Question 1

The nurse is caring for a 26-year-old patient who cannot meet their nutritional needs by mouth. The interdisciplinary team decided inserting an NG tube for enteral feedings would be best. After inserting the tube, the nurse knows which of the following is the most accurate way to verify the placement of the tube?

Accepted Answer

Answer reason: Radiographic confirmation is the gold standard for initial verification of NG/enteral tube placement because it directly shows the tube tip location and detects dangerous malposition in the airway. Methods like aspirating contents or checking pH can be unreliable when patients are on acid-suppressing therapy, have continuous feeds, or when aspirate cannot be obtained. The air-bolus auscultation (“whoosh test”) is inaccurate and can falsely reassure even if the tube is in the respiratory tract. Using X-ray before starting feedings reduces the risk of aspiration pneumonia and other serious complications.

Question 2

A client is being prepared for a thoracentesis. A nurse assists the client to which position for the procedure?

Accepted Answer

Answer reason: When the client must remain in bed, placing them on the unaffected side helps keep the affected side uppermost and more accessible for needle insertion and drainage. This also promotes better expansion of the unaffected lung, helping maintain gas exchange during the procedure. Positions such as prone or Sims’ with the bed flat do not provide optimal pleural access or respiratory mechanics and can increase discomfort and procedural difficulty.

Question 3

A nurse is educating a patient on how to obtain a capillary blood glucose sample. Which of the following instructions would not be appropriate to include?

Accepted Answer

Answer reason: Capillary glucose sampling technique aims to obtain an adequate specimen while minimizing pain and tissue injury. The puncture should be made on the lateral side of the fingertip, not the center, because the center has more nerve endings and is more sensitive. Cleansing the site, applying the strip to the blood drop without smearing, and (commonly) wiping away the first drop help reduce contamination or dilution and improve accuracy. Center puncture increases discomfort and can lead to poorer tolerance and technique adherence.

Question 4

What is the appropriate infusion time for the dialysate in your 38 y.o. patient with chronic renal failure undergoing peritoneal dialysis?

Accepted Answer

Answer reason: The fill/infusion phase is typically about 10–20 minutes and may extend up to roughly 30 minutes depending on catheter function and patient tolerance. This makes 30 minutes the best choice among the options for an appropriate infusion time. Options like 2 to 3 hours reflect the dwell time rather than the infusion phase, and 1 hour is longer than expected for a routine fill and may suggest flow obstruction or malposition.

Question 5

We can use intraoperative radiotherapy for patients with?

Accepted Answer

Answer reason: Intraoperative radiotherapy (IORT) is commonly used in selected patients with breast cancer, where a single dose of radiation is delivered directly to the tumor bed during surgery. This approach reduces exposure to surrounding tissues and may replace or shorten external beam radiation in appropriate cases. It is not routinely used as a standard approach for prostate, liver, or lung cancer.

Question 6

Treatment for cementoma?

Accepted Answer

Answer reason: Cementoma (benign cementoblastoma or periapical cemental dysplasia depending on context) is often asymptomatic and typically requires no treatment unless complications develop. Management is usually observation with periodic follow-up.

Question 7

The nurse is reviewing with a client how to collect a clean catch urine specimen. What is the appropriate sequence to teach the client?

Accepted Answer

Answer reason: A clean-catch urine specimen requires cleansing the meatus first to reduce contamination, then initiating voiding to flush urethral contaminants, followed by collecting the midstream urine. This technique ensures the most accurate and uncontaminated sample for diagnostic testing.

Question 8

You have a patient that is receiving peritoneal dialysis. What should you do when you notice the return fluid is slowly draining?

Accepted Answer

Answer reason: Peritoneal dialysis outflow depends on unobstructed tubing and gravity drainage, so the first nursing action for slow drainage is to assess for a mechanical cause. Kinks, dependent loops, or a closed clamp are common and quickly correctable sources of impaired effluent flow. Raising the drainage bag above the abdomen would reduce the pressure gradient needed for drainage and can worsen outflow. Repositioning or asking the patient to cough may help if the catheter tip is malpositioned, but these are typically attempted after verifying the system is not mechanically obstructed.

Question 9

A client with a cervical spine injury has Gardner-Wells tongs inserted for which of the following reasons?

Accepted Answer

Answer reason: Gardner-Wells tongs provide skeletal traction to maintain cervical alignment and stabilize the spine after injury, reducing motion that could worsen spinal cord compression. Their purpose is to apply controlled longitudinal traction through the skull to keep the cervical vertebrae in a neutral, immobilized position until definitive management occurs. They do not directly improve soft-tissue wound healing, and they do not prevent autonomic dysreflexia, which is managed by identifying/removing noxious stimuli and controlling blood pressure. They also are not used to approximate skull fractures; their role is traction for cervical spine stabilization.

Question 10

A client is to be on bed rest for 24 hours and the affected extremity is to be kept straight during this time. Which of the following procedures would require a client to do the above?

Accepted Answer

Answer reason: After arterial access or vascular grafting, maintaining limb immobilization with the extremity kept straight reduces stress on the vessel or insertion site and helps prevent bleeding, hematoma, and disruption of the repair. Bed rest for a set period (often around 24 hours depending on procedure/site) supports hemostasis and protects distal circulation while the site stabilizes. This instruction is particularly characteristic of procedures involving femoral/arterial manipulation where hip flexion can reopen the puncture/repair site. In contrast, a myelogram focuses on head elevation and neurologic monitoring rather than keeping an extremity straight.

Question 11

A client with a partial bowel obstruction will undergo nasoenteric tube placement later in the day. The nurse should explain to the client that which position will be used after placement to promote tube migration to the intended area?

Accepted Answer

Answer reason: Lying on the right side places the pylorus in a more dependent position, which supports gastric emptying and tube progression. Elevating the head of bed also reduces risk of reflux and aspiration while the tube is in the stomach and migrating distally. Left-side positioning is more likely to keep the tube in the gastric body/fundus and can slow progression, making it less effective for intended small-bowel placement.

Question 12

A client with pleural effusion is scheduled to have a thoracentesis. The nurse on duty will assist the client to which position during the procedure?

Accepted Answer

Answer reason: Thoracentesis requires positioning that optimizes access to the pleural space while minimizing risk of organ puncture and supporting ventilation. Elevating the head of the bed helps pleural fluid pool dependently and improves respiratory mechanics during the procedure. Placing the client on the unaffected side (lateral decubitus) helps expose the affected hemithorax for safer needle insertion and helps maintain better ventilation-perfusion by keeping the healthier lung more expanded. Options with the head of bed flat or supine reduce dependent pooling and can compromise breathing and procedural access, increasing complication risk.

Question 13

A patient who underwent abdominal surgery now has a gaping incision due to delayed wound healing. Which method is correct when you irrigate a gaping abdominal incision with sterile normal saline solution, using a piston syringe?

Accepted Answer

Answer reason: The key principle in wound irrigation is to reduce bioburden and remove loose debris while minimizing additional tissue trauma. Continuing irrigation until the return is clear indicates effective flushing of exudate/contaminants from the wound bed. Using a rapid, forceful stream risks driving microorganisms deeper and damaging fragile granulation tissue, which can worsen healing. Wet-to-dry dressings are nonselective mechanical debridement and are not automatically indicated after routine irrigation of a surgical incision; dressing choice depends on the wound plan and tissue type.

Question 14

The nurse has emptied a Jackson Pratt wound drainage device and needs to reestablish suction to the tube. Which action should the nurse take to accomplish this objective?

Accepted Answer

Answer reason: Jackson-Pratt drains are closed-suction systems that create negative pressure when the bulb/reservoir is compressed and then sealed. After emptying, compressing the collection chamber expels air so that, once closed, it re-expands and pulls fluid from the wound into the reservoir. Ensuring no kinks supports patency but does not generate suction if negative pressure is not reestablished. Cleaning the port and closing the cap are important for asepsis and maintaining the seal, but suction is produced by compressing the chamber before sealing.

Question 15

A patient with ascites is scheduled for a LeVeen peritoneal-venous shunt. The patient asks why this needs to be done instead of a paracentesis. What is the best response by the nurse?

Accepted Answer

Answer reason: A peritoneovenous (LeVeen) shunt returns ascitic fluid from the peritoneal cavity into the venous circulation, allowing intravascular reabsorption of albumin and other proteins rather than removing them from the body. Repeated large-volume paracentesis can remove protein-rich fluid and contribute to hypoalbuminemia and reduced oncotic pressure, which can worsen edema/ascites. The shunt’s purpose is not to promote sodium retention; ascites is typically associated with sodium and water retention that is treated with restriction/diuretics. Infection risk is not inherently lower with a shunt because an implanted device can itself be a source of complications, and analgesic requirements are not the clinical rationale for choosing a shunt.

Question 16

The nurse assists the health care provider with the removal of a chest tube. During removal of the chest tube, the nurse instructs the client to perform which action?

Accepted Answer

Answer reason: The key principle during chest tube removal is to prevent air from being pulled into the pleural space, which could precipitate a pneumothorax. Bearing down while exhaling creates a Valsalva maneuver that increases intrathoracic pressure, helping oppose inward air entry as the tube is withdrawn. This also reduces the negative intrapleural pressure gradient that would otherwise favor air being sucked through the tract. In contrast, deep inspiration increases negative intrathoracic pressure and can increase the risk of air entrainment at the moment the tube is removed. Coordinating this maneuver with immediate occlusive dressing application supports maintenance of pleural integrity.

Question 17

A physician orders an intestinal tube to decompress a client's GI tract. When gathering equipment for this procedure, a nurse should obtain a ...?

Accepted Answer

Answer reason: Intestinal decompression specifically requires a long tube designed to pass beyond the stomach into the small intestine to relieve distention and remove intestinal contents. This is the role of an intestinal (enteric) decompression tube such as the Miller-Abbott, which is used for small-bowel decompression (e.g., obstruction/ileus). A Salem sump and a Levin are primarily gastric tubes used for stomach decompression/aspiration rather than intestinal decompression. A Sengstaken-Blakemore is for tamponading bleeding esophageal/gastric varices, not for routine GI decompression.

Question 18

The nurse has a prescription to discontinue a client's nasogastric tube. The nurse prepares the client and asks the client to take a deep breath and perform which action next?

Accepted Answer

Answer reason: Removing an NG tube can stimulate gagging and create a brief risk of aspiration if the client inhales during withdrawal. Instructing the client to hold their breath momentarily helps close the glottis and reduces the chance that secretions will be drawn into the airway as the tube passes the pharynx. This also helps the nurse remove the tube smoothly and quickly with less coughing. A common distractor is exhaling rapidly, which may lead to uncoordinated breathing and does not protect the airway as reliably as a brief breath-hold.

Question 19

The nurse assesses the water seal chamber of a closed chest drainage system and notes fluctuations in the chamber. What does this finding indicate?

Accepted Answer

Answer reason: Tidaling (fluctuation) in the water-seal chamber reflects normal pressure changes in the pleural space with inspiration and expiration when the chest tube remains patent. This indicates the drainage system is transmitting intrathoracic pressure changes appropriately rather than being obstructed. A kinked tube would more likely reduce or stop tidaling, while an air leak is suggested by continuous bubbling in the water-seal chamber (not simply fluctuation). When the lung reexpands, tidaling typically diminishes and may cease, so the presence of fluctuations supports expected function rather than full reexpansion.

Question 20

The nurse assists the health care provider in performing a paracentesis. Which position does the nurse assist the client to assume for the procedure?

Accepted Answer

Answer reason: Sitting upright (often with feet supported) allows gravity to collect fluid in the dependent lower abdomen, improving access and reducing the chance of bowel injury. This position also helps with patient stability and breathing compared with fully supine positioning when significant ascites is present. Lateral or supine positions are more typical for other procedures (e.g., lumbar puncture) and can make fluid less dependent and the abdomen harder to access safely.

Question 21

The nurse has done preoperative teaching with a client scheduled for percutaneous insertion of an inferior vena cava (IVC) filter. Which client statement indicates the need for further teaching about the procedure?

Accepted Answer

Answer reason: IVC filters are typically placed percutaneously by interventional radiology using local anesthesia with conscious/moderate sedation, not routine general anesthesia. A client expecting general anesthesia indicates misunderstanding of what to anticipate (airway management, recovery time, and sedation risks). While complications can occur, the procedure is generally low risk, and trapped thrombi can increase venous pressure and contribute to lower-extremity swelling. An IVC filter does not treat the underlying hypercoagulable state and many patients still require anticoagulation when it is safe, so statements implying reduced need for anticoagulants can be context-dependent rather than universally incorrect.

Question 22

A nurse is caring for a client who is receiving oxygen at 2 L/min via a nasal cannula. What oxygen concentration is the client receiving?

Accepted Answer

Answer reason: At 2 L/min, the estimated delivered concentration is about 21% + (2 × 4%) ≈ 29%, commonly rounded/tested as 28%. This approximation is used clinically for quick estimation despite variability from mouth breathing and tidal volume. Higher percentages like 36%, 50%, and 70% are more consistent with higher-flow devices or different oxygen delivery systems rather than 2 L/min via nasal cannula.

Question 23

A patient with chronic obstructive pulmonary disease (COPD) requires high-oxygen supplementation with a precise oxygen concentration. The nurse should anticipate the physician ordering which of the following?

Accepted Answer

Answer reason: A Venturi device entrains room air through a calibrated jet to deliver a precise, predictable oxygen concentration across a range of flow rates. A nasal cannula provides variable FiO2 depending on the patient’s inspiratory flow and minute ventilation, so it is not ideal when precision is required. An aerosol mask is more often used for humidification and can deliver variable FiO2 unless tightly controlled. BiPAP is noninvasive ventilatory support for ventilation failure and work of breathing, not the standard first-choice simply to deliver a precise oxygen concentration.

Question 24

A client with end-stage renal disease has opted for an arteriovenous (AV) fistula for long-term treatment with hemodialysis. Following the surgical creation of the AV fistula, when will the client be able to use it for hemodialysis?

Accepted Answer

Answer reason: This maturation typically takes several weeks, making this timeframe appropriate for routine hemodialysis access use. Using it too early increases risks of infiltration, thrombosis, and fistula failure because the vessel wall and flow are not yet adequate. Longer timeframes may be needed in some patients, but the standard exam expectation for fistula usability is about 4–6 weeks (or more), not just a couple of weeks.

Question 25

A nurse cares for a client with a right pleural effusion requiring treatment. Which item does the nurse have available for immediate use by the health care provider?

Accepted Answer

Answer reason: The procedure used for therapeutic drainage is thoracentesis, so the priority is to have the sterile thoracentesis equipment immediately available for the provider. An arterial blood gas kit may help assess oxygenation/ventilation but does not treat the effusion. Intubation and central line supplies are not indicated unless the client has separate airway failure or vascular access needs.

Question 26

A patient with a chest tube has no fluctuation of water in the water seal chamber. What could be the cause of this?

Accepted Answer

Answer reason: Tidaling (fluctuation) in the water-seal chamber reflects changing intrapleural pressure with respiration; absence of tidaling suggests either the pleural space is no longer communicating with the drainage system or airflow/pressure changes are not reaching the chamber. When the lung re-expands, the pleural space is minimized and intrapleural pressure changes may no longer cause visible oscillation. Alternatively, a dependent loop, kinked tubing, or occlusion can block transmission of pressure changes to the water seal and also stop tidaling. An air leak typically causes continuous bubbling in the water-seal chamber rather than an absence of fluctuation.

Question 27

A nurse is preparing a client for surgery. The nurse understands that the perioperative phase that begins when the client is transferred to the surgical suite table and ends when the client is transferred to the PACU is called?

Accepted Answer

Answer reason: The intraoperative phase is defined as the period from when the patient enters the operating room and is placed on the OR table through completion of the procedure and handoff/transfer out of the OR. Transfer to the PACU marks the start of the immediate postoperative phase, so the timeframe described ends at the boundary of intraoperative care. Preoperative care occurs before arrival to the OR (assessment, consent verification, teaching), and postoperative care occurs after surgery including PACU recovery. “Admission” is not a standard perioperative phase term used to define this OR-to-PACU interval.

Question 28

The nurse has reinforced teaching with a client who is scheduled for a bronchoscopy. Which of the following statements by the client would require follow-up?

Accepted Answer

Answer reason: " After bronchoscopy, protective airway reflexes (gag/cough) can remain depressed from topical anesthesia and sedation, creating a high aspiration risk. Oral intake should be withheld until the gag reflex has fully returned and the client is alert. This statement indicates misunderstanding of a key post-procedure safety precaution and requires follow-up teaching. By contrast, removing dentures, use of local anesthetic, and signing informed consent are expected components of pre-procedure preparation.

Question 29

The nurse assists the primary health care provider with the removal of a chest tube. During the procedure, the nurse instructs the client to perform which action?

Accepted Answer

Answer reason: Chest-tube removal risks air being drawn into the pleural space through the tract, potentially causing a pneumothorax. Having the client take a deep breath and hold it (or perform a Valsalva) increases intrathoracic pressure at the moment the tube is withdrawn, helping prevent air entry. This timing also supports rapid sealing of the site as the occlusive dressing is applied. Options that involve normal breathing or deep inhalation without holding can allow negative intrathoracic pressure during inspiration, increasing the chance of air being pulled into the pleural cavity.

Question 30

After the insertion of a peripherally inserted central catheter, the nurse should?

Accepted Answer

Answer reason: A chest x-ray (or other approved verification method per policy) confirms the catheter tip is in the appropriate central venous location prior to initiating any infusions. Starting fluids immediately risks extravasation or ineffective therapy if the catheter is not correctly positioned. Removing the guidewire is performed by the inserter during placement and does not address post-insertion safety verification responsibilities.

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Therapeutic Procedures Practice Test 9

Therapeutic Procedures NCLEX Practice Test

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