CLINICAL NURSING SKILLS AND
TECHNIQUES COMPREHENSIVE EXAM
QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE
1. When preparing a sterile field, which action by the nurse would most likely contaminate
the area?
A. Placing the sterile drape so it hangs over the edge of the table.
B. Reaching over the sterile field to pick up a sterile gauze pad.
C. Opening the outermost flap of a sterile kit away from the body.
D. Holding sterile forceps above the level of the waist.
Answer: B
Conceptual Explanation: Reaching over a sterile field violates sterile technique as
microorganisms can drop from the nurse’s sleeves or arms onto the field.
2. A nurse is measuring blood pressure in a patient with a very large arm using a standard-
sized cuff. What is the most likely result?
A. The reading will be falsely low.
B. The reading will be falsely high.
C. The diastolic reading will be correct but systolic will be high.
,D. The reading will be unaffected by cuff size.
Answer: B
Conceptual Explanation: Using a cuff that is too small for the limb circumference results
in a falsely high blood pressure reading.
3. Which of the following is the most reliable method for verifying the initial placement of a
small-bore nasogastric feeding tube?
A. Auscultation of air insufflated into the stomach.
B. Measuring the pH of the aspirated gastric contents.
C. X-ray examination of the chest and abdomen.
D. Checking the color of the fluid aspirated from the tube.
Answer: C
Conceptual Explanation: Radiographic (X-ray) confirmation is the gold standard and most
reliable method for verifying the initial placement of an NG tube.
4. During tracheostomy suctioning, the nurse notes the patient’s heart rate drops from 92 to
52 beats per minute. What is the priority action?
A. Stop suctioning and provide supplemental oxygen.
B. Notify the healthcare provider immediately.
C. Complete the suctioning as quickly as possible.
D. Document the event as a vagal response.
, Answer: A
Conceptual Explanation: A sudden drop in heart rate indicates a vagal response or
hypoxia; the nurse must stop the procedure and re-oxygenate the patient immediately.
5. A nurse is preparing to administer an intramuscular injection into the ventrogluteal site.
Which anatomical landmarks should be used?
A. The acromion process and the axillary fold.
B. The vastus lateralis muscle and the knee.
C. The greater trochanter, anterior superior iliac spine, and iliac crest.
D. The posterior superior iliac spine and the greater trochanter.
Answer: C
Conceptual Explanation: The ventrogluteal site is located by placing the palm over the
greater trochanter and pointing the index finger toward the anterior superior iliac spine.
6. Which assessment finding in a patient wearing wrist restraints requires the nurse’s
immediate intervention?
A. The patient is complaining of being thirsty.
B. The restraint is tied with a quick-release knot.
C. The patient’s fingers are cold and pale.
D. Two fingers can be inserted between the restraint and the wrist.
Answer: C
TECHNIQUES COMPREHENSIVE EXAM
QUESTIONS AND CORRECT ANSWERS
LATEST UPDATE
1. When preparing a sterile field, which action by the nurse would most likely contaminate
the area?
A. Placing the sterile drape so it hangs over the edge of the table.
B. Reaching over the sterile field to pick up a sterile gauze pad.
C. Opening the outermost flap of a sterile kit away from the body.
D. Holding sterile forceps above the level of the waist.
Answer: B
Conceptual Explanation: Reaching over a sterile field violates sterile technique as
microorganisms can drop from the nurse’s sleeves or arms onto the field.
2. A nurse is measuring blood pressure in a patient with a very large arm using a standard-
sized cuff. What is the most likely result?
A. The reading will be falsely low.
B. The reading will be falsely high.
C. The diastolic reading will be correct but systolic will be high.
,D. The reading will be unaffected by cuff size.
Answer: B
Conceptual Explanation: Using a cuff that is too small for the limb circumference results
in a falsely high blood pressure reading.
3. Which of the following is the most reliable method for verifying the initial placement of a
small-bore nasogastric feeding tube?
A. Auscultation of air insufflated into the stomach.
B. Measuring the pH of the aspirated gastric contents.
C. X-ray examination of the chest and abdomen.
D. Checking the color of the fluid aspirated from the tube.
Answer: C
Conceptual Explanation: Radiographic (X-ray) confirmation is the gold standard and most
reliable method for verifying the initial placement of an NG tube.
4. During tracheostomy suctioning, the nurse notes the patient’s heart rate drops from 92 to
52 beats per minute. What is the priority action?
A. Stop suctioning and provide supplemental oxygen.
B. Notify the healthcare provider immediately.
C. Complete the suctioning as quickly as possible.
D. Document the event as a vagal response.
, Answer: A
Conceptual Explanation: A sudden drop in heart rate indicates a vagal response or
hypoxia; the nurse must stop the procedure and re-oxygenate the patient immediately.
5. A nurse is preparing to administer an intramuscular injection into the ventrogluteal site.
Which anatomical landmarks should be used?
A. The acromion process and the axillary fold.
B. The vastus lateralis muscle and the knee.
C. The greater trochanter, anterior superior iliac spine, and iliac crest.
D. The posterior superior iliac spine and the greater trochanter.
Answer: C
Conceptual Explanation: The ventrogluteal site is located by placing the palm over the
greater trochanter and pointing the index finger toward the anterior superior iliac spine.
6. Which assessment finding in a patient wearing wrist restraints requires the nurse’s
immediate intervention?
A. The patient is complaining of being thirsty.
B. The restraint is tied with a quick-release knot.
C. The patient’s fingers are cold and pale.
D. Two fingers can be inserted between the restraint and the wrist.
Answer: C
