NURS 121L-B | Introduction to Medical-Surgical Nursing Practicum -
Exam 1 2026 |WCU
1. A nurse is preparing to administer an intramuscular (IM) injection to a client
who is obese. Which of the following actions should the nurse take to ensure
the medication reaches the muscle tissue?
A. Use a 1-inch needle and insert at a 45-degree angle.
B. Use a 1.5-inch needle and insert at a 90-degree angle.
C. Spread the skin taut and use a 5/8-inch needle.
D. Pinch the skin and insert the needle at a 15-degree angle.
Answer: B
Rationale: For an obese client, a longer needle (at least 1.5 inches) is required to penetrate
the subcutaneous fat and reach the muscle tissue, and a 90-degree angle is standard for IM
injections.
2. When performing a physical assessment, the nurse finds a client’s skin is cool,
pale, and moist. Which of the following is the priority nursing action?
A. Document the findings in the electronic health record.
B. Ask the client about their recent dietary intake.
C. Apply a warm blanket to the client.
D. Check the client’s vital signs and oxygen saturation.
Answer: D
Rationale: Cool, pale, and moist skin (diaphoresis) can be a sign of shock or cardiovascular
compromise; checking vital signs is the priority assessment to determine stability.
,3. A nurse is caring for a client with a history of seizures. Which of the following
safety precautions should the nurse implement?
A. Keep a padded tongue blade at the bedside.
B. Ensure suction equipment and oxygen are available at the bedside.
C. Place the bed in the highest position with all four side rails up.
D. Restrain the client’s limbs during a seizure activity.
Answer: B
Rationale: Standard seizure precautions include having suction and oxygen ready to
manage the airway post-seizure. Padded tongue blades are contraindicated as they can
cause injury.
4. Which of the following is the most accurate method for the nurse to verify
the identity of a client before medication administration?
A. Check the room number on the medication administration record (MAR).
B. Ask the client to state their name and date of birth.
C. Compare the client’s face with the photo in the medical record.
D. Ask a family member to confirm the client’s identity.
Answer: B
Rationale: Two unique identifiers (name and date of birth) provided by the client are the
standard for safe patient identification.
5. A nurse is performing an abdominal assessment. In which order should the
nurse perform the following physical examination techniques?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
D. Palpation, Percussion, Auscultation, Inspection
Answer: A
, Rationale: For the abdomen, auscultation is performed before percussion and palpation to
avoid altering bowel sounds.
6. A client is diagnosed with Clostridioides difficile (C. diff). Which of the
following infection control measures must the nurse implement?
A. Use soap and water for hand hygiene after leaving the room.
B. Perform hand hygiene with alcohol-based hand sanitizer only.
C. Wear an N95 respirator mask when entering the room.
D. Keep the room door closed at all times (Negative Pressure).
Answer: A
Rationale: Alcohol-based sanitizers do not kill C. diff spores; handwashing with soap and
water is mandatory for physical removal of spores.
7. During the assessment of a surgical wound, the nurse notes the presence of
thick, yellow-green drainage. How should this be documented?
A. Purulent drainage
B. Serous drainage
C. Serosanguineous drainage
D. Sanguineous drainage
Answer: A
Rationale: Purulent drainage is thick and indicates infection; it can be yellow, green, or
brown. Serous is clear, and sanguineous is bloody.
Exam 1 2026 |WCU
1. A nurse is preparing to administer an intramuscular (IM) injection to a client
who is obese. Which of the following actions should the nurse take to ensure
the medication reaches the muscle tissue?
A. Use a 1-inch needle and insert at a 45-degree angle.
B. Use a 1.5-inch needle and insert at a 90-degree angle.
C. Spread the skin taut and use a 5/8-inch needle.
D. Pinch the skin and insert the needle at a 15-degree angle.
Answer: B
Rationale: For an obese client, a longer needle (at least 1.5 inches) is required to penetrate
the subcutaneous fat and reach the muscle tissue, and a 90-degree angle is standard for IM
injections.
2. When performing a physical assessment, the nurse finds a client’s skin is cool,
pale, and moist. Which of the following is the priority nursing action?
A. Document the findings in the electronic health record.
B. Ask the client about their recent dietary intake.
C. Apply a warm blanket to the client.
D. Check the client’s vital signs and oxygen saturation.
Answer: D
Rationale: Cool, pale, and moist skin (diaphoresis) can be a sign of shock or cardiovascular
compromise; checking vital signs is the priority assessment to determine stability.
,3. A nurse is caring for a client with a history of seizures. Which of the following
safety precautions should the nurse implement?
A. Keep a padded tongue blade at the bedside.
B. Ensure suction equipment and oxygen are available at the bedside.
C. Place the bed in the highest position with all four side rails up.
D. Restrain the client’s limbs during a seizure activity.
Answer: B
Rationale: Standard seizure precautions include having suction and oxygen ready to
manage the airway post-seizure. Padded tongue blades are contraindicated as they can
cause injury.
4. Which of the following is the most accurate method for the nurse to verify
the identity of a client before medication administration?
A. Check the room number on the medication administration record (MAR).
B. Ask the client to state their name and date of birth.
C. Compare the client’s face with the photo in the medical record.
D. Ask a family member to confirm the client’s identity.
Answer: B
Rationale: Two unique identifiers (name and date of birth) provided by the client are the
standard for safe patient identification.
5. A nurse is performing an abdominal assessment. In which order should the
nurse perform the following physical examination techniques?
A. Inspection, Auscultation, Percussion, Palpation
B. Inspection, Palpation, Percussion, Auscultation
C. Auscultation, Inspection, Palpation, Percussion
D. Palpation, Percussion, Auscultation, Inspection
Answer: A
, Rationale: For the abdomen, auscultation is performed before percussion and palpation to
avoid altering bowel sounds.
6. A client is diagnosed with Clostridioides difficile (C. diff). Which of the
following infection control measures must the nurse implement?
A. Use soap and water for hand hygiene after leaving the room.
B. Perform hand hygiene with alcohol-based hand sanitizer only.
C. Wear an N95 respirator mask when entering the room.
D. Keep the room door closed at all times (Negative Pressure).
Answer: A
Rationale: Alcohol-based sanitizers do not kill C. diff spores; handwashing with soap and
water is mandatory for physical removal of spores.
7. During the assessment of a surgical wound, the nurse notes the presence of
thick, yellow-green drainage. How should this be documented?
A. Purulent drainage
B. Serous drainage
C. Serosanguineous drainage
D. Sanguineous drainage
Answer: A
Rationale: Purulent drainage is thick and indicates infection; it can be yellow, green, or
brown. Serous is clear, and sanguineous is bloody.
