, NU 136: Fundamentals of Nursing
Midterm Exam Questions and Answers
with Rationale 2026/2027 Update
Question 1
A nurse is reviewing the five steps of the nursing process.
Which phase involves analyzing client data to identify actual or
potential health problems, risks, and nursing diagnoses?
A. Assessment
B. Nursing diagnosis
C. Planning
D. Evaluation
Correct Answer: B. Nursing diagnosis
Expert Rationale: The nursing diagnosis phase involves
analyzing and synthesizing assessment data to identify specific
health problems, clinical judgments, and human responses to
health conditions or life processes, which guide the selection of
nursing interventions.
Question 2
A nurse is measuring a client oral body temperature using an
electronic thermometer. Which factor can cause a falsely low
temperature reading?
A. Recent ingestion of a hot cup of coffee
, B. Active chewing of gum right before measurement
C. Improper placement of the probe posterior to the
sublingual pocket or mouth breathing by the client
D. Presence of acute systemic infection and chills
Correct Answer: C. Improper placement of the probe
posterior to the sublingual pocket or mouth breathing by the
client
Expert Rationale: Oral temperature measurements depend on
proper placement deep in the sublingual pocket with the mouth
closed. Mouth breathing or loose probe placement allows cool
ambient air to lower the reading, resulting in a falsely low
temperature.
Question 3
A nurse is assessing an adult client radial pulse and notes that
the rate is 110 beats per minute. How should the nurse document
this finding?
A. Bradycardia
B. Eupnea
C. Tachycardia
D. Asystole
Correct Answer: C. Tachycardia
Expert Rationale: Tachycardia is defined as a resting heart rate
above 100 beats per minute in an adult client. Bradycardia refers
, to a slow heart rate below 60 beats per minute, while eupnea
describes normal breathing.
Question 4
A nurse is preparing to perform a sterile wound dressing change.
Which action contaminates the sterile field?
A. Opening sterile packages away from the body first
B. Reaching across the established sterile field to adjust
equipment
C. Keeping all sterile items above waist level
D. Opening the outermost flap of a sterile wrap away from the
body
Correct Answer: B. Reaching across the established sterile
field to adjust equipment
Expert Rationale: Reaching across a sterile field is a violation
of sterile technique because unsterile clothing or arms pass over
the sterile area, risking contamination from invisible
microorganisms or shedding skin particles.
Question 5
A nurse is planning care for a client admitted with a diagnosis of
bacterial pneumonia. Which transmission-based precaution must
the nurse implement?
A. Airborne precautions using an N95 respirator mask
Midterm Exam Questions and Answers
with Rationale 2026/2027 Update
Question 1
A nurse is reviewing the five steps of the nursing process.
Which phase involves analyzing client data to identify actual or
potential health problems, risks, and nursing diagnoses?
A. Assessment
B. Nursing diagnosis
C. Planning
D. Evaluation
Correct Answer: B. Nursing diagnosis
Expert Rationale: The nursing diagnosis phase involves
analyzing and synthesizing assessment data to identify specific
health problems, clinical judgments, and human responses to
health conditions or life processes, which guide the selection of
nursing interventions.
Question 2
A nurse is measuring a client oral body temperature using an
electronic thermometer. Which factor can cause a falsely low
temperature reading?
A. Recent ingestion of a hot cup of coffee
, B. Active chewing of gum right before measurement
C. Improper placement of the probe posterior to the
sublingual pocket or mouth breathing by the client
D. Presence of acute systemic infection and chills
Correct Answer: C. Improper placement of the probe
posterior to the sublingual pocket or mouth breathing by the
client
Expert Rationale: Oral temperature measurements depend on
proper placement deep in the sublingual pocket with the mouth
closed. Mouth breathing or loose probe placement allows cool
ambient air to lower the reading, resulting in a falsely low
temperature.
Question 3
A nurse is assessing an adult client radial pulse and notes that
the rate is 110 beats per minute. How should the nurse document
this finding?
A. Bradycardia
B. Eupnea
C. Tachycardia
D. Asystole
Correct Answer: C. Tachycardia
Expert Rationale: Tachycardia is defined as a resting heart rate
above 100 beats per minute in an adult client. Bradycardia refers
, to a slow heart rate below 60 beats per minute, while eupnea
describes normal breathing.
Question 4
A nurse is preparing to perform a sterile wound dressing change.
Which action contaminates the sterile field?
A. Opening sterile packages away from the body first
B. Reaching across the established sterile field to adjust
equipment
C. Keeping all sterile items above waist level
D. Opening the outermost flap of a sterile wrap away from the
body
Correct Answer: B. Reaching across the established sterile
field to adjust equipment
Expert Rationale: Reaching across a sterile field is a violation
of sterile technique because unsterile clothing or arms pass over
the sterile area, risking contamination from invisible
microorganisms or shedding skin particles.
Question 5
A nurse is planning care for a client admitted with a diagnosis of
bacterial pneumonia. Which transmission-based precaution must
the nurse implement?
A. Airborne precautions using an N95 respirator mask
