Exam 1 - NUR 2392 / NUR 2392 (Latest 2026/2027)
Multidimensional Care II / MDC 2 - Rasmussen University
75 Questions | Comprehensive Nursing Examination
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (Q1-Q15)
Q1. A 68-year-old patient is admitted with severe vomiting and diarrhea for the past 3 days. The nurse assesses the
patient and notes dry mucous membranes, decreased skin turgor, heart rate of 110 bpm, blood pressure of 90/60
mmHg, and diminished urine output. Which intravenous fluid should the nurse expect to be prescribed as the initial
replacement for this patient?
A. 0.45% sodium chloride (hypotonic solution)
B. Lactated Ringer's (isotonic solution) [CORRECT]
C. 5% dextrose in water (D5W)
D. 3% sodium chloride (hypertonic solution)
Correct Answer: B
Rationale: The patient presents with classic signs of hypovolemia (dehydration) secondary to fluid loss from vomiting and diarrhea.
Isotonic solutions such as Lactated Ringer's or 0.9% normal saline are the initial fluids of choice for hypovolemia because they expand
the intravascular volume without causing significant fluid shifts between compartments. Lactated Ringer's is preferred over 0.9% NS for
large-volume resuscitation because it contains electrolytes more closely resembling plasma and helps prevent hyperchloremic metabolic
acidosis. Hypotonic solutions (0.45% NS) are used for hypernatremia, not acute volume replacement. D5W is a hypotonic solution once
dextrose is metabolized and is not used for volume expansion. Hypertonic saline (3% NaCl) is reserved for severe symptomatic
hyponatremia.
Q2. The nurse is caring for a patient with heart failure who has gained 4 pounds in 2 days, presents with bilateral
pitting edema of the lower extremities, jugular vein distension (JVD), crackles on lung auscultation, and shortness of
breath. Which nursing intervention is the priority for this patient?
A. Encourage the patient to drink at least 3 liters of fluid daily to promote renal function
B. Administer prescribed furosemide (Lasix) and implement fluid and sodium restriction [CORRECT]
C. Place the patient in Trendelenburg position to improve venous return
D. Apply warm compresses to the lower extremities to reduce edema
Correct Answer: B
Rationale: This patient demonstrates signs of hypervolemia (fluid volume excess), which is a common complication of heart failure due
to the kidneys retaining sodium and water. The priority intervention is to administer prescribed diuretics such as furosemide (Lasix) to
promote diuresis and reduce fluid overload, while simultaneously implementing fluid and sodium restriction. Daily weights, intake and
output monitoring, and assessment of edema and lung sounds are essential ongoing assessments. Trendelenburg position would worsen
the condition by increasing venous return and cardiac workload. Warm compresses do not address the underlying fluid overload.
Encouraging large fluid intake is contraindicated in hypervolemia.
Q3. A patient's serum sodium level is 122 mEq/L. The nurse observes the patient becoming increasingly confused,
experiencing a headache, and having one episode of a seizure. Which condition does the nurse correctly suspect, and
what is the most likely underlying pathophysiology?
A. Hypernatremia caused by excessive sodium intake leading to cellular dehydration
B. Hyponatremia caused by water intoxication leading to cerebral edema [CORRECT]
C. Hypernatremia caused by inadequate ADH secretion leading to fluid loss
D. Hyponatremia caused by excessive aldosterone secretion leading to sodium retention
Page 1
, NUR 2392 / MDC 2 - Exam 1 | Rasmussen University | 2026-2027
Correct Answer: B
Rationale: A serum sodium level of 122 mEq/L is significantly below the normal range of 135-145 mEq/L, indicating hyponatremia. The
patient's neurologic symptoms (confusion, headache, seizure) are the result of water intoxication causing cerebral edema. When serum
sodium drops, water moves into the cells by osmosis, causing cellular swelling. This is particularly dangerous in the brain because the
skull limits expansion, leading to increased intracranial pressure and neurologic manifestations including confusion, seizures, and
potentially coma or death.
Q4. The nurse is reviewing the serum potassium level of a patient and notes a value of 2.8 mEq/L. Which ECG
changes should the nurse anticipate for this patient?
A. Peaked T waves and widened QRS complexes
B. Flattened T waves and presence of U waves [CORRECT]
C. Prolonged PR interval and narrowed QRS complexes
D. Elevated ST segments and absent P waves
Correct Answer: B
Rationale: A serum potassium level of 2.8 mEq/L is critically low (normal is 3.5-5.0 mEq/L), indicating hypokalemia. On ECG,
hypokalemia characteristically produces flattened or inverted T waves, the appearance of U waves (extra deflection after the T wave),
ST depression, and a prolonged QT interval. These changes reflect the altered repolarization of cardiac cells due to insufficient
potassium. In contrast, hyperkalemia (K greater than 5.0) causes peaked T waves, widened QRS complexes, and eventually a sine wave
pattern leading to cardiac arrest.
Q5. A patient with a serum potassium level of 6.5 mEq/L is experiencing muscle weakness and cardiac arrhythmias.
Which medication should the nurse prepare to administer FIRST to protect the cardiac muscle?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin with dextrose (D50)
C. Calcium gluconate [CORRECT]
D. Furosemide (Lasix) IV push
Correct Answer: C
Rationale: With a serum potassium of 6.5 mEq/L, this patient has life-threatening hyperkalemia requiring immediate intervention.
Calcium gluconate is the FIRST medication to administer because it stabilizes the cardiac cell membrane and raises the threshold for
excitation, protecting the heart from arrhythmias caused by elevated potassium. It does NOT lower the potassium level but provides a
critical cardiac protective effect while other treatments take effect. Insulin with dextrose drives potassium intracellularly, Kayexalate
binds potassium in the GI tract for excretion, and furosemide promotes renal potassium excretion.
Q6. The nurse is assessing a patient with a serum calcium level of 7.2 mg/dL. Which clinical manifestations should
the nurse expect to find during the assessment?
A. Constipation, renal calculi, and shortened QT interval
B. Tetany, positive Chvostek and Trousseau signs, and prolonged QT interval [CORRECT]
C. Muscle weakness, hypotension, and respiratory depression
D. Confusion, polyuria, and bone pain
Correct Answer: B
Rationale: A serum calcium level of 7.2 mg/dL is significantly below the normal range of 8.5-10.5 mg/dL, indicating hypocalcemia. The
classic clinical manifestations include tetany (muscle spasms), positive Chvostek sign (facial muscle twitch when the facial nerve is
tapped), positive Trousseau sign (carpal spasm when blood pressure cuff is inflated), and a prolonged QT interval on ECG due to
delayed repolarization. Constipation, renal calculi, and shortened QT are associated with hypercalcemia. Muscle weakness and
respiratory depression are associated with hypermagnesemia.
Q7. A patient's arterial blood gas (ABG) results are: pH 7.32, PaCO2 48 mmHg, HCO3 24 mEq/L. Using the ROME
method of ABG interpretation, how should the nurse correctly analyze these results?
A. Respiratory acidosis, partially compensated
B. Respiratory alkalosis, uncompensated
Page 2
, NUR 2392 / MDC 2 - Exam 1 | Rasmussen University | 2026-2027
C. Metabolic acidosis, partially compensated
D. Respiratory acidosis, uncompensated [CORRECT]
Correct Answer: D
Rationale: Using the ROME method (Respiratory Opposite, Metabolic Equal), the nurse first assesses the pH. A pH of 7.32 is below the
normal range of 7.35-7.45, indicating acidosis. Next, the PaCO2 (48 mmHg) is above the normal range of 35-45 mmHg, which is
elevated. Applying the ROME principle: the respiratory component (PaCO2) is opposite to the pH (both acidotic), confirming
respiratory acidosis. The HCO3 (24 mEq/L) is within the normal range of 22-26 mEq/L, meaning the kidneys have not yet compensated,
making this uncompensated respiratory acidosis.
Q8. The nurse receives ABG results for a patient with diabetic ketoacidosis (DKA): pH 7.25, PaCO2 30 mmHg,
HCO3 16 mEq/L. Which acid-base imbalance do these results indicate?
A. Respiratory acidosis, partially compensated
B. Metabolic acidosis, partially compensated [CORRECT]
C. Metabolic alkalosis, uncompensated
D. Respiratory alkalosis, partially compensated
Correct Answer: B
Rationale: Using the ROME method, the pH of 7.25 is below 7.35, indicating acidosis. The HCO3 of 16 mEq/L is below the normal
range of 22-26 mEq/L, which is in the same acid direction as the pH (Metabolic Equal). This indicates metabolic acidosis. The PaCO2
of 30 mmHg is below normal range (35-45 mmHg), showing that the patient is hyperventilating (Kussmaul respirations) to compensate
by blowing off CO2. Because the pH is still outside the normal range despite compensation, this is partially compensated metabolic
acidosis.
Q9. A patient with a serum magnesium level of 1.0 mEq/L is experiencing muscle tremors, confusion, and cardiac
arrhythmias. Which intervention should the nurse anticipate implementing?
A. Administer magnesium sulfate IV as prescribed [CORRECT]
B. Administer calcium gluconate IV to counteract the arrhythmias
C. Initiate seizure precautions and administer an anticonvulsant
D. Prepare the patient for emergent hemodialysis
Correct Answer: A
Rationale: A serum magnesium level of 1.0 mEq/L is below the normal range of 1.3-2.1 mEq/L, indicating hypomagnesemia. The
patient's symptoms of tremors, confusion, and cardiac arrhythmias are classic manifestations of low magnesium. Magnesium is critical
for normal neuromuscular and cardiac function. The primary intervention is to administer magnesium sulfate IV as prescribed to
restore magnesium levels. It is important to monitor the patient closely during IV magnesium administration because rapid infusion can
cause hypotension, respiratory depression, and cardiac arrest.
Q10. A patient with chronic hypernatremia (serum sodium 152 mEq/L) complains of extreme thirst, and the nurse
notes the patient is confused and has dry mucous membranes. Which nursing intervention is most appropriate for this
patient?
A. Administer hypotonic IV fluids rapidly to correct the sodium level
B. Encourage oral fluid intake and monitor for signs of fluid imbalance [CORRECT]
C. Administer 3% hypertonic saline to further increase serum sodium
D. Restrict all fluid intake to prevent further sodium dilution
Correct Answer: B
Rationale: Hypernatremia (sodium greater than 145 mEq/L) causes cellular dehydration because excess sodium in the extracellular
fluid draws water out of cells. The most appropriate intervention is to encourage oral fluid intake (water or hypotonic fluids) and
monitor for signs of fluid imbalance. For chronic hypernatremia, correction must be done slowly over 48-72 hours to prevent cerebral
edema from rapid fluid shifts. Rapid administration of hypotonic IV fluids can cause dangerous swelling of brain cells. Administering
hypertonic saline would worsen the hypernatremia.
Page 3
Multidimensional Care II / MDC 2 - Rasmussen University
75 Questions | Comprehensive Nursing Examination
Section 1: Fluid, Electrolyte, and Acid-Base Imbalances (Q1-Q15)
Q1. A 68-year-old patient is admitted with severe vomiting and diarrhea for the past 3 days. The nurse assesses the
patient and notes dry mucous membranes, decreased skin turgor, heart rate of 110 bpm, blood pressure of 90/60
mmHg, and diminished urine output. Which intravenous fluid should the nurse expect to be prescribed as the initial
replacement for this patient?
A. 0.45% sodium chloride (hypotonic solution)
B. Lactated Ringer's (isotonic solution) [CORRECT]
C. 5% dextrose in water (D5W)
D. 3% sodium chloride (hypertonic solution)
Correct Answer: B
Rationale: The patient presents with classic signs of hypovolemia (dehydration) secondary to fluid loss from vomiting and diarrhea.
Isotonic solutions such as Lactated Ringer's or 0.9% normal saline are the initial fluids of choice for hypovolemia because they expand
the intravascular volume without causing significant fluid shifts between compartments. Lactated Ringer's is preferred over 0.9% NS for
large-volume resuscitation because it contains electrolytes more closely resembling plasma and helps prevent hyperchloremic metabolic
acidosis. Hypotonic solutions (0.45% NS) are used for hypernatremia, not acute volume replacement. D5W is a hypotonic solution once
dextrose is metabolized and is not used for volume expansion. Hypertonic saline (3% NaCl) is reserved for severe symptomatic
hyponatremia.
Q2. The nurse is caring for a patient with heart failure who has gained 4 pounds in 2 days, presents with bilateral
pitting edema of the lower extremities, jugular vein distension (JVD), crackles on lung auscultation, and shortness of
breath. Which nursing intervention is the priority for this patient?
A. Encourage the patient to drink at least 3 liters of fluid daily to promote renal function
B. Administer prescribed furosemide (Lasix) and implement fluid and sodium restriction [CORRECT]
C. Place the patient in Trendelenburg position to improve venous return
D. Apply warm compresses to the lower extremities to reduce edema
Correct Answer: B
Rationale: This patient demonstrates signs of hypervolemia (fluid volume excess), which is a common complication of heart failure due
to the kidneys retaining sodium and water. The priority intervention is to administer prescribed diuretics such as furosemide (Lasix) to
promote diuresis and reduce fluid overload, while simultaneously implementing fluid and sodium restriction. Daily weights, intake and
output monitoring, and assessment of edema and lung sounds are essential ongoing assessments. Trendelenburg position would worsen
the condition by increasing venous return and cardiac workload. Warm compresses do not address the underlying fluid overload.
Encouraging large fluid intake is contraindicated in hypervolemia.
Q3. A patient's serum sodium level is 122 mEq/L. The nurse observes the patient becoming increasingly confused,
experiencing a headache, and having one episode of a seizure. Which condition does the nurse correctly suspect, and
what is the most likely underlying pathophysiology?
A. Hypernatremia caused by excessive sodium intake leading to cellular dehydration
B. Hyponatremia caused by water intoxication leading to cerebral edema [CORRECT]
C. Hypernatremia caused by inadequate ADH secretion leading to fluid loss
D. Hyponatremia caused by excessive aldosterone secretion leading to sodium retention
Page 1
, NUR 2392 / MDC 2 - Exam 1 | Rasmussen University | 2026-2027
Correct Answer: B
Rationale: A serum sodium level of 122 mEq/L is significantly below the normal range of 135-145 mEq/L, indicating hyponatremia. The
patient's neurologic symptoms (confusion, headache, seizure) are the result of water intoxication causing cerebral edema. When serum
sodium drops, water moves into the cells by osmosis, causing cellular swelling. This is particularly dangerous in the brain because the
skull limits expansion, leading to increased intracranial pressure and neurologic manifestations including confusion, seizures, and
potentially coma or death.
Q4. The nurse is reviewing the serum potassium level of a patient and notes a value of 2.8 mEq/L. Which ECG
changes should the nurse anticipate for this patient?
A. Peaked T waves and widened QRS complexes
B. Flattened T waves and presence of U waves [CORRECT]
C. Prolonged PR interval and narrowed QRS complexes
D. Elevated ST segments and absent P waves
Correct Answer: B
Rationale: A serum potassium level of 2.8 mEq/L is critically low (normal is 3.5-5.0 mEq/L), indicating hypokalemia. On ECG,
hypokalemia characteristically produces flattened or inverted T waves, the appearance of U waves (extra deflection after the T wave),
ST depression, and a prolonged QT interval. These changes reflect the altered repolarization of cardiac cells due to insufficient
potassium. In contrast, hyperkalemia (K greater than 5.0) causes peaked T waves, widened QRS complexes, and eventually a sine wave
pattern leading to cardiac arrest.
Q5. A patient with a serum potassium level of 6.5 mEq/L is experiencing muscle weakness and cardiac arrhythmias.
Which medication should the nurse prepare to administer FIRST to protect the cardiac muscle?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Insulin with dextrose (D50)
C. Calcium gluconate [CORRECT]
D. Furosemide (Lasix) IV push
Correct Answer: C
Rationale: With a serum potassium of 6.5 mEq/L, this patient has life-threatening hyperkalemia requiring immediate intervention.
Calcium gluconate is the FIRST medication to administer because it stabilizes the cardiac cell membrane and raises the threshold for
excitation, protecting the heart from arrhythmias caused by elevated potassium. It does NOT lower the potassium level but provides a
critical cardiac protective effect while other treatments take effect. Insulin with dextrose drives potassium intracellularly, Kayexalate
binds potassium in the GI tract for excretion, and furosemide promotes renal potassium excretion.
Q6. The nurse is assessing a patient with a serum calcium level of 7.2 mg/dL. Which clinical manifestations should
the nurse expect to find during the assessment?
A. Constipation, renal calculi, and shortened QT interval
B. Tetany, positive Chvostek and Trousseau signs, and prolonged QT interval [CORRECT]
C. Muscle weakness, hypotension, and respiratory depression
D. Confusion, polyuria, and bone pain
Correct Answer: B
Rationale: A serum calcium level of 7.2 mg/dL is significantly below the normal range of 8.5-10.5 mg/dL, indicating hypocalcemia. The
classic clinical manifestations include tetany (muscle spasms), positive Chvostek sign (facial muscle twitch when the facial nerve is
tapped), positive Trousseau sign (carpal spasm when blood pressure cuff is inflated), and a prolonged QT interval on ECG due to
delayed repolarization. Constipation, renal calculi, and shortened QT are associated with hypercalcemia. Muscle weakness and
respiratory depression are associated with hypermagnesemia.
Q7. A patient's arterial blood gas (ABG) results are: pH 7.32, PaCO2 48 mmHg, HCO3 24 mEq/L. Using the ROME
method of ABG interpretation, how should the nurse correctly analyze these results?
A. Respiratory acidosis, partially compensated
B. Respiratory alkalosis, uncompensated
Page 2
, NUR 2392 / MDC 2 - Exam 1 | Rasmussen University | 2026-2027
C. Metabolic acidosis, partially compensated
D. Respiratory acidosis, uncompensated [CORRECT]
Correct Answer: D
Rationale: Using the ROME method (Respiratory Opposite, Metabolic Equal), the nurse first assesses the pH. A pH of 7.32 is below the
normal range of 7.35-7.45, indicating acidosis. Next, the PaCO2 (48 mmHg) is above the normal range of 35-45 mmHg, which is
elevated. Applying the ROME principle: the respiratory component (PaCO2) is opposite to the pH (both acidotic), confirming
respiratory acidosis. The HCO3 (24 mEq/L) is within the normal range of 22-26 mEq/L, meaning the kidneys have not yet compensated,
making this uncompensated respiratory acidosis.
Q8. The nurse receives ABG results for a patient with diabetic ketoacidosis (DKA): pH 7.25, PaCO2 30 mmHg,
HCO3 16 mEq/L. Which acid-base imbalance do these results indicate?
A. Respiratory acidosis, partially compensated
B. Metabolic acidosis, partially compensated [CORRECT]
C. Metabolic alkalosis, uncompensated
D. Respiratory alkalosis, partially compensated
Correct Answer: B
Rationale: Using the ROME method, the pH of 7.25 is below 7.35, indicating acidosis. The HCO3 of 16 mEq/L is below the normal
range of 22-26 mEq/L, which is in the same acid direction as the pH (Metabolic Equal). This indicates metabolic acidosis. The PaCO2
of 30 mmHg is below normal range (35-45 mmHg), showing that the patient is hyperventilating (Kussmaul respirations) to compensate
by blowing off CO2. Because the pH is still outside the normal range despite compensation, this is partially compensated metabolic
acidosis.
Q9. A patient with a serum magnesium level of 1.0 mEq/L is experiencing muscle tremors, confusion, and cardiac
arrhythmias. Which intervention should the nurse anticipate implementing?
A. Administer magnesium sulfate IV as prescribed [CORRECT]
B. Administer calcium gluconate IV to counteract the arrhythmias
C. Initiate seizure precautions and administer an anticonvulsant
D. Prepare the patient for emergent hemodialysis
Correct Answer: A
Rationale: A serum magnesium level of 1.0 mEq/L is below the normal range of 1.3-2.1 mEq/L, indicating hypomagnesemia. The
patient's symptoms of tremors, confusion, and cardiac arrhythmias are classic manifestations of low magnesium. Magnesium is critical
for normal neuromuscular and cardiac function. The primary intervention is to administer magnesium sulfate IV as prescribed to
restore magnesium levels. It is important to monitor the patient closely during IV magnesium administration because rapid infusion can
cause hypotension, respiratory depression, and cardiac arrest.
Q10. A patient with chronic hypernatremia (serum sodium 152 mEq/L) complains of extreme thirst, and the nurse
notes the patient is confused and has dry mucous membranes. Which nursing intervention is most appropriate for this
patient?
A. Administer hypotonic IV fluids rapidly to correct the sodium level
B. Encourage oral fluid intake and monitor for signs of fluid imbalance [CORRECT]
C. Administer 3% hypertonic saline to further increase serum sodium
D. Restrict all fluid intake to prevent further sodium dilution
Correct Answer: B
Rationale: Hypernatremia (sodium greater than 145 mEq/L) causes cellular dehydration because excess sodium in the extracellular
fluid draws water out of cells. The most appropriate intervention is to encourage oral fluid intake (water or hypotonic fluids) and
monitor for signs of fluid imbalance. For chronic hypernatremia, correction must be done slowly over 48-72 hours to prevent cerebral
edema from rapid fluid shifts. Rapid administration of hypotonic IV fluids can cause dangerous swelling of brain cells. Administering
hypertonic saline would worsen the hypernatremia.
Page 3
