UR2755 / NUR 2755 FINAL EXAM
N
2025-2026 | Multidimensional Care
IV | MDC 4 – Rasmussen | Latest
Verified Q&A | Pass Guaranteed -
A+ Graded
100 Questions – 100% Correct with Detailed Rationales (A+ Graded)
art A: Multiple Choice (Q1–75)
P
Q1 (Neurological – ICP): A patient with a traumatic brain injury has a GCS of 6. The nurse notes
a systolic blood pressure of 170 mm Hg and a heart rate of 52 bpm. What additional
assessment is most important?
A. Check pupil response to light.
B. Reassess GCS in 15 minutes.
C. Administer a fluid bolus.
D. Prepare for immediate intubation.
[CORRECT] A
Rationale: Cushing's triad (hypertension + bradycardia + irregular respirations) indicates
increased ICP. Pupillary changes (blown or sluggish pupil) signal uncal herniation and require
immediate intervention. Distractor D is incorrect – intubation may be needed, but pupil
assessment is the priority for localizing herniation. Clinical pearl: Cushing's triad is a late sign –
treat ICP early.
Q2 (Neurological – Stroke): A 68-year-old patient presents with sudden onset of right-sided
weakness, aphasia, and facial droop. The symptom onset was confirmed at 2 hours ago. Which
intervention is the priority?
A. Administer aspirin 325 mg immediately.
B. Obtain a CT scan of the head without contrast.
C. Start a heparin infusion at 18 units/kg/hr.
D. Position the patient flat with the head of bed at 0°.
[CORRECT] B
Rationale: Per the AHA/ASA 2023 stroke guidelines, a non-contrast CT head is required within
25 minutes of arrival to rule out hemorrhage before administering tPA. Distractor A is incorrect –
aspirin is contraindicated until hemorrhage is ruled out. Clinical pearl: "Time is brain" – every
minute of delay costs 1.9 million neurons.
, 3 (Neurological – Stroke): A patient with an acute ischemic stroke is receiving alteplase (tPA).
Q
Which blood pressure parameter requires immediate notification of the provider?
A. Systolic BP 150 mm Hg
B. Diastolic BP 95 mm Hg
C. Systolic BP 185 mm Hg
D. Mean arterial pressure 75 mm Hg
[CORRECT] C
Rationale: Per AHA/ASA guidelines, tPA must be held if systolic BP exceeds 185 mm Hg or
diastolic exceeds 110 mm Hg during and for 24 hours after infusion. Distractor A is incorrect –
150 mm Hg is within acceptable range. Clinical pearl: BP goal during tPA: SBP <185 and DBP
<110 mm Hg.
Q4 (Neurological – Seizures): A patient in the ICU has been seizing continuously for 8 minutes.
Two doses of lorazepam 4 mg IV have been administered without cessation. What is the next
priority intervention?
A. Administer another dose of lorazepam 4 mg IV.
B. Start a phenytoin loading dose of 20 mg/kg IV.
C. Administer fosphenytoin 20 mg PE/kg IV at 150 mg PE/min.
D. Prepare for endotracheal intubation and propofol infusion.
[CORRECT] C
Rationale: Per the 2016 AAN/AES status epilepticus guidelines, after two failed benzodiazepine
doses, second-line therapy with fosphenytoin (or levetiracetam/valproate) is indicated. Distractor
D is incorrect – this is third-line therapy for refractory status epilepticus. Clinical pearl: SE
timeline: 0-5 min = pre-hospital, 5-30 min = established, >30 min = refractory.
Q5 (Neurological – Spinal Cord Injury): A patient with a T6 spinal cord injury reports a severe
pounding headache, diaphoresis above the level of injury, and nasal congestion. The nurse
notes BP is 210/120 mm Hg. What is the first action?
A. Administer sublingual nitroglycerin.
B. Sit the patient upright and loosen tight clothing.
C. Insert a urinary catheter immediately.
D. Give IV hydralazine 20 mg push.
[CORRECT] B
Rationale: Autonomic dysreflexia is a medical emergency triggered by noxious stimuli below the
injury level; sitting upright lowers BP by inducing orthostatic pooling. Distractor A is incorrect –
nitrates may worsen hypotension below the injury level. Clinical pearl: Most common trigger =
bladder distention; check catheter patency after positioning.
Q6 (Neurological – Alzheimer's): A nurse is caring for a patient with moderate Alzheimer's
disease who becomes agitated during evening care. Which non-pharmacological intervention is
most appropriate?
A. Administer haloperidol 2 mg IM.
B. Provide a calm, well-lit environment and familiar routines.
C. Restrain the patient to prevent injury.
D. Transfer the patient to a private room with minimal stimulation.
[CORRECT] B
, ationale: Per the Alzheimer's Association guidelines, sundowning is managed with
R
environmental modifications, consistent routines, and adequate lighting. Distractor A is incorrect
– antipsychotics increase mortality in dementia and are last resort. Clinical pearl: "Sundowning"
peaks 4-8 PM; increase daytime activity and maintain circadian rhythm.
Q7 (Neurological – Parkinson's): A patient with Parkinson's disease is prescribed
carbidopa-levodopa. The nurse should instruct the patient to avoid which food?
A. Bananas
B. Grapefruit juice
C. Protein-rich meals
D. Dairy products
[CORRECT] C
Rationale: Dietary protein competes with levodopa for absorption via the large neutral amino
acid transporter (LNAA), reducing drug efficacy. Distractor B is incorrect – grapefruit affects
CYP3A4 metabolism, not levodopa. Clinical pearl: Take levodopa 30-60 minutes before or 1
hour after high-protein meals.
Q8 (Neurological – MS): A patient with multiple sclerosis is experiencing an acute exacerbation.
Which medication is the first-line treatment for reducing inflammation during a relapse?
A. Interferon beta-1a
B. Methylprednisolone 1 g/day IV for 3-5 days
C. Fingolimod
D. Ocrelizumab
[CORRECT] B
Rationale: Per the NMSS guidelines, high-dose IV corticosteroids are first-line for acute MS
exacerbations to shorten recovery time. Distractor A is incorrect – interferons are
disease-modifying therapies for maintenance, not acute treatment. Clinical pearl: Steroids do
not alter disease course; DMTs (A, C, D) prevent future relapses.
Q9 (Neurological – Guillain-Barré): A patient with Guillain-Barré syndrome develops respiratory
distress with a negative inspiratory force (NIF) of -15 cm H2O and vital capacity of 12 mL/kg.
What is the priority intervention?
A. Administer nebulized albuterol.
B. Prepare for elective intubation.
C. Start non-invasive positive pressure ventilation.
D. Increase oxygen via nasal cannula to 6 L/min.
[CORRECT] B
Rationale: Per AAN guidelines, intubation is indicated when NIF < -20 cm H2O or vital capacity
< 15 mL/kg in GBS. Distractor C is incorrect – NIV is contraindicated in rapidly progressive
neuromuscular weakness. Clinical pearl: GBS respiratory failure is due to diaphragm weakness,
not airway obstruction.
Q10 (Neurological – GCS): A patient opens eyes to painful stimulus, makes incomprehensible
sounds, and withdraws from pain. What is the GCS score?
A. 6
B. 7
C. 8
D. 9
N
2025-2026 | Multidimensional Care
IV | MDC 4 – Rasmussen | Latest
Verified Q&A | Pass Guaranteed -
A+ Graded
100 Questions – 100% Correct with Detailed Rationales (A+ Graded)
art A: Multiple Choice (Q1–75)
P
Q1 (Neurological – ICP): A patient with a traumatic brain injury has a GCS of 6. The nurse notes
a systolic blood pressure of 170 mm Hg and a heart rate of 52 bpm. What additional
assessment is most important?
A. Check pupil response to light.
B. Reassess GCS in 15 minutes.
C. Administer a fluid bolus.
D. Prepare for immediate intubation.
[CORRECT] A
Rationale: Cushing's triad (hypertension + bradycardia + irregular respirations) indicates
increased ICP. Pupillary changes (blown or sluggish pupil) signal uncal herniation and require
immediate intervention. Distractor D is incorrect – intubation may be needed, but pupil
assessment is the priority for localizing herniation. Clinical pearl: Cushing's triad is a late sign –
treat ICP early.
Q2 (Neurological – Stroke): A 68-year-old patient presents with sudden onset of right-sided
weakness, aphasia, and facial droop. The symptom onset was confirmed at 2 hours ago. Which
intervention is the priority?
A. Administer aspirin 325 mg immediately.
B. Obtain a CT scan of the head without contrast.
C. Start a heparin infusion at 18 units/kg/hr.
D. Position the patient flat with the head of bed at 0°.
[CORRECT] B
Rationale: Per the AHA/ASA 2023 stroke guidelines, a non-contrast CT head is required within
25 minutes of arrival to rule out hemorrhage before administering tPA. Distractor A is incorrect –
aspirin is contraindicated until hemorrhage is ruled out. Clinical pearl: "Time is brain" – every
minute of delay costs 1.9 million neurons.
, 3 (Neurological – Stroke): A patient with an acute ischemic stroke is receiving alteplase (tPA).
Q
Which blood pressure parameter requires immediate notification of the provider?
A. Systolic BP 150 mm Hg
B. Diastolic BP 95 mm Hg
C. Systolic BP 185 mm Hg
D. Mean arterial pressure 75 mm Hg
[CORRECT] C
Rationale: Per AHA/ASA guidelines, tPA must be held if systolic BP exceeds 185 mm Hg or
diastolic exceeds 110 mm Hg during and for 24 hours after infusion. Distractor A is incorrect –
150 mm Hg is within acceptable range. Clinical pearl: BP goal during tPA: SBP <185 and DBP
<110 mm Hg.
Q4 (Neurological – Seizures): A patient in the ICU has been seizing continuously for 8 minutes.
Two doses of lorazepam 4 mg IV have been administered without cessation. What is the next
priority intervention?
A. Administer another dose of lorazepam 4 mg IV.
B. Start a phenytoin loading dose of 20 mg/kg IV.
C. Administer fosphenytoin 20 mg PE/kg IV at 150 mg PE/min.
D. Prepare for endotracheal intubation and propofol infusion.
[CORRECT] C
Rationale: Per the 2016 AAN/AES status epilepticus guidelines, after two failed benzodiazepine
doses, second-line therapy with fosphenytoin (or levetiracetam/valproate) is indicated. Distractor
D is incorrect – this is third-line therapy for refractory status epilepticus. Clinical pearl: SE
timeline: 0-5 min = pre-hospital, 5-30 min = established, >30 min = refractory.
Q5 (Neurological – Spinal Cord Injury): A patient with a T6 spinal cord injury reports a severe
pounding headache, diaphoresis above the level of injury, and nasal congestion. The nurse
notes BP is 210/120 mm Hg. What is the first action?
A. Administer sublingual nitroglycerin.
B. Sit the patient upright and loosen tight clothing.
C. Insert a urinary catheter immediately.
D. Give IV hydralazine 20 mg push.
[CORRECT] B
Rationale: Autonomic dysreflexia is a medical emergency triggered by noxious stimuli below the
injury level; sitting upright lowers BP by inducing orthostatic pooling. Distractor A is incorrect –
nitrates may worsen hypotension below the injury level. Clinical pearl: Most common trigger =
bladder distention; check catheter patency after positioning.
Q6 (Neurological – Alzheimer's): A nurse is caring for a patient with moderate Alzheimer's
disease who becomes agitated during evening care. Which non-pharmacological intervention is
most appropriate?
A. Administer haloperidol 2 mg IM.
B. Provide a calm, well-lit environment and familiar routines.
C. Restrain the patient to prevent injury.
D. Transfer the patient to a private room with minimal stimulation.
[CORRECT] B
, ationale: Per the Alzheimer's Association guidelines, sundowning is managed with
R
environmental modifications, consistent routines, and adequate lighting. Distractor A is incorrect
– antipsychotics increase mortality in dementia and are last resort. Clinical pearl: "Sundowning"
peaks 4-8 PM; increase daytime activity and maintain circadian rhythm.
Q7 (Neurological – Parkinson's): A patient with Parkinson's disease is prescribed
carbidopa-levodopa. The nurse should instruct the patient to avoid which food?
A. Bananas
B. Grapefruit juice
C. Protein-rich meals
D. Dairy products
[CORRECT] C
Rationale: Dietary protein competes with levodopa for absorption via the large neutral amino
acid transporter (LNAA), reducing drug efficacy. Distractor B is incorrect – grapefruit affects
CYP3A4 metabolism, not levodopa. Clinical pearl: Take levodopa 30-60 minutes before or 1
hour after high-protein meals.
Q8 (Neurological – MS): A patient with multiple sclerosis is experiencing an acute exacerbation.
Which medication is the first-line treatment for reducing inflammation during a relapse?
A. Interferon beta-1a
B. Methylprednisolone 1 g/day IV for 3-5 days
C. Fingolimod
D. Ocrelizumab
[CORRECT] B
Rationale: Per the NMSS guidelines, high-dose IV corticosteroids are first-line for acute MS
exacerbations to shorten recovery time. Distractor A is incorrect – interferons are
disease-modifying therapies for maintenance, not acute treatment. Clinical pearl: Steroids do
not alter disease course; DMTs (A, C, D) prevent future relapses.
Q9 (Neurological – Guillain-Barré): A patient with Guillain-Barré syndrome develops respiratory
distress with a negative inspiratory force (NIF) of -15 cm H2O and vital capacity of 12 mL/kg.
What is the priority intervention?
A. Administer nebulized albuterol.
B. Prepare for elective intubation.
C. Start non-invasive positive pressure ventilation.
D. Increase oxygen via nasal cannula to 6 L/min.
[CORRECT] B
Rationale: Per AAN guidelines, intubation is indicated when NIF < -20 cm H2O or vital capacity
< 15 mL/kg in GBS. Distractor C is incorrect – NIV is contraindicated in rapidly progressive
neuromuscular weakness. Clinical pearl: GBS respiratory failure is due to diaphragm weakness,
not airway obstruction.
Q10 (Neurological – GCS): A patient opens eyes to painful stimulus, makes incomprehensible
sounds, and withdraws from pain. What is the GCS score?
A. 6
B. 7
C. 8
D. 9
