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NUR 104 Midterm Exam 1 (2026/2027) |
Excelsior College — Nursing
Foundations Practice Examination.
NURSING CARE SCENARIO 1: BASIC CARE (Questions 1-5)
SCENARIO: Mrs. Eleanor Whitfield, 82 years old, is admitted to the medical-surgical unit
following a left hip hemiarthroplasty. She has a history of hypertension, type 2 diabetes, and
mild cognitive impairment. She is drowsy but arousable, reports pain at 7/10, and has an
indwelling urinary catheter. Her vital signs are: T 98.8°F (37.1°C) oral, P 88 and irregular, R 20, BP
142/86, SpO₂ 94% on room air. She is NPO except for ice chips due to post-operative nausea.
Q1: The nurse is performing Mrs. Whitfield's morning hygiene care. Which action is most
appropriate for providing oral care to this patient?
A. Position the patient supine with a pillow under her head and use a toothbrush with
toothpaste
B. Place the patient in high-Fowler's position, brush her teeth with a soft toothbrush, and use
suction if available
C. Use a foam swab dipped in lemon-glycerin solution to clean her oral cavity
D. Defer oral care until she is able to sit at the sink independently
Correct Answer: B [CORRECT]
Rationale: High-Fowler's position reduces aspiration risk during oral care in a drowsy patient. A
soft toothbrush is appropriate for oral hygiene, and suction should be available for patients with
altered consciousness or swallowing difficulty to prevent aspiration. Lemon-glycerin swabs are
not recommended because they are drying to oral mucosa and can contribute to xerostomia.
Q2: During perineal care, the nurse notes the indwelling catheter tubing is secured to Mrs.
Whitfield's thigh. Which additional intervention is essential for catheter care?
, 2
A. Cleanse the catheter tubing from the meatus outward using circular strokes
B. Ensure the urine collection bag is positioned below the level of the bladder at all times
C. Clamp the catheter for 2 hours to maintain bladder tone
D. Change the catheter every 48 hours to prevent infection
Correct Answer: B [CORRECT]
Rationale: Positioning the drainage bag below the bladder level prevents backflow of urine,
which reduces the risk of catheter-associated urinary tract infection (CAUTI). Cleaning should be
from the meatus outward (clean to dirty), not along the tubing. Routine clamping is
contraindicated, and catheters should not be changed on a fixed schedule but only when
clinically indicated.
Q3: Mrs. Whitfield's daughter asks why her mother cannot have a full liquid breakfast. The
nurse's best response is based on which understanding?
A. The NPO status reduces the risk of aspiration during the immediate post-operative period
B. The patient needs to fast to prevent medication interactions
C. The NPO status allows the surgical site to heal without digestive demands
D. The patient must prove she can tolerate ice chips before any other intake
Correct Answer: A [CORRECT]
Rationale: Post-operative nausea and drowsiness increase aspiration risk. Maintaining NPO
status until bowel sounds return and the gag reflex is intact protects the airway. NPO status is
not related to medication interactions or surgical site healing, and tolerance of ice chips alone
does not establish safe swallowing.
Q4: The nurse is preparing to bathe Mrs. Whitfield. Which principle of bed bath administration
should guide the nurse's actions?
A. Bathe the patient from the cleanest area to the dirtiest area
B. Use hot water to provide maximum comfort and relaxation
C. Expose the entire body at once to complete the bath quickly
D. Begin with the back and buttocks, then proceed to the face
, 3
Correct Answer: A [CORRECT]
Rationale: Cleaning from cleanest to dirtiest areas prevents the spread of microorganisms. The
face is typically the cleanest area and should be bathed first; the perineal area is considered the
dirtiest and should be bathed last. Water should be warm (110-115°F), not hot, and only the
body part being washed should be exposed to maintain warmth and dignity.
Q5: While performing the bath, the nurse notices Mrs. Whitfield's skin on her lower extremities
is dry and flaking. Which intervention is most appropriate?
A. Avoid applying lotion to prevent fungal growth in moist skin folds
B. Apply a thin layer of lotion using long, firm strokes to stimulate circulation
C. Use talcum powder liberally to absorb moisture
D. Vigorously rub the skin with a washcloth to remove dead cells
Correct Answer: B [CORRECT]
Rationale: Applying lotion with gentle, long strokes hydrates dry skin and stimulates circulation.
Lotion should not be applied between toes or in skin folds where moisture accumulation can
cause maceration. Talcum powder is not recommended due to inhalation risks, and vigorous
rubbing can damage fragile elderly skin.
NURSING PROCESS SCENARIO 1: ASSESSMENT & DIAGNOSIS (Questions 6-8)
SCENARIO: Mr. James Okafor, 68 years old, is admitted with community-acquired pneumonia.
He has a productive cough with thick yellow sputum, a fever of 102.1°F (38.9°C), chills, and
crackles in the right lower lobe. He reports fatigue and shortness of breath with minimal
exertion. His oxygen saturation is 89% on room air. He has a 40-year smoking history and lives
alone.
Q6: Which assessment finding represents subjective data?
A. Temperature of 102.1°F (38.9°C)
B. Crackles in the right lower lobe on auscultation
NUR 104 Midterm Exam 1 (2026/2027) |
Excelsior College — Nursing
Foundations Practice Examination.
NURSING CARE SCENARIO 1: BASIC CARE (Questions 1-5)
SCENARIO: Mrs. Eleanor Whitfield, 82 years old, is admitted to the medical-surgical unit
following a left hip hemiarthroplasty. She has a history of hypertension, type 2 diabetes, and
mild cognitive impairment. She is drowsy but arousable, reports pain at 7/10, and has an
indwelling urinary catheter. Her vital signs are: T 98.8°F (37.1°C) oral, P 88 and irregular, R 20, BP
142/86, SpO₂ 94% on room air. She is NPO except for ice chips due to post-operative nausea.
Q1: The nurse is performing Mrs. Whitfield's morning hygiene care. Which action is most
appropriate for providing oral care to this patient?
A. Position the patient supine with a pillow under her head and use a toothbrush with
toothpaste
B. Place the patient in high-Fowler's position, brush her teeth with a soft toothbrush, and use
suction if available
C. Use a foam swab dipped in lemon-glycerin solution to clean her oral cavity
D. Defer oral care until she is able to sit at the sink independently
Correct Answer: B [CORRECT]
Rationale: High-Fowler's position reduces aspiration risk during oral care in a drowsy patient. A
soft toothbrush is appropriate for oral hygiene, and suction should be available for patients with
altered consciousness or swallowing difficulty to prevent aspiration. Lemon-glycerin swabs are
not recommended because they are drying to oral mucosa and can contribute to xerostomia.
Q2: During perineal care, the nurse notes the indwelling catheter tubing is secured to Mrs.
Whitfield's thigh. Which additional intervention is essential for catheter care?
, 2
A. Cleanse the catheter tubing from the meatus outward using circular strokes
B. Ensure the urine collection bag is positioned below the level of the bladder at all times
C. Clamp the catheter for 2 hours to maintain bladder tone
D. Change the catheter every 48 hours to prevent infection
Correct Answer: B [CORRECT]
Rationale: Positioning the drainage bag below the bladder level prevents backflow of urine,
which reduces the risk of catheter-associated urinary tract infection (CAUTI). Cleaning should be
from the meatus outward (clean to dirty), not along the tubing. Routine clamping is
contraindicated, and catheters should not be changed on a fixed schedule but only when
clinically indicated.
Q3: Mrs. Whitfield's daughter asks why her mother cannot have a full liquid breakfast. The
nurse's best response is based on which understanding?
A. The NPO status reduces the risk of aspiration during the immediate post-operative period
B. The patient needs to fast to prevent medication interactions
C. The NPO status allows the surgical site to heal without digestive demands
D. The patient must prove she can tolerate ice chips before any other intake
Correct Answer: A [CORRECT]
Rationale: Post-operative nausea and drowsiness increase aspiration risk. Maintaining NPO
status until bowel sounds return and the gag reflex is intact protects the airway. NPO status is
not related to medication interactions or surgical site healing, and tolerance of ice chips alone
does not establish safe swallowing.
Q4: The nurse is preparing to bathe Mrs. Whitfield. Which principle of bed bath administration
should guide the nurse's actions?
A. Bathe the patient from the cleanest area to the dirtiest area
B. Use hot water to provide maximum comfort and relaxation
C. Expose the entire body at once to complete the bath quickly
D. Begin with the back and buttocks, then proceed to the face
, 3
Correct Answer: A [CORRECT]
Rationale: Cleaning from cleanest to dirtiest areas prevents the spread of microorganisms. The
face is typically the cleanest area and should be bathed first; the perineal area is considered the
dirtiest and should be bathed last. Water should be warm (110-115°F), not hot, and only the
body part being washed should be exposed to maintain warmth and dignity.
Q5: While performing the bath, the nurse notices Mrs. Whitfield's skin on her lower extremities
is dry and flaking. Which intervention is most appropriate?
A. Avoid applying lotion to prevent fungal growth in moist skin folds
B. Apply a thin layer of lotion using long, firm strokes to stimulate circulation
C. Use talcum powder liberally to absorb moisture
D. Vigorously rub the skin with a washcloth to remove dead cells
Correct Answer: B [CORRECT]
Rationale: Applying lotion with gentle, long strokes hydrates dry skin and stimulates circulation.
Lotion should not be applied between toes or in skin folds where moisture accumulation can
cause maceration. Talcum powder is not recommended due to inhalation risks, and vigorous
rubbing can damage fragile elderly skin.
NURSING PROCESS SCENARIO 1: ASSESSMENT & DIAGNOSIS (Questions 6-8)
SCENARIO: Mr. James Okafor, 68 years old, is admitted with community-acquired pneumonia.
He has a productive cough with thick yellow sputum, a fever of 102.1°F (38.9°C), chills, and
crackles in the right lower lobe. He reports fatigue and shortness of breath with minimal
exertion. His oxygen saturation is 89% on room air. He has a 40-year smoking history and lives
alone.
Q6: Which assessment finding represents subjective data?
A. Temperature of 102.1°F (38.9°C)
B. Crackles in the right lower lobe on auscultation
