting in minimal scar tissue.
Question 2: A nurse notices that a patient's IV site is cool, pale, and swollen but the infusion is still running. What complication is occurring?
- Phlebitis
- Infiltration (Correct answer)
- Air embolism
- Thrombosis
Correct answer: Infiltration
Infiltration occurs when IV fluid leaks into surrounding tissue, causing coolness, pallor, and swelling at the site.
Question 3: When performing postural drainage for a patient with secretions in the right lower lobe, what position should the nurse use?
- High Fowler's on the right side
- Left lateral with foot of bed elevated (Correct answer)
- Right lateral with foot of bed elevated
- Prone with head of bed elevated
Correct answer: Left lateral with foot of bed elevated
Draining the right lower lobe requires left lateral positioning with the foot of bed elevated so gravity moves secretions toward the central airways.
Question 4: A nurse is performing tracheostomy care. When should the inner cannula be replaced or cleaned?
- Only when the patient is suctioned
- Every 8 hours or per facility protocol (Correct answer)
- Once per day at 0600
- Only when secretions are visible
Correct answer: Every 8 hours or per facility protocol
Inner cannulas are cleaned or replaced every 8 hours (or per facility protocol) to prevent secretion buildup and maintain airway patency.
Question 5: During administration of a blood transfusion, the patient develops fever, chills, and low back pain within 15 minutes. What is the priority nursing action?
- Slow the transfusion rate and monitor
- Stop the transfusion and keep the IV line open with normal saline (Correct answer)
- Administer diphenhydramine and continue the transfusion
- Increase the IV flow rate to dilute the reaction
Correct answer: Stop the transfusion and keep the IV line open with normal saline
Signs of an acute hemolytic reaction require immediately stopping the transfusion while keeping venous access with normal saline, then notifying the provider and blood bank.
Question 6: Which technique is used to verify correct placement of a small-bore (dobhoff) feeding tube before initiating enteral feedings?
- Auscultating over the epigastric area while injecting air
- Checking gastric pH of aspirate and confirming with X-ray (Correct answer)
- Submerging the tube end in water to check for bubbles
- Observing respiratory rate for 5 minutes after insertion
Correct answer: Checking gastric pH of aspirate and confirming with X-ray
Radiographic confirmation plus aspirate pH testing (pH <5 suggests gastric placement) is the gold standard for verifying small-bore feeding tube placement.
Question 7: A nurse is teaching a patient to use a peak flow meter. Which instruction is correct?
- Inhale slowly through the mouthpiece, then exhale normally
- Stand or sit upright, inhale deeply, place meter in mouth, and exhale as hard and fast as possible (Correct answer)
- Exhale gently into the meter to avoid false high readings
- Take three puffs of bronchodilator before measuring peak flow
Correct answer: Stand or sit upright, inhale deeply, place meter in mouth, and exhale as hard and fast as possible
Peak flow is measured by a maximal forced exhalation after a deep inhalation, with the patient upright, to obtain an accurate measurement of airflow.
RPN Clinical Skills 3
Which sign indicates that a wound is healing by primary intention?