NUR 2392
Multidimensional Care II (MDC 2)
Final Examination
Institution: Rasmussen University
Course: NUR 2392 - Multidimensional Care II
Total Questions: 100 Multiple Choice
Format: 4 Options (A-D), One Correct Answer
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Comprehensive coverage of MDC 2 modules: Cardiovascular, Peripheral Vascular, Hematologic,
Renal, Endocrine, Fluid/Electrolytes, and Integrated Clinical Scenarios
,NUR 2392 / MDC 2 Final Examination | Rasmussen University | 2026-2027 100 Questions
Section 1: Cardiovascular Disorders (CAD, Heart Failure, Hypertension, Valvular
Disorders, Dysrhythmias)
Q1: A 58-year-old male presents to the emergency department with crushing
substernal chest pain that began 45 minutes ago. The pain radiates to his left
arm and jaw. He is diaphoretic and nauseated. Which cardiac biomarker is the
gold standard for confirming myocardial infarction and typically rises within
3-4 hours post-MI?
A. A. Creatine kinase-MB (CK-MB)
B. B. Myoglobin
C. C. Troponin I [CORRECT]
D. D. B-type natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the gold standard cardiac biomarker for diagnosing myocardial infarction
because of its high cardiac specificity and sensitivity; it rises within 3-4 hours post-MI and remains
elevated for 7-10 days. CK-MB is less specific (also found in skeletal muscle) and returns to normal
within 48-72 hours. Myoglobin rises earliest (1-2 hours) but is not cardiac-specific. BNP is used for
heart failure diagnosis, not acute MI confirmation. Rasmussen MDC 2 curriculum identifies Troponin
I as the primary biomarker in the ACS assessment framework.
Q2: A nurse is caring for a patient diagnosed with unstable angina. Which
statement best differentiates unstable angina from stable angina?
A. A. Unstable angina occurs only during periods of extreme emotional stress
B. B. Unstable angina is relieved by rest and nitroglycerin
C. C. Unstable angina occurs unpredictably, may happen at rest, and is a medical
emergency [CORRECT]
D. D. Unstable angina is caused by coronary vasospasm without atherosclerotic plaque
Correct Answer: C
Rationale: Unstable angina is characterized by unpredictable chest pain that occurs at rest, increases
in frequency or severity, and is not reliably relieved by rest or nitroglycerin, making it a medical
emergency requiring immediate intervention. Stable angina is predictable, occurs with exertion, and
is relieved by rest or nitroglycerin. Prinzmetal (variant) angina is caused by coronary vasospasm. The
distinction between unstable and stable angina is a critical concept in the Rasmussen MDC 2
cardiovascular module, as unstable angina signals impending MI and requires MONA intervention.
Q3: A patient arrives at the emergency department with suspected acute
coronary syndrome. The physician orders the initial MONA protocol. What does
the acronym MONA stand for in this context?
A. A. Morphine, Oxygen, Nitrates, Aspirin [CORRECT]
B. B. Metoprolol, Oxygen, Niacin, Amiodarone
C. C. Morphine, Osmitrol, Nitroprusside, Aspirin
D. D. Metolazone, Oxygen, Nitroglycerin, Atenolol
Correct Answer: A
Page 2
,NUR 2392 / MDC 2 Final Examination | Rasmussen University | 2026-2027 100 Questions
Rationale: MONA is the standard initial collaborative care protocol for acute coronary syndrome:
Morphine (for pain and anxiety reduction, also reduces preload), Oxygen (to improve myocardial
oxygenation, though current evidence supports O2 only if SpO2 is below 94%), Nitroglycerin (for
vasodilation and preload reduction), and Aspirin (antiplatelet therapy to prevent further thrombus
formation). This protocol is foundational in the Rasmussen MDC 2 ACS management framework and
is tested extensively on the final exam.
Q4: A 65-year-old female patient is prescribed atorvastatin (Lipitor) for
hyperlipidemia following a myocardial infarction. Which laboratory values
should the nurse monitor to assess for adverse effects of this medication?
A. A. Serum sodium and potassium levels
B. B. Liver function tests (AST/ALT) and creatine kinase for muscle pain [CORRECT]
C. C. Prothrombin time (PT) and international normalized ratio (INR)
D. D. Blood urea nitrogen (BUN) and serum creatinine
Correct Answer: B
Rationale: Atorvastatin, an HMG-CoA reductase inhibitor (statin), requires monitoring of liver
function tests (AST/ALT) due to the risk of hepatotoxicity, and creatine kinase (CK) for detecting
rhabdomyolysis, a rare but serious side effect causing muscle breakdown. The patient should also be
educated to report unexplained muscle pain, tenderness, or weakness. Monitoring sodium,
potassium, PT/INR, BUN, and creatinine is not specific to statin therapy. Rasmussen MDC 2 lipid
management module emphasizes these monitoring parameters as essential nursing responsibilities.
Q5: A patient with coronary artery disease asks the nurse which lifestyle
modification would be the most impactful in reducing cardiovascular risk.
Which response by the nurse is most appropriate?
A. A. Reducing dietary sodium intake to less than 2 grams per day
B. B. Smoking cessation [CORRECT]
C. C. Walking 30 minutes three times per week
D. D. Limiting alcohol consumption to one drink per day
Correct Answer: B
Rationale: Smoking cessation is identified as the single most impactful lifestyle modification for
reducing cardiovascular risk because tobacco use directly contributes to endothelial damage,
accelerates atherosclerosis, increases platelet aggregation, and raises blood pressure. While all listed
modifications are beneficial components of cardiac risk reduction, smoking cessation has the greatest
individual impact on outcomes. The Rasmussen MDC 2 cardiovascular module explicitly identifies
smoking cessation as the priority patient education topic for CAD risk factor modification.
Q6: A nurse is assessing a patient 4 hours post-percutaneous coronary
intervention (PCI) with stent placement via the femoral artery approach. Which
assessment finding requires immediate notification of the provider?
A. A. The patient reports mild groin tenderness at the puncture site
B. B. Absence of the pedal pulse in the affected extremity [CORRECT]
C. C. The patient has a heart rate of 88 beats per minute
D. D. Blood pressure of 130/82 mmHg
Page 3
, NUR 2392 / MDC 2 Final Examination | Rasmussen University | 2026-2027 100 Questions
Correct Answer: B
Rationale: Absence of the pedal pulse in the affected extremity after femoral artery PCI is a critical
finding indicating possible arterial occlusion, thrombosis, or bleeding at the insertion site. This
requires immediate provider notification and intervention to prevent limb ischemia. Post-PCI nursing
care in the Rasmussen MDC 2 curriculum mandates frequent assessment of peripheral pulses distal
to the access site, along with monitoring the puncture site for bleeding, hematoma formation, and
signs of infection. Mild groin tenderness is expected.
Q7: A 52-year-old patient is admitted with left-sided heart failure. Which
clinical manifestation is most consistent with this diagnosis?
A. A. Dependent pitting edema in the lower extremities
B. B. Jugular venous distension (JVD)
C. C. Pulmonary crackles, dyspnea, and orthopnea [CORRECT]
D. D. Hepatomegaly and ascites
Correct Answer: C
Rationale: Left-sided heart failure results in impaired left ventricular ejection, causing blood to back
up into the pulmonary circulation. This leads to pulmonary congestion manifested as crackles on
auscultation, dyspnea (especially on exertion), orthopnea (difficulty breathing when lying flat),
paroxysmal nocturnal dyspnea, and fatigue. Dependent edema, JVD, hepatomegaly, and ascites are
manifestations of right-sided heart failure, which often develops secondary to left-sided failure.
Distinguishing left-sided from right-sided heart failure manifestations is a core competency in the
Rasmussen MDC 2 heart failure module.
Q8: A patient with heart failure has a daily weight gain of 3 pounds over two
days. Which nursing intervention is the priority?
A. A. Encourage the patient to reduce fluid intake to 500 mL per day
B. B. Assess the patient for other signs of fluid overload and notify the provider
[CORRECT]
C. C. Administer the scheduled diuretic and recheck weight in one week
D. D. Restrict dietary sodium to less than 1 gram per day
Correct Answer: B
Rationale: A daily weight gain of 2-3 pounds over 1-2 days is the best clinical indicator of fluid
retention and fluid volume excess in heart failure patients, signaling potential decompensation. The
priority nursing action is to assess for other signs of fluid overload (edema, shortness of breath,
crackles, JVD, increased BNP) and notify the provider, as the patient may need medication
adjustment such as increasing diuretic dosage. Daily weights are the most sensitive indicator of fluid
volume status in heart failure, as emphasized in the Rasmussen MDC 2 heart failure assessment
framework.
Q9: A nurse is providing discharge teaching to a patient with heart failure.
Which dietary instruction is most important to include?
A. A. Increase protein intake to promote cardiac muscle repair
B. B. Limit sodium intake to 2 grams per day [CORRECT]
C. C. Consume a high-potassium diet to offset diuretic effects
Page 4
Multidimensional Care II (MDC 2)
Final Examination
Institution: Rasmussen University
Course: NUR 2392 - Multidimensional Care II
Total Questions: 100 Multiple Choice
Format: 4 Options (A-D), One Correct Answer
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Comprehensive coverage of MDC 2 modules: Cardiovascular, Peripheral Vascular, Hematologic,
Renal, Endocrine, Fluid/Electrolytes, and Integrated Clinical Scenarios
,NUR 2392 / MDC 2 Final Examination | Rasmussen University | 2026-2027 100 Questions
Section 1: Cardiovascular Disorders (CAD, Heart Failure, Hypertension, Valvular
Disorders, Dysrhythmias)
Q1: A 58-year-old male presents to the emergency department with crushing
substernal chest pain that began 45 minutes ago. The pain radiates to his left
arm and jaw. He is diaphoretic and nauseated. Which cardiac biomarker is the
gold standard for confirming myocardial infarction and typically rises within
3-4 hours post-MI?
A. A. Creatine kinase-MB (CK-MB)
B. B. Myoglobin
C. C. Troponin I [CORRECT]
D. D. B-type natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the gold standard cardiac biomarker for diagnosing myocardial infarction
because of its high cardiac specificity and sensitivity; it rises within 3-4 hours post-MI and remains
elevated for 7-10 days. CK-MB is less specific (also found in skeletal muscle) and returns to normal
within 48-72 hours. Myoglobin rises earliest (1-2 hours) but is not cardiac-specific. BNP is used for
heart failure diagnosis, not acute MI confirmation. Rasmussen MDC 2 curriculum identifies Troponin
I as the primary biomarker in the ACS assessment framework.
Q2: A nurse is caring for a patient diagnosed with unstable angina. Which
statement best differentiates unstable angina from stable angina?
A. A. Unstable angina occurs only during periods of extreme emotional stress
B. B. Unstable angina is relieved by rest and nitroglycerin
C. C. Unstable angina occurs unpredictably, may happen at rest, and is a medical
emergency [CORRECT]
D. D. Unstable angina is caused by coronary vasospasm without atherosclerotic plaque
Correct Answer: C
Rationale: Unstable angina is characterized by unpredictable chest pain that occurs at rest, increases
in frequency or severity, and is not reliably relieved by rest or nitroglycerin, making it a medical
emergency requiring immediate intervention. Stable angina is predictable, occurs with exertion, and
is relieved by rest or nitroglycerin. Prinzmetal (variant) angina is caused by coronary vasospasm. The
distinction between unstable and stable angina is a critical concept in the Rasmussen MDC 2
cardiovascular module, as unstable angina signals impending MI and requires MONA intervention.
Q3: A patient arrives at the emergency department with suspected acute
coronary syndrome. The physician orders the initial MONA protocol. What does
the acronym MONA stand for in this context?
A. A. Morphine, Oxygen, Nitrates, Aspirin [CORRECT]
B. B. Metoprolol, Oxygen, Niacin, Amiodarone
C. C. Morphine, Osmitrol, Nitroprusside, Aspirin
D. D. Metolazone, Oxygen, Nitroglycerin, Atenolol
Correct Answer: A
Page 2
,NUR 2392 / MDC 2 Final Examination | Rasmussen University | 2026-2027 100 Questions
Rationale: MONA is the standard initial collaborative care protocol for acute coronary syndrome:
Morphine (for pain and anxiety reduction, also reduces preload), Oxygen (to improve myocardial
oxygenation, though current evidence supports O2 only if SpO2 is below 94%), Nitroglycerin (for
vasodilation and preload reduction), and Aspirin (antiplatelet therapy to prevent further thrombus
formation). This protocol is foundational in the Rasmussen MDC 2 ACS management framework and
is tested extensively on the final exam.
Q4: A 65-year-old female patient is prescribed atorvastatin (Lipitor) for
hyperlipidemia following a myocardial infarction. Which laboratory values
should the nurse monitor to assess for adverse effects of this medication?
A. A. Serum sodium and potassium levels
B. B. Liver function tests (AST/ALT) and creatine kinase for muscle pain [CORRECT]
C. C. Prothrombin time (PT) and international normalized ratio (INR)
D. D. Blood urea nitrogen (BUN) and serum creatinine
Correct Answer: B
Rationale: Atorvastatin, an HMG-CoA reductase inhibitor (statin), requires monitoring of liver
function tests (AST/ALT) due to the risk of hepatotoxicity, and creatine kinase (CK) for detecting
rhabdomyolysis, a rare but serious side effect causing muscle breakdown. The patient should also be
educated to report unexplained muscle pain, tenderness, or weakness. Monitoring sodium,
potassium, PT/INR, BUN, and creatinine is not specific to statin therapy. Rasmussen MDC 2 lipid
management module emphasizes these monitoring parameters as essential nursing responsibilities.
Q5: A patient with coronary artery disease asks the nurse which lifestyle
modification would be the most impactful in reducing cardiovascular risk.
Which response by the nurse is most appropriate?
A. A. Reducing dietary sodium intake to less than 2 grams per day
B. B. Smoking cessation [CORRECT]
C. C. Walking 30 minutes three times per week
D. D. Limiting alcohol consumption to one drink per day
Correct Answer: B
Rationale: Smoking cessation is identified as the single most impactful lifestyle modification for
reducing cardiovascular risk because tobacco use directly contributes to endothelial damage,
accelerates atherosclerosis, increases platelet aggregation, and raises blood pressure. While all listed
modifications are beneficial components of cardiac risk reduction, smoking cessation has the greatest
individual impact on outcomes. The Rasmussen MDC 2 cardiovascular module explicitly identifies
smoking cessation as the priority patient education topic for CAD risk factor modification.
Q6: A nurse is assessing a patient 4 hours post-percutaneous coronary
intervention (PCI) with stent placement via the femoral artery approach. Which
assessment finding requires immediate notification of the provider?
A. A. The patient reports mild groin tenderness at the puncture site
B. B. Absence of the pedal pulse in the affected extremity [CORRECT]
C. C. The patient has a heart rate of 88 beats per minute
D. D. Blood pressure of 130/82 mmHg
Page 3
, NUR 2392 / MDC 2 Final Examination | Rasmussen University | 2026-2027 100 Questions
Correct Answer: B
Rationale: Absence of the pedal pulse in the affected extremity after femoral artery PCI is a critical
finding indicating possible arterial occlusion, thrombosis, or bleeding at the insertion site. This
requires immediate provider notification and intervention to prevent limb ischemia. Post-PCI nursing
care in the Rasmussen MDC 2 curriculum mandates frequent assessment of peripheral pulses distal
to the access site, along with monitoring the puncture site for bleeding, hematoma formation, and
signs of infection. Mild groin tenderness is expected.
Q7: A 52-year-old patient is admitted with left-sided heart failure. Which
clinical manifestation is most consistent with this diagnosis?
A. A. Dependent pitting edema in the lower extremities
B. B. Jugular venous distension (JVD)
C. C. Pulmonary crackles, dyspnea, and orthopnea [CORRECT]
D. D. Hepatomegaly and ascites
Correct Answer: C
Rationale: Left-sided heart failure results in impaired left ventricular ejection, causing blood to back
up into the pulmonary circulation. This leads to pulmonary congestion manifested as crackles on
auscultation, dyspnea (especially on exertion), orthopnea (difficulty breathing when lying flat),
paroxysmal nocturnal dyspnea, and fatigue. Dependent edema, JVD, hepatomegaly, and ascites are
manifestations of right-sided heart failure, which often develops secondary to left-sided failure.
Distinguishing left-sided from right-sided heart failure manifestations is a core competency in the
Rasmussen MDC 2 heart failure module.
Q8: A patient with heart failure has a daily weight gain of 3 pounds over two
days. Which nursing intervention is the priority?
A. A. Encourage the patient to reduce fluid intake to 500 mL per day
B. B. Assess the patient for other signs of fluid overload and notify the provider
[CORRECT]
C. C. Administer the scheduled diuretic and recheck weight in one week
D. D. Restrict dietary sodium to less than 1 gram per day
Correct Answer: B
Rationale: A daily weight gain of 2-3 pounds over 1-2 days is the best clinical indicator of fluid
retention and fluid volume excess in heart failure patients, signaling potential decompensation. The
priority nursing action is to assess for other signs of fluid overload (edema, shortness of breath,
crackles, JVD, increased BNP) and notify the provider, as the patient may need medication
adjustment such as increasing diuretic dosage. Daily weights are the most sensitive indicator of fluid
volume status in heart failure, as emphasized in the Rasmussen MDC 2 heart failure assessment
framework.
Q9: A nurse is providing discharge teaching to a patient with heart failure.
Which dietary instruction is most important to include?
A. A. Increase protein intake to promote cardiac muscle repair
B. B. Limit sodium intake to 2 grams per day [CORRECT]
C. C. Consume a high-potassium diet to offset diuretic effects
Page 4
