Eight questions written by our own nurse educator, every one with the rationale set out in full. The rationale is the resource. The score is not.
A practice question you get right for the wrong reason has taught you nothing, and it will not repeat itself in the same shape on exam day. So read every rationale, including the ones you answered correctly. That is the entire technique.
A nurse inserts an NG tube in a patient with abdominal distention and vomiting. After insertion, which action is the priority before using the tube for feeding or medication administration?
Correct answer: B. Initial placement must be confirmed using the approved method before the tube is used for anything at all.
Why the others fail. A is the single most important distractor in this set: auscultating an injected air bolus is not reliable confirmation, because sound transmits to the epigastrium from a tube in the airway or the oesophagus just as readily as from one in the stomach. The American Association of Critical-Care Nurses addresses this directly in its practice alert on verification of feeding tube placement in adults. C uses the tube before it has been confirmed, which is the error the question is testing. D is subjective and tells you nothing about location.
While an NG tube is being inserted, the patient begins coughing forcefully and develops difficulty breathing. What should the nurse do first?
Correct answer: C. Coughing and respiratory distress during insertion may indicate the tube has entered the airway. Stop, and assess airway and breathing.
Note the trap in reverse. The absence of coughing does not prove the tube is not in the airway. A sedated, obtunded or neurologically impaired patient may not cough at all with a tube in the trachea, which is exactly why absence of coughing appears on the list of things that are not confirmation.
An NG tube has been confirmed in the stomach and is prescribed for gastric decompression. Which finding requires the nurse's immediate attention?
Correct answer: C. New respiratory distress with desaturation signals a potential airway or respiratory complication and requires immediate assessment.
Why this one is worth sitting with. The tube was confirmed. Confirmation is not permanent: tubes migrate after vomiting, retching, coughing and movement, which is why ongoing monitoring is a separate requirement from initial verification. A and D are expected findings. B is common and not urgent.
A nurse is inserting a peripheral IV catheter and sees blood return in the catheter chamber. What should the nurse do next?
Correct answer: B. Blood return indicates the vessel has been entered. The flexible catheter is advanced, not the needle.
Why D is dangerous rather than merely wrong. Reinserting the needle into a catheter that has already been advanced can shear the catheter and embolise a fragment. It is a never event in technique terms, and it is why the option appears here at all. Note also that flashback tells you where the needle tip is, not where the catheter is, which is the distinction the whole question rests on.
A patient receiving IV fluids reports burning at the IV site. The nurse observes swelling and coolness around the insertion site. Which complication should the nurse suspect?
Correct answer: B. Coolness, swelling, discomfort and leaking are the findings associated with infiltration, which is fluid entering the tissue rather than the vein.
The word doing the work is "coolness." Infused fluid is at room temperature, so tissue it collects in feels cool. Inflammation, by contrast, feels warm. That single sign separates the two commonest answers on this topic, and it is why the discrimination table below is worth memorising over any list of definitions.
A nurse assesses a peripheral IV and observes redness, warmth, tenderness, and a palpable cord along the vein. Which complication is most likely?
Correct answer: B. Redness, warmth, tenderness and a palpable cord along the vein track are characteristic of phlebitis, which is inflammation of the vein wall.
The palpable cord is the giveaway. It follows the line of the vein, because the vein itself is inflamed. Infiltration produces diffuse swelling that does not follow the vessel. The Infusion Nurses Society publishes separate graded scales for phlebitis and for infiltration, which exist precisely because these two are assessed and documented differently.
A new nurse is preparing to insert a peripheral IV. Which action demonstrates the best infection-prevention practice?
Correct answer: B. Antiseptic must be allowed to air dry according to the product and facility instructions. Drying time is part of how the antiseptic works, not a delay before the real step.
A and C are both recontamination. Re-palpating a cleaned site undoes the preparation, and blowing on it introduces organisms from the respiratory tract. The Centers for Disease Control and Prevention publishes guidance on preventing intravascular catheter-related infection that covers site preparation.
A nurse successfully inserts a peripheral IV. During the final assessment, the patient reports increasing pain and the nurse notices swelling around the insertion site. What is the priority action?
Correct answer: C. Pain with swelling can indicate infiltration or extravasation depending on what is being infused. Stop the infusion and follow the facility protocol.
Why D is the tempting wrong answer. Swelling after IV insertion is not expected, and an initially good blood return does not exclude a complication developing afterwards. Extravasation, where the infusing agent is a vesicant, is time critical, and the difference between infiltration and extravasation is what is in the bag rather than what the site looks like.
If you take one table away from this page, take this one. Two complications, similar presentations, opposite findings on the sign that matters.
| Infiltration | Phlebitis | |
|---|---|---|
| What it is | Fluid entering the tissue instead of the vein | Inflammation of the vein wall itself |
| Temperature | Cool to touch | Warm to touch |
| Colour | Pale, blanched, taut | Red, following the vein |
| Shape | Diffuse swelling around the site | A palpable cord along the vein track |
| Other findings | Discomfort, leaking at the site | Tenderness along the vessel |
| Assessed with | The Infusion Nurses Society infiltration scale | The Infusion Nurses Society phlebitis scale |
The order is the entire safety argument. USE comes last and it comes after CONFIRM, never alongside it.
CHECK is the order, two patient identifiers, allergies, hand hygiene and gloves. It is first because it is what a validation actually fails people on, and because a sequence that begins at LOCATE quietly teaches you to skip it.
Recognising infiltration on paper and recognising it on a patient at 3 a.m. are different skills. Both of ours are assessed under observation.
