NURS 104L | Fundamentals of Nursing Skills Lab Exam 2 Study Guide
2026 |WCU
1. When administering an intramuscular (IM) injection using the Z-track
method, what is the primary rationale for this technique?
A. To reduce the risk of hitting a major blood vessel
B. To decrease the speed of absorption for long-acting medications
C. To minimize local skin irritation by sealing the medication in muscle tissue
D. To prevent the needle from hitting the underlying bone structure
Answer: C
Rationale: The Z-track method is used in IM injections to displace the skin and
subcutaneous tissue before needle insertion. This creates a zigzag path that seals the
medication within the muscle, preventing leakage into the subcutaneous tissue and
reducing irritation.
2. A nurse is preparing to administer 0.5 mL of a medication subcutaneously to
an average-sized adult. Which needle gauge and length should the nurse select?
A. 18-gauge, 1.5-inch needle
B. 22-gauge, 1-inch needle
C. 30-gauge, 1.5-inch needle
D. 25-gauge, 5/8-inch needle
Answer: D
Rationale: For subcutaneous injections in an average adult, a 25- to 27-gauge needle that
is 3/8 to 5/8 inches long is appropriate. Larger gauges like 18 or 22 are used for IM or IV,
and 1.5 inches is too long for subcutaneous tissue.
,3. When mixing regular insulin and NPH insulin in the same syringe, which step
must the nurse perform first?
A. Draw up the NPH insulin first.
B. Inject air into the NPH vial.
C. Draw up the regular insulin first.
D. Inject air into the regular vial.
Answer: B
Rationale: The correct sequence for mixing insulin is: Inject air into the NPH (cloudy),
inject air into the regular (clear), draw up the regular (clear), then draw up the NPH
(cloudy). Air goes into the cloudy vial first.
4. The nurse is performing a sterile dressing change. Which action would
constitute a break in the sterile field?
A. Keeping the sterile field within the line of vision.
B. Opening the outer wrapper of a sterile kit away from the body.
C. Reaching over the sterile field to pick up a discarded wrapper.
D. Dropping a sterile gauze onto the field from 2 inches above.
Answer: C
Rationale: Reaching over a sterile field contaminates it because micro-organisms can fall
from the nurse’s non-sterile sleeves or arms onto the field. One must move around the
perimeter.
5. A patient requires suctioning of a tracheostomy. What is the maximum
amount of time the nurse should apply suction during a single pass?
A. 10 to 15 seconds
B. 5 seconds
C. 20 to 30 seconds
D. Until the airway is completely clear
Answer: A
, Rationale: Suctioning should be limited to 10-15 seconds per pass to prevent hypoxia and
mucosal trauma. Prolonged suctioning can significantly drop oxygen saturation levels.
6. Which landmark is used to identify the ventrogluteal injection site?
A. The acromion process
B. The posterior superior iliac spine and the iliac crest
C. The patella and the greater trochanter
D. The greater trochanter and the anterior superior iliac spine
Answer: D
Rationale: To locate the ventrogluteal site, the nurse places the palm over the greater
trochanter, points the index finger toward the anterior superior iliac spine, and extends the
middle finger toward the iliac crest, forming a ‘V’.
7. While inserting an indwelling urinary catheter in a female patient, the nurse
notices the catheter has entered the vagina. What is the nurse’s next action?
A. Remove the catheter and reinsert it into the meatus.
B. Ask the patient to cough and push the catheter deeper.
C. Wipe the catheter with antiseptic and move it upward.
D. Leave the catheter in the vagina and use a new sterile kit for a second attempt.
Answer: D
Rationale: If the catheter enters the vagina, it is contaminated. Leaving it in place serves as
a landmark to avoid the vagina on the next attempt with a completely new sterile catheter
and kit.
2026 |WCU
1. When administering an intramuscular (IM) injection using the Z-track
method, what is the primary rationale for this technique?
A. To reduce the risk of hitting a major blood vessel
B. To decrease the speed of absorption for long-acting medications
C. To minimize local skin irritation by sealing the medication in muscle tissue
D. To prevent the needle from hitting the underlying bone structure
Answer: C
Rationale: The Z-track method is used in IM injections to displace the skin and
subcutaneous tissue before needle insertion. This creates a zigzag path that seals the
medication within the muscle, preventing leakage into the subcutaneous tissue and
reducing irritation.
2. A nurse is preparing to administer 0.5 mL of a medication subcutaneously to
an average-sized adult. Which needle gauge and length should the nurse select?
A. 18-gauge, 1.5-inch needle
B. 22-gauge, 1-inch needle
C. 30-gauge, 1.5-inch needle
D. 25-gauge, 5/8-inch needle
Answer: D
Rationale: For subcutaneous injections in an average adult, a 25- to 27-gauge needle that
is 3/8 to 5/8 inches long is appropriate. Larger gauges like 18 or 22 are used for IM or IV,
and 1.5 inches is too long for subcutaneous tissue.
,3. When mixing regular insulin and NPH insulin in the same syringe, which step
must the nurse perform first?
A. Draw up the NPH insulin first.
B. Inject air into the NPH vial.
C. Draw up the regular insulin first.
D. Inject air into the regular vial.
Answer: B
Rationale: The correct sequence for mixing insulin is: Inject air into the NPH (cloudy),
inject air into the regular (clear), draw up the regular (clear), then draw up the NPH
(cloudy). Air goes into the cloudy vial first.
4. The nurse is performing a sterile dressing change. Which action would
constitute a break in the sterile field?
A. Keeping the sterile field within the line of vision.
B. Opening the outer wrapper of a sterile kit away from the body.
C. Reaching over the sterile field to pick up a discarded wrapper.
D. Dropping a sterile gauze onto the field from 2 inches above.
Answer: C
Rationale: Reaching over a sterile field contaminates it because micro-organisms can fall
from the nurse’s non-sterile sleeves or arms onto the field. One must move around the
perimeter.
5. A patient requires suctioning of a tracheostomy. What is the maximum
amount of time the nurse should apply suction during a single pass?
A. 10 to 15 seconds
B. 5 seconds
C. 20 to 30 seconds
D. Until the airway is completely clear
Answer: A
, Rationale: Suctioning should be limited to 10-15 seconds per pass to prevent hypoxia and
mucosal trauma. Prolonged suctioning can significantly drop oxygen saturation levels.
6. Which landmark is used to identify the ventrogluteal injection site?
A. The acromion process
B. The posterior superior iliac spine and the iliac crest
C. The patella and the greater trochanter
D. The greater trochanter and the anterior superior iliac spine
Answer: D
Rationale: To locate the ventrogluteal site, the nurse places the palm over the greater
trochanter, points the index finger toward the anterior superior iliac spine, and extends the
middle finger toward the iliac crest, forming a ‘V’.
7. While inserting an indwelling urinary catheter in a female patient, the nurse
notices the catheter has entered the vagina. What is the nurse’s next action?
A. Remove the catheter and reinsert it into the meatus.
B. Ask the patient to cough and push the catheter deeper.
C. Wipe the catheter with antiseptic and move it upward.
D. Leave the catheter in the vagina and use a new sterile kit for a second attempt.
Answer: D
Rationale: If the catheter enters the vagina, it is contaminated. Leaving it in place serves as
a landmark to avoid the vagina on the next attempt with a completely new sterile catheter
and kit.
