Nursing Skills and Procedures – RN Flashcards

Twenty-eight rapid-recall cards for Nursing Skills and Procedures at registered nurse depth, covering intravenous and central venous access, complex wound management, complication recognition, and prioritization.

Intravenous and Central Venous Therapy

What is the immediate nursing action for suspected venous air embolism?

Clamp the catheter, place the client in left lateral Trendelenburg, the Durant maneuver, to trap air in the right ventricular apex, administer 100 percent oxygen, and notify the provider.

How does infiltration differ from extravasation, and how does management differ?

Infiltration is leakage of a nonvesicant into tissue: stop, remove the catheter, elevate, apply a compress. Extravasation is leakage of a vesicant such as a vasopressor or chemotherapy agent: stop the infusion but leave the catheter in place, aspirate residual drug, notify the provider, and give the specific antidote, for example phentolamine for norepinephrine.

What are the signs of phlebitis, and what is the nursing response?

Redness, warmth, tenderness, and a palpable venous cord. Discontinue the catheter, apply a warm compress, and restart in the opposite extremity.

Which intravenous solutions are hypertonic, and what is the key monitoring priority?

3 percent sodium chloride, dextrose 10 percent in water, and dextrose 5 percent in 0.9 percent sodium chloride or in lactated Ringer. Infuse slowly through a large vein with frequent neurologic checks, serum sodium monitoring, and assessment for fluid overload.

Why is dextrose 5 percent in water unsuitable for a client with cerebral edema?

Once the dextrose is metabolized, only free water remains, so the solution behaves as hypotonic and shifts water into cells, worsening cerebral edema.

What is the absolute rule for intravenous potassium chloride?

Never give by intravenous push or bolus. Always dilute and infuse by electronic pump within institutional concentration and rate limits, monitoring the cardiac rhythm, the site, and urine output. Also check magnesium, since hypomagnesemia makes hypokalemia refractory.

What gauge catheter is preferred for blood product administration in an adult?

An 18 gauge is preferred; a 20 gauge is generally acceptable. Prime only with 0.9 percent sodium chloride using filtered Y-tubing.

Why must a small volume syringe never be used to force a flush on a central line?

A smaller barrel generates much higher pressure per unit of force and can rupture the catheter or dislodge a thrombus. Absent blood return may indicate a fibrin sheath and is reported, never forced.

List the core elements of the central line infection prevention bundle.

Hand hygiene, maximal sterile barrier precautions at insertion, chlorhexidine antisepsis with full air drying, optimal site selection with the femoral site avoided in adults, scrubbing the needleless connector before every access, sterile dressing changes on schedule or whenever damp, loose, or soiled, and daily review of line necessity with prompt removal.

What must be confirmed before the first use of a newly placed central venous catheter or peripherally inserted central catheter?

Radiographic confirmation of tip position in the lower superior vena cava.

What complication is assessed for immediately after subclavian or internal jugular central line insertion?

Pneumothorax. Watch for sudden dyspnea, chest pain, diminished or absent breath sounds on the affected side, and tracheal deviation.

What client teaching applies to an arm with a peripherally inserted central catheter?

No blood pressure measurement and no venipuncture in that arm, keep the dressing dry and intact, and report swelling, pain, redness, drainage, or an increase in external catheter length.

Describe the immediate response to a suspected acute hemolytic transfusion reaction.

Stop the transfusion, disconnect the blood tubing and maintain the line with 0.9 percent sodium chloride through new tubing, assess and obtain vital signs, notify the provider and blood bank, and return the unit and tubing with post-transfusion blood and urine specimens.

How are transfusion-associated circulatory overload and transfusion-related acute lung injury distinguished?

Circulatory overload produces dyspnea, crackles, jugular venous distension, and hypertension and responds to slowing the rate and diuretics. Transfusion-related acute lung injury produces acute hypoxemia with bilateral infiltrates but without volume overload or hypertension and requires respiratory support.

Wound Management

Differentiate a stage 3 pressure injury from a stage 4.

Stage 3 is full thickness with visible adipose tissue, possible undermining and tunneling, and no exposed fascia, muscle, tendon, ligament, cartilage, or bone. Stage 4 exposes or allows direct palpation of those deeper structures.

When is a pressure injury documented as unstageable, and what does deep tissue pressure injury look like?

Unstageable when slough or eschar obscures the base so depth cannot be determined. Deep tissue pressure injury is persistent nonblanchable deep red, maroon, or purple discoloration, or a blood-filled blister, over intact or nonintact skin.

Why is stable dry eschar on an ischemic heel left intact?

It functions as the body's biological cover over poorly perfused tissue. Keep it dry, offload the heel, and report any new erythema, fluctuance, drainage, odor, or softening, which signal infection and change the plan.

Match the dressing to the wound

heavy exudate, dry wound bed, clean shallow stage 2.

Heavy exudate calls for alginate or foam. A dry wound bed calls for hydrogel to donate moisture. A clean shallow stage 2 wound suits a hydrocolloid, which maintains moisture and promotes autolytic debridement.

Why is wet-to-dry gauze no longer recommended as routine wound care?

It performs nonselective mechanical debridement that removes healthy granulation tissue along with necrotic tissue, is painful, and disrupts moisture balance. It should be questioned when ordered for a clean granulating wound.

List the contraindications to negative pressure wound therapy.

Untreated osteomyelitis, malignancy within the wound, exposed vessels, organs, or anastomoses, and necrotic tissue with eschar. Frank blood in the canister is an emergency.

How is a wound culture correctly obtained?

Cleanse the wound with normal saline first, then swab viable tissue in the wound bed with a rotating motion. Do not culture pus, slough, or eschar, and obtain the specimen before antibiotics when possible.

State the full nursing response to wound evisceration.

Stay with the client, position low Fowler with knees flexed, cover the viscera with sterile gauze moistened with sterile normal saline, never attempt reinsertion, keep the client NPO, monitor for hypovolemic shock, and notify the surgeon immediately.

Airway, Enteral, and Injection Skills

What is the gold standard for verifying placement of a newly inserted small-bore feeding tube?

Radiographic confirmation before first use. Before subsequent feedings, aspirate and check pH, with about 5.5 or lower supporting gastric placement, and compare the external tube length with the documented mark. Auscultation of an air bolus is unreliable and unacceptable.

What are the current considerations for gastric residual volume?

Traditional practice holds the feeding for a residual above 500 mL and prompts closer assessment between about 200 and 500 mL. Current critical care guidance discourages routine residual checks as the sole indicator; assess distension, nausea, vomiting, and bowel function as well, and follow facility policy.

What is refeeding syndrome, and who is at risk?

A dangerous fall in phosphate, magnesium, and potassium when nutrition is reintroduced to a severely malnourished client, producing cardiac and respiratory failure and arrhythmias. Advance nutrition slowly and monitor electrolytes closely.

Which oxygen device delivers the most precise concentration, and when is it preferred?

The Venturi mask, delivering 24 to 60 percent by color-coded adapter. It is preferred when an exact concentration is required, as in chronic obstructive pulmonary disease with a target saturation commonly around 88 to 92 percent.

What does a fully collapsing nonrebreather reservoir bag indicate, and what is the action?

Inspiratory demand exceeds delivered flow, so room air is entrained and the delivered concentration falls. Increase the flow rate until the bag remains partially inflated, generally 10 to 15 L/min or higher. Never remove the one-way valves.

Why is the ventrogluteal site preferred for large volume or viscous intramuscular injections, and how is it located?

It accommodates up to about 3 mL and is free of major nerves and large vessels. Place the palm on the greater trochanter, the index finger on the anterior superior iliac spine, and the middle finger along the iliac crest, then inject into the V using Z-track technique at 90 degrees.

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