D445 NURS 3118
Intermediate Nursing Skills
Final 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 routine blood sampling and IV medication. Despite
several attempts with the traditional method, peripheral veins remain
elusive.
Question: Which advanced technique should the nurse use to improve
the success of IV insertion?
- A) Reattempting with a standard tourniquet and small gauge IV
- B) Utilizing an ultrasound‑guided IV insertion technique
- C) Requesting central line insertion immediately
- D) Applying topical vasodilators only
Correct ANS: B
Rationale: Ultrasound guidance allows visualization of deeper and less
palpable veins, enhancing success rates in patients with difficult venous
access without resorting directly to invasive central venous access.
---
Question 2
Case Scenario: A 58‑year‑old woman with a diabetic foot ulcer requires
advanced wound management. The wound is extensive with areas of
necrosis and moderate exudate.
Question: Which intervention represents an advanced nursing skill in
wound care management for this patient?
- A) Simple cleansing with saline only
- B) Application of a hydrocolloid dressing without debridement
- C) Performing sharp debridement followed by application of negative
pressure wound therapy (NPWT)
- D) Covering the wound with a non-adhesive gel pad only
Correct ANS: C
Rationale: Sharp debridement removes necrotic tissue and, combined
2
,with NPWT, helps promote granulation and manage exudate. This
intervention requires advanced assessment and technical skills to ensure
effective wound healing in a complex diabetic ulcer.
---
Question 3
Case Scenario: A 50‑year‑old patient is ordered a nasogastric (NG) tube
for enteral feeding. The patient is anxious about tube placement.
Question: Which step in the NG tube insertion process is most critical
in ensuring both patient comfort and procedural accuracy?
- A) Estimating the tube insertion length from the tip of the nose to the
earlobe to the xiphoid process
- B) Inserting the tube rapidly to minimize discomfort
- C) Relying solely on the patient’s verbal report for tube placement
verification
- D) Not confirming placement with any further methods once inserted
Correct ANS: A
Rationale: Accurate measurement from the nose, along the ear to the
xiphoid process is essential for proper NG tube placement. This step
minimizes complications and, along with methods to confirm placement,
enhances both patient comfort and safety.
---
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: Which consideration is most important in selecting the
appropriate needle size and injection site for IM administration in the
deltoid?
- A) The patient’s gender only
- B) The patient’s body mass and muscle mass at the deltoid
- C) The volume of medication regardless of anatomical landmarks
3
, - D) Using the same needle size for all adults
Correct ANS: B
Rationale: The patient’s body and muscle mass influence the selection
of needle length and gauge to ensure the injection reaches the muscle
tissue. Proper site selection in the deltoid is critical to avoid injury and
ensure effective medication delivery.
---
Question 5
Case Scenario: A 68‑year‑old male with benign prostatic hyperplasia is
scheduled for Foley catheter insertion. He has an enlarged prostate, and
urethral catheterization may be challenging.
Question: What advanced technique should the nurse consider to
reduce patient discomfort and potential trauma during catheter
insertion?
- A) Use a standard Foley catheter without lubricant
- B) Prelubricate the catheter with a sterile water‑soluble lubricant and
use gentle techniques with possible flexible catheters
- C) Force insertion despite resistance
- D) Skip catheterization and delay treatment
Correct ANS: B
Rationale: Prelubrication of the catheter with a sterile water‑soluble
lubricant and employing gentle insertion techniques (and using a flexible
catheter, if needed) help to minimize discomfort and urethral trauma in
patients with prostatic enlargement.
---
Question 6
Case Scenario: A 72‑year‑old patient with limited mobility requires
transfer from bed to wheelchair. The patient is heavy and at risk for falls.
Question: Which intervention best exemplifies advanced nursing skills
4
Intermediate Nursing Skills
Final 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 routine blood sampling and IV medication. Despite
several attempts with the traditional method, peripheral veins remain
elusive.
Question: Which advanced technique should the nurse use to improve
the success of IV insertion?
- A) Reattempting with a standard tourniquet and small gauge IV
- B) Utilizing an ultrasound‑guided IV insertion technique
- C) Requesting central line insertion immediately
- D) Applying topical vasodilators only
Correct ANS: B
Rationale: Ultrasound guidance allows visualization of deeper and less
palpable veins, enhancing success rates in patients with difficult venous
access without resorting directly to invasive central venous access.
---
Question 2
Case Scenario: A 58‑year‑old woman with a diabetic foot ulcer requires
advanced wound management. The wound is extensive with areas of
necrosis and moderate exudate.
Question: Which intervention represents an advanced nursing skill in
wound care management for this patient?
- A) Simple cleansing with saline only
- B) Application of a hydrocolloid dressing without debridement
- C) Performing sharp debridement followed by application of negative
pressure wound therapy (NPWT)
- D) Covering the wound with a non-adhesive gel pad only
Correct ANS: C
Rationale: Sharp debridement removes necrotic tissue and, combined
2
,with NPWT, helps promote granulation and manage exudate. This
intervention requires advanced assessment and technical skills to ensure
effective wound healing in a complex diabetic ulcer.
---
Question 3
Case Scenario: A 50‑year‑old patient is ordered a nasogastric (NG) tube
for enteral feeding. The patient is anxious about tube placement.
Question: Which step in the NG tube insertion process is most critical
in ensuring both patient comfort and procedural accuracy?
- A) Estimating the tube insertion length from the tip of the nose to the
earlobe to the xiphoid process
- B) Inserting the tube rapidly to minimize discomfort
- C) Relying solely on the patient’s verbal report for tube placement
verification
- D) Not confirming placement with any further methods once inserted
Correct ANS: A
Rationale: Accurate measurement from the nose, along the ear to the
xiphoid process is essential for proper NG tube placement. This step
minimizes complications and, along with methods to confirm placement,
enhances both patient comfort and safety.
---
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: Which consideration is most important in selecting the
appropriate needle size and injection site for IM administration in the
deltoid?
- A) The patient’s gender only
- B) The patient’s body mass and muscle mass at the deltoid
- C) The volume of medication regardless of anatomical landmarks
3
, - D) Using the same needle size for all adults
Correct ANS: B
Rationale: The patient’s body and muscle mass influence the selection
of needle length and gauge to ensure the injection reaches the muscle
tissue. Proper site selection in the deltoid is critical to avoid injury and
ensure effective medication delivery.
---
Question 5
Case Scenario: A 68‑year‑old male with benign prostatic hyperplasia is
scheduled for Foley catheter insertion. He has an enlarged prostate, and
urethral catheterization may be challenging.
Question: What advanced technique should the nurse consider to
reduce patient discomfort and potential trauma during catheter
insertion?
- A) Use a standard Foley catheter without lubricant
- B) Prelubricate the catheter with a sterile water‑soluble lubricant and
use gentle techniques with possible flexible catheters
- C) Force insertion despite resistance
- D) Skip catheterization and delay treatment
Correct ANS: B
Rationale: Prelubrication of the catheter with a sterile water‑soluble
lubricant and employing gentle insertion techniques (and using a flexible
catheter, if needed) help to minimize discomfort and urethral trauma in
patients with prostatic enlargement.
---
Question 6
Case Scenario: A 72‑year‑old patient with limited mobility requires
transfer from bed to wheelchair. The patient is heavy and at risk for falls.
Question: Which intervention best exemplifies advanced nursing skills
4
