NUR109 Midterm Exam: Foundations of
Nursing Practice Questions And Well
Graded Solutions With Rationales
Updated 2026-2027
Master your NUR109 Midterm with this complete study set. Features 100+ highly relevant, NCLEX-style
multiple-choice questions with verified answers highlighted in bold italics and deep diagnostic
rationales. Covers clinical nursing fundamentals, safety protocols, abdominal assessments, patient
isolation tiers, fluid balances, and legal ethical frameworks. Perfect for active recall, tracking
knowledge gaps, and scoring an A+ on your foundations exam. Fully updated for the current
curriculum.
1. A nurse is preparing to administer an oral medication to a client. Which action is the
most reliable method for the nurse to verify the client’s identity?
A) Asking the client to state their name and date of birth
B) Checking the room number and bed assignment on the MAR
C) Asking a family member at the bedside to confirm the name
D) Checking the client's name on the chart against the medication label
Answer: A) Asking the client to state their name and date of birth
Rationale: The Joint Commission requires at least two unique client identifiers prior
to administering care, medication, or treatments. Asking the client to verbally state
their full name and date of birth, and comparing it to their identification band,
provides the most reliable verification. Room numbers and bed assignments are
temporary and subject to change, increasing the risk of medication errors.
2. A client diagnosed with acute deep vein thrombosis (DVT) is prescribed
heparin therapy. Which laboratory value must the nurse monitor closely to evaluate
the therapeutic effect of this medication?
A) Prothrombin time (PT)
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Platelet count
Answer: B) Activated partial thromboplastin time (aPTT)
Rationale: Activated partial thromboplastin time (aPTT) is used to monitor the
therapeutic effect of unfractionated heparin. Prothrombin time (PT) and International
normalized ratio (INR) are utilized to evaluate the efficacy of warfarin therapy. While
platelet counts are monitored during heparin therapy to screen for heparin-induced
thrombocytopenia (HIT), they do not measure heparin's anticoagulant efficacy.
,3. While performing an assessment on an older adult client, the nurse notes a
localized, unstageable pressure injury on the sacrum. What characteristic makes this
pressure injury unstageable?
A) The presence of deep tract tunneling into the muscle layer
B) Slough or eschar completely obscuring the true depth of the wound bed
C) Exposed bone, tendon, or muscle tissue within the wound center
D) Persistent, non-blanchable erythema of intact skin
Answer: B) Slough or eschar completely obscuring the true depth of the
wound bed
Rationale: An unstageable pressure injury occurs when the true anatomic depth of
tissue damage cannot be confirmed because the wound bed is obscured by slough
(yellow, tan, gray, green, or brown) or eschar (tan, brown, or black). Stage 4 injuries
involve exposed bone or muscle. Non-blanchable erythema of intact skin defines a
Stage 1 pressure injury.
4. A nurse is caring for a client who is recovering from abdominal surgery and is
reluctant to ambulate due to pain. Which rationale explains why early postoperative
ambulation is vital to prioritize?
A) It decreases the metabolic demand for oxygen during recovery
B) It minimizes the risk of atelectasis and deep vein thrombosis
C) It prevents the development of localized surgical site infections
D) It decreases the need for patient-controlled analgesia (PCA) use
Answer: B) It minimizes the risk of atelectasis and deep vein thrombosis
Rationale: Postoperative immobility significantly elevates the risk of venous stasis,
leading to deep vein thrombosis (DVT), and causes shallow breathing, which leads
to atelectasis. Early ambulation promotes lung expansion and venous return. While it
improves overall recovery, it increases temporary metabolic oxygen demands and
does not directly target surgical site skin infections.
5. A client is admitted with a severe fluid volume deficit. Which clinical
assessment finding should the nurse expect to observe?
A) Bounding peripheral pulses and a high blood pressure
B) Decreased heart rate and clear lung sounds upon auscultation
C) Orthostatic hypotension and tenting skin turgor
D) Jugular venous distention when sitting upright at 45 degrees
Answer: C) Orthostatic hypotension and tenting skin turgor
Rationale: Fluid volume deficit results in intravascular and interstitial dehydration.
Signs include orthostatic hypotension, a weak and thready pulse, delayed capillary
refill, and poor skin turgor (tenting). Bounding pulses, elevated blood pressure, and
jugular venous distention indicate fluid volume excess.
,6. A nurse is preparing to insert an indwelling urinary catheter for a female client.
Which step must the nurse perform first to maintain strict surgical asepsis?
A) Cleanse the perineal area from the back to the front using antiseptic wipes
B) Open the sterile catheter kit using the outermost flap away from the body
C) Apply sterile gloves before opening any outer packaging of the kit
D) Lubricate the catheter tip with water-soluble gel prior to cleansing the labia
Answer: B) Open the sterile catheter kit using the outermost flap away from
the body
Rationale: When opening a sterile field or kit, the nurse must open the outermost flap
away from the body first to prevent reaching over the sterile field later, which would
contaminate it. Perineal cleansing must be done front-to-back to prevent introducing
rectal bacteria into the urethra. Sterile gloves are only donned after the outer
unsterile packaging of the kit is opened.
7. A nurse assesses a client who is receiving intravenous fluids and notes
edema, coolness to the touch, and pallor around the insertion site. How should the
nurse document this complication?
A) Phlebitis
B) Infiltration
C) Infection
D) Thrombosis
Answer: B) Infiltration
Rationale: Infiltration occurs when non-vesicant IV fluid leaks into the surrounding
subcutaneous tissue. Classic signs include localized edema, coolness, blanching
(pallor), and discomfort. Phlebitis is inflammation of the vein characterized by heat,
redness, tenderness, and a palpable cord. Infection presents with warmth, erythema,
and purulent drainage.
8. Which standard precaution action should a nurse take when disposing of a
used syringe and needle after administering an intramuscular injection?
A) Recap the needle using a two-handed technique before disposal
B) Disconnect the needle from the syringe barrel prior to discarding
C) Drop the entire intact syringe and needle assembly into a sharps container
D) Place the uncapped needle directly into a trash can if a sharps bin is full
Answer: C) Drop the entire intact syringe and needle assembly into a sharps
container
Rationale: To prevent accidental needlestick injuries, needles should never be
recapped using two hands, broken, or uncoupled from the syringe by hand. The
entire intact needle and syringe system must be deposited immediately into a
puncture-resistant sharps container located at the point of use.
, 9. A client is placed on transmission-based Airborne Precautions. Which piece of
personal protective equipment (PPE) must the nurse don before entering the client’s
room?
A) A standard fluid-resistant surgical mask
B) A fitted N95 or higher particulate respirator mask
C) A sterile gown and protective face shield
D) Clean examination gloves only
Answer: B) A fitted N95 or higher particulate respirator mask
Rationale: Airborne precautions are used for pathogens that remain suspended in
the air for long periods (e.g., tuberculosis, varicella, measles). Healthcare workers
must wear a fit-tested N95 or PAPR respirator mask to filter these small particles.
Surgical masks are used for Droplet precautions, which involve larger respiratory
droplets.
10. A nurse is planning care for an immobile bedbound client. Which intervention
should the nurse include to prevent the development of plantar flexion contractures
(foot drop)?
A) Keep the client's knees slightly flexed using pillows
B) Apply a trochanter roll against the lateral aspect of the hips
C) Support the client's feet in dorsiflexion using specialized foot boots
D) Place a soft pillow directly under the client's Achilles tendons
Answer: C) Support the client's feet in dorsiflexion using specialized foot
boots
Rationale: Foot drop occurs when the foot remains in an extended plantar flexion
position for long periods, causing permanent shortening of the tendons. Utilizing foot
boots, high-top sneakers, or footboards maintains the ankle in a neutral 90-degree
dorsiflexion position. Trochanter rolls prevent external rotation of the hips.
11. A nurse is evaluating a client's understanding of a low-sodium diet prescribed
for hypertension management. Which food choice indicates that the client
understands the diet?
A) Canned tomato soup with saltine crackers
B) Fresh grilled chicken breast with steamed broccoli
C) Smoked deli turkey breast and swiss cheese sandwich
D) Pickled vegetables with a side of potato chips
Answer: B) Fresh grilled chicken breast with steamed broccoli
Rationale: Fresh, unprocessed meats and fresh vegetables are naturally very low in
sodium. Canned soups, processed deli meats, crackers, pickles, and potato chips
are loaded with high levels of added sodium used for preservation and flavoring,
which worsens fluid retention and blood pressure.
Nursing Practice Questions And Well
Graded Solutions With Rationales
Updated 2026-2027
Master your NUR109 Midterm with this complete study set. Features 100+ highly relevant, NCLEX-style
multiple-choice questions with verified answers highlighted in bold italics and deep diagnostic
rationales. Covers clinical nursing fundamentals, safety protocols, abdominal assessments, patient
isolation tiers, fluid balances, and legal ethical frameworks. Perfect for active recall, tracking
knowledge gaps, and scoring an A+ on your foundations exam. Fully updated for the current
curriculum.
1. A nurse is preparing to administer an oral medication to a client. Which action is the
most reliable method for the nurse to verify the client’s identity?
A) Asking the client to state their name and date of birth
B) Checking the room number and bed assignment on the MAR
C) Asking a family member at the bedside to confirm the name
D) Checking the client's name on the chart against the medication label
Answer: A) Asking the client to state their name and date of birth
Rationale: The Joint Commission requires at least two unique client identifiers prior
to administering care, medication, or treatments. Asking the client to verbally state
their full name and date of birth, and comparing it to their identification band,
provides the most reliable verification. Room numbers and bed assignments are
temporary and subject to change, increasing the risk of medication errors.
2. A client diagnosed with acute deep vein thrombosis (DVT) is prescribed
heparin therapy. Which laboratory value must the nurse monitor closely to evaluate
the therapeutic effect of this medication?
A) Prothrombin time (PT)
B) Activated partial thromboplastin time (aPTT)
C) International normalized ratio (INR)
D) Platelet count
Answer: B) Activated partial thromboplastin time (aPTT)
Rationale: Activated partial thromboplastin time (aPTT) is used to monitor the
therapeutic effect of unfractionated heparin. Prothrombin time (PT) and International
normalized ratio (INR) are utilized to evaluate the efficacy of warfarin therapy. While
platelet counts are monitored during heparin therapy to screen for heparin-induced
thrombocytopenia (HIT), they do not measure heparin's anticoagulant efficacy.
,3. While performing an assessment on an older adult client, the nurse notes a
localized, unstageable pressure injury on the sacrum. What characteristic makes this
pressure injury unstageable?
A) The presence of deep tract tunneling into the muscle layer
B) Slough or eschar completely obscuring the true depth of the wound bed
C) Exposed bone, tendon, or muscle tissue within the wound center
D) Persistent, non-blanchable erythema of intact skin
Answer: B) Slough or eschar completely obscuring the true depth of the
wound bed
Rationale: An unstageable pressure injury occurs when the true anatomic depth of
tissue damage cannot be confirmed because the wound bed is obscured by slough
(yellow, tan, gray, green, or brown) or eschar (tan, brown, or black). Stage 4 injuries
involve exposed bone or muscle. Non-blanchable erythema of intact skin defines a
Stage 1 pressure injury.
4. A nurse is caring for a client who is recovering from abdominal surgery and is
reluctant to ambulate due to pain. Which rationale explains why early postoperative
ambulation is vital to prioritize?
A) It decreases the metabolic demand for oxygen during recovery
B) It minimizes the risk of atelectasis and deep vein thrombosis
C) It prevents the development of localized surgical site infections
D) It decreases the need for patient-controlled analgesia (PCA) use
Answer: B) It minimizes the risk of atelectasis and deep vein thrombosis
Rationale: Postoperative immobility significantly elevates the risk of venous stasis,
leading to deep vein thrombosis (DVT), and causes shallow breathing, which leads
to atelectasis. Early ambulation promotes lung expansion and venous return. While it
improves overall recovery, it increases temporary metabolic oxygen demands and
does not directly target surgical site skin infections.
5. A client is admitted with a severe fluid volume deficit. Which clinical
assessment finding should the nurse expect to observe?
A) Bounding peripheral pulses and a high blood pressure
B) Decreased heart rate and clear lung sounds upon auscultation
C) Orthostatic hypotension and tenting skin turgor
D) Jugular venous distention when sitting upright at 45 degrees
Answer: C) Orthostatic hypotension and tenting skin turgor
Rationale: Fluid volume deficit results in intravascular and interstitial dehydration.
Signs include orthostatic hypotension, a weak and thready pulse, delayed capillary
refill, and poor skin turgor (tenting). Bounding pulses, elevated blood pressure, and
jugular venous distention indicate fluid volume excess.
,6. A nurse is preparing to insert an indwelling urinary catheter for a female client.
Which step must the nurse perform first to maintain strict surgical asepsis?
A) Cleanse the perineal area from the back to the front using antiseptic wipes
B) Open the sterile catheter kit using the outermost flap away from the body
C) Apply sterile gloves before opening any outer packaging of the kit
D) Lubricate the catheter tip with water-soluble gel prior to cleansing the labia
Answer: B) Open the sterile catheter kit using the outermost flap away from
the body
Rationale: When opening a sterile field or kit, the nurse must open the outermost flap
away from the body first to prevent reaching over the sterile field later, which would
contaminate it. Perineal cleansing must be done front-to-back to prevent introducing
rectal bacteria into the urethra. Sterile gloves are only donned after the outer
unsterile packaging of the kit is opened.
7. A nurse assesses a client who is receiving intravenous fluids and notes
edema, coolness to the touch, and pallor around the insertion site. How should the
nurse document this complication?
A) Phlebitis
B) Infiltration
C) Infection
D) Thrombosis
Answer: B) Infiltration
Rationale: Infiltration occurs when non-vesicant IV fluid leaks into the surrounding
subcutaneous tissue. Classic signs include localized edema, coolness, blanching
(pallor), and discomfort. Phlebitis is inflammation of the vein characterized by heat,
redness, tenderness, and a palpable cord. Infection presents with warmth, erythema,
and purulent drainage.
8. Which standard precaution action should a nurse take when disposing of a
used syringe and needle after administering an intramuscular injection?
A) Recap the needle using a two-handed technique before disposal
B) Disconnect the needle from the syringe barrel prior to discarding
C) Drop the entire intact syringe and needle assembly into a sharps container
D) Place the uncapped needle directly into a trash can if a sharps bin is full
Answer: C) Drop the entire intact syringe and needle assembly into a sharps
container
Rationale: To prevent accidental needlestick injuries, needles should never be
recapped using two hands, broken, or uncoupled from the syringe by hand. The
entire intact needle and syringe system must be deposited immediately into a
puncture-resistant sharps container located at the point of use.
, 9. A client is placed on transmission-based Airborne Precautions. Which piece of
personal protective equipment (PPE) must the nurse don before entering the client’s
room?
A) A standard fluid-resistant surgical mask
B) A fitted N95 or higher particulate respirator mask
C) A sterile gown and protective face shield
D) Clean examination gloves only
Answer: B) A fitted N95 or higher particulate respirator mask
Rationale: Airborne precautions are used for pathogens that remain suspended in
the air for long periods (e.g., tuberculosis, varicella, measles). Healthcare workers
must wear a fit-tested N95 or PAPR respirator mask to filter these small particles.
Surgical masks are used for Droplet precautions, which involve larger respiratory
droplets.
10. A nurse is planning care for an immobile bedbound client. Which intervention
should the nurse include to prevent the development of plantar flexion contractures
(foot drop)?
A) Keep the client's knees slightly flexed using pillows
B) Apply a trochanter roll against the lateral aspect of the hips
C) Support the client's feet in dorsiflexion using specialized foot boots
D) Place a soft pillow directly under the client's Achilles tendons
Answer: C) Support the client's feet in dorsiflexion using specialized foot
boots
Rationale: Foot drop occurs when the foot remains in an extended plantar flexion
position for long periods, causing permanent shortening of the tendons. Utilizing foot
boots, high-top sneakers, or footboards maintains the ankle in a neutral 90-degree
dorsiflexion position. Trochanter rolls prevent external rotation of the hips.
11. A nurse is evaluating a client's understanding of a low-sodium diet prescribed
for hypertension management. Which food choice indicates that the client
understands the diet?
A) Canned tomato soup with saltine crackers
B) Fresh grilled chicken breast with steamed broccoli
C) Smoked deli turkey breast and swiss cheese sandwich
D) Pickled vegetables with a side of potato chips
Answer: B) Fresh grilled chicken breast with steamed broccoli
Rationale: Fresh, unprocessed meats and fresh vegetables are naturally very low in
sodium. Canned soups, processed deli meats, crackers, pickles, and potato chips
are loaded with high levels of added sodium used for preservation and flavoring,
which worsens fluid retention and blood pressure.
