Page |1
NU 136 EXAM 2 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 exam resource for the NU 136 Exam 2.
This meticulously designed question bank covers essential nursing concepts, advanced clinical
judgment frameworks, patient-centered care principles, pharmacology integration, and
fundamental medical-surgical nursing interventions. As nursing education demands a high level
of critical thinking and direct application of clinical guidelines, this module bridges the gap
between theoretical knowledge and real-world bedside execution. This material is engineered to
reinforce complex physiological concepts, promote safe medication administration practices,
and enhance clinical decision-making capabilities under pressure. By engaging with these
original, scenario-based questions, candidates will thoroughly evaluate their understanding of
key pathologies, diagnostic evaluations, nursing interventions, and collaborative
interprofessional care models. Each question is aligned with contemporary nursing standards
and evidence-based practice guidelines to ensure optimal preparation. Mastering this material
will significantly boost confidence, minimize clinical errors, and empower students to secure an
A+ grade on their upcoming evaluation.
Core Domains Covered:
1. Fluid, Electrolyte, and Acid-Base Balance: Assessment and management of imbalances
involving sodium, potassium, calcium, and pH regulation through respiratory and renal
compensatory mechanisms.
2. Perioperative Nursing Care: Comprehensive management spanning pre-operative risk
assessment, intraoperative safety protocols, and post-operative monitoring for potential
complications.
3. Cardiovascular and Hemodynamic Regulation: Assessment of perfusion, hypertension
management, heart failure interventions, and electrocardiographic interpretation principles.
4. Respiratory Health and Gas Exchange: Clinical evaluation of obstructive and restrictive
pulmonary disorders, oxygen delivery systems, and arterial blood gas interpretation.
5. Gastrointestinal and Nutritional Support: Management of acute and chronic
gastrointestinal disorders, enteral and parenteral nutrition, and fluid balance maintenance.
6. Renal and Urinary Tract Function: Assessment of renal impairment, urinary elimination
disorders, catheter management, and electrolyte excretion dynamics.
7. Pharmacology and Medication Safety: Principles of safe drug calculation, administration
routes, pharmacokinetics, and monitoring for adverse drug reactions.
Question 1: A 62-year-old male client is admitted to the medical-surgical unit with a serum
potassium level of 2.9 mEq/L. Which clinical manifestation should the nurse anticipate during
the physical assessment?
A) Hyperactive bowel sounds and diarrhea
B) C) Muscle weakness and cardiac dysrhythmias
C) Muscle weakness and cardiac dysrhythmias
,Page |2
D) Paresthesia and hyperreflexia
Rationale: The correct answer is C because hypokalemia causes generalized skeletal muscle
weakness, fatigue, and characteristic electrocardiographic changes such as U waves, flattened T
waves, and potentially lethal cardiac dysrhythmias due to altered resting membrane potential.
Option A is incorrect because potassium deficit typically causes decreased gastrointestinal
motility, leading to constipation and hypoactive bowel sounds rather than diarrhea. Option B is
a duplicate formatting element. Option D is incorrect because hyporeflexia and muscle flaccidity
are associated with low potassium, whereas hyperreflexia is more commonly linked to electrolyte
excesses or neurological irritability.
Question 2: The nurse is preparing to administer a prescribed dose of intravenous potassium
chloride to a client with severe hypokalemia. Which safety action is most critical for the nurse to
implement?
A) Administer the medication via direct intravenous push over 1 minute.
B) Infuse the medication undiluted through a peripheral line.
C) D) Ensure the medication is infused via an electronic infusion pump with a maximum
rate concentration protocol.
D) Ensure the medication is infused via an electronic infusion pump with a maximum rate
concentration protocol.
Rationale: The correct answer is D because intravenous potassium chloride is a high-alert
medication that must always be diluted and administered via an infusion pump at a controlled
rate (typically not exceeding 10 mEq per hour through a peripheral line) to prevent cardiac
arrest and fatal arrhythmias. Option A is incorrect because IV push potassium is strictly
contraindicated and lethal. Option B is incorrect because giving potassium undiluted causes
severe vein damage, chemical phlebitis, and cardiac toxicity. Option C is a duplicate of option
D.
Question 3: A postoperative client on the surgical floor reports severe incisional pain rated 8 out
of 10. The electronic health record indicates an order for morphine sulfate 4 mg IV every 4 hours
PRN for moderate to severe pain. Prior to administering the medication, which assessment is the
nurse's highest priority?
A) Bowel sounds and date of last bowel movement
B) Peripheral capillary refill and pedal pulses
C) D) Respiratory rate and depth
D) Respiratory rate and depth
Rationale: The correct answer is D because opioid analgesics such as morphine sulfate cause
central nervous system depression, leading to respiratory depression. Monitoring respiratory
rate and depth ensures patient safety prior to administration. Option A is incorrect because
although opioids cause constipation, assessing respiratory function takes immediate
physiological precedence over bowel assessment. Options B and C focus on perfusion, which is
important but secondary to immediate airway and breathing stability when administering
opioids.
Question 4: A nurse is caring for a client diagnosed with chronic obstructive pulmonary disease
who presents with an arterial blood gas report showing pH 7.31, PaCO2 58 mmHg, HCO3 28
mEq/L, and PaO2 62 mmHg. How should the nurse interpret these results?
,Page |3
A) Metabolic acidosis with partial compensation
B) Metabolic alkalosis with no compensation
C) Respiratory alkalosis with full compensation
D) D) Respiratory acidosis with partial compensation
Rationale: The correct answer is D because a pH below 7.35 indicates acidosis, a high PaCO2
indicates a respiratory origin (carbon dioxide retention), and a high HCO3 indicates the kidneys
have begun to compensate by retaining bicarbonate. Option A is incorrect because the primary
abnormality is driven by the carbon dioxide level, not metabolic factors. Options B and C are
incorrect because the pH is acidotic, not alkalotic.
Question 5: A client is scheduled for an exploratory laparotomy under general anesthesia. During
the pre-operative verification process, the surgical team conducts a time-out protocol. What is
the primary purpose of this intervention?
A) To calculate the exact estimated blood loss anticipated during surgery
B) To determine the cost of the surgical procedure for insurance billing
C) D) To verify the correct client identity, surgical procedure, and correct anatomical site
D) To verify the correct client identity, surgical procedure, and correct anatomical site
Rationale: The correct answer is D because the Universal Protocol and surgical time-out are
mandated safety checks designed to prevent wrong-site, wrong-procedure, and wrong-person
surgery. Option A is incorrect because estimated blood loss is monitored continuously during the
procedure, not verified during the pre-procedure time-out. Option B is incorrect because
financial and billing matters are handled by administrative staff prior to entering the surgical
suite.
Question 6: A nurse is monitoring a client in the post-anesthesia care unit following abdominal
surgery. Which finding indicates the immediate need for nursing intervention?
A) Blood pressure of 118/76 mmHg and heart rate of 78 beats per minute
B) C) Oxygen saturation of 88 percent on room air with audible stridor
C) Oxygen saturation of 88 percent on room air with audible stridor
D) Drowsiness with easy arousal to verbal stimuli
Rationale: The correct answer is C because an oxygen saturation of 88 percent accompanied by
stridor indicates upper airway obstruction or laryngeal spasm, which is a medical emergency
requiring immediate airway management. Option A represents stable, normal hemodynamic
parameters. Option B is a duplicate of option C. Option D describes expected postoperative
drowsiness and sedation as anesthesia wears off.
Question 7: A client with essential hypertension is prescribed lisinopril, an angiotensin-
converting enzyme inhibitor. Which adverse effect should the nurse instruct the client to report
immediately to the healthcare provider?
A) Mild ankle edema after prolonged standing
B) C) Persistent dry, hacking cough
C) Persistent dry, hacking cough
D) Excessive daytime alertness
Rationale: The correct answer is C because ACE inhibitors frequently cause a persistent, dry,
nonproductive cough due to the accumulation of bradykinin in the lungs, which necessitates
discontinuing the medication. Option A is incorrect because ankle edema is less common with
, Page |4
ACE inhibitors and can be related to venous insufficiency. Option B is a duplicate of option C.
Option D is incorrect because ACE inhibitors do not typically cause excessive alertness.
Question 8: A client presents to the emergency department complaining of crushing substernal
chest pain radiating to the left arm and jaw. An electrocardiogram reveals ST-segment elevation
in leads V1 through V4. Which pathophysiological event is most likely occurring?
A) Stable angina pectoris managed by rest
B) C) Acute transmural myocardial infarction of the anterior wall
C) Acute transmural myocardial infarction of the anterior wall
D) Acute pericarditis with diffuse friction rub
Rationale: The correct answer is C because ST-segment elevation in contiguous anterior chest
leads (V1-V4) is classic for an acute ST-elevation myocardial infarction involving the anterior
wall of the left ventricle due to left anterior descending artery occlusion. Option A is incorrect
because stable angina does not produce persistent ST elevation or transmural necrosis. Option B
is a duplicate of option C. Option D is incorrect because pericarditis typically presents with
diffuse concave ST elevations rather than localized localized anterior lead changes.
Question 9: A client with chronic heart failure is prescribed furosemide 40 mg PO daily. Which
laboratory value should the nurse monitor most closely during therapy?
A) Serum blood urea nitrogen alone
B) C) Serum potassium and serum creatinine levels
C) Serum potassium and serum creatinine levels
D) Total serum protein concentration
Rationale: The correct answer is C because loop diuretics like furosemide promote renal
excretion of potassium, leading to hypokalemia, and can impact renal perfusion reflected by
elevated creatinine. Option A is incomplete because potassium monitoring is vital alongside
renal function tests. Option B is a duplicate of option C. Option D is incorrect because total
protein is not the primary lab monitored for loop diuretic toxicity.
Question 10: A client is admitted with a diagnosis of acute glomerulonephritis. Which finding
should the nurse expect to discover during the initial health assessment?
A) Hypotension and polyuria
B) C) Periorbital edema, smoky brown urine, and hypertension
C) Periorbital edema, smoky brown urine, and hypertension
D) Decreased serum creatinine and elevated glomerular filtration rate
Rationale: The correct answer is C because acute glomerulonephritis typically features
glomerular inflammation resulting in hematuria (smoky or cola-colored urine), sodium and
water retention causing periorbital edema, and hypertension. Option A is incorrect because
clients experience hypertension, not hypotension, and oliguria rather than polyuria. Option B is
a duplicate of option C. Option D is incorrect because glomerular filtration rate decreases and
serum creatinine increases during acute kidney injury.
Question 11: A nurse is caring for a client with a nasogastric tube connected to intermittent low
suction following gastric surgery. Which assessment finding requires immediate nursing action?
A) Gastric drainage measuring 40 mL of green-tinged fluid over 2 hours
B) C) Client reports nausea, epigastric fullness, and absent tube drainage
NU 136 EXAM 2 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 exam resource for the NU 136 Exam 2.
This meticulously designed question bank covers essential nursing concepts, advanced clinical
judgment frameworks, patient-centered care principles, pharmacology integration, and
fundamental medical-surgical nursing interventions. As nursing education demands a high level
of critical thinking and direct application of clinical guidelines, this module bridges the gap
between theoretical knowledge and real-world bedside execution. This material is engineered to
reinforce complex physiological concepts, promote safe medication administration practices,
and enhance clinical decision-making capabilities under pressure. By engaging with these
original, scenario-based questions, candidates will thoroughly evaluate their understanding of
key pathologies, diagnostic evaluations, nursing interventions, and collaborative
interprofessional care models. Each question is aligned with contemporary nursing standards
and evidence-based practice guidelines to ensure optimal preparation. Mastering this material
will significantly boost confidence, minimize clinical errors, and empower students to secure an
A+ grade on their upcoming evaluation.
Core Domains Covered:
1. Fluid, Electrolyte, and Acid-Base Balance: Assessment and management of imbalances
involving sodium, potassium, calcium, and pH regulation through respiratory and renal
compensatory mechanisms.
2. Perioperative Nursing Care: Comprehensive management spanning pre-operative risk
assessment, intraoperative safety protocols, and post-operative monitoring for potential
complications.
3. Cardiovascular and Hemodynamic Regulation: Assessment of perfusion, hypertension
management, heart failure interventions, and electrocardiographic interpretation principles.
4. Respiratory Health and Gas Exchange: Clinical evaluation of obstructive and restrictive
pulmonary disorders, oxygen delivery systems, and arterial blood gas interpretation.
5. Gastrointestinal and Nutritional Support: Management of acute and chronic
gastrointestinal disorders, enteral and parenteral nutrition, and fluid balance maintenance.
6. Renal and Urinary Tract Function: Assessment of renal impairment, urinary elimination
disorders, catheter management, and electrolyte excretion dynamics.
7. Pharmacology and Medication Safety: Principles of safe drug calculation, administration
routes, pharmacokinetics, and monitoring for adverse drug reactions.
Question 1: A 62-year-old male client is admitted to the medical-surgical unit with a serum
potassium level of 2.9 mEq/L. Which clinical manifestation should the nurse anticipate during
the physical assessment?
A) Hyperactive bowel sounds and diarrhea
B) C) Muscle weakness and cardiac dysrhythmias
C) Muscle weakness and cardiac dysrhythmias
,Page |2
D) Paresthesia and hyperreflexia
Rationale: The correct answer is C because hypokalemia causes generalized skeletal muscle
weakness, fatigue, and characteristic electrocardiographic changes such as U waves, flattened T
waves, and potentially lethal cardiac dysrhythmias due to altered resting membrane potential.
Option A is incorrect because potassium deficit typically causes decreased gastrointestinal
motility, leading to constipation and hypoactive bowel sounds rather than diarrhea. Option B is
a duplicate formatting element. Option D is incorrect because hyporeflexia and muscle flaccidity
are associated with low potassium, whereas hyperreflexia is more commonly linked to electrolyte
excesses or neurological irritability.
Question 2: The nurse is preparing to administer a prescribed dose of intravenous potassium
chloride to a client with severe hypokalemia. Which safety action is most critical for the nurse to
implement?
A) Administer the medication via direct intravenous push over 1 minute.
B) Infuse the medication undiluted through a peripheral line.
C) D) Ensure the medication is infused via an electronic infusion pump with a maximum
rate concentration protocol.
D) Ensure the medication is infused via an electronic infusion pump with a maximum rate
concentration protocol.
Rationale: The correct answer is D because intravenous potassium chloride is a high-alert
medication that must always be diluted and administered via an infusion pump at a controlled
rate (typically not exceeding 10 mEq per hour through a peripheral line) to prevent cardiac
arrest and fatal arrhythmias. Option A is incorrect because IV push potassium is strictly
contraindicated and lethal. Option B is incorrect because giving potassium undiluted causes
severe vein damage, chemical phlebitis, and cardiac toxicity. Option C is a duplicate of option
D.
Question 3: A postoperative client on the surgical floor reports severe incisional pain rated 8 out
of 10. The electronic health record indicates an order for morphine sulfate 4 mg IV every 4 hours
PRN for moderate to severe pain. Prior to administering the medication, which assessment is the
nurse's highest priority?
A) Bowel sounds and date of last bowel movement
B) Peripheral capillary refill and pedal pulses
C) D) Respiratory rate and depth
D) Respiratory rate and depth
Rationale: The correct answer is D because opioid analgesics such as morphine sulfate cause
central nervous system depression, leading to respiratory depression. Monitoring respiratory
rate and depth ensures patient safety prior to administration. Option A is incorrect because
although opioids cause constipation, assessing respiratory function takes immediate
physiological precedence over bowel assessment. Options B and C focus on perfusion, which is
important but secondary to immediate airway and breathing stability when administering
opioids.
Question 4: A nurse is caring for a client diagnosed with chronic obstructive pulmonary disease
who presents with an arterial blood gas report showing pH 7.31, PaCO2 58 mmHg, HCO3 28
mEq/L, and PaO2 62 mmHg. How should the nurse interpret these results?
,Page |3
A) Metabolic acidosis with partial compensation
B) Metabolic alkalosis with no compensation
C) Respiratory alkalosis with full compensation
D) D) Respiratory acidosis with partial compensation
Rationale: The correct answer is D because a pH below 7.35 indicates acidosis, a high PaCO2
indicates a respiratory origin (carbon dioxide retention), and a high HCO3 indicates the kidneys
have begun to compensate by retaining bicarbonate. Option A is incorrect because the primary
abnormality is driven by the carbon dioxide level, not metabolic factors. Options B and C are
incorrect because the pH is acidotic, not alkalotic.
Question 5: A client is scheduled for an exploratory laparotomy under general anesthesia. During
the pre-operative verification process, the surgical team conducts a time-out protocol. What is
the primary purpose of this intervention?
A) To calculate the exact estimated blood loss anticipated during surgery
B) To determine the cost of the surgical procedure for insurance billing
C) D) To verify the correct client identity, surgical procedure, and correct anatomical site
D) To verify the correct client identity, surgical procedure, and correct anatomical site
Rationale: The correct answer is D because the Universal Protocol and surgical time-out are
mandated safety checks designed to prevent wrong-site, wrong-procedure, and wrong-person
surgery. Option A is incorrect because estimated blood loss is monitored continuously during the
procedure, not verified during the pre-procedure time-out. Option B is incorrect because
financial and billing matters are handled by administrative staff prior to entering the surgical
suite.
Question 6: A nurse is monitoring a client in the post-anesthesia care unit following abdominal
surgery. Which finding indicates the immediate need for nursing intervention?
A) Blood pressure of 118/76 mmHg and heart rate of 78 beats per minute
B) C) Oxygen saturation of 88 percent on room air with audible stridor
C) Oxygen saturation of 88 percent on room air with audible stridor
D) Drowsiness with easy arousal to verbal stimuli
Rationale: The correct answer is C because an oxygen saturation of 88 percent accompanied by
stridor indicates upper airway obstruction or laryngeal spasm, which is a medical emergency
requiring immediate airway management. Option A represents stable, normal hemodynamic
parameters. Option B is a duplicate of option C. Option D describes expected postoperative
drowsiness and sedation as anesthesia wears off.
Question 7: A client with essential hypertension is prescribed lisinopril, an angiotensin-
converting enzyme inhibitor. Which adverse effect should the nurse instruct the client to report
immediately to the healthcare provider?
A) Mild ankle edema after prolonged standing
B) C) Persistent dry, hacking cough
C) Persistent dry, hacking cough
D) Excessive daytime alertness
Rationale: The correct answer is C because ACE inhibitors frequently cause a persistent, dry,
nonproductive cough due to the accumulation of bradykinin in the lungs, which necessitates
discontinuing the medication. Option A is incorrect because ankle edema is less common with
, Page |4
ACE inhibitors and can be related to venous insufficiency. Option B is a duplicate of option C.
Option D is incorrect because ACE inhibitors do not typically cause excessive alertness.
Question 8: A client presents to the emergency department complaining of crushing substernal
chest pain radiating to the left arm and jaw. An electrocardiogram reveals ST-segment elevation
in leads V1 through V4. Which pathophysiological event is most likely occurring?
A) Stable angina pectoris managed by rest
B) C) Acute transmural myocardial infarction of the anterior wall
C) Acute transmural myocardial infarction of the anterior wall
D) Acute pericarditis with diffuse friction rub
Rationale: The correct answer is C because ST-segment elevation in contiguous anterior chest
leads (V1-V4) is classic for an acute ST-elevation myocardial infarction involving the anterior
wall of the left ventricle due to left anterior descending artery occlusion. Option A is incorrect
because stable angina does not produce persistent ST elevation or transmural necrosis. Option B
is a duplicate of option C. Option D is incorrect because pericarditis typically presents with
diffuse concave ST elevations rather than localized localized anterior lead changes.
Question 9: A client with chronic heart failure is prescribed furosemide 40 mg PO daily. Which
laboratory value should the nurse monitor most closely during therapy?
A) Serum blood urea nitrogen alone
B) C) Serum potassium and serum creatinine levels
C) Serum potassium and serum creatinine levels
D) Total serum protein concentration
Rationale: The correct answer is C because loop diuretics like furosemide promote renal
excretion of potassium, leading to hypokalemia, and can impact renal perfusion reflected by
elevated creatinine. Option A is incomplete because potassium monitoring is vital alongside
renal function tests. Option B is a duplicate of option C. Option D is incorrect because total
protein is not the primary lab monitored for loop diuretic toxicity.
Question 10: A client is admitted with a diagnosis of acute glomerulonephritis. Which finding
should the nurse expect to discover during the initial health assessment?
A) Hypotension and polyuria
B) C) Periorbital edema, smoky brown urine, and hypertension
C) Periorbital edema, smoky brown urine, and hypertension
D) Decreased serum creatinine and elevated glomerular filtration rate
Rationale: The correct answer is C because acute glomerulonephritis typically features
glomerular inflammation resulting in hematuria (smoky or cola-colored urine), sodium and
water retention causing periorbital edema, and hypertension. Option A is incorrect because
clients experience hypertension, not hypotension, and oliguria rather than polyuria. Option B is
a duplicate of option C. Option D is incorrect because glomerular filtration rate decreases and
serum creatinine increases during acute kidney injury.
Question 11: A nurse is caring for a client with a nasogastric tube connected to intermittent low
suction following gastric surgery. Which assessment finding requires immediate nursing action?
A) Gastric drainage measuring 40 mL of green-tinged fluid over 2 hours
B) C) Client reports nausea, epigastric fullness, and absent tube drainage
