WGU D453 Advanced Nursing Skills
Practice Exam QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025
1. A nurse is performing tracheostomy care for a client. Which action
should the nurse take first?
A. Apply sterile gloves
B. Remove the inner cannula
C. Explain the procedure to the client
D. Suction the tracheostomy tube
Rationale: Client education and preparation reduces anxiety and
promotes cooperation before initiating care.
2. What is the correct angle to insert an intramuscular injection into the
deltoid muscle?
A. 15 degrees
B. 90 degrees
, C. 45 degrees
D. 30 degrees
Rationale: IM injections are administered at a 90-degree angle to
ensure medication reaches the muscle.
3. Which finding should the nurse report immediately during central line
dressing change?
A. Redness and purulent drainage at insertion site
B. Transparent dressing intact
C. Cap secure on lumen
D. Patient reports mild discomfort
Rationale: Signs of infection at a central line site require immediate
intervention to prevent sepsis.
4. When performing sterile wound irrigation, what should the nurse do
after donning sterile gloves?
A. Remove old dressing
B. Pour solution into the sterile basin
C. Apply new dressing
D. Discard old gloves
Rationale: After donning sterile gloves, the next step is preparing the
sterile field, including pouring the solution.
5. Which urinary catheter size is most appropriate for an adult female?
A. 8 Fr
B. 24 Fr
, C. 14 Fr
D. 20 Fr
Rationale: A 14 French catheter is standard for adult females to
minimize trauma while ensuring adequate drainage.
6. A nurse notes crepitus around a chest tube insertion site. What is the
priority action?
A. Increase suction
B. Continue monitoring
C. Notify the provider
D. Reposition the chest tube
Rationale: Crepitus may indicate subcutaneous emphysema, which
could signify air leakage and needs prompt evaluation.
7. A client with a PEG tube is receiving medications. What is the best
nursing action between medications?
A. Crush all meds together
B. Mix meds with formula
C. Flush with 30 mL water
D. Use sterile water only
Rationale: Flushing between medications prevents clogging and
potential drug interactions in the tube.
8. What is the first step when removing personal protective equipment
(PPE)?
A. Remove gown
, B. Remove gloves
C. Remove goggles
D. Remove mask
Rationale: Gloves are the most contaminated and should be removed
first to reduce cross-contamination.
9. When preparing a patient for a thoracentesis, the nurse should:
A. Assist client into an upright position leaning forward
B. Encourage deep breathing
C. Apply abdominal binder
D. Elevate legs
Rationale: Proper positioning facilitates drainage of pleural fluid and
minimizes complications.
10. What is the primary reason for using a Z-track method during
injection?
A. Prevent medication leakage
B. Increase absorption
C. Reduce injection time
D. Avoid using sterile gloves
Rationale: Z-track injections seal the medication in the muscle and
reduce skin irritation.
11–20
Practice Exam QUESTIONS AND
CORRECT ANSWERS (VERIFIED
ANSWERS) PLUS RATIONALES 2025
1. A nurse is performing tracheostomy care for a client. Which action
should the nurse take first?
A. Apply sterile gloves
B. Remove the inner cannula
C. Explain the procedure to the client
D. Suction the tracheostomy tube
Rationale: Client education and preparation reduces anxiety and
promotes cooperation before initiating care.
2. What is the correct angle to insert an intramuscular injection into the
deltoid muscle?
A. 15 degrees
B. 90 degrees
, C. 45 degrees
D. 30 degrees
Rationale: IM injections are administered at a 90-degree angle to
ensure medication reaches the muscle.
3. Which finding should the nurse report immediately during central line
dressing change?
A. Redness and purulent drainage at insertion site
B. Transparent dressing intact
C. Cap secure on lumen
D. Patient reports mild discomfort
Rationale: Signs of infection at a central line site require immediate
intervention to prevent sepsis.
4. When performing sterile wound irrigation, what should the nurse do
after donning sterile gloves?
A. Remove old dressing
B. Pour solution into the sterile basin
C. Apply new dressing
D. Discard old gloves
Rationale: After donning sterile gloves, the next step is preparing the
sterile field, including pouring the solution.
5. Which urinary catheter size is most appropriate for an adult female?
A. 8 Fr
B. 24 Fr
, C. 14 Fr
D. 20 Fr
Rationale: A 14 French catheter is standard for adult females to
minimize trauma while ensuring adequate drainage.
6. A nurse notes crepitus around a chest tube insertion site. What is the
priority action?
A. Increase suction
B. Continue monitoring
C. Notify the provider
D. Reposition the chest tube
Rationale: Crepitus may indicate subcutaneous emphysema, which
could signify air leakage and needs prompt evaluation.
7. A client with a PEG tube is receiving medications. What is the best
nursing action between medications?
A. Crush all meds together
B. Mix meds with formula
C. Flush with 30 mL water
D. Use sterile water only
Rationale: Flushing between medications prevents clogging and
potential drug interactions in the tube.
8. What is the first step when removing personal protective equipment
(PPE)?
A. Remove gown
, B. Remove gloves
C. Remove goggles
D. Remove mask
Rationale: Gloves are the most contaminated and should be removed
first to reduce cross-contamination.
9. When preparing a patient for a thoracentesis, the nurse should:
A. Assist client into an upright position leaning forward
B. Encourage deep breathing
C. Apply abdominal binder
D. Elevate legs
Rationale: Proper positioning facilitates drainage of pleural fluid and
minimizes complications.
10. What is the primary reason for using a Z-track method during
injection?
A. Prevent medication leakage
B. Increase absorption
C. Reduce injection time
D. Avoid using sterile gloves
Rationale: Z-track injections seal the medication in the muscle and
reduce skin irritation.
11–20
