NUR2755 / NUR 2755 Final Exam
(Latest 2026/2027)
Multidimensional Care IV / MDC 4
Rasmussen University
Total Questions 100 Format Multiple Choice
Time Limit 2 Hours Passing Score 75%
Cognitive Level Distribution: Knowledge (25%) | Application (55%) | Analysis (20%)
Question Types: Standard Multiple Choice (75%) | Select All That Apply (15%) | Ordered Response (10%)
Section 1: Neurological Disorders
Questions 1-20
1. A nurse is assessing a client with a suspected traumatic brain injury. The client's intracranial pressure (ICP)
monitor reads 22 mmHg. Which interpretation by the nurse is most appropriate?
A.) This is a normal reading requiring no intervention
B.) This is mildly elevated and should be reassessed in 4 hours
C.) This is significantly elevated and requires immediate intervention [CORRECT]
D.) This reading indicates the monitor needs recalibration
Correct Answer: C
Cognitive Level: Analysis | Question Type: Multiple Choice
Rationale: Normal ICP ranges from 5-15 mmHg. An ICP of 22 mmHg is significantly elevated and exceeds the threshold of
20 mmHg, which indicates increased intracranial pressure that requires immediate nursing and medical intervention. Sustained
ICP above 20 mmHg can lead to decreased cerebral perfusion pressure (CPP), cerebral ischemia, and potential brain
herniation. The nurse should notify the provider immediately, elevate the head of the bed to 30 degrees, and ensure the client's
neck is in a neutral position to optimize venous drainage. Options A and B are incorrect because 22 mmHg is not normal or
mildly elevated. Option D is inappropriate because the nurse should first treat the client, not assume equipment malfunction.
2. A client with increased intracranial pressure is exhibiting Cushing's triad. Which set of findings should the
nurse anticipate?
A.) Tachycardia, hypotension, and warm flushed skin
B.) Bradycardia, widening pulse pressure, and irregular respirations [CORRECT]
C.) Tachycardia, narrowed pulse pressure, and shallow respirations
D.) Bradycardia, hypotension, and Cheyne-Stokes respirations
Correct Answer: B
NUR2755 / MDC 4 Final Exam | Page 1
,Cognitive Level: Knowledge | Question Type: Multiple Choice
Rationale: Cushing's triad is a classic late sign of increased intracranial pressure and consists of three hallmark findings:
bradycardia (due to increased vagal stimulation from brainstem compression), widening pulse pressure (increased systolic with
decreased diastolic, reflecting the body's attempt to maintain cerebral perfusion against elevated ICP), and irregular
respirations such as Cheyne-Stokes or ataxic breathing patterns (reflecting brainstem herniation). This triad indicates a medical
emergency suggesting impending brain herniation. Option A describes findings consistent with distributive or neurogenic shock,
not increased ICP. Option C is incorrect because tachycardia and narrowed pulse pressure are not components of Cushing's
triad. Option D is partially correct but incorrectly includes hypotension instead of widening pulse pressure.
3. A nurse is caring for a client who is experiencing a tonic-clonic seizure. Which action should the nurse take
first?
A.) Restrain the client to prevent injury
B.) Insert a padded tongue blade between the teeth
C.) Clear the area of hazardous objects and protect the head [CORRECT]
D.) Administer oxygen via nasal cannula at 2 L/min
Correct Answer: C
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: During an active tonic-clonic seizure, the priority nursing action is to ensure client safety by clearing the area of
hazardous objects and protecting the head from injury. The nurse should never restrain the client (Option A) because this can
cause musculoskeletal injury. Inserting a tongue blade or any object into the mouth (Option B) is contraindicated because it can
cause dental trauma, airway obstruction, or lacerations; the risk of tongue biting during a seizure is minimal compared to the
risks of intervention. While oxygen administration (Option D) may be appropriate after the seizure (postictal phase), it is not
the first action during the active seizure. The ABC framework guides prioritization: airway patency is maintained by
positioning the client on the side once the clonic phase allows, not by inserting objects into the airway.
4. A client arrives to the emergency department with signs of status epilepticus. The nurse understands that
which of the following defines this condition?
A.) A single seizure lasting less than 5 minutes
B.) Two or more seizures without full recovery of consciousness between episodes [CORRECT]
C.) A seizure that occurs only during sleep
D.) Absence seizures occurring more than 10 times per day
Correct Answer: B
Cognitive Level: Knowledge | Question Type: Multiple Choice
Rationale: Status epilepticus is defined as a seizure lasting longer than 5 minutes or two or more discrete seizures occurring
without full recovery of consciousness between episodes. This is a neurological emergency requiring immediate treatment
because prolonged seizure activity can cause neuronal damage, hypoxia, hyperthermia, and metabolic acidosis. The mortality
rate for status epilepticus can be as high as 20% if not treated promptly. Option A is incorrect because a single seizure lasting
less than 5 minutes is a routine seizure. Option C describes a benign condition. Option D describes a high frequency of a
specific seizure type but does not meet the clinical definition of status epilepticus. Treatment typically involves IV
benzodiazepines (lorazepam or diazepam) as first-line therapy, followed by IV fosphenytoin or valproate if seizures persist.
5. A nurse is assessing a client who had an ischemic stroke. The client's Glasgow Coma Scale (GCS) score is
calculated as follows: Eye opening = 2 (to pain), Verbal response = 3 (inappropriate words), Motor response
= 4 (withdraws from pain). What is the total GCS score?
NUR2755 / MDC 4 Final Exam | Page 2
, A.) 7
B.) 9 [CORRECT]
C.) 10
D.) 12
Correct Answer: B
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: The Glasgow Coma Scale (GCS) ranges from 3 to 15 and assesses three domains: eye opening (1-4), verbal
response (1-5), and motor response (1-6). For this client, Eye opening = 2 (opens eyes to pain), Verbal response = 3 (utters
inappropriate words), Motor response = 4 (withdraws from painful stimuli). The total GCS score is 2 + 3 + 4 = 9. A GCS of 9
indicates moderate brain injury (severe is 3-8, moderate is 9-12, mild is 13-15). This score suggests the client requires close
neurological monitoring and potentially airway protection, as scores below 8 often necessitate intubation. Option A (7) would
indicate severe injury. Options C and D (10 and 12) would indicate moderate injury but do not match the calculated sum.
6. A nurse observes a client with a severe brain injury exhibiting decerebrate posturing. Which description
best characterizes this finding?
A.) Flexion of the arms with extension of the legs
B.) Extension and rigidity of all four extremities [CORRECT]
C.) Flaccid paralysis of all extremities
D.) Spontaneous random movements of all extremities
Correct Answer: B
Cognitive Level: Analysis | Question Type: Multiple Choice
Rationale: Decerebrate posturing is characterized by abnormal extension and rigid pronation of all four extremities (arms and
legs extended, toes pointed, head arched back). This indicates severe damage to the brainstem, specifically at the level of the
midbrain or pons, and carries a significantly worse prognosis than decorticate posturing. In contrast, decorticate posturing
(Option A) involves flexion of the arms, wrists, and fingers with extension of the legs, indicating damage above the brainstem
at the thalamus or cerebral hemispheres. Option C describes flaccid paralysis, which is not a posturing pattern. Option D is
incorrect because decerebrate posturing is a stereotypical, purposeless response, not random spontaneous movement.
Decerebrate posturing is an ominous neurological sign that warrants immediate intervention and notification of the healthcare
provider.
7. A nurse is providing discharge teaching to a client newly diagnosed with Parkinson's disease who is
prescribed selegiline, an MAO-B inhibitor. Which dietary instruction is most critical for the nurse to include?
A.) Increase intake of vitamin K-rich foods such as spinach and kale
B.) Avoid tyramine-rich foods such as aged cheese, cured meats, and fermented products
[CORRECT]
C.) Limit fluid intake to 1,000 mL per day to prevent edema
D.) Consume a high-protein diet with at least 1.5 g/kg of protein daily
Correct Answer: B
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: Selegiline is a selective monoamine oxidase-B (MAO-B) inhibitor used in Parkinson's disease. At higher doses,
selectivity for MAO-B is lost, and MAO-A inhibition can occur, which may precipitate a hypertensive crisis if the client
consumes tyramine-rich foods. The nurse should instruct the client to avoid aged cheeses, cured meats, fermented products (soy
sauce, sauerkraut), tap beer, and red wine. Although low-dose selegiline (5-10 mg/day) has a lower risk of tyramine
interaction than nonselective MAO inhibitors, the dietary instruction remains a safety priority. Option A is relevant for clients
NUR2755 / MDC 4 Final Exam | Page 3
, on warfarin, not selegiline. Option C is incorrect and potentially harmful, as dehydration can worsen Parkinson symptoms.
Option D is not specifically related to selegiline; in fact, high-protein diets can interfere with levodopa absorption, though this
is not the primary concern for selegiline.
8. A client with multiple sclerosis (MS) reports severe muscle spasticity that interferes with activities of daily
living. The nurse anticipates which medication will be prescribed?
A.) Dantrolene (Dantrium)
B.) Baclofen (Lioresal) [CORRECT]
C.) Cyclobenzaprine (Flexeril)
D.) Methocarbamol (Robaxin)
Correct Answer: B
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: Baclofen (Lioresal) is the first-line oral medication for treating spasticity in multiple sclerosis. It works as a
GABA-B receptor agonist in the spinal cord, reducing hyperreflexia and muscle spasms. Baclofen is particularly effective for
the type of spasticity seen in MS because it acts at the spinal level to inhibit reflex arcs responsible for excessive muscle tone.
Dantrolene (Option A) acts directly on skeletal muscle and is typically reserved for spasticity from conditions like cerebral
palsy, spinal cord injury, or stroke, and it carries a risk of hepatotoxicity. Cyclobenzaprine (Option C) is a skeletal muscle
relaxant used primarily for acute musculoskeletal conditions and has significant anticholinergic side effects. Methocarbamol
(Option D) is also used for acute musculoskeletal pain, not chronic spasticity from MS. For severe cases, intrathecal baclofen
via a surgically implanted pump may be considered.
9. A client with Guillain-Barre syndrome (GBS) is admitted to the intensive care unit. The nurse understands
that which characteristic is most consistent with this condition?
A.) Descending paralysis beginning in the face and moving downward
B.) Ascending paralysis beginning in the lower extremities and progressing upward [CORRECT]
C.) Unilateral weakness affecting only the left side of the body
D.) Intermittent paralysis that worsens during periods of stress
Correct Answer: B
Cognitive Level: Knowledge | Question Type: Multiple Choice
Rationale: Guillain-Barre syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, classically
presenting with ascending, symmetric, areflexic paralysis that begins in the distal lower extremities and progresses upward.
This hallmark pattern distinguishes GBS from other neurological conditions. The paralysis typically reaches its peak within 2-4
weeks. Option A describes the reverse pattern and is incorrect; descending paralysis is associated with conditions like botulism.
Option C describes a stroke presentation, not GBS. Option D is incorrect because GBS progresses steadily rather than
intermittently. The most critical nursing concern with GBS is respiratory monitoring, as the ascending paralysis can affect the
diaphragm and intercostal muscles, potentially leading to respiratory failure. The nurse should monitor vital capacity and
prepare for possible mechanical ventilation.
10. A nurse is caring for a client with a spinal cord injury at T6. The client suddenly complains of a severe
headache and the nurse notes flushing above the level of injury, diaphoresis, and a blood pressure of 190/105
mmHg. What is the nurse's priority action?
A.) Administer prescribed antihypertensive medication
B.) Assess for and remove any potential noxious stimuli below the level of injury [CORRECT]
C.) Place the client in a supine position with legs elevated
NUR2755 / MDC 4 Final Exam | Page 4
(Latest 2026/2027)
Multidimensional Care IV / MDC 4
Rasmussen University
Total Questions 100 Format Multiple Choice
Time Limit 2 Hours Passing Score 75%
Cognitive Level Distribution: Knowledge (25%) | Application (55%) | Analysis (20%)
Question Types: Standard Multiple Choice (75%) | Select All That Apply (15%) | Ordered Response (10%)
Section 1: Neurological Disorders
Questions 1-20
1. A nurse is assessing a client with a suspected traumatic brain injury. The client's intracranial pressure (ICP)
monitor reads 22 mmHg. Which interpretation by the nurse is most appropriate?
A.) This is a normal reading requiring no intervention
B.) This is mildly elevated and should be reassessed in 4 hours
C.) This is significantly elevated and requires immediate intervention [CORRECT]
D.) This reading indicates the monitor needs recalibration
Correct Answer: C
Cognitive Level: Analysis | Question Type: Multiple Choice
Rationale: Normal ICP ranges from 5-15 mmHg. An ICP of 22 mmHg is significantly elevated and exceeds the threshold of
20 mmHg, which indicates increased intracranial pressure that requires immediate nursing and medical intervention. Sustained
ICP above 20 mmHg can lead to decreased cerebral perfusion pressure (CPP), cerebral ischemia, and potential brain
herniation. The nurse should notify the provider immediately, elevate the head of the bed to 30 degrees, and ensure the client's
neck is in a neutral position to optimize venous drainage. Options A and B are incorrect because 22 mmHg is not normal or
mildly elevated. Option D is inappropriate because the nurse should first treat the client, not assume equipment malfunction.
2. A client with increased intracranial pressure is exhibiting Cushing's triad. Which set of findings should the
nurse anticipate?
A.) Tachycardia, hypotension, and warm flushed skin
B.) Bradycardia, widening pulse pressure, and irregular respirations [CORRECT]
C.) Tachycardia, narrowed pulse pressure, and shallow respirations
D.) Bradycardia, hypotension, and Cheyne-Stokes respirations
Correct Answer: B
NUR2755 / MDC 4 Final Exam | Page 1
,Cognitive Level: Knowledge | Question Type: Multiple Choice
Rationale: Cushing's triad is a classic late sign of increased intracranial pressure and consists of three hallmark findings:
bradycardia (due to increased vagal stimulation from brainstem compression), widening pulse pressure (increased systolic with
decreased diastolic, reflecting the body's attempt to maintain cerebral perfusion against elevated ICP), and irregular
respirations such as Cheyne-Stokes or ataxic breathing patterns (reflecting brainstem herniation). This triad indicates a medical
emergency suggesting impending brain herniation. Option A describes findings consistent with distributive or neurogenic shock,
not increased ICP. Option C is incorrect because tachycardia and narrowed pulse pressure are not components of Cushing's
triad. Option D is partially correct but incorrectly includes hypotension instead of widening pulse pressure.
3. A nurse is caring for a client who is experiencing a tonic-clonic seizure. Which action should the nurse take
first?
A.) Restrain the client to prevent injury
B.) Insert a padded tongue blade between the teeth
C.) Clear the area of hazardous objects and protect the head [CORRECT]
D.) Administer oxygen via nasal cannula at 2 L/min
Correct Answer: C
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: During an active tonic-clonic seizure, the priority nursing action is to ensure client safety by clearing the area of
hazardous objects and protecting the head from injury. The nurse should never restrain the client (Option A) because this can
cause musculoskeletal injury. Inserting a tongue blade or any object into the mouth (Option B) is contraindicated because it can
cause dental trauma, airway obstruction, or lacerations; the risk of tongue biting during a seizure is minimal compared to the
risks of intervention. While oxygen administration (Option D) may be appropriate after the seizure (postictal phase), it is not
the first action during the active seizure. The ABC framework guides prioritization: airway patency is maintained by
positioning the client on the side once the clonic phase allows, not by inserting objects into the airway.
4. A client arrives to the emergency department with signs of status epilepticus. The nurse understands that
which of the following defines this condition?
A.) A single seizure lasting less than 5 minutes
B.) Two or more seizures without full recovery of consciousness between episodes [CORRECT]
C.) A seizure that occurs only during sleep
D.) Absence seizures occurring more than 10 times per day
Correct Answer: B
Cognitive Level: Knowledge | Question Type: Multiple Choice
Rationale: Status epilepticus is defined as a seizure lasting longer than 5 minutes or two or more discrete seizures occurring
without full recovery of consciousness between episodes. This is a neurological emergency requiring immediate treatment
because prolonged seizure activity can cause neuronal damage, hypoxia, hyperthermia, and metabolic acidosis. The mortality
rate for status epilepticus can be as high as 20% if not treated promptly. Option A is incorrect because a single seizure lasting
less than 5 minutes is a routine seizure. Option C describes a benign condition. Option D describes a high frequency of a
specific seizure type but does not meet the clinical definition of status epilepticus. Treatment typically involves IV
benzodiazepines (lorazepam or diazepam) as first-line therapy, followed by IV fosphenytoin or valproate if seizures persist.
5. A nurse is assessing a client who had an ischemic stroke. The client's Glasgow Coma Scale (GCS) score is
calculated as follows: Eye opening = 2 (to pain), Verbal response = 3 (inappropriate words), Motor response
= 4 (withdraws from pain). What is the total GCS score?
NUR2755 / MDC 4 Final Exam | Page 2
, A.) 7
B.) 9 [CORRECT]
C.) 10
D.) 12
Correct Answer: B
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: The Glasgow Coma Scale (GCS) ranges from 3 to 15 and assesses three domains: eye opening (1-4), verbal
response (1-5), and motor response (1-6). For this client, Eye opening = 2 (opens eyes to pain), Verbal response = 3 (utters
inappropriate words), Motor response = 4 (withdraws from painful stimuli). The total GCS score is 2 + 3 + 4 = 9. A GCS of 9
indicates moderate brain injury (severe is 3-8, moderate is 9-12, mild is 13-15). This score suggests the client requires close
neurological monitoring and potentially airway protection, as scores below 8 often necessitate intubation. Option A (7) would
indicate severe injury. Options C and D (10 and 12) would indicate moderate injury but do not match the calculated sum.
6. A nurse observes a client with a severe brain injury exhibiting decerebrate posturing. Which description
best characterizes this finding?
A.) Flexion of the arms with extension of the legs
B.) Extension and rigidity of all four extremities [CORRECT]
C.) Flaccid paralysis of all extremities
D.) Spontaneous random movements of all extremities
Correct Answer: B
Cognitive Level: Analysis | Question Type: Multiple Choice
Rationale: Decerebrate posturing is characterized by abnormal extension and rigid pronation of all four extremities (arms and
legs extended, toes pointed, head arched back). This indicates severe damage to the brainstem, specifically at the level of the
midbrain or pons, and carries a significantly worse prognosis than decorticate posturing. In contrast, decorticate posturing
(Option A) involves flexion of the arms, wrists, and fingers with extension of the legs, indicating damage above the brainstem
at the thalamus or cerebral hemispheres. Option C describes flaccid paralysis, which is not a posturing pattern. Option D is
incorrect because decerebrate posturing is a stereotypical, purposeless response, not random spontaneous movement.
Decerebrate posturing is an ominous neurological sign that warrants immediate intervention and notification of the healthcare
provider.
7. A nurse is providing discharge teaching to a client newly diagnosed with Parkinson's disease who is
prescribed selegiline, an MAO-B inhibitor. Which dietary instruction is most critical for the nurse to include?
A.) Increase intake of vitamin K-rich foods such as spinach and kale
B.) Avoid tyramine-rich foods such as aged cheese, cured meats, and fermented products
[CORRECT]
C.) Limit fluid intake to 1,000 mL per day to prevent edema
D.) Consume a high-protein diet with at least 1.5 g/kg of protein daily
Correct Answer: B
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: Selegiline is a selective monoamine oxidase-B (MAO-B) inhibitor used in Parkinson's disease. At higher doses,
selectivity for MAO-B is lost, and MAO-A inhibition can occur, which may precipitate a hypertensive crisis if the client
consumes tyramine-rich foods. The nurse should instruct the client to avoid aged cheeses, cured meats, fermented products (soy
sauce, sauerkraut), tap beer, and red wine. Although low-dose selegiline (5-10 mg/day) has a lower risk of tyramine
interaction than nonselective MAO inhibitors, the dietary instruction remains a safety priority. Option A is relevant for clients
NUR2755 / MDC 4 Final Exam | Page 3
, on warfarin, not selegiline. Option C is incorrect and potentially harmful, as dehydration can worsen Parkinson symptoms.
Option D is not specifically related to selegiline; in fact, high-protein diets can interfere with levodopa absorption, though this
is not the primary concern for selegiline.
8. A client with multiple sclerosis (MS) reports severe muscle spasticity that interferes with activities of daily
living. The nurse anticipates which medication will be prescribed?
A.) Dantrolene (Dantrium)
B.) Baclofen (Lioresal) [CORRECT]
C.) Cyclobenzaprine (Flexeril)
D.) Methocarbamol (Robaxin)
Correct Answer: B
Cognitive Level: Application | Question Type: Multiple Choice
Rationale: Baclofen (Lioresal) is the first-line oral medication for treating spasticity in multiple sclerosis. It works as a
GABA-B receptor agonist in the spinal cord, reducing hyperreflexia and muscle spasms. Baclofen is particularly effective for
the type of spasticity seen in MS because it acts at the spinal level to inhibit reflex arcs responsible for excessive muscle tone.
Dantrolene (Option A) acts directly on skeletal muscle and is typically reserved for spasticity from conditions like cerebral
palsy, spinal cord injury, or stroke, and it carries a risk of hepatotoxicity. Cyclobenzaprine (Option C) is a skeletal muscle
relaxant used primarily for acute musculoskeletal conditions and has significant anticholinergic side effects. Methocarbamol
(Option D) is also used for acute musculoskeletal pain, not chronic spasticity from MS. For severe cases, intrathecal baclofen
via a surgically implanted pump may be considered.
9. A client with Guillain-Barre syndrome (GBS) is admitted to the intensive care unit. The nurse understands
that which characteristic is most consistent with this condition?
A.) Descending paralysis beginning in the face and moving downward
B.) Ascending paralysis beginning in the lower extremities and progressing upward [CORRECT]
C.) Unilateral weakness affecting only the left side of the body
D.) Intermittent paralysis that worsens during periods of stress
Correct Answer: B
Cognitive Level: Knowledge | Question Type: Multiple Choice
Rationale: Guillain-Barre syndrome (GBS) is an autoimmune disorder affecting the peripheral nervous system, classically
presenting with ascending, symmetric, areflexic paralysis that begins in the distal lower extremities and progresses upward.
This hallmark pattern distinguishes GBS from other neurological conditions. The paralysis typically reaches its peak within 2-4
weeks. Option A describes the reverse pattern and is incorrect; descending paralysis is associated with conditions like botulism.
Option C describes a stroke presentation, not GBS. Option D is incorrect because GBS progresses steadily rather than
intermittently. The most critical nursing concern with GBS is respiratory monitoring, as the ascending paralysis can affect the
diaphragm and intercostal muscles, potentially leading to respiratory failure. The nurse should monitor vital capacity and
prepare for possible mechanical ventilation.
10. A nurse is caring for a client with a spinal cord injury at T6. The client suddenly complains of a severe
headache and the nurse notes flushing above the level of injury, diaphoresis, and a blood pressure of 190/105
mmHg. What is the nurse's priority action?
A.) Administer prescribed antihypertensive medication
B.) Assess for and remove any potential noxious stimuli below the level of injury [CORRECT]
C.) Place the client in a supine position with legs elevated
NUR2755 / MDC 4 Final Exam | Page 4
