NCLEX Comfort & Therapeutic Procedures questions
The PrepScore bank has 67 Comfort & Therapeutic Procedures questions, each with a rationale and two tags: the Client Needs category from the test plan and the clinical judgment step it tests. In this topic the items lean on Recognize cues and Generate solutions, which is worth knowing before you practise it. Three worked samples are below, answers behind a reveal.
Pressure injury staging, NG tube verification, ostomy care, tracheostomy suctioning, IV extravasation, heat/cold therapy, non-pharmacologic pain, bowel/bladder retraining.
Three worked questions
Q1. A 35-year-old female at the clinic needs a clean-catch midstream urine specimen for UTI workup. The clinic nurse prepares the patient for the procedure. When obtaining a clean-catch midstream urine specimen, which technique does the nurse instruct the patient to use?
- A. Collect the first void only without midstream collection or perineal cleansing prior to the specimen collection
- B. Clean perineal area from front-to-back with antiseptic wipes + start void → midstream collect into sterile container (do not touch inside of container) → finish void in toilet + cap container immediately
- C. Use a non-sterile cup for the clean-catch midstream urine specimen without sterile technique during the collection
- D. Collect all urine for 24 hours regardless of the clean-catch midstream urine specimen requested for UTI workup
Show answer and rationale
Answer: Clean perineal area from front-to-back with antiseptic wipes + start void → midstream collect into sterile container (do not touch inside of container) → finish void in toilet + cap container immediately
Clean-catch midstream: clean perineal front-to-back + start void → midstream collect into sterile container (don't touch inside) → finish in toilet + cap immediately. First void, non-sterile cup, or 24-h collection are wrong.
Q2. A 40-year-old female with high-anxiety about needles needs venipuncture for routine labs. The phlebotomy nurse plans to maximize comfort during the procedure. Which actions REDUCE DISCOMFORT during a venipuncture? Select all that apply.
- A. Apply topical anesthetic (EMLA, LMX-4) if time allows (30-60 min onset) — reduces puncture pain
- B. Use distraction techniques (deep breathing, conversation, music, screen time)
- C. Confirm warmth + visible vein selection (palpation + visual assessment, warm compress if needed)
- D. Insert at proper angle (15-30°) + smooth motion + advance until flashback (no probing)
- E. Apply tourniquet for 5+ minutes (excessive — risks hemoconcentration and discomfort)
- F. Repeatedly probe with the needle if first attempt fails (causes tissue trauma and bruising)
Show answer and rationale
Answer: Apply topical anesthetic (EMLA, LMX-4) if time allows (30-60 min onset) — reduces puncture painUse distraction techniques (deep breathing, conversation, music, screen time)Confirm warmth + visible vein selection (palpation + visual assessment, warm compress if needed)Insert at proper angle (15-30°) + smooth motion + advance until flashback (no probing)
Venipuncture comfort: topical anesthetic + distraction + warmth/visible vein + proper angle/smooth motion. Excessive tourniquet (> 1 min) and probing cause discomfort and trauma.
Q3. A 55-year-old male with chronic tracheostomy on ventilator support has thick secretions requiring suctioning. The respiratory nurse prepares for tracheal suctioning. Which technique is APPROPRIATE during tracheostomy suctioning?
- A. Suction continuously while withdrawing the catheter from the airway despite the hypoxemia and mucosal damage risk
- B. Apply suction only on WITHDRAWAL (not insertion) + limit each pass to ≤ 10-15 seconds + pre-oxygenate with 100% FiO2 + use sterile technique + appropriate catheter size (catheter OD ≤ ½ inner diameter of trach tube)
- C. Insert as deeply as possible without depth limits despite the mucosal damage and bleeding risk during suctioning
- D. Use bare hands without sterile technique despite the infection control standards during tracheal suctioning procedure
Show answer and rationale
Answer: Apply suction only on WITHDRAWAL (not insertion) + limit each pass to ≤ 10-15 seconds + pre-oxygenate with 100% FiO2 + use sterile technique + appropriate catheter size (catheter OD ≤ ½ inner diameter of trach tube)
Tracheostomy suctioning: suction ONLY on withdrawal + ≤ 10-15 sec/pass + pre-oxygenate with 100% FiO2 + sterile technique + catheter OD ≤ ½ trach inner diameter. Continuous suction, deep insertion, or bare hands are wrong.
The rules that decide these questions
From the pack's rule cards — the reasoning shortcuts a wrong answer usually means you were missing.
Stage 1: non-blanchable erythema, skin INTACT. Stage 2: partial thickness, pink-red wound bed (looks like blister). Stage 3: full thickness, subcutaneous fat visible, no bone/tendon/muscle. Stage 4: full thickness with EXPOSED bone, tendon, or muscle. Unstageable: covered by eschar/slough — stable dry heel eschar typically left intact. DTI: intact discolored skin from damage beneath.
Initial NG placement requires X-ray before any feeding or medication. pH < 5.5 + green-yellow aspirate is a bridge check while awaiting X-ray. Auscultation (air bolus) is OUTDATED and DANGEROUS — air sounds can be heard from a lung-placed tube. Mark + document external tube length after X-ray; verify length unchanged before each subsequent use.
Pre-oxygenate with 100% O2 for 30-60 sec. Sterile catheter + sterile gloves. Insert WITHOUT suction; suction only on withdrawal, ≤ 10-15 seconds, with rotation. Routine saline lavage is NOT recommended (causes hypoxia + carries bacteria). Reoxygenate between passes. Reassess SpO2 + breath sounds.
Pink/red = healthy. Pale pink = monitor + workup (Hb, hydration). Purple/dusky = ischemia, notify surgeon STAT. Black = necrosis, surgical emergency. Always document color + size + output. Initial post-op output expected within 24-48 h; delayed output + dusky stoma = ischemia / obstruction.
Infiltration = non-vesicant fluid in tissue. Extravasation = VESICANT fluid in tissue (chemo, vasopressors, calcium, contrast — TISSUE NECROSIS RISK). For both: STOP infusion + remove IV + elevate + restart IV at a new site. Extravasation adds: drug-specific antidote + drug-specific compress (cold for anthracyclines, warm for vinca) + escalation.
Cold (RICE) for acute injury < 48-72 h — reduces inflammation, swelling, bleeding. Heat for chronic pain + muscle stiffness — increases blood flow + relaxes muscle. NEVER apply heat to DVT (dislodges clot), active bleeding, or anesthetized areas. Always use barrier (towel) + 15-20 min max + check skin frequently in diabetes/neuropathy.
Practise the whole pack, tagged and explained
Every item carries its Client Needs category and clinical judgment step, so a wrong answer names the step that failed.
Frequently asked questions
How many Comfort & Therapeutic Procedures questions does the bank have?
67 multiple-choice items, plus 10 unfolding cases in the Comfort & Therapeutic Procedures pack, each with a rationale.
Are the samples real bank items?
Yes — the three questions above are drawn from the live bank, with their real rationales and tags.
Which clinical judgment steps does this topic train?
Most items in this topic test Recognize cues and Generate solutions, though every step appears.
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