MDC III (Multidimensional Care III)
Final Exam Mastery: Practice
Questions & Answers with Clinical
Rationales
SECTION 1: CARDIAC & HEMODYNAMIC DISORDERS
(Questions 1–30)
1. A nurse provides morning care for a client in the ICU. Suddenly, the bedside
monitor shows ventricular fibrillation and the client becomes unresponsive. After
calling for assistance, what action should the nurse take next?
A) Prepare for endotracheal intubation
B) Provide electrical cardioversion
C) Begin cardiopulmonary resuscitation (CPR)
D) Administer intravenous epinephrine
Answer: C) Begin cardiopulmonary resuscitation (CPR)
Rationale: For a pulseless, unresponsive patient in ventricular fibrillation, immediate CPR
is the priority while preparing for defibrillation. High-quality CPR maintains perfusion
until an AED or defibrillator is available. Intubation, epinephrine, and cardioversion are
later steps in the ACLS algorithm.
,2. A client with left-sided heart failure reports dyspnea and has crackles in both
lungs. What is the nurse's priority action?
A) Administer a diuretic as ordered
B) Place the client in a supine position
C) Increase IV fluid rate
D) Prepare for intubation
Answer: A) Administer a diuretic as ordered
Rationale: Left-sided heart failure leads to pulmonary congestion, causing dyspnea and
crackles. Administering a diuretic helps reduce fluid volume and pulmonary congestion.
The client should be placed in high Fowler's position, not supine, to ease breathing.
3. Which of the following clients would NOT be a candidate for thrombolytic
therapy?
A) Blood pressure 100/60 mm Hg
B) Patient with NSTEMI
C) History of hemorrhagic stroke one month ago
D) Client age of 65
Answer: C) History of hemorrhagic stroke one month ago
Rationale: A history of hemorrhagic stroke is an absolute contraindication for
thrombolytic therapy due to the risk of intracranial bleeding. Other contraindications
include active bleeding, recent surgery, and severe uncontrolled hypertension.
,4. Which client is most at risk for developing endocarditis?
A) A client who recently underwent a valve replacement
B) A client with Marfan's syndrome
C) A client recently diagnosed with mitral stenosis
D) A client who recently had a valve replacement and had dental work recently
performed
Answer: D) A client who recently had a valve replacement and had dental work
recently performed
Rationale: Clients with prosthetic heart valves are at high risk for infective endocarditis,
especially following invasive procedures like dental work that can cause transient
bacteremia. Prophylactic antibiotics are recommended before dental procedures for
these patients.
5. A nurse educates the client on which test is the best tool for diagnosing heart
failure?
A) Echocardiography
B) Pulmonary artery catheter
C) Radionuclide studies
D) Multigated angiographic (MUGA) scan
Answer: A) Echocardiography
Rationale: Echocardiography is a non-invasive diagnostic test used to evaluate the
pumping function of the ventricles and is considered the best tool for diagnosing heart
failure. It assesses ejection fraction, valve function, and structural abnormalities.
, 6. Which assessment finding is consistent with mitral valve prolapse?
A) Systolic click/late systolic murmur
B) Urinary frequency
C) Atrial fibrillation
D) Claudication
Answer: A) Systolic click/late systolic murmur
Rationale: Mitral valve prolapse is characterized by a mid-systolic click followed by a late
systolic murmur on auscultation. This occurs due to the prolapsing of the mitral valve
leaflets into the left atrium during systole.
7. What is a treatment option for a client with infective endocarditis?
A) Antimicrobials
B) Anticoagulants
C) Diet modification
D) Bedrest
Answer: A) Antimicrobials
Rationale: Antimicrobial therapy is the primary treatment for infective endocarditis.
Antibiotics such as penicillin G, procaine penicillin, and penicillin V are used to kill
microorganisms and stop their growth. Long-term IV antibiotic therapy is typically
required.
Final Exam Mastery: Practice
Questions & Answers with Clinical
Rationales
SECTION 1: CARDIAC & HEMODYNAMIC DISORDERS
(Questions 1–30)
1. A nurse provides morning care for a client in the ICU. Suddenly, the bedside
monitor shows ventricular fibrillation and the client becomes unresponsive. After
calling for assistance, what action should the nurse take next?
A) Prepare for endotracheal intubation
B) Provide electrical cardioversion
C) Begin cardiopulmonary resuscitation (CPR)
D) Administer intravenous epinephrine
Answer: C) Begin cardiopulmonary resuscitation (CPR)
Rationale: For a pulseless, unresponsive patient in ventricular fibrillation, immediate CPR
is the priority while preparing for defibrillation. High-quality CPR maintains perfusion
until an AED or defibrillator is available. Intubation, epinephrine, and cardioversion are
later steps in the ACLS algorithm.
,2. A client with left-sided heart failure reports dyspnea and has crackles in both
lungs. What is the nurse's priority action?
A) Administer a diuretic as ordered
B) Place the client in a supine position
C) Increase IV fluid rate
D) Prepare for intubation
Answer: A) Administer a diuretic as ordered
Rationale: Left-sided heart failure leads to pulmonary congestion, causing dyspnea and
crackles. Administering a diuretic helps reduce fluid volume and pulmonary congestion.
The client should be placed in high Fowler's position, not supine, to ease breathing.
3. Which of the following clients would NOT be a candidate for thrombolytic
therapy?
A) Blood pressure 100/60 mm Hg
B) Patient with NSTEMI
C) History of hemorrhagic stroke one month ago
D) Client age of 65
Answer: C) History of hemorrhagic stroke one month ago
Rationale: A history of hemorrhagic stroke is an absolute contraindication for
thrombolytic therapy due to the risk of intracranial bleeding. Other contraindications
include active bleeding, recent surgery, and severe uncontrolled hypertension.
,4. Which client is most at risk for developing endocarditis?
A) A client who recently underwent a valve replacement
B) A client with Marfan's syndrome
C) A client recently diagnosed with mitral stenosis
D) A client who recently had a valve replacement and had dental work recently
performed
Answer: D) A client who recently had a valve replacement and had dental work
recently performed
Rationale: Clients with prosthetic heart valves are at high risk for infective endocarditis,
especially following invasive procedures like dental work that can cause transient
bacteremia. Prophylactic antibiotics are recommended before dental procedures for
these patients.
5. A nurse educates the client on which test is the best tool for diagnosing heart
failure?
A) Echocardiography
B) Pulmonary artery catheter
C) Radionuclide studies
D) Multigated angiographic (MUGA) scan
Answer: A) Echocardiography
Rationale: Echocardiography is a non-invasive diagnostic test used to evaluate the
pumping function of the ventricles and is considered the best tool for diagnosing heart
failure. It assesses ejection fraction, valve function, and structural abnormalities.
, 6. Which assessment finding is consistent with mitral valve prolapse?
A) Systolic click/late systolic murmur
B) Urinary frequency
C) Atrial fibrillation
D) Claudication
Answer: A) Systolic click/late systolic murmur
Rationale: Mitral valve prolapse is characterized by a mid-systolic click followed by a late
systolic murmur on auscultation. This occurs due to the prolapsing of the mitral valve
leaflets into the left atrium during systole.
7. What is a treatment option for a client with infective endocarditis?
A) Antimicrobials
B) Anticoagulants
C) Diet modification
D) Bedrest
Answer: A) Antimicrobials
Rationale: Antimicrobial therapy is the primary treatment for infective endocarditis.
Antibiotics such as penicillin G, procaine penicillin, and penicillin V are used to kill
microorganisms and stop their growth. Long-term IV antibiotic therapy is typically
required.
