N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
N176 Exam 3 and Exam 4 Practice Bundle
2026–2027 • Original practice questions • Answers and detailed rationales
Scope note: N176 course content can differ by school and program. This resource is a broad adult-health/practical-
nursing practice set, not a verified match to a specific syllabus, and it is not an official, leaked, or actual course exam.
How to use this resource
• Answer each question before reading the answer and rationale.
• Review why every distractor is incorrect, not only the correct option.
• Prioritize immediate safety, airway/breathing/circulation, acute change from baseline, and escalation when a client
deteriorates.
• Use your instructor's syllabus, assigned readings, medication references, and local protocols as the final authority.
Bundle contents and suggested study sequence
This bundle contains two separate practice exams with 50 original questions each (100 total), answer keys, detailed
rationales, explanations of incorrect options, and high-yield checklists.
1. First: complete Exam 3 without viewing the answer explanations.
2. Second: review every rationale and record weak topics.
3. Third: complete Exam 4 under timed conditions.
4. Fourth: revisit missed concepts using course materials and the checklists.
Exam 3 Practice Exam — Questions 1–50
57 original multiple-choice questions. Select the single best answer for each question.
Question 1. [Respiratory] A client with pneumonia becomes increasingly confused, restless, and tachypneic.
Which action should the nurse take first?
A. Obtain a complete dietary history
B. Assess oxygen saturation and respiratory effort
C. Encourage the client to walk in the hallway
D. Offer oral fluids and reassess in one hour
Correct answer: B. Assess oxygen saturation and respiratory effort
Detailed rationale: New confusion and restlessness can be early signs of hypoxemia. Rapid assessment of
oxygenation and work of breathing guides urgent intervention.
Why the other options are incorrect:
A. Dietary history does not address a possible immediate oxygenation problem.
C. Ambulation may worsen distress before oxygenation is assessed.
D. Waiting an hour delays recognition of possible respiratory deterioration.
───────────────────────────────────────────────────────
Question 2. [Respiratory] A client with COPD is receiving oxygen as prescribed and becomes drowsy. What is
the nurse's priority?
A. Remove oxygen without assessment
B. Assess respiratory status, oxygen saturation, and level of consciousness
C. Encourage the client to sleep
D. Increase oxygen flow independently to the maximum setting
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Correct answer: B. Assess respiratory status, oxygen saturation, and level of consciousness
Detailed rationale: A change in alertness may indicate worsening ventilation, hypoxemia, or hypercapnia. Assess
promptly and escalate care according to findings and prescribed parameters.
Why the other options are incorrect:
A. Abruptly removing prescribed oxygen can worsen hypoxemia.
C. Drowsiness is a change requiring assessment, not simply sleep.
D. Oxygen should not be independently increased to an arbitrary maximum; assess and follow orders/protocol.
───────────────────────────────────────────────────────
Question 3. [Respiratory] Which finding in a client with asthma requires immediate escalation?
A. Mild expiratory wheeze after exercise
B. Ability to speak in full sentences
C. Silent chest with severe respiratory effort
D. Occasional dry cough
Correct answer: C. Silent chest with severe respiratory effort
Detailed rationale: A silent chest during severe distress may mean minimal air movement and impending
respiratory failure; urgent emergency response is required.
Why the other options are incorrect:
A. Mild wheezing after exertion can occur and still requires assessment, but is less alarming than absent airflow.
B. Speaking in full sentences generally suggests less severe distress.
D. An occasional dry cough alone is not the most urgent finding.
───────────────────────────────────────────────────────
Question 4. [Respiratory] A nurse is teaching incentive spirometer use after surgery. Which instruction is
correct?
A. Blow forcefully into the device
B. Inhale slowly and deeply through the mouthpiece, then briefly hold the breath
C. Use it only when short of breath
D. Lie flat and use it once daily
Correct answer: B. Inhale slowly and deeply through the mouthpiece, then briefly hold the breath
Detailed rationale: Slow sustained inhalation expands alveoli; a brief breath hold supports lung expansion.
Frequency should follow the care plan, often while awake.
Why the other options are incorrect:
A. The usual technique is slow inhalation, not forceful exhalation.
C. Use is preventive and scheduled, not only when symptoms occur.
D. Upright positioning supports expansion and once-daily use is generally insufficient.
───────────────────────────────────────────────────────
Question 5. [Cardiovascular] A client reports crushing chest pressure, diaphoresis, and nausea. What should
the nurse do first?
A. Ask the client to walk to the nurses' station
B. Activate the emergency response pathway and rapidly assess ABCs
C. Give a large meal to reduce nausea
D. Document the report and reassess at the end of the shift
Correct answer: B. Activate the emergency response pathway and rapidly assess ABCs
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Detailed rationale: These symptoms may indicate acute coronary syndrome. Immediate assessment and
emergency escalation are needed; follow facility protocol for ECG and prescribed therapies.
Why the other options are incorrect:
A. Exertion may worsen ischemia and delays care.
C. Food is inappropriate during an acute possible cardiac event and may complicate procedures.
D. Delayed reassessment is unsafe.
───────────────────────────────────────────────────────
Question 6. [Cardiovascular] Which assessment finding is most consistent with worsening left-sided heart
failure?
A. Increasing crackles and orthopnea
B. Dry skin on both hands
C. Improved exercise tolerance
D. Urine that is pale yellow
Correct answer: A. Increasing crackles and orthopnea
Detailed rationale: Left-sided heart failure can cause pulmonary congestion, crackles, dyspnea, and orthopnea. A
worsening respiratory pattern warrants prompt assessment.
Why the other options are incorrect:
B. Dry hands are nonspecific and do not indicate pulmonary congestion.
C. Improved tolerance suggests improvement, not worsening.
D. Urine color alone does not establish heart-failure severity.
───────────────────────────────────────────────────────
Question 7. [Cardiovascular] A client taking furosemide reports muscle weakness. Which laboratory value is
most important to review?
A. Potassium
B. Amylase
C. Hemoglobin A1c
D. Bilirubin
Correct answer: A. Potassium
Detailed rationale: Loop diuretics can increase potassium loss. Hypokalemia may cause weakness and
dysrhythmias, so potassium and related clinical findings need review.
Why the other options are incorrect:
B. Amylase is not the primary expected concern with loop-diuretic use.
C. A1c reflects longer-term glycemic control, not acute diuretic-related weakness.
D. Bilirubin is not the most relevant value for this medication concern.
───────────────────────────────────────────────────────
Question 8. [Cardiovascular] A client with peripheral arterial disease reports leg pain while walking that
improves with rest. The nurse recognizes this as:
A. Intermittent claudication
B. Venous stasis dermatitis
C. Acute compartment syndrome
D. Neuropathic pain from shingles
Correct answer: A. Intermittent claudication
Detailed rationale: Exertional leg pain relieved by rest is classic intermittent claudication caused by inadequate
arterial blood flow during activity.
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Why the other options are incorrect:
B. Venous stasis dermatitis is associated with chronic venous insufficiency and skin changes.
C. Compartment syndrome is an acute limb-threatening condition with escalating pain and tense swelling.
D. Shingles-related neuropathic pain follows a dermatomal pattern and is not defined by exertion.
───────────────────────────────────────────────────────
Question 9. [Cardiovascular] Which action is appropriate when measuring orthostatic vital signs?
A. Measure only while the client is lying down
B. Compare blood pressure and pulse across lying, sitting, and standing positions per protocol
C. Ask the client to stand quickly without assistance
D. Record only the highest blood pressure
Correct answer: B. Compare blood pressure and pulse across lying, sitting, and standing positions per protocol
Detailed rationale: Comparing measurements by position and observing symptoms can identify orthostatic
changes. Assist the client to reduce fall risk.
Why the other options are incorrect:
A. A single lying measurement cannot identify positional change.
C. Rapid unsupported standing increases fall risk.
D. All relevant measurements and symptoms should be documented.
───────────────────────────────────────────────────────
Question 10. [Endocrine] A client with diabetes is shaky, sweaty, and confused. The nurse suspects
hypoglycemia. If the client is awake and can swallow safely, what is the best initial action?
A. Give a rapid-acting carbohydrate according to protocol
B. Administer the scheduled insulin dose
C. Encourage exercise
D. Withhold all carbohydrates for one hour
Correct answer: A. Give a rapid-acting carbohydrate according to protocol
Detailed rationale: Symptoms suggest low blood glucose. If swallowing is safe, give a fast-acting carbohydrate per
protocol and recheck glucose at the recommended interval.
Why the other options are incorrect:
B. Insulin may worsen hypoglycemia.
C. Exercise can further lower glucose.
D. Withholding carbohydrate delays correction of a potentially dangerous low glucose.
───────────────────────────────────────────────────────
Question 11. [Endocrine] Which finding is most concerning for diabetic ketoacidosis?
A. Fruity breath with deep, rapid respirations and dehydration
B. Mild hunger before lunch
C. A single normal temperature reading
D. A healed abrasion on the forearm
Correct answer: A. Fruity breath with deep, rapid respirations and dehydration
Detailed rationale: DKA may cause dehydration, fruity breath, and Kussmaul respirations from metabolic acidosis.
It requires urgent treatment and monitoring.
Why the other options are incorrect:
B. Hunger alone is nonspecific.
C. A normal temperature does not exclude DKA but is not the defining warning sign here.
Educational practice material • Not an official or verified examination
N176 Exam 3 and Exam 4 Practice Bundle
2026–2027 • Original practice questions • Answers and detailed rationales
Scope note: N176 course content can differ by school and program. This resource is a broad adult-health/practical-
nursing practice set, not a verified match to a specific syllabus, and it is not an official, leaked, or actual course exam.
How to use this resource
• Answer each question before reading the answer and rationale.
• Review why every distractor is incorrect, not only the correct option.
• Prioritize immediate safety, airway/breathing/circulation, acute change from baseline, and escalation when a client
deteriorates.
• Use your instructor's syllabus, assigned readings, medication references, and local protocols as the final authority.
Bundle contents and suggested study sequence
This bundle contains two separate practice exams with 50 original questions each (100 total), answer keys, detailed
rationales, explanations of incorrect options, and high-yield checklists.
1. First: complete Exam 3 without viewing the answer explanations.
2. Second: review every rationale and record weak topics.
3. Third: complete Exam 4 under timed conditions.
4. Fourth: revisit missed concepts using course materials and the checklists.
Exam 3 Practice Exam — Questions 1–50
57 original multiple-choice questions. Select the single best answer for each question.
Question 1. [Respiratory] A client with pneumonia becomes increasingly confused, restless, and tachypneic.
Which action should the nurse take first?
A. Obtain a complete dietary history
B. Assess oxygen saturation and respiratory effort
C. Encourage the client to walk in the hallway
D. Offer oral fluids and reassess in one hour
Correct answer: B. Assess oxygen saturation and respiratory effort
Detailed rationale: New confusion and restlessness can be early signs of hypoxemia. Rapid assessment of
oxygenation and work of breathing guides urgent intervention.
Why the other options are incorrect:
A. Dietary history does not address a possible immediate oxygenation problem.
C. Ambulation may worsen distress before oxygenation is assessed.
D. Waiting an hour delays recognition of possible respiratory deterioration.
───────────────────────────────────────────────────────
Question 2. [Respiratory] A client with COPD is receiving oxygen as prescribed and becomes drowsy. What is
the nurse's priority?
A. Remove oxygen without assessment
B. Assess respiratory status, oxygen saturation, and level of consciousness
C. Encourage the client to sleep
D. Increase oxygen flow independently to the maximum setting
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Correct answer: B. Assess respiratory status, oxygen saturation, and level of consciousness
Detailed rationale: A change in alertness may indicate worsening ventilation, hypoxemia, or hypercapnia. Assess
promptly and escalate care according to findings and prescribed parameters.
Why the other options are incorrect:
A. Abruptly removing prescribed oxygen can worsen hypoxemia.
C. Drowsiness is a change requiring assessment, not simply sleep.
D. Oxygen should not be independently increased to an arbitrary maximum; assess and follow orders/protocol.
───────────────────────────────────────────────────────
Question 3. [Respiratory] Which finding in a client with asthma requires immediate escalation?
A. Mild expiratory wheeze after exercise
B. Ability to speak in full sentences
C. Silent chest with severe respiratory effort
D. Occasional dry cough
Correct answer: C. Silent chest with severe respiratory effort
Detailed rationale: A silent chest during severe distress may mean minimal air movement and impending
respiratory failure; urgent emergency response is required.
Why the other options are incorrect:
A. Mild wheezing after exertion can occur and still requires assessment, but is less alarming than absent airflow.
B. Speaking in full sentences generally suggests less severe distress.
D. An occasional dry cough alone is not the most urgent finding.
───────────────────────────────────────────────────────
Question 4. [Respiratory] A nurse is teaching incentive spirometer use after surgery. Which instruction is
correct?
A. Blow forcefully into the device
B. Inhale slowly and deeply through the mouthpiece, then briefly hold the breath
C. Use it only when short of breath
D. Lie flat and use it once daily
Correct answer: B. Inhale slowly and deeply through the mouthpiece, then briefly hold the breath
Detailed rationale: Slow sustained inhalation expands alveoli; a brief breath hold supports lung expansion.
Frequency should follow the care plan, often while awake.
Why the other options are incorrect:
A. The usual technique is slow inhalation, not forceful exhalation.
C. Use is preventive and scheduled, not only when symptoms occur.
D. Upright positioning supports expansion and once-daily use is generally insufficient.
───────────────────────────────────────────────────────
Question 5. [Cardiovascular] A client reports crushing chest pressure, diaphoresis, and nausea. What should
the nurse do first?
A. Ask the client to walk to the nurses' station
B. Activate the emergency response pathway and rapidly assess ABCs
C. Give a large meal to reduce nausea
D. Document the report and reassess at the end of the shift
Correct answer: B. Activate the emergency response pathway and rapidly assess ABCs
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Detailed rationale: These symptoms may indicate acute coronary syndrome. Immediate assessment and
emergency escalation are needed; follow facility protocol for ECG and prescribed therapies.
Why the other options are incorrect:
A. Exertion may worsen ischemia and delays care.
C. Food is inappropriate during an acute possible cardiac event and may complicate procedures.
D. Delayed reassessment is unsafe.
───────────────────────────────────────────────────────
Question 6. [Cardiovascular] Which assessment finding is most consistent with worsening left-sided heart
failure?
A. Increasing crackles and orthopnea
B. Dry skin on both hands
C. Improved exercise tolerance
D. Urine that is pale yellow
Correct answer: A. Increasing crackles and orthopnea
Detailed rationale: Left-sided heart failure can cause pulmonary congestion, crackles, dyspnea, and orthopnea. A
worsening respiratory pattern warrants prompt assessment.
Why the other options are incorrect:
B. Dry hands are nonspecific and do not indicate pulmonary congestion.
C. Improved tolerance suggests improvement, not worsening.
D. Urine color alone does not establish heart-failure severity.
───────────────────────────────────────────────────────
Question 7. [Cardiovascular] A client taking furosemide reports muscle weakness. Which laboratory value is
most important to review?
A. Potassium
B. Amylase
C. Hemoglobin A1c
D. Bilirubin
Correct answer: A. Potassium
Detailed rationale: Loop diuretics can increase potassium loss. Hypokalemia may cause weakness and
dysrhythmias, so potassium and related clinical findings need review.
Why the other options are incorrect:
B. Amylase is not the primary expected concern with loop-diuretic use.
C. A1c reflects longer-term glycemic control, not acute diuretic-related weakness.
D. Bilirubin is not the most relevant value for this medication concern.
───────────────────────────────────────────────────────
Question 8. [Cardiovascular] A client with peripheral arterial disease reports leg pain while walking that
improves with rest. The nurse recognizes this as:
A. Intermittent claudication
B. Venous stasis dermatitis
C. Acute compartment syndrome
D. Neuropathic pain from shingles
Correct answer: A. Intermittent claudication
Detailed rationale: Exertional leg pain relieved by rest is classic intermittent claudication caused by inadequate
arterial blood flow during activity.
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Why the other options are incorrect:
B. Venous stasis dermatitis is associated with chronic venous insufficiency and skin changes.
C. Compartment syndrome is an acute limb-threatening condition with escalating pain and tense swelling.
D. Shingles-related neuropathic pain follows a dermatomal pattern and is not defined by exertion.
───────────────────────────────────────────────────────
Question 9. [Cardiovascular] Which action is appropriate when measuring orthostatic vital signs?
A. Measure only while the client is lying down
B. Compare blood pressure and pulse across lying, sitting, and standing positions per protocol
C. Ask the client to stand quickly without assistance
D. Record only the highest blood pressure
Correct answer: B. Compare blood pressure and pulse across lying, sitting, and standing positions per protocol
Detailed rationale: Comparing measurements by position and observing symptoms can identify orthostatic
changes. Assist the client to reduce fall risk.
Why the other options are incorrect:
A. A single lying measurement cannot identify positional change.
C. Rapid unsupported standing increases fall risk.
D. All relevant measurements and symptoms should be documented.
───────────────────────────────────────────────────────
Question 10. [Endocrine] A client with diabetes is shaky, sweaty, and confused. The nurse suspects
hypoglycemia. If the client is awake and can swallow safely, what is the best initial action?
A. Give a rapid-acting carbohydrate according to protocol
B. Administer the scheduled insulin dose
C. Encourage exercise
D. Withhold all carbohydrates for one hour
Correct answer: A. Give a rapid-acting carbohydrate according to protocol
Detailed rationale: Symptoms suggest low blood glucose. If swallowing is safe, give a fast-acting carbohydrate per
protocol and recheck glucose at the recommended interval.
Why the other options are incorrect:
B. Insulin may worsen hypoglycemia.
C. Exercise can further lower glucose.
D. Withholding carbohydrate delays correction of a potentially dangerous low glucose.
───────────────────────────────────────────────────────
Question 11. [Endocrine] Which finding is most concerning for diabetic ketoacidosis?
A. Fruity breath with deep, rapid respirations and dehydration
B. Mild hunger before lunch
C. A single normal temperature reading
D. A healed abrasion on the forearm
Correct answer: A. Fruity breath with deep, rapid respirations and dehydration
Detailed rationale: DKA may cause dehydration, fruity breath, and Kussmaul respirations from metabolic acidosis.
It requires urgent treatment and monitoring.
Why the other options are incorrect:
B. Hunger alone is nonspecific.
C. A normal temperature does not exclude DKA but is not the defining warning sign here.
Educational practice material • Not an official or verified examination
