NUR 2502 Exam 1 - Multidimensional Care III (MDC 3) Rasmussen University | 2026-2027
NUR 2502 / NUR2502 Exam 1 (Latest )
Multidimensional Care III / MDC 3
Rasmussen University | College of Nursing
75 Questions | 7 Sections | Cognitive Mix: 25% Recall / 55% Application / 20% Analysis
Instructions: Select the single best answer for each question. Scenario-based items require application of the nursing process (Assess
→ Diagnose → Plan → Implement → Evaluate) and prioritization frameworks (ABC, Maslow, acute-vs-chronic). Each item includes the
correct answer and a comprehensive rationale with MDC 3 clinical reasoning.
Section 1: Oncology Nursing – Cancer Pathophysiology, Staging, Treatment Modalities
& Nursing Care (Questions Q1–Q15)
Q1: A nurse is teaching a community health class about carcinogenesis. Which sequence correctly identifies the
three sequential phases of cancer development?
A. Initiation → Promotion → Progression [CORRECT]
B. Initiation → Progression → Promotion
C. Promotion → Initiation → Progression
D. Progression → Promotion → Initiation
Correct Answer: A
Rationale: Carcinogenesis follows a strict sequence: Initiation (a single cell undergoes irreversible genetic mutation from a
carcinogen), then Promotion (mutated cell is stimulated to divide by promoters like hormones or chronic inflammation), and finally
Progression (tumor achieves invasive and metastatic potential through additional mutations). The other sequences invert the biology;
promotion cannot precede the initial mutation, and progression is the terminal phase. This foundational concept from the MDC 3
oncology module underpins risk-reduction teaching.
Q2: Which statement by a nursing student about tumor suppressor genes indicates correct understanding?
A. Tumor suppressor genes like RAS promote cell division when activated.
B. BRCA1 and BRCA2 mutations increase lifetime risk of breast and ovarian cancers. [CORRECT]
C. HER2/neu overexpression is a tumor suppressor gene abnormality.
D. p53 mutations cause cancer only when inherited from both parents.
Correct Answer: B
Rationale: Tumor suppressor genes normally restrain cell growth; loss-of-function mutations (BRCA1/BRCA2, p53) remove the
brakes on proliferation and elevate cancer risk. BRCA1/BRCA2 mutations are strongly linked to hereditary breast and ovarian
cancer. RAS and HER2/neu are oncogenes (gain-of-function accelerators), not tumor suppressors. p53 mutations are commonly
sporadic (one allele sufficient, two-hit hypothesis); inheritance is not required. Differentiating oncogenes from tumor suppressors is a
high-yield MDC 3 recall item.
Q3: A patient's pathology report reads: T3 N1 M0, Grade 2. The nurse correctly interprets this staging as:
A. Small primary tumor, no lymph node involvement, no distant metastasis.
B. Any size tumor with distant metastasis and high-grade histology.
C. Carcinoma in situ with no invasion.
D. Large primary tumor with regional lymph node involvement and no distant metastasis. [CORRECT]
Correct Answer: D
Rationale: TNM staging: T3 indicates a larger primary tumor with extension; N1 indicates regional lymph node involvement; M0
indicates no distant metastasis. Grade 2 reflects moderate differentiation (histological grade, separate from TNM stage). Option A
describes early-stage disease (T1 N0 M0). Option B describes Stage IV with metastasis (M1). Option C describes Stage 0 (in situ).
Higher stage = more extensive disease, the central principle of TNM staging taught in the oncology module.
NUR 2502 / NUR2502 Exam 1 (Latest 2026/2027) - MDC 3 Page 1
,NUR 2502 Exam 1 - Multidimensional Care III (MDC 3) Rasmussen University | 2026-2027
Q4: When comparing benign and malignant tumors, which feature is characteristic of malignant tumors only?
A. Localized, non-invasive, regular borders
B. Symmetrical, regular shape, no recurrence
C. Poorly differentiated, invasive, metastatic potential [CORRECT]
D. Encapsulated, well-differentiated, slow growth
Correct Answer: C
Rationale: Malignant tumors are poorly differentiated (lose normal cell architecture), invasive (infiltrate surrounding tissues), and
have metastatic potential via lymphatic or hematogenous spread. They grow rapidly and irregularly. Benign tumors are
encapsulated, well-differentiated, slow-growing, and remain localized. Encapsulation and well-differentiation (options A and B) are
benign features. This differentiation guides prognosis discussions and treatment planning in MDC 3 oncology care.
Q5: A patient with advanced ovarian cancer is scheduled for surgical removal of as much tumor bulk as possible,
followed by chemotherapy. The nurse identifies this procedure as:
A. Debulking surgery [CORRECT]
B. Palliative resection
C. Diagnostic biopsy
D. Curative resection
Correct Answer: A
Rationale: Debulking surgery removes as much tumor mass as possible when complete resection is not feasible, reducing tumor
burden to enhance the effectiveness of adjuvant chemotherapy or radiation. It is commonly performed for ovarian cancer. Diagnostic
biopsy (option C) obtains tissue for diagnosis only. Curative resection (option D) aims to remove all tumor with negative margins.
Palliative resection (option B) relieves symptoms (e.g., bowel obstruction) without intent to cure. Distinguishing surgical intents is a core
MDC 3 oncology nursing competency.
Q6: A patient receiving external beam radiation to the chest for lung cancer reports increasing fatigue, dry cough,
and low-grade fever six weeks into treatment. The nurse recognizes these findings as most consistent with:
A. Superior vena cava syndrome
B. Neutropenic fever
C. Radiation pneumonitis [CORRECT]
D. Tumor lysis syndrome
Correct Answer: C
Rationale: Radiation pneumonitis typically develops 1-3 months after thoracic radiation, presenting with fatigue, dry cough,
dyspnea, and low-grade fever due to inflammation of normal lung tissue within the radiation field. Tumor lysis syndrome (option D)
presents with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia after cytotoxic therapy. Neutropenic fever (option B)
requires ANC <500/mm³ and lacks a cough pattern. SVC syndrome (option A) causes facial/upper extremity edema and JVD.
Recognizing radiation pneumonitis ensures timely corticosteroid intervention.
Q7: A patient receiving doxorubicin (Adriamycin) for breast cancer asks about long-term monitoring. The nurse
correctly teaches that the priority assessment is:
A. Liver function and bilirubin levels
B. Pulmonary function tests for fibrosis
C. Renal function and creatinine clearance
D. Echocardiogram to monitor for cardiotoxicity [CORRECT]
Correct Answer: D
Rationale: Doxorubicin is an anthracycline chemotherapeutic associated with dose-dependent cardiotoxicity (cardiomyopathy and
CHF). Baseline and serial echocardiograms or MUGA scans monitor left ventricular ejection fraction. Cisplatin (not doxorubicin)
causes nephrotoxicity (option C). Bleomycin causes pulmonary fibrosis (option B). Many agents affect liver function, but doxorubicin's
signature toxicity is cardiac. Cumulative lifetime dose limit (usually 450-550 mg/m²) is enforced to minimize risk. MDC 3
chemotherapy toxicity mapping is a high-frequency exam topic.
NUR 2502 / NUR2502 Exam 1 (Latest 2026/2027) - MDC 3 Page 2
, NUR 2502 Exam 1 - Multidimensional Care III (MDC 3) Rasmussen University | 2026-2027
Q8: A patient receiving cyclophosphamide (Cytoxan) is taught to drink at least 3 liters of fluid daily and void
frequently. The nurse explains this intervention is primarily to prevent:
A. Hemorrhagic cystitis from acrolein metabolite [CORRECT]
B. Nephrotoxicity from uric acid crystals
C. Cardiotoxicity from fluid overload
D. Neurotoxicity from drug accumulation
Correct Answer: A
Rationale: Cyclophosphamide produces the toxic metabolite acrolein, which accumulates in the bladder and damages urothelium,
causing hemorrhagic cystitis. Aggressive hydration and frequent voiding flush acrolein from the bladder; mesna (2-mercaptoethane
sulfonate) may be co-administered to neutralize acrolein. Option B describes tumor lysis prevention. Option D describes vincristine
neurotoxicity. Option C is incorrect; aggressive hydration is protective, not harmful. Patient education on hydration is a high-yield
MDC 3 chemotherapy nursing intervention.
Q9: A patient with HER2-positive breast cancer is prescribed trastuzumab (Herceptin). The nurse correctly
teaches that this medication is:
A. An angiogenesis inhibitor blocking VEGF
B. A tyrosine kinase inhibitor taken orally
C. A monoclonal antibody targeting HER2/neu receptors [CORRECT]
D. A checkpoint inhibitor enhancing T-cell response
Correct Answer: C
Rationale: Trastuzumab (Herceptin) is a monoclonal antibody that binds the HER2/neu receptor on HER2-overexpressing breast
cancer cells, marking them for immune destruction and inhibiting proliferation. Cardiac function monitoring is required (risk of
cardiotoxicity). Imatinib and gefitinib are oral tyrosine kinase inhibitors (option B). Bevacizumab targets VEGF (option A).
Pembrolizumab and nivolumab are checkpoint inhibitors (option D). Targeted therapy classification is a frequent MDC 3 recall item.
Q10: A postmenopausal patient with estrogen receptor-positive (ER+) breast cancer is started on tamoxifen.
Which patient statement indicates the need for further teaching?
A. "I will take this medication for the next 5 to 10 years as prescribed."
B. "I should have regular gynecologic exams because of endometrial cancer risk."
C. "I will report any vaginal bleeding to my provider immediately."
D. "I should stop taking this if I have hot flashes and night sweats." [CORRECT]
Correct Answer: D
Rationale: Tamoxifen is a selective estrogen receptor modulator (SERM) used for ER+ breast cancer. Hot flashes and night sweats
are common side effects, not reasons to stop therapy. Patients must complete the 5-10 year course. Tamoxifen increases risk of
endometrial hyperplasia/cancer and venous thromboembolism, so vaginal bleeding (option C) and gynecologic surveillance (option
B) are critical teaching points. Adherence (option A) is essential. Stopping therapy for menopausal symptoms (option D) jeopardizes
recurrence risk reduction and indicates teaching failure.
Q11: A patient with newly diagnosed acute lymphoblastic leukemia began chemotherapy 48 hours ago. Lab results:
potassium 6.8 mEq/L, phosphorus 8.2 mg/dL, calcium 5.4 mg/dL, uric acid 14 mg/dL. The nurse's priority action is
to:
A. Initiate aggressive IV hydration and administer rasburicase [CORRECT]
B. Administer oral calcium supplements immediately
C. Administer the next chemotherapy dose as scheduled
D. Restrict fluids to prevent fluid overload
Correct Answer: A
Rationale: The patient has tumor lysis syndrome (TLS): hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia
from rapid tumor cell breakdown. Priority is aggressive IV hydration (to promote renal excretion of uric acid and electrolytes) and
NUR 2502 / NUR2502 Exam 1 (Latest 2026/2027) - MDC 3 Page 3
NUR 2502 / NUR2502 Exam 1 (Latest )
Multidimensional Care III / MDC 3
Rasmussen University | College of Nursing
75 Questions | 7 Sections | Cognitive Mix: 25% Recall / 55% Application / 20% Analysis
Instructions: Select the single best answer for each question. Scenario-based items require application of the nursing process (Assess
→ Diagnose → Plan → Implement → Evaluate) and prioritization frameworks (ABC, Maslow, acute-vs-chronic). Each item includes the
correct answer and a comprehensive rationale with MDC 3 clinical reasoning.
Section 1: Oncology Nursing – Cancer Pathophysiology, Staging, Treatment Modalities
& Nursing Care (Questions Q1–Q15)
Q1: A nurse is teaching a community health class about carcinogenesis. Which sequence correctly identifies the
three sequential phases of cancer development?
A. Initiation → Promotion → Progression [CORRECT]
B. Initiation → Progression → Promotion
C. Promotion → Initiation → Progression
D. Progression → Promotion → Initiation
Correct Answer: A
Rationale: Carcinogenesis follows a strict sequence: Initiation (a single cell undergoes irreversible genetic mutation from a
carcinogen), then Promotion (mutated cell is stimulated to divide by promoters like hormones or chronic inflammation), and finally
Progression (tumor achieves invasive and metastatic potential through additional mutations). The other sequences invert the biology;
promotion cannot precede the initial mutation, and progression is the terminal phase. This foundational concept from the MDC 3
oncology module underpins risk-reduction teaching.
Q2: Which statement by a nursing student about tumor suppressor genes indicates correct understanding?
A. Tumor suppressor genes like RAS promote cell division when activated.
B. BRCA1 and BRCA2 mutations increase lifetime risk of breast and ovarian cancers. [CORRECT]
C. HER2/neu overexpression is a tumor suppressor gene abnormality.
D. p53 mutations cause cancer only when inherited from both parents.
Correct Answer: B
Rationale: Tumor suppressor genes normally restrain cell growth; loss-of-function mutations (BRCA1/BRCA2, p53) remove the
brakes on proliferation and elevate cancer risk. BRCA1/BRCA2 mutations are strongly linked to hereditary breast and ovarian
cancer. RAS and HER2/neu are oncogenes (gain-of-function accelerators), not tumor suppressors. p53 mutations are commonly
sporadic (one allele sufficient, two-hit hypothesis); inheritance is not required. Differentiating oncogenes from tumor suppressors is a
high-yield MDC 3 recall item.
Q3: A patient's pathology report reads: T3 N1 M0, Grade 2. The nurse correctly interprets this staging as:
A. Small primary tumor, no lymph node involvement, no distant metastasis.
B. Any size tumor with distant metastasis and high-grade histology.
C. Carcinoma in situ with no invasion.
D. Large primary tumor with regional lymph node involvement and no distant metastasis. [CORRECT]
Correct Answer: D
Rationale: TNM staging: T3 indicates a larger primary tumor with extension; N1 indicates regional lymph node involvement; M0
indicates no distant metastasis. Grade 2 reflects moderate differentiation (histological grade, separate from TNM stage). Option A
describes early-stage disease (T1 N0 M0). Option B describes Stage IV with metastasis (M1). Option C describes Stage 0 (in situ).
Higher stage = more extensive disease, the central principle of TNM staging taught in the oncology module.
NUR 2502 / NUR2502 Exam 1 (Latest 2026/2027) - MDC 3 Page 1
,NUR 2502 Exam 1 - Multidimensional Care III (MDC 3) Rasmussen University | 2026-2027
Q4: When comparing benign and malignant tumors, which feature is characteristic of malignant tumors only?
A. Localized, non-invasive, regular borders
B. Symmetrical, regular shape, no recurrence
C. Poorly differentiated, invasive, metastatic potential [CORRECT]
D. Encapsulated, well-differentiated, slow growth
Correct Answer: C
Rationale: Malignant tumors are poorly differentiated (lose normal cell architecture), invasive (infiltrate surrounding tissues), and
have metastatic potential via lymphatic or hematogenous spread. They grow rapidly and irregularly. Benign tumors are
encapsulated, well-differentiated, slow-growing, and remain localized. Encapsulation and well-differentiation (options A and B) are
benign features. This differentiation guides prognosis discussions and treatment planning in MDC 3 oncology care.
Q5: A patient with advanced ovarian cancer is scheduled for surgical removal of as much tumor bulk as possible,
followed by chemotherapy. The nurse identifies this procedure as:
A. Debulking surgery [CORRECT]
B. Palliative resection
C. Diagnostic biopsy
D. Curative resection
Correct Answer: A
Rationale: Debulking surgery removes as much tumor mass as possible when complete resection is not feasible, reducing tumor
burden to enhance the effectiveness of adjuvant chemotherapy or radiation. It is commonly performed for ovarian cancer. Diagnostic
biopsy (option C) obtains tissue for diagnosis only. Curative resection (option D) aims to remove all tumor with negative margins.
Palliative resection (option B) relieves symptoms (e.g., bowel obstruction) without intent to cure. Distinguishing surgical intents is a core
MDC 3 oncology nursing competency.
Q6: A patient receiving external beam radiation to the chest for lung cancer reports increasing fatigue, dry cough,
and low-grade fever six weeks into treatment. The nurse recognizes these findings as most consistent with:
A. Superior vena cava syndrome
B. Neutropenic fever
C. Radiation pneumonitis [CORRECT]
D. Tumor lysis syndrome
Correct Answer: C
Rationale: Radiation pneumonitis typically develops 1-3 months after thoracic radiation, presenting with fatigue, dry cough,
dyspnea, and low-grade fever due to inflammation of normal lung tissue within the radiation field. Tumor lysis syndrome (option D)
presents with hyperuricemia, hyperkalemia, hyperphosphatemia, hypocalcemia after cytotoxic therapy. Neutropenic fever (option B)
requires ANC <500/mm³ and lacks a cough pattern. SVC syndrome (option A) causes facial/upper extremity edema and JVD.
Recognizing radiation pneumonitis ensures timely corticosteroid intervention.
Q7: A patient receiving doxorubicin (Adriamycin) for breast cancer asks about long-term monitoring. The nurse
correctly teaches that the priority assessment is:
A. Liver function and bilirubin levels
B. Pulmonary function tests for fibrosis
C. Renal function and creatinine clearance
D. Echocardiogram to monitor for cardiotoxicity [CORRECT]
Correct Answer: D
Rationale: Doxorubicin is an anthracycline chemotherapeutic associated with dose-dependent cardiotoxicity (cardiomyopathy and
CHF). Baseline and serial echocardiograms or MUGA scans monitor left ventricular ejection fraction. Cisplatin (not doxorubicin)
causes nephrotoxicity (option C). Bleomycin causes pulmonary fibrosis (option B). Many agents affect liver function, but doxorubicin's
signature toxicity is cardiac. Cumulative lifetime dose limit (usually 450-550 mg/m²) is enforced to minimize risk. MDC 3
chemotherapy toxicity mapping is a high-frequency exam topic.
NUR 2502 / NUR2502 Exam 1 (Latest 2026/2027) - MDC 3 Page 2
, NUR 2502 Exam 1 - Multidimensional Care III (MDC 3) Rasmussen University | 2026-2027
Q8: A patient receiving cyclophosphamide (Cytoxan) is taught to drink at least 3 liters of fluid daily and void
frequently. The nurse explains this intervention is primarily to prevent:
A. Hemorrhagic cystitis from acrolein metabolite [CORRECT]
B. Nephrotoxicity from uric acid crystals
C. Cardiotoxicity from fluid overload
D. Neurotoxicity from drug accumulation
Correct Answer: A
Rationale: Cyclophosphamide produces the toxic metabolite acrolein, which accumulates in the bladder and damages urothelium,
causing hemorrhagic cystitis. Aggressive hydration and frequent voiding flush acrolein from the bladder; mesna (2-mercaptoethane
sulfonate) may be co-administered to neutralize acrolein. Option B describes tumor lysis prevention. Option D describes vincristine
neurotoxicity. Option C is incorrect; aggressive hydration is protective, not harmful. Patient education on hydration is a high-yield
MDC 3 chemotherapy nursing intervention.
Q9: A patient with HER2-positive breast cancer is prescribed trastuzumab (Herceptin). The nurse correctly
teaches that this medication is:
A. An angiogenesis inhibitor blocking VEGF
B. A tyrosine kinase inhibitor taken orally
C. A monoclonal antibody targeting HER2/neu receptors [CORRECT]
D. A checkpoint inhibitor enhancing T-cell response
Correct Answer: C
Rationale: Trastuzumab (Herceptin) is a monoclonal antibody that binds the HER2/neu receptor on HER2-overexpressing breast
cancer cells, marking them for immune destruction and inhibiting proliferation. Cardiac function monitoring is required (risk of
cardiotoxicity). Imatinib and gefitinib are oral tyrosine kinase inhibitors (option B). Bevacizumab targets VEGF (option A).
Pembrolizumab and nivolumab are checkpoint inhibitors (option D). Targeted therapy classification is a frequent MDC 3 recall item.
Q10: A postmenopausal patient with estrogen receptor-positive (ER+) breast cancer is started on tamoxifen.
Which patient statement indicates the need for further teaching?
A. "I will take this medication for the next 5 to 10 years as prescribed."
B. "I should have regular gynecologic exams because of endometrial cancer risk."
C. "I will report any vaginal bleeding to my provider immediately."
D. "I should stop taking this if I have hot flashes and night sweats." [CORRECT]
Correct Answer: D
Rationale: Tamoxifen is a selective estrogen receptor modulator (SERM) used for ER+ breast cancer. Hot flashes and night sweats
are common side effects, not reasons to stop therapy. Patients must complete the 5-10 year course. Tamoxifen increases risk of
endometrial hyperplasia/cancer and venous thromboembolism, so vaginal bleeding (option C) and gynecologic surveillance (option
B) are critical teaching points. Adherence (option A) is essential. Stopping therapy for menopausal symptoms (option D) jeopardizes
recurrence risk reduction and indicates teaching failure.
Q11: A patient with newly diagnosed acute lymphoblastic leukemia began chemotherapy 48 hours ago. Lab results:
potassium 6.8 mEq/L, phosphorus 8.2 mg/dL, calcium 5.4 mg/dL, uric acid 14 mg/dL. The nurse's priority action is
to:
A. Initiate aggressive IV hydration and administer rasburicase [CORRECT]
B. Administer oral calcium supplements immediately
C. Administer the next chemotherapy dose as scheduled
D. Restrict fluids to prevent fluid overload
Correct Answer: A
Rationale: The patient has tumor lysis syndrome (TLS): hyperkalemia, hyperphosphatemia, hypocalcemia, and hyperuricemia
from rapid tumor cell breakdown. Priority is aggressive IV hydration (to promote renal excretion of uric acid and electrolytes) and
NUR 2502 / NUR2502 Exam 1 (Latest 2026/2027) - MDC 3 Page 3
