NURS 101L | Fundamentals of Nursing Skills Lab | Week 14
Comprehensive Final Quiz 2026 |WCU
1. When performing wound irrigation, which pressure range is considered most
effective for removing debris without damaging healthy granulation tissue?
A. 4 to 15 psi
B. 1 to 3 psi
C. 20 to 25 psi
D. 30 to 40 psi
Answer: A
Rationale: Pressures between 4 and 15 psi are sufficient to remove surface contaminants
and bacteria while preserving the integrity of healing tissue. Higher pressures can drive
bacteria deeper into the wound.
2. A nurse is preparing to suction a patient’s tracheostomy. What is the
maximum duration for each suction pass to prevent hypoxia?
A. 5 seconds
B. 20 to 30 seconds
C. 10 to 15 seconds
D. 60 seconds
Answer: C
Rationale: Suctioning should be limited to 10-15 seconds per pass to minimize the risk of
hypoxemia, cardiopulmonary compromise, and mucosal trauma.
,3. Which clinical observation is the most definitive indicator that a patient’s
indwelling urinary catheter is incorrectly placed in the vagina instead of the
urethra during insertion?
A. No urine return is visualized in the tubing
B. Resistance is felt when advancing the catheter
C. The patient reports a stinging sensation
D. Cloudy discharge is noted on the catheter tip
Answer: A
Rationale: The absence of urine return when the catheter is fully advanced is the primary
sign of misplacement. If this occurs, the catheter should be left in place as a landmark and a
new sterile kit used for the second attempt.
4. While assessing a surgical wound, the nurse notes the protrusion of internal
organs through the incision. What is the immediate priority nursing action?
A. Reinsert the organs gently into the abdominal cavity
B. Place the patient in a High-Fowler’s position to reduce pressure
C. Apply a dry sterile pressure dressing to stop any bleeding
D. Cover the protruding organs with sterile towels moistened with sterile normal saline
Answer: D
Rationale: Evisceration is a medical emergency. The nurse must cover the exposed organs
with sterile, saline-soaked dressings to keep them moist and prevent infection while
notifying the surgeon immediately.
, 5. When changing a central venous catheter dressing, which direction should
the nurse wipe the site with chlorhexidine solution?
A. In a back-and-forth friction scrub for at least 30 seconds
B. In a circular motion from the periphery toward the center
C. From top to bottom using a single stroke
D. Only around the outer edges of the old dressing site
Answer: A
Rationale: Current evidence-based practice for chlorhexidine gluconate (CHG) requires a
back-and-forth friction scrub to ensure the antiseptic reaches all layers of the skin to
reduce microbial load.
6. A patient with a Jackson-Pratt (JP) drain has 50 mL of serosanguineous fluid in
the bulb. After emptying the bulb, what is the next critical step to ensure the
drain functions properly?
A. Keep the bulb inflated to allow gravity drainage
B. Irrigate the tubing with 10 mL of sterile water
C. Tape the bulb to the patient’s bedsheet below the wound level
D. Clean the drainage port with alcohol and fully compress the bulb before capping
Answer: D
Rationale: A JP drain works by suction. Compressing the bulb after emptying creates the
negative pressure required to pull fluid from the surgical site.
Comprehensive Final Quiz 2026 |WCU
1. When performing wound irrigation, which pressure range is considered most
effective for removing debris without damaging healthy granulation tissue?
A. 4 to 15 psi
B. 1 to 3 psi
C. 20 to 25 psi
D. 30 to 40 psi
Answer: A
Rationale: Pressures between 4 and 15 psi are sufficient to remove surface contaminants
and bacteria while preserving the integrity of healing tissue. Higher pressures can drive
bacteria deeper into the wound.
2. A nurse is preparing to suction a patient’s tracheostomy. What is the
maximum duration for each suction pass to prevent hypoxia?
A. 5 seconds
B. 20 to 30 seconds
C. 10 to 15 seconds
D. 60 seconds
Answer: C
Rationale: Suctioning should be limited to 10-15 seconds per pass to minimize the risk of
hypoxemia, cardiopulmonary compromise, and mucosal trauma.
,3. Which clinical observation is the most definitive indicator that a patient’s
indwelling urinary catheter is incorrectly placed in the vagina instead of the
urethra during insertion?
A. No urine return is visualized in the tubing
B. Resistance is felt when advancing the catheter
C. The patient reports a stinging sensation
D. Cloudy discharge is noted on the catheter tip
Answer: A
Rationale: The absence of urine return when the catheter is fully advanced is the primary
sign of misplacement. If this occurs, the catheter should be left in place as a landmark and a
new sterile kit used for the second attempt.
4. While assessing a surgical wound, the nurse notes the protrusion of internal
organs through the incision. What is the immediate priority nursing action?
A. Reinsert the organs gently into the abdominal cavity
B. Place the patient in a High-Fowler’s position to reduce pressure
C. Apply a dry sterile pressure dressing to stop any bleeding
D. Cover the protruding organs with sterile towels moistened with sterile normal saline
Answer: D
Rationale: Evisceration is a medical emergency. The nurse must cover the exposed organs
with sterile, saline-soaked dressings to keep them moist and prevent infection while
notifying the surgeon immediately.
, 5. When changing a central venous catheter dressing, which direction should
the nurse wipe the site with chlorhexidine solution?
A. In a back-and-forth friction scrub for at least 30 seconds
B. In a circular motion from the periphery toward the center
C. From top to bottom using a single stroke
D. Only around the outer edges of the old dressing site
Answer: A
Rationale: Current evidence-based practice for chlorhexidine gluconate (CHG) requires a
back-and-forth friction scrub to ensure the antiseptic reaches all layers of the skin to
reduce microbial load.
6. A patient with a Jackson-Pratt (JP) drain has 50 mL of serosanguineous fluid in
the bulb. After emptying the bulb, what is the next critical step to ensure the
drain functions properly?
A. Keep the bulb inflated to allow gravity drainage
B. Irrigate the tubing with 10 mL of sterile water
C. Tape the bulb to the patient’s bedsheet below the wound level
D. Clean the drainage port with alcohol and fully compress the bulb before capping
Answer: D
Rationale: A JP drain works by suction. Compressing the bulb after emptying creates the
negative pressure required to pull fluid from the surgical site.
