Page |1
NU 136 EXAM 2ACTUAL EXAM [ QUESTION 1-
200] AND ANSWERS UPDATED 2026/2027| 100%
VERIFIED|DETAILED RATIONALES –PASS
GUARANTEED A+ GRADED |INSTANT
DOWNLOAD
Introduction: Welcome to the comprehensive practice examination for NU 136 Exam 2. This
meticulously designed question bank is engineered to evaluate and reinforce your mastery of
intermediate nursing concepts, clinical decision-making, and patient-centered care principles.
Covering critical topics such as advanced pharmacological interventions, fluid and electrolyte
balance, perioperative nursing care, and complex medical-surgical alterations, this resource
bridges the gap between theoretical knowledge and practical bedside application. Utilizing
rigorous, scenario-based questions built directly upon official curriculum objectives, this module
challenges you to prioritize interventions, analyze diagnostic data, and apply evidence-based
guidelines. Engaging with this material enhances your critical thinking, refines your clinical
judgment, and ensures you are thoroughly prepared to excel on your upcoming academic
assessments and safely manage complex patient populations in clinical practice.
Core Domains Covered:
1. Perioperative Nursing Care: Focuses on comprehensive patient assessment, safety
protocols, surgical asepsis, intraoperative monitoring, and post-anesthesia recovery
management.
2. Fluid, Electrolyte, and Acid-Base Imbalances: Addresses the physiological regulation of
body fluids, identification of electrolyte disturbances, interpretation of arterial blood gases,
and implementation of corrective therapy.
3. Advanced Pharmacological Principles: Evaluates safe medication administration,
pharmacokinetic monitoring, identification of adverse drug reactions, and management of
specialized drug therapies.
4. Respiratory Alterations and Oxygenation: Covers clinical assessment and management of
acute and chronic respiratory disorders, oxygen delivery systems, and pulmonary hygiene
techniques.
5. Cardiovascular and Hemodynamic Regulation: Examines the nursing management of
hypertension, heart failure, vascular disorders, and cardiac rhythm abnormalities.
6. Gastrointestinal and Nutritional Support: Focuses on enteral and parenteral nutrition,
management of gastrointestinal motility disorders, and post-procedural care.
7. Renal and Urinary Tract Function: Addresses acute and chronic renal disorders, urinary
diversion management, and diagnostic evaluation of kidney function.
Question 1: A 62-year-old patient is admitted to the medical-surgical unit for an elective bowel
resection. During the preoperative assessment, the patient expresses extreme anxiety regarding
the impending general anesthesia and surgical outcome. Which nursing intervention is most
appropriate at this time?
A) Administer the prescribed preoperative sedative immediately to reduce anxiety levels.
,Page |2
B) C) Encourage the patient to verbalize specific fears and provide concise, factual
information regarding the procedure.
C) Reassure the patient by stating that surgical complications are exceedingly rare.
D) Notify the surgeon immediately to postpone the procedure until the patient is completely
calm.
Rationale: Encouraging the patient to verbalize specific fears allows the nurse to identify the
root cause of anxiety and provide targeted, factual education that alleviates unfounded worries.
The correct answer is C because active listening and structured information reduce situational
anxiety effectively. Option A is incorrect because sedatives should not replace therapeutic
communication and patient education. Option B is incorrect because offering false reassurance
minimizes the patient's valid concerns and damages trust. Option D is incorrect because mild to
moderate preoperative anxiety is normal and does not necessitate postponing surgery unless the
patient is experiencing unmanageable panic.
Question 2: A nurse is caring for a postoperative patient on the first day following an open
cholecystectomy. Which finding requires immediate nursing intervention?
A) Mild serosanguineous drainage noted on the abdominal surgical dressing.
B) Reported pain score of four out of ten at the incision site when turning.
C) D) Urine output of fifteen milliliters per hour over the past two consecutive hours.
D) Auscultation of hypoactive bowel sounds in all four abdominal quadrants.
Rationale: Urine output less than thirty milliliters per hour indicates potential renal
hypoperfusion, hypovolemia, or urinary retention, requiring immediate evaluation. The correct
answer is D because adequate renal perfusion is a primary indicator of hemodynamic stability.
Option A is incorrect because mild serosanguineous drainage is expected postoperatively.
Option B is incorrect because a moderate pain score is manageable with prescribed analgesics.
Option C is incorrect because hypoactive bowel sounds are common immediately following
abdominal surgery due to temporary paralytic ileus.
Question 3: A patient is receiving a continuous intravenous infusion of regular insulin for severe
hyperglycemia. Laboratory results indicate a serum potassium level of three point two
milliequivalents per liter. What is the priority nursing action?
A) Continue the insulin infusion as ordered and recheck potassium levels in four hours.
B) C) Hold the insulin infusion, notify the healthcare provider, and prepare to administer
potassium replacement.
C) Administer oral sodium polystyrene sulfonate immediately to bind excess ions.
D) Increase the infusion rate of normal saline to flush excess glucose and electrolytes.
Rationale: Insulin drives potassium into cells, which can dangerously worsen hypokalemia,
potentially triggering lethal cardiac dysrhythmias. The correct answer is C because addressing
low potassium is critical before resuming insulin therapy. Option A is incorrect because
continuing insulin during hypokalemia places the patient at high risk for cardiac complications.
Option B is incorrect because sodium polystyrene sulfonate is used to treat hyperkalemia, not
hypokalemia. Option D is incorrect because increasing normal saline does not address the
urgent potassium deficit.
Question 4: A nurse is assessing an adult patient with a confirmed diagnosis of respiratory
alkalosis. Which clinical manifestation is most characteristic of this acid-base imbalance?
,Page |3
A) Kussmaul respirations and profound lethargy.
B) C) Lightheadedness, circumoral numbness, and paresthesias in the extremities.
C) Bradycardia, hypoventilation, and warm, flushed skin.
D) Diarrhea, abdominal cramping, and generalized muscle weakness.
Rationale: Respiratory alkalosis is caused by hyperventilation, leading to decreased carbon
dioxide levels and subsequent ionized hypocalcemia, which manifests as paresthesias and
lightheadedness. The correct answer is C because acute hypocapnia alters neuromuscular
excitability. Option A is characteristic of metabolic acidosis. Option B is characteristic of
respiratory acidosis. Option D is characteristic of metabolic alkalosis or gastrointestinal losses.
Question 5: A patient is prescribed digoxin zero point two five milligrams orally once daily for
heart failure. Prior to administering the medication, the nurse assesses an apical pulse rate of
fifty-two beats per minute. What is the appropriate nursing action?
A) Administer the medication as prescribed and document the pulse rate.
B) C) Withhold the dose, notify the healthcare provider, and monitor for signs of toxicity.
C) Administer half of the prescribed dose and recheck the heart rate in one hour.
D) Crush the tablet and mix it with applesauce to facilitate rapid absorption.
Rationale: Digoxin should be withheld if the adult apical pulse is less than sixty beats per minute
to prevent severe bradycardia and toxicity. The correct answer is C because safety protocols
dictate holding negative chronotropic agents during bradycardia. Option A is incorrect because
giving the drug during bradycardia violates safety standards. Option B is incorrect because
nurses cannot independently alter prescribed medication dosages. Option D is incorrect because
altering the administration form without verification is unsafe.
Question 6: A nurse is monitoring a patient receiving a blood transfusion of packed red blood
cells. Fifteen minutes after initiation, the patient develops a fever of thirty-nine degrees Celsius,
chills, lower back pain, and dark urine. Which type of transfusion reaction is occurring?
A) Allergic transfusion reaction.
B) C) Acute hemolytic transfusion reaction.
C) Transfusion-associated circulatory overload.
D) Febrile non-hemolytic transfusion reaction.
Rationale: Lower back pain, fever, chills, and hemoglobinuria are classic signs of an acute
hemolytic transfusion reaction resulting from ABO incompatibility. The correct answer is C
because red blood cell destruction triggers an antigen-antibody immune response affecting renal
tubules. Option A typically presents with urticaria and pruritus without back pain or dark urine.
Option B presents with respiratory distress, hypertension, and pulmonary edema. Option D
presents with fever and chills but lacks lower back pain and hemoglobinuria.
Question 7: A patient with chronic obstructive pulmonary disease is admitted with acute
hypercapnic respiratory failure. Which oxygen delivery device is most appropriate to ensure
precise and controlled fraction of inspired oxygen delivery?
A) Simple face mask at six liters per minute.
B) C) Venturi mask at set percentage levels.
C) Non-rebreather mask at fifteen liters per minute.
D) Nasal cannula at six liters per minute.
, Page |4
Rationale: A Venturi mask delivers a precise, controlled concentration of oxygen, making it
ideal for patients with chronic obstructive pulmonary disease who rely on hypoxic drive. The
correct answer is C because it prevents excessive oxygen delivery that could suppress
respiration. Option A and D deliver variable oxygen concentrations depending on patient
breathing patterns. Option B delivers very high oxygen concentrations, which risks suppressing
ventilation in chronic carbon dioxide retainers.
Question 8: A nurse is caring for a client diagnosed with acute pancreatitis. Which laboratory
abnormality is most diagnostic for this condition?
A) Decreased serum creatinine and blood urea nitrogen.
B) C) Elevated serum lipase and amylase levels.
C) Elevated white blood cell count with hypocalcemia.
D) Decreased serum albumin and total protein levels.
Rationale: Serum lipase and amylase are primary pancreatic enzymes that elevate significantly
during acute inflammation of the pancreas. The correct answer is C because elevated lipase is
highly specific and sensitive for acute pancreatitis. Option A reflects renal function rather than
pancreatic status. Option B indicates inflammation and potential fat necrosis but is not
singularly diagnostic. Option D reflects nutritional status.
Question 9: A patient is prescribed warfarin therapy following deep vein thrombosis. Which
laboratory test is essential for monitoring the therapeutic efficacy of this medication?
A) Activated partial thromboplastin time.
B) C) International normalized ratio.
C) Platelet count and bleeding time.
D) Hemoglobin and hematocrit levels.
Rationale: Warfarin is monitored using the international normalized ratio to ensure the
therapeutic range is maintained and to prevent bleeding or clotting complications. The correct
answer is C because international normalized ratio standardizes prothrombin time results across
laboratories. Option A is used to monitor unfractionated heparin therapy. Option B and D
evaluate clotting cell counts and oxygen-carrying capacity, respectively.
Question 10: A nurse is assessing a client with fluid volume excess secondary to chronic kidney
disease. Which clinical finding is most consistent with this diagnosis?
A) Flattened neck veins when lying flat.
B) C) Bounding peripheral pulses and peripheral edema.
C) Decreased central venous pressure readings.
D) Increased skin turgor and dry mucous membranes.
Rationale: Fluid volume excess leads to hypervolemia, characterized by bounding pulses,
dependent peripheral edema, elevated blood pressure, and jugular venous distention. The
correct answer is C because excess intravascular volume increases hydrostatic pressure. Option
A, B, and D are clinical indicators of fluid volume deficit or dehydration.
Question 11: A patient scheduled for an exploratory laparotomy signs the informed consent
form. Shortly afterward, the patient tells the nurse, "I do not understand what the surgeon is
going to do, and I am scared." What is the appropriate nursing action?
A) Explain the surgical procedure in detail and have the patient initial the consent form.
NU 136 EXAM 2ACTUAL EXAM [ QUESTION 1-
200] AND ANSWERS UPDATED 2026/2027| 100%
VERIFIED|DETAILED RATIONALES –PASS
GUARANTEED A+ GRADED |INSTANT
DOWNLOAD
Introduction: Welcome to the comprehensive practice examination for NU 136 Exam 2. This
meticulously designed question bank is engineered to evaluate and reinforce your mastery of
intermediate nursing concepts, clinical decision-making, and patient-centered care principles.
Covering critical topics such as advanced pharmacological interventions, fluid and electrolyte
balance, perioperative nursing care, and complex medical-surgical alterations, this resource
bridges the gap between theoretical knowledge and practical bedside application. Utilizing
rigorous, scenario-based questions built directly upon official curriculum objectives, this module
challenges you to prioritize interventions, analyze diagnostic data, and apply evidence-based
guidelines. Engaging with this material enhances your critical thinking, refines your clinical
judgment, and ensures you are thoroughly prepared to excel on your upcoming academic
assessments and safely manage complex patient populations in clinical practice.
Core Domains Covered:
1. Perioperative Nursing Care: Focuses on comprehensive patient assessment, safety
protocols, surgical asepsis, intraoperative monitoring, and post-anesthesia recovery
management.
2. Fluid, Electrolyte, and Acid-Base Imbalances: Addresses the physiological regulation of
body fluids, identification of electrolyte disturbances, interpretation of arterial blood gases,
and implementation of corrective therapy.
3. Advanced Pharmacological Principles: Evaluates safe medication administration,
pharmacokinetic monitoring, identification of adverse drug reactions, and management of
specialized drug therapies.
4. Respiratory Alterations and Oxygenation: Covers clinical assessment and management of
acute and chronic respiratory disorders, oxygen delivery systems, and pulmonary hygiene
techniques.
5. Cardiovascular and Hemodynamic Regulation: Examines the nursing management of
hypertension, heart failure, vascular disorders, and cardiac rhythm abnormalities.
6. Gastrointestinal and Nutritional Support: Focuses on enteral and parenteral nutrition,
management of gastrointestinal motility disorders, and post-procedural care.
7. Renal and Urinary Tract Function: Addresses acute and chronic renal disorders, urinary
diversion management, and diagnostic evaluation of kidney function.
Question 1: A 62-year-old patient is admitted to the medical-surgical unit for an elective bowel
resection. During the preoperative assessment, the patient expresses extreme anxiety regarding
the impending general anesthesia and surgical outcome. Which nursing intervention is most
appropriate at this time?
A) Administer the prescribed preoperative sedative immediately to reduce anxiety levels.
,Page |2
B) C) Encourage the patient to verbalize specific fears and provide concise, factual
information regarding the procedure.
C) Reassure the patient by stating that surgical complications are exceedingly rare.
D) Notify the surgeon immediately to postpone the procedure until the patient is completely
calm.
Rationale: Encouraging the patient to verbalize specific fears allows the nurse to identify the
root cause of anxiety and provide targeted, factual education that alleviates unfounded worries.
The correct answer is C because active listening and structured information reduce situational
anxiety effectively. Option A is incorrect because sedatives should not replace therapeutic
communication and patient education. Option B is incorrect because offering false reassurance
minimizes the patient's valid concerns and damages trust. Option D is incorrect because mild to
moderate preoperative anxiety is normal and does not necessitate postponing surgery unless the
patient is experiencing unmanageable panic.
Question 2: A nurse is caring for a postoperative patient on the first day following an open
cholecystectomy. Which finding requires immediate nursing intervention?
A) Mild serosanguineous drainage noted on the abdominal surgical dressing.
B) Reported pain score of four out of ten at the incision site when turning.
C) D) Urine output of fifteen milliliters per hour over the past two consecutive hours.
D) Auscultation of hypoactive bowel sounds in all four abdominal quadrants.
Rationale: Urine output less than thirty milliliters per hour indicates potential renal
hypoperfusion, hypovolemia, or urinary retention, requiring immediate evaluation. The correct
answer is D because adequate renal perfusion is a primary indicator of hemodynamic stability.
Option A is incorrect because mild serosanguineous drainage is expected postoperatively.
Option B is incorrect because a moderate pain score is manageable with prescribed analgesics.
Option C is incorrect because hypoactive bowel sounds are common immediately following
abdominal surgery due to temporary paralytic ileus.
Question 3: A patient is receiving a continuous intravenous infusion of regular insulin for severe
hyperglycemia. Laboratory results indicate a serum potassium level of three point two
milliequivalents per liter. What is the priority nursing action?
A) Continue the insulin infusion as ordered and recheck potassium levels in four hours.
B) C) Hold the insulin infusion, notify the healthcare provider, and prepare to administer
potassium replacement.
C) Administer oral sodium polystyrene sulfonate immediately to bind excess ions.
D) Increase the infusion rate of normal saline to flush excess glucose and electrolytes.
Rationale: Insulin drives potassium into cells, which can dangerously worsen hypokalemia,
potentially triggering lethal cardiac dysrhythmias. The correct answer is C because addressing
low potassium is critical before resuming insulin therapy. Option A is incorrect because
continuing insulin during hypokalemia places the patient at high risk for cardiac complications.
Option B is incorrect because sodium polystyrene sulfonate is used to treat hyperkalemia, not
hypokalemia. Option D is incorrect because increasing normal saline does not address the
urgent potassium deficit.
Question 4: A nurse is assessing an adult patient with a confirmed diagnosis of respiratory
alkalosis. Which clinical manifestation is most characteristic of this acid-base imbalance?
,Page |3
A) Kussmaul respirations and profound lethargy.
B) C) Lightheadedness, circumoral numbness, and paresthesias in the extremities.
C) Bradycardia, hypoventilation, and warm, flushed skin.
D) Diarrhea, abdominal cramping, and generalized muscle weakness.
Rationale: Respiratory alkalosis is caused by hyperventilation, leading to decreased carbon
dioxide levels and subsequent ionized hypocalcemia, which manifests as paresthesias and
lightheadedness. The correct answer is C because acute hypocapnia alters neuromuscular
excitability. Option A is characteristic of metabolic acidosis. Option B is characteristic of
respiratory acidosis. Option D is characteristic of metabolic alkalosis or gastrointestinal losses.
Question 5: A patient is prescribed digoxin zero point two five milligrams orally once daily for
heart failure. Prior to administering the medication, the nurse assesses an apical pulse rate of
fifty-two beats per minute. What is the appropriate nursing action?
A) Administer the medication as prescribed and document the pulse rate.
B) C) Withhold the dose, notify the healthcare provider, and monitor for signs of toxicity.
C) Administer half of the prescribed dose and recheck the heart rate in one hour.
D) Crush the tablet and mix it with applesauce to facilitate rapid absorption.
Rationale: Digoxin should be withheld if the adult apical pulse is less than sixty beats per minute
to prevent severe bradycardia and toxicity. The correct answer is C because safety protocols
dictate holding negative chronotropic agents during bradycardia. Option A is incorrect because
giving the drug during bradycardia violates safety standards. Option B is incorrect because
nurses cannot independently alter prescribed medication dosages. Option D is incorrect because
altering the administration form without verification is unsafe.
Question 6: A nurse is monitoring a patient receiving a blood transfusion of packed red blood
cells. Fifteen minutes after initiation, the patient develops a fever of thirty-nine degrees Celsius,
chills, lower back pain, and dark urine. Which type of transfusion reaction is occurring?
A) Allergic transfusion reaction.
B) C) Acute hemolytic transfusion reaction.
C) Transfusion-associated circulatory overload.
D) Febrile non-hemolytic transfusion reaction.
Rationale: Lower back pain, fever, chills, and hemoglobinuria are classic signs of an acute
hemolytic transfusion reaction resulting from ABO incompatibility. The correct answer is C
because red blood cell destruction triggers an antigen-antibody immune response affecting renal
tubules. Option A typically presents with urticaria and pruritus without back pain or dark urine.
Option B presents with respiratory distress, hypertension, and pulmonary edema. Option D
presents with fever and chills but lacks lower back pain and hemoglobinuria.
Question 7: A patient with chronic obstructive pulmonary disease is admitted with acute
hypercapnic respiratory failure. Which oxygen delivery device is most appropriate to ensure
precise and controlled fraction of inspired oxygen delivery?
A) Simple face mask at six liters per minute.
B) C) Venturi mask at set percentage levels.
C) Non-rebreather mask at fifteen liters per minute.
D) Nasal cannula at six liters per minute.
, Page |4
Rationale: A Venturi mask delivers a precise, controlled concentration of oxygen, making it
ideal for patients with chronic obstructive pulmonary disease who rely on hypoxic drive. The
correct answer is C because it prevents excessive oxygen delivery that could suppress
respiration. Option A and D deliver variable oxygen concentrations depending on patient
breathing patterns. Option B delivers very high oxygen concentrations, which risks suppressing
ventilation in chronic carbon dioxide retainers.
Question 8: A nurse is caring for a client diagnosed with acute pancreatitis. Which laboratory
abnormality is most diagnostic for this condition?
A) Decreased serum creatinine and blood urea nitrogen.
B) C) Elevated serum lipase and amylase levels.
C) Elevated white blood cell count with hypocalcemia.
D) Decreased serum albumin and total protein levels.
Rationale: Serum lipase and amylase are primary pancreatic enzymes that elevate significantly
during acute inflammation of the pancreas. The correct answer is C because elevated lipase is
highly specific and sensitive for acute pancreatitis. Option A reflects renal function rather than
pancreatic status. Option B indicates inflammation and potential fat necrosis but is not
singularly diagnostic. Option D reflects nutritional status.
Question 9: A patient is prescribed warfarin therapy following deep vein thrombosis. Which
laboratory test is essential for monitoring the therapeutic efficacy of this medication?
A) Activated partial thromboplastin time.
B) C) International normalized ratio.
C) Platelet count and bleeding time.
D) Hemoglobin and hematocrit levels.
Rationale: Warfarin is monitored using the international normalized ratio to ensure the
therapeutic range is maintained and to prevent bleeding or clotting complications. The correct
answer is C because international normalized ratio standardizes prothrombin time results across
laboratories. Option A is used to monitor unfractionated heparin therapy. Option B and D
evaluate clotting cell counts and oxygen-carrying capacity, respectively.
Question 10: A nurse is assessing a client with fluid volume excess secondary to chronic kidney
disease. Which clinical finding is most consistent with this diagnosis?
A) Flattened neck veins when lying flat.
B) C) Bounding peripheral pulses and peripheral edema.
C) Decreased central venous pressure readings.
D) Increased skin turgor and dry mucous membranes.
Rationale: Fluid volume excess leads to hypervolemia, characterized by bounding pulses,
dependent peripheral edema, elevated blood pressure, and jugular venous distention. The
correct answer is C because excess intravascular volume increases hydrostatic pressure. Option
A, B, and D are clinical indicators of fluid volume deficit or dehydration.
Question 11: A patient scheduled for an exploratory laparotomy signs the informed consent
form. Shortly afterward, the patient tells the nurse, "I do not understand what the surgeon is
going to do, and I am scared." What is the appropriate nursing action?
A) Explain the surgical procedure in detail and have the patient initial the consent form.
