NUR 2392 / MDC 2 Final Exam - Rasmussen University 2026/2027 Multidimensional Care II
Final Exam - NUR 2392
Multidimensional Care II (MDC 2)
Rasmussen University | Latest Edition
Format: Multiple Choice Cognitive Levels: 25% Recall | 55%
Total Questions: 150
(A-D) Application | 20% Analysis
Content Focus: Endocrine Disorders | Cancer & Oncology | Fluid, Electrolyte & Acid-Base | Cardiovascular &
Respiratory Emergencies | Renal, GI & Hepatic | Perioperative Care | Multisystem Management | Integrated NGN
Clinical Scenarios
Aligned with 2026-2027 Rasmussen University NUR 2392 MDC 2 curriculum standards, multidimensional care competencies,
and Next-Generation NCLEX (NGN) clinical judgment framework.
SECTION 1: ENDOCRINE DISORDERS (Q1 - Q25)
Pituitary, Thyroid, Pancreas, Adrenals, Parathyroid | DI, SIADH, Graves', Hypothyroidism, Cushing, Addison, DM,
DKA, HHNS
Q1: A 42-year-old client is admitted with polyuria (8 L/day), polydipsia, and a urine specific gravity of
1.002. Serum sodium is 152 mEq/L. Which condition should the nurse suspect, and what is the priority
medication?
A. SIADH; administer tolvaptan
B. Diabetes insipidus; administer desmopressin (DDAVP) [CORRECT]
C. Diabetes mellitus; administer regular insulin
D. Addison disease; administer hydrocortisone
Correct Answer: B
Rationale: Diabetes insipidus (DI) is caused by ADH deficiency, leading to massive urine output with very dilute urine
(specific gravity <1.005) and hypernatremia from free water loss. Desmopressin (DDAVP), a synthetic ADH analog, is
the treatment of choice. SIADH presents with hyponatremia and euvolemia, the opposite presentation. Diabetes mellitus
causes glycosuria with elevated serum glucose, and Addison disease causes hyperkalemia and hypotension, not
hypernatremia.
Q2: The nurse is caring for a client with SIADH. Which finding requires immediate intervention?
A. Serum sodium 118 mEq/L with confusion [CORRECT]
B. Urine specific gravity 1.030
C. Serum sodium 135 mEq/L
D. Daily weight gain of 0.3 kg
Correct Answer: A
Rationale: In SIADH, excess ADH causes water retention leading to dilutional hyponatremia. A serum sodium of 118
mEq/L with confusion indicates severe hyponatremia with neurologic involvement - a medical emergency requiring
hypertonic saline (3% NaCl) on an infusion pump to prevent cerebral edema and seizure. Specific gravity of 1.030 is
expected in SIADH (concentrated urine). Mild weight gain and sodium of 135 mEq/L are not emergent.
150 Questions | Comprehensive Rationales Page 1
,NUR 2392 / MDC 2 Final Exam - Rasmussen University 2026/2027 Multidimensional Care II
Q3: A client with Graves' disease is admitted for thyroidectomy. Which preoperative nursing intervention
is the highest priority?
A. Administer levothyroxine as prescribed
B. Maintain a warm environment to prevent chills
C. Administer methimazole and atenolol to achieve euthyroid state [CORRECT]
D. Encourage consumption of iodine-rich foods
Correct Answer: C
Rationale: Before thyroidectomy, the client must be returned to a euthyroid state to prevent thyroid storm. Methimazole
blocks thyroid hormone synthesis, and atenolol (beta-blocker) controls tachycardia and adrenergic symptoms.
Levothyroxine is used for hypothyroidism, not hyperthyroidism. A cool environment is preferred for hyperthyroid clients
due to heat intolerance. Iodine administration (Lugol's solution) may be used briefly preoperatively but is not the primary
medication.
Q4: A client receiving levothyroxine for hypothyroidism reports fatigue, cold intolerance, and constipation.
The TSH level is 12 mIU/mL (normal 0.4-4.0). Which action by the nurse is most appropriate?
A. Instruct the client to skip the next dose
B. Notify the provider; the dose likely needs to be increased [CORRECT]
C. Document findings; this is an expected response
D. Administer an extra dose immediately
Correct Answer: B
Rationale: An elevated TSH indicates the pituitary is trying to stimulate an underactive thyroid, meaning the
levothyroxine dose is subtherapeutic. Symptoms of fatigue, cold intolerance, and constipation confirm persistent
hypothyroidism. The provider should be notified to adjust the dose upward. Skipping doses or giving extra doses without
an order is unsafe. These findings are not expected when therapy is therapeutic.
Q5: A client with Cushing syndrome is admitted. Which assessment finding requires the most immediate
follow-up?
A. Moon face and purple striae on abdomen
B. Serum glucose 285 mg/dL [CORRECT]
C. Buffalo hump on upper back
D. Weight gain of 4 lb over 2 weeks
Correct Answer: B
Rationale: Cushing syndrome involves excess cortisol, which causes hyperglycemia through gluconeogenesis and insulin
resistance. A glucose of 285 mg/dL requires immediate intervention due to risk of osmotic diuresis, dehydration, and
progression to HHS. Moon face, buffalo hump, and purple striae are classic expected findings that do not require urgent
intervention. Weight gain is also expected from cortisol-induced fluid retention.
Q6: A client with Addison disease is admitted with vomiting, abdominal pain, and hypotension (BP 84/52).
Serum sodium is 124 mEq/L and potassium is 6.2 mEq/L. Which medication should the nurse prepare to
administer first?
A. Oral fludrocortisone
B. IV hydrocortisone [CORRECT]
C. Oral levothyroxine
D. IV insulin and dextrose
150 Questions | Comprehensive Rationales Page 2
,NUR 2392 / MDC 2 Final Exam - Rasmussen University 2026/2027 Multidimensional Care II
Correct Answer: B
Rationale: This client is in acute adrenal crisis, a life-threatening condition requiring immediate IV hydrocortisone
(glucocorticoid replacement). The clinical picture of hypotension, hyponatremia, hyperkalemia, vomiting, and abdominal
pain is classic for adrenal crisis. Oral fludrocortisone is used for chronic mineralocorticoid replacement but not in acute
crisis. IV insulin/dextrose treats hyperkalemia but does not address the underlying cortisol deficiency, which is the
priority.
Q7: A client with type 1 diabetes is alert but diaphoretic, tremulous, and reports palpitations. Capillary
glucose is 48 mg/dL. Which action should the nurse take first?
A. Administer 1 mg glucagon IM
B. Administer 50 mL of 50% dextrose IV push
C. Provide 15 g of rapid-acting carbohydrates orally [CORRECT]
D. Recheck glucose in 15 minutes
Correct Answer: C
Rationale: For a conscious, alert hypoglycemic client, the priority is oral administration of 15 g of rapid-acting
carbohydrates (4 oz juice, glucose tablets). The 15/15 rule: give 15 g carbohydrate, then recheck glucose in 15 minutes.
Glucagon IM is used when the client cannot safely swallow. IV dextrose (D50W) is reserved for unresponsive clients or
those unable to take oral intake. Rechecking alone does not treat the hypoglycemia.
Q8: An unconscious client with type 1 diabetes has a capillary glucose of 32 mg/dL. IV access is
established. Which intervention is most appropriate?
A. Administer 25 g of 50% dextrose IV push [CORRECT]
B. Administer glucagon 1 mg IM
C. Apply glucose gel to buccal mucosa
D. Give 4 oz of orange juice by mouth
Correct Answer: A
Rationale: For an unresponsive hypoglycemic client with IV access, IV dextrose (D50W, 25 g) is the treatment of choice
because it rapidly raises serum glucose. Glucagon IM is an alternative when IV access is unavailable but takes 10-20
minutes to work. Oral glucose gel or juice is contraindicated in an unconscious client due to aspiration risk. This is a
medical emergency requiring immediate IV intervention.
Q9: A client with type 1 diabetes presents with Kussmaul respirations, fruity breath odor, and blood
glucose 612 mg/dL. Arterial pH is 7.22. Which finding is most concerning and indicates severe DKA?
A. Serum potassium 3.1 mEq/L [CORRECT]
B. Urine ketones 3+
C. Blood glucose 612 mg/dL
D. Serum bicarbonate 10 mEq/L
Correct Answer: A
Rationale: In DKA, potassium shifts extracellularly due to acidosis, but total body potassium is depleted from osmotic
diuresis. A serum potassium of 3.1 mEq/L indicates severe depletion that can precipitate fatal cardiac arrhythmias once
insulin therapy begins (insulin drives potassium back into cells). Ketones, hyperglycemia, and low bicarbonate are all
expected in DKA and will improve with insulin and fluids. Hypokalemia requires replacement before or during insulin
therapy.
150 Questions | Comprehensive Rationales Page 3
, NUR 2392 / MDC 2 Final Exam - Rasmussen University 2026/2027 Multidimensional Care II
Q10: A client is receiving IV insulin for DKA. The current glucose is 250 mg/dL. Which action should the
nurse anticipate?
A. Discontinue insulin infusion immediately
B. Add 5% dextrose to the IV fluids [CORRECT]
C. Increase the insulin infusion rate
D. Administer IV glucagon
Correct Answer: B
Rationale: When glucose falls to 250 mg/dL during DKA treatment, dextrose (5% D5W) should be added to IV fluids to
prevent hypoglycemia while insulin continues to clear ketones. Insulin must continue until ketones are cleared and the
anion gap closes, not stopped when glucose normalizes. Increasing insulin would cause hypoglycemia. Glucagon is used
for hypoglycemia treatment, not DKA management.
Q11: A client with type 2 diabetes presents with hyperosmolar hyperglycemic state (HHS). Glucose is 920
mg/dL, and serum osmolality is 360 mOsm/kg. Which is the priority intervention?
A. Administer IV regular insulin 25 units IV push
B. Administer 0.9% normal saline IV rapidly [CORRECT]
C. Administer IV sodium bicarbonate
D. Administer IV potassium chloride
Correct Answer: B
Rationale: In HHS, the priority is aggressive fluid resuscitation with 0.9% normal saline to correct severe dehydration
from osmotic diuresis. Clients can be 6-10 L deficient. Insulin is given after fluid replacement begins to avoid vascular
collapse from rapid intracellular fluid shifts. IV push insulin is dangerous. Sodium bicarbonate is used for severe
metabolic acidosis (not typical in HHS). Potassium replacement occurs after renal function and serum levels are assessed.
Q12: A client is diagnosed with myxedema coma. Which assessment finding is most characteristic of this
condition?
A. Tachycardia and hyperthermia
B. Hypothermia and bradycardia [CORRECT]
C. Hypertension and agitation
D. Diaphoresis and tremors
Correct Answer: B
Rationale: Myxedema coma is a life-threatening complication of severe, prolonged hypothyroidism. Classic findings
include hypothermia, bradycardia, hypoventilation, hyponatremia, and altered mental status progressing to coma due to
decreased metabolic rate. Tachycardia, hyperthermia, agitation, and tremors are manifestations of thyroid storm
(hyperthyroid crisis), the opposite endocrine emergency.
Q13: A client with adrenal insufficiency is prescribed hydrocortisone 20 mg every morning and 10 mg
every evening. The client develops a fever of 101.2°F. What is the most appropriate action?
A. Continue the normal dose and monitor temperature
B. Notify the provider; a 'stress dose' of hydrocortisone may be needed [CORRECT]
C. Hold the evening dose to prevent fever
D. Administer acetaminophen and recheck temperature
Correct Answer: B
150 Questions | Comprehensive Rationales Page 4
Final Exam - NUR 2392
Multidimensional Care II (MDC 2)
Rasmussen University | Latest Edition
Format: Multiple Choice Cognitive Levels: 25% Recall | 55%
Total Questions: 150
(A-D) Application | 20% Analysis
Content Focus: Endocrine Disorders | Cancer & Oncology | Fluid, Electrolyte & Acid-Base | Cardiovascular &
Respiratory Emergencies | Renal, GI & Hepatic | Perioperative Care | Multisystem Management | Integrated NGN
Clinical Scenarios
Aligned with 2026-2027 Rasmussen University NUR 2392 MDC 2 curriculum standards, multidimensional care competencies,
and Next-Generation NCLEX (NGN) clinical judgment framework.
SECTION 1: ENDOCRINE DISORDERS (Q1 - Q25)
Pituitary, Thyroid, Pancreas, Adrenals, Parathyroid | DI, SIADH, Graves', Hypothyroidism, Cushing, Addison, DM,
DKA, HHNS
Q1: A 42-year-old client is admitted with polyuria (8 L/day), polydipsia, and a urine specific gravity of
1.002. Serum sodium is 152 mEq/L. Which condition should the nurse suspect, and what is the priority
medication?
A. SIADH; administer tolvaptan
B. Diabetes insipidus; administer desmopressin (DDAVP) [CORRECT]
C. Diabetes mellitus; administer regular insulin
D. Addison disease; administer hydrocortisone
Correct Answer: B
Rationale: Diabetes insipidus (DI) is caused by ADH deficiency, leading to massive urine output with very dilute urine
(specific gravity <1.005) and hypernatremia from free water loss. Desmopressin (DDAVP), a synthetic ADH analog, is
the treatment of choice. SIADH presents with hyponatremia and euvolemia, the opposite presentation. Diabetes mellitus
causes glycosuria with elevated serum glucose, and Addison disease causes hyperkalemia and hypotension, not
hypernatremia.
Q2: The nurse is caring for a client with SIADH. Which finding requires immediate intervention?
A. Serum sodium 118 mEq/L with confusion [CORRECT]
B. Urine specific gravity 1.030
C. Serum sodium 135 mEq/L
D. Daily weight gain of 0.3 kg
Correct Answer: A
Rationale: In SIADH, excess ADH causes water retention leading to dilutional hyponatremia. A serum sodium of 118
mEq/L with confusion indicates severe hyponatremia with neurologic involvement - a medical emergency requiring
hypertonic saline (3% NaCl) on an infusion pump to prevent cerebral edema and seizure. Specific gravity of 1.030 is
expected in SIADH (concentrated urine). Mild weight gain and sodium of 135 mEq/L are not emergent.
150 Questions | Comprehensive Rationales Page 1
,NUR 2392 / MDC 2 Final Exam - Rasmussen University 2026/2027 Multidimensional Care II
Q3: A client with Graves' disease is admitted for thyroidectomy. Which preoperative nursing intervention
is the highest priority?
A. Administer levothyroxine as prescribed
B. Maintain a warm environment to prevent chills
C. Administer methimazole and atenolol to achieve euthyroid state [CORRECT]
D. Encourage consumption of iodine-rich foods
Correct Answer: C
Rationale: Before thyroidectomy, the client must be returned to a euthyroid state to prevent thyroid storm. Methimazole
blocks thyroid hormone synthesis, and atenolol (beta-blocker) controls tachycardia and adrenergic symptoms.
Levothyroxine is used for hypothyroidism, not hyperthyroidism. A cool environment is preferred for hyperthyroid clients
due to heat intolerance. Iodine administration (Lugol's solution) may be used briefly preoperatively but is not the primary
medication.
Q4: A client receiving levothyroxine for hypothyroidism reports fatigue, cold intolerance, and constipation.
The TSH level is 12 mIU/mL (normal 0.4-4.0). Which action by the nurse is most appropriate?
A. Instruct the client to skip the next dose
B. Notify the provider; the dose likely needs to be increased [CORRECT]
C. Document findings; this is an expected response
D. Administer an extra dose immediately
Correct Answer: B
Rationale: An elevated TSH indicates the pituitary is trying to stimulate an underactive thyroid, meaning the
levothyroxine dose is subtherapeutic. Symptoms of fatigue, cold intolerance, and constipation confirm persistent
hypothyroidism. The provider should be notified to adjust the dose upward. Skipping doses or giving extra doses without
an order is unsafe. These findings are not expected when therapy is therapeutic.
Q5: A client with Cushing syndrome is admitted. Which assessment finding requires the most immediate
follow-up?
A. Moon face and purple striae on abdomen
B. Serum glucose 285 mg/dL [CORRECT]
C. Buffalo hump on upper back
D. Weight gain of 4 lb over 2 weeks
Correct Answer: B
Rationale: Cushing syndrome involves excess cortisol, which causes hyperglycemia through gluconeogenesis and insulin
resistance. A glucose of 285 mg/dL requires immediate intervention due to risk of osmotic diuresis, dehydration, and
progression to HHS. Moon face, buffalo hump, and purple striae are classic expected findings that do not require urgent
intervention. Weight gain is also expected from cortisol-induced fluid retention.
Q6: A client with Addison disease is admitted with vomiting, abdominal pain, and hypotension (BP 84/52).
Serum sodium is 124 mEq/L and potassium is 6.2 mEq/L. Which medication should the nurse prepare to
administer first?
A. Oral fludrocortisone
B. IV hydrocortisone [CORRECT]
C. Oral levothyroxine
D. IV insulin and dextrose
150 Questions | Comprehensive Rationales Page 2
,NUR 2392 / MDC 2 Final Exam - Rasmussen University 2026/2027 Multidimensional Care II
Correct Answer: B
Rationale: This client is in acute adrenal crisis, a life-threatening condition requiring immediate IV hydrocortisone
(glucocorticoid replacement). The clinical picture of hypotension, hyponatremia, hyperkalemia, vomiting, and abdominal
pain is classic for adrenal crisis. Oral fludrocortisone is used for chronic mineralocorticoid replacement but not in acute
crisis. IV insulin/dextrose treats hyperkalemia but does not address the underlying cortisol deficiency, which is the
priority.
Q7: A client with type 1 diabetes is alert but diaphoretic, tremulous, and reports palpitations. Capillary
glucose is 48 mg/dL. Which action should the nurse take first?
A. Administer 1 mg glucagon IM
B. Administer 50 mL of 50% dextrose IV push
C. Provide 15 g of rapid-acting carbohydrates orally [CORRECT]
D. Recheck glucose in 15 minutes
Correct Answer: C
Rationale: For a conscious, alert hypoglycemic client, the priority is oral administration of 15 g of rapid-acting
carbohydrates (4 oz juice, glucose tablets). The 15/15 rule: give 15 g carbohydrate, then recheck glucose in 15 minutes.
Glucagon IM is used when the client cannot safely swallow. IV dextrose (D50W) is reserved for unresponsive clients or
those unable to take oral intake. Rechecking alone does not treat the hypoglycemia.
Q8: An unconscious client with type 1 diabetes has a capillary glucose of 32 mg/dL. IV access is
established. Which intervention is most appropriate?
A. Administer 25 g of 50% dextrose IV push [CORRECT]
B. Administer glucagon 1 mg IM
C. Apply glucose gel to buccal mucosa
D. Give 4 oz of orange juice by mouth
Correct Answer: A
Rationale: For an unresponsive hypoglycemic client with IV access, IV dextrose (D50W, 25 g) is the treatment of choice
because it rapidly raises serum glucose. Glucagon IM is an alternative when IV access is unavailable but takes 10-20
minutes to work. Oral glucose gel or juice is contraindicated in an unconscious client due to aspiration risk. This is a
medical emergency requiring immediate IV intervention.
Q9: A client with type 1 diabetes presents with Kussmaul respirations, fruity breath odor, and blood
glucose 612 mg/dL. Arterial pH is 7.22. Which finding is most concerning and indicates severe DKA?
A. Serum potassium 3.1 mEq/L [CORRECT]
B. Urine ketones 3+
C. Blood glucose 612 mg/dL
D. Serum bicarbonate 10 mEq/L
Correct Answer: A
Rationale: In DKA, potassium shifts extracellularly due to acidosis, but total body potassium is depleted from osmotic
diuresis. A serum potassium of 3.1 mEq/L indicates severe depletion that can precipitate fatal cardiac arrhythmias once
insulin therapy begins (insulin drives potassium back into cells). Ketones, hyperglycemia, and low bicarbonate are all
expected in DKA and will improve with insulin and fluids. Hypokalemia requires replacement before or during insulin
therapy.
150 Questions | Comprehensive Rationales Page 3
, NUR 2392 / MDC 2 Final Exam - Rasmussen University 2026/2027 Multidimensional Care II
Q10: A client is receiving IV insulin for DKA. The current glucose is 250 mg/dL. Which action should the
nurse anticipate?
A. Discontinue insulin infusion immediately
B. Add 5% dextrose to the IV fluids [CORRECT]
C. Increase the insulin infusion rate
D. Administer IV glucagon
Correct Answer: B
Rationale: When glucose falls to 250 mg/dL during DKA treatment, dextrose (5% D5W) should be added to IV fluids to
prevent hypoglycemia while insulin continues to clear ketones. Insulin must continue until ketones are cleared and the
anion gap closes, not stopped when glucose normalizes. Increasing insulin would cause hypoglycemia. Glucagon is used
for hypoglycemia treatment, not DKA management.
Q11: A client with type 2 diabetes presents with hyperosmolar hyperglycemic state (HHS). Glucose is 920
mg/dL, and serum osmolality is 360 mOsm/kg. Which is the priority intervention?
A. Administer IV regular insulin 25 units IV push
B. Administer 0.9% normal saline IV rapidly [CORRECT]
C. Administer IV sodium bicarbonate
D. Administer IV potassium chloride
Correct Answer: B
Rationale: In HHS, the priority is aggressive fluid resuscitation with 0.9% normal saline to correct severe dehydration
from osmotic diuresis. Clients can be 6-10 L deficient. Insulin is given after fluid replacement begins to avoid vascular
collapse from rapid intracellular fluid shifts. IV push insulin is dangerous. Sodium bicarbonate is used for severe
metabolic acidosis (not typical in HHS). Potassium replacement occurs after renal function and serum levels are assessed.
Q12: A client is diagnosed with myxedema coma. Which assessment finding is most characteristic of this
condition?
A. Tachycardia and hyperthermia
B. Hypothermia and bradycardia [CORRECT]
C. Hypertension and agitation
D. Diaphoresis and tremors
Correct Answer: B
Rationale: Myxedema coma is a life-threatening complication of severe, prolonged hypothyroidism. Classic findings
include hypothermia, bradycardia, hypoventilation, hyponatremia, and altered mental status progressing to coma due to
decreased metabolic rate. Tachycardia, hyperthermia, agitation, and tremors are manifestations of thyroid storm
(hyperthyroid crisis), the opposite endocrine emergency.
Q13: A client with adrenal insufficiency is prescribed hydrocortisone 20 mg every morning and 10 mg
every evening. The client develops a fever of 101.2°F. What is the most appropriate action?
A. Continue the normal dose and monitor temperature
B. Notify the provider; a 'stress dose' of hydrocortisone may be needed [CORRECT]
C. Hold the evening dose to prevent fever
D. Administer acetaminophen and recheck temperature
Correct Answer: B
150 Questions | Comprehensive Rationales Page 4
