NUR2755 MDC 4 Final Exam Questions
And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your NUR2755 Multidimensional Care IV (MDC 4) Final Exam with this updated, comprehensive test
bank. Features authentic exam-style questions with verified correct answers and deep clinical
rationales. Covers high-yield topics: emergency triage, burn management, Parkland formula, shock
states, sepsis triads, and neurological critical care. Perfect for final exam preparation, active recall,
and boosting your scores. Download now to secure your guaranteed pass and master advanced
nursing
1. A patient is admitted to the emergency department with deep partial-thickness burns
to the entire anterior chest and abdomen. What percentage of total body surface
area (TBSA) is burned according to the Rule of Nines?
A) 9%
B) 18%
C) 27%
D) 36%
Correct Answer: B
Rationale: According to the Rule of Nines, the entire anterior trunk (chest and
abdomen combined) accounts for 18% of the Total Body Surface Area (TBSA).
2. A nurse calculates fluid resuscitation for a 70 kg patient with a 50% TBSA burn using
the Parkland Formula (4 mL × kg × % TBSA). What volume of Lactated Ringer's
should be infused over the first 8 hours from the time of injury?
A) 3,500 mL
B) 7,000 mL
C) 14,000 mL
D) 28,000 mL
Correct Answer: B
Rationale: The total 24-hour fluid requirement is \(4 \text{ mL} \times 70 \text{ kg}
\times 50 = 14,000 \text{ mL}\). Half of this total volume (\(7,000 \text{ mL}\)) must be
administered over the first 8 hours.
3. Which clinical finding is the most reliable indicator that fluid resuscitation is adequate
in a patient recovering from burn shock?
A) Hourly urine output of 0.5 to 1 mL/kg/hour
B) Systolic blood pressure greater than 120 mm Hg
C) Clear breath sounds bilaterally
D) Heart rate less than 100 beats per minute
Correct Answer: A
Rationale: Target urine output of 0.5 to 1 mL/kg/hour for an adult is the most
objective, reliable indicator of adequate end-organ perfusion during fluid
resuscitation.
4. A patient rescued from a house fire presents with singed nasal hairs, a hoarse voice,
and dark soot in their saliva. What is the immediate priority action for the nurse?
A) Administer broad-spectrum intravenous antibiotics.
B) Apply topical silver sulfadiazine to facial burns.
C) Prepare for immediate endotracheal intubation.
D) Insert a large-bore nasogastric tube.
, Correct Answer: C
Rationale: These signs indicate an inhalation injury, which can cause rapid, life-
threatening upper airway edema. Securing the airway via intubation takes immediate
precedence.
5. During the acute phase of a burn injury, which nursing diagnosis is considered the
highest priority once the airway and fluid status are stabilized?
A) Deficient Fluid Volume
B) Risk for Infection
C) Disturbed Body Image
D) Impaired Physical Mobility
Correct Answer: B
Rationale: In the acute phase (48 to 72 hours post-injury), the loss of the skin barrier
combined with altered immune mechanisms places the patient at extreme risk for
septic complications.
6. A nurse assesses a patient in the emergency department who presents with a blood
pressure of 82/40 mm Hg, a heart rate of 126 beats/minute, cool/clammy skin, and
flat neck veins. Which type of shock should the nurse suspect?
A) Neurogenic shock
B) Cardiogenic shock
C) Hypovolemic shock
D) Anaphylactic shock
Correct Answer: C
Rationale: Hypovolemic shock is characterized by hypotension, tachycardia, flat
neck veins, and cold, clammy skin due to a drop in circulating blood volume and
compensatory vasoconstriction.
7. Which set of vital signs and clinical assessments uniquely distinguishes neurogenic
shock from other forms of shock?
A) Hypotension and bradycardia
B) Hypotension and tachycardia
C) Hypertension and bradycardia
D) Hypertension and tachycardia
Correct Answer: A
Rationale: Neurogenic shock involves a loss of sympathetic nervous system tone,
leading to massive vasodilation (hypotension) and an inability to mount a
compensatory tachycardic response (bradycardia).
8. A patient with severe urosepsis is exhibiting a blood pressure of 86/44 mm Hg
despite aggressive fluid resuscitation with 30 mL/kg of crystalloids. The nurse
recognizes that the patient has entered which stage or condition?
A) Compensatory sepsis
B) Refractory hypovolemia
C) Septic shock
D) Neurogenic collapse
Correct Answer: C
Rationale: Septic shock is defined as sepsis accompanied by persistent hypotension
that requires vasopressors to maintain a mean arterial pressure (MAP) \(\geq 65
\text{ mm Hg}\) despite adequate fluid resuscitation.
9. A nurse monitors a non-diabetic patient with early sepsis. Which subtle metabolic
change should the nurse recognize as a standard systemic response to inflammatory
stress?
A) Blood glucose level of 195 mg/dL
, B) Blood glucose level of 55 mg/dL
C) Serum potassium level of 2.8 mEq/L
D) Serum sodium level of 155 mEq/L
Correct Answer: A
Rationale: Hyperglycemia in the absence of diabetes mellitus is a classic early sign
of sepsis, driven by the release of stress hormones (cortisol and epinephrine) and
glycogenolysis.
10. A patient is prescribed phenytoin sodium for the prevention of tonic-clonic seizures.
What critical instruction must be included in the discharge teaching?
A) "You may stop taking this medication as soon as you are seizure-free for two
weeks."
B) "Double the next dose if you experience a mild aura or feel a headache coming
on."
C) "Never stop taking this medication abruptly, as it can cause continuous,
unceasing seizures."
D) "Take this medication only on days when you feel extra stressed or tired."
Correct Answer: C
Rationale: Abrupt cessation of anti-epileptic drugs like phenytoin can trigger status
epilepticus, a life-threatening emergency marked by continuous seizure activity.
11. A family member asks the nurse what specific laboratory or imaging test can
definitively confirm a diagnosis of Alzheimer's disease in their living relative. How
should the nurse respond?
A) "An MRI scan of the brain provides an absolute, definitive diagnosis."
B) "A specialized genetic blood test confirms the presence of Alzheimer's disease."
C) "A definitive diagnosis can only be made post-mortem by examining brain tissue
during an autopsy."
D) "A lumbar puncture with cerebrospinal fluid analysis yields a definitive diagnosis."
Correct Answer: C
Rationale: While clinical assessments and imaging rule out other causes, a definitive
diagnosis of Alzheimer's disease requires post-mortem identification of neurofibrillary
tangles and amyloid plaques.
12. A patient presents with acute neurological deficits. Which diagnostic test must be
performed immediately to differentiate between an ischemic stroke and a
hemorrhagic stroke before starting thrombolytic therapy?
A) Lumbar puncture
B) Non-contrast Computed Tomography (CT) scan of the head
C) Electroencephalogram (EEG)
D) Carotid artery duplex ultrasound
Correct Answer: B
Rationale: A non-contrast head CT scan is the gold standard for ruling out
intracranial hemorrhage. Thrombolytics are strictly contraindicated in hemorrhagic
stroke.
13. The nurse reviews preoperative laboratory values for a patient scheduled for an
elective cholecystectomy. Which result requires immediate notification of the
surgeon?
A) Potassium level of 4.0 mEq/L
B) White blood cell count of 8,500/mm³
C) Hemoglobin level of 7.8 g/dL
D) Prothrombin time (PT) of 11.5 seconds
Correct Answer: C
, Rationale: A hemoglobin level of 7.8 g/dL indicates severe anemia, which
compromises intraoperative tissue oxygenation and requires immediate evaluation
before anesthesia.
14. What post-operative teaching strategy should the nurse prioritize to prevent the
development of atelectasis and hypostatic pneumonia?
A) Restricting oral fluids for the first 48 hours
B) Encouraging deep breathing, coughing, and frequent use of an incentive
spirometer
C) Maintaining a strict supine position for 5 days
D) Administering prophylactic antiemetics every 4 hours
Correct Answer: B
Rationale: Frequent coughing, deep breathing, and incentive spirometry promote
alveolar expansion, mobilize pulmonary secretions, and reduce the risk of respiratory
infections.
15. Using the Emergency Severity Index (ESI) framework, which patient should the
triage nurse classify as an ESI Level 5 (Non-Urgent)?
A) A 50-year-old presenting with tearing chest pain radiating to the back.
B) A 24-year-old with an open femur fracture and a weak distal pulse.
C) A 65-year-old with a cold, swollen ankle after a minor trip, with intact
neurovascular status.
D) A 12-year-old with stridor and intercostal retractions.
Correct Answer: C
Rationale: ESI Level 5 is reserved for stable patients who require minimal or no
specialized hospital resources (e.g., a simple examination or prescription refill).
16. A patient is brought to the emergency department with a core temperature of
105.2°F (40.7°C), altered mental status, and hot, dry, non-sweating skin. Which
condition should the nurse prioritize?
A) Heat exhaustion
B) Heat cramps
C) Heat stroke
D) Neuroleptic malignant syndrome
Correct Answer: C
Rationale: Heat stroke is a life-threatening emergency characterized by a core
temperature above 104°F, neurological dysfunction, and an absence of sweating due
to thermoregulatory failure.
17. When actively rewarming a patient experiencing severe hypothermia, why must the
nurse prioritize continuous cardiac monitoring?
A) Rapid rewarming can precipitate life-threatening ventricular fibrillation.
B) Hypothermia increases the risk of developing bundle branch blocks.
C) Myocardial tissue becomes hyper-responsive to calcium channel blockers during
rewarming.
D) The heart rate must be kept above 150 beats per minute to restore tissue
perfusion.
Correct Answer: A
Rationale: Cold myocardium is highly irritable. As cold peripheral blood returns to the
core during rewarming (afterdrop), it can trigger fatal dysrhythmias like ventricular
fibrillation.
18. A patient is diagnosed with an acute ischemic stroke and is a candidate for tissue
plasminogen activator (tPA). The nurse knows that the medication must be
administered within what maximum timeframe from the onset of symptoms?
And Well Graded Solutions With
Rationales Updated 2026-2027
Ace your NUR2755 Multidimensional Care IV (MDC 4) Final Exam with this updated, comprehensive test
bank. Features authentic exam-style questions with verified correct answers and deep clinical
rationales. Covers high-yield topics: emergency triage, burn management, Parkland formula, shock
states, sepsis triads, and neurological critical care. Perfect for final exam preparation, active recall,
and boosting your scores. Download now to secure your guaranteed pass and master advanced
nursing
1. A patient is admitted to the emergency department with deep partial-thickness burns
to the entire anterior chest and abdomen. What percentage of total body surface
area (TBSA) is burned according to the Rule of Nines?
A) 9%
B) 18%
C) 27%
D) 36%
Correct Answer: B
Rationale: According to the Rule of Nines, the entire anterior trunk (chest and
abdomen combined) accounts for 18% of the Total Body Surface Area (TBSA).
2. A nurse calculates fluid resuscitation for a 70 kg patient with a 50% TBSA burn using
the Parkland Formula (4 mL × kg × % TBSA). What volume of Lactated Ringer's
should be infused over the first 8 hours from the time of injury?
A) 3,500 mL
B) 7,000 mL
C) 14,000 mL
D) 28,000 mL
Correct Answer: B
Rationale: The total 24-hour fluid requirement is \(4 \text{ mL} \times 70 \text{ kg}
\times 50 = 14,000 \text{ mL}\). Half of this total volume (\(7,000 \text{ mL}\)) must be
administered over the first 8 hours.
3. Which clinical finding is the most reliable indicator that fluid resuscitation is adequate
in a patient recovering from burn shock?
A) Hourly urine output of 0.5 to 1 mL/kg/hour
B) Systolic blood pressure greater than 120 mm Hg
C) Clear breath sounds bilaterally
D) Heart rate less than 100 beats per minute
Correct Answer: A
Rationale: Target urine output of 0.5 to 1 mL/kg/hour for an adult is the most
objective, reliable indicator of adequate end-organ perfusion during fluid
resuscitation.
4. A patient rescued from a house fire presents with singed nasal hairs, a hoarse voice,
and dark soot in their saliva. What is the immediate priority action for the nurse?
A) Administer broad-spectrum intravenous antibiotics.
B) Apply topical silver sulfadiazine to facial burns.
C) Prepare for immediate endotracheal intubation.
D) Insert a large-bore nasogastric tube.
, Correct Answer: C
Rationale: These signs indicate an inhalation injury, which can cause rapid, life-
threatening upper airway edema. Securing the airway via intubation takes immediate
precedence.
5. During the acute phase of a burn injury, which nursing diagnosis is considered the
highest priority once the airway and fluid status are stabilized?
A) Deficient Fluid Volume
B) Risk for Infection
C) Disturbed Body Image
D) Impaired Physical Mobility
Correct Answer: B
Rationale: In the acute phase (48 to 72 hours post-injury), the loss of the skin barrier
combined with altered immune mechanisms places the patient at extreme risk for
septic complications.
6. A nurse assesses a patient in the emergency department who presents with a blood
pressure of 82/40 mm Hg, a heart rate of 126 beats/minute, cool/clammy skin, and
flat neck veins. Which type of shock should the nurse suspect?
A) Neurogenic shock
B) Cardiogenic shock
C) Hypovolemic shock
D) Anaphylactic shock
Correct Answer: C
Rationale: Hypovolemic shock is characterized by hypotension, tachycardia, flat
neck veins, and cold, clammy skin due to a drop in circulating blood volume and
compensatory vasoconstriction.
7. Which set of vital signs and clinical assessments uniquely distinguishes neurogenic
shock from other forms of shock?
A) Hypotension and bradycardia
B) Hypotension and tachycardia
C) Hypertension and bradycardia
D) Hypertension and tachycardia
Correct Answer: A
Rationale: Neurogenic shock involves a loss of sympathetic nervous system tone,
leading to massive vasodilation (hypotension) and an inability to mount a
compensatory tachycardic response (bradycardia).
8. A patient with severe urosepsis is exhibiting a blood pressure of 86/44 mm Hg
despite aggressive fluid resuscitation with 30 mL/kg of crystalloids. The nurse
recognizes that the patient has entered which stage or condition?
A) Compensatory sepsis
B) Refractory hypovolemia
C) Septic shock
D) Neurogenic collapse
Correct Answer: C
Rationale: Septic shock is defined as sepsis accompanied by persistent hypotension
that requires vasopressors to maintain a mean arterial pressure (MAP) \(\geq 65
\text{ mm Hg}\) despite adequate fluid resuscitation.
9. A nurse monitors a non-diabetic patient with early sepsis. Which subtle metabolic
change should the nurse recognize as a standard systemic response to inflammatory
stress?
A) Blood glucose level of 195 mg/dL
, B) Blood glucose level of 55 mg/dL
C) Serum potassium level of 2.8 mEq/L
D) Serum sodium level of 155 mEq/L
Correct Answer: A
Rationale: Hyperglycemia in the absence of diabetes mellitus is a classic early sign
of sepsis, driven by the release of stress hormones (cortisol and epinephrine) and
glycogenolysis.
10. A patient is prescribed phenytoin sodium for the prevention of tonic-clonic seizures.
What critical instruction must be included in the discharge teaching?
A) "You may stop taking this medication as soon as you are seizure-free for two
weeks."
B) "Double the next dose if you experience a mild aura or feel a headache coming
on."
C) "Never stop taking this medication abruptly, as it can cause continuous,
unceasing seizures."
D) "Take this medication only on days when you feel extra stressed or tired."
Correct Answer: C
Rationale: Abrupt cessation of anti-epileptic drugs like phenytoin can trigger status
epilepticus, a life-threatening emergency marked by continuous seizure activity.
11. A family member asks the nurse what specific laboratory or imaging test can
definitively confirm a diagnosis of Alzheimer's disease in their living relative. How
should the nurse respond?
A) "An MRI scan of the brain provides an absolute, definitive diagnosis."
B) "A specialized genetic blood test confirms the presence of Alzheimer's disease."
C) "A definitive diagnosis can only be made post-mortem by examining brain tissue
during an autopsy."
D) "A lumbar puncture with cerebrospinal fluid analysis yields a definitive diagnosis."
Correct Answer: C
Rationale: While clinical assessments and imaging rule out other causes, a definitive
diagnosis of Alzheimer's disease requires post-mortem identification of neurofibrillary
tangles and amyloid plaques.
12. A patient presents with acute neurological deficits. Which diagnostic test must be
performed immediately to differentiate between an ischemic stroke and a
hemorrhagic stroke before starting thrombolytic therapy?
A) Lumbar puncture
B) Non-contrast Computed Tomography (CT) scan of the head
C) Electroencephalogram (EEG)
D) Carotid artery duplex ultrasound
Correct Answer: B
Rationale: A non-contrast head CT scan is the gold standard for ruling out
intracranial hemorrhage. Thrombolytics are strictly contraindicated in hemorrhagic
stroke.
13. The nurse reviews preoperative laboratory values for a patient scheduled for an
elective cholecystectomy. Which result requires immediate notification of the
surgeon?
A) Potassium level of 4.0 mEq/L
B) White blood cell count of 8,500/mm³
C) Hemoglobin level of 7.8 g/dL
D) Prothrombin time (PT) of 11.5 seconds
Correct Answer: C
, Rationale: A hemoglobin level of 7.8 g/dL indicates severe anemia, which
compromises intraoperative tissue oxygenation and requires immediate evaluation
before anesthesia.
14. What post-operative teaching strategy should the nurse prioritize to prevent the
development of atelectasis and hypostatic pneumonia?
A) Restricting oral fluids for the first 48 hours
B) Encouraging deep breathing, coughing, and frequent use of an incentive
spirometer
C) Maintaining a strict supine position for 5 days
D) Administering prophylactic antiemetics every 4 hours
Correct Answer: B
Rationale: Frequent coughing, deep breathing, and incentive spirometry promote
alveolar expansion, mobilize pulmonary secretions, and reduce the risk of respiratory
infections.
15. Using the Emergency Severity Index (ESI) framework, which patient should the
triage nurse classify as an ESI Level 5 (Non-Urgent)?
A) A 50-year-old presenting with tearing chest pain radiating to the back.
B) A 24-year-old with an open femur fracture and a weak distal pulse.
C) A 65-year-old with a cold, swollen ankle after a minor trip, with intact
neurovascular status.
D) A 12-year-old with stridor and intercostal retractions.
Correct Answer: C
Rationale: ESI Level 5 is reserved for stable patients who require minimal or no
specialized hospital resources (e.g., a simple examination or prescription refill).
16. A patient is brought to the emergency department with a core temperature of
105.2°F (40.7°C), altered mental status, and hot, dry, non-sweating skin. Which
condition should the nurse prioritize?
A) Heat exhaustion
B) Heat cramps
C) Heat stroke
D) Neuroleptic malignant syndrome
Correct Answer: C
Rationale: Heat stroke is a life-threatening emergency characterized by a core
temperature above 104°F, neurological dysfunction, and an absence of sweating due
to thermoregulatory failure.
17. When actively rewarming a patient experiencing severe hypothermia, why must the
nurse prioritize continuous cardiac monitoring?
A) Rapid rewarming can precipitate life-threatening ventricular fibrillation.
B) Hypothermia increases the risk of developing bundle branch blocks.
C) Myocardial tissue becomes hyper-responsive to calcium channel blockers during
rewarming.
D) The heart rate must be kept above 150 beats per minute to restore tissue
perfusion.
Correct Answer: A
Rationale: Cold myocardium is highly irritable. As cold peripheral blood returns to the
core during rewarming (afterdrop), it can trigger fatal dysrhythmias like ventricular
fibrillation.
18. A patient is diagnosed with an acute ischemic stroke and is a candidate for tissue
plasminogen activator (tPA). The nurse knows that the medication must be
administered within what maximum timeframe from the onset of symptoms?
