MDC III EXAM 1 (RASMUSSEN)
2026: THE COMPREHENSIVE 400-
Questions REVIEW WITH ACCURATE
ANSWERS & CLINICAL RATIONALES
[Most Recent] /Graded A+
1. A patient with sickle cell anemia is admitted with a vaso-occlusive
crisis. Which intervention should the nurse prioritize?
• A. Administer oral iron supplements.
• B. Apply cold compresses to painful joints.
• C. Infuse IV fluids and administer analgesics.
• D. Place the patient in high-Fowler's position.
Answer: C. Hydration (IV fluids) and pain management are the priority
for vaso-occlusive crisis to decrease blood viscosity and manage severe
pain. Cold compresses cause vasoconstriction (worsens sickling), iron is
contraindicated (hemochromatosis risk), and position changes do not
address the underlying pathology.
2. A patient receiving a blood transfusion develops chills, fever, and
lower back pain 30 minutes into the infusion. What is the nurse's
priority action?
• A. Slow the infusion rate.
• B. Administer diphenhydramine (Benadryl).
• C. Stop the transfusion and infuse normal saline.
• D. Obtain a urine sample.
Answer: C. This presentation indicates an acute hemolytic transfusion
reaction. The priority is to STOP the transfusion immediately, maintain IV
access with normal saline, and notify the provider. Slowing the infusion
would continue the reaction.
,3. Which laboratory finding is most consistent with Heparin-Induced
Thrombocytopenia (HIT)?
• A. Platelet count of 150,000/µL.
• B. Platelet count drop from 220,000 to 90,000/µL.
• C. INR of 3.5.
• D. Hemoglobin of 7.5 g/dL.
Answer: B. HIT is characterized by a ≥50% drop in platelet count from
baseline, typically 5–10 days after heparin initiation. The absolute count
is often still >100,000, but the significant drop is the hallmark.
4. The nurse is caring for a patient with Immune Thrombocytopenic
Purpura (ITP). Which finding requires immediate intervention?
• A. Petechiae on the lower extremities.
• B. Platelet count of 30,000/µL.
• C. Complaint of severe headache and blurred vision.
• D. Bruising on the arms.
Answer: C. Severe headache and blurred vision are signs of intracranial
hemorrhage (the most fatal complication of ITP). This requires immediate
emergency assessment and intervention.
5. A patient with non-Hodgkin's lymphoma is receiving
chemotherapy. The nurse monitors for Tumor Lysis Syndrome (TLS).
Which laboratory values indicate this syndrome?
• A. Hypokalemia and Hyponatremia.
• B. Hyperkalemia, Hyperuricemia, and Hyperphosphatemia.
• C. Hypocalcemia and Hyperuricemia.
• D. Hypercalcemia and Hypophosphatemia.
,Answer: C. TLS is caused by rapid tumor cell breakdown, releasing
intracellular contents. Findings include hyperkalemia, hyperuricemia,
hyperphosphatemia, and hypocalcemia (secondary to calcium binding
with phosphate).
Module 2: Fluid & Electrolyte Imbalances
Topics: SIADH, Diabetes Insipidus, Hyper/Hyponatremia,
Hyper/Hypokalemia, ABG Interpretation.
6. A patient with small cell lung cancer develops Syndrome of
Inappropriate Antidiuretic Hormone (SIADH). Which assessment
finding correlates with this condition?
• A. Polyuria and polydipsia.
• B. Serum sodium of 128 mEq/L and weight gain.
• C. Serum osmolality of 310 mOsm/kg.
• D. Blood pressure of 160/90 mmHg.
Answer: B. SIADH causes water retention leading to dilutional
hyponatremia (Na <135), low serum osmolality, and weight gain (fluid
overload). Polyuria and polydipsia are seen in Diabetes Insipidus.
7. A patient is recovering from a transsphenoidal hypophysectomy.
The nurse notes a urine output of 600 mL in 1 hour with a specific
gravity of 1.001. What is the priority nursing action?
• A. Restrict oral fluids.
• B. Administer IV fluids as prescribed and notify the provider.
• C. Administer furosemide (Lasix).
• D. Document as expected finding.
, Answer: B. This is classic Diabetes Insipidus (DI) due to lack of ADH from
pituitary damage. High urine output with low specific gravity leads to
severe dehydration. The priority is fluid replacement and administering
desmopressin (DDAVP) per order. Notifying the provider is critical.
8. An ABG result shows: pH 7.31, PaCO2 50 mmHg, HCO3 24 mEq/L.
What is the correct interpretation?
• A. Metabolic Acidosis, fully compensated.
• B. Respiratory Acidosis, uncompensated.
• C. Respiratory Alkalosis, partially compensated.
• D. Metabolic Alkalosis, uncompensated.
Answer: B. pH is low (acidosis). PaCO2 is high (respiratory cause). HCO3
is normal (no renal compensation yet). Therefore: Respiratory Acidosis,
Uncompensated.
9. A patient with severe vomiting is at risk for which acid-base
imbalance?
• A. Respiratory Acidosis.
• B. Metabolic Acidosis.
• C. Respiratory Alkalosis.
• D. Metabolic Alkalosis.
Answer: D. Vomiting leads to loss of gastric acid (Hydrochloric acid).
Loss of acid causes the blood to become more alkaline -> Metabolic
Alkalosis.
10. A patient's serum potassium is 6.8 mEq/L. Which EKG change is
most concerning?
2026: THE COMPREHENSIVE 400-
Questions REVIEW WITH ACCURATE
ANSWERS & CLINICAL RATIONALES
[Most Recent] /Graded A+
1. A patient with sickle cell anemia is admitted with a vaso-occlusive
crisis. Which intervention should the nurse prioritize?
• A. Administer oral iron supplements.
• B. Apply cold compresses to painful joints.
• C. Infuse IV fluids and administer analgesics.
• D. Place the patient in high-Fowler's position.
Answer: C. Hydration (IV fluids) and pain management are the priority
for vaso-occlusive crisis to decrease blood viscosity and manage severe
pain. Cold compresses cause vasoconstriction (worsens sickling), iron is
contraindicated (hemochromatosis risk), and position changes do not
address the underlying pathology.
2. A patient receiving a blood transfusion develops chills, fever, and
lower back pain 30 minutes into the infusion. What is the nurse's
priority action?
• A. Slow the infusion rate.
• B. Administer diphenhydramine (Benadryl).
• C. Stop the transfusion and infuse normal saline.
• D. Obtain a urine sample.
Answer: C. This presentation indicates an acute hemolytic transfusion
reaction. The priority is to STOP the transfusion immediately, maintain IV
access with normal saline, and notify the provider. Slowing the infusion
would continue the reaction.
,3. Which laboratory finding is most consistent with Heparin-Induced
Thrombocytopenia (HIT)?
• A. Platelet count of 150,000/µL.
• B. Platelet count drop from 220,000 to 90,000/µL.
• C. INR of 3.5.
• D. Hemoglobin of 7.5 g/dL.
Answer: B. HIT is characterized by a ≥50% drop in platelet count from
baseline, typically 5–10 days after heparin initiation. The absolute count
is often still >100,000, but the significant drop is the hallmark.
4. The nurse is caring for a patient with Immune Thrombocytopenic
Purpura (ITP). Which finding requires immediate intervention?
• A. Petechiae on the lower extremities.
• B. Platelet count of 30,000/µL.
• C. Complaint of severe headache and blurred vision.
• D. Bruising on the arms.
Answer: C. Severe headache and blurred vision are signs of intracranial
hemorrhage (the most fatal complication of ITP). This requires immediate
emergency assessment and intervention.
5. A patient with non-Hodgkin's lymphoma is receiving
chemotherapy. The nurse monitors for Tumor Lysis Syndrome (TLS).
Which laboratory values indicate this syndrome?
• A. Hypokalemia and Hyponatremia.
• B. Hyperkalemia, Hyperuricemia, and Hyperphosphatemia.
• C. Hypocalcemia and Hyperuricemia.
• D. Hypercalcemia and Hypophosphatemia.
,Answer: C. TLS is caused by rapid tumor cell breakdown, releasing
intracellular contents. Findings include hyperkalemia, hyperuricemia,
hyperphosphatemia, and hypocalcemia (secondary to calcium binding
with phosphate).
Module 2: Fluid & Electrolyte Imbalances
Topics: SIADH, Diabetes Insipidus, Hyper/Hyponatremia,
Hyper/Hypokalemia, ABG Interpretation.
6. A patient with small cell lung cancer develops Syndrome of
Inappropriate Antidiuretic Hormone (SIADH). Which assessment
finding correlates with this condition?
• A. Polyuria and polydipsia.
• B. Serum sodium of 128 mEq/L and weight gain.
• C. Serum osmolality of 310 mOsm/kg.
• D. Blood pressure of 160/90 mmHg.
Answer: B. SIADH causes water retention leading to dilutional
hyponatremia (Na <135), low serum osmolality, and weight gain (fluid
overload). Polyuria and polydipsia are seen in Diabetes Insipidus.
7. A patient is recovering from a transsphenoidal hypophysectomy.
The nurse notes a urine output of 600 mL in 1 hour with a specific
gravity of 1.001. What is the priority nursing action?
• A. Restrict oral fluids.
• B. Administer IV fluids as prescribed and notify the provider.
• C. Administer furosemide (Lasix).
• D. Document as expected finding.
, Answer: B. This is classic Diabetes Insipidus (DI) due to lack of ADH from
pituitary damage. High urine output with low specific gravity leads to
severe dehydration. The priority is fluid replacement and administering
desmopressin (DDAVP) per order. Notifying the provider is critical.
8. An ABG result shows: pH 7.31, PaCO2 50 mmHg, HCO3 24 mEq/L.
What is the correct interpretation?
• A. Metabolic Acidosis, fully compensated.
• B. Respiratory Acidosis, uncompensated.
• C. Respiratory Alkalosis, partially compensated.
• D. Metabolic Alkalosis, uncompensated.
Answer: B. pH is low (acidosis). PaCO2 is high (respiratory cause). HCO3
is normal (no renal compensation yet). Therefore: Respiratory Acidosis,
Uncompensated.
9. A patient with severe vomiting is at risk for which acid-base
imbalance?
• A. Respiratory Acidosis.
• B. Metabolic Acidosis.
• C. Respiratory Alkalosis.
• D. Metabolic Alkalosis.
Answer: D. Vomiting leads to loss of gastric acid (Hydrochloric acid).
Loss of acid causes the blood to become more alkaline -> Metabolic
Alkalosis.
10. A patient's serum potassium is 6.8 mEq/L. Which EKG change is
most concerning?
