==============================
EXAM TITLE: NUR2755 Multidimensional Care IV MDC 4 Final Exam
Questions | 100% Correct Answers with Detailed Rationales
(2026/2027)
Nursing Comprehensive Final Examination – Multidimensional Care IV
==============================
SECTION 1: Complex Fluid, Electrolyte, and Acid-Base Imbalances
Question 1
A client in the early phase of septic shock presents with which of the following clinical
findings?
A. Narrowed pulse pressure and cool, clammy skin
B. Widened pulse pressure and warm, flushed skin
C. Bradycardia and hypotension
D. Oliguria and metabolic alkalosis
Correct Answer: B
Rationale: Early septic shock (warm shock) is characterized by
peripheral vasodilation, resulting in a widened pulse pressure and
warm, flushed skin. Narrowed pulse pressure and cool, clammy skin
occur in late or cold septic shock. Bradycardia is not typical;
tachycardia is expected. Metabolic acidosis, not alkalosis, develops
due to lactic acid accumulation from tissue hypoperfusion.
,Question 2
A postoperative client develops disseminated intravascular coagulation (DIC).
Laboratory analysis reveals prolonged PT/INR and aPTT, decreased fibrinogen, and
elevated D-dimer. The nurse recognizes that the most appropriate intervention is:
A. Administering heparin infusion to interrupt the coagulation cascade
B. Preparing to administer fresh frozen plasma and cryoprecipitate
C. Initiating thrombolytic therapy to dissolve microclots
D. Administering aspirin to inhibit platelet aggregation
Correct Answer: B
Rationale: In acute DIC with bleeding, clotting factors are consumed.
Fresh frozen plasma replaces clotting factors, and cryoprecipitate
replaces fibrinogen. Heparin may be used in chronic DIC with
thrombosis but is contraindicated in acute bleeding DIC.
Thrombolytics would worsen bleeding. Aspirin is contraindicated due
to bleeding risk.
Question 3
A client with syndrome of inappropriate antidiuretic hormone (SIADH) is being treated
with fluid restriction. Which laboratory finding best differentiates SIADH from diabetes
insipidus (DI)?
A. SIADH: dilute urine; DI: concentrated urine
B. SIADH: concentrated urine; DI: dilute urine
C. SIADH: hypernatremia; DI: hyponatremia
D. SIADH: elevated serum osmolality; DI: decreased serum osmolality
Correct Answer: B
,Rationale: SIADH causes water retention, resulting in concentrated
urine (high urine osmolality) and hyponatremia. DI causes water loss,
resulting in dilute urine (low urine osmolality) and hypernatremia.
Option A reverses the urine concentration findings. Option C reverses
the sodium values. Option D reverses the serum osmolality findings.
Question 4
A client presents with hypovolemic shock following a massive gastrointestinal bleed.
After establishing two large-bore IV lines, which fluid should the nurse anticipate
administering first?
A. 0.45% normal saline
B. Lactated Ringer's solution
C. 5% dextrose in water
D. Fresh frozen plasma
Correct Answer: B
Rationale: Lactated Ringer's is an isotonic crystalloid and the fluid of
choice for initial resuscitation in hypovolemic shock. It expands
intravascular volume effectively. 0.45% saline is hypotonic and can
cause cellular swelling. D5W is hypotonic after dextrose metabolism
and does not expand plasma volume effectively. Fresh frozen plasma
is used for coagulopathy, not initial volume resuscitation.
Question 5
, A client with diabetic ketoacidosis has arterial blood gas results showing a pH of 7.25,
PaCO2 of 30 mmHg, and HCO3- of 14 mEq/L. The nurse understands that the client's
respiratory pattern represents:
A. Metabolic alkalosis with respiratory compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Metabolic acidosis without compensation
Correct Answer: B
Rationale: The low pH indicates acidosis. The low HCO3- confirms a
metabolic origin. The low PaCO2 (hyperventilation) represents
respiratory compensation via Kussmaul respirations, which blow off
carbon dioxide to raise pH. Full compensation would normalize pH;
here pH remains low, indicating partial compensation.
Question 6
A client with acute kidney injury presents with peaked T waves on the ECG and a serum
potassium of 6.8 mEq/L. After ensuring IV access, which intervention should the nurse
prioritize?
A. Administering sodium polystyrene sulfonate (Kayexalate) orally
B. Administering 10% calcium gluconate IV push
C. Preparing the client for emergent hemodialysis
D. Administering regular insulin with 50% dextrose IV
Correct Answer: B
EXAM TITLE: NUR2755 Multidimensional Care IV MDC 4 Final Exam
Questions | 100% Correct Answers with Detailed Rationales
(2026/2027)
Nursing Comprehensive Final Examination – Multidimensional Care IV
==============================
SECTION 1: Complex Fluid, Electrolyte, and Acid-Base Imbalances
Question 1
A client in the early phase of septic shock presents with which of the following clinical
findings?
A. Narrowed pulse pressure and cool, clammy skin
B. Widened pulse pressure and warm, flushed skin
C. Bradycardia and hypotension
D. Oliguria and metabolic alkalosis
Correct Answer: B
Rationale: Early septic shock (warm shock) is characterized by
peripheral vasodilation, resulting in a widened pulse pressure and
warm, flushed skin. Narrowed pulse pressure and cool, clammy skin
occur in late or cold septic shock. Bradycardia is not typical;
tachycardia is expected. Metabolic acidosis, not alkalosis, develops
due to lactic acid accumulation from tissue hypoperfusion.
,Question 2
A postoperative client develops disseminated intravascular coagulation (DIC).
Laboratory analysis reveals prolonged PT/INR and aPTT, decreased fibrinogen, and
elevated D-dimer. The nurse recognizes that the most appropriate intervention is:
A. Administering heparin infusion to interrupt the coagulation cascade
B. Preparing to administer fresh frozen plasma and cryoprecipitate
C. Initiating thrombolytic therapy to dissolve microclots
D. Administering aspirin to inhibit platelet aggregation
Correct Answer: B
Rationale: In acute DIC with bleeding, clotting factors are consumed.
Fresh frozen plasma replaces clotting factors, and cryoprecipitate
replaces fibrinogen. Heparin may be used in chronic DIC with
thrombosis but is contraindicated in acute bleeding DIC.
Thrombolytics would worsen bleeding. Aspirin is contraindicated due
to bleeding risk.
Question 3
A client with syndrome of inappropriate antidiuretic hormone (SIADH) is being treated
with fluid restriction. Which laboratory finding best differentiates SIADH from diabetes
insipidus (DI)?
A. SIADH: dilute urine; DI: concentrated urine
B. SIADH: concentrated urine; DI: dilute urine
C. SIADH: hypernatremia; DI: hyponatremia
D. SIADH: elevated serum osmolality; DI: decreased serum osmolality
Correct Answer: B
,Rationale: SIADH causes water retention, resulting in concentrated
urine (high urine osmolality) and hyponatremia. DI causes water loss,
resulting in dilute urine (low urine osmolality) and hypernatremia.
Option A reverses the urine concentration findings. Option C reverses
the sodium values. Option D reverses the serum osmolality findings.
Question 4
A client presents with hypovolemic shock following a massive gastrointestinal bleed.
After establishing two large-bore IV lines, which fluid should the nurse anticipate
administering first?
A. 0.45% normal saline
B. Lactated Ringer's solution
C. 5% dextrose in water
D. Fresh frozen plasma
Correct Answer: B
Rationale: Lactated Ringer's is an isotonic crystalloid and the fluid of
choice for initial resuscitation in hypovolemic shock. It expands
intravascular volume effectively. 0.45% saline is hypotonic and can
cause cellular swelling. D5W is hypotonic after dextrose metabolism
and does not expand plasma volume effectively. Fresh frozen plasma
is used for coagulopathy, not initial volume resuscitation.
Question 5
, A client with diabetic ketoacidosis has arterial blood gas results showing a pH of 7.25,
PaCO2 of 30 mmHg, and HCO3- of 14 mEq/L. The nurse understands that the client's
respiratory pattern represents:
A. Metabolic alkalosis with respiratory compensation
B. Metabolic acidosis with respiratory compensation
C. Respiratory acidosis with metabolic compensation
D. Metabolic acidosis without compensation
Correct Answer: B
Rationale: The low pH indicates acidosis. The low HCO3- confirms a
metabolic origin. The low PaCO2 (hyperventilation) represents
respiratory compensation via Kussmaul respirations, which blow off
carbon dioxide to raise pH. Full compensation would normalize pH;
here pH remains low, indicating partial compensation.
Question 6
A client with acute kidney injury presents with peaked T waves on the ECG and a serum
potassium of 6.8 mEq/L. After ensuring IV access, which intervention should the nurse
prioritize?
A. Administering sodium polystyrene sulfonate (Kayexalate) orally
B. Administering 10% calcium gluconate IV push
C. Preparing the client for emergent hemodialysis
D. Administering regular insulin with 50% dextrose IV
Correct Answer: B
