N176 Exam 4 Study Guide 2026–2027
N176 Exam 4 Study Guide 2026–2027 | Key Concepts and Review
Disclaimer: This study guide is an independent educational resource developed by a nursing exam-
preparation writer. It is not affiliated with, endorsed by, or derived from any actual or leaked examination.
All content is based on standard nursing curricula for practical nursing programs (NUR/N176 level) and is
intended for study purposes only. Clinical decisions should always be based on current evidence-based
guidelines and institutional policy.
Neurological Disorders: Stroke and Multiple Sclerosis
Question 1
A client is admitted with sudden onset of right-sided hemiplegia and expressive aphasia. The
nurse suspects a stroke affecting which cerebral hemisphere?
A) Left hemisphere
B) Right hemisphere
C) Cerebellum
D) Brainstem
Correct Answer: A) Left hemisphere
Rationale: The left cerebral hemisphere controls the right side of the body and contains
Broca's area (speech production). Expressive aphasia (difficulty producing speech) and
right-sided weakness are classic presentations of a left hemispheric stroke . Right
hemispheric strokes typically present with left-sided paralysis, spatial-perceptual deficits,
and impulsive behavior.
Why the other options are incorrect:
B) Right hemisphere: A right CVA causes left-sided hemiplegia and spatial-perceptual deficits,
not expressive aphasia.
C) Cerebellum: Cerebellar strokes primarily affect balance, coordination, and ataxia, not
language or unilateral hemiplegia.
D) Brainstem: Brainstem strokes may cause cranial nerve deficits, altered consciousness, or
"locked-in" syndrome, but not the specific pattern of right hemiplegia with aphasia.
Question 2
The nurse is caring for a client with multiple sclerosis (MS). Which symptom should the nurse
anticipate as a common early manifestation?
A) Unilateral neglect
B) Diplopia and blurred vision
C) Expressive aphasia
D) Hemiplegia
Correct Answer: B) Diplopia and blurred vision
Rationale: Visual disturbances such as diplopia (double vision), blurred vision, and
nystagmus are common early symptoms of MS due to inflammation and demyelination of
N176 Exam 4 Study Guide 2026–2027 | Page 1
, N176 Exam 4 Study Guide 2026–2027
the optic nerve and brainstem pathways . Other early symptoms include sensory changes,
weakness, and ataxia.
Why the other options are incorrect:
A) Unilateral neglect: This is associated with right hemispheric strokes, not MS.
C) Expressive aphasia: Language deficits are not typical of MS; they suggest a left hemispheric
stroke.
D) Hemiplegia: MS typically causes generalized weakness or spasticity rather than sudden
complete hemiplegia.
Diabetes Mellitus: Diagnostic Criteria and Acute Complications
Question 3
Which laboratory finding is diagnostic for diabetes mellitus?
A) Fasting blood glucose of 110 mg/dL
B) Random blood glucose of 150 mg/dL
C) Fasting blood glucose of 126 mg/dL or higher
D) Hemoglobin A1C of 5.5%
Correct Answer: C) Fasting blood glucose of 126 mg/dL or higher
Rationale: The diagnostic criteria for diabetes include a fasting blood glucose of 126 mg/dL
or higher, a 2-hour postprandial glucose of 200 mg/dL or more during an oral glucose
tolerance test, a random glucose of 200 mg/dL or more with symptoms, or an HbA1c of
6.5% or higher .
Why the other options are incorrect:
A) 110 mg/dL: This falls within the prediabetes range (100–125 mg/dL fasting).
B) 150 mg/dL: A random glucose of 150 is not diagnostic without symptoms; the threshold is
200 mg/dL with symptoms.
D) HbA1c of 5.5%: This is within the normal range (below 5.7%); diabetes is diagnosed at 6.5%
or higher.
Question 4
A client with type 1 diabetes presents with blood glucose of 480 mg/dL, Kussmaul respirations,
and fruity breath. Which complication should the nurse suspect?
A) Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemia
D) Somogyi effect
N176 Exam 4 Study Guide 2026–2027 | Page 2
, N176 Exam 4 Study Guide 2026–2027
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: DKA is characterized by hyperglycemia (typically >300 mg/dL), ketone
production, metabolic acidosis, Kussmaul respirations (deep, rapid breathing), and fruity
acetone breath . It occurs most commonly in type 1 diabetes due to absolute insulin
deficiency.
Why the other options are incorrect:
A) HHNS: This occurs primarily in type 2 diabetes, presents with severe hyperglycemia and
dehydration, but typically lacks significant ketosis and acidosis.
C) Hypoglycemia: Presents with blood glucose below 70 mg/dL, shakiness, diaphoresis, and
confusion—not hyperglycemia.
D) Somogyi effect: This refers to rebound hyperglycemia in the morning due to nocturnal
hypoglycemia, not an acute emergency presentation.
Question 5
The nurse is teaching a client about the 15/15 rule for managing hypoglycemia. Which
instruction is correct?
A) "Take 15 grams of carbohydrates and wait 15 minutes before checking your blood glucose."
B) "Take 15 units of insulin and recheck in 15 minutes."
C) "Eat 15 grams of protein and exercise for 15 minutes."
D) "Drink 15 ounces of water and rest for 15 minutes."
Correct Answer: A) "Take 15 grams of carbohydrates and wait 15 minutes before checking
your blood glucose."
Rationale: The 15/15 rule involves consuming 15 grams of a fast-acting carbohydrate (such
as 4 oz of juice or glucose tablets), waiting 15 minutes, and rechecking blood glucose. If still
below 70 mg/dL, repeat the process .
Why the other options are incorrect:
B) Insulin: Insulin lowers blood glucose and would worsen hypoglycemia.
C) Protein and exercise: Protein is not a fast-acting carbohydrate, and exercise can further
lower glucose.
D) Water and rest: Water does not raise blood glucose and is not a treatment for hypoglycemia.
Respiratory: Mechanical Ventilation
Question 6
A nurse is caring for a client on mechanical ventilation. Which finding best indicates proper
endotracheal (ET) tube placement?
A) Air emerges from the ET tube
B) Breath sounds are equal bilaterally
C) Breath sounds are auscultated over the epigastrium
D) Chest excursion is asymmetrical
N176 Exam 4 Study Guide 2026–2027 | Page 3
, N176 Exam 4 Study Guide 2026–2027
Correct Answer: B) Breath sounds are equal bilaterally
Rationale: Equal bilateral breath sounds indicate that the ET tube is properly positioned
above the carina and ventilating both lungs equally . This is confirmed alongside chest x-ray
and capnography.
Why the other options are incorrect:
A) Air emerges from the ET tube: This simply confirms the tube is in the airway, not that it is
positioned correctly (it could be in the esophagus with air movement).
C) Breath sounds over the epigastrium: This suggests esophageal intubation, which is a critical
complication.
D) Asymmetrical chest excursion: This suggests the tube has advanced too far (often into the
right mainstem bronchus), not correct placement.
Question 7
Which nursing intervention is appropriate for a client receiving mechanical ventilation?
A) Suctioning every hour to prevent complications
B) Applying soft wrist restraints as ordered
C) Monitoring the client's response to the ventilator
D) Maintaining the client in a supine position at all times
Correct Answer: C) Monitoring the client's response to the ventilator
Rationale: Continuous monitoring of the client's respiratory status, oxygen saturation, and
response to ventilator settings is a core nursing responsibility for ventilated clients . This
includes assessing lung sounds, work of breathing, and synchrony with the ventilator.
Why the other options are incorrect:
A) Suctioning every hour: Routine hourly suctioning is not recommended; suctioning should be
performed based on clinical indication (e.g., visible secretions, increased airway pressures).
B) Soft wrist restraints: Restraints are not a routine intervention and require specific indications
and provider orders; they are not a standard ventilator care measure.
D) Supine position: The head of the bed should be elevated 30–45 degrees to reduce the risk of
ventilator-associated pneumonia (VAP).
Musculoskeletal: Osteomyelitis and Compartment Syndrome
Question 8
A client with a femur fracture reports pain disproportionate to the injury, and the nurse notes
pallor and pulselessness in the affected extremity. Which complication should the nurse
suspect?
A) Fat embolism syndrome
B) Compartment syndrome
C) Osteomyelitis
D) Deep vein thrombosis
N176 Exam 4 Study Guide 2026–2027 | Page 4
N176 Exam 4 Study Guide 2026–2027 | Key Concepts and Review
Disclaimer: This study guide is an independent educational resource developed by a nursing exam-
preparation writer. It is not affiliated with, endorsed by, or derived from any actual or leaked examination.
All content is based on standard nursing curricula for practical nursing programs (NUR/N176 level) and is
intended for study purposes only. Clinical decisions should always be based on current evidence-based
guidelines and institutional policy.
Neurological Disorders: Stroke and Multiple Sclerosis
Question 1
A client is admitted with sudden onset of right-sided hemiplegia and expressive aphasia. The
nurse suspects a stroke affecting which cerebral hemisphere?
A) Left hemisphere
B) Right hemisphere
C) Cerebellum
D) Brainstem
Correct Answer: A) Left hemisphere
Rationale: The left cerebral hemisphere controls the right side of the body and contains
Broca's area (speech production). Expressive aphasia (difficulty producing speech) and
right-sided weakness are classic presentations of a left hemispheric stroke . Right
hemispheric strokes typically present with left-sided paralysis, spatial-perceptual deficits,
and impulsive behavior.
Why the other options are incorrect:
B) Right hemisphere: A right CVA causes left-sided hemiplegia and spatial-perceptual deficits,
not expressive aphasia.
C) Cerebellum: Cerebellar strokes primarily affect balance, coordination, and ataxia, not
language or unilateral hemiplegia.
D) Brainstem: Brainstem strokes may cause cranial nerve deficits, altered consciousness, or
"locked-in" syndrome, but not the specific pattern of right hemiplegia with aphasia.
Question 2
The nurse is caring for a client with multiple sclerosis (MS). Which symptom should the nurse
anticipate as a common early manifestation?
A) Unilateral neglect
B) Diplopia and blurred vision
C) Expressive aphasia
D) Hemiplegia
Correct Answer: B) Diplopia and blurred vision
Rationale: Visual disturbances such as diplopia (double vision), blurred vision, and
nystagmus are common early symptoms of MS due to inflammation and demyelination of
N176 Exam 4 Study Guide 2026–2027 | Page 1
, N176 Exam 4 Study Guide 2026–2027
the optic nerve and brainstem pathways . Other early symptoms include sensory changes,
weakness, and ataxia.
Why the other options are incorrect:
A) Unilateral neglect: This is associated with right hemispheric strokes, not MS.
C) Expressive aphasia: Language deficits are not typical of MS; they suggest a left hemispheric
stroke.
D) Hemiplegia: MS typically causes generalized weakness or spasticity rather than sudden
complete hemiplegia.
Diabetes Mellitus: Diagnostic Criteria and Acute Complications
Question 3
Which laboratory finding is diagnostic for diabetes mellitus?
A) Fasting blood glucose of 110 mg/dL
B) Random blood glucose of 150 mg/dL
C) Fasting blood glucose of 126 mg/dL or higher
D) Hemoglobin A1C of 5.5%
Correct Answer: C) Fasting blood glucose of 126 mg/dL or higher
Rationale: The diagnostic criteria for diabetes include a fasting blood glucose of 126 mg/dL
or higher, a 2-hour postprandial glucose of 200 mg/dL or more during an oral glucose
tolerance test, a random glucose of 200 mg/dL or more with symptoms, or an HbA1c of
6.5% or higher .
Why the other options are incorrect:
A) 110 mg/dL: This falls within the prediabetes range (100–125 mg/dL fasting).
B) 150 mg/dL: A random glucose of 150 is not diagnostic without symptoms; the threshold is
200 mg/dL with symptoms.
D) HbA1c of 5.5%: This is within the normal range (below 5.7%); diabetes is diagnosed at 6.5%
or higher.
Question 4
A client with type 1 diabetes presents with blood glucose of 480 mg/dL, Kussmaul respirations,
and fruity breath. Which complication should the nurse suspect?
A) Hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
B) Diabetic ketoacidosis (DKA)
C) Hypoglycemia
D) Somogyi effect
N176 Exam 4 Study Guide 2026–2027 | Page 2
, N176 Exam 4 Study Guide 2026–2027
Correct Answer: B) Diabetic ketoacidosis (DKA)
Rationale: DKA is characterized by hyperglycemia (typically >300 mg/dL), ketone
production, metabolic acidosis, Kussmaul respirations (deep, rapid breathing), and fruity
acetone breath . It occurs most commonly in type 1 diabetes due to absolute insulin
deficiency.
Why the other options are incorrect:
A) HHNS: This occurs primarily in type 2 diabetes, presents with severe hyperglycemia and
dehydration, but typically lacks significant ketosis and acidosis.
C) Hypoglycemia: Presents with blood glucose below 70 mg/dL, shakiness, diaphoresis, and
confusion—not hyperglycemia.
D) Somogyi effect: This refers to rebound hyperglycemia in the morning due to nocturnal
hypoglycemia, not an acute emergency presentation.
Question 5
The nurse is teaching a client about the 15/15 rule for managing hypoglycemia. Which
instruction is correct?
A) "Take 15 grams of carbohydrates and wait 15 minutes before checking your blood glucose."
B) "Take 15 units of insulin and recheck in 15 minutes."
C) "Eat 15 grams of protein and exercise for 15 minutes."
D) "Drink 15 ounces of water and rest for 15 minutes."
Correct Answer: A) "Take 15 grams of carbohydrates and wait 15 minutes before checking
your blood glucose."
Rationale: The 15/15 rule involves consuming 15 grams of a fast-acting carbohydrate (such
as 4 oz of juice or glucose tablets), waiting 15 minutes, and rechecking blood glucose. If still
below 70 mg/dL, repeat the process .
Why the other options are incorrect:
B) Insulin: Insulin lowers blood glucose and would worsen hypoglycemia.
C) Protein and exercise: Protein is not a fast-acting carbohydrate, and exercise can further
lower glucose.
D) Water and rest: Water does not raise blood glucose and is not a treatment for hypoglycemia.
Respiratory: Mechanical Ventilation
Question 6
A nurse is caring for a client on mechanical ventilation. Which finding best indicates proper
endotracheal (ET) tube placement?
A) Air emerges from the ET tube
B) Breath sounds are equal bilaterally
C) Breath sounds are auscultated over the epigastrium
D) Chest excursion is asymmetrical
N176 Exam 4 Study Guide 2026–2027 | Page 3
, N176 Exam 4 Study Guide 2026–2027
Correct Answer: B) Breath sounds are equal bilaterally
Rationale: Equal bilateral breath sounds indicate that the ET tube is properly positioned
above the carina and ventilating both lungs equally . This is confirmed alongside chest x-ray
and capnography.
Why the other options are incorrect:
A) Air emerges from the ET tube: This simply confirms the tube is in the airway, not that it is
positioned correctly (it could be in the esophagus with air movement).
C) Breath sounds over the epigastrium: This suggests esophageal intubation, which is a critical
complication.
D) Asymmetrical chest excursion: This suggests the tube has advanced too far (often into the
right mainstem bronchus), not correct placement.
Question 7
Which nursing intervention is appropriate for a client receiving mechanical ventilation?
A) Suctioning every hour to prevent complications
B) Applying soft wrist restraints as ordered
C) Monitoring the client's response to the ventilator
D) Maintaining the client in a supine position at all times
Correct Answer: C) Monitoring the client's response to the ventilator
Rationale: Continuous monitoring of the client's respiratory status, oxygen saturation, and
response to ventilator settings is a core nursing responsibility for ventilated clients . This
includes assessing lung sounds, work of breathing, and synchrony with the ventilator.
Why the other options are incorrect:
A) Suctioning every hour: Routine hourly suctioning is not recommended; suctioning should be
performed based on clinical indication (e.g., visible secretions, increased airway pressures).
B) Soft wrist restraints: Restraints are not a routine intervention and require specific indications
and provider orders; they are not a standard ventilator care measure.
D) Supine position: The head of the bed should be elevated 30–45 degrees to reduce the risk of
ventilator-associated pneumonia (VAP).
Musculoskeletal: Osteomyelitis and Compartment Syndrome
Question 8
A client with a femur fracture reports pain disproportionate to the injury, and the nurse notes
pallor and pulselessness in the affected extremity. Which complication should the nurse
suspect?
A) Fat embolism syndrome
B) Compartment syndrome
C) Osteomyelitis
D) Deep vein thrombosis
N176 Exam 4 Study Guide 2026–2027 | Page 4
