,NUR 2392 / NUR 2392 Exam 2 —
Multidimensional Care II (MDC II) | Rasmussen
University | 2026/2027 Exam Prep + Q&A +
Detailed Rationales
Q1. A client with type 1 diabetes mellitus is admitted with a blood glucose of 580 mg/dL, pH
7.18, HCO₃⁻ 10 mEq/L, and positive serum ketones. Which action should the nurse take first?
A. Administer regular insulin IV bolus as prescribed
B. Begin IV fluid resuscitation with 0.9% sodium chloride
C. Monitor serum potassium level
D. Assess for Kussmaul respirations
Correct Answer: B. Begin IV fluid resuscitation with 0.9% sodium chloride
Rationale: In diabetic ketoacidosis (DKA), the priority is fluid resuscitation with 0.9% sodium
chloride to restore intravascular volume and improve perfusion. Insulin administration
follows fluid resuscitation. Potassium monitoring is critical but does not precede fluid
resuscitation. Assessing for Kussmaul respirations is part of the assessment but is not the first
action. The nurse should also monitor glucose and potassium closely as insulin is initiated.
Key Takeaway: Fluid resuscitation precedes insulin administration in DKA.
Q2. A client with heart failure has a potassium level of 3.1 mEq/L and is prescribed
furosemide. Which action should the nurse take first?
A. Administer the furosemide as prescribed
B. Hold the furosemide and notify the provider
C. Encourage the client to eat potassium-rich foods
D. Obtain a repeat potassium level
Correct Answer: B. Hold the furosemide and notify the provider
Rationale: Furosemide is a loop diuretic that causes potassium loss. Administering it to a
client with hypokalemia (potassium below 3.5 mEq/L) can worsen the imbalance and increase
,the risk of cardiac dysrhythmias. The nurse should hold the medication and notify the
provider. Encouraging potassium-rich foods is appropriate for mild hypokalemia but does not
replace holding the diuretic. A repeat potassium level may be needed but the priority is to
withhold the medication.
Key Takeaway: Hold loop diuretics when potassium is below 3.5 mEq/L and notify the
provider.
Q3. A client with a spinal cord injury at T5 develops a severe headache, blood pressure
220/118 mm Hg, and heart rate 48 beats/min. Which action should the nurse take first?
A. Administer antihypertensive medication
B. Elevate the head of the bed to 90 degrees
C. Insert a urinary catheter
D. Perform a rectal examination
Correct Answer: B. Elevate the head of the bed to 90 degrees
Rationale: Autonomic dysreflexia is a life-threatening emergency in clients with spinal cord
injuries at or above T6. It is triggered by a noxious stimulus below the level of injury, most
commonly a distended bladder. The first action is to elevate the head of the bed to 90 degrees
to reduce intracranial pressure and lower blood pressure. Then the nurse should identify and
remove the trigger. Antihypertensive medication may be needed if blood pressure remains
elevated. Rectal examination can worsen the condition.
Key Takeaway: Elevate the head of the bed first for autonomic dysreflexia, then remove the
trigger.
Q4. A client with cirrhosis has a serum ammonia level of 210 mcg/dL and increasing
confusion. Which medication should the nurse anticipate administering?
A. Lactulose
B. Furosemide
C. Spironolactone
D. Propranolol
Correct Answer: A. Lactulose
, Rationale: Hepatic encephalopathy occurs when the damaged liver cannot convert ammonia
to urea. Lactulose is a laxative that traps ammonia in the gut and promotes its excretion in the
stool, reducing serum ammonia levels. Furosemide and spironolactone are diuretics used for
ascites. Propranolol is used for portal hypertension prophylaxis. The nurse should also
monitor for improvement in mental status and ammonia levels.
Key Takeaway: Lactulose reduces ammonia levels in hepatic encephalopathy.
Q5. A client with Graves disease is admitted with a heart rate of 152 beats/min, temperature
of 104.2°F, and severe agitation. Which medication should the nurse anticipate administering
first?
A. Methimazole
B. Propranolol
C. Levothyroxine
D. Radioactive iodine
Correct Answer: B. Propranolol
Rationale: This client is experiencing thyroid storm, a life-threatening exacerbation of
hyperthyroidism. Propranolol, a beta-blocker, is administered first to control the sympathetic
effects of excess thyroid hormone, including tachycardia, agitation, and hyperthermia.
Methimazole and radioactive iodine are used for long-term management of hyperthyroidism.
Levothyroxine is used for hypothyroidism. The nurse should also administer supportive care
and monitor for cardiac dysrhythmias.
Key Takeaway: Beta-blockers such as propranolol are first-line for thyroid storm to control
sympathetic symptoms.
Q6. A client with a perforated peptic ulcer presents with sudden severe abdominal pain, a
rigid board-like abdomen, and absent bowel sounds. Which action should the nurse take first?
A. Administer a PRN antacid
B. Prepare the client for emergency surgery
C. Insert a nasogastric tube
D. Obtain an abdominal x-ray
Multidimensional Care II (MDC II) | Rasmussen
University | 2026/2027 Exam Prep + Q&A +
Detailed Rationales
Q1. A client with type 1 diabetes mellitus is admitted with a blood glucose of 580 mg/dL, pH
7.18, HCO₃⁻ 10 mEq/L, and positive serum ketones. Which action should the nurse take first?
A. Administer regular insulin IV bolus as prescribed
B. Begin IV fluid resuscitation with 0.9% sodium chloride
C. Monitor serum potassium level
D. Assess for Kussmaul respirations
Correct Answer: B. Begin IV fluid resuscitation with 0.9% sodium chloride
Rationale: In diabetic ketoacidosis (DKA), the priority is fluid resuscitation with 0.9% sodium
chloride to restore intravascular volume and improve perfusion. Insulin administration
follows fluid resuscitation. Potassium monitoring is critical but does not precede fluid
resuscitation. Assessing for Kussmaul respirations is part of the assessment but is not the first
action. The nurse should also monitor glucose and potassium closely as insulin is initiated.
Key Takeaway: Fluid resuscitation precedes insulin administration in DKA.
Q2. A client with heart failure has a potassium level of 3.1 mEq/L and is prescribed
furosemide. Which action should the nurse take first?
A. Administer the furosemide as prescribed
B. Hold the furosemide and notify the provider
C. Encourage the client to eat potassium-rich foods
D. Obtain a repeat potassium level
Correct Answer: B. Hold the furosemide and notify the provider
Rationale: Furosemide is a loop diuretic that causes potassium loss. Administering it to a
client with hypokalemia (potassium below 3.5 mEq/L) can worsen the imbalance and increase
,the risk of cardiac dysrhythmias. The nurse should hold the medication and notify the
provider. Encouraging potassium-rich foods is appropriate for mild hypokalemia but does not
replace holding the diuretic. A repeat potassium level may be needed but the priority is to
withhold the medication.
Key Takeaway: Hold loop diuretics when potassium is below 3.5 mEq/L and notify the
provider.
Q3. A client with a spinal cord injury at T5 develops a severe headache, blood pressure
220/118 mm Hg, and heart rate 48 beats/min. Which action should the nurse take first?
A. Administer antihypertensive medication
B. Elevate the head of the bed to 90 degrees
C. Insert a urinary catheter
D. Perform a rectal examination
Correct Answer: B. Elevate the head of the bed to 90 degrees
Rationale: Autonomic dysreflexia is a life-threatening emergency in clients with spinal cord
injuries at or above T6. It is triggered by a noxious stimulus below the level of injury, most
commonly a distended bladder. The first action is to elevate the head of the bed to 90 degrees
to reduce intracranial pressure and lower blood pressure. Then the nurse should identify and
remove the trigger. Antihypertensive medication may be needed if blood pressure remains
elevated. Rectal examination can worsen the condition.
Key Takeaway: Elevate the head of the bed first for autonomic dysreflexia, then remove the
trigger.
Q4. A client with cirrhosis has a serum ammonia level of 210 mcg/dL and increasing
confusion. Which medication should the nurse anticipate administering?
A. Lactulose
B. Furosemide
C. Spironolactone
D. Propranolol
Correct Answer: A. Lactulose
, Rationale: Hepatic encephalopathy occurs when the damaged liver cannot convert ammonia
to urea. Lactulose is a laxative that traps ammonia in the gut and promotes its excretion in the
stool, reducing serum ammonia levels. Furosemide and spironolactone are diuretics used for
ascites. Propranolol is used for portal hypertension prophylaxis. The nurse should also
monitor for improvement in mental status and ammonia levels.
Key Takeaway: Lactulose reduces ammonia levels in hepatic encephalopathy.
Q5. A client with Graves disease is admitted with a heart rate of 152 beats/min, temperature
of 104.2°F, and severe agitation. Which medication should the nurse anticipate administering
first?
A. Methimazole
B. Propranolol
C. Levothyroxine
D. Radioactive iodine
Correct Answer: B. Propranolol
Rationale: This client is experiencing thyroid storm, a life-threatening exacerbation of
hyperthyroidism. Propranolol, a beta-blocker, is administered first to control the sympathetic
effects of excess thyroid hormone, including tachycardia, agitation, and hyperthermia.
Methimazole and radioactive iodine are used for long-term management of hyperthyroidism.
Levothyroxine is used for hypothyroidism. The nurse should also administer supportive care
and monitor for cardiac dysrhythmias.
Key Takeaway: Beta-blockers such as propranolol are first-line for thyroid storm to control
sympathetic symptoms.
Q6. A client with a perforated peptic ulcer presents with sudden severe abdominal pain, a
rigid board-like abdomen, and absent bowel sounds. Which action should the nurse take first?
A. Administer a PRN antacid
B. Prepare the client for emergency surgery
C. Insert a nasogastric tube
D. Obtain an abdominal x-ray
