N176 MIDTERM EXAM PRACTICE QUESTIONS & STUDY GUIDE • 2026–2027
N176 Midterm Exam Practice Questions & Study
Guide
2026–2027 Edition
Note: This practice resource is created for educational preparation. N176 course titles vary by
institution (e.g., Advanced Nursing Lab, Mental Health Nursing Clinical, Concepts of Adult
Health Nursing). The content below reflects core medical-surgical and fundamental nursing
concepts commonly assessed in midterm examinations.
Section 1: Perioperative Nursing Care
Question 1
A nurse is preparing a patient for surgery. Which task is the primary responsibility of the nurse
regarding informed consent?
A. Explaining the risks and benefits of the procedure to the patient
B. Deciding whether the patient requires surgery
C. Witnessing the patient sign the consent form
D. Discussing alternative treatment options with the patient
Correct Answer: C
Rationale: The nurse's legal role in informed consent is limited to witnessing the patient's
signature and verifying that the patient appears competent to provide consent . If the nurse
suspects the patient does not understand the procedure, the nurse must notify the surgeon
before witnessing the signature.
Why other options are incorrect:
• A: Explaining risks and benefits is the surgeon's legal responsibility, not the nurse's.
• B: Deciding whether surgery is required is a medical decision made by the surgeon.
• D: Discussing alternative treatments is also the surgeon's responsibility during the
informed consent process.
Question 2
A post-operative patient reports a "popping" sensation at the abdominal incision after coughing.
The nurse notes that the wound has opened and internal organs are visible. Which is the priority
action?
A. Apply a dry sterile dressing immediately
B. Cover the wound with sterile dressings soaked in normal saline
C. Place the patient in a High-Fowler's position
D. Push the organs back into the abdominal cavity
Correct Answer: B
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, N176 MIDTERM EXAM PRACTICE QUESTIONS & STUDY GUIDE • 2026–2027
Rationale: This scenario describes evisceration, a surgical emergency. The priority is to
cover the exposed organs with sterile dressings moistened with sterile normal saline to
prevent tissue drying and necrosis . The nurse should also notify the surgeon immediately
and position the patient in low-Fowler's with knees flexed to reduce abdominal tension.
Why other options are incorrect:
• A: A dry dressing would cause the exposed organs to adhere and dry out, worsening
tissue damage.
• C: High-Fowler's increases abdominal tension, which can worsen the evisceration.
• D: Never push organs back into the cavity; this causes severe infection and tissue
damage.
Question 3
A nurse is caring for a patient scheduled for surgery. Which finding requires immediate
notification of the surgeon?
A. Blood pressure 130/80 mmHg
B. Temperature 101.2°F
C. Heart rate 88 bpm
D. Respiratory rate 18 breaths/min
Correct Answer: B
Rationale: An elevated temperature may indicate an active infection, which increases
surgical risk and warrants immediate medical evaluation to determine if surgery should be
postponed . Normal vital signs do not require urgent notification.
Why other options are incorrect:
• A, C, D: All are within normal adult parameters and do not require immediate surgeon
notification.
Question 4
A nurse is assessing a patient in the PACU. Which assessment finding is the highest priority?
A. Oxygen saturation 88% on room air
B. Patient reports incisional pain 6/10
C. Urinary output 30 mL/hr
D. Surgical dressing dry and intact
Correct Answer: A
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, oxygenation is
always the highest priority. An SpO₂ of 88% indicates hypoxemia requiring immediate
intervention . Pain, urinary output, and dressing integrity are important but secondary.
Why other options are incorrect:
• B: Pain management is important but not life-threatening.
• C: 30 mL/hr is within acceptable post-operative range.
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, N176 MIDTERM EXAM PRACTICE QUESTIONS & STUDY GUIDE • 2026–2027
• D: A dry, intact dressing is a normal, expected finding.
Section 2: Fluid, Electrolyte & Acid-Base Balance
Question 5
Which clinical manifestation should a nurse expect in a patient with a potassium level of 2.8
mEq/L?
A. Muscle weakness and cardiac dysrhythmias
B. Peaked T waves on EKG
C. Increased deep tendon reflexes
D. Positive Trousseau's sign
Correct Answer: A
Rationale: A potassium level of 2.8 mEq/L indicates hypokalemia. Potassium is essential
for electrical conduction in the heart and muscle contraction. Common manifestations
include muscle weakness, leg cramps, and cardiac dysrhythmias .
Why other options are incorrect:
• B: Peaked T waves are associated with hyperkalemia.
• C: Hypokalemia causes decreased (not increased) deep tendon reflexes.
• D: Trousseau's sign is associated with hypocalcemia.
Question 6
A patient's ABG results are: pH 7.25, PaCO₂ 50, HCO₃ 24. How should the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Correct Answer: B
Rationale: The pH of 7.25 is below normal (7.35–7.45), indicating acidosis. The PaCO₂ of 50
is elevated above normal (35–45), while HCO₃ is within normal limits. Because the elevated
PaCO₂ matches the acidic pH, this represents respiratory acidosis, typically caused by
hypoventilation .
Why other options are incorrect:
• A: Metabolic acidosis would show decreased HCO₃.
• C: Respiratory alkalosis would show elevated pH and decreased PaCO₂.
• D: Metabolic alkalosis would show elevated pH and elevated HCO₃.
Question 7
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, N176 MIDTERM EXAM PRACTICE QUESTIONS & STUDY GUIDE • 2026–2027
A nurse is assessing a patient for fluid volume excess. Which finding is most consistent with this
diagnosis?
A. Sunken eyeballs and dry mucous membranes
B. Decreased blood pressure and rapid pulse
C. Crackles in the lungs and peripheral edema
D. Poor skin turgor and weight loss
Correct Answer: C
Rationale: Fluid volume excess (hypervolemia) results in pulmonary congestion (crackles)
and peripheral edema due to increased hydrostatic pressure and fluid shifting into
interstitial spaces.
Why other options are incorrect:
• A, B, D: These are classic signs of fluid volume deficit (dehydration/hypovolemia).
Question 8
A patient is prescribed furosemide for edema. Which laboratory value should the practical nurse
monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes excretion of potassium along with
water and sodium. Hypokalemia is a common and dangerous side effect that can lead to
cardiac arrhythmias .
Why other options are incorrect:
• A, C, D: While electrolytes should be monitored generally, potassium is the most critical
due to the risk of life-threatening dysrhythmias.
Section 3: Cardiovascular & Respiratory Nursing
Question 9
Which dietary instruction is most appropriate for a patient diagnosed with congestive heart
failure?
A. Increase intake of canned soups
B. Limit fluid intake to 4 liters per day
C. Increase intake of saturated fats
D. Follow a low-sodium diet
Correct Answer: D
N176 Midterm Exam Preparation | Page 4
N176 Midterm Exam Practice Questions & Study
Guide
2026–2027 Edition
Note: This practice resource is created for educational preparation. N176 course titles vary by
institution (e.g., Advanced Nursing Lab, Mental Health Nursing Clinical, Concepts of Adult
Health Nursing). The content below reflects core medical-surgical and fundamental nursing
concepts commonly assessed in midterm examinations.
Section 1: Perioperative Nursing Care
Question 1
A nurse is preparing a patient for surgery. Which task is the primary responsibility of the nurse
regarding informed consent?
A. Explaining the risks and benefits of the procedure to the patient
B. Deciding whether the patient requires surgery
C. Witnessing the patient sign the consent form
D. Discussing alternative treatment options with the patient
Correct Answer: C
Rationale: The nurse's legal role in informed consent is limited to witnessing the patient's
signature and verifying that the patient appears competent to provide consent . If the nurse
suspects the patient does not understand the procedure, the nurse must notify the surgeon
before witnessing the signature.
Why other options are incorrect:
• A: Explaining risks and benefits is the surgeon's legal responsibility, not the nurse's.
• B: Deciding whether surgery is required is a medical decision made by the surgeon.
• D: Discussing alternative treatments is also the surgeon's responsibility during the
informed consent process.
Question 2
A post-operative patient reports a "popping" sensation at the abdominal incision after coughing.
The nurse notes that the wound has opened and internal organs are visible. Which is the priority
action?
A. Apply a dry sterile dressing immediately
B. Cover the wound with sterile dressings soaked in normal saline
C. Place the patient in a High-Fowler's position
D. Push the organs back into the abdominal cavity
Correct Answer: B
N176 Midterm Exam Preparation | Page 1
, N176 MIDTERM EXAM PRACTICE QUESTIONS & STUDY GUIDE • 2026–2027
Rationale: This scenario describes evisceration, a surgical emergency. The priority is to
cover the exposed organs with sterile dressings moistened with sterile normal saline to
prevent tissue drying and necrosis . The nurse should also notify the surgeon immediately
and position the patient in low-Fowler's with knees flexed to reduce abdominal tension.
Why other options are incorrect:
• A: A dry dressing would cause the exposed organs to adhere and dry out, worsening
tissue damage.
• C: High-Fowler's increases abdominal tension, which can worsen the evisceration.
• D: Never push organs back into the cavity; this causes severe infection and tissue
damage.
Question 3
A nurse is caring for a patient scheduled for surgery. Which finding requires immediate
notification of the surgeon?
A. Blood pressure 130/80 mmHg
B. Temperature 101.2°F
C. Heart rate 88 bpm
D. Respiratory rate 18 breaths/min
Correct Answer: B
Rationale: An elevated temperature may indicate an active infection, which increases
surgical risk and warrants immediate medical evaluation to determine if surgery should be
postponed . Normal vital signs do not require urgent notification.
Why other options are incorrect:
• A, C, D: All are within normal adult parameters and do not require immediate surgeon
notification.
Question 4
A nurse is assessing a patient in the PACU. Which assessment finding is the highest priority?
A. Oxygen saturation 88% on room air
B. Patient reports incisional pain 6/10
C. Urinary output 30 mL/hr
D. Surgical dressing dry and intact
Correct Answer: A
Rationale: Using the ABC (Airway, Breathing, Circulation) priority framework, oxygenation is
always the highest priority. An SpO₂ of 88% indicates hypoxemia requiring immediate
intervention . Pain, urinary output, and dressing integrity are important but secondary.
Why other options are incorrect:
• B: Pain management is important but not life-threatening.
• C: 30 mL/hr is within acceptable post-operative range.
N176 Midterm Exam Preparation | Page 2
, N176 MIDTERM EXAM PRACTICE QUESTIONS & STUDY GUIDE • 2026–2027
• D: A dry, intact dressing is a normal, expected finding.
Section 2: Fluid, Electrolyte & Acid-Base Balance
Question 5
Which clinical manifestation should a nurse expect in a patient with a potassium level of 2.8
mEq/L?
A. Muscle weakness and cardiac dysrhythmias
B. Peaked T waves on EKG
C. Increased deep tendon reflexes
D. Positive Trousseau's sign
Correct Answer: A
Rationale: A potassium level of 2.8 mEq/L indicates hypokalemia. Potassium is essential
for electrical conduction in the heart and muscle contraction. Common manifestations
include muscle weakness, leg cramps, and cardiac dysrhythmias .
Why other options are incorrect:
• B: Peaked T waves are associated with hyperkalemia.
• C: Hypokalemia causes decreased (not increased) deep tendon reflexes.
• D: Trousseau's sign is associated with hypocalcemia.
Question 6
A patient's ABG results are: pH 7.25, PaCO₂ 50, HCO₃ 24. How should the nurse interpret these
findings?
A. Metabolic Acidosis
B. Respiratory Acidosis
C. Respiratory Alkalosis
D. Metabolic Alkalosis
Correct Answer: B
Rationale: The pH of 7.25 is below normal (7.35–7.45), indicating acidosis. The PaCO₂ of 50
is elevated above normal (35–45), while HCO₃ is within normal limits. Because the elevated
PaCO₂ matches the acidic pH, this represents respiratory acidosis, typically caused by
hypoventilation .
Why other options are incorrect:
• A: Metabolic acidosis would show decreased HCO₃.
• C: Respiratory alkalosis would show elevated pH and decreased PaCO₂.
• D: Metabolic alkalosis would show elevated pH and elevated HCO₃.
Question 7
N176 Midterm Exam Preparation | Page 3
, N176 MIDTERM EXAM PRACTICE QUESTIONS & STUDY GUIDE • 2026–2027
A nurse is assessing a patient for fluid volume excess. Which finding is most consistent with this
diagnosis?
A. Sunken eyeballs and dry mucous membranes
B. Decreased blood pressure and rapid pulse
C. Crackles in the lungs and peripheral edema
D. Poor skin turgor and weight loss
Correct Answer: C
Rationale: Fluid volume excess (hypervolemia) results in pulmonary congestion (crackles)
and peripheral edema due to increased hydrostatic pressure and fluid shifting into
interstitial spaces.
Why other options are incorrect:
• A, B, D: These are classic signs of fluid volume deficit (dehydration/hypovolemia).
Question 8
A patient is prescribed furosemide for edema. Which laboratory value should the practical nurse
monitor most closely?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Rationale: Furosemide is a loop diuretic that causes excretion of potassium along with
water and sodium. Hypokalemia is a common and dangerous side effect that can lead to
cardiac arrhythmias .
Why other options are incorrect:
• A, C, D: While electrolytes should be monitored generally, potassium is the most critical
due to the risk of life-threatening dysrhythmias.
Section 3: Cardiovascular & Respiratory Nursing
Question 9
Which dietary instruction is most appropriate for a patient diagnosed with congestive heart
failure?
A. Increase intake of canned soups
B. Limit fluid intake to 4 liters per day
C. Increase intake of saturated fats
D. Follow a low-sodium diet
Correct Answer: D
N176 Midterm Exam Preparation | Page 4
