RASMUSSEN UNIVERSITY • COLLEGE OF NURSING
NUR 2755 / NUR 2755
Exam 1
Multidimensional Care IV / MDC 4
Comprehensive Examination
75-Question Practice Examination covering Neurological Disorders, Shock
States, Burns and Wound Management, Respiratory Disorders, Cardiovascular
Disorders, Prioritization and Delegation, and Integrated Clinical Scenarios
aligned with 2026-2027 curriculum standards.
Latest Edition
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
75 Multiple-Choice Questions (A-D Format)
MDC 4 ADVANCED NURSING COMPETENCIES • RASMUSSEN UNIVERSITY
, NUR 2755 / NUR 2755 Exam 1
Multidimensional Care IV (MDC 4) — Comprehensive Examination
Instructions: Select the BEST answer for each question. Each question has four options (A–D) with
exactly one correct answer. Cognitive levels: 25% Recall, 55% Application, 20% Analysis. 75 Questions
Total.
Section 1: Neurological Disorders (Seizures, Stroke, Increased ICP,
Parkinson's, MS, & Spinal Cord Injury)
1. A nurse is caring for a client with increased intracranial pressure (ICP). Which of the following findings is
an early sign of increased ICP?
A. Decerebrate posturing with extended, rigid extremities
B. Widened pulse pressure with bradycardia
C. Projectile vomiting and decreasing level of consciousness [CORRECT]
D. Dilated and fixed pupils bilaterally
Correct Answer: C
Rationale: Early signs of increased ICP include headache, projectile vomiting, decreased level of consciousness,
and pupillary changes (response to light diminishes). Cushing triad (widened pulse pressure, bradycardia, irregular
respirations) is a late sign indicating significant herniation risk. Decerebrate posturing and fixed dilated pupils are
critical signs of brain herniation requiring immediate intervention (Rasmussen MDC 4, Neurological Assessment
Module). Decerebrate posturing (Option A) indicates severe brainstem damage and is a late/terminal sign, not an
early indicator.
2. A client presents with increasing systolic blood pressure, bradycardia, and irregular respirations. The nurse
recognizes this as which of the following?
A. Cushing triad
B. Brown-Sequard syndrome
C. Normal ICP compensation
D. Autonomic dysreflexia
Correct Answer: A
Rationale: Cushing triad is a late and ominous sign of increased ICP consisting of widening pulse pressure
(increasing systolic BP), bradycardia, and irregular respirations (Cheyne-Stokes or ataxic patterns). This triad
indicates significant brainstem compression and impending herniation, requiring emergency intervention. Normal
ICP is 5-15 mmHg; sustained ICP greater than 20 mmHg is concerning (Rasmussen MDC 4 Neurological
Module). Brown-Sequard syndrome (Option B) is a hemisection of the spinal cord causing ipsilateral motor loss
and contralateral pain/temperature loss. Autonomic dysreflexia (Option D) occurs with spinal cord injuries above
NUR 2755 Exam 1 | MDC 4 Page 1 Rasmussen University
, T6 and presents with severe hypertension, bradycardia, and pounding headache triggered by noxious stimuli below
the injury level.
3. A nurse is assessing a client who experienced a seizure. The client reports seeing flashing lights before the
seizure began and is now confused and fatigued. The nurse identifies that the flashing lights occurred during
which seizure phase?
A. Interictal phase
B. Ictal phase
C. Pre-ictal phase (aura) [CORRECT]
D. Post-ictal phase
Correct Answer: C
Rationale: Seizures have three distinct phases. The pre-ictal phase (aura) precedes the seizure and may include
sensory experiences such as flashing lights, unusual smells, or behavioral changes that serve as warning signs. The
ictal phase is the active seizure with uncontrolled neuronal firing. The post-ictal phase follows the seizure and
includes confusion, fatigue, drowsiness, and disorientation. The interictal period (Option A) refers to the time
between seizures when the patient is at baseline (Rasmussen MDC 4 Seizure Management Module). Recognizing
the aura allows the nurse to implement safety measures before the ictal phase begins.
4. A client with a history of seizures is experiencing continuous seizure activity that has lasted for 8 minutes
without regaining consciousness. Which of the following is the priority nursing intervention?
A. Administer phenytoin (Dilantin) IV push
B. Prepare for intubation and mechanical ventilation
C. Administer a benzodiazepine as prescribed [CORRECT]
D. Document the duration and type of seizure activity
Correct Answer: C
Rationale: Status epilepticus is defined as continuous seizure activity lasting longer than 5 minutes or recurrent
seizures without recovery of consciousness between episodes. This is a neurological emergency. The priority
intervention is administration of a benzodiazepine (such as lorazepam or diazepam) to terminate seizure activity
rapidly. Benzodiazepines act as first-line treatment because they enhance GABA activity and quickly stop seizure
propagation. Phenytoin (Option A) is used for longer-term seizure management but has a slower onset of action
and is administered after benzodiazepines. While documentation (Option D) is important, it is not the priority over
life-saving treatment. Intubation (Option B) may become necessary if airway compromise develops but is not the
first intervention (Rasmussen MDC 4 Seizure Emergency Protocol).
5. A nurse is providing discharge teaching to a client prescribed phenytoin (Dilantin). Which of the following
statements by the client indicates an understanding of the teaching?
A. 'I should schedule regular dental checkups because this medication can cause gum overgrowth.'
B. 'I can stop taking this medication once I have been seizure-free for 6 months.'
C. 'I should eat plenty of leafy green vegetables to maintain consistent vitamin K levels.'
D. 'I should take this medication with antacids to prevent stomach upset.'
Correct Answer: A
Rationale: Phenytoin (Dilantin) has a therapeutic level of 10-20 mcg/mL and requires specific patient education.
Key teaching points include: regular dental checkups due to gingival hyperplasia (gum overgrowth), use of
alternative birth control methods (phenytoin decreases oral contraceptive effectiveness), and the importance of
NUR 2755 Exam 1 | MDC 4 Page 2 Rasmussen University
NUR 2755 / NUR 2755
Exam 1
Multidimensional Care IV / MDC 4
Comprehensive Examination
75-Question Practice Examination covering Neurological Disorders, Shock
States, Burns and Wound Management, Respiratory Disorders, Cardiovascular
Disorders, Prioritization and Delegation, and Integrated Clinical Scenarios
aligned with 2026-2027 curriculum standards.
Latest Edition
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
75 Multiple-Choice Questions (A-D Format)
MDC 4 ADVANCED NURSING COMPETENCIES • RASMUSSEN UNIVERSITY
, NUR 2755 / NUR 2755 Exam 1
Multidimensional Care IV (MDC 4) — Comprehensive Examination
Instructions: Select the BEST answer for each question. Each question has four options (A–D) with
exactly one correct answer. Cognitive levels: 25% Recall, 55% Application, 20% Analysis. 75 Questions
Total.
Section 1: Neurological Disorders (Seizures, Stroke, Increased ICP,
Parkinson's, MS, & Spinal Cord Injury)
1. A nurse is caring for a client with increased intracranial pressure (ICP). Which of the following findings is
an early sign of increased ICP?
A. Decerebrate posturing with extended, rigid extremities
B. Widened pulse pressure with bradycardia
C. Projectile vomiting and decreasing level of consciousness [CORRECT]
D. Dilated and fixed pupils bilaterally
Correct Answer: C
Rationale: Early signs of increased ICP include headache, projectile vomiting, decreased level of consciousness,
and pupillary changes (response to light diminishes). Cushing triad (widened pulse pressure, bradycardia, irregular
respirations) is a late sign indicating significant herniation risk. Decerebrate posturing and fixed dilated pupils are
critical signs of brain herniation requiring immediate intervention (Rasmussen MDC 4, Neurological Assessment
Module). Decerebrate posturing (Option A) indicates severe brainstem damage and is a late/terminal sign, not an
early indicator.
2. A client presents with increasing systolic blood pressure, bradycardia, and irregular respirations. The nurse
recognizes this as which of the following?
A. Cushing triad
B. Brown-Sequard syndrome
C. Normal ICP compensation
D. Autonomic dysreflexia
Correct Answer: A
Rationale: Cushing triad is a late and ominous sign of increased ICP consisting of widening pulse pressure
(increasing systolic BP), bradycardia, and irregular respirations (Cheyne-Stokes or ataxic patterns). This triad
indicates significant brainstem compression and impending herniation, requiring emergency intervention. Normal
ICP is 5-15 mmHg; sustained ICP greater than 20 mmHg is concerning (Rasmussen MDC 4 Neurological
Module). Brown-Sequard syndrome (Option B) is a hemisection of the spinal cord causing ipsilateral motor loss
and contralateral pain/temperature loss. Autonomic dysreflexia (Option D) occurs with spinal cord injuries above
NUR 2755 Exam 1 | MDC 4 Page 1 Rasmussen University
, T6 and presents with severe hypertension, bradycardia, and pounding headache triggered by noxious stimuli below
the injury level.
3. A nurse is assessing a client who experienced a seizure. The client reports seeing flashing lights before the
seizure began and is now confused and fatigued. The nurse identifies that the flashing lights occurred during
which seizure phase?
A. Interictal phase
B. Ictal phase
C. Pre-ictal phase (aura) [CORRECT]
D. Post-ictal phase
Correct Answer: C
Rationale: Seizures have three distinct phases. The pre-ictal phase (aura) precedes the seizure and may include
sensory experiences such as flashing lights, unusual smells, or behavioral changes that serve as warning signs. The
ictal phase is the active seizure with uncontrolled neuronal firing. The post-ictal phase follows the seizure and
includes confusion, fatigue, drowsiness, and disorientation. The interictal period (Option A) refers to the time
between seizures when the patient is at baseline (Rasmussen MDC 4 Seizure Management Module). Recognizing
the aura allows the nurse to implement safety measures before the ictal phase begins.
4. A client with a history of seizures is experiencing continuous seizure activity that has lasted for 8 minutes
without regaining consciousness. Which of the following is the priority nursing intervention?
A. Administer phenytoin (Dilantin) IV push
B. Prepare for intubation and mechanical ventilation
C. Administer a benzodiazepine as prescribed [CORRECT]
D. Document the duration and type of seizure activity
Correct Answer: C
Rationale: Status epilepticus is defined as continuous seizure activity lasting longer than 5 minutes or recurrent
seizures without recovery of consciousness between episodes. This is a neurological emergency. The priority
intervention is administration of a benzodiazepine (such as lorazepam or diazepam) to terminate seizure activity
rapidly. Benzodiazepines act as first-line treatment because they enhance GABA activity and quickly stop seizure
propagation. Phenytoin (Option A) is used for longer-term seizure management but has a slower onset of action
and is administered after benzodiazepines. While documentation (Option D) is important, it is not the priority over
life-saving treatment. Intubation (Option B) may become necessary if airway compromise develops but is not the
first intervention (Rasmussen MDC 4 Seizure Emergency Protocol).
5. A nurse is providing discharge teaching to a client prescribed phenytoin (Dilantin). Which of the following
statements by the client indicates an understanding of the teaching?
A. 'I should schedule regular dental checkups because this medication can cause gum overgrowth.'
B. 'I can stop taking this medication once I have been seizure-free for 6 months.'
C. 'I should eat plenty of leafy green vegetables to maintain consistent vitamin K levels.'
D. 'I should take this medication with antacids to prevent stomach upset.'
Correct Answer: A
Rationale: Phenytoin (Dilantin) has a therapeutic level of 10-20 mcg/mL and requires specific patient education.
Key teaching points include: regular dental checkups due to gingival hyperplasia (gum overgrowth), use of
alternative birth control methods (phenytoin decreases oral contraceptive effectiveness), and the importance of
NUR 2755 Exam 1 | MDC 4 Page 2 Rasmussen University
