NUR 2502 / NUR2502: MULTIDIMENSIONAL CARE III / MDC
3
EXAM 1 (LATEST ) RASMUSSEN
Comprehensive Examination - Aligned with the Rasmussen University NUR 2502 Course Syllabus, NCLEX-RN Test
Plan, QSEN Competencies, and Multidimensional Care III Nursing Standards (2026/2027 Edition)
120 Questions | 8 Sections | Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | Includes 20 Priority-Setting, 15
Pharmacology, and 10 Laboratory Interpretation Items | 75% Scenario-Based / 25% Direct Knowledge
Section 1: Complex Cardiovascular Disorders
Questions 1-20 | 20 items
Q1: A client admitted with severe substernal chest pain has a 12-lead ECG showing ST-segment elevation in
leads II, III, and aVF. The nurse recognizes that these findings are most consistent with which condition?
A. Inferior wall myocardial infarction [CORRECT]
B. Left ventricular hypertrophy
C. Acute pericarditis
D. Anterolateral wall myocardial infarction
Correct Answer: A
Rationale: Leads II, III, and aVF face the inferior wall of the left ventricle, which is supplied by the right coronary
artery, so ST elevation in these leads indicates an inferior wall myocardial infarction (NUR 2502 MDC III cardiac
module). Anterolateral infarction produces changes in leads I, aVL, and V3-V6. Left ventricular hypertrophy shows tall
R waves and voltage criteria rather than focal ST elevation, and pericarditis characteristically produces diffuse ST
elevation in multiple lead groups with PR-segment depression.
Q2: A client arrives at the emergency department reporting unrelieved substernal chest pressure radiating to
the left jaw. The client is diaphoretic and anxious. Which action should the nurse take FIRST?
A. Establish intravenous access
B. Administer a sublingual nitroglycerin tablet
C. Draw serum cardiac troponin levels
D. Obtain a 12-lead electrocardiogram [CORRECT]
Correct Answer: D
Rationale: American Heart Association guidelines followed in the NUR 2502 curriculum require a 12-lead ECG within
10 minutes of arrival for any client with chest pain, because the ECG identifies STEMI and drives immediate
reperfusion decisions. Troponin levels and IV access are important but do not determine whether the client needs
emergency catheterization. Nitroglycerin is administered after the ECG is obtained and blood pressure is confirmed,
since hypotension and right ventricular infarction are contraindications.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 1
,NUR 2502 / NUR2502: Multidimensional Care III / MDC 3 Exam 1 (Latest ) Rasmussen
Q3: The nurse is assessing a client with chronic heart failure. Which assessment finding indicates
RIGHT-sided heart failure rather than left-sided heart failure?
A. Dependent bilateral ankle edema and jugular venous distension [CORRECT]
B. Bilateral crackles in the lower lung bases
C. Orthopnea requiring three pillows to sleep
D. Pink, frothy sputum with worsening dyspnea
Correct Answer: A
Rationale: Right-sided heart failure causes systemic venous congestion, producing jugular venous distension, dependent
peripheral edema, hepatomegaly, and ascites, which are hallmark findings in the NUR 2502 MDC III heart failure
content. Crackles, orthopnea, and pink frothy sputum reflect pulmonary congestion caused by left-sided failure, in
which blood backs up into the pulmonary circulation. Distinguishing the two ventricles guides which assessments the
nurse prioritizes during daily care.
Q4: The charge nurse is making rounds on a medical-surgical unit. Which client should the nurse see FIRST?
A. A 58-year-old with heart failure reporting sudden dyspnea, pink frothy sputum, and SpO2 of 86%
[CORRECT]
B. A 62-year-old with heart failure who has 2+ dependent ankle edema while on daily furosemide
C. A 55-year-old with stable atrial fibrillation, apical rate 84, receiving apixaban
D. A 70-year-old on day 2 after CABG who is ambulating in the hallway with pain rated 3/10
Correct Answer: A
Rationale: Sudden dyspnea with pink frothy sputum and oxygen saturation of 86% signals acute pulmonary edema, an
immediately life-threatening airway and breathing problem that takes priority under the ABC framework emphasized
throughout NUR 2502 (NCLEX-RN Management of Care). The other three clients have chronic or stable findings:
ankle edema on diuretics, controlled atrial fibrillation, and routine postoperative recovery, all of which can safely wait
while the nurse stabilizes the deteriorating client.
Q5: Before administering the morning dose of digoxin, the nurse palpates an apical pulse of 54 beats/min and
irregular. The client reports nausea and states that lights have yellow-green halos around them. Which action
should the nurse take?
A. Administer half of the prescribed dose and continue monitoring
B. Administer the dose and document the findings
C. Withhold the dose and notify the health care provider [CORRECT]
D. Recheck the apical pulse in 30 minutes and then administer the dose
Correct Answer: C
Rationale: Digoxin is withheld when the apical pulse is below 60 beats/min in an adult, and nausea with xanthopsia
(yellow-green visual halos) are classic manifestations of digoxin toxicity, which can occur even at therapeutic serum
levels when potassium is low (NUR 2502 pharmacology standards). The nurse must never independently alter a dose, so
notifying the provider and anticipating a serum digoxin level and potassium check is the safe, evidence-based response.
Administering the dose or simply rechecking later could precipitate life-threatening dysrhythmias.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 2
,NUR 2502 / NUR2502: Multidimensional Care III / MDC 3 Exam 1 (Latest ) Rasmussen
Q6: A client develops cardiogenic shock 12 hours after an acute myocardial infarction. Which set of
assessment findings should the nurse expect?
A. Fever, tachycardia, warm extremities, and hypotension
B. Hypotension, tachycardia, cool and clammy skin, and decreased urine output [CORRECT]
C. Bounding pulses, flushed skin, and widened pulse pressure
D. Hypertension, bradycardia, and warm dry skin
Correct Answer: B
Rationale: Cardiogenic shock results from pump failure, so cardiac output falls and produces hypotension,
compensatory tachycardia, sympathetic vasoconstriction with cool clammy skin, and oliguria from poor renal perfusion,
the classic cluster taught in NUR 2502 MDC III. Bounding pulses and flushed skin describe the warm phase of
distributive shock, and hypertension with bradycardia suggests increased intracranial pressure (Cushing response).
Warm skin with fever and hypotension characterizes septic shock, not pump failure.
Q7: A client with new-onset atrial fibrillation has a ventricular rate of 142, an irregular pulse, and a blood
pressure of 108/70 mmHg. The client is alert and reports only palpitations. Which prescription does the nurse
anticipate FIRST?
A. Intravenous atropine bolus
B. Immediate synchronized cardioversion
C. Unsynchronized defibrillation
D. Intravenous diltiazem with initiation of anticoagulation [CORRECT]
Correct Answer: D
Rationale: A hemodynamically stable client with new atrial fibrillation is managed first with rate control using an IV
calcium channel blocker such as diltiazem, along with anticoagulation to prevent thromboembolic stroke, per the
dysrhythmia management standards in the NUR 2502 curriculum. Synchronized cardioversion is reserved for
hemodynamic instability, and if atrial fibrillation has lasted longer than 48 hours, anticoagulation is prioritized before
rhythm conversion. Defibrillation is used only for pulseless ventricular tachycardia or ventricular fibrillation, and
atropine treats symptomatic bradycardia.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 3
, NUR 2502 / NUR2502: Multidimensional Care III / MDC 3 Exam 1 (Latest ) Rasmussen
Q8: A client receiving furosemide has a serum potassium level of 2.8 mEq/L and frequent premature
ventricular contractions on the cardiac monitor. Which interpretation and action by the nurse are MOST
appropriate?
A. This is a normal potassium level; document the findings and continue care
B. This is hyperkalemia; prepare sodium polystyrene as prescribed
C. This is severe hypokalemia potentiating dysrhythmias; notify the provider for potassium replacement
[CORRECT]
D. This is an expected result of loop diuretic therapy; continue routine monitoring only
Correct Answer: C
Rationale: The normal serum potassium range is 3.5 to 5.0 mEq/L, so 2.8 mEq/L represents severe hypokalemia, which
increases myocardial automaticity and produces PVCs that can deteriorate into ventricular tachycardia (NCLEX-RN
Reduction of Risk Potential). Although loop diuretics commonly cause potassium loss, hypokalemia this profound is
never expected and requires provider notification for replacement, usually IV potassium infused no faster than 10
mEq/hr per peripheral line. Sodium polystyrene treats hyperkalemia, not hypokalemia.
Q9: Two hours after percutaneous coronary intervention, a client reports recurrent chest pain rated 4/10 that
feels similar to the pain before the procedure. Which action should the nurse take FIRST?
A. Increase the rate of the maintenance IV fluid
B. Reposition the client and encourage rest
C. Obtain a 12-lead ECG and vital signs [CORRECT]
D. Administer the prescribed PRN IV morphine
Correct Answer: C
Rationale: Recurrent chest pain after PCI may indicate acute stent thrombosis or reocclusion, so the nurse assesses first
with a 12-lead ECG and vital signs before any intervention, consistent with the assessment-first principle in NUR 2502
and NCLEX-RN Management of Care. Morphine may mask the characteristics of the pain and blunt the physiologic
response, and increasing IV fluids without hemodynamic data could precipitate heart failure in a post-MI client.
Repositioning and rest are comfort measures that must never replace assessment of potential reocclusion.
Q10: On postoperative day 1 after CABG, a client in the cardiac ICU has mediastinal chest tube drainage of
180 mL/hr of bright red blood for 2 consecutive hours, with a falling central venous pressure and tachycardia.
Which interpretation and action are MOST appropriate?
A. This is expected postoperative drainage; continue to monitor hourly
B. Clamp the chest tube and prepare for removal
C. Increase the IV heparin infusion per protocol
D. Recognize possible postoperative hemorrhage; notify the surgeon immediately [CORRECT]
Correct Answer: D
Rationale: Mediastinal drainage exceeding approximately 100 to 200 mL/hr for 2 consecutive hours, especially with a
falling CVP and tachycardia, signals active hemorrhage and possible impending tamponade, which requires immediate
surgeon notification and preparation for re-exploration (NUR 2502 postoperative cardiac care). Chest tubes are never
clamped while actively bleeding because clamping can cause blood to accumulate and produce tamponade. Heparin is
contraindicated in active postoperative bleeding and would worsen hemorrhage.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 4
3
EXAM 1 (LATEST ) RASMUSSEN
Comprehensive Examination - Aligned with the Rasmussen University NUR 2502 Course Syllabus, NCLEX-RN Test
Plan, QSEN Competencies, and Multidimensional Care III Nursing Standards (2026/2027 Edition)
120 Questions | 8 Sections | Cognitive Levels: 20% Recall, 50% Application, 30% Analysis | Includes 20 Priority-Setting, 15
Pharmacology, and 10 Laboratory Interpretation Items | 75% Scenario-Based / 25% Direct Knowledge
Section 1: Complex Cardiovascular Disorders
Questions 1-20 | 20 items
Q1: A client admitted with severe substernal chest pain has a 12-lead ECG showing ST-segment elevation in
leads II, III, and aVF. The nurse recognizes that these findings are most consistent with which condition?
A. Inferior wall myocardial infarction [CORRECT]
B. Left ventricular hypertrophy
C. Acute pericarditis
D. Anterolateral wall myocardial infarction
Correct Answer: A
Rationale: Leads II, III, and aVF face the inferior wall of the left ventricle, which is supplied by the right coronary
artery, so ST elevation in these leads indicates an inferior wall myocardial infarction (NUR 2502 MDC III cardiac
module). Anterolateral infarction produces changes in leads I, aVL, and V3-V6. Left ventricular hypertrophy shows tall
R waves and voltage criteria rather than focal ST elevation, and pericarditis characteristically produces diffuse ST
elevation in multiple lead groups with PR-segment depression.
Q2: A client arrives at the emergency department reporting unrelieved substernal chest pressure radiating to
the left jaw. The client is diaphoretic and anxious. Which action should the nurse take FIRST?
A. Establish intravenous access
B. Administer a sublingual nitroglycerin tablet
C. Draw serum cardiac troponin levels
D. Obtain a 12-lead electrocardiogram [CORRECT]
Correct Answer: D
Rationale: American Heart Association guidelines followed in the NUR 2502 curriculum require a 12-lead ECG within
10 minutes of arrival for any client with chest pain, because the ECG identifies STEMI and drives immediate
reperfusion decisions. Troponin levels and IV access are important but do not determine whether the client needs
emergency catheterization. Nitroglycerin is administered after the ECG is obtained and blood pressure is confirmed,
since hypotension and right ventricular infarction are contraindications.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 1
,NUR 2502 / NUR2502: Multidimensional Care III / MDC 3 Exam 1 (Latest ) Rasmussen
Q3: The nurse is assessing a client with chronic heart failure. Which assessment finding indicates
RIGHT-sided heart failure rather than left-sided heart failure?
A. Dependent bilateral ankle edema and jugular venous distension [CORRECT]
B. Bilateral crackles in the lower lung bases
C. Orthopnea requiring three pillows to sleep
D. Pink, frothy sputum with worsening dyspnea
Correct Answer: A
Rationale: Right-sided heart failure causes systemic venous congestion, producing jugular venous distension, dependent
peripheral edema, hepatomegaly, and ascites, which are hallmark findings in the NUR 2502 MDC III heart failure
content. Crackles, orthopnea, and pink frothy sputum reflect pulmonary congestion caused by left-sided failure, in
which blood backs up into the pulmonary circulation. Distinguishing the two ventricles guides which assessments the
nurse prioritizes during daily care.
Q4: The charge nurse is making rounds on a medical-surgical unit. Which client should the nurse see FIRST?
A. A 58-year-old with heart failure reporting sudden dyspnea, pink frothy sputum, and SpO2 of 86%
[CORRECT]
B. A 62-year-old with heart failure who has 2+ dependent ankle edema while on daily furosemide
C. A 55-year-old with stable atrial fibrillation, apical rate 84, receiving apixaban
D. A 70-year-old on day 2 after CABG who is ambulating in the hallway with pain rated 3/10
Correct Answer: A
Rationale: Sudden dyspnea with pink frothy sputum and oxygen saturation of 86% signals acute pulmonary edema, an
immediately life-threatening airway and breathing problem that takes priority under the ABC framework emphasized
throughout NUR 2502 (NCLEX-RN Management of Care). The other three clients have chronic or stable findings:
ankle edema on diuretics, controlled atrial fibrillation, and routine postoperative recovery, all of which can safely wait
while the nurse stabilizes the deteriorating client.
Q5: Before administering the morning dose of digoxin, the nurse palpates an apical pulse of 54 beats/min and
irregular. The client reports nausea and states that lights have yellow-green halos around them. Which action
should the nurse take?
A. Administer half of the prescribed dose and continue monitoring
B. Administer the dose and document the findings
C. Withhold the dose and notify the health care provider [CORRECT]
D. Recheck the apical pulse in 30 minutes and then administer the dose
Correct Answer: C
Rationale: Digoxin is withheld when the apical pulse is below 60 beats/min in an adult, and nausea with xanthopsia
(yellow-green visual halos) are classic manifestations of digoxin toxicity, which can occur even at therapeutic serum
levels when potassium is low (NUR 2502 pharmacology standards). The nurse must never independently alter a dose, so
notifying the provider and anticipating a serum digoxin level and potassium check is the safe, evidence-based response.
Administering the dose or simply rechecking later could precipitate life-threatening dysrhythmias.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 2
,NUR 2502 / NUR2502: Multidimensional Care III / MDC 3 Exam 1 (Latest ) Rasmussen
Q6: A client develops cardiogenic shock 12 hours after an acute myocardial infarction. Which set of
assessment findings should the nurse expect?
A. Fever, tachycardia, warm extremities, and hypotension
B. Hypotension, tachycardia, cool and clammy skin, and decreased urine output [CORRECT]
C. Bounding pulses, flushed skin, and widened pulse pressure
D. Hypertension, bradycardia, and warm dry skin
Correct Answer: B
Rationale: Cardiogenic shock results from pump failure, so cardiac output falls and produces hypotension,
compensatory tachycardia, sympathetic vasoconstriction with cool clammy skin, and oliguria from poor renal perfusion,
the classic cluster taught in NUR 2502 MDC III. Bounding pulses and flushed skin describe the warm phase of
distributive shock, and hypertension with bradycardia suggests increased intracranial pressure (Cushing response).
Warm skin with fever and hypotension characterizes septic shock, not pump failure.
Q7: A client with new-onset atrial fibrillation has a ventricular rate of 142, an irregular pulse, and a blood
pressure of 108/70 mmHg. The client is alert and reports only palpitations. Which prescription does the nurse
anticipate FIRST?
A. Intravenous atropine bolus
B. Immediate synchronized cardioversion
C. Unsynchronized defibrillation
D. Intravenous diltiazem with initiation of anticoagulation [CORRECT]
Correct Answer: D
Rationale: A hemodynamically stable client with new atrial fibrillation is managed first with rate control using an IV
calcium channel blocker such as diltiazem, along with anticoagulation to prevent thromboembolic stroke, per the
dysrhythmia management standards in the NUR 2502 curriculum. Synchronized cardioversion is reserved for
hemodynamic instability, and if atrial fibrillation has lasted longer than 48 hours, anticoagulation is prioritized before
rhythm conversion. Defibrillation is used only for pulseless ventricular tachycardia or ventricular fibrillation, and
atropine treats symptomatic bradycardia.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 3
, NUR 2502 / NUR2502: Multidimensional Care III / MDC 3 Exam 1 (Latest ) Rasmussen
Q8: A client receiving furosemide has a serum potassium level of 2.8 mEq/L and frequent premature
ventricular contractions on the cardiac monitor. Which interpretation and action by the nurse are MOST
appropriate?
A. This is a normal potassium level; document the findings and continue care
B. This is hyperkalemia; prepare sodium polystyrene as prescribed
C. This is severe hypokalemia potentiating dysrhythmias; notify the provider for potassium replacement
[CORRECT]
D. This is an expected result of loop diuretic therapy; continue routine monitoring only
Correct Answer: C
Rationale: The normal serum potassium range is 3.5 to 5.0 mEq/L, so 2.8 mEq/L represents severe hypokalemia, which
increases myocardial automaticity and produces PVCs that can deteriorate into ventricular tachycardia (NCLEX-RN
Reduction of Risk Potential). Although loop diuretics commonly cause potassium loss, hypokalemia this profound is
never expected and requires provider notification for replacement, usually IV potassium infused no faster than 10
mEq/hr per peripheral line. Sodium polystyrene treats hyperkalemia, not hypokalemia.
Q9: Two hours after percutaneous coronary intervention, a client reports recurrent chest pain rated 4/10 that
feels similar to the pain before the procedure. Which action should the nurse take FIRST?
A. Increase the rate of the maintenance IV fluid
B. Reposition the client and encourage rest
C. Obtain a 12-lead ECG and vital signs [CORRECT]
D. Administer the prescribed PRN IV morphine
Correct Answer: C
Rationale: Recurrent chest pain after PCI may indicate acute stent thrombosis or reocclusion, so the nurse assesses first
with a 12-lead ECG and vital signs before any intervention, consistent with the assessment-first principle in NUR 2502
and NCLEX-RN Management of Care. Morphine may mask the characteristics of the pain and blunt the physiologic
response, and increasing IV fluids without hemodynamic data could precipitate heart failure in a post-MI client.
Repositioning and rest are comfort measures that must never replace assessment of potential reocclusion.
Q10: On postoperative day 1 after CABG, a client in the cardiac ICU has mediastinal chest tube drainage of
180 mL/hr of bright red blood for 2 consecutive hours, with a falling central venous pressure and tachycardia.
Which interpretation and action are MOST appropriate?
A. This is expected postoperative drainage; continue to monitor hourly
B. Clamp the chest tube and prepare for removal
C. Increase the IV heparin infusion per protocol
D. Recognize possible postoperative hemorrhage; notify the surgeon immediately [CORRECT]
Correct Answer: D
Rationale: Mediastinal drainage exceeding approximately 100 to 200 mL/hr for 2 consecutive hours, especially with a
falling CVP and tachycardia, signals active hemorrhage and possible impending tamponade, which requires immediate
surgeon notification and preparation for re-exploration (NUR 2502 postoperative cardiac care). Chest tubes are never
clamped while actively bleeding because clamping can cause blood to accumulate and produce tamponade. Heparin is
contraindicated in active postoperative bleeding and would worsen hemorrhage.
NUR 2502 Multidimensional Care III (MDC 3) - Exam 1 (Latest ) 4
