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 examination module for NU 136 Exam 2. This original
practice material is meticulously designed to align with official course objectives and modern
clinical nursing standards. This set covers fundamental medical-surgical concepts,
pharmacological interventions, fluid and electrolyte balances, perioperative nursing care, and
specialized patient monitoring techniques essential for safe clinical practice. Each scenario-
based question challenges your critical thinking, clinical judgment, and application of the
nursing process rather than rote memorization. Mastering these concepts is vital for nursing
students aiming to excel in their academic evaluations and build a robust foundation for safe,
evidence-based patient care. By engaging with these advanced questions and detailed rationales,
candidates will identify knowledge gaps, refine their clinical decision-making abilities, and gain
the confidence required to achieve an A+ grade on the official exam.
Core Domains Covered:
1. Perioperative Nursing Care: Preoperative assessment, intraoperative safety protocols, and
postoperative monitoring for complications such as hemorrhage and atelectasis.
2. Fluid, Electrolyte, and Acid-Base Balances: Identifying imbalances such as hyponatremia,
hyperkalemia, respiratory acidosis, and metabolic alkalosis, along with appropriate
interventions.
3. Pain Management and Comfort: Assessing acute and chronic pain, pharmacological
management via analgesics, and non-pharmacological comfort measures.
4. Wound Healing and Integumentary Integrity: Staging pressure injuries, evaluating wound
drainage, understanding primary and secondary intention healing, and preventing skin
breakdown.
5. Cardiovascular and Hemodynamic Monitoring: Recognizing signs of heart failure,
hypertension, peripheral vascular disease, and interpreting vital sign trends.
6. Respiratory Health and Oxygenation: Managing oxygen therapy delivery systems, assessing
breath sounds, and caring for patients with chronic obstructive pulmonary disease or
pneumonia.
7. Medication Administration and Safety: Applying the rights of medication administration,
calculating dosages safely, and monitoring adverse drug reactions.
Question 1: A 68-year-old post-operative patient on the surgical unit reports sudden shortness of
breath and pleuritic chest pain 3 days after abdominal surgery. Vital signs show heart rate 118
beats per minute, respiratory rate 28 breaths per minute, blood pressure 100/64 mmHg, and
oxygen saturation 88 percent on room air. Which of the following is the priority nursing action?
A) Administer prescribed oral pain medication for the chest discomfort
,Page |2
B) C) Apply supplemental oxygen via nasal cannula and notify the rapid response team
C) Elevate the head of the bed and encourage deep breathing exercises
D) Obtain a 12-lead electrocardiogram to rule out myocardial infarction
Rationale: The patient is exhibiting classic signs of a pulmonary embolism (tachycardia,
tachypnea, hypoxemia, and pleuritic chest pain following surgery). The priority nursing action
according to the ABCDE framework is to immediately apply supplemental oxygen to correct
hypoxemia and notify the rapid response team or provider for emergency intervention. While an
ECG is useful, oxygenation and stabilization take precedence. Pain medication does not address
the underlying respiratory failure. Elevating the head of the bed is helpful but insufficient
without immediate oxygen delivery.
Question 2: A nurse is caring for a client admitted with severe vomiting over the past 3 days.
Arterial blood gas results reveal pH 7.50, PaCO2 48 mmHg, and HCO3 29 mEq/L. How should
the nurse interpret these results?
A) Respiratory acidosis with renal compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis uncompensated
D) D) Metabolic alkalosis with partial respiratory compensation
Rationale: The pH is elevated at 7.50, indicating alkalosis. The HCO3 is elevated at 29 mEq/L,
indicating a primary metabolic cause (excess base from loss of gastric acid via vomiting). The
PaCO2 is elevated at 48 mmHg, indicating that the respiratory system is attempting to
compensate by hypoventilating to retain carbon dioxide, which means compensation is partial.
Therefore, the interpretation is metabolic alkalosis with partial respiratory compensation.
Question 3: A nurse is assessing a client who is receiving a continuous intravenous infusion of
regular insulin for diabetic ketoacidosis. Which electrolyte value requires the most immediate
intervention by the nurse?
A) Sodium 138 mEq/L
B) C) Potassium 2.9 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 1.8 mG/dL
Rationale: Insulin drives potassium back into the cells alongside glucose, which can cause a
rapid drop in serum potassium levels. A potassium level of 2.9 mEq/L is critically low and poses
a severe risk for life-threatening cardiac dysrhythmias. Insulin infusion must be paused, and
potassium replacement must be administered immediately according to protocol before resuming
insulin. The other electrolyte values are within or near normal limits.
Question 4: A nurse is developing a care plan for a client who has a Stage 3 pressure injury on
the sacrum. Which of the following interventions should be included in the plan?
A) Clean the wound using full-strength povidone-iodine solution during each dressing change
B) Massage the bony prominences surrounding the wound site every 2 hours to stimulate blood
flow
C) D) Cleanse the wound gently with normal saline solution and apply a prescribed
hydrocolloid or absorbent dressing
D) Expose the wound bed to dry air for one hour twice daily to promote scab formation
,Page |3
Rationale: Stage 3 pressure injuries involve full-thickness skin loss with damage to
subcutaneous tissue. Cleaning should be performed using gentle, non-cytotoxic solutions such as
normal saline rather than harsh antiseptics like povidone-iodine, which damage healthy
granulation tissue. Moist wound healing is standard practice; exposing the wound to dry air
delays healing. Massaging bony prominences is contraindicated because it damages underlying
capillaries and deep tissue.
Question 5: A client is scheduled for a total hip arthroplasty in the morning. During the pre-
operative assessment, the client expresses extreme fear about the surgery and states they want to
cancel it. Which of the following is the most appropriate initial response by the nurse?
A) Reassure the client that the surgical team is highly experienced and complications are rare
B) C) Explore the client's specific concerns and fears regarding the procedure
C) Notify the surgeon immediately that the client is refusing the scheduled operation
D) Administer the pre-operative sedative medication to help calm the client's anxiety
Rationale: The therapeutic nursing response to expressed fear or hesitation is to explore the
client's specific concerns. Active listening and open-ended communication allow the nurse to
identify misconceptions or address specific anxieties before involving the provider or
proceeding. Reassuring prematurely dismisses the client's feelings. Sedatives should not be given
to force compliance before informed consent and therapeutic communication are addressed.
Notifying the surgeon of cancellation is premature before exploring the root cause of the anxiety.
Question 6: A nurse is caring for a client with heart failure who is prescribed furosemide 40 mg
PO daily. Which of the following assessment findings indicates the medication is effective?
A) Blood pressure reading of 140/90 mmHg
B) C) Daily weight loss of 2 kilograms and decreased peripheral edema
C) Serum potassium level of 3.2 mEq/L
D) Client report of increased thirst and dry mucous membranes
Rationale: Furosemide is a loop diuretic designed to eliminate excess fluid volume in clients
with heart failure. Effective diuresis is best indicated by a downward trend in daily weight and a
reduction in peripheral edema and crackles in the lungs. A potassium level of 3.2 mEq/L
indicates hypokalemia, an adverse side effect rather than a sign of efficacy. Increased thirst and
dry mucous membranes may indicate dehydration rather than therapeutic balance.
Question 7: A client with chronic obstructive pulmonary disease is receiving supplemental
oxygen at 4 liters per minute via nasal cannula. The client becomes lethargic and confused, with
an arterial blood gas showing PaO2 95 mmHg and PaCO2 65 mmHg. Which physiological
mechanism explains this finding?
A) Increased metabolic rate producing excess carbon dioxide
B) C) Suppression of the hypoxic drive to breathe leading to carbon dioxide retention
D) Acute metabolic alkalosis caused by oxygen toxicity in the alveoli
C) Complete airway obstruction due to retained thick pulmonary secretions
Rationale: Clients with chronic obstructive pulmonary disease often rely on a hypoxic drive (low
oxygen levels stimulate breathing) rather than hypercapnic drive to regulate respiration.
Administering high-flow oxygen raises the arterial oxygen level, removing the stimulus to
breathe, leading to hypoventilation, severe carbon dioxide retention (hypercapnia), and carbon
, Page |4
dioxide narcosis. Oxygen flow rates for these clients should generally be kept low unless
specifically ordered otherwise.
Question 8: A nurse is preparing to administer digoxin 0.25 mg orally to a client with atrial
fibrillation. Prior to administering the medication, which assessment is most critical?
A) Measure the client's blood pressure in both arms
B) C) Auscultate the apical pulse for a full minute
C) Check the client's most recent serum sodium level
D) Assess the client for peripheral pitting edema in the lower extremities
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases myocardial
contractility. The nurse must auscultate the apical pulse for a full minute prior to administration
and withhold the dose if the heart rate is below 60 beats per minute in an adult. Blood pressure,
sodium, and peripheral edema assessments are important for overall cardiovascular status but
do not supersede the safety check for digoxin-induced bradycardia.
Question 9: A client is admitted to the medical-surgical unit with a diagnosis of acute
pancreatitis. Which of the following laboratory findings is most specifically elevated in this
condition?
A) Serum creatinine
B) C) Serum lipase
C) Alanine aminotransferase
D) White blood cell count
Rationale: Serum lipase and amylase are specific pancreatic enzymes that elevate significantly
during acute inflammation of the pancreas, with serum lipase remaining elevated longer and
providing higher specificity. While white blood cells may elevate due to inflammation and
creatinine due to renal involvement, serum lipase is the primary diagnostic marker for acute
pancreatitis.
Question 10: A nurse is caring for a client who has a newly placed tracheostomy tube with a
cuffed inner cannula. Which nursing intervention is essential for maintaining airway safety?
A) Deflate the cuff continuously to prevent tracheal necrosis
B) C) Maintain cuff pressure between 20 and 30 centimeters of water
C) Perform routine tracheostomy tube changes every 24 hours
D) Suction the tracheostomy airway vigorously for 20 seconds during each pass
Rationale: Maintaining appropriate cuff pressure between 20 and 30 centimeters of water (or 15
to 22 millimeters of mercury) is critical to prevent tracheal wall ischemia and necrosis while
ensuring an adequate seal for mechanical ventilation and preventing aspiration. Cuff pressure
should be monitored regularly. Routine tube changes are performed by advanced practitioners
or after the first established tract, usually not every 24 hours. Suctioning should never exceed 10
to 15 seconds per pass to prevent severe hypoxia.
Question 11: A client is prescribed warfarin therapy following a deep vein thrombosis. Which
dietary instruction should the nurse reinforce during client education?
A) Eliminate all green leafy vegetables from your daily meal plan
B) C) Maintain a consistent daily intake of foods containing vitamin K
C) Increase consumption of citrus fruits to enhance drug absorption
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 examination module for NU 136 Exam 2. This original
practice material is meticulously designed to align with official course objectives and modern
clinical nursing standards. This set covers fundamental medical-surgical concepts,
pharmacological interventions, fluid and electrolyte balances, perioperative nursing care, and
specialized patient monitoring techniques essential for safe clinical practice. Each scenario-
based question challenges your critical thinking, clinical judgment, and application of the
nursing process rather than rote memorization. Mastering these concepts is vital for nursing
students aiming to excel in their academic evaluations and build a robust foundation for safe,
evidence-based patient care. By engaging with these advanced questions and detailed rationales,
candidates will identify knowledge gaps, refine their clinical decision-making abilities, and gain
the confidence required to achieve an A+ grade on the official exam.
Core Domains Covered:
1. Perioperative Nursing Care: Preoperative assessment, intraoperative safety protocols, and
postoperative monitoring for complications such as hemorrhage and atelectasis.
2. Fluid, Electrolyte, and Acid-Base Balances: Identifying imbalances such as hyponatremia,
hyperkalemia, respiratory acidosis, and metabolic alkalosis, along with appropriate
interventions.
3. Pain Management and Comfort: Assessing acute and chronic pain, pharmacological
management via analgesics, and non-pharmacological comfort measures.
4. Wound Healing and Integumentary Integrity: Staging pressure injuries, evaluating wound
drainage, understanding primary and secondary intention healing, and preventing skin
breakdown.
5. Cardiovascular and Hemodynamic Monitoring: Recognizing signs of heart failure,
hypertension, peripheral vascular disease, and interpreting vital sign trends.
6. Respiratory Health and Oxygenation: Managing oxygen therapy delivery systems, assessing
breath sounds, and caring for patients with chronic obstructive pulmonary disease or
pneumonia.
7. Medication Administration and Safety: Applying the rights of medication administration,
calculating dosages safely, and monitoring adverse drug reactions.
Question 1: A 68-year-old post-operative patient on the surgical unit reports sudden shortness of
breath and pleuritic chest pain 3 days after abdominal surgery. Vital signs show heart rate 118
beats per minute, respiratory rate 28 breaths per minute, blood pressure 100/64 mmHg, and
oxygen saturation 88 percent on room air. Which of the following is the priority nursing action?
A) Administer prescribed oral pain medication for the chest discomfort
,Page |2
B) C) Apply supplemental oxygen via nasal cannula and notify the rapid response team
C) Elevate the head of the bed and encourage deep breathing exercises
D) Obtain a 12-lead electrocardiogram to rule out myocardial infarction
Rationale: The patient is exhibiting classic signs of a pulmonary embolism (tachycardia,
tachypnea, hypoxemia, and pleuritic chest pain following surgery). The priority nursing action
according to the ABCDE framework is to immediately apply supplemental oxygen to correct
hypoxemia and notify the rapid response team or provider for emergency intervention. While an
ECG is useful, oxygenation and stabilization take precedence. Pain medication does not address
the underlying respiratory failure. Elevating the head of the bed is helpful but insufficient
without immediate oxygen delivery.
Question 2: A nurse is caring for a client admitted with severe vomiting over the past 3 days.
Arterial blood gas results reveal pH 7.50, PaCO2 48 mmHg, and HCO3 29 mEq/L. How should
the nurse interpret these results?
A) Respiratory acidosis with renal compensation
B) Metabolic acidosis with respiratory compensation
C) Respiratory alkalosis uncompensated
D) D) Metabolic alkalosis with partial respiratory compensation
Rationale: The pH is elevated at 7.50, indicating alkalosis. The HCO3 is elevated at 29 mEq/L,
indicating a primary metabolic cause (excess base from loss of gastric acid via vomiting). The
PaCO2 is elevated at 48 mmHg, indicating that the respiratory system is attempting to
compensate by hypoventilating to retain carbon dioxide, which means compensation is partial.
Therefore, the interpretation is metabolic alkalosis with partial respiratory compensation.
Question 3: A nurse is assessing a client who is receiving a continuous intravenous infusion of
regular insulin for diabetic ketoacidosis. Which electrolyte value requires the most immediate
intervention by the nurse?
A) Sodium 138 mEq/L
B) C) Potassium 2.9 mEq/L
C) Calcium 9.2 mg/dL
D) Magnesium 1.8 mG/dL
Rationale: Insulin drives potassium back into the cells alongside glucose, which can cause a
rapid drop in serum potassium levels. A potassium level of 2.9 mEq/L is critically low and poses
a severe risk for life-threatening cardiac dysrhythmias. Insulin infusion must be paused, and
potassium replacement must be administered immediately according to protocol before resuming
insulin. The other electrolyte values are within or near normal limits.
Question 4: A nurse is developing a care plan for a client who has a Stage 3 pressure injury on
the sacrum. Which of the following interventions should be included in the plan?
A) Clean the wound using full-strength povidone-iodine solution during each dressing change
B) Massage the bony prominences surrounding the wound site every 2 hours to stimulate blood
flow
C) D) Cleanse the wound gently with normal saline solution and apply a prescribed
hydrocolloid or absorbent dressing
D) Expose the wound bed to dry air for one hour twice daily to promote scab formation
,Page |3
Rationale: Stage 3 pressure injuries involve full-thickness skin loss with damage to
subcutaneous tissue. Cleaning should be performed using gentle, non-cytotoxic solutions such as
normal saline rather than harsh antiseptics like povidone-iodine, which damage healthy
granulation tissue. Moist wound healing is standard practice; exposing the wound to dry air
delays healing. Massaging bony prominences is contraindicated because it damages underlying
capillaries and deep tissue.
Question 5: A client is scheduled for a total hip arthroplasty in the morning. During the pre-
operative assessment, the client expresses extreme fear about the surgery and states they want to
cancel it. Which of the following is the most appropriate initial response by the nurse?
A) Reassure the client that the surgical team is highly experienced and complications are rare
B) C) Explore the client's specific concerns and fears regarding the procedure
C) Notify the surgeon immediately that the client is refusing the scheduled operation
D) Administer the pre-operative sedative medication to help calm the client's anxiety
Rationale: The therapeutic nursing response to expressed fear or hesitation is to explore the
client's specific concerns. Active listening and open-ended communication allow the nurse to
identify misconceptions or address specific anxieties before involving the provider or
proceeding. Reassuring prematurely dismisses the client's feelings. Sedatives should not be given
to force compliance before informed consent and therapeutic communication are addressed.
Notifying the surgeon of cancellation is premature before exploring the root cause of the anxiety.
Question 6: A nurse is caring for a client with heart failure who is prescribed furosemide 40 mg
PO daily. Which of the following assessment findings indicates the medication is effective?
A) Blood pressure reading of 140/90 mmHg
B) C) Daily weight loss of 2 kilograms and decreased peripheral edema
C) Serum potassium level of 3.2 mEq/L
D) Client report of increased thirst and dry mucous membranes
Rationale: Furosemide is a loop diuretic designed to eliminate excess fluid volume in clients
with heart failure. Effective diuresis is best indicated by a downward trend in daily weight and a
reduction in peripheral edema and crackles in the lungs. A potassium level of 3.2 mEq/L
indicates hypokalemia, an adverse side effect rather than a sign of efficacy. Increased thirst and
dry mucous membranes may indicate dehydration rather than therapeutic balance.
Question 7: A client with chronic obstructive pulmonary disease is receiving supplemental
oxygen at 4 liters per minute via nasal cannula. The client becomes lethargic and confused, with
an arterial blood gas showing PaO2 95 mmHg and PaCO2 65 mmHg. Which physiological
mechanism explains this finding?
A) Increased metabolic rate producing excess carbon dioxide
B) C) Suppression of the hypoxic drive to breathe leading to carbon dioxide retention
D) Acute metabolic alkalosis caused by oxygen toxicity in the alveoli
C) Complete airway obstruction due to retained thick pulmonary secretions
Rationale: Clients with chronic obstructive pulmonary disease often rely on a hypoxic drive (low
oxygen levels stimulate breathing) rather than hypercapnic drive to regulate respiration.
Administering high-flow oxygen raises the arterial oxygen level, removing the stimulus to
breathe, leading to hypoventilation, severe carbon dioxide retention (hypercapnia), and carbon
, Page |4
dioxide narcosis. Oxygen flow rates for these clients should generally be kept low unless
specifically ordered otherwise.
Question 8: A nurse is preparing to administer digoxin 0.25 mg orally to a client with atrial
fibrillation. Prior to administering the medication, which assessment is most critical?
A) Measure the client's blood pressure in both arms
B) C) Auscultate the apical pulse for a full minute
C) Check the client's most recent serum sodium level
D) Assess the client for peripheral pitting edema in the lower extremities
Rationale: Digoxin is a cardiac glycoside that slows the heart rate and increases myocardial
contractility. The nurse must auscultate the apical pulse for a full minute prior to administration
and withhold the dose if the heart rate is below 60 beats per minute in an adult. Blood pressure,
sodium, and peripheral edema assessments are important for overall cardiovascular status but
do not supersede the safety check for digoxin-induced bradycardia.
Question 9: A client is admitted to the medical-surgical unit with a diagnosis of acute
pancreatitis. Which of the following laboratory findings is most specifically elevated in this
condition?
A) Serum creatinine
B) C) Serum lipase
C) Alanine aminotransferase
D) White blood cell count
Rationale: Serum lipase and amylase are specific pancreatic enzymes that elevate significantly
during acute inflammation of the pancreas, with serum lipase remaining elevated longer and
providing higher specificity. While white blood cells may elevate due to inflammation and
creatinine due to renal involvement, serum lipase is the primary diagnostic marker for acute
pancreatitis.
Question 10: A nurse is caring for a client who has a newly placed tracheostomy tube with a
cuffed inner cannula. Which nursing intervention is essential for maintaining airway safety?
A) Deflate the cuff continuously to prevent tracheal necrosis
B) C) Maintain cuff pressure between 20 and 30 centimeters of water
C) Perform routine tracheostomy tube changes every 24 hours
D) Suction the tracheostomy airway vigorously for 20 seconds during each pass
Rationale: Maintaining appropriate cuff pressure between 20 and 30 centimeters of water (or 15
to 22 millimeters of mercury) is critical to prevent tracheal wall ischemia and necrosis while
ensuring an adequate seal for mechanical ventilation and preventing aspiration. Cuff pressure
should be monitored regularly. Routine tube changes are performed by advanced practitioners
or after the first established tract, usually not every 24 hours. Suctioning should never exceed 10
to 15 seconds per pass to prevent severe hypoxia.
Question 11: A client is prescribed warfarin therapy following a deep vein thrombosis. Which
dietary instruction should the nurse reinforce during client education?
A) Eliminate all green leafy vegetables from your daily meal plan
B) C) Maintain a consistent daily intake of foods containing vitamin K
C) Increase consumption of citrus fruits to enhance drug absorption
