NUR 2755 MDC4 FINAL EXAM | MULTIDIMENSIONAL CARE IV STUDY GUIDE 2026/2027
COMPREHENSIVE UNIVERSITY-LEVEL EXAMINATION
SECTION A: EMERGENCY AND CRITICAL CARE NURSING (Questions 1–25)
1. A patient arrives in the emergency department with a gunshot wound to the
abdomen and is hypotensive with a blood pressure of 78/42 mmHg. Which type of
shock is the priority concern?
A. Cardiogenic shock
B. Obstructive shock
C. Hypovolemic shock
D. Neurogenic shock
Answer: C. Hypovolemic shock
Rationale: Penetrating abdominal trauma causes significant blood loss, leading to
hypovolemic shock from reduced intravascular volume.
2. A patient with sepsis has been resuscitated with 30 mL/kg of crystalloids but
remains hypotensive. Which vasopressor is the first-line agent?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
Answer: B. Norepinephrine
Rationale: Norepinephrine is the recommended first-line vasopressor for septic shock per
Surviving Sepsis Campaign guidelines.
3. A patient in cardiac arrest presents with pulseless electrical activity (PEA). Which
reversible cause should the nurse assess for FIRST?
,A. Hypoglycemia
B. Hypovolemia
C. Hyperkalemia
D. Hypothermia
Answer: B. Hypovolemia
Rationale: Hypovolemia is one of the most common and immediately correctable causes
of PEA.
4. A patient is admitted with acute respiratory distress syndrome (ARDS). Which
ventilator strategy is most appropriate?
A. High tidal volumes to improve oxygenation
B. Low tidal volumes with high PEEP
C. High respiratory rate with low PEEP
D. Pressure support ventilation only
Answer: B. Low tidal volumes with high PEEP
Rationale: Lung-protective ventilation with low tidal volumes (6 mL/kg) and adequate PEEP
reduces mortality in ARDS.
5. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22
mmHg. Which intervention is the priority?
A. Administer a bolus of hypotonic saline
B. Elevate the head of the bed to 30 degrees
C. Perform vigorous endotracheal suctioning
D. Position the patient flat and supine
Answer: B. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed promotes venous drainage and reduces ICP.
6. A patient is in the emergency department with anaphylaxis. Which medication
should be administered FIRST?
A. Diphenhydramine IV
B. Methylprednisolone IV
C. Epinephrine IM
D. Albuterol nebulized
Answer: C. Epinephrine IM
Rationale: Intramuscular epinephrine is the first-line treatment for anaphylaxis and should
be given immediately.
7. A patient with a tension pneumothorax requires immediate intervention. Which
procedure is performed?
A. Chest tube insertion
,B. Needle decompression
C. Pericardiocentesis
D. Thoracentesis
Answer: B. Needle decompression
Rationale: Needle decompression is the immediate life-saving intervention for tension
pneumothorax before chest tube placement.
8. A patient in the ICU develops ventricular tachycardia with a pulse. Which
intervention is indicated?
A. Defibrillation
B. Synchronized cardioversion
C. CPR initiation
D. Adenosine administration
Answer: B. Synchronized cardioversion
Rationale: Unstable ventricular tachycardia with a pulse requires synchronized
cardioversion.
9. A patient has a blood glucose of 32 mg/dL and is unresponsive. Which medication
should the nurse administer?
A. Insulin IV
B. Dextrose 50% IV
C. Glucagon IM
D. Normal saline IV
Answer: B. Dextrose 50% IV
Rationale: IV dextrose rapidly corrects severe hypoglycemia in an unresponsive patient.
10. A patient is diagnosed with disseminated intravascular coagulation (DIC). Which
laboratory finding is expected?
A. Increased platelet count
B. Decreased D-dimer
C. Prolonged PT and aPTT
D. Increased fibrinogen
Answer: C. Prolonged PT and aPTT
Rationale: DIC causes consumption of clotting factors, leading to prolonged PT and aPTT.
11. A patient with a STEMI is scheduled for percutaneous coronary intervention (PCI).
Which medication should be given first?
A. Aspirin 325 mg chewed
B. Metoprolol IV
C. Morphine IV
, D. Nitroglycerin SL
Answer: A. Aspirin 325 mg chewed
Rationale: Aspirin is the first medication administered in STEMI to inhibit platelet
aggregation.
12. A patient is admitted with acute pancreatitis. Which laboratory value is most
indicative of severity?
A. Serum amylase
B. Serum lipase
C. C-reactive protein (CRP)
D. White blood cell count
Answer: C. C-reactive protein (CRP)
Rationale: CRP is a marker of systemic inflammation and correlates with pancreatitis
severity.
13. A patient with a pulmonary embolism is hemodynamically stable. Which
medication is the priority?
A. Warfarin
B. Unfractionated heparin
C. Alteplase
D. Aspirin
Answer: B. Unfractionated heparin
Rationale: Heparin is the first-line anticoagulant for stable PE; thrombolytics are for
unstable patients.
14. A patient is experiencing status epilepticus. Which medication is first-line?
A. Phenytoin
B. Levetiracetam
C. Lorazepam
D. Valproic acid
Answer: C. Lorazepam
Rationale: Benzodiazepines such as lorazepam are first-line for terminating status
epilepticus.
15. A patient with a cervical spinal cord injury develops bradycardia and hypotension.
Which condition is suspected?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Hypovolemic shock
COMPREHENSIVE UNIVERSITY-LEVEL EXAMINATION
SECTION A: EMERGENCY AND CRITICAL CARE NURSING (Questions 1–25)
1. A patient arrives in the emergency department with a gunshot wound to the
abdomen and is hypotensive with a blood pressure of 78/42 mmHg. Which type of
shock is the priority concern?
A. Cardiogenic shock
B. Obstructive shock
C. Hypovolemic shock
D. Neurogenic shock
Answer: C. Hypovolemic shock
Rationale: Penetrating abdominal trauma causes significant blood loss, leading to
hypovolemic shock from reduced intravascular volume.
2. A patient with sepsis has been resuscitated with 30 mL/kg of crystalloids but
remains hypotensive. Which vasopressor is the first-line agent?
A. Dopamine
B. Norepinephrine
C. Vasopressin
D. Phenylephrine
Answer: B. Norepinephrine
Rationale: Norepinephrine is the recommended first-line vasopressor for septic shock per
Surviving Sepsis Campaign guidelines.
3. A patient in cardiac arrest presents with pulseless electrical activity (PEA). Which
reversible cause should the nurse assess for FIRST?
,A. Hypoglycemia
B. Hypovolemia
C. Hyperkalemia
D. Hypothermia
Answer: B. Hypovolemia
Rationale: Hypovolemia is one of the most common and immediately correctable causes
of PEA.
4. A patient is admitted with acute respiratory distress syndrome (ARDS). Which
ventilator strategy is most appropriate?
A. High tidal volumes to improve oxygenation
B. Low tidal volumes with high PEEP
C. High respiratory rate with low PEEP
D. Pressure support ventilation only
Answer: B. Low tidal volumes with high PEEP
Rationale: Lung-protective ventilation with low tidal volumes (6 mL/kg) and adequate PEEP
reduces mortality in ARDS.
5. A patient with a traumatic brain injury has an intracranial pressure (ICP) of 22
mmHg. Which intervention is the priority?
A. Administer a bolus of hypotonic saline
B. Elevate the head of the bed to 30 degrees
C. Perform vigorous endotracheal suctioning
D. Position the patient flat and supine
Answer: B. Elevate the head of the bed to 30 degrees
Rationale: Elevating the head of the bed promotes venous drainage and reduces ICP.
6. A patient is in the emergency department with anaphylaxis. Which medication
should be administered FIRST?
A. Diphenhydramine IV
B. Methylprednisolone IV
C. Epinephrine IM
D. Albuterol nebulized
Answer: C. Epinephrine IM
Rationale: Intramuscular epinephrine is the first-line treatment for anaphylaxis and should
be given immediately.
7. A patient with a tension pneumothorax requires immediate intervention. Which
procedure is performed?
A. Chest tube insertion
,B. Needle decompression
C. Pericardiocentesis
D. Thoracentesis
Answer: B. Needle decompression
Rationale: Needle decompression is the immediate life-saving intervention for tension
pneumothorax before chest tube placement.
8. A patient in the ICU develops ventricular tachycardia with a pulse. Which
intervention is indicated?
A. Defibrillation
B. Synchronized cardioversion
C. CPR initiation
D. Adenosine administration
Answer: B. Synchronized cardioversion
Rationale: Unstable ventricular tachycardia with a pulse requires synchronized
cardioversion.
9. A patient has a blood glucose of 32 mg/dL and is unresponsive. Which medication
should the nurse administer?
A. Insulin IV
B. Dextrose 50% IV
C. Glucagon IM
D. Normal saline IV
Answer: B. Dextrose 50% IV
Rationale: IV dextrose rapidly corrects severe hypoglycemia in an unresponsive patient.
10. A patient is diagnosed with disseminated intravascular coagulation (DIC). Which
laboratory finding is expected?
A. Increased platelet count
B. Decreased D-dimer
C. Prolonged PT and aPTT
D. Increased fibrinogen
Answer: C. Prolonged PT and aPTT
Rationale: DIC causes consumption of clotting factors, leading to prolonged PT and aPTT.
11. A patient with a STEMI is scheduled for percutaneous coronary intervention (PCI).
Which medication should be given first?
A. Aspirin 325 mg chewed
B. Metoprolol IV
C. Morphine IV
, D. Nitroglycerin SL
Answer: A. Aspirin 325 mg chewed
Rationale: Aspirin is the first medication administered in STEMI to inhibit platelet
aggregation.
12. A patient is admitted with acute pancreatitis. Which laboratory value is most
indicative of severity?
A. Serum amylase
B. Serum lipase
C. C-reactive protein (CRP)
D. White blood cell count
Answer: C. C-reactive protein (CRP)
Rationale: CRP is a marker of systemic inflammation and correlates with pancreatitis
severity.
13. A patient with a pulmonary embolism is hemodynamically stable. Which
medication is the priority?
A. Warfarin
B. Unfractionated heparin
C. Alteplase
D. Aspirin
Answer: B. Unfractionated heparin
Rationale: Heparin is the first-line anticoagulant for stable PE; thrombolytics are for
unstable patients.
14. A patient is experiencing status epilepticus. Which medication is first-line?
A. Phenytoin
B. Levetiracetam
C. Lorazepam
D. Valproic acid
Answer: C. Lorazepam
Rationale: Benzodiazepines such as lorazepam are first-line for terminating status
epilepticus.
15. A patient with a cervical spinal cord injury develops bradycardia and hypotension.
Which condition is suspected?
A. Septic shock
B. Neurogenic shock
C. Cardiogenic shock
D. Hypovolemic shock
