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MDC 2 FINAL COMPREHENSIVE EXAM 2026/2027 |
MULTIDIMENSIONAL CARE II – RASMUSSEN COLLEGE |
EXPERT VERIFIED | 100 QUESTIONS & COMPLETE
RATIONALES | PASS GUARANTEED - A+ GRADED
SECTION 1: FLUID, ELECTROLYTE & ACID-BASE IMBALANCES (Questions 1-10)
Q1: The nurse is reviewing arterial blood gas (ABG) results for a patient with diabetic ketoacidosis (DKA): pH
7.22, PaCO₂ 32 mmHg, HCO₃⁻ 14 mEq/L. Which acid-base imbalance is present?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: C
Rationale: DKA causes metabolic acidosis from ketone body accumulation. pH 7.22 is low, and HCO₃⁻ 14
mEq/L is low (metabolic cause). The low PaCO₂ 32 mmHg indicates respiratory compensation (Kussmaul
respirations). This is uncompensated metabolic acidosis. Key teaching point: DKA causes metabolic acidosis
with respiratory compensation (Kussmaul respirations); monitor for anion gap and treat with insulin and
fluids.
Q2: A patient with prolonged vomiting is at risk for which acid-base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: D
Rationale: Prolonged vomiting causes loss of hydrochloric acid (HCl) from the stomach, leading to metabolic
alkalosis. The body compensates by hypoventilating (retaining CO₂) but the primary imbalance is metabolic
alkalosis. This is accompanied by hypokalemia and hypochloremia. Key teaching point: Prolonged vomiting
→ metabolic alkalosis from loss of gastric HCl; monitor for hypokalemia and hypochloremia.
Q3: A patient with chronic obstructive pulmonary disease (COPD) has an ABG result of pH 7.34, PaCO₂ 58
mmHg, HCO₃⁻ 32 mEq/L. What does the HCO₃⁻ value indicate?
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A. No compensation is occurring
B. Renal compensation for respiratory acidosis
C. The patient has metabolic alkalosis
D. The patient has respiratory alkalosis
Correct Answer: B
Rationale: The elevated HCO₃⁻ (32 mEq/L) indicates renal compensation for chronic respiratory acidosis. In
chronic CO₂ retention, the kidneys retain HCO₃⁻ to buffer the acid load. pH remains below normal (7.34)
despite compensation, confirming respiratory acidosis. Key teaching point: In chronic respiratory acidosis,
renal compensation elevates HCO₃⁻; pH remains low despite compensation.
Q4: A patient with hyperkalemia (K⁺ 6.8 mEq/L) is experiencing cardiac arrhythmias. Which medication
should the nurse administer first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Calcium gluconate
C. Regular insulin and 50% dextrose
D. Furosemide
Correct Answer: B
Rationale: Calcium gluconate is administered first to stabilize the cardiac membrane and prevent life-
threatening arrhythmias in severe hyperkalemia (K⁺ >6.5 mEq/L). Insulin and dextrose shift potassium into
cells. Kayexalate removes potassium from the body but takes hours to work. Furosemide promotes potassium
excretion. Key teaching point: Calcium gluconate is given first in severe hyperkalemia to protect the heart;
insulin/dextrose shifts potassium into cells; Kayexalate removes it slowly.
Q5: A patient with hypokalemia (K⁺ 2.8 mEq/L) is receiving IV potassium replacement. Which action is
appropriate?
A. Administer IV push over 2-5 minutes
B. Administer IV infusion at 40 mEq/hour
C. Administer IV infusion at 10 mEq/hour
D. Administer IM injection
Correct Answer: C
Rationale: IV potassium should be infused slowly at a rate of 10-20 mEq/hour to prevent hyperkalemia and
cardiac arrhythmias. IV push is contraindicated. 40 mEq/hour is too fast. IM injection is not appropriate. Key
teaching point: IV potassium should be infused at-20 ≤10mEq/hour; IV push is contraindicated; monitor
ECG.
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Q6: A patient with SIADH (syndrome of inappropriate antidiuretic hormone) is at risk for which electrolyte
imbalance?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Correct Answer: B
Rationale: SIADH causes excessive ADH release, leading to water retention and dilutional hyponatremia. The
patient has hypervolemia with low serum sodium. Treatment includes fluid restriction and hypertonic saline
if severe. Key teaching point: SIADH causes dilutional hyponatremia; treatment includes fluid restriction;
monitor for seizures and cerebral edema.
Q7: The nurse is assessing a patient with fluid volume deficit (dehydration). Which finding is consistent with
this condition?
A. Bounding pulse
B. Jugular venous distention
C. Orthostatic hypotension
D. Crackles in the lungs
Correct Answer: C
Rationale: Orthostatic hypotension (decreased blood pressure when standing) and tachycardia are signs of
fluid volume deficit. Bounding pulse, JVD, and crackles are signs of fluid volume excess. Key teaching point:
Orthostatic hypotension and tachycardia indicate fluid volume deficit; monitor I&O, skin turgor, and daily
weights.
Q8: A patient with heart failure and fluid overload is prescribed furosemide. Which assessment finding
indicates the medication is effective?
A. Increased dyspnea
B. Weight gain
C. Decreased edema
D. Increased JVD
Correct Answer: C
Rationale: Furosemide is a loop diuretic that reduces fluid volume. Decreased edema indicates the medication
is effective. Increased dyspnea, weight gain, and increased JVD indicate worsening fluid overload. Key
teaching point: Effective diuresis is indicated by decreased edema, weight loss, and decreased dyspnea;
monitor daily weights and I&O.
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Q9: A patient with hyponatremia (Na⁺ 122 mEq/L) is at risk for which complication?
A. Seizures
B. Hypotension
C. Cardiac arrhythmias
D. All of the above
Correct Answer: D
Rationale: Severe hyponatremia (Na⁺ <125 mEq/L) can cause seizures, hypotension, cardiac arrhythmias, and
cerebral edema. All of these are potential complications. Treatment includes fluid restriction and hypertonic
saline if severe. Key teaching point: Hyponatremia can cause seizures, hypotension, and cardiac
arrhythmias; monitor neuro status and serum sodium closely.
Q10: A patient with hypernatremia (Na⁺ 158 mEq/L) is at risk for which complication?
A. Fluid overload
B. Cerebral edema
C. Hypovolemia
D. Seizures from fluid shifts
Correct Answer: D
Rationale: Hypernatremia causes water to shift out of cells, leading to cellular dehydration. In the brain, this
can cause seizures, confusion, and coma. Treatment includes hypotonic fluids and correction of the
underlying cause. Key teaching point: Hypernatremia causes cellular dehydration; monitor for confusion,
seizures, and coma; correct slowly to avoid cerebral edema.
SECTION 2: CARDIOVASCULAR & RESPIRATORY DISORDERS (Questions 11-25)
Q11: A patient with heart failure is prescribed furosemide and digoxin. Which laboratory value should the
nurse monitor closely to prevent digoxin toxicity?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Rationale: Furosemide causes potassium wasting. Hypokalemia increases the risk of digoxin toxicity. The
nurse should monitor serum potassium levels closely and report levels below 3.5 mEq/L. Key teaching point:
Monitor potassium levels in patients taking digoxin and diuretics; hypokalemia increases digoxin toxicity
risk.
MDC 2 FINAL COMPREHENSIVE EXAM 2026/2027 |
MULTIDIMENSIONAL CARE II – RASMUSSEN COLLEGE |
EXPERT VERIFIED | 100 QUESTIONS & COMPLETE
RATIONALES | PASS GUARANTEED - A+ GRADED
SECTION 1: FLUID, ELECTROLYTE & ACID-BASE IMBALANCES (Questions 1-10)
Q1: The nurse is reviewing arterial blood gas (ABG) results for a patient with diabetic ketoacidosis (DKA): pH
7.22, PaCO₂ 32 mmHg, HCO₃⁻ 14 mEq/L. Which acid-base imbalance is present?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: C
Rationale: DKA causes metabolic acidosis from ketone body accumulation. pH 7.22 is low, and HCO₃⁻ 14
mEq/L is low (metabolic cause). The low PaCO₂ 32 mmHg indicates respiratory compensation (Kussmaul
respirations). This is uncompensated metabolic acidosis. Key teaching point: DKA causes metabolic acidosis
with respiratory compensation (Kussmaul respirations); monitor for anion gap and treat with insulin and
fluids.
Q2: A patient with prolonged vomiting is at risk for which acid-base imbalance?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Correct Answer: D
Rationale: Prolonged vomiting causes loss of hydrochloric acid (HCl) from the stomach, leading to metabolic
alkalosis. The body compensates by hypoventilating (retaining CO₂) but the primary imbalance is metabolic
alkalosis. This is accompanied by hypokalemia and hypochloremia. Key teaching point: Prolonged vomiting
→ metabolic alkalosis from loss of gastric HCl; monitor for hypokalemia and hypochloremia.
Q3: A patient with chronic obstructive pulmonary disease (COPD) has an ABG result of pH 7.34, PaCO₂ 58
mmHg, HCO₃⁻ 32 mEq/L. What does the HCO₃⁻ value indicate?
,2
A. No compensation is occurring
B. Renal compensation for respiratory acidosis
C. The patient has metabolic alkalosis
D. The patient has respiratory alkalosis
Correct Answer: B
Rationale: The elevated HCO₃⁻ (32 mEq/L) indicates renal compensation for chronic respiratory acidosis. In
chronic CO₂ retention, the kidneys retain HCO₃⁻ to buffer the acid load. pH remains below normal (7.34)
despite compensation, confirming respiratory acidosis. Key teaching point: In chronic respiratory acidosis,
renal compensation elevates HCO₃⁻; pH remains low despite compensation.
Q4: A patient with hyperkalemia (K⁺ 6.8 mEq/L) is experiencing cardiac arrhythmias. Which medication
should the nurse administer first?
A. Sodium polystyrene sulfonate (Kayexalate)
B. Calcium gluconate
C. Regular insulin and 50% dextrose
D. Furosemide
Correct Answer: B
Rationale: Calcium gluconate is administered first to stabilize the cardiac membrane and prevent life-
threatening arrhythmias in severe hyperkalemia (K⁺ >6.5 mEq/L). Insulin and dextrose shift potassium into
cells. Kayexalate removes potassium from the body but takes hours to work. Furosemide promotes potassium
excretion. Key teaching point: Calcium gluconate is given first in severe hyperkalemia to protect the heart;
insulin/dextrose shifts potassium into cells; Kayexalate removes it slowly.
Q5: A patient with hypokalemia (K⁺ 2.8 mEq/L) is receiving IV potassium replacement. Which action is
appropriate?
A. Administer IV push over 2-5 minutes
B. Administer IV infusion at 40 mEq/hour
C. Administer IV infusion at 10 mEq/hour
D. Administer IM injection
Correct Answer: C
Rationale: IV potassium should be infused slowly at a rate of 10-20 mEq/hour to prevent hyperkalemia and
cardiac arrhythmias. IV push is contraindicated. 40 mEq/hour is too fast. IM injection is not appropriate. Key
teaching point: IV potassium should be infused at-20 ≤10mEq/hour; IV push is contraindicated; monitor
ECG.
,3
Q6: A patient with SIADH (syndrome of inappropriate antidiuretic hormone) is at risk for which electrolyte
imbalance?
A. Hypernatremia
B. Hyponatremia
C. Hyperkalemia
D. Hypocalcemia
Correct Answer: B
Rationale: SIADH causes excessive ADH release, leading to water retention and dilutional hyponatremia. The
patient has hypervolemia with low serum sodium. Treatment includes fluid restriction and hypertonic saline
if severe. Key teaching point: SIADH causes dilutional hyponatremia; treatment includes fluid restriction;
monitor for seizures and cerebral edema.
Q7: The nurse is assessing a patient with fluid volume deficit (dehydration). Which finding is consistent with
this condition?
A. Bounding pulse
B. Jugular venous distention
C. Orthostatic hypotension
D. Crackles in the lungs
Correct Answer: C
Rationale: Orthostatic hypotension (decreased blood pressure when standing) and tachycardia are signs of
fluid volume deficit. Bounding pulse, JVD, and crackles are signs of fluid volume excess. Key teaching point:
Orthostatic hypotension and tachycardia indicate fluid volume deficit; monitor I&O, skin turgor, and daily
weights.
Q8: A patient with heart failure and fluid overload is prescribed furosemide. Which assessment finding
indicates the medication is effective?
A. Increased dyspnea
B. Weight gain
C. Decreased edema
D. Increased JVD
Correct Answer: C
Rationale: Furosemide is a loop diuretic that reduces fluid volume. Decreased edema indicates the medication
is effective. Increased dyspnea, weight gain, and increased JVD indicate worsening fluid overload. Key
teaching point: Effective diuresis is indicated by decreased edema, weight loss, and decreased dyspnea;
monitor daily weights and I&O.
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Q9: A patient with hyponatremia (Na⁺ 122 mEq/L) is at risk for which complication?
A. Seizures
B. Hypotension
C. Cardiac arrhythmias
D. All of the above
Correct Answer: D
Rationale: Severe hyponatremia (Na⁺ <125 mEq/L) can cause seizures, hypotension, cardiac arrhythmias, and
cerebral edema. All of these are potential complications. Treatment includes fluid restriction and hypertonic
saline if severe. Key teaching point: Hyponatremia can cause seizures, hypotension, and cardiac
arrhythmias; monitor neuro status and serum sodium closely.
Q10: A patient with hypernatremia (Na⁺ 158 mEq/L) is at risk for which complication?
A. Fluid overload
B. Cerebral edema
C. Hypovolemia
D. Seizures from fluid shifts
Correct Answer: D
Rationale: Hypernatremia causes water to shift out of cells, leading to cellular dehydration. In the brain, this
can cause seizures, confusion, and coma. Treatment includes hypotonic fluids and correction of the
underlying cause. Key teaching point: Hypernatremia causes cellular dehydration; monitor for confusion,
seizures, and coma; correct slowly to avoid cerebral edema.
SECTION 2: CARDIOVASCULAR & RESPIRATORY DISORDERS (Questions 11-25)
Q11: A patient with heart failure is prescribed furosemide and digoxin. Which laboratory value should the
nurse monitor closely to prevent digoxin toxicity?
A. Serum sodium
B. Serum potassium
C. Serum calcium
D. Serum magnesium
Correct Answer: B
Rationale: Furosemide causes potassium wasting. Hypokalemia increases the risk of digoxin toxicity. The
nurse should monitor serum potassium levels closely and report levels below 3.5 mEq/L. Key teaching point:
Monitor potassium levels in patients taking digoxin and diuretics; hypokalemia increases digoxin toxicity
risk.
