Final Exam
NUR2392 / NUR 2392 (Latest 2026/2027)
Multidimensional Care II / MDC 2
Rasmussen University
100 Multiple-Choice Questions
Comprehensive Coverage of MDC 2 Final Exam Blueprint
Cardiovascular | Peripheral Vascular | Hematologic | Renal | Endocrine | Fluid and Electrolyte |
Integrated Scenarios
Question Distribution: 25% Recall | 55% Application | 20% Analysis
Format: 75% Scenario-Based | 20% Direct Recall | 5% Clinical Judgment
Answer Key with Detailed Rationales Included
NUR2392 MDC 2 Final Exam | Page 1
,Section 1: Cardiovascular Disorders
Topics: CAD, Heart Failure, Hypertension, Valvular Disorders, Dysrhythmias
Q1. A nurse is caring for a client with acute coronary syndrome (ACS) who reports
substernal chest pain radiating to the left arm. The nurse anticipates which diagnostic
finding as the gold standard biomarker for myocardial infarction?
A. Elevated CK-MB within 1-2 hours of symptom onset
B. Elevated troponin I levels within 3-4 hours of symptom onset [CORRECT]
C. Elevated myoglobin within 30 minutes of symptom onset
D. Elevated B-type natriuretic peptide (BNP) levels
Correct Answer: B
Rationale: Troponin I is the gold standard cardiac biomarker for myocardial infarction, as it is highly specific to
cardiac muscle and rises within 3-4 hours post-MI, peaking at 12-24 hours. CK-MB is less specific (also found in
skeletal muscle) and rises later. Myoglobin is very early but lacks cardiac specificity. BNP reflects heart failure,
not acute myocardial injury. Per 2026 MDC 2 curriculum, troponin I remains the primary diagnostic marker for
confirming MI.
Q2. A nurse is providing discharge teaching to a client following a myocardial infarction.
Which statement by the client indicates the most effective lifestyle modification for
reducing cardiovascular risk?
A. 'I will reduce my sodium intake to less than 3 grams per day'
B. 'I will walk for 30 minutes three times per week'
C. 'I will quit smoking and avoid secondhand smoke exposure' [CORRECT]
D. 'I will take aspirin every morning with breakfast'
Correct Answer: C
Rationale: Smoking cessation is the single most impactful lifestyle modification for reducing cardiovascular risk
after MI. Nicotine causes vasoconstriction, increases heart rate and blood pressure, promotes platelet
aggregation, and damages endothelial cells, accelerating atherosclerosis. While sodium reduction, exercise, and
medication adherence are important components of cardiac rehabilitation, smoking cessation has the greatest
effect on long-term outcomes and mortality reduction. Per Rasmussen MDC 2 guidelines, smoking cessation is
prioritized in post-MI education.
Q3. A nurse is assessing a client with suspected unstable angina. Which finding
differentiates unstable angina from stable angina?
A. Chest pain relieved by rest and nitroglycerin
B. Chest pain that occurs predictably with exertion
C. Chest pain occurring at rest and increasing in frequency and duration [CORRECT]
D. Chest pain described as a pressure sensation radiating to the jaw
Correct Answer: C
Rationale: Unstable angina is characterized by chest pain that occurs at rest, is new in onset, or increases in
frequency, duration, and severity compared to previous anginal episodes. It is considered a medical emergency
because it signals impending myocardial infarction. Stable angina is predictable, occurs with exertion, and is
relieved by rest or nitroglycerin. Prinzmetal (variant) angina is caused by coronary vasospasm, typically at rest,
and is treated with calcium channel blockers. Recognizing the progression from stable to unstable angina is
critical for timely intervention per MDC 2 standards.
NUR2392 MDC 2 Final Exam | Page 2
,Q4. A client arrives in the emergency department with suspected STEMI. The nurse
prepares to administer the initial collaborative care known as MONA. Which
intervention is the highest priority?
A. Administer morphine sulfate 2-4 mg IV for pain relief
B. Administer aspirin 324 mg to chew and swallow [CORRECT]
C. Apply oxygen at 2-4 L/min via nasal cannula
D. Administer nitroglycerin sublingually
Correct Answer: B
Rationale: In the MONA protocol for STEMI, aspirin is the highest priority initial intervention. Aspirin inhibits
platelet aggregation by irreversibly blocking cyclooxygenase-1, reducing thrombus formation at the site of plaque
rupture. The AHA and ACC guidelines emphasize that aspirin should be given as early as possible (chewed for
faster absorption). Morphine, oxygen, and nitroglycerin follow in the protocol. Oxygen is only administered if
SpO2 is below 94% per current guidelines to avoid hyperoxia-induced vasoconstriction. Per 2026 MDC 2
standards, aspirin remains first in the MONA sequence.
Q5. A nurse is caring for a client 6 hours post-percutaneous coronary intervention (PCI)
with stent placement. Which assessment finding requires immediate intervention?
A. Pedal pulses are 2+ and symmetric bilaterally
B. The puncture site dressing has a small amount of serous drainage
C. The client reports a 2/10 discomfort at the access site
D. The client's blood pressure has dropped from 130/80 to 88/54 mmHg [CORRECT]
Correct Answer: D
Rationale: A significant drop in blood pressure post-PCI is the most critical finding, as it may indicate
retroperitoneal bleeding from the femoral access site or internal hemorrhage. Hypotension with a widening pulse
pressure is an early sign of hypovolemic shock. While minor drainage and mild discomfort at the access site are
expected findings, they do not require immediate intervention. Strong and symmetric peripheral pulses indicate
adequate perfusion to the extremity. The nurse must immediately assess for signs of bleeding, apply pressure if
needed, and notify the provider per MDC 2 post-PCI protocols.
Q6. A client with coronary artery disease is prescribed atorvastatin. The nurse should
teach the client to report which adverse effect immediately?
A. Mild gastrointestinal upset after taking the medication
B. Unexplained muscle pain, tenderness, or weakness [CORRECT]
C. Mild headache in the morning
D. Slight increase in appetite
Correct Answer: B
Rationale: Atorvastatin is an HMG-CoA reductase inhibitor (statin) that can cause myopathy and, rarely,
rhabdomyolysis, which is characterized by muscle pain, tenderness, and weakness. Rhabdomyolysis can lead to
acute kidney injury from myoglobin release. The nurse should instruct the client to report unexplained muscle
symptoms immediately and monitor liver function (AST/ALT) since statins can also cause hepatotoxicity. Mild GI
upset and headache are common but less concerning side effects. Per MDC 2 medication management
guidelines, monitoring for statin-induced muscle toxicity is a priority nursing intervention.
Q7. A nurse is assessing a client with heart failure. Which finding is the BEST early
indicator of fluid volume excess?
A. Crackles in the lung bases bilaterally
B. Weight gain of 1 kg (2.2 lb) in 24 hours [CORRECT]
C. Sacral edema upon palpation
D. Jugular venous distention (JVD) at 45 degrees
Correct Answer: B
Rationale: Daily weight measurement is the most sensitive and earliest indicator of fluid volume excess in heart
failure clients. A weight gain of 1 kg (2.2 lb) in 24 hours or 2 kg (4.4 lb) in one week indicates fluid retention
before visible edema or pulmonary symptoms develop. Crackles, sacral edema, and JVD are later signs of fluid
overload that appear after significant fluid accumulation. Per MDC 2 nursing priorities for heart failure
management, daily weights are the gold standard for monitoring fluid status and adjusting diuretic therapy.
NUR2392 MDC 2 Final Exam | Page 3
, Q8. A client presents with shortness of breath, orthopnea, fatigue, and a S3 gallop on
auscultation. The nurse recognizes these findings as manifestations of which type of
heart failure?
A. Right-sided heart failure
B. Left-sided heart failure with systolic dysfunction [CORRECT]
C. Left-sided heart failure with diastolic dysfunction
D. Biventricular heart failure
Correct Answer: B
Rationale: Shortness of breath, orthopnea (dyspnea when lying flat), fatigue, and an S3 gallop are classic
manifestations of left-sided heart failure with systolic dysfunction (HFrEF). In systolic failure, the left ventricle
cannot eject blood effectively, leading to backward flow into the pulmonary circulation, causing pulmonary
congestion. The S3 gallop is produced by rapid ventricular filling into a stiff, noncompliant left ventricle.
Right-sided heart failure manifests with peripheral edema, JVD, hepatomegaly, and ascites. Diastolic failure
(HFpEF) involves impaired relaxation and filling rather than ejection issues.
Q9. A nurse is developing a teaching plan for a client with heart failure. Which dietary
instruction is MOST important to include?
A. Restrict total fluid intake to less than 500 mL per day
B. Limit sodium intake to 2 grams per day [CORRECT]
C. Increase potassium-rich foods in the diet
D. Limit protein intake to 40 grams per day
Correct Answer: B
Rationale: Sodium restriction to 2 grams per day is the most important dietary modification for heart failure
clients. Excess sodium intake promotes water retention, exacerbating fluid overload and increasing cardiac
workload. While fluid restriction may be needed in severe cases (typically 1.5-2 L/day, not 500 mL), sodium
restriction is universally recommended. Increasing potassium may be needed if the client is on
potassium-wasting diuretics, but it is not the primary dietary intervention. Protein restriction is not indicated for
heart failure. Per MDC 2 heart failure management guidelines, sodium restriction is the cornerstone of dietary
therapy.
Q10. A client with heart failure is prescribed digoxin. Which statement by the nurse
indicates understanding of the medication's therapeutic monitoring?
A. 'I will monitor for hypokalemia, which increases the risk of digoxin toxicity'
[CORRECT]
B. 'I will teach the client to take the medication with a high-fiber meal'
C. 'I will expect the client's heart rate to increase within the therapeutic range'
D. 'I will instruct the client to double the dose if a dose is missed'
Correct Answer: A
Rationale: Digoxin has a narrow therapeutic index (0.5-2.0 ng/mL), and hypokalemia significantly increases the
risk of digoxin toxicity because potassium and digoxin compete for binding sites at the Na+/K+-ATPase pump.
When potassium is low, more digoxin binds, increasing its effects and toxicity risk. The nurse should monitor
potassium levels, especially in clients also taking diuretics. Digoxin decreases (not increases) heart rate by
increasing vagal tone and AV node conduction delay. A missed dose should never be doubled. Taking it with
high-fiber meals may decrease absorption. Per MDC 2 pharmacology standards, monitoring potassium and
recognizing toxicity (nausea, visual changes, dysrhythmias) are essential.
NUR2392 MDC 2 Final Exam | Page 4
NUR2392 / NUR 2392 (Latest 2026/2027)
Multidimensional Care II / MDC 2
Rasmussen University
100 Multiple-Choice Questions
Comprehensive Coverage of MDC 2 Final Exam Blueprint
Cardiovascular | Peripheral Vascular | Hematologic | Renal | Endocrine | Fluid and Electrolyte |
Integrated Scenarios
Question Distribution: 25% Recall | 55% Application | 20% Analysis
Format: 75% Scenario-Based | 20% Direct Recall | 5% Clinical Judgment
Answer Key with Detailed Rationales Included
NUR2392 MDC 2 Final Exam | Page 1
,Section 1: Cardiovascular Disorders
Topics: CAD, Heart Failure, Hypertension, Valvular Disorders, Dysrhythmias
Q1. A nurse is caring for a client with acute coronary syndrome (ACS) who reports
substernal chest pain radiating to the left arm. The nurse anticipates which diagnostic
finding as the gold standard biomarker for myocardial infarction?
A. Elevated CK-MB within 1-2 hours of symptom onset
B. Elevated troponin I levels within 3-4 hours of symptom onset [CORRECT]
C. Elevated myoglobin within 30 minutes of symptom onset
D. Elevated B-type natriuretic peptide (BNP) levels
Correct Answer: B
Rationale: Troponin I is the gold standard cardiac biomarker for myocardial infarction, as it is highly specific to
cardiac muscle and rises within 3-4 hours post-MI, peaking at 12-24 hours. CK-MB is less specific (also found in
skeletal muscle) and rises later. Myoglobin is very early but lacks cardiac specificity. BNP reflects heart failure,
not acute myocardial injury. Per 2026 MDC 2 curriculum, troponin I remains the primary diagnostic marker for
confirming MI.
Q2. A nurse is providing discharge teaching to a client following a myocardial infarction.
Which statement by the client indicates the most effective lifestyle modification for
reducing cardiovascular risk?
A. 'I will reduce my sodium intake to less than 3 grams per day'
B. 'I will walk for 30 minutes three times per week'
C. 'I will quit smoking and avoid secondhand smoke exposure' [CORRECT]
D. 'I will take aspirin every morning with breakfast'
Correct Answer: C
Rationale: Smoking cessation is the single most impactful lifestyle modification for reducing cardiovascular risk
after MI. Nicotine causes vasoconstriction, increases heart rate and blood pressure, promotes platelet
aggregation, and damages endothelial cells, accelerating atherosclerosis. While sodium reduction, exercise, and
medication adherence are important components of cardiac rehabilitation, smoking cessation has the greatest
effect on long-term outcomes and mortality reduction. Per Rasmussen MDC 2 guidelines, smoking cessation is
prioritized in post-MI education.
Q3. A nurse is assessing a client with suspected unstable angina. Which finding
differentiates unstable angina from stable angina?
A. Chest pain relieved by rest and nitroglycerin
B. Chest pain that occurs predictably with exertion
C. Chest pain occurring at rest and increasing in frequency and duration [CORRECT]
D. Chest pain described as a pressure sensation radiating to the jaw
Correct Answer: C
Rationale: Unstable angina is characterized by chest pain that occurs at rest, is new in onset, or increases in
frequency, duration, and severity compared to previous anginal episodes. It is considered a medical emergency
because it signals impending myocardial infarction. Stable angina is predictable, occurs with exertion, and is
relieved by rest or nitroglycerin. Prinzmetal (variant) angina is caused by coronary vasospasm, typically at rest,
and is treated with calcium channel blockers. Recognizing the progression from stable to unstable angina is
critical for timely intervention per MDC 2 standards.
NUR2392 MDC 2 Final Exam | Page 2
,Q4. A client arrives in the emergency department with suspected STEMI. The nurse
prepares to administer the initial collaborative care known as MONA. Which
intervention is the highest priority?
A. Administer morphine sulfate 2-4 mg IV for pain relief
B. Administer aspirin 324 mg to chew and swallow [CORRECT]
C. Apply oxygen at 2-4 L/min via nasal cannula
D. Administer nitroglycerin sublingually
Correct Answer: B
Rationale: In the MONA protocol for STEMI, aspirin is the highest priority initial intervention. Aspirin inhibits
platelet aggregation by irreversibly blocking cyclooxygenase-1, reducing thrombus formation at the site of plaque
rupture. The AHA and ACC guidelines emphasize that aspirin should be given as early as possible (chewed for
faster absorption). Morphine, oxygen, and nitroglycerin follow in the protocol. Oxygen is only administered if
SpO2 is below 94% per current guidelines to avoid hyperoxia-induced vasoconstriction. Per 2026 MDC 2
standards, aspirin remains first in the MONA sequence.
Q5. A nurse is caring for a client 6 hours post-percutaneous coronary intervention (PCI)
with stent placement. Which assessment finding requires immediate intervention?
A. Pedal pulses are 2+ and symmetric bilaterally
B. The puncture site dressing has a small amount of serous drainage
C. The client reports a 2/10 discomfort at the access site
D. The client's blood pressure has dropped from 130/80 to 88/54 mmHg [CORRECT]
Correct Answer: D
Rationale: A significant drop in blood pressure post-PCI is the most critical finding, as it may indicate
retroperitoneal bleeding from the femoral access site or internal hemorrhage. Hypotension with a widening pulse
pressure is an early sign of hypovolemic shock. While minor drainage and mild discomfort at the access site are
expected findings, they do not require immediate intervention. Strong and symmetric peripheral pulses indicate
adequate perfusion to the extremity. The nurse must immediately assess for signs of bleeding, apply pressure if
needed, and notify the provider per MDC 2 post-PCI protocols.
Q6. A client with coronary artery disease is prescribed atorvastatin. The nurse should
teach the client to report which adverse effect immediately?
A. Mild gastrointestinal upset after taking the medication
B. Unexplained muscle pain, tenderness, or weakness [CORRECT]
C. Mild headache in the morning
D. Slight increase in appetite
Correct Answer: B
Rationale: Atorvastatin is an HMG-CoA reductase inhibitor (statin) that can cause myopathy and, rarely,
rhabdomyolysis, which is characterized by muscle pain, tenderness, and weakness. Rhabdomyolysis can lead to
acute kidney injury from myoglobin release. The nurse should instruct the client to report unexplained muscle
symptoms immediately and monitor liver function (AST/ALT) since statins can also cause hepatotoxicity. Mild GI
upset and headache are common but less concerning side effects. Per MDC 2 medication management
guidelines, monitoring for statin-induced muscle toxicity is a priority nursing intervention.
Q7. A nurse is assessing a client with heart failure. Which finding is the BEST early
indicator of fluid volume excess?
A. Crackles in the lung bases bilaterally
B. Weight gain of 1 kg (2.2 lb) in 24 hours [CORRECT]
C. Sacral edema upon palpation
D. Jugular venous distention (JVD) at 45 degrees
Correct Answer: B
Rationale: Daily weight measurement is the most sensitive and earliest indicator of fluid volume excess in heart
failure clients. A weight gain of 1 kg (2.2 lb) in 24 hours or 2 kg (4.4 lb) in one week indicates fluid retention
before visible edema or pulmonary symptoms develop. Crackles, sacral edema, and JVD are later signs of fluid
overload that appear after significant fluid accumulation. Per MDC 2 nursing priorities for heart failure
management, daily weights are the gold standard for monitoring fluid status and adjusting diuretic therapy.
NUR2392 MDC 2 Final Exam | Page 3
, Q8. A client presents with shortness of breath, orthopnea, fatigue, and a S3 gallop on
auscultation. The nurse recognizes these findings as manifestations of which type of
heart failure?
A. Right-sided heart failure
B. Left-sided heart failure with systolic dysfunction [CORRECT]
C. Left-sided heart failure with diastolic dysfunction
D. Biventricular heart failure
Correct Answer: B
Rationale: Shortness of breath, orthopnea (dyspnea when lying flat), fatigue, and an S3 gallop are classic
manifestations of left-sided heart failure with systolic dysfunction (HFrEF). In systolic failure, the left ventricle
cannot eject blood effectively, leading to backward flow into the pulmonary circulation, causing pulmonary
congestion. The S3 gallop is produced by rapid ventricular filling into a stiff, noncompliant left ventricle.
Right-sided heart failure manifests with peripheral edema, JVD, hepatomegaly, and ascites. Diastolic failure
(HFpEF) involves impaired relaxation and filling rather than ejection issues.
Q9. A nurse is developing a teaching plan for a client with heart failure. Which dietary
instruction is MOST important to include?
A. Restrict total fluid intake to less than 500 mL per day
B. Limit sodium intake to 2 grams per day [CORRECT]
C. Increase potassium-rich foods in the diet
D. Limit protein intake to 40 grams per day
Correct Answer: B
Rationale: Sodium restriction to 2 grams per day is the most important dietary modification for heart failure
clients. Excess sodium intake promotes water retention, exacerbating fluid overload and increasing cardiac
workload. While fluid restriction may be needed in severe cases (typically 1.5-2 L/day, not 500 mL), sodium
restriction is universally recommended. Increasing potassium may be needed if the client is on
potassium-wasting diuretics, but it is not the primary dietary intervention. Protein restriction is not indicated for
heart failure. Per MDC 2 heart failure management guidelines, sodium restriction is the cornerstone of dietary
therapy.
Q10. A client with heart failure is prescribed digoxin. Which statement by the nurse
indicates understanding of the medication's therapeutic monitoring?
A. 'I will monitor for hypokalemia, which increases the risk of digoxin toxicity'
[CORRECT]
B. 'I will teach the client to take the medication with a high-fiber meal'
C. 'I will expect the client's heart rate to increase within the therapeutic range'
D. 'I will instruct the client to double the dose if a dose is missed'
Correct Answer: A
Rationale: Digoxin has a narrow therapeutic index (0.5-2.0 ng/mL), and hypokalemia significantly increases the
risk of digoxin toxicity because potassium and digoxin compete for binding sites at the Na+/K+-ATPase pump.
When potassium is low, more digoxin binds, increasing its effects and toxicity risk. The nurse should monitor
potassium levels, especially in clients also taking diuretics. Digoxin decreases (not increases) heart rate by
increasing vagal tone and AV node conduction delay. A missed dose should never be doubled. Taking it with
high-fiber meals may decrease absorption. Per MDC 2 pharmacology standards, monitoring potassium and
recognizing toxicity (nausea, visual changes, dysrhythmias) are essential.
NUR2392 MDC 2 Final Exam | Page 4
