RPN Clinical Skills 5 — Questions and Answers
Question 1: A nurse applies a continuous pulse oximetry probe to a patient's finger. The reading is 84% despite the patient appearing comfortable. What should the nurse do first?
- Administer supplemental oxygen immediately
- Assess probe placement, perfusion, and patient's actual respiratory status (Correct answer)
- Document the reading and continue monitoring
- Notify the physician of critical desaturation
Correct answer: Assess probe placement, perfusion, and patient's actual respiratory status
A falsely low reading can result from poor probe placement, nail polish, peripheral vasoconstriction, or motion artifact, so clinical assessment comes before intervention.
Question 2: When using the Z-track technique for an intramuscular injection, what is the purpose?
- To reduce pain at the injection site
- To prevent the medication from leaking back into subcutaneous tissue (Correct answer)
- To ensure the needle enters a large muscle mass
- To reduce the risk of nerve damage
Correct answer: To prevent the medication from leaking back into subcutaneous tissue
The Z-track technique displaces skin and subcutaneous tissue before injection, sealing the medication in the muscle to prevent irritating or staining agents from tracking back.
Question 3: A patient is receiving continuous bladder irrigation (CBI) after a TURP. The nurse observes that the drainage is bright red with clots and the catheter is not draining. What is the priority action?
- Increase the CBI irrigation rate
- Attempt to manually irrigate the catheter with 50 mL normal saline using a syringe (Correct answer)
- Clamp the irrigation tubing and notify the surgeon
- Encourage the patient to increase oral fluid intake
Correct answer: Attempt to manually irrigate the catheter with 50 mL normal saline using a syringe
A blocked catheter after TURP requires gentle manual irrigation to dislodge clots and restore drainage, which is the priority over simply increasing flow into a blocked system.
Question 4: A patient is on contact precautions. A nurse enters the room to perform wound care. In what order should PPE be donned?
- Gown, mask, goggles, gloves (Correct answer)
- Gloves, gown, mask, goggles
- Mask, goggles, gown, gloves
- Gown, gloves, mask, goggles
Correct answer: Gown, mask, goggles, gloves
CDC guidelines specify donning PPE in the order: gown first, then mask/respirator, then goggles/face shield, then gloves — ensuring each layer protects the next.
Question 5: When performing range-of-motion exercises for a patient with a painful joint, which principle applies?
- Move the joint rapidly to reduce discomfort duration
- Stop at the point of resistance or patient-reported pain (Correct answer)
- Exercise through pain to prevent contracture formation
- Perform ROM only when the patient is anesthetized
Correct answer: Stop at the point of resistance or patient-reported pain
ROM exercises should stop at the point of resistance or reported pain to avoid joint injury, muscle damage, or increased inflammation.
Question 6: A nurse is preparing to collect a midstream clean-catch urine specimen from a female patient. Which instruction is correct?
- Collect all urine from the first morning void into the container
- Cleanse the perineum front to back, begin urinating, then collect midstream into the container (Correct answer)
- Cleanse the perineum back to front, collect the first stream
- No perineal cleaning is necessary for a midstream specimen
Correct answer: Cleanse the perineum front to back, begin urinating, then collect midstream into the container
Front-to-back perineal cleansing followed by discarding the initial urine stream reduces contamination of the midstream specimen with periurethral bacteria.
Question 7: A nurse is changing a colostomy bag. The patient's stoma appears dark purple-black. What should the nurse do?
- Document the normal appearance and continue the bag change
- Apply a cold compress to reduce discoloration
- Report the finding immediately — this indicates impaired stoma perfusion (Correct answer)
- Irrigate the stoma with saline to improve circulation
Correct answer: Report the finding immediately — this indicates impaired stoma perfusion
A dark purple or black stoma indicates ischemia or necrosis of the stoma tissue, which requires immediate reporting to the surgeon.
RPN Clinical Skills 5
A nurse applies a continuous pulse oximetry probe to a patient's finger.
The reading is 84% despite the patient appearing comfortable.
What should the nurse do first?