RPN Clinical Skills 4 — Questions and Answers
Question 1: A patient has a chest tube connected to a water-seal drainage system. The nurse notices the water level in the water-seal chamber is not fluctuating (tidaling). What does this indicate?
- The lung has re-expanded or the tube is kinked/obstructed (Correct answer)
- The system is functioning normally
- Air is entering the pleural space
- The drainage system needs to be replaced immediately
Correct answer: The lung has re-expanded or the tube is kinked/obstructed
Absence of tidaling indicates either successful lung re-expansion (expected) or a kinked or obstructed tube (requiring assessment).
Question 2: When applying elastic compression stockings (TED hose), which action is correct?
- Apply stockings after the patient has been ambulating for 30 minutes
- Apply stockings while the patient is supine before dependent edema accumulates (Correct answer)
- Apply stockings only to the affected leg in DVT patients
- Apply stockings over skin lotion to reduce friction
Correct answer: Apply stockings while the patient is supine before dependent edema accumulates
Compression stockings should be applied while the patient is supine (legs elevated) to prevent trapping edema under the stocking.
Question 3: The nurse is performing a capillary blood glucose test. After the lancet puncture, what is the correct action regarding the first drop of blood?
- Use the first drop for the glucose test strip
- Wipe away the first drop and use the second drop (Correct answer)
- Apply pressure to enlarge the first drop for testing
- Warm the site for 5 minutes before testing the first drop
Correct answer: Wipe away the first drop and use the second drop
The first drop of blood may be contaminated with tissue fluid, so it is wiped away and the second drop is applied to the test strip for accurate results.
Question 4: A patient returns from surgery with a Jackson-Pratt (JP) drain. The nurse notes the bulb is fully expanded. What action should be taken?
- Notify the surgeon immediately
- Empty the drain and recompress the bulb to restore suction (Correct answer)
- Clamp the drain tubing and continue monitoring
- Remove the drain as it is no longer functioning
Correct answer: Empty the drain and recompress the bulb to restore suction
A fully expanded JP drain bulb has lost suction; it must be emptied, measured, the output recorded, and the bulb recompressed to restore negative pressure drainage.
Question 5: Which site is preferred for intramuscular injection in an infant younger than 12 months?
- Dorsogluteal
- Deltoid
- Vastus lateralis (Correct answer)
- Ventrogluteal
Correct answer: Vastus lateralis
The vastus lateralis (anterolateral thigh) is the preferred IM injection site in infants because it is large and well-developed at this age.
Question 6: A patient using a walker is descending stairs. Which instruction is correct?
- Lead with the walker, then the weaker leg, then the stronger leg
- Walkers are not safe for stair use; use crutches instead (Correct answer)
- Lead with the stronger leg, then the walker, then the weaker leg
- Walkers cannot be used on stairs under any circumstance
Correct answer: Walkers are not safe for stair use; use crutches instead
Standard walkers are not designed for stair use; patients requiring stairs need crutches or a stair-capable assistive device.
Question 7: During suctioning of an adult patient's airway, the nurse applies suction for how long per pass?
- No more than 5 seconds
- 10–15 seconds (Correct answer)
- 20–25 seconds
- 30 seconds
Correct answer: 10–15 seconds
Suctioning should be limited to 10–15 seconds per pass to prevent hypoxia, mucosal trauma, and vagal stimulation.
RPN Clinical Skills 4
A patient has a chest tube connected to a water-seal drainage system.
The nurse notices the water level in the water-seal chamber is not fluctuating (tidaling).
What does this indicate?