N176 Final Exam: Comprehensive Practice Questions and Correct Answers with Detailed
Rationales | Latest Update 2026/2027 | Complete Exam Review and Study Guide
Section 1: Prioritization, Delegation, and Clinical Judgment
Question 1
A nurse is caring for four clients. After receiving the change-of-shift report, which client should
the nurse assess first?
A) A client with COPD reporting fatigue and an oxygen saturation of 89% on 2L nasal cannula.
B) A client 24 hours post-appendectomy requesting pain medication for incisional pain rated 6/10.
C) A client with diabetes mellitus waiting for their scheduled morning insulin dose.
D) A client who returned from a cardiac catheterization 30 minutes ago and is reporting new-onset
back pain.
Answer
Answer: D
Rationale
** New-onset back pain after a cardiac catheterization is a classic, ominous sign of retroperitoneal
bleeding or hematoma formation, which can lead to hypovolemic shock. This falls under the
**Circulation** priority in the ABCs framework and requires immediate assessment. While an oxygen
saturation of 89% is concerning, for a client with chronic COPD, this may be closer to their baseline.
Pain management and routine medication administration do not take priority over a potential acute
bleed .
Question 2
A registered nurse (RN) is working with a licensed practical nurse (LPN) and unlicensed
assistive personnel (UAP). Which task is most appropriate for the RN to delegate to the LPN?
A) Administering the initial dose of a new intravenous antibiotic.
B) Assessing a newly admitted client for the first time.
C) Reinforcing discharge teaching about wound care that was provided by the RN.
D) Titrating a continuous heparin infusion based on aPTT results.
Answer
Answer: C
,Rationale
** The LPN can perform interventions that are stable and predictable. Reinforcing teaching that has
already been performed by the RN is an appropriate task for an LPN, as it does not involve the initial
assessment or complex clinical judgment of the RN. Administering an initial dose of a new IV
medication, performing the initial assessment, and titrating high-alert medications like heparin are all
RN-level responsibilities .
Question 3
A client with heart failure suddenly develops severe dyspnea, crackles, and pink frothy
sputum. Which action should the nurse take first?
A) Place the client flat and elevate the legs.
B) Position the client upright and apply oxygen as prescribed.
C) Encourage oral fluids to thin secretions.
D) Obtain a daily weight before intervening.
Answer
Answer: B
Rationale
** These findings suggest acute pulmonary edema. Upright positioning reduces venous return and
improves ventilation; oxygen and urgent escalation are indicated while the nurse rapidly assesses the
client. Lying flat can worsen pulmonary congestion, and additional fluid can worsen fluid overload. A
daily weight is useful for monitoring heart failure but does not address an acute respiratory emergency
.
Question 4
A client reports crushing chest pressure radiating to the jaw with diaphoresis. What is the
nurse's priority?
A) Arrange a routine outpatient appointment.
B) Ask the client to walk to see whether symptoms improve.
C) Activate the emergency response pathway and obtain rapid assessment.
D) Offer a meal to reduce nausea.
Answer
Answer: C
2
,Rationale
** Possible acute coronary syndrome requires immediate emergency assessment, prompt ECG, and
treatment under protocol. Do not delay escalation. Routine follow-up dangerously delays evaluation of
a possible myocardial infarction, and exertion increases cardiac workload and is unsafe during
suspected ischemia .
Question 5
Which finding is most concerning in a client receiving an opioid after surgery?
A) Pain rated 6/10.
B) Respiratory rate 8/min and difficult arousal.
C) Mild nausea after medication.
D) No bowel movement for one day.
Answer
Answer: B
Rationale
** Bradypnea with reduced responsiveness indicates possible opioid-induced respiratory depression.
Support airway and breathing, summon help, and follow emergency protocol, including naloxone when
indicated. Pain, nausea, and constipation are important but are not the most immediate threat to life .
Question 6
A client with diabetes is awake, shaky, and diaphoretic. Point-of-care glucose is 54 mg/dL. The
client can swallow safely. What should the nurse do?
A) Give 15 g of fast-acting carbohydrate and recheck glucose in about 15 minutes.
B) Administer the scheduled rapid-acting insulin.
C) Give a high-fat meal and recheck in two hours.
D) Withhold all carbohydrates.
Answer
Answer: A
Rationale
** This is a classic presentation of hypoglycemia. If the client can swallow safely, the priority is to
3
, administer a fast-acting carbohydrate (e.g., juice, glucose tablets) and recheck the glucose level in 15
minutes per protocol .
---
### Section 2: Cardiovascular System
Question 7
A nurse is assessing a client with left-sided heart failure. Which finding is expected?
A) Jugular venous distention.
B) Crackles in the lungs.
C) Peripheral edema.
D) Hepatomegaly.
Answer
Answer: B
Rationale
** Left-sided heart failure causes blood to back up into the pulmonary circulation, leading to pulmonary
congestion and crackles (rales). Right-sided failure causes systemic congestion (JVD, edema,
hepatomegaly).
Question 8
A client on heparin has an aPTT of 95 seconds. What is the priority action?
A) Increase the heparin dose.
B) Hold heparin and notify the provider.
C) Administer vitamin K.
D) Encourage ambulation.
Answer
Answer: B
Rationale
** A prolonged aPTT indicates an increased bleeding risk. Heparin should be held and the provider
notified. Vitamin K is the antidote for warfarin, not heparin.
4
Rationales | Latest Update 2026/2027 | Complete Exam Review and Study Guide
Section 1: Prioritization, Delegation, and Clinical Judgment
Question 1
A nurse is caring for four clients. After receiving the change-of-shift report, which client should
the nurse assess first?
A) A client with COPD reporting fatigue and an oxygen saturation of 89% on 2L nasal cannula.
B) A client 24 hours post-appendectomy requesting pain medication for incisional pain rated 6/10.
C) A client with diabetes mellitus waiting for their scheduled morning insulin dose.
D) A client who returned from a cardiac catheterization 30 minutes ago and is reporting new-onset
back pain.
Answer
Answer: D
Rationale
** New-onset back pain after a cardiac catheterization is a classic, ominous sign of retroperitoneal
bleeding or hematoma formation, which can lead to hypovolemic shock. This falls under the
**Circulation** priority in the ABCs framework and requires immediate assessment. While an oxygen
saturation of 89% is concerning, for a client with chronic COPD, this may be closer to their baseline.
Pain management and routine medication administration do not take priority over a potential acute
bleed .
Question 2
A registered nurse (RN) is working with a licensed practical nurse (LPN) and unlicensed
assistive personnel (UAP). Which task is most appropriate for the RN to delegate to the LPN?
A) Administering the initial dose of a new intravenous antibiotic.
B) Assessing a newly admitted client for the first time.
C) Reinforcing discharge teaching about wound care that was provided by the RN.
D) Titrating a continuous heparin infusion based on aPTT results.
Answer
Answer: C
,Rationale
** The LPN can perform interventions that are stable and predictable. Reinforcing teaching that has
already been performed by the RN is an appropriate task for an LPN, as it does not involve the initial
assessment or complex clinical judgment of the RN. Administering an initial dose of a new IV
medication, performing the initial assessment, and titrating high-alert medications like heparin are all
RN-level responsibilities .
Question 3
A client with heart failure suddenly develops severe dyspnea, crackles, and pink frothy
sputum. Which action should the nurse take first?
A) Place the client flat and elevate the legs.
B) Position the client upright and apply oxygen as prescribed.
C) Encourage oral fluids to thin secretions.
D) Obtain a daily weight before intervening.
Answer
Answer: B
Rationale
** These findings suggest acute pulmonary edema. Upright positioning reduces venous return and
improves ventilation; oxygen and urgent escalation are indicated while the nurse rapidly assesses the
client. Lying flat can worsen pulmonary congestion, and additional fluid can worsen fluid overload. A
daily weight is useful for monitoring heart failure but does not address an acute respiratory emergency
.
Question 4
A client reports crushing chest pressure radiating to the jaw with diaphoresis. What is the
nurse's priority?
A) Arrange a routine outpatient appointment.
B) Ask the client to walk to see whether symptoms improve.
C) Activate the emergency response pathway and obtain rapid assessment.
D) Offer a meal to reduce nausea.
Answer
Answer: C
2
,Rationale
** Possible acute coronary syndrome requires immediate emergency assessment, prompt ECG, and
treatment under protocol. Do not delay escalation. Routine follow-up dangerously delays evaluation of
a possible myocardial infarction, and exertion increases cardiac workload and is unsafe during
suspected ischemia .
Question 5
Which finding is most concerning in a client receiving an opioid after surgery?
A) Pain rated 6/10.
B) Respiratory rate 8/min and difficult arousal.
C) Mild nausea after medication.
D) No bowel movement for one day.
Answer
Answer: B
Rationale
** Bradypnea with reduced responsiveness indicates possible opioid-induced respiratory depression.
Support airway and breathing, summon help, and follow emergency protocol, including naloxone when
indicated. Pain, nausea, and constipation are important but are not the most immediate threat to life .
Question 6
A client with diabetes is awake, shaky, and diaphoretic. Point-of-care glucose is 54 mg/dL. The
client can swallow safely. What should the nurse do?
A) Give 15 g of fast-acting carbohydrate and recheck glucose in about 15 minutes.
B) Administer the scheduled rapid-acting insulin.
C) Give a high-fat meal and recheck in two hours.
D) Withhold all carbohydrates.
Answer
Answer: A
Rationale
** This is a classic presentation of hypoglycemia. If the client can swallow safely, the priority is to
3
, administer a fast-acting carbohydrate (e.g., juice, glucose tablets) and recheck the glucose level in 15
minutes per protocol .
---
### Section 2: Cardiovascular System
Question 7
A nurse is assessing a client with left-sided heart failure. Which finding is expected?
A) Jugular venous distention.
B) Crackles in the lungs.
C) Peripheral edema.
D) Hepatomegaly.
Answer
Answer: B
Rationale
** Left-sided heart failure causes blood to back up into the pulmonary circulation, leading to pulmonary
congestion and crackles (rales). Right-sided failure causes systemic congestion (JVD, edema,
hepatomegaly).
Question 8
A client on heparin has an aPTT of 95 seconds. What is the priority action?
A) Increase the heparin dose.
B) Hold heparin and notify the provider.
C) Administer vitamin K.
D) Encourage ambulation.
Answer
Answer: B
Rationale
** A prolonged aPTT indicates an increased bleeding risk. Heparin should be held and the provider
notified. Vitamin K is the antidote for warfarin, not heparin.
4
