N170 | CLINICAL CASE STUDIES & PRACTICE QUESTIONS | 2026–2027
N170 CLINICAL CASE STUDIES
& PRACTICE QUESTIONS
2026–2027 | Nursing Clinical Judgment Review
10 clinical cases • 30 original multiple-choice questions • Answers, detailed rationales, and incorrect-option
explanations
Instructions
• Read each case and use the clinical details provided to select the single best answer for each question.
• Prioritize immediate threats, use focused assessment, escalate deterioration, and reassess after interventions.
• Review the rationale and each incorrect-option explanation after answering.
• This resource is original practice material, not an official, leaked, or verified N170 exam.
Clinical Cases and Questions
Case 1: Acute Respiratory Deterioration
Clinical scenario: A 68-year-old client admitted with pneumonia becomes increasingly restless. Respiratory rate is
32/min, oxygen saturation is 86% on the currently prescribed oxygen, and the client can speak only a few words at a
time.
Question 1. Which action has the highest priority?
A. Complete a detailed dietary history
B. Assess airway and breathing, call for urgent assistance, and follow the emergency oxygenation protocol
C. Encourage the client to walk to improve lung expansion
D. Wait 30 minutes and repeat the oxygen saturation
Correct Answer: B
Detailed Rationale: The client has significant hypoxemia and respiratory distress. Immediate focused
assessment and escalation are required; oxygen support should follow the prescribed plan and emergency
protocol.
Why the Other Options Are Incorrect
A. Dietary history is not the immediate priority during respiratory compromise.
C. Ambulation can increase oxygen demand and is unsafe during severe distress.
D. Waiting delays treatment of potentially life-threatening hypoxemia.
────────────────────────────────────────────────
Question 2. Which additional finding would most strongly indicate worsening respiratory fatigue?
A. The client asks for a blanket
B. The client becomes drowsy and has decreasing respiratory effort
C. The client reports being thirsty
D. The client asks when lunch will arrive
Correct Answer: B
Original educational practice resource • Not an official or verified exam
, N170 | CLINICAL CASE STUDIES & PRACTICE QUESTIONS | 2026–2027
Detailed Rationale: Reduced alertness with declining respiratory effort can indicate fatigue and impending
respiratory failure, requiring immediate escalation.
Why the Other Options Are Incorrect
A. A blanket request alone does not indicate respiratory fatigue.
C. Thirst is nonspecific and does not indicate respiratory fatigue.
D. A meal-related question does not indicate worsening breathing.
────────────────────────────────────────────────
Question 3. After emergency support begins, which reassessment is most important?
A. Repeat respiratory effort, mental status, and oxygenation
B. Ask about preferred television programs
C. Measure height
D. Review the client's usual bedtime
Correct Answer: A
Detailed Rationale: Reassessment of breathing, mental status, and oxygenation determines whether
interventions are effective and whether further escalation is needed.
Why the Other Options Are Incorrect
B. Television preference is unrelated to acute respiratory response.
C. Height does not evaluate response to emergency respiratory care.
D. Usual bedtime does not determine immediate treatment effectiveness.
────────────────────────────────────────────────
Case 2: Possible Stroke
Clinical scenario: A 74-year-old client suddenly develops right facial droop, right arm weakness, and difficulty
speaking while eating breakfast. A family member reports the client was speaking normally shortly before the
symptoms began.
Question 4. What should the nurse do first?
A. Activate the stroke emergency response and establish the last-known-well time
B. Give water to check swallowing
C. Allow the client to rest and reassess in an hour
D. Ask the client to walk to test strength
Correct Answer: A
Detailed Rationale: Sudden focal neurologic deficits suggest possible acute stroke. Activate the stroke
pathway immediately and establish the last-known-well time; do not delay for nonessential tasks.
Why the Other Options Are Incorrect
B. Oral fluids may cause aspiration if swallowing is impaired.
C. Delay can reduce access to time-sensitive treatment.
D. Walking may cause a fall and delays emergency evaluation.
────────────────────────────────────────────────
Question 5. Which action is safest while swallowing status is unknown?
A. Keep the client NPO until swallowing is screened or assessed
B. Give tablets with applesauce without checking
C. Offer thin liquids through a straw
Original educational practice resource • Not an official or verified exam
N170 CLINICAL CASE STUDIES
& PRACTICE QUESTIONS
2026–2027 | Nursing Clinical Judgment Review
10 clinical cases • 30 original multiple-choice questions • Answers, detailed rationales, and incorrect-option
explanations
Instructions
• Read each case and use the clinical details provided to select the single best answer for each question.
• Prioritize immediate threats, use focused assessment, escalate deterioration, and reassess after interventions.
• Review the rationale and each incorrect-option explanation after answering.
• This resource is original practice material, not an official, leaked, or verified N170 exam.
Clinical Cases and Questions
Case 1: Acute Respiratory Deterioration
Clinical scenario: A 68-year-old client admitted with pneumonia becomes increasingly restless. Respiratory rate is
32/min, oxygen saturation is 86% on the currently prescribed oxygen, and the client can speak only a few words at a
time.
Question 1. Which action has the highest priority?
A. Complete a detailed dietary history
B. Assess airway and breathing, call for urgent assistance, and follow the emergency oxygenation protocol
C. Encourage the client to walk to improve lung expansion
D. Wait 30 minutes and repeat the oxygen saturation
Correct Answer: B
Detailed Rationale: The client has significant hypoxemia and respiratory distress. Immediate focused
assessment and escalation are required; oxygen support should follow the prescribed plan and emergency
protocol.
Why the Other Options Are Incorrect
A. Dietary history is not the immediate priority during respiratory compromise.
C. Ambulation can increase oxygen demand and is unsafe during severe distress.
D. Waiting delays treatment of potentially life-threatening hypoxemia.
────────────────────────────────────────────────
Question 2. Which additional finding would most strongly indicate worsening respiratory fatigue?
A. The client asks for a blanket
B. The client becomes drowsy and has decreasing respiratory effort
C. The client reports being thirsty
D. The client asks when lunch will arrive
Correct Answer: B
Original educational practice resource • Not an official or verified exam
, N170 | CLINICAL CASE STUDIES & PRACTICE QUESTIONS | 2026–2027
Detailed Rationale: Reduced alertness with declining respiratory effort can indicate fatigue and impending
respiratory failure, requiring immediate escalation.
Why the Other Options Are Incorrect
A. A blanket request alone does not indicate respiratory fatigue.
C. Thirst is nonspecific and does not indicate respiratory fatigue.
D. A meal-related question does not indicate worsening breathing.
────────────────────────────────────────────────
Question 3. After emergency support begins, which reassessment is most important?
A. Repeat respiratory effort, mental status, and oxygenation
B. Ask about preferred television programs
C. Measure height
D. Review the client's usual bedtime
Correct Answer: A
Detailed Rationale: Reassessment of breathing, mental status, and oxygenation determines whether
interventions are effective and whether further escalation is needed.
Why the Other Options Are Incorrect
B. Television preference is unrelated to acute respiratory response.
C. Height does not evaluate response to emergency respiratory care.
D. Usual bedtime does not determine immediate treatment effectiveness.
────────────────────────────────────────────────
Case 2: Possible Stroke
Clinical scenario: A 74-year-old client suddenly develops right facial droop, right arm weakness, and difficulty
speaking while eating breakfast. A family member reports the client was speaking normally shortly before the
symptoms began.
Question 4. What should the nurse do first?
A. Activate the stroke emergency response and establish the last-known-well time
B. Give water to check swallowing
C. Allow the client to rest and reassess in an hour
D. Ask the client to walk to test strength
Correct Answer: A
Detailed Rationale: Sudden focal neurologic deficits suggest possible acute stroke. Activate the stroke
pathway immediately and establish the last-known-well time; do not delay for nonessential tasks.
Why the Other Options Are Incorrect
B. Oral fluids may cause aspiration if swallowing is impaired.
C. Delay can reduce access to time-sensitive treatment.
D. Walking may cause a fall and delays emergency evaluation.
────────────────────────────────────────────────
Question 5. Which action is safest while swallowing status is unknown?
A. Keep the client NPO until swallowing is screened or assessed
B. Give tablets with applesauce without checking
C. Offer thin liquids through a straw
Original educational practice resource • Not an official or verified exam
