D445 NURS 3118
Intermediate Nursing Skills
Objective Assessment Review
(Questions & Solutions)
2025
1
, Question 1
Case Scenario: A 42‑year‑old male with a history of difficult venous
access is admitted for IV medication administration. After several
unsuccessful peripheral attempts, the nurse opts for an alternative
method.
Question: Which advanced technique should the nurse employ to
successfully gain IV access?
- A) Repeated blind cannulation using a standard tourniquet
- B) Ultrasound-guided IV catheter insertion
- C) Immediate request for central venous line placement
- D) Application of topical vasodilators alone without technical
assistance
Correct ANS: B
Rationale: Ultrasound guidance enhances visualization of deeper veins,
increasing the success rate in patients with difficult access while avoiding
the unnecessary invasiveness of central line insertion.
---
Question 2
Case Scenario: A 58‑year‑old female with a diabetic foot ulcer, areas of
necrosis, and moderate exudate is scheduled for advanced wound care
management.
Question: Which intervention best demonstrates advanced nursing
skills in wound management for this patient?
- A) Simple saline cleansing only
- B) Application of a hydrocolloid dressing without debridement
- C) Sharp debridement followed by negative pressure wound therapy
(NPWT)
- D) Covering the wound with a non-adhesive gel pad
2
, Correct ANS: C
Rationale: Sharp debridement removes necrotic tissue and, when
combined with NPWT, optimizes wound bed preparation, manages
exudate, and promotes granulation tissue formation—key for the
complex diabetic ulcer.
---
Question 3
Case Scenario: A 30‑year‑old patient requires a nasogastric (NG) tube
for enteral feeding. The patient expresses concern about discomfort.
Question: What is the critical step that enhances both accurate
placement and patient comfort during NG tube insertion?
- A) Measuring insertion length using the distance from the tip of the
nose to the earlobe and then to the xiphoid process (NEX measurement)
- B) Inserting the tube rapidly to minimize patient discomfort
- C) Relying solely on the patient’s verbal feedback
- D) Not confirming the tube placement once inserted
Correct ANS: A
Rationale: The NEX measurement (nose–ear–xiphoid) is essential to
estimate the proper NG tube length and reduce complications. It
combines precision with patient safety and comfort.
---
Question 4
Case Scenario: A nurse is preparing to administer an intramuscular (IM)
injection in the deltoid muscle of a 30‑year‑old patient.
Question: What is the most important consideration to ensure proper
IM injection technique in this site?
- A) Using the same needle size for all adult patients
- B) Selecting the injection site based on the patient’s body habitus and
muscle bulk
- C) Administering the injection without discussing the procedure with
3
Intermediate Nursing Skills
Objective Assessment Review
(Questions & Solutions)
2025
1
, Question 1
Case Scenario: A 42‑year‑old male with a history of difficult venous
access is admitted for IV medication administration. After several
unsuccessful peripheral attempts, the nurse opts for an alternative
method.
Question: Which advanced technique should the nurse employ to
successfully gain IV access?
- A) Repeated blind cannulation using a standard tourniquet
- B) Ultrasound-guided IV catheter insertion
- C) Immediate request for central venous line placement
- D) Application of topical vasodilators alone without technical
assistance
Correct ANS: B
Rationale: Ultrasound guidance enhances visualization of deeper veins,
increasing the success rate in patients with difficult access while avoiding
the unnecessary invasiveness of central line insertion.
---
Question 2
Case Scenario: A 58‑year‑old female with a diabetic foot ulcer, areas of
necrosis, and moderate exudate is scheduled for advanced wound care
management.
Question: Which intervention best demonstrates advanced nursing
skills in wound management for this patient?
- A) Simple saline cleansing only
- B) Application of a hydrocolloid dressing without debridement
- C) Sharp debridement followed by negative pressure wound therapy
(NPWT)
- D) Covering the wound with a non-adhesive gel pad
2
, Correct ANS: C
Rationale: Sharp debridement removes necrotic tissue and, when
combined with NPWT, optimizes wound bed preparation, manages
exudate, and promotes granulation tissue formation—key for the
complex diabetic ulcer.
---
Question 3
Case Scenario: A 30‑year‑old patient requires a nasogastric (NG) tube
for enteral feeding. The patient expresses concern about discomfort.
Question: What is the critical step that enhances both accurate
placement and patient comfort during NG tube insertion?
- A) Measuring insertion length using the distance from the tip of the
nose to the earlobe and then to the xiphoid process (NEX measurement)
- B) Inserting the tube rapidly to minimize patient discomfort
- C) Relying solely on the patient’s verbal feedback
- D) Not confirming the tube placement once inserted
Correct ANS: A
Rationale: The NEX measurement (nose–ear–xiphoid) is essential to
estimate the proper NG tube length and reduce complications. It
combines precision with patient safety and comfort.
---
Question 4
Case Scenario: A nurse is preparing to administer an intramuscular (IM)
injection in the deltoid muscle of a 30‑year‑old patient.
Question: What is the most important consideration to ensure proper
IM injection technique in this site?
- A) Using the same needle size for all adult patients
- B) Selecting the injection site based on the patient’s body habitus and
muscle bulk
- C) Administering the injection without discussing the procedure with
3
