2026/2027
NU 136 Fundamentals of Nursing
Exam 2 2026/2027 Complete Review
Manual for Test Bank Practice,
Critical Thinking, and Nursing
Fundamentals Examination
Readiness
Question 1
A nurse inserting a nasogastric (NG) tube notes that the client begins coughing and
experiencing respiratory distress. What is the most appropriate nursing action?
A. Advance the tube quickly
B. Notify the healthcare provider immediately
C. Remove the tube completely
D. Pull back on the tube and pause insertion
Correct Answer: D. Pull back on the tube and pause insertion
Rationale: Respiratory distress during NG tube insertion suggests possible entry into
the airway. The priority is to immediately stop advancement and withdraw slightly to
prevent further airway compromise. Advancing the tube worsens the situation, while
full removal or provider notification is not the first immediate safety action.
Question 2
A postoperative client arrives from the PACU. What is the nurse’s first priority?
A. Check surgical dressing
B. Assess vital signs
C. Assess airway patency
D. Check drains for patency
Correct Answer: C. Assess airway patency
Rationale: Airway management is always the highest priority in postoperative care.
Without a patent airway, oxygenation is compromised, making all other assessments
secondary.
,2026/2027
Question 3
Which position is most appropriate for administering a cleansing enema?
A. Right Sims’ position
B. Supine position
C. High Fowler’s position
D. Left Sims’ position
Correct Answer: D. Left Sims’ position
Rationale: The left Sims’ position follows the natural curvature of the colon, allowing
gravity to assist enema flow. Other positions do not promote optimal distribution and
may increase discomfort.
Question 4
What is the correct position for NG tube insertion?
A. Low Fowler’s
B. Supine flat
C. Right lateral
D. High Fowler’s
Correct Answer: D. High Fowler’s
Rationale: High Fowler’s position reduces aspiration risk and promotes easier tube
passage. Flat positions increase aspiration risk.
Question 5
Before administering medications via NG tube, which actions are appropriate? (Select
all)
A. Check gastric residual
B. Aspirate stomach contents
C. Turn off suction
D. Replace tube to opposite nostril
E. Check gastric pH
Correct Answer: A, B, C, E
Rationale: These actions confirm placement, prevent suction loss of medication, and
ensure safe administration. Changing nostrils is unnecessary and invasive.
,2026/2027
Question 6
How should NG medication be managed when suction is present?
A. Keep suction running
B. Flush with cold water
C. Clamp tube 30–60 minutes after administration
D. Increase suction briefly
Correct Answer: C. Clamp tube 30–60 minutes after administration
Rationale: Clamping allows medication absorption. Suction or flushing removes
medication and reduces effectiveness.
Question 7
A gastric pH of 7.35 is found in NG aspirate. What is the nurse’s action?
A. Document placement
B. Retest pH
C. Auscultate air bolus
D. Request chest X-ray
Correct Answer: D. Request chest X-ray
Rationale: Gastric pH should be acidic (<3.5). A neutral pH suggests misplacement,
requiring radiographic confirmation.
Question 8
How is NG tube length correctly measured?
A. Nose to sternum
B. Nose to ear only
C. Nose → ear → xiphoid process
D. Nose to umbilicus
Correct Answer: C. Nose → ear → xiphoid process
Rationale: This ensures correct anatomical placement into the stomach.
Question 9
Which NG drainage finding 24 hours post-op requires immediate reporting?
, 2026/2027
A. Green tinged
B. Light brown
C. Dark brown
D. Dark red
Correct Answer: D. Dark red
Rationale: Dark red drainage suggests active bleeding and hemorrhage.
Question 10
A client has diarrhea for 4 days. What findings are expected? (Select all)
A. Hypotension
B. Fever
C. Peripheral edema
D. Poor skin turgor
E. Bradycardia
Correct Answer: A, B, D
Rationale: Diarrhea causes dehydration, leading to hypotension, fever, and poor skin
turgor.
Question 11
Client reports cramping during enema administration. What should nurse do?
A. Continue flow
B. Increase flow rate
C. Clamp tubing briefly
D. Ignore complaint
Correct Answer: C. Clamp tubing briefly
Rationale: Pausing flow reduces intestinal spasms and improves tolerance.
Question 12
Which actions are correct during enema administration? (Select all)
A. Warm solution
B. Left side positioning
C. Lubricate tube
NU 136 Fundamentals of Nursing
Exam 2 2026/2027 Complete Review
Manual for Test Bank Practice,
Critical Thinking, and Nursing
Fundamentals Examination
Readiness
Question 1
A nurse inserting a nasogastric (NG) tube notes that the client begins coughing and
experiencing respiratory distress. What is the most appropriate nursing action?
A. Advance the tube quickly
B. Notify the healthcare provider immediately
C. Remove the tube completely
D. Pull back on the tube and pause insertion
Correct Answer: D. Pull back on the tube and pause insertion
Rationale: Respiratory distress during NG tube insertion suggests possible entry into
the airway. The priority is to immediately stop advancement and withdraw slightly to
prevent further airway compromise. Advancing the tube worsens the situation, while
full removal or provider notification is not the first immediate safety action.
Question 2
A postoperative client arrives from the PACU. What is the nurse’s first priority?
A. Check surgical dressing
B. Assess vital signs
C. Assess airway patency
D. Check drains for patency
Correct Answer: C. Assess airway patency
Rationale: Airway management is always the highest priority in postoperative care.
Without a patent airway, oxygenation is compromised, making all other assessments
secondary.
,2026/2027
Question 3
Which position is most appropriate for administering a cleansing enema?
A. Right Sims’ position
B. Supine position
C. High Fowler’s position
D. Left Sims’ position
Correct Answer: D. Left Sims’ position
Rationale: The left Sims’ position follows the natural curvature of the colon, allowing
gravity to assist enema flow. Other positions do not promote optimal distribution and
may increase discomfort.
Question 4
What is the correct position for NG tube insertion?
A. Low Fowler’s
B. Supine flat
C. Right lateral
D. High Fowler’s
Correct Answer: D. High Fowler’s
Rationale: High Fowler’s position reduces aspiration risk and promotes easier tube
passage. Flat positions increase aspiration risk.
Question 5
Before administering medications via NG tube, which actions are appropriate? (Select
all)
A. Check gastric residual
B. Aspirate stomach contents
C. Turn off suction
D. Replace tube to opposite nostril
E. Check gastric pH
Correct Answer: A, B, C, E
Rationale: These actions confirm placement, prevent suction loss of medication, and
ensure safe administration. Changing nostrils is unnecessary and invasive.
,2026/2027
Question 6
How should NG medication be managed when suction is present?
A. Keep suction running
B. Flush with cold water
C. Clamp tube 30–60 minutes after administration
D. Increase suction briefly
Correct Answer: C. Clamp tube 30–60 minutes after administration
Rationale: Clamping allows medication absorption. Suction or flushing removes
medication and reduces effectiveness.
Question 7
A gastric pH of 7.35 is found in NG aspirate. What is the nurse’s action?
A. Document placement
B. Retest pH
C. Auscultate air bolus
D. Request chest X-ray
Correct Answer: D. Request chest X-ray
Rationale: Gastric pH should be acidic (<3.5). A neutral pH suggests misplacement,
requiring radiographic confirmation.
Question 8
How is NG tube length correctly measured?
A. Nose to sternum
B. Nose to ear only
C. Nose → ear → xiphoid process
D. Nose to umbilicus
Correct Answer: C. Nose → ear → xiphoid process
Rationale: This ensures correct anatomical placement into the stomach.
Question 9
Which NG drainage finding 24 hours post-op requires immediate reporting?
, 2026/2027
A. Green tinged
B. Light brown
C. Dark brown
D. Dark red
Correct Answer: D. Dark red
Rationale: Dark red drainage suggests active bleeding and hemorrhage.
Question 10
A client has diarrhea for 4 days. What findings are expected? (Select all)
A. Hypotension
B. Fever
C. Peripheral edema
D. Poor skin turgor
E. Bradycardia
Correct Answer: A, B, D
Rationale: Diarrhea causes dehydration, leading to hypotension, fever, and poor skin
turgor.
Question 11
Client reports cramping during enema administration. What should nurse do?
A. Continue flow
B. Increase flow rate
C. Clamp tubing briefly
D. Ignore complaint
Correct Answer: C. Clamp tubing briefly
Rationale: Pausing flow reduces intestinal spasms and improves tolerance.
Question 12
Which actions are correct during enema administration? (Select all)
A. Warm solution
B. Left side positioning
C. Lubricate tube
