1
NUR 2502 / NUR2502 Final Exam
(Latest 2025/2026):
Multidimensional Care III / MDC 3 –
Rasmussen Comprehensive 150-
Question Multiple-Choice
Examination - VERSION 2.0 Advanced
Clinical Reasoning & Complex Patient
Scenarios.
Instructions:
This examination consists of 150 multiple-choice questions. Select the single best
answer for each question. Each question has one correct answer. Questions are
designed to test advanced clinical reasoning, prioritization, and application of
multidimensional care concepts. Read each question carefully and choose the response
that most accurately addresses the clinical scenario.
SECTION 1: CARDIOVASCULAR & HEMODYNAMIC
DISORDERS (Questions 1-25)
1. A 68-year-old male with a history of ischemic cardiomyopathy (LVEF 25%) is
admitted with acute decompensated heart failure. He presents with orthopnea, S3
gallop, cool extremities, and a serum BNP of 1,800 pg/mL. Vital signs: BP 88/52
,2
mm Hg, HR 118 bpm, RR 28/min, SpO2 88% on 4L NC. Which of the following is
the priority intervention?
A. Administer IV furosemide 80 mg bolus.
B. Initiate dobutamine infusion at 2.5 mcg/kg/min.
C. Place the patient on non-invasive positive pressure ventilation (BiPAP).
D. Administer IV nitroglycerin infusion.
- detailed 100% correctanswer :- C
Rationale: This patient presents with acute decompensated heart failure with signs of
cardiogenic shock (hypotension, tachycardia, cool extremities) and respiratory failure
(SpO2 88% on 4L, tachypnea). BiPAP is the priority to improve oxygenation and
ventilation, reduce preload, and potentially avoid intubation. While dobutamine may be
needed for inotropic support, improving oxygenation is the immediate priority.
Furosemide and nitroglycerin would further lower preload and blood pressure,
potentially worsening perfusion.
2. A 72-year-old female with a history of hypertension, diabetes, and CKD stage 3
is admitted with acute coronary syndrome. Her ECG shows 2-mm ST depression in
leads V1-V4 with T-wave inversions. Troponin I is 2.8 ng/mL (normal < 0.04).
Which of the following best describes this patient's clinical presentation?
A. ST-elevation myocardial infarction (STEMI)
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. Unstable angina
D. Prinzmetal's angina
- detailed 100% correctanswer :- B
Rationale: This patient has elevated troponin (indicating myocardial necrosis) without
ST-segment elevation on ECG, which defines NSTEMI. The ST depressions and T-wave
inversions in the anterior leads (V1-V4) indicate ischemia. Unstable angina would have
no troponin elevation. STEMI requires ST elevation. Prinzmetal's angina is caused by
coronary vasospasm.
,3
3. A patient with aortic stenosis and a prosthetic mechanical valve is being
discharged on warfarin. Which of the following represents the most significant
drug interaction that could increase bleeding risk?
A. Concurrent use of omeprazole
B. Concurrent use of amiodarone
C. Concurrent use of metoprolol
D. Concurrent use of furosemide
- detailed 100% correctanswer :- B
Rationale: Amiodarone significantly inhibits warfarin metabolism (CYP2C9 and CYP1A2),
leading to elevated INR and increased bleeding risk. This interaction requires close
monitoring and possible warfarin dose reduction. Omeprazole, metoprolol, and
furosemide have less significant interactions with warfarin.
4. A 55-year-old male with a history of hyperlipidemia presents with acute-onset,
severe "ripping" chest pain radiating to the back. BP is 180/100 mm Hg in the
right arm and 140/80 mm Hg in the left arm. Which of the following is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Acute pericarditis
- detailed 100% correctanswer :- C
Rationale: Aortic dissection classically presents with sudden, severe "ripping" or
"tearing" chest pain radiating to the back, with a pulse or blood pressure differential
between arms. This is a surgical emergency requiring immediate CT angiography. An MI
typically presents with pressure-type chest pain; PE with dyspnea and pleuritic pain;
pericarditis with positional pain relieved by leaning forward.
, 4
5. A patient with end-stage heart failure is being evaluated for a left ventricular
assist device (LVAD). Which of the following assessment findings would be a
contraindication to LVAD placement?
A. History of recurrent ventricular tachycardia
B. Right ventricular failure with severe dysfunction
C. Previous sternotomy
D. Creatinine 1.8 mg/dL
- detailed 100% correctanswer :- B
Rationale: Significant right ventricular failure is a contraindication for LVAD placement
because the LVAD increases right-sided venous return, which the failing right ventricle
cannot accommodate. Patients with severe RV dysfunction may require a biventricular
assist device (BiVAD) or heart transplant. History of VT is an indication for an
implantable cardioverter-defibrillator (ICD), not a contraindication to LVAD.
6. A patient with Marfan syndrome presents with a new murmur and dyspnea on
exertion. Echocardiogram reveals severe mitral valve prolapse with regurgitation.
The nurse understands that which of the following is the most significant long-
term risk in this patient?
A. Infective endocarditis
B. Aortic dissection
C. Heart failure
D. Pulmonary hypertension
- detailed 100% correctanswer :- B
Rationale: Patients with Marfan syndrome are at highest risk for aortic dissection due to
cystic medial necrosis of the aorta. While mitral valve prolapse, infective endocarditis,
and heart failure are concerns, aortic dissection is the most life-threatening
complication. Prophylactic beta-blockers and regular echocardiographic surveillance are
essential.
NUR 2502 / NUR2502 Final Exam
(Latest 2025/2026):
Multidimensional Care III / MDC 3 –
Rasmussen Comprehensive 150-
Question Multiple-Choice
Examination - VERSION 2.0 Advanced
Clinical Reasoning & Complex Patient
Scenarios.
Instructions:
This examination consists of 150 multiple-choice questions. Select the single best
answer for each question. Each question has one correct answer. Questions are
designed to test advanced clinical reasoning, prioritization, and application of
multidimensional care concepts. Read each question carefully and choose the response
that most accurately addresses the clinical scenario.
SECTION 1: CARDIOVASCULAR & HEMODYNAMIC
DISORDERS (Questions 1-25)
1. A 68-year-old male with a history of ischemic cardiomyopathy (LVEF 25%) is
admitted with acute decompensated heart failure. He presents with orthopnea, S3
gallop, cool extremities, and a serum BNP of 1,800 pg/mL. Vital signs: BP 88/52
,2
mm Hg, HR 118 bpm, RR 28/min, SpO2 88% on 4L NC. Which of the following is
the priority intervention?
A. Administer IV furosemide 80 mg bolus.
B. Initiate dobutamine infusion at 2.5 mcg/kg/min.
C. Place the patient on non-invasive positive pressure ventilation (BiPAP).
D. Administer IV nitroglycerin infusion.
- detailed 100% correctanswer :- C
Rationale: This patient presents with acute decompensated heart failure with signs of
cardiogenic shock (hypotension, tachycardia, cool extremities) and respiratory failure
(SpO2 88% on 4L, tachypnea). BiPAP is the priority to improve oxygenation and
ventilation, reduce preload, and potentially avoid intubation. While dobutamine may be
needed for inotropic support, improving oxygenation is the immediate priority.
Furosemide and nitroglycerin would further lower preload and blood pressure,
potentially worsening perfusion.
2. A 72-year-old female with a history of hypertension, diabetes, and CKD stage 3
is admitted with acute coronary syndrome. Her ECG shows 2-mm ST depression in
leads V1-V4 with T-wave inversions. Troponin I is 2.8 ng/mL (normal < 0.04).
Which of the following best describes this patient's clinical presentation?
A. ST-elevation myocardial infarction (STEMI)
B. Non-ST-elevation myocardial infarction (NSTEMI)
C. Unstable angina
D. Prinzmetal's angina
- detailed 100% correctanswer :- B
Rationale: This patient has elevated troponin (indicating myocardial necrosis) without
ST-segment elevation on ECG, which defines NSTEMI. The ST depressions and T-wave
inversions in the anterior leads (V1-V4) indicate ischemia. Unstable angina would have
no troponin elevation. STEMI requires ST elevation. Prinzmetal's angina is caused by
coronary vasospasm.
,3
3. A patient with aortic stenosis and a prosthetic mechanical valve is being
discharged on warfarin. Which of the following represents the most significant
drug interaction that could increase bleeding risk?
A. Concurrent use of omeprazole
B. Concurrent use of amiodarone
C. Concurrent use of metoprolol
D. Concurrent use of furosemide
- detailed 100% correctanswer :- B
Rationale: Amiodarone significantly inhibits warfarin metabolism (CYP2C9 and CYP1A2),
leading to elevated INR and increased bleeding risk. This interaction requires close
monitoring and possible warfarin dose reduction. Omeprazole, metoprolol, and
furosemide have less significant interactions with warfarin.
4. A 55-year-old male with a history of hyperlipidemia presents with acute-onset,
severe "ripping" chest pain radiating to the back. BP is 180/100 mm Hg in the
right arm and 140/80 mm Hg in the left arm. Which of the following is the most
likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Acute pericarditis
- detailed 100% correctanswer :- C
Rationale: Aortic dissection classically presents with sudden, severe "ripping" or
"tearing" chest pain radiating to the back, with a pulse or blood pressure differential
between arms. This is a surgical emergency requiring immediate CT angiography. An MI
typically presents with pressure-type chest pain; PE with dyspnea and pleuritic pain;
pericarditis with positional pain relieved by leaning forward.
, 4
5. A patient with end-stage heart failure is being evaluated for a left ventricular
assist device (LVAD). Which of the following assessment findings would be a
contraindication to LVAD placement?
A. History of recurrent ventricular tachycardia
B. Right ventricular failure with severe dysfunction
C. Previous sternotomy
D. Creatinine 1.8 mg/dL
- detailed 100% correctanswer :- B
Rationale: Significant right ventricular failure is a contraindication for LVAD placement
because the LVAD increases right-sided venous return, which the failing right ventricle
cannot accommodate. Patients with severe RV dysfunction may require a biventricular
assist device (BiVAD) or heart transplant. History of VT is an indication for an
implantable cardioverter-defibrillator (ICD), not a contraindication to LVAD.
6. A patient with Marfan syndrome presents with a new murmur and dyspnea on
exertion. Echocardiogram reveals severe mitral valve prolapse with regurgitation.
The nurse understands that which of the following is the most significant long-
term risk in this patient?
A. Infective endocarditis
B. Aortic dissection
C. Heart failure
D. Pulmonary hypertension
- detailed 100% correctanswer :- B
Rationale: Patients with Marfan syndrome are at highest risk for aortic dissection due to
cystic medial necrosis of the aorta. While mitral valve prolapse, infective endocarditis,
and heart failure are concerns, aortic dissection is the most life-threatening
complication. Prophylactic beta-blockers and regular echocardiographic surveillance are
essential.
