NUR 2392 / NUR2392 EXAM 2 (LATEST )
Multidimensional Care II / MDC 2 - Rasmussen
120 Questions | NCLEX-RN Aligned | QSEN Competencies | Comprehensive Examination
EXAMINATION OVERVIEW: 120 Questions | 9 Sections | Cognitive Levels: 20% Recall, 50% Application, 30%
Analysis | Includes 20 Priority-Setting, 15 Pharmacology, 10 Lab Interpretation, and 5 Integrated Case Study
Questions | Time Limit: 180 Minutes
Section 1: Perioperative Nursing
Q1: A 67-year-old client is being prepared for an elective cholecystectomy. Which preoperative
assessment finding requires the most immediate follow-up before surgery can safely proceed?
A. Blood pressure of 148/88 mmHg documented twice in the past hour
B. Serum potassium level of 3.1 mEq/L from morning labs *[CORRECT]*
C. Hemoglobin of 11.2 g/dL drawn 24 hours ago
D. Heart rate of 92 beats per minute and regular
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) significantly increases the risk of life-threatening
cardiac dysrhythmias under general anesthesia and potentiates the effects of neuromuscular
blocking agents used during intubation. The NUR 2392 perioperative curriculum emphasizes
that all electrolyte imbalances must be corrected prior to surgery to ensure client safety.
While a blood pressure of 148/88 mmHg warrants monitoring, it is not an absolute
contraindication. A hemoglobin of 11.2 g/dL is borderline but generally acceptable for
non-cardiac surgery, and a heart rate of 92 bpm falls within normal limits.
Q2: A client scheduled for abdominal surgery asks the nurse why she must remove her nail
polish before going to the operating room. Which response by the nurse is most accurate?
A. Nail polish interferes with the surgical skin preparation solution.
B. Nail polish prevents accurate pulse oximetry readings during surgery. *[CORRECT]*
C. Nail polish may contain chemicals that interact with anesthesia gases.
D. It is hospital policy for infection control purposes.
Correct Answer: B
Rationale: Pulse oximetry relies on light transmission through the nail bed to measure
arterial oxygen saturation, and dark nail polish absorbs the light waves, producing inaccurate
or absent readings. The NUR 2392 perioperative content identifies pulse oximetry as a
standard intraoperative monitor that must remain reliable throughout the procedure. The
other responses are not the primary evidence-based reason for nail polish removal and would
mislead the client about the underlying safety rationale.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 1
,NUR 2392 Exam 2 - Multidimensional Care II (2026/2027) Rasmussen University
Q3: A postoperative client returns from the PACU after general anesthesia. The client is restless,
agitated, and pulling at the surgical dressing. What is the priority nursing action?
A. Apply soft wrist restraints to protect the surgical site
B. Assess for bladder distention and bowel sounds
C. Administer the prescribed dose of IV morphine
D. Assess oxygen saturation and airway patency *[CORRECT]*
Correct Answer: D
Rationale: Restlessness and agitation in the immediate postoperative period are classic signs
of hypoxia until proven otherwise, and the ABC framework directs oxygenation assessment
first per NCLEX-RN priorities. NUR 2392 PACU content emphasizes that hypoxia must be
ruled out before attributing restlessness to pain or anxiety. Restraints (option A) should never
be a first-line intervention. Administering morphine (option C) before ruling out hypoxia
could cause further respiratory depression. Bladder distention (option B) is a possible cause
but is assessed after the airway.
Q4: A client 24 hours post-colon surgery reports a sudden "popping" sensation at the incision. On
assessment, the wound edges are separated and a loop of bowel is visible. Which action should
the nurse take first?
A. Cover the wound with sterile saline-soaked gauze *[CORRECT]*
B. Place the client in supine position with knees flexed
C. Assess vital signs to establish a baseline
D. Notify the surgeon immediately
Correct Answer: A
Rationale: Wound evisceration is a surgical emergency, and the priority is to protect the
exposed bowel from drying and contamination by covering it with sterile saline-soaked gauze.
NUR 2392 perioperative content emphasizes this as the immediate first action to prevent
organ damage and infection. After covering the wound, the nurse should position the client in
supine with knees flexed to reduce abdominal tension, call the surgeon, and assess vital signs.
Failure to cover the bowel first risks desiccation and contamination of the peritoneal cavity.
Q5: A client receiving patient-controlled analgesia (PCA) with morphine postoperatively is found
sleepy but arousable, with a respiratory rate of 10 breaths/min and SpO2 of 92%. What is the
priority intervention?
A. Administer naloxone (Narcan) per protocol *[CORRECT]*
B. Apply oxygen at 2 L/min via nasal cannula
C. Encourage the client to deep breathe and cough
D. Discontinue the PCA infusion and document
Correct Answer: A
Rationale: A respiratory rate of 10 with decreased level of consciousness indicates
opioid-induced respiratory depression, a life-threatening emergency requiring immediate
administration of naloxone, the opioid antagonist. NUR 2392 perioperative pharmacology
emphasizes that naloxone reverses respiratory depression by displacing opioids from receptor
sites. Applying oxygen (option B) treats the symptom but not the cause. Deep breathing
(option C) is ineffective with a depressed sensorium. Simply discontinuing the PCA (option D)
does not reverse the opioid already bound to receptors.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 2
,NUR 2392 Exam 2 - Multidimensional Care II (2026/2027) Rasmussen University
Q6: Which client scheduled for surgery has the greatest risk for intraoperative malignant
hyperthermia?
A. A 45-year-old with a history of well-controlled asthma
B. A 28-year-old with a family history of malignant hyperthermia *[CORRECT]*
C. A 60-year-old with type 2 diabetes managed with metformin
D. A 35-year-old with hypothyroidism on levothyroxine
Correct Answer: B
Rationale: Malignant hyperthermia is an inherited autosomal dominant disorder triggered by
succinylcholine and volatile inhaled anesthetics such as sevoflurane and desflurane. A family
history of malignant hyperthermia is the strongest risk factor and requires preoperative
screening and a non-triggering anesthetic plan per NUR 2392 perioperative content. The other
conditions (asthma, diabetes, hypothyroidism) pose general anesthesia risks but are not
specifically linked to malignant hyperthermia.
Q7: A client is being discharged after a laparoscopic cholecystectomy. Which client statement
indicates a need for further teaching?
A. I should report any yellowing of my skin or eyes to my provider.
B. I can resume all my normal activities within 24 hours of going home. *[CORRECT]*
C. I will call the surgeon if I develop a fever over 101 degrees Fahrenheit.
D. I should keep the incision sites clean and dry.
Correct Answer: B
Rationale: Full recovery from laparoscopic cholecystectomy typically takes one to two weeks
with a gradual return to activities, and resuming all normal activities within 24 hours is
unrealistic and risks wound injury or internal complications. NUR 2392 discharge teaching
emphasizes that clients should avoid heavy lifting and strenuous activity for the prescribed
period. The other statements demonstrate appropriate understanding of postoperative care,
including recognition of jaundice (which could indicate bile duct injury), infection signs, and
wound care.
Q8: A client is receiving IV heparin postoperatively for DVT prophylaxis. The aPTT is 98 seconds
(control 30 seconds). What is the most appropriate nursing action?
A. Increase the heparin infusion rate to achieve therapeutic range
B. Document the finding; the value is within therapeutic range
C. Notify the provider to adjust the heparin dose *[CORRECT]*
D. Administer protamine sulfate as the antidote
Correct Answer: C
Rationale: An aPTT of 98 seconds indicates anticoagulation exceeds the therapeutic range,
which is typically 1.5 to 2.5 times the control (45 to 75 seconds for this client). The provider
should be notified to adjust the dose per the NUR 2392 perioperative anticoagulation protocol.
Increasing the rate (option A) would worsen the bleeding risk. Simply documenting (option B)
ignores a critical value. Protamine sulfate (option D) is reserved for severe bleeding or critical
elevations, not this moderate overshoot.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 3
, NUR 2392 Exam 2 - Multidimensional Care II (2026/2027) Rasmussen University
Q9: The nurse is preparing to witness informed consent for a non-English-speaking client
scheduled for an emergency appendectomy. Which action is most appropriate?
A. Ask a bilingual family member to translate the consent form
B. Use a hospital-certified medical interpreter via phone or video *[CORRECT]*
C. Explain the procedure using simple pictures and gestures
D. Have the client sign and explain the procedure afterward
Correct Answer: B
Rationale: Per the Joint Commission standards and NUR 2392 legal and ethical content,
informed consent must be obtained through a hospital-certified medical interpreter to ensure
accurate bidirectional information exchange. Family members (option A) may not translate
medical terminology accurately and may have conflicts of interest. Pictures (option C) cannot
convey risks, benefits, and alternatives. Having the client sign without understanding (option
D) violates the ethical principle of autonomy and the legal doctrine of informed consent.
Q10: A client post-thyroidectomy develops a temperature of 104 degrees Fahrenheit (40 degrees
C), tachycardia of 130 beats/min, and confusion 12 hours after surgery. Which complication
should the nurse suspect?
A. Thyroid storm *[CORRECT]*
B. Hypovolemic shock
C. Malignant hyperthermia
D. Surgical site infection
Correct Answer: A
Rationale: These signs occurring post-thyroidectomy strongly suggest thyroid storm
(thyrotoxic crisis), a life-threatening hypermetabolic state characterized by hyperpyrexia,
tachycardia, and altered mental status. NUR 2392 endocrine and perioperative content
emphasizes this as a complication of thyroid surgery in clients with inadequately treated
hyperthyroidism. Malignant hyperthermia (option C) occurs intraoperatively, not 12 hours
later. Hypovolemic shock (option B) would present with hypotension. Surgical site infection
(option D) typically develops later and would not cause such extreme hyperpyrexia and
tachycardia.
Q11: A client is in the PACU after general anesthesia. The client's oxygen saturation is 90% on
room air with a respiratory rate of 14. Which action should the nurse take first?
A. Apply oxygen at 2 L/min via nasal cannula *[CORRECT]*
B. Suction the airway to remove secretions
C. Encourage the client to cough and deep breathe
D. Reassess the reading in 5 minutes
Correct Answer: A
Rationale: An SpO2 of 90% indicates hypoxemia and requires immediate oxygen application
to prevent further deterioration. NUR 2392 PACU protocols require SpO2 of 92% or higher in
the postoperative period. Suctioning (option B) and coughing (option C) may be needed if
secretions are present, but oxygen is the first action to correct the hypoxemia. Waiting to
reassess (option D) is unsafe and delays essential intervention.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 4
Multidimensional Care II / MDC 2 - Rasmussen
120 Questions | NCLEX-RN Aligned | QSEN Competencies | Comprehensive Examination
EXAMINATION OVERVIEW: 120 Questions | 9 Sections | Cognitive Levels: 20% Recall, 50% Application, 30%
Analysis | Includes 20 Priority-Setting, 15 Pharmacology, 10 Lab Interpretation, and 5 Integrated Case Study
Questions | Time Limit: 180 Minutes
Section 1: Perioperative Nursing
Q1: A 67-year-old client is being prepared for an elective cholecystectomy. Which preoperative
assessment finding requires the most immediate follow-up before surgery can safely proceed?
A. Blood pressure of 148/88 mmHg documented twice in the past hour
B. Serum potassium level of 3.1 mEq/L from morning labs *[CORRECT]*
C. Hemoglobin of 11.2 g/dL drawn 24 hours ago
D. Heart rate of 92 beats per minute and regular
Correct Answer: B
Rationale: Hypokalemia (K+ < 3.5 mEq/L) significantly increases the risk of life-threatening
cardiac dysrhythmias under general anesthesia and potentiates the effects of neuromuscular
blocking agents used during intubation. The NUR 2392 perioperative curriculum emphasizes
that all electrolyte imbalances must be corrected prior to surgery to ensure client safety.
While a blood pressure of 148/88 mmHg warrants monitoring, it is not an absolute
contraindication. A hemoglobin of 11.2 g/dL is borderline but generally acceptable for
non-cardiac surgery, and a heart rate of 92 bpm falls within normal limits.
Q2: A client scheduled for abdominal surgery asks the nurse why she must remove her nail
polish before going to the operating room. Which response by the nurse is most accurate?
A. Nail polish interferes with the surgical skin preparation solution.
B. Nail polish prevents accurate pulse oximetry readings during surgery. *[CORRECT]*
C. Nail polish may contain chemicals that interact with anesthesia gases.
D. It is hospital policy for infection control purposes.
Correct Answer: B
Rationale: Pulse oximetry relies on light transmission through the nail bed to measure
arterial oxygen saturation, and dark nail polish absorbs the light waves, producing inaccurate
or absent readings. The NUR 2392 perioperative content identifies pulse oximetry as a
standard intraoperative monitor that must remain reliable throughout the procedure. The
other responses are not the primary evidence-based reason for nail polish removal and would
mislead the client about the underlying safety rationale.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 1
,NUR 2392 Exam 2 - Multidimensional Care II (2026/2027) Rasmussen University
Q3: A postoperative client returns from the PACU after general anesthesia. The client is restless,
agitated, and pulling at the surgical dressing. What is the priority nursing action?
A. Apply soft wrist restraints to protect the surgical site
B. Assess for bladder distention and bowel sounds
C. Administer the prescribed dose of IV morphine
D. Assess oxygen saturation and airway patency *[CORRECT]*
Correct Answer: D
Rationale: Restlessness and agitation in the immediate postoperative period are classic signs
of hypoxia until proven otherwise, and the ABC framework directs oxygenation assessment
first per NCLEX-RN priorities. NUR 2392 PACU content emphasizes that hypoxia must be
ruled out before attributing restlessness to pain or anxiety. Restraints (option A) should never
be a first-line intervention. Administering morphine (option C) before ruling out hypoxia
could cause further respiratory depression. Bladder distention (option B) is a possible cause
but is assessed after the airway.
Q4: A client 24 hours post-colon surgery reports a sudden "popping" sensation at the incision. On
assessment, the wound edges are separated and a loop of bowel is visible. Which action should
the nurse take first?
A. Cover the wound with sterile saline-soaked gauze *[CORRECT]*
B. Place the client in supine position with knees flexed
C. Assess vital signs to establish a baseline
D. Notify the surgeon immediately
Correct Answer: A
Rationale: Wound evisceration is a surgical emergency, and the priority is to protect the
exposed bowel from drying and contamination by covering it with sterile saline-soaked gauze.
NUR 2392 perioperative content emphasizes this as the immediate first action to prevent
organ damage and infection. After covering the wound, the nurse should position the client in
supine with knees flexed to reduce abdominal tension, call the surgeon, and assess vital signs.
Failure to cover the bowel first risks desiccation and contamination of the peritoneal cavity.
Q5: A client receiving patient-controlled analgesia (PCA) with morphine postoperatively is found
sleepy but arousable, with a respiratory rate of 10 breaths/min and SpO2 of 92%. What is the
priority intervention?
A. Administer naloxone (Narcan) per protocol *[CORRECT]*
B. Apply oxygen at 2 L/min via nasal cannula
C. Encourage the client to deep breathe and cough
D. Discontinue the PCA infusion and document
Correct Answer: A
Rationale: A respiratory rate of 10 with decreased level of consciousness indicates
opioid-induced respiratory depression, a life-threatening emergency requiring immediate
administration of naloxone, the opioid antagonist. NUR 2392 perioperative pharmacology
emphasizes that naloxone reverses respiratory depression by displacing opioids from receptor
sites. Applying oxygen (option B) treats the symptom but not the cause. Deep breathing
(option C) is ineffective with a depressed sensorium. Simply discontinuing the PCA (option D)
does not reverse the opioid already bound to receptors.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 2
,NUR 2392 Exam 2 - Multidimensional Care II (2026/2027) Rasmussen University
Q6: Which client scheduled for surgery has the greatest risk for intraoperative malignant
hyperthermia?
A. A 45-year-old with a history of well-controlled asthma
B. A 28-year-old with a family history of malignant hyperthermia *[CORRECT]*
C. A 60-year-old with type 2 diabetes managed with metformin
D. A 35-year-old with hypothyroidism on levothyroxine
Correct Answer: B
Rationale: Malignant hyperthermia is an inherited autosomal dominant disorder triggered by
succinylcholine and volatile inhaled anesthetics such as sevoflurane and desflurane. A family
history of malignant hyperthermia is the strongest risk factor and requires preoperative
screening and a non-triggering anesthetic plan per NUR 2392 perioperative content. The other
conditions (asthma, diabetes, hypothyroidism) pose general anesthesia risks but are not
specifically linked to malignant hyperthermia.
Q7: A client is being discharged after a laparoscopic cholecystectomy. Which client statement
indicates a need for further teaching?
A. I should report any yellowing of my skin or eyes to my provider.
B. I can resume all my normal activities within 24 hours of going home. *[CORRECT]*
C. I will call the surgeon if I develop a fever over 101 degrees Fahrenheit.
D. I should keep the incision sites clean and dry.
Correct Answer: B
Rationale: Full recovery from laparoscopic cholecystectomy typically takes one to two weeks
with a gradual return to activities, and resuming all normal activities within 24 hours is
unrealistic and risks wound injury or internal complications. NUR 2392 discharge teaching
emphasizes that clients should avoid heavy lifting and strenuous activity for the prescribed
period. The other statements demonstrate appropriate understanding of postoperative care,
including recognition of jaundice (which could indicate bile duct injury), infection signs, and
wound care.
Q8: A client is receiving IV heparin postoperatively for DVT prophylaxis. The aPTT is 98 seconds
(control 30 seconds). What is the most appropriate nursing action?
A. Increase the heparin infusion rate to achieve therapeutic range
B. Document the finding; the value is within therapeutic range
C. Notify the provider to adjust the heparin dose *[CORRECT]*
D. Administer protamine sulfate as the antidote
Correct Answer: C
Rationale: An aPTT of 98 seconds indicates anticoagulation exceeds the therapeutic range,
which is typically 1.5 to 2.5 times the control (45 to 75 seconds for this client). The provider
should be notified to adjust the dose per the NUR 2392 perioperative anticoagulation protocol.
Increasing the rate (option A) would worsen the bleeding risk. Simply documenting (option B)
ignores a critical value. Protamine sulfate (option D) is reserved for severe bleeding or critical
elevations, not this moderate overshoot.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 3
, NUR 2392 Exam 2 - Multidimensional Care II (2026/2027) Rasmussen University
Q9: The nurse is preparing to witness informed consent for a non-English-speaking client
scheduled for an emergency appendectomy. Which action is most appropriate?
A. Ask a bilingual family member to translate the consent form
B. Use a hospital-certified medical interpreter via phone or video *[CORRECT]*
C. Explain the procedure using simple pictures and gestures
D. Have the client sign and explain the procedure afterward
Correct Answer: B
Rationale: Per the Joint Commission standards and NUR 2392 legal and ethical content,
informed consent must be obtained through a hospital-certified medical interpreter to ensure
accurate bidirectional information exchange. Family members (option A) may not translate
medical terminology accurately and may have conflicts of interest. Pictures (option C) cannot
convey risks, benefits, and alternatives. Having the client sign without understanding (option
D) violates the ethical principle of autonomy and the legal doctrine of informed consent.
Q10: A client post-thyroidectomy develops a temperature of 104 degrees Fahrenheit (40 degrees
C), tachycardia of 130 beats/min, and confusion 12 hours after surgery. Which complication
should the nurse suspect?
A. Thyroid storm *[CORRECT]*
B. Hypovolemic shock
C. Malignant hyperthermia
D. Surgical site infection
Correct Answer: A
Rationale: These signs occurring post-thyroidectomy strongly suggest thyroid storm
(thyrotoxic crisis), a life-threatening hypermetabolic state characterized by hyperpyrexia,
tachycardia, and altered mental status. NUR 2392 endocrine and perioperative content
emphasizes this as a complication of thyroid surgery in clients with inadequately treated
hyperthyroidism. Malignant hyperthermia (option C) occurs intraoperatively, not 12 hours
later. Hypovolemic shock (option B) would present with hypotension. Surgical site infection
(option D) typically develops later and would not cause such extreme hyperpyrexia and
tachycardia.
Q11: A client is in the PACU after general anesthesia. The client's oxygen saturation is 90% on
room air with a respiratory rate of 14. Which action should the nurse take first?
A. Apply oxygen at 2 L/min via nasal cannula *[CORRECT]*
B. Suction the airway to remove secretions
C. Encourage the client to cough and deep breathe
D. Reassess the reading in 5 minutes
Correct Answer: A
Rationale: An SpO2 of 90% indicates hypoxemia and requires immediate oxygen application
to prevent further deterioration. NUR 2392 PACU protocols require SpO2 of 92% or higher in
the postoperative period. Suctioning (option B) and coughing (option C) may be needed if
secretions are present, but oxygen is the first action to correct the hypoxemia. Waiting to
reassess (option D) is unsafe and delays essential intervention.
Comprehensive Examination - 120 Questions Property of NUR 2392 MDC II Course Page 4
