NUR 2755 Multidimensional Care IV – Exam 2
(Latest 2026/2027) | NCLEX-RN® Aligned Review
& 75 Verified Questions with Answers
Section 1. Complex Cardiovascular & Shock Management (1-15)
Q1. [NGN – Bow-Tie]
A 58-year-old, 24 h post-fibrinolytic anterior MI, suddenly reports “I can’t breathe.” VS: BP
88/60, HR 118, RR 32, SpO₂ 86 % on 4 L NC. Auscultation: diffuse crackles, S₃ gallop.
Drag the correct option into each box.
CAUSE (drop zone)
A. Cardiac tamponade
B. Pulmonary embolism
C. Acute heart failure
D. Anxiety
PRIORITY NURSE ACTION (drop zone)
E. Give PRN morphine
F. Increase IV fluid rate
G. Apply O₂ & call rapid-response
H. Prepare for STAT echo
,EXPECTED OUTCOME (drop zone)
I. Resolved inflammation
J. Reduced preload
K. Identification of pericardial effusion
L. Improved perfusion
Correct Bow-Tie: C → G → J
Rationale: Acute HF (C) is most consistent with S₃, crackles, hypoxia, and low SpO₂.
Calling rapid-response (G) mobilizes providers for immediate IV diuretic/vasodilator
therapy before independent morphine or fluid bolus (either could worsen hypotension).
Expected outcome of furosemide after return of spontaneous circulation is reduced
preload (J), decreasing pulmonary congestion. Tamponade would show equalization of
pressures and muffled heart sounds; PE would present with clear lungs and right-sided
strain; anxiety would not produce S₃ or hypoxia on 4 L.
Q2.
A patient with non-ischemic cardiomyopathy has a pulmonary artery wedge pressure
(PAWP) of 18 mmHg and a cardiac index (CI) 1.9 L/min/m². Which order should the
nurse implement first?
A. Start dobutamine 5 mcg/kg/min
B. Restrict oral fluids to 1 L/day
C. Administer furosemide 40 mg IV push
D. Place in Trendelenburg position
,Correct: A
Rationale: PAWP >15 mmHg indicates fluid backup, but CI <2.2 shows cardiogenic
shock; inotropy (A) is priority to restore perfusion before diuresis (C) or fluid restriction
(B). Trendelenburg (D) increases venous return and afterload, worsening HF.
Q3. [NGN – Matrix/Grid SATA]
Charge nurse is making assignments for four acute-care patients. Which patients are
appropriate to assign to an experienced LPN under direct RN supervision? (Select all
that apply.)
Patient A: 2 days post-PCI, stable, PO meds only
Patient B: New-onset atrial fib, on heparin drip, q6h aPTT draws
Patient C: Cardiogenic shock, on dobutamine & milrinone gtts
Patient D: CHF exacerbation, receiving first dose of PO ACE-I
Patient E: Hypertensive crisis, on nicardipine drip, titrated q15min
Correct: A, D
Rationale: LPN scope under RN supervision includes stable post-procedure patients (A)
and oral medication administration (D). IV anti-coagulants (B), vasoactive drips (C, E),
and titration require RN-level judgment and cannot be delegated.
Q4.
A patient in hypovolemic shock receives 2 L LR. BP 78/52 → 92/58, HR 122 → 110, UO
0.3 → 0.4 mL/kg/h. Which evaluation statement best indicates the goal is NOT yet met?
A. “Capillary refill remains >4 s”
, B. “Lactate decreased 6 → 3 mmol/L”
C. “MAP is now 69 mmHg”
D. “Base deficit normalized”
Correct: A
Rationale: Persistent delayed capillary refill (A) signals ongoing poor peripheral
perfusion despite modest BP improvement. Lactate drop (B), MAP ≥65 (C), and normal
base deficit (D) suggest resuscitation is working; therefore A is the cue that more
volume or vasoactive support is needed.
Q5.
Immediately after synchronized cardioversion for VT, the monitor shows sinus rhythm
74/min, but the radial pulse feels irregularly weak. The nurse’s first action is to:
A. Check carotid pulse for 10 s
B. Obtain 12-lead ECG
C. Assess BP & SpO₂
D. Charge defib to 200 J
Correct: C
Rationale: Clinical judgment step “Recognize Cues” → weak irregular pulse suggests
possible perfusion failure; assess BP & SpO₂ (C) provides data to determine if pulse is
truly perfusing or if pseudo-EMD exists. Carotid check (A) delays assessment; 12-lead
(B) is diagnostic, not priority; charging (D) is premature without evidence of recurrence.
Q6. [NGN – Extended Drag & Drop]
(Latest 2026/2027) | NCLEX-RN® Aligned Review
& 75 Verified Questions with Answers
Section 1. Complex Cardiovascular & Shock Management (1-15)
Q1. [NGN – Bow-Tie]
A 58-year-old, 24 h post-fibrinolytic anterior MI, suddenly reports “I can’t breathe.” VS: BP
88/60, HR 118, RR 32, SpO₂ 86 % on 4 L NC. Auscultation: diffuse crackles, S₃ gallop.
Drag the correct option into each box.
CAUSE (drop zone)
A. Cardiac tamponade
B. Pulmonary embolism
C. Acute heart failure
D. Anxiety
PRIORITY NURSE ACTION (drop zone)
E. Give PRN morphine
F. Increase IV fluid rate
G. Apply O₂ & call rapid-response
H. Prepare for STAT echo
,EXPECTED OUTCOME (drop zone)
I. Resolved inflammation
J. Reduced preload
K. Identification of pericardial effusion
L. Improved perfusion
Correct Bow-Tie: C → G → J
Rationale: Acute HF (C) is most consistent with S₃, crackles, hypoxia, and low SpO₂.
Calling rapid-response (G) mobilizes providers for immediate IV diuretic/vasodilator
therapy before independent morphine or fluid bolus (either could worsen hypotension).
Expected outcome of furosemide after return of spontaneous circulation is reduced
preload (J), decreasing pulmonary congestion. Tamponade would show equalization of
pressures and muffled heart sounds; PE would present with clear lungs and right-sided
strain; anxiety would not produce S₃ or hypoxia on 4 L.
Q2.
A patient with non-ischemic cardiomyopathy has a pulmonary artery wedge pressure
(PAWP) of 18 mmHg and a cardiac index (CI) 1.9 L/min/m². Which order should the
nurse implement first?
A. Start dobutamine 5 mcg/kg/min
B. Restrict oral fluids to 1 L/day
C. Administer furosemide 40 mg IV push
D. Place in Trendelenburg position
,Correct: A
Rationale: PAWP >15 mmHg indicates fluid backup, but CI <2.2 shows cardiogenic
shock; inotropy (A) is priority to restore perfusion before diuresis (C) or fluid restriction
(B). Trendelenburg (D) increases venous return and afterload, worsening HF.
Q3. [NGN – Matrix/Grid SATA]
Charge nurse is making assignments for four acute-care patients. Which patients are
appropriate to assign to an experienced LPN under direct RN supervision? (Select all
that apply.)
Patient A: 2 days post-PCI, stable, PO meds only
Patient B: New-onset atrial fib, on heparin drip, q6h aPTT draws
Patient C: Cardiogenic shock, on dobutamine & milrinone gtts
Patient D: CHF exacerbation, receiving first dose of PO ACE-I
Patient E: Hypertensive crisis, on nicardipine drip, titrated q15min
Correct: A, D
Rationale: LPN scope under RN supervision includes stable post-procedure patients (A)
and oral medication administration (D). IV anti-coagulants (B), vasoactive drips (C, E),
and titration require RN-level judgment and cannot be delegated.
Q4.
A patient in hypovolemic shock receives 2 L LR. BP 78/52 → 92/58, HR 122 → 110, UO
0.3 → 0.4 mL/kg/h. Which evaluation statement best indicates the goal is NOT yet met?
A. “Capillary refill remains >4 s”
, B. “Lactate decreased 6 → 3 mmol/L”
C. “MAP is now 69 mmHg”
D. “Base deficit normalized”
Correct: A
Rationale: Persistent delayed capillary refill (A) signals ongoing poor peripheral
perfusion despite modest BP improvement. Lactate drop (B), MAP ≥65 (C), and normal
base deficit (D) suggest resuscitation is working; therefore A is the cue that more
volume or vasoactive support is needed.
Q5.
Immediately after synchronized cardioversion for VT, the monitor shows sinus rhythm
74/min, but the radial pulse feels irregularly weak. The nurse’s first action is to:
A. Check carotid pulse for 10 s
B. Obtain 12-lead ECG
C. Assess BP & SpO₂
D. Charge defib to 200 J
Correct: C
Rationale: Clinical judgment step “Recognize Cues” → weak irregular pulse suggests
possible perfusion failure; assess BP & SpO₂ (C) provides data to determine if pulse is
truly perfusing or if pseudo-EMD exists. Carotid check (A) delays assessment; 12-lead
(B) is diagnostic, not priority; charging (D) is premature without evidence of recurrence.
Q6. [NGN – Extended Drag & Drop]
