NUR 2502 / NUR2502 FINAL EXAM (LATEST ):
MULTIDIMENSIONAL CARE III / MDC 3 - RASMUSSEN
Section 1: Complex Cardiovascular Disorders
Q1. A client is admitted to the emergency department with crushing substernal chest pain that began 45
minutes ago. Which electrocardiographic (ECG) finding indicates myocardial injury consistent with
STEMI?
A. ST depression of 2 mm in leads V5 and V6
B. T-wave inversion in the inferior leads
C. ST-segment elevation of 2 mm in two contiguous leads [CORRECT]
D. A pathologic Q wave in lead aVL
Correct Answer: C
Rationale: ST-segment elevation in two contiguous leads is the defining ECG criterion for STEMI and reflects
transmural myocardial injury, triggering immediate reperfusion protocols per NUR 2502 acute coronary syndrome
content. ST depression and T-wave inversion suggest ischemia or NSTEMI but do not meet STEMI criteria.
Pathologic Q waves indicate completed necrosis and develop hours to days after infarction, making them a late, not
acute, injury marker. This aligns with the NCLEX-RN Physiological Adaptation standard for early recognition of
life-threatening cardiac events.
Q2. A client with chest pain has blood drawn for cardiac markers. Which laboratory value is the most
specific indicator of myocardial cell injury?
A. Creatine kinase-MB (CK-MB) of 6 percent
B. Troponin I of 2.4 ng/mL [CORRECT]
C. Myoglobin of 95 mcg/L
D. White blood cell count of 12,500/mm3
Correct Answer: B
Rationale: Cardiac troponin I is the most specific and sensitive biomarker for myocardial injury and rises within 3
to 4 hours of injury, remaining elevated for up to 10 days; this is the gold standard emphasized in the NUR 2502
cardiovascular module. CK-MB is cardiac-sensitive but less specific than troponin and can rise with skeletal muscle
damage. Myoglobin is the earliest marker to rise but lacks cardiac specificity because it is also released from
skeletal muscle. An elevated WBC may accompany inflammation or stress but is nonspecific for infarction,
consistent with NCLEX-RN laboratory value interpretation standards.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 1
, Q3. A 58-year-old client arrives at the emergency department reporting chest pressure, diaphoresis, and
nausea that started 30 minutes ago. Which action should the nurse take first?
A. Administer sublingual nitroglycerin as prescribed
B. Draw blood for serial cardiac troponin levels
C. Establish intravenous access in two large-bore sites
D. Obtain a 12-lead ECG within 10 minutes of arrival [CORRECT]
Correct Answer: D
Rationale: Obtaining a 12-lead ECG within 10 minutes of arrival is the priority because it differentiates STEMI
from NSTEMI and determines whether the client needs emergency reperfusion; every minute of delay increases
myocardial loss, per NUR 2502 and AHA time-to-treatment standards. Nitroglycerin, troponin draws, and IV
access are all appropriate interventions, but they follow ECG acquisition in the acute coronary syndrome sequence.
This prioritization reflects the NCLEX-RN Management of Care standard of establishing treatment priorities by
urgent need.
Q4. The nurse is working on a telemetry unit. Which client should the nurse assess first?
A. A client with atrial fibrillation and a radial pulse rate of 84
B. A client with chest pain radiating to the jaw and left arm who is diaphoretic [CORRECT]
C. A client who is 2 days post-cardiac catheterization requesting discharge instructions
D. A client with stable angina who reports relief after one dose of nitroglycerin
Correct Answer: B
Rationale: Chest pain radiating to the jaw and arm with diaphoresis suggests an evolving acute coronary syndrome
and possible extension of infarction, so this client requires immediate assessment and intervention; airway,
breathing, circulation, and acute ischemic symptoms always take priority per NCLEX-RN prioritization
frameworks taught in NUR 2502. The client in stable atrial fibrillation with a controlled rate, the client requesting
routine teaching, and the client with relieved angina are all in stable condition and can be seen afterward.
Q5. A client with acute heart failure develops severe dyspnea, pink frothy sputum, and crackles throughout
all lung fields. Which nursing action should be performed first?
A. Position the client upright with the legs dependent [CORRECT]
B. Encourage the client to increase oral fluid intake
C. Ambulate the client slowly in the hallway
D. Place the client flat in a supine position
Correct Answer: A
Rationale: High Fowler position with legs dependent uses gravity to decrease venous return and reduce pulmonary
congestion, providing immediate relief in acute pulmonary edema; this is the first-line nursing action in the NUR
2502 heart failure module. Oxygen, diuretics, and nitroglycerin follow per prescription. Increasing fluids worsens
volume overload, ambulation increases cardiac demand during an acute crisis, and a supine position worsens venous
return and dyspnea, reflecting the NCLEX-RN principle of selecting the action that supports oxygenation and
circulation first.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 2
, Q6. A client receiving digoxin 0.25 mg daily reports nausea and states that objects appear yellow-green with
halos. The apical pulse is 52 beats/min and the serum digoxin level is 2.6 ng/mL. Which action should the
nurse take first?
A. Administer the next scheduled dose with an antiemetic
B. Encourage potassium-rich foods and reassess in 4 hours
C. Request an order for a 12-lead ECG only
D. Withhold the digoxin dose and notify the health care provider [CORRECT]
Correct Answer: D
Rationale: Nausea, visual halos, and bradycardia with a digoxin level above the therapeutic range of 0.5 to 2.0
ng/mL are classic manifestations of digoxin toxicity, so the nurse must withhold the dose and notify the provider
immediately; digoxin is a high-alert medication per QSEN safety competencies. Administering another dose risks
life-threatening dysrhythmias, and masking symptoms with an antiemetic delays treatment. Potassium-rich foods
may be ordered later for hypokalemia-induced toxicity, but they do not address the current toxic level, consistent
with NCLEX-RN pharmacological therapy standards.
Q7. A client presents with dyspnea on exertion, orthopnea, bilateral crackles, and an S3 gallop. Based on
these findings, the nurse recognizes which type of heart failure?
A. Right-sided heart failure
B. Cor pulmonale
C. Left-sided heart failure [CORRECT]
D. High-output failure
Correct Answer: C
Rationale: Dyspnea, orthopnea, crackles, and an S3 gallop reflect pulmonary congestion from blood backing up
into the left atrium and lungs, which is characteristic of left-sided heart failure per the NUR 2502 pathophysiology
curriculum. Right-sided failure and cor pulmonale produce systemic congestion such as peripheral edema, jugular
venous distention, and hepatomegaly rather than pulmonary crackles. High-output failure occurs when cardiac
output remains elevated despite increased demand, as in sepsis or thyrotoxicosis, and does not specifically produce
these findings.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 3
, Q8. A client with atrial fibrillation has a ventricular rate of 148 beats/min and a blood pressure of 84/52
mm Hg. The client reports dizziness and shortness of breath. Which intervention should the nurse anticipate
first?
A. Immediate synchronized cardioversion [CORRECT]
B. Intravenous diltiazem bolus
C. Oral anticoagulation with apixaban
D. Carotid sinus massage
Correct Answer: A
Rationale: An unstable tachydysrhythmia, evidenced by hypotension, dizziness, and dyspnea, requires immediate
synchronized cardioversion rather than rate-control medications, per ACLS guidelines and the NUR 2502
dysrhythmia module. Diltiazem is appropriate only for stable atrial fibrillation with rapid ventricular response.
Anticoagulation is part of long-term stroke prevention but does not correct the current instability. Carotid sinus
massage is used for certain stable supraventricular tachycardias and carries embolization risk in this client,
reflecting the NCLEX-RN Physiological Adaptation standard of matching intervention to hemodynamic stability.
Q9. A client with new-onset atrial fibrillation is being discharged on warfarin. Which client statement
indicates correct understanding of the medication teaching?
A. I will double my dose if I miss one to catch up
B. I will keep my intake of leafy green vegetables consistent from day to day [CORRECT]
C. An INR of 1.5 means my blood is in the therapeutic range
D. I should take ibuprofen for my arthritis pain instead of acetaminophen
Correct Answer: B
Rationale: Consistent vitamin K intake from leafy greens keeps the international normalized ratio stable, because
fluctuations in vitamin K alter warfarin's anticoagulant effect; this is a core teaching point in the NUR 2502
anticoagulation module. Doubling a missed dose risks dangerous over-anticoagulation, the target INR for atrial
fibrillation is 2.0 to 3.0 rather than 1.5, and NSAIDs such as ibuprofen add antiplatelet and gastric irritation effects
that increase bleeding risk, consistent with NCLEX-RN pharmacological and parenteral therapies content.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 4
MULTIDIMENSIONAL CARE III / MDC 3 - RASMUSSEN
Section 1: Complex Cardiovascular Disorders
Q1. A client is admitted to the emergency department with crushing substernal chest pain that began 45
minutes ago. Which electrocardiographic (ECG) finding indicates myocardial injury consistent with
STEMI?
A. ST depression of 2 mm in leads V5 and V6
B. T-wave inversion in the inferior leads
C. ST-segment elevation of 2 mm in two contiguous leads [CORRECT]
D. A pathologic Q wave in lead aVL
Correct Answer: C
Rationale: ST-segment elevation in two contiguous leads is the defining ECG criterion for STEMI and reflects
transmural myocardial injury, triggering immediate reperfusion protocols per NUR 2502 acute coronary syndrome
content. ST depression and T-wave inversion suggest ischemia or NSTEMI but do not meet STEMI criteria.
Pathologic Q waves indicate completed necrosis and develop hours to days after infarction, making them a late, not
acute, injury marker. This aligns with the NCLEX-RN Physiological Adaptation standard for early recognition of
life-threatening cardiac events.
Q2. A client with chest pain has blood drawn for cardiac markers. Which laboratory value is the most
specific indicator of myocardial cell injury?
A. Creatine kinase-MB (CK-MB) of 6 percent
B. Troponin I of 2.4 ng/mL [CORRECT]
C. Myoglobin of 95 mcg/L
D. White blood cell count of 12,500/mm3
Correct Answer: B
Rationale: Cardiac troponin I is the most specific and sensitive biomarker for myocardial injury and rises within 3
to 4 hours of injury, remaining elevated for up to 10 days; this is the gold standard emphasized in the NUR 2502
cardiovascular module. CK-MB is cardiac-sensitive but less specific than troponin and can rise with skeletal muscle
damage. Myoglobin is the earliest marker to rise but lacks cardiac specificity because it is also released from
skeletal muscle. An elevated WBC may accompany inflammation or stress but is nonspecific for infarction,
consistent with NCLEX-RN laboratory value interpretation standards.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 1
, Q3. A 58-year-old client arrives at the emergency department reporting chest pressure, diaphoresis, and
nausea that started 30 minutes ago. Which action should the nurse take first?
A. Administer sublingual nitroglycerin as prescribed
B. Draw blood for serial cardiac troponin levels
C. Establish intravenous access in two large-bore sites
D. Obtain a 12-lead ECG within 10 minutes of arrival [CORRECT]
Correct Answer: D
Rationale: Obtaining a 12-lead ECG within 10 minutes of arrival is the priority because it differentiates STEMI
from NSTEMI and determines whether the client needs emergency reperfusion; every minute of delay increases
myocardial loss, per NUR 2502 and AHA time-to-treatment standards. Nitroglycerin, troponin draws, and IV
access are all appropriate interventions, but they follow ECG acquisition in the acute coronary syndrome sequence.
This prioritization reflects the NCLEX-RN Management of Care standard of establishing treatment priorities by
urgent need.
Q4. The nurse is working on a telemetry unit. Which client should the nurse assess first?
A. A client with atrial fibrillation and a radial pulse rate of 84
B. A client with chest pain radiating to the jaw and left arm who is diaphoretic [CORRECT]
C. A client who is 2 days post-cardiac catheterization requesting discharge instructions
D. A client with stable angina who reports relief after one dose of nitroglycerin
Correct Answer: B
Rationale: Chest pain radiating to the jaw and arm with diaphoresis suggests an evolving acute coronary syndrome
and possible extension of infarction, so this client requires immediate assessment and intervention; airway,
breathing, circulation, and acute ischemic symptoms always take priority per NCLEX-RN prioritization
frameworks taught in NUR 2502. The client in stable atrial fibrillation with a controlled rate, the client requesting
routine teaching, and the client with relieved angina are all in stable condition and can be seen afterward.
Q5. A client with acute heart failure develops severe dyspnea, pink frothy sputum, and crackles throughout
all lung fields. Which nursing action should be performed first?
A. Position the client upright with the legs dependent [CORRECT]
B. Encourage the client to increase oral fluid intake
C. Ambulate the client slowly in the hallway
D. Place the client flat in a supine position
Correct Answer: A
Rationale: High Fowler position with legs dependent uses gravity to decrease venous return and reduce pulmonary
congestion, providing immediate relief in acute pulmonary edema; this is the first-line nursing action in the NUR
2502 heart failure module. Oxygen, diuretics, and nitroglycerin follow per prescription. Increasing fluids worsens
volume overload, ambulation increases cardiac demand during an acute crisis, and a supine position worsens venous
return and dyspnea, reflecting the NCLEX-RN principle of selecting the action that supports oxygenation and
circulation first.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 2
, Q6. A client receiving digoxin 0.25 mg daily reports nausea and states that objects appear yellow-green with
halos. The apical pulse is 52 beats/min and the serum digoxin level is 2.6 ng/mL. Which action should the
nurse take first?
A. Administer the next scheduled dose with an antiemetic
B. Encourage potassium-rich foods and reassess in 4 hours
C. Request an order for a 12-lead ECG only
D. Withhold the digoxin dose and notify the health care provider [CORRECT]
Correct Answer: D
Rationale: Nausea, visual halos, and bradycardia with a digoxin level above the therapeutic range of 0.5 to 2.0
ng/mL are classic manifestations of digoxin toxicity, so the nurse must withhold the dose and notify the provider
immediately; digoxin is a high-alert medication per QSEN safety competencies. Administering another dose risks
life-threatening dysrhythmias, and masking symptoms with an antiemetic delays treatment. Potassium-rich foods
may be ordered later for hypokalemia-induced toxicity, but they do not address the current toxic level, consistent
with NCLEX-RN pharmacological therapy standards.
Q7. A client presents with dyspnea on exertion, orthopnea, bilateral crackles, and an S3 gallop. Based on
these findings, the nurse recognizes which type of heart failure?
A. Right-sided heart failure
B. Cor pulmonale
C. Left-sided heart failure [CORRECT]
D. High-output failure
Correct Answer: C
Rationale: Dyspnea, orthopnea, crackles, and an S3 gallop reflect pulmonary congestion from blood backing up
into the left atrium and lungs, which is characteristic of left-sided heart failure per the NUR 2502 pathophysiology
curriculum. Right-sided failure and cor pulmonale produce systemic congestion such as peripheral edema, jugular
venous distention, and hepatomegaly rather than pulmonary crackles. High-output failure occurs when cardiac
output remains elevated despite increased demand, as in sepsis or thyrotoxicosis, and does not specifically produce
these findings.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 3
, Q8. A client with atrial fibrillation has a ventricular rate of 148 beats/min and a blood pressure of 84/52
mm Hg. The client reports dizziness and shortness of breath. Which intervention should the nurse anticipate
first?
A. Immediate synchronized cardioversion [CORRECT]
B. Intravenous diltiazem bolus
C. Oral anticoagulation with apixaban
D. Carotid sinus massage
Correct Answer: A
Rationale: An unstable tachydysrhythmia, evidenced by hypotension, dizziness, and dyspnea, requires immediate
synchronized cardioversion rather than rate-control medications, per ACLS guidelines and the NUR 2502
dysrhythmia module. Diltiazem is appropriate only for stable atrial fibrillation with rapid ventricular response.
Anticoagulation is part of long-term stroke prevention but does not correct the current instability. Carotid sinus
massage is used for certain stable supraventricular tachycardias and carries embolization risk in this client,
reflecting the NCLEX-RN Physiological Adaptation standard of matching intervention to hemodynamic stability.
Q9. A client with new-onset atrial fibrillation is being discharged on warfarin. Which client statement
indicates correct understanding of the medication teaching?
A. I will double my dose if I miss one to catch up
B. I will keep my intake of leafy green vegetables consistent from day to day [CORRECT]
C. An INR of 1.5 means my blood is in the therapeutic range
D. I should take ibuprofen for my arthritis pain instead of acetaminophen
Correct Answer: B
Rationale: Consistent vitamin K intake from leafy greens keeps the international normalized ratio stable, because
fluctuations in vitamin K alter warfarin's anticoagulant effect; this is a core teaching point in the NUR 2502
anticoagulation module. Doubling a missed dose risks dangerous over-anticoagulation, the target INR for atrial
fibrillation is 2.0 to 3.0 rather than 1.5, and NSAIDs such as ibuprofen add antiplatelet and gastric irritation effects
that increase bleeding risk, consistent with NCLEX-RN pharmacological and parenteral therapies content.
NUR 2502 / NUR2502 Multidimensional Care III (MDC 3) - Final Examination 2026/2027 4
