Page |1
NU 136 EXAM 2 VERSION 1 ACTUAL 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 material for NU 136 Exam 2 Version 1. This
meticulously crafted question set is designed to test and reinforce your clinical knowledge,
critical thinking skills, and theoretical understanding across foundational nursing concepts. This
practice set covers essential topics including advanced med-surgical nursing interventions,
pharmacology, fluid and electrolyte balance, perioperative care, and complex pathophysiology
aligned directly with current curriculum objectives. Achieving mastery in these areas is crucial
for nursing candidates, as it bridges the gap between classroom theory and safe, evidence-based
bedside practice. By working through these original, scenario-based questions and detailed
rationales, you will develop the analytical skills necessary to prioritize patient care effectively,
recognize subtle clinical changes, and make sound clinical judgments. This resource is
structured to build your confidence, identify knowledge gaps, and ensure you are thoroughly
prepared to excel on your upcoming examination and secure an A+ grade.
Core Domains Covered:
1. Perioperative Nursing Care: Focuses on pre-operative assessment, intraoperative safety
measures, and post-anesthesia recovery monitoring.
2. Fluid, Electrolyte, and Acid-Base Balance: Covers imbalances, compensatory mechanisms,
arterial blood gas interpretation, and IV therapy management.
3. Cardiovascular and Hemodynamic Alterations: Explores hypertension, heart failure,
dysrhythmias, and peripheral vascular disorders.
4. Respiratory Pathophysiology and Management: Addresses obstructive and restrictive
pulmonary diseases, oxygen delivery systems, and chest tube care.
5. Gastrointestinal and Metabolic Disorders: Examines acute and chronic GI conditions,
nutritional support, and endocrine regulation.
6. Renal and Urinary Tract Function: Focuses on acute kidney injury, chronic kidney disease,
dialysis, and urinary elimination disorders.
7. Pharmacological Principles and Safe Administration: Evaluates drug calculations, adverse
effects, contraindications, and therapeutic monitoring.
Question 1: A 45-year-old male is admitted to the medical-surgical unit following an exploratory
laparoscopy. Which postoperative finding requires immediate nursing intervention?
A) Mild drowsiness and disorientation to time
B) Urine output of forty milliliters over the past two hours
C) Surgical dressing with a moderate amount of serosanguinous drainage
D) Respiratory rate of ten breaths per minute and oxygen saturation of eighty-eight percent on
room air
,Page |2
Rationale: A respiratory rate of ten breaths per minute and an oxygen saturation of eighty-eight
percent indicate respiratory depression, likely secondary to residual anesthesia or opioid
analgesics. This is a life-threatening complication that requires immediate airway management
and intervention. Option A is expected post-anesthesia drowsiness. Option B reflects critically
low urine output, but airway takes absolute priority. Option C is a normal expected finding for
early postoperative drainage.
Question 2: A nurse is evaluating a patient receiving a continuous infusion of normal saline at
one hundred twenty-five milliliters per hour. Which assessment finding indicates fluid volume
overload?
A) Flat neck veins when lying flat
B) Bounding peripheral pulses and crackles in lung bases
C) Serum sodium level of one hundred forty milliequivalents per liter
D) Poor skin turgor and dry mucous membranes
Rationale: Bounding pulses and crackles in the lung bases are hallmark signs of hypervolemia
due to excess fluid volume accumulating in the vascular space and alveoli. Option A indicates
fluid deficit. Option C is within normal limits. Option D indicates hypovolemia or dehydration,
the exact opposite of fluid overload.
Question 3: A patient with chronic renal failure has a serum potassium level of six point five
milliequivalents per liter. Which medication should the nurse anticipate administering first to
protect the myocardium?
A) Regular insulin with fifty percent dextrose intravenously
B) Sodium polystyrene sulfonate orally
C) Calcium gluconate intravenously
D) Furosemide intravenously
Rationale: Intravenous calcium gluconate does not lower serum potassium, but it immediately
stabilizes the cardiac cell membrane against the arrhythmogenic effects of severe hyperkalemia.
Therefore, it is given first. Options A, B, and D actually work to shift or remove potassium from
the body, but calcium provides immediate cardiac protection.
Question 4: A nurse is caring for a patient experiencing an acute panic attack who is breathing
rapidly at thirty-two breaths per minute. Which arterial blood gas result is expected?
A) pH seven point three zero, carbon dioxide forty-eight
B) pH seven point five zero, carbon dioxide twenty-eight
C) pH seven point three two, bicarbonate twenty-two
D) pH seven point four eight, bicarbonate thirty-two
Rationale: Rapid breathing causes hyperventilation, blowing off carbon dioxide and leading to
respiratory alkalosis characterized by an elevated pH and decreased carbon dioxide. Option A
indicates respiratory acidosis. Option C indicates metabolic acidosis. Option D indicates
metabolic alkalosis.
Question 5: A patient is prescribed digoxin for heart failure. Which assessment finding should
prompt the nurse to hold the medication and notify the healthcare provider?
A) Apical pulse rate of fifty-two beats per minute
B) Blood pressure of one hundred ten over seventy millimeters of mercury
,Page |3
C) Serum potassium level of four point zero milliequivalents per liter
D) Mild fatigue and generalized weakness
Rationale: Digoxin slows the heart rate. If the apical pulse drops below sixty beats per minute in
an adult, the nurse must hold the dose and notify the provider to prevent severe bradycardia or
toxicity. Option B is within normal limits. Option C is normal. Option D can be associated with
heart failure itself, but heart rate is the direct safety trigger for digoxin administration.
Question 6: A patient is scheduled for an abdominal surgery and is signing the informed consent
form. The patient states, "I still do not understand what an exploratory laparotomy actually
involves." What is the best initial nursing action?
A) Explain the surgical procedure in detail to the patient
B) Proceed with witnessing the signature since the form is already filled out
C) Notify the surgeon that the patient requires further clarification before signing
D) Document that the patient refused surgery
Rationale: Obtaining informed consent regarding the surgical procedure is the legal and ethical
responsibility of the physician. The nurse acts as a witness to the signature, not the explainer of
the procedure. If the patient lacks understanding, the nurse must notify the surgeon. Option A is
outside the nurse's scope for obtaining primary consent. Options B and D are inappropriate and
violate patient rights.
Question 7: A nurse is caring for a client with a nasogastric tube to low intermittent suction.
Which electrolyte imbalance is this client most at risk for developing?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Rationale: Gastric secretions are rich in hydrochloric acid, potassium, and chloride. Continuous
suctioning removes these fluids, frequently resulting in metabolic alkalosis and hypokalemia.
Options A, C, and D are less commonly associated with direct upper gastrointestinal fluid loss
via suctioning.
Question 8: A client with type one diabetes mellitus is found unresponsive, cool, and clammy.
Fingerstick blood glucose reads forty milligrams per deciliter. Which action should the nurse
take first?
A) Administer regular insulin subcutaneously
B) Administer fifty percent dextrose intravenous push
C) Provide a complex carbohydrate and protein snack orally
D) Call the rapid response team and check deep tendon reflexes
Rationale: A blood glucose of forty milligrams per deciliter indicates severe hypoglycemia.
Because the patient is unresponsive, oral intake is contraindicated due to aspiration risk.
Intravenous fifty percent dextrose is the priority emergency treatment. Option A would worsen
the hypoglycemia. Option C is unsafe for an unresponsive patient. Option D delays immediate
lifesaving glucose administration.
Question 9: A nurse is assessing a patient with left-sided heart failure. Which clinical
manifestation is most characteristic of this condition?
, Page |4
A) Jugular venous distension
B) Dependent peripheral edema
C) Exertional dyspnea and orthopnea
D) Hepatomegaly and ascites
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
resulting in respiratory symptoms such as exertional dyspnea, orthopnea, and crackles. Options
A, B, and D are classic manifestations of right-sided heart failure due to systemic venous
congestion.
Question 10: A patient with chronic obstructive pulmonary disease is receiving oxygen via nasal
cannula at four liters per minute. The nurse notes the patient is increasingly lethargic with a
respiratory rate of eight breaths per minute. What is the physiological mechanism behind this
change?
A) Suppression of the hypoxic drive to breathe
B) Acute metabolic alkalosis from oxygen toxicity
C) Hypercapnic respiratory failure due to carbon dioxide retention
D) Complete airway obstruction from excessive mucus production
Rationale: Patients with advanced chronic obstructive pulmonary disease often rely on a
hypoxic drive—low oxygen levels—to stimulate breathing. Administering high-flow oxygen can
remove this stimulus, leading to hypoventilation, severe carbon dioxide retention, and lethargy.
Options B, C, and D do not accurately describe the specific primary mechanism of oxygen-
induced hypoventilation in this context.
Question 11: A nurse is caring for a postoperative client who has not voided eight hours after
surgery. Which assessment technique should the nurse use first to evaluate bladder distension?
A) Auscultate bilateral lower quadrants for bowel sounds
B) Palpate and gently percuss the suprapubic region
C) Insert an indwelling urinary catheter immediately
D) Perform a clean-catch urinalysis
Rationale: Palpation and percussion of the suprapubic region are non-invasive assessment
techniques used to detect bladder fullness and distension when a client is unable to void. Option
A assesses bowel motility, not bladder status. Option C is premature without confirming
retention via bladder scan or palpation. Option D is unnecessary at this stage.
Question 12: A patient is prescribed warfarin for deep vein thrombosis prophylaxis. Which
laboratory test should the nurse monitor to evaluate the therapeutic efficacy of this medication?
A) Activated partial thromboplastin time
B) Prothrombin time and International Normalized Ratio
C) Platelet count and bleeding time
D) Hemoglobin and hematocrit levels
Rationale: Warfarin acts on vitamin K-dependent clotting factors and is monitored using the
Prothrombin time and International Normalized Ratio. Option A monitors heparin therapy.
Option C evaluates platelet disorders. Option D assesses oxygen-carrying capacity and blood
loss.
NU 136 EXAM 2 VERSION 1 ACTUAL 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 material for NU 136 Exam 2 Version 1. This
meticulously crafted question set is designed to test and reinforce your clinical knowledge,
critical thinking skills, and theoretical understanding across foundational nursing concepts. This
practice set covers essential topics including advanced med-surgical nursing interventions,
pharmacology, fluid and electrolyte balance, perioperative care, and complex pathophysiology
aligned directly with current curriculum objectives. Achieving mastery in these areas is crucial
for nursing candidates, as it bridges the gap between classroom theory and safe, evidence-based
bedside practice. By working through these original, scenario-based questions and detailed
rationales, you will develop the analytical skills necessary to prioritize patient care effectively,
recognize subtle clinical changes, and make sound clinical judgments. This resource is
structured to build your confidence, identify knowledge gaps, and ensure you are thoroughly
prepared to excel on your upcoming examination and secure an A+ grade.
Core Domains Covered:
1. Perioperative Nursing Care: Focuses on pre-operative assessment, intraoperative safety
measures, and post-anesthesia recovery monitoring.
2. Fluid, Electrolyte, and Acid-Base Balance: Covers imbalances, compensatory mechanisms,
arterial blood gas interpretation, and IV therapy management.
3. Cardiovascular and Hemodynamic Alterations: Explores hypertension, heart failure,
dysrhythmias, and peripheral vascular disorders.
4. Respiratory Pathophysiology and Management: Addresses obstructive and restrictive
pulmonary diseases, oxygen delivery systems, and chest tube care.
5. Gastrointestinal and Metabolic Disorders: Examines acute and chronic GI conditions,
nutritional support, and endocrine regulation.
6. Renal and Urinary Tract Function: Focuses on acute kidney injury, chronic kidney disease,
dialysis, and urinary elimination disorders.
7. Pharmacological Principles and Safe Administration: Evaluates drug calculations, adverse
effects, contraindications, and therapeutic monitoring.
Question 1: A 45-year-old male is admitted to the medical-surgical unit following an exploratory
laparoscopy. Which postoperative finding requires immediate nursing intervention?
A) Mild drowsiness and disorientation to time
B) Urine output of forty milliliters over the past two hours
C) Surgical dressing with a moderate amount of serosanguinous drainage
D) Respiratory rate of ten breaths per minute and oxygen saturation of eighty-eight percent on
room air
,Page |2
Rationale: A respiratory rate of ten breaths per minute and an oxygen saturation of eighty-eight
percent indicate respiratory depression, likely secondary to residual anesthesia or opioid
analgesics. This is a life-threatening complication that requires immediate airway management
and intervention. Option A is expected post-anesthesia drowsiness. Option B reflects critically
low urine output, but airway takes absolute priority. Option C is a normal expected finding for
early postoperative drainage.
Question 2: A nurse is evaluating a patient receiving a continuous infusion of normal saline at
one hundred twenty-five milliliters per hour. Which assessment finding indicates fluid volume
overload?
A) Flat neck veins when lying flat
B) Bounding peripheral pulses and crackles in lung bases
C) Serum sodium level of one hundred forty milliequivalents per liter
D) Poor skin turgor and dry mucous membranes
Rationale: Bounding pulses and crackles in the lung bases are hallmark signs of hypervolemia
due to excess fluid volume accumulating in the vascular space and alveoli. Option A indicates
fluid deficit. Option C is within normal limits. Option D indicates hypovolemia or dehydration,
the exact opposite of fluid overload.
Question 3: A patient with chronic renal failure has a serum potassium level of six point five
milliequivalents per liter. Which medication should the nurse anticipate administering first to
protect the myocardium?
A) Regular insulin with fifty percent dextrose intravenously
B) Sodium polystyrene sulfonate orally
C) Calcium gluconate intravenously
D) Furosemide intravenously
Rationale: Intravenous calcium gluconate does not lower serum potassium, but it immediately
stabilizes the cardiac cell membrane against the arrhythmogenic effects of severe hyperkalemia.
Therefore, it is given first. Options A, B, and D actually work to shift or remove potassium from
the body, but calcium provides immediate cardiac protection.
Question 4: A nurse is caring for a patient experiencing an acute panic attack who is breathing
rapidly at thirty-two breaths per minute. Which arterial blood gas result is expected?
A) pH seven point three zero, carbon dioxide forty-eight
B) pH seven point five zero, carbon dioxide twenty-eight
C) pH seven point three two, bicarbonate twenty-two
D) pH seven point four eight, bicarbonate thirty-two
Rationale: Rapid breathing causes hyperventilation, blowing off carbon dioxide and leading to
respiratory alkalosis characterized by an elevated pH and decreased carbon dioxide. Option A
indicates respiratory acidosis. Option C indicates metabolic acidosis. Option D indicates
metabolic alkalosis.
Question 5: A patient is prescribed digoxin for heart failure. Which assessment finding should
prompt the nurse to hold the medication and notify the healthcare provider?
A) Apical pulse rate of fifty-two beats per minute
B) Blood pressure of one hundred ten over seventy millimeters of mercury
,Page |3
C) Serum potassium level of four point zero milliequivalents per liter
D) Mild fatigue and generalized weakness
Rationale: Digoxin slows the heart rate. If the apical pulse drops below sixty beats per minute in
an adult, the nurse must hold the dose and notify the provider to prevent severe bradycardia or
toxicity. Option B is within normal limits. Option C is normal. Option D can be associated with
heart failure itself, but heart rate is the direct safety trigger for digoxin administration.
Question 6: A patient is scheduled for an abdominal surgery and is signing the informed consent
form. The patient states, "I still do not understand what an exploratory laparotomy actually
involves." What is the best initial nursing action?
A) Explain the surgical procedure in detail to the patient
B) Proceed with witnessing the signature since the form is already filled out
C) Notify the surgeon that the patient requires further clarification before signing
D) Document that the patient refused surgery
Rationale: Obtaining informed consent regarding the surgical procedure is the legal and ethical
responsibility of the physician. The nurse acts as a witness to the signature, not the explainer of
the procedure. If the patient lacks understanding, the nurse must notify the surgeon. Option A is
outside the nurse's scope for obtaining primary consent. Options B and D are inappropriate and
violate patient rights.
Question 7: A nurse is caring for a client with a nasogastric tube to low intermittent suction.
Which electrolyte imbalance is this client most at risk for developing?
A) Hyperkalemia
B) Hypokalemia
C) Hypernatremia
D) Hypercalcemia
Rationale: Gastric secretions are rich in hydrochloric acid, potassium, and chloride. Continuous
suctioning removes these fluids, frequently resulting in metabolic alkalosis and hypokalemia.
Options A, C, and D are less commonly associated with direct upper gastrointestinal fluid loss
via suctioning.
Question 8: A client with type one diabetes mellitus is found unresponsive, cool, and clammy.
Fingerstick blood glucose reads forty milligrams per deciliter. Which action should the nurse
take first?
A) Administer regular insulin subcutaneously
B) Administer fifty percent dextrose intravenous push
C) Provide a complex carbohydrate and protein snack orally
D) Call the rapid response team and check deep tendon reflexes
Rationale: A blood glucose of forty milligrams per deciliter indicates severe hypoglycemia.
Because the patient is unresponsive, oral intake is contraindicated due to aspiration risk.
Intravenous fifty percent dextrose is the priority emergency treatment. Option A would worsen
the hypoglycemia. Option C is unsafe for an unresponsive patient. Option D delays immediate
lifesaving glucose administration.
Question 9: A nurse is assessing a patient with left-sided heart failure. Which clinical
manifestation is most characteristic of this condition?
, Page |4
A) Jugular venous distension
B) Dependent peripheral edema
C) Exertional dyspnea and orthopnea
D) Hepatomegaly and ascites
Rationale: Left-sided heart failure causes blood to back up into the pulmonary circulation,
resulting in respiratory symptoms such as exertional dyspnea, orthopnea, and crackles. Options
A, B, and D are classic manifestations of right-sided heart failure due to systemic venous
congestion.
Question 10: A patient with chronic obstructive pulmonary disease is receiving oxygen via nasal
cannula at four liters per minute. The nurse notes the patient is increasingly lethargic with a
respiratory rate of eight breaths per minute. What is the physiological mechanism behind this
change?
A) Suppression of the hypoxic drive to breathe
B) Acute metabolic alkalosis from oxygen toxicity
C) Hypercapnic respiratory failure due to carbon dioxide retention
D) Complete airway obstruction from excessive mucus production
Rationale: Patients with advanced chronic obstructive pulmonary disease often rely on a
hypoxic drive—low oxygen levels—to stimulate breathing. Administering high-flow oxygen can
remove this stimulus, leading to hypoventilation, severe carbon dioxide retention, and lethargy.
Options B, C, and D do not accurately describe the specific primary mechanism of oxygen-
induced hypoventilation in this context.
Question 11: A nurse is caring for a postoperative client who has not voided eight hours after
surgery. Which assessment technique should the nurse use first to evaluate bladder distension?
A) Auscultate bilateral lower quadrants for bowel sounds
B) Palpate and gently percuss the suprapubic region
C) Insert an indwelling urinary catheter immediately
D) Perform a clean-catch urinalysis
Rationale: Palpation and percussion of the suprapubic region are non-invasive assessment
techniques used to detect bladder fullness and distension when a client is unable to void. Option
A assesses bowel motility, not bladder status. Option C is premature without confirming
retention via bladder scan or palpation. Option D is unnecessary at this stage.
Question 12: A patient is prescribed warfarin for deep vein thrombosis prophylaxis. Which
laboratory test should the nurse monitor to evaluate the therapeutic efficacy of this medication?
A) Activated partial thromboplastin time
B) Prothrombin time and International Normalized Ratio
C) Platelet count and bleeding time
D) Hemoglobin and hematocrit levels
Rationale: Warfarin acts on vitamin K-dependent clotting factors and is monitored using the
Prothrombin time and International Normalized Ratio. Option A monitors heparin therapy.
Option C evaluates platelet disorders. Option D assesses oxygen-carrying capacity and blood
loss.
