NUR 2502 | Multidimensional Care 3 Exam 1 | Rasmussen College 2026/2027
NUR 2502 Multidimensional Care 3 Exam 1
Rasmussen College | 2026/2027 Edition | MDC3 Exam 1 | 50 Questions | A+ Graded
Aligned with NCLEX-RN Advanced Nursing Competencies & Rasmussen NUR2502 Curriculum Standards
Instructions: Select the BEST answer for each question. Each question has one correct response. Comprehensive rationales with
nursing clinical reasoning are provided after each question.
SECTION 1: NEUROLOGICAL DISORDERS — Increased ICP, Stroke, Seizures,
Head Trauma, & Spinal Cord Injury (Q1-Q12)
Q1. A 42-year-old male is admitted to the neuro ICU after a motor vehicle crash with a closed head injury. The nurse
observes restlessness, confusion, and projectile vomiting without nausea. The patient’s vital signs are BP 150/88,
HR 58, RR 10. Which pathophysiologic principle, governed by the Monro-Kellie doctrine, best explains these
findings?
A. The skull is a rigid container; an increase in one intracranial component (brain tissue, blood, or CSF)
requires a compensatory decrease in another, and once compensation is exhausted, intracranial
pressure rises rapidly. [CORRECT]
B. Cerebral perfusion pressure (CPP) is independent of intracranial pressure (ICP) and is solely determined by
systemic mean arterial pressure (MAP).
C. Intracranial pressure remains stable regardless of cerebral edema because the dura mater is highly elastic and
accommodates volume changes.
D. The brain’s metabolic demand decreases after head trauma, leading to a corresponding decrease in cerebral
blood flow and CSF production.
Correct Answer: A
Rationale: The Monro-Kellie doctrine states the rigid skull contains brain tissue, blood, and CSF in a fixed volume; when one
component increases (edema, hemorrhage, hydrocephalus), compensation initially shifts CSF to the spinal canal and venous
blood out of the skull. Once this compensation is exhausted, small volume increases produce exponential ICP elevation,
manifesting as early signs (restlessness, confusion, projectile vomiting) and progressing to Cushing’s triad (hypertension,
bradycardia, irregular respirations). Option B is incorrect because CPP = MAP − ICP, making it directly ICP-dependent. Option
C is incorrect because the dura is inelastic. Option D is incorrect because metabolic demand and blood flow typically increase
after trauma to meet injured tissue needs.
Q2. The nurse caring for a patient with a traumatic brain injury notes a blood pressure of 184/96 mmHg, heart rate of
48 beats/minute, and an irregular respiratory pattern with Cheyne-Stokes breathing. The intracranial pressure
(ICP) reading is 28 mmHg. Which interpretation and priority action should the nurse implement?
A. The patient is exhibiting Cushing’s triad, a late sign of markedly elevated ICP indicating impending
brainstem herniation; the nurse should immediately notify the provider, elevate the head of the bed to
30 degrees in neutral midline position, and prepare to administer an osmotic diuretic such as mannitol.
[CORRECT]
B. The findings suggest a vasovagal response; the nurse should lower the head of the bed and administer a 500 mL
IV fluid bolus to restore cerebral perfusion.
C. The patient is experiencing sympathetic nervous system overstimulation; the nurse should administer labetalol IV
push to lower blood pressure to 120/80 mmHg.
D. The ICP of 28 mmHg is within acceptable limits for a traumatic brain injury patient; continue monitoring and
document the findings as expected.
Page 1 | MDC3 Exam 1 | A+ Graded Content
,NUR 2502 | Multidimensional Care 3 Exam 1 | Rasmussen College 2026/2027
Correct Answer: A
Rationale: Cushing’s triad (widening pulse pressure with hypertension, bradycardia, and irregular respirations) is a LATE,
ominous sign of significantly elevated ICP (normal 5-15 mmHg) signaling brainstem ischemia and impending herniation. The
priority is to reduce ICP immediately: elevate HOB 30 degrees in neutral midline to promote venous drainage, maintain
normothermia, and administer osmotic diuretics (mannitol) as ordered while notifying the provider. Option B would worsen ICP
by increasing cerebral blood volume. Option C is dangerous because aggressively lowering BP reduces cerebral perfusion
pressure (CPP = MAP − ICP), worsening ischemia. Option D is incorrect because an ICP of 28 mmHg is critically elevated and
requires intervention, not observation.
Q3. A nurse is positioning a patient with increased intracranial pressure (ICP) of 22 mmHg. Which positioning
intervention is most appropriate to reduce ICP while maintaining cerebral perfusion pressure (CPP)?
A. Elevate the head of the bed to 30 degrees and maintain the head in a neutral midline position to promote
jugular venous outflow. [CORRECT]
B. Place the patient in Trendelenburg position at 15 degrees to increase cerebral perfusion pressure.
C. Maintain the patient flat and supine with the head turned to the right side to prevent aspiration.
D. Elevate the head of the bed to 90 degrees to maximize venous drainage from the cranium.
Correct Answer: A
Rationale: Elevating the head of the bed to 30 degrees with the head in a neutral midline position promotes jugular venous
outflow and reduces cerebral blood volume, thereby lowering ICP while maintaining adequate CPP (target > 60 mmHg).
Trendelenburg position (Option B) increases intrathoracic pressure and impairs venous drainage, worsening ICP. A flat supine
position with the head turned (Option C) obstructs the jugular veins and impedes venous return. Extreme elevation of 90 degrees
(Option D) risks hypotension and a dangerous reduction in CPP, particularly if hypovolemia is present.
Q4. A patient with severe traumatic brain injury receives an order for IV mannitol 0.5 g/kg for acute intracranial
pressure (ICP) management. Which assessment finding would alert the nurse to a potential adverse effect
requiring immediate intervention?
A. Serum sodium of 148 mEq/L and serum osmolality of 310 mOsm/kg, indicating mannitol-induced
osmotic diuresis with hypernatremia and risk of rebound ICP elevation. [CORRECT]
B. Urine output of 50 mL/hour, indicating therapeutic effectiveness of the mannitol.
C. Blood pressure of 110/70 mmHg, indicating improved cerebral perfusion pressure.
D. Heart rate of 80 beats/minute, indicating resolution of Cushing’s triad.
Correct Answer: A
Rationale: Mannitol is an osmotic diuretic that draws fluid from brain tissue into the intravascular space; it can cause
significant dehydration, hypernatremia, hypokalemia, and acute kidney injury. Serum osmolality must be monitored and kept
below 320 mOsm/kg, and total daily dose should not exceed 1.5 g/kg/day to avoid rebound ICP elevation and renal toxicity.
Option B is incorrect because urine output of 50 mL/hr is normal but does not signal an adverse effect. Options C and D
describe desirable outcomes, not adverse effects. The critical safety parameters are electrolytes, serum osmolality, renal
function, and signs of rebound ICP.
Q5. A patient with an intraventricular catheter (ventriculostomy) is being monitored for increased intracranial
pressure (ICP). The nurse notes the CSF drainage bag is positioned 15 cm above the level of the patient’s external
auditory meatus. The drainage system has produced 180 mL of cloudy pink-tinged CSF in the past 4 hours. What
is the priority nursing action?
A. Lower the drainage bag to the prescribed level (typically 10-15 mmHg above the external auditory
meatus), monitor CSF color/clarity/volume hourly, and notify the provider of the cloudy appearance
suggesting possible infection and the high drainage volume suggesting over-drainage risk. [CORRECT]
B. Raise the drainage bag higher to slow the drainage rate, then continue to monitor the patient.
Page 2 | MDC3 Exam 1 | A+ Graded Content
, NUR 2502 | Multidimensional Care 3 Exam 1 | Rasmussen College 2026/2027
C. Clamp the drainage system for 30 minutes to assess for rebound ICP elevation.
D. Irrigate the catheter with 10 mL of sterile normal saline to clear the bloody drainage.
Correct Answer: A
Rationale: Ventriculostomy drainage requires precise level control; the system is leveled at the prescribed height (often 10-15
mmHg above the external auditory meatus) and CSF output, color, and clarity are documented hourly. Excessive drainage (>
10-15 mL/hour typically) risks ventricular collapse and subdural hematoma. Cloudy CSF suggests infection
(ventriculitis/meningitis) requiring provider notification and possible CSF culture. Option B without provider input is unsafe.
Option C clamping can cause dangerous ICP spikes. Option D irrigation is outside nursing scope without a specific provider
order and could introduce infection.
Q6. A 68-year-old female arrives at the emergency department 90 minutes after sudden onset of right-sided
weakness, facial droop, and aphasia. CT scan confirms an ischemic stroke with no hemorrhage. Her blood
pressure is 192/110 mmHg. Which action by the nurse is most appropriate regarding tissue plasminogen activator
(tPA) administration?
A. The patient may be a candidate for IV tPA if eligibility criteria are met (within 3-4.5 hours of symptom
onset, no contraindications); blood pressure must be lowered to < 185/110 mmHg before and
maintained < 180/105 mmHg for 24 hours after administration using IV labetalol or nicardipine.
[CORRECT]
B. tPA cannot be administered because the patient arrived outside the 60-minute treatment window.
C. tPA should be administered immediately without blood pressure management because time is brain.
D. tPA is contraindicated because the patient has aphasia, which is an absolute contraindication.
Correct Answer: A
Rationale: IV alteplase (tPA) is indicated for acute ischemic stroke within 3-4.5 hours of symptom onset, provided
contraindications (recent surgery, head trauma, GI bleeding, active bleeding, uncontrolled hypertension) are excluded. Blood
pressure must be controlled to < 185/110 mmHg before tPA administration and maintained < 180/105 mmHg for 24 hours
post-administration to minimize hemorrhagic transformation risk. Option B is incorrect because the 90-minute arrival is well
within the 3-4.5 hour window. Option C is unsafe because uncontrolled hypertension dramatically increases hemorrhagic
transformation risk. Option D is incorrect because aphasia is a stroke symptom, not a contraindication.
Q7. A 55-year-old male presents with a sudden severe “thunderclap” headache described as “the worst headache of
my life,” followed by nausea, vomiting, and a brief loss of consciousness. Vital signs reveal BP 170/100, HR 88,
RR 18. Which type of stroke is most likely, and what is the priority nursing intervention?
A. Subarachnoid hemorrhage (hemorrhagic stroke); the priority is to maintain airway, breathing,
circulation, initiate stroke protocol, obtain STAT CT scan, avoid anticoagulants/antiplatelets, control
blood pressure, and prepare for possible nimodipine administration to prevent vasospasm.
[CORRECT]
B. Ischemic thrombotic stroke; the priority is to administer IV tPA within 3-4.5 hours of symptom onset.
C. Transient ischemic attack (TIA); the priority is to discharge the patient with aspirin therapy and outpatient
follow-up.
D. Lacunar infarct; the priority is to begin anticoagulation therapy with heparin infusion.
Correct Answer: A
Rationale: A sudden “thunderclap” or “worst headache of my life” is the classic presentation of a subarachnoid hemorrhage
(SAH), typically caused by a ruptured cerebral aneurysm. Management focuses on ABCs, CT to confirm hemorrhage, blood
pressure control, avoidance of anticoagulants, and administration of the calcium channel blocker nimodipine to reduce cerebral
vasospasm (a major cause of secondary ischemia 3-14 days post-SAH). Options B and D are dangerous because
anticoagulants/thrombolytics would worsen bleeding. Option C is incorrect because SAH is a life-threatening emergency, not a
Page 3 | MDC3 Exam 1 | A+ Graded Content
NUR 2502 Multidimensional Care 3 Exam 1
Rasmussen College | 2026/2027 Edition | MDC3 Exam 1 | 50 Questions | A+ Graded
Aligned with NCLEX-RN Advanced Nursing Competencies & Rasmussen NUR2502 Curriculum Standards
Instructions: Select the BEST answer for each question. Each question has one correct response. Comprehensive rationales with
nursing clinical reasoning are provided after each question.
SECTION 1: NEUROLOGICAL DISORDERS — Increased ICP, Stroke, Seizures,
Head Trauma, & Spinal Cord Injury (Q1-Q12)
Q1. A 42-year-old male is admitted to the neuro ICU after a motor vehicle crash with a closed head injury. The nurse
observes restlessness, confusion, and projectile vomiting without nausea. The patient’s vital signs are BP 150/88,
HR 58, RR 10. Which pathophysiologic principle, governed by the Monro-Kellie doctrine, best explains these
findings?
A. The skull is a rigid container; an increase in one intracranial component (brain tissue, blood, or CSF)
requires a compensatory decrease in another, and once compensation is exhausted, intracranial
pressure rises rapidly. [CORRECT]
B. Cerebral perfusion pressure (CPP) is independent of intracranial pressure (ICP) and is solely determined by
systemic mean arterial pressure (MAP).
C. Intracranial pressure remains stable regardless of cerebral edema because the dura mater is highly elastic and
accommodates volume changes.
D. The brain’s metabolic demand decreases after head trauma, leading to a corresponding decrease in cerebral
blood flow and CSF production.
Correct Answer: A
Rationale: The Monro-Kellie doctrine states the rigid skull contains brain tissue, blood, and CSF in a fixed volume; when one
component increases (edema, hemorrhage, hydrocephalus), compensation initially shifts CSF to the spinal canal and venous
blood out of the skull. Once this compensation is exhausted, small volume increases produce exponential ICP elevation,
manifesting as early signs (restlessness, confusion, projectile vomiting) and progressing to Cushing’s triad (hypertension,
bradycardia, irregular respirations). Option B is incorrect because CPP = MAP − ICP, making it directly ICP-dependent. Option
C is incorrect because the dura is inelastic. Option D is incorrect because metabolic demand and blood flow typically increase
after trauma to meet injured tissue needs.
Q2. The nurse caring for a patient with a traumatic brain injury notes a blood pressure of 184/96 mmHg, heart rate of
48 beats/minute, and an irregular respiratory pattern with Cheyne-Stokes breathing. The intracranial pressure
(ICP) reading is 28 mmHg. Which interpretation and priority action should the nurse implement?
A. The patient is exhibiting Cushing’s triad, a late sign of markedly elevated ICP indicating impending
brainstem herniation; the nurse should immediately notify the provider, elevate the head of the bed to
30 degrees in neutral midline position, and prepare to administer an osmotic diuretic such as mannitol.
[CORRECT]
B. The findings suggest a vasovagal response; the nurse should lower the head of the bed and administer a 500 mL
IV fluid bolus to restore cerebral perfusion.
C. The patient is experiencing sympathetic nervous system overstimulation; the nurse should administer labetalol IV
push to lower blood pressure to 120/80 mmHg.
D. The ICP of 28 mmHg is within acceptable limits for a traumatic brain injury patient; continue monitoring and
document the findings as expected.
Page 1 | MDC3 Exam 1 | A+ Graded Content
,NUR 2502 | Multidimensional Care 3 Exam 1 | Rasmussen College 2026/2027
Correct Answer: A
Rationale: Cushing’s triad (widening pulse pressure with hypertension, bradycardia, and irregular respirations) is a LATE,
ominous sign of significantly elevated ICP (normal 5-15 mmHg) signaling brainstem ischemia and impending herniation. The
priority is to reduce ICP immediately: elevate HOB 30 degrees in neutral midline to promote venous drainage, maintain
normothermia, and administer osmotic diuretics (mannitol) as ordered while notifying the provider. Option B would worsen ICP
by increasing cerebral blood volume. Option C is dangerous because aggressively lowering BP reduces cerebral perfusion
pressure (CPP = MAP − ICP), worsening ischemia. Option D is incorrect because an ICP of 28 mmHg is critically elevated and
requires intervention, not observation.
Q3. A nurse is positioning a patient with increased intracranial pressure (ICP) of 22 mmHg. Which positioning
intervention is most appropriate to reduce ICP while maintaining cerebral perfusion pressure (CPP)?
A. Elevate the head of the bed to 30 degrees and maintain the head in a neutral midline position to promote
jugular venous outflow. [CORRECT]
B. Place the patient in Trendelenburg position at 15 degrees to increase cerebral perfusion pressure.
C. Maintain the patient flat and supine with the head turned to the right side to prevent aspiration.
D. Elevate the head of the bed to 90 degrees to maximize venous drainage from the cranium.
Correct Answer: A
Rationale: Elevating the head of the bed to 30 degrees with the head in a neutral midline position promotes jugular venous
outflow and reduces cerebral blood volume, thereby lowering ICP while maintaining adequate CPP (target > 60 mmHg).
Trendelenburg position (Option B) increases intrathoracic pressure and impairs venous drainage, worsening ICP. A flat supine
position with the head turned (Option C) obstructs the jugular veins and impedes venous return. Extreme elevation of 90 degrees
(Option D) risks hypotension and a dangerous reduction in CPP, particularly if hypovolemia is present.
Q4. A patient with severe traumatic brain injury receives an order for IV mannitol 0.5 g/kg for acute intracranial
pressure (ICP) management. Which assessment finding would alert the nurse to a potential adverse effect
requiring immediate intervention?
A. Serum sodium of 148 mEq/L and serum osmolality of 310 mOsm/kg, indicating mannitol-induced
osmotic diuresis with hypernatremia and risk of rebound ICP elevation. [CORRECT]
B. Urine output of 50 mL/hour, indicating therapeutic effectiveness of the mannitol.
C. Blood pressure of 110/70 mmHg, indicating improved cerebral perfusion pressure.
D. Heart rate of 80 beats/minute, indicating resolution of Cushing’s triad.
Correct Answer: A
Rationale: Mannitol is an osmotic diuretic that draws fluid from brain tissue into the intravascular space; it can cause
significant dehydration, hypernatremia, hypokalemia, and acute kidney injury. Serum osmolality must be monitored and kept
below 320 mOsm/kg, and total daily dose should not exceed 1.5 g/kg/day to avoid rebound ICP elevation and renal toxicity.
Option B is incorrect because urine output of 50 mL/hr is normal but does not signal an adverse effect. Options C and D
describe desirable outcomes, not adverse effects. The critical safety parameters are electrolytes, serum osmolality, renal
function, and signs of rebound ICP.
Q5. A patient with an intraventricular catheter (ventriculostomy) is being monitored for increased intracranial
pressure (ICP). The nurse notes the CSF drainage bag is positioned 15 cm above the level of the patient’s external
auditory meatus. The drainage system has produced 180 mL of cloudy pink-tinged CSF in the past 4 hours. What
is the priority nursing action?
A. Lower the drainage bag to the prescribed level (typically 10-15 mmHg above the external auditory
meatus), monitor CSF color/clarity/volume hourly, and notify the provider of the cloudy appearance
suggesting possible infection and the high drainage volume suggesting over-drainage risk. [CORRECT]
B. Raise the drainage bag higher to slow the drainage rate, then continue to monitor the patient.
Page 2 | MDC3 Exam 1 | A+ Graded Content
, NUR 2502 | Multidimensional Care 3 Exam 1 | Rasmussen College 2026/2027
C. Clamp the drainage system for 30 minutes to assess for rebound ICP elevation.
D. Irrigate the catheter with 10 mL of sterile normal saline to clear the bloody drainage.
Correct Answer: A
Rationale: Ventriculostomy drainage requires precise level control; the system is leveled at the prescribed height (often 10-15
mmHg above the external auditory meatus) and CSF output, color, and clarity are documented hourly. Excessive drainage (>
10-15 mL/hour typically) risks ventricular collapse and subdural hematoma. Cloudy CSF suggests infection
(ventriculitis/meningitis) requiring provider notification and possible CSF culture. Option B without provider input is unsafe.
Option C clamping can cause dangerous ICP spikes. Option D irrigation is outside nursing scope without a specific provider
order and could introduce infection.
Q6. A 68-year-old female arrives at the emergency department 90 minutes after sudden onset of right-sided
weakness, facial droop, and aphasia. CT scan confirms an ischemic stroke with no hemorrhage. Her blood
pressure is 192/110 mmHg. Which action by the nurse is most appropriate regarding tissue plasminogen activator
(tPA) administration?
A. The patient may be a candidate for IV tPA if eligibility criteria are met (within 3-4.5 hours of symptom
onset, no contraindications); blood pressure must be lowered to < 185/110 mmHg before and
maintained < 180/105 mmHg for 24 hours after administration using IV labetalol or nicardipine.
[CORRECT]
B. tPA cannot be administered because the patient arrived outside the 60-minute treatment window.
C. tPA should be administered immediately without blood pressure management because time is brain.
D. tPA is contraindicated because the patient has aphasia, which is an absolute contraindication.
Correct Answer: A
Rationale: IV alteplase (tPA) is indicated for acute ischemic stroke within 3-4.5 hours of symptom onset, provided
contraindications (recent surgery, head trauma, GI bleeding, active bleeding, uncontrolled hypertension) are excluded. Blood
pressure must be controlled to < 185/110 mmHg before tPA administration and maintained < 180/105 mmHg for 24 hours
post-administration to minimize hemorrhagic transformation risk. Option B is incorrect because the 90-minute arrival is well
within the 3-4.5 hour window. Option C is unsafe because uncontrolled hypertension dramatically increases hemorrhagic
transformation risk. Option D is incorrect because aphasia is a stroke symptom, not a contraindication.
Q7. A 55-year-old male presents with a sudden severe “thunderclap” headache described as “the worst headache of
my life,” followed by nausea, vomiting, and a brief loss of consciousness. Vital signs reveal BP 170/100, HR 88,
RR 18. Which type of stroke is most likely, and what is the priority nursing intervention?
A. Subarachnoid hemorrhage (hemorrhagic stroke); the priority is to maintain airway, breathing,
circulation, initiate stroke protocol, obtain STAT CT scan, avoid anticoagulants/antiplatelets, control
blood pressure, and prepare for possible nimodipine administration to prevent vasospasm.
[CORRECT]
B. Ischemic thrombotic stroke; the priority is to administer IV tPA within 3-4.5 hours of symptom onset.
C. Transient ischemic attack (TIA); the priority is to discharge the patient with aspirin therapy and outpatient
follow-up.
D. Lacunar infarct; the priority is to begin anticoagulation therapy with heparin infusion.
Correct Answer: A
Rationale: A sudden “thunderclap” or “worst headache of my life” is the classic presentation of a subarachnoid hemorrhage
(SAH), typically caused by a ruptured cerebral aneurysm. Management focuses on ABCs, CT to confirm hemorrhage, blood
pressure control, avoidance of anticoagulants, and administration of the calcium channel blocker nimodipine to reduce cerebral
vasospasm (a major cause of secondary ischemia 3-14 days post-SAH). Options B and D are dangerous because
anticoagulants/thrombolytics would worsen bleeding. Option C is incorrect because SAH is a life-threatening emergency, not a
Page 3 | MDC3 Exam 1 | A+ Graded Content
