N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
N176 Exam 4 Practice Exam
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.
Exam 4 Practice Exam
83 original multiple-choice questions. Select the single best answer for each question.
Question 1. [Respiratory] A client with acute respiratory distress is using accessory muscles and can speak
only one or two words at a time. What is the nurse's priority?
A. Call for urgent assistance and assess airway, breathing, oxygenation
B. Offer a full glass of water
C. Complete the admission history first
D. Encourage the client to lie flat
Correct answer: A. Call for urgent assistance and assess airway, breathing, oxygenation
Detailed rationale: Severe work of breathing and inability to speak full sentences signal possible respiratory failure.
Immediate ABC assessment and escalation take priority.
Why the other options are incorrect:
B. Oral fluids may create aspiration risk and do not address respiratory distress.
C. A full history must not delay stabilization.
D. Flat positioning can worsen breathing in many clients.
───────────────────────────────────────────────────────
Question 2. [Respiratory] A client with pneumonia has an oxygen saturation of 86% on room air and new
cyanosis. What should the nurse do?
A. Initiate urgent assessment and oxygen per protocol/prescription while escalating care
B. Document the value and recheck at the next routine round
C. Ask the client to walk to improve circulation
D. Encourage breath-holding
Correct answer: A. Initiate urgent assessment and oxygen per protocol/prescription while escalating care
Detailed rationale: Severe hypoxemia with cyanosis is an emergency. Support oxygenation and promptly escalate
according to orders and local protocol.
Why the other options are incorrect:
B. Delayed reassessment is unsafe.
C. Exertion may worsen oxygen demand.
D. Breath-holding does not correct hypoxemia.
───────────────────────────────────────────────────────
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Question 3. [Respiratory] Which technique helps prevent ventilator-associated complications in an intubated
client when not contraindicated?
A. Consistent oral care, appropriate head-of-bed elevation, and bundle-based prevention
B. Routine disconnection of ventilator tubing
C. Keeping the client supine at all times
D. Avoiding assessment of sedation and readiness to wean
Correct answer: A. Consistent oral care, appropriate head-of-bed elevation, and bundle-based prevention
Detailed rationale: Evidence-based prevention bundles include oral care, appropriate positioning, minimizing
unnecessary sedation, and evaluating readiness to liberate from ventilation.
Why the other options are incorrect:
B. Unnecessary disconnection can contaminate the circuit and disrupt ventilation.
C. Supine positioning may increase aspiration risk when elevation is appropriate.
D. Assessment of sedation and weaning readiness is important.
───────────────────────────────────────────────────────
Question 4. [Cardiovascular] A client with heart failure gains 2.2 kg (4.8 lb) over three days and reports
increased orthopnea. What is the best response?
A. Promptly report the trend and assess for fluid overload according to the care plan
B. Reassure the client that rapid weight gain is expected
C. Recommend increasing sodium intake
D. Stop prescribed diuretics
Correct answer: A. Promptly report the trend and assess for fluid overload according to the care plan
Detailed rationale: Rapid weight gain and worsening orthopnea can indicate fluid retention and decompensation.
Assess and notify the care team for treatment adjustment.
Why the other options are incorrect:
B. The trend may signal worsening heart failure.
C. High sodium intake can worsen fluid retention.
D. Stopping prescribed diuretics without direction may worsen congestion.
───────────────────────────────────────────────────────
Question 5. [Cardiovascular] A client with suspected myocardial infarction asks why an ECG is needed
quickly. The nurse's best explanation is:
A. “It helps identify changes that guide urgent treatment.”
B. “It proves that every chest pain is caused by a heart attack.”
C. “It replaces blood tests and clinical assessment.”
D. “It is mainly used to measure lung capacity.”
Correct answer: A. “It helps identify changes that guide urgent treatment.”
Detailed rationale: A 12-lead ECG can identify ischemic changes and help guide time-sensitive care, but it is
interpreted alongside symptoms, biomarkers, and clinical assessment.
Why the other options are incorrect:
B. An ECG does not prove every chest-pain cause or rule out all disease by itself.
C. Other tests and assessment may still be necessary.
D. ECG assesses cardiac electrical activity, not lung capacity.
───────────────────────────────────────────────────────
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Question 6. [Cardiovascular] Which finding may indicate peripheral venous insufficiency rather than arterial
insufficiency?
A. Dependent edema with brown discoloration around the ankles
B. Cool pale foot with diminished pulses and exertional pain
C. Sudden severe pain with absent pulse
D. Pain relieved by dangling the leg
Correct answer: A. Dependent edema with brown discoloration around the ankles
Detailed rationale: Chronic venous insufficiency often causes dependent edema, skin changes, and brown ankle
discoloration. Arterial disease more often causes coolness, diminished pulses, and claudication/rest pain.
Why the other options are incorrect:
B. This pattern is more consistent with arterial insufficiency.
C. Acute pain with absent pulse suggests limb-threatening arterial occlusion.
D. Relief by dependency can occur with severe arterial insufficiency.
───────────────────────────────────────────────────────
Question 7. [Endocrine] A client with hyperthyroidism has fever, marked tachycardia, agitation, and vomiting.
Which complication is the priority concern?
A. Thyroid storm
B. Routine seasonal allergy
C. Stable hypothyroidism
D. Uncomplicated muscle strain
Correct answer: A. Thyroid storm
Detailed rationale: Fever, severe tachycardia, and CNS/GI changes in hyperthyroidism may indicate thyroid storm,
a life-threatening emergency.
Why the other options are incorrect:
B. Allergy does not explain this systemic pattern.
C. The presentation is not consistent with stable hypothyroidism.
D. Muscle strain does not explain severe systemic instability.
───────────────────────────────────────────────────────
Question 8. [Endocrine] A client with diabetes has repeated episodes of hypoglycemia overnight. What is the
most appropriate nursing action?
A. Review glucose trends, meal/activity pattern, and prescribed regimen with the care team
B. Advise the client to stop all insulin permanently
C. Ignore episodes if morning glucose is normal
D. Recommend skipping dinner
Correct answer: A. Review glucose trends, meal/activity pattern, and prescribed regimen with the care team
Detailed rationale: Recurrent lows require assessment of medication timing/dose, food intake, activity, renal
function, and other contributors; treatment changes should be coordinated.
Why the other options are incorrect:
B. Abruptly stopping all insulin can be dangerous, especially in type 1 diabetes.
C. A normal morning reading does not erase overnight risk.
D. Skipping meals can worsen hypoglycemia.
───────────────────────────────────────────────────────
Educational practice material • Not an official or verified examination
N176 Exam 4 Practice Exam
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.
Exam 4 Practice Exam
83 original multiple-choice questions. Select the single best answer for each question.
Question 1. [Respiratory] A client with acute respiratory distress is using accessory muscles and can speak
only one or two words at a time. What is the nurse's priority?
A. Call for urgent assistance and assess airway, breathing, oxygenation
B. Offer a full glass of water
C. Complete the admission history first
D. Encourage the client to lie flat
Correct answer: A. Call for urgent assistance and assess airway, breathing, oxygenation
Detailed rationale: Severe work of breathing and inability to speak full sentences signal possible respiratory failure.
Immediate ABC assessment and escalation take priority.
Why the other options are incorrect:
B. Oral fluids may create aspiration risk and do not address respiratory distress.
C. A full history must not delay stabilization.
D. Flat positioning can worsen breathing in many clients.
───────────────────────────────────────────────────────
Question 2. [Respiratory] A client with pneumonia has an oxygen saturation of 86% on room air and new
cyanosis. What should the nurse do?
A. Initiate urgent assessment and oxygen per protocol/prescription while escalating care
B. Document the value and recheck at the next routine round
C. Ask the client to walk to improve circulation
D. Encourage breath-holding
Correct answer: A. Initiate urgent assessment and oxygen per protocol/prescription while escalating care
Detailed rationale: Severe hypoxemia with cyanosis is an emergency. Support oxygenation and promptly escalate
according to orders and local protocol.
Why the other options are incorrect:
B. Delayed reassessment is unsafe.
C. Exertion may worsen oxygen demand.
D. Breath-holding does not correct hypoxemia.
───────────────────────────────────────────────────────
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Question 3. [Respiratory] Which technique helps prevent ventilator-associated complications in an intubated
client when not contraindicated?
A. Consistent oral care, appropriate head-of-bed elevation, and bundle-based prevention
B. Routine disconnection of ventilator tubing
C. Keeping the client supine at all times
D. Avoiding assessment of sedation and readiness to wean
Correct answer: A. Consistent oral care, appropriate head-of-bed elevation, and bundle-based prevention
Detailed rationale: Evidence-based prevention bundles include oral care, appropriate positioning, minimizing
unnecessary sedation, and evaluating readiness to liberate from ventilation.
Why the other options are incorrect:
B. Unnecessary disconnection can contaminate the circuit and disrupt ventilation.
C. Supine positioning may increase aspiration risk when elevation is appropriate.
D. Assessment of sedation and weaning readiness is important.
───────────────────────────────────────────────────────
Question 4. [Cardiovascular] A client with heart failure gains 2.2 kg (4.8 lb) over three days and reports
increased orthopnea. What is the best response?
A. Promptly report the trend and assess for fluid overload according to the care plan
B. Reassure the client that rapid weight gain is expected
C. Recommend increasing sodium intake
D. Stop prescribed diuretics
Correct answer: A. Promptly report the trend and assess for fluid overload according to the care plan
Detailed rationale: Rapid weight gain and worsening orthopnea can indicate fluid retention and decompensation.
Assess and notify the care team for treatment adjustment.
Why the other options are incorrect:
B. The trend may signal worsening heart failure.
C. High sodium intake can worsen fluid retention.
D. Stopping prescribed diuretics without direction may worsen congestion.
───────────────────────────────────────────────────────
Question 5. [Cardiovascular] A client with suspected myocardial infarction asks why an ECG is needed
quickly. The nurse's best explanation is:
A. “It helps identify changes that guide urgent treatment.”
B. “It proves that every chest pain is caused by a heart attack.”
C. “It replaces blood tests and clinical assessment.”
D. “It is mainly used to measure lung capacity.”
Correct answer: A. “It helps identify changes that guide urgent treatment.”
Detailed rationale: A 12-lead ECG can identify ischemic changes and help guide time-sensitive care, but it is
interpreted alongside symptoms, biomarkers, and clinical assessment.
Why the other options are incorrect:
B. An ECG does not prove every chest-pain cause or rule out all disease by itself.
C. Other tests and assessment may still be necessary.
D. ECG assesses cardiac electrical activity, not lung capacity.
───────────────────────────────────────────────────────
Educational practice material • Not an official or verified examination
, N176 • ORIGINAL PRACTICE RESOURCE • 2026–2027
Question 6. [Cardiovascular] Which finding may indicate peripheral venous insufficiency rather than arterial
insufficiency?
A. Dependent edema with brown discoloration around the ankles
B. Cool pale foot with diminished pulses and exertional pain
C. Sudden severe pain with absent pulse
D. Pain relieved by dangling the leg
Correct answer: A. Dependent edema with brown discoloration around the ankles
Detailed rationale: Chronic venous insufficiency often causes dependent edema, skin changes, and brown ankle
discoloration. Arterial disease more often causes coolness, diminished pulses, and claudication/rest pain.
Why the other options are incorrect:
B. This pattern is more consistent with arterial insufficiency.
C. Acute pain with absent pulse suggests limb-threatening arterial occlusion.
D. Relief by dependency can occur with severe arterial insufficiency.
───────────────────────────────────────────────────────
Question 7. [Endocrine] A client with hyperthyroidism has fever, marked tachycardia, agitation, and vomiting.
Which complication is the priority concern?
A. Thyroid storm
B. Routine seasonal allergy
C. Stable hypothyroidism
D. Uncomplicated muscle strain
Correct answer: A. Thyroid storm
Detailed rationale: Fever, severe tachycardia, and CNS/GI changes in hyperthyroidism may indicate thyroid storm,
a life-threatening emergency.
Why the other options are incorrect:
B. Allergy does not explain this systemic pattern.
C. The presentation is not consistent with stable hypothyroidism.
D. Muscle strain does not explain severe systemic instability.
───────────────────────────────────────────────────────
Question 8. [Endocrine] A client with diabetes has repeated episodes of hypoglycemia overnight. What is the
most appropriate nursing action?
A. Review glucose trends, meal/activity pattern, and prescribed regimen with the care team
B. Advise the client to stop all insulin permanently
C. Ignore episodes if morning glucose is normal
D. Recommend skipping dinner
Correct answer: A. Review glucose trends, meal/activity pattern, and prescribed regimen with the care team
Detailed rationale: Recurrent lows require assessment of medication timing/dose, food intake, activity, renal
function, and other contributors; treatment changes should be coordinated.
Why the other options are incorrect:
B. Abruptly stopping all insulin can be dangerous, especially in type 1 diabetes.
C. A normal morning reading does not erase overnight risk.
D. Skipping meals can worsen hypoglycemia.
───────────────────────────────────────────────────────
Educational practice material • Not an official or verified examination
