NUR2755 / NUR 2755 EXAM 1 | Multidimensional Care IV (MDC 4) | Rasmussen University
RASMUSSEN UNIVERSITY | NUR 2755 | MULTIDIMENSIONAL CARE IV (MDC 4)
NUR2755 / NUR 2755 EXAM 1 (LATEST ):
MULTIDIMENSIONAL CARE IV / MDC 4 - RASMUSSEN
Comprehensive Examination | 120 Questions | Sections 1-8 | NCLEX-RN Test Plan Aligned | Complete Answer Key with
Rationales
Section 1: Complex Cardiovascular & Hematological Disorders (Questions 1-20)
Q1: A 62-year-old female client with type 2 diabetes arrives at the emergency department reporting 3 hours
of progressive fatigue, shortness of breath, and "indigestion." She denies any chest pain. Which assessment
finding should the nurse recognize as most suggestive of an acute myocardial infarction?
A. Blood pressure 118/74 mm Hg with a regular apical pulse of 76/min
B. Complete relief of symptoms after taking an over-the-counter antacid
C. Diaphoresis, pallor, and new bibasilar crackles on auscultation [CORRECT]
D. Oral temperature 37.2 C (99 F) with a productive cough of yellow sputum
Correct Answer: C
Rationale: Women and clients with diabetes frequently present with atypical MI symptoms such as fatigue, dyspnea,
and epigastric discomfort without chest pain; sympathetic activation causes diaphoresis and pallor, and acute left
ventricular dysfunction produces pulmonary congestion with crackles. Antacid relief points to a gastrointestinal cause,
and unremarkable vital signs are nonspecific for MI. Fever with purulent sputum suggests an infectious respiratory
process instead.
Q2: A 66-year-old male client arrives at the emergency department with acute substernal chest pressure that
began 45 minutes ago. Laboratory studies are drawn on arrival. Which result should the nurse report to the
provider immediately?
A. Troponin I of 4.2 ng/mL (reference range less than 0.04 ng/mL) [CORRECT]
B. B-type natriuretic peptide of 480 pg/mL
C. White blood cell count of 12,000/mm3
D. Potassium of 4.2 mEq/L
Correct Answer: A
Rationale: Troponin I is the most specific serum marker of myocardial injury, and a markedly elevated level in a
client with active chest pain indicates an acute MI that mandates immediate activation of the reperfusion pathway.
Mild BNP elevation can reflect ventricular strain and mild leukocytosis commonly accompanies physiologic stress,
but neither takes priority over the troponin. The potassium value is within normal limits.
1
,NUR2755 / NUR 2755 EXAM 1 | Multidimensional Care IV (MDC 4) | Rasmussen University
Q3: A 54-year-old male client reports chest pain unrelieved by nitroglycerin. The 12-lead ECG shows
ST-segment elevation in leads II, III, and aVF, blood pressure is 142/88 mm Hg, and SpO2 is 95% on room
air. Which action should the nurse take first?
A. Administer IV morphine as prescribed for pain control
B. Obtain serial troponin levels at 0 and 3 hours
C. Apply transcutaneous pacing pads to the client's chest
D. Activate the cardiac catheterization team for emergent percutaneous coronary intervention
[CORRECT]
Correct Answer: D
Rationale: ST-elevation MI requires urgent reperfusion with a door-to-balloon goal of 90 minutes or less, so
activating the catheterization team is the time-critical first action. Morphine and serial troponins are appropriate
supportive measures but must never delay reperfusion, and troponin results are not required to activate the STEMI
pathway. Pacing pads are unnecessary because the client has no bradycardia or heart block.
Q4: A 74-year-old female client admitted with acute decompensated heart failure is receiving IV
furosemide 40 mg every 12 hours. Which assessment finding 24 hours after admission indicates the
treatment is producing the desired effect?
A. Weight gain of 1 kg (2.2 lb) with increasing peripheral edema
B. Weight loss of 1.5 kg (3.3 lb) with decreased crackles in both lung bases [CORRECT]
C. Decreased urine output with dark amber concentrated urine
D. Jugular venous distention increased from 6 to 9 cm above the sternal angle
Correct Answer: B
Rationale: Loop diuretics promote sodium and water excretion, so a therapeutic response is demonstrated by
increased urine output, daily weight loss, and clearing of pulmonary crackles as preload and pulmonary congestion
decrease. Continued weight gain, worsening edema, falling urine output, and rising jugular venous distention all
indicate persistent fluid volume excess and an inadequate diuretic response.
2
,NUR2755 / NUR 2755 EXAM 1 | Multidimensional Care IV (MDC 4) | Rasmussen University
Q5: Two hours after admission for an acute MI, a 60-year-old male client's blood pressure drops to 84/52
mm Hg, heart rate rises to 118/min, and urine output falls to 15 mL/hr with cool, clammy skin. Which
additional finding should the nurse anticipate that distinguishes cardiogenic shock from hypovolemic
shock?
A. Flat neck veins with poor skin turgor
B. Dry mucous membranes with weak, thready peripheral pulses
C. Distended neck veins with worsening pulmonary crackles [CORRECT]
D. Bounding peripheral pulses with warm, flushed skin
Correct Answer: C
Rationale: In cardiogenic shock, pump failure causes blood to back up into the pulmonary and systemic venous
circulations, producing high filling pressures, distended neck veins, and pulmonary crackles. Flat neck veins, dry
mucous membranes, and thready pulses characterize hypovolemic shock from volume loss, while bounding pulses
with warm, flushed skin describe early septic or distributive shock.
Q6: A 55-year-old female client with heart failure is newly prescribed lisinopril 10 mg daily at the
cardiology clinic. Which instruction is most important for the nurse to include in the discharge teaching?
A. Report swelling of the lips, face, or tongue to the provider immediately [CORRECT]
B. Increase intake of potassium-rich foods such as bananas and orange juice
C. Stop taking the medication if dizziness occurs after the first dose
D. Use an over-the-counter NSAID such as ibuprofen for joint pain
Correct Answer: A
Rationale: Angioedema of the lips, face, or tongue is a potentially life-threatening adverse effect of ACE inhibitors
that can obstruct the airway and requires emergency care, so clients must report it immediately. ACE inhibitors
promote potassium retention, so increasing potassium intake is unsafe, dizziness should be reported rather than
prompting abrupt discontinuation, and NSAIDs impair renal perfusion and reduce the effectiveness of ACE
inhibitors.
Q7: A 70-year-old male client with new-onset atrial fibrillation and a ventricular rate of 138/min is
receiving an IV diltiazem infusion on the telemetry unit. Which assessment finding during the infusion
requires immediate notification of the provider?
A. Apical pulse 88/min with an irregularly irregular rhythm
B. Blood pressure decrease from 128/78 to 106/68 mm Hg
C. Client report that palpitations have improved
D. Systolic blood pressure of 78 mm Hg with an apical pulse of 48/min [CORRECT]
Correct Answer: D
Rationale: Diltiazem slows AV nodal conduction, and severe hypotension with bradycardia indicates excessive
calcium channel blockade requiring immediate discontinuation of the infusion and provider notification. A rate near
88/min with an irregularly irregular rhythm reflects effective rate control, a modest blood pressure decline is an
anticipated effect, and improved palpitations signal a therapeutic response.
3
, NUR2755 / NUR 2755 EXAM 1 | Multidimensional Care IV (MDC 4) | Rasmussen University
Q8: The nurse should recognize that defibrillation differs from synchronized cardioversion in that
defibrillation:
A. Uses lower energy levels and does not require client sedation
B. Delivers a shock not timed to the R wave and is indicated for ventricular fibrillation and pulseless
ventricular tachycardia [CORRECT]
C. Is the treatment of choice for stable atrial fibrillation with rapid ventricular response
D. Requires the synchronize button to be activated before shock delivery
Correct Answer: B
Rationale: Defibrillation delivers an unsynchronized shock at a random point in the cardiac cycle and is the treatment
for pulseless lethal rhythms such as ventricular fibrillation and pulseless ventricular tachycardia. Synchronized
cardioversion times the shock to the R wave to avoid inducing ventricular fibrillation during the vulnerable T wave
and is used for unstable tachydysrhythmias with a pulse, such as atrial fibrillation, typically requiring higher energy,
sedation, and activation of the sync function.
Q9: A 45-year-old client with an implanted cardioverter-defibrillator (ICD) is found unresponsive and
apneic, and the telemetry monitor shows ventricular fibrillation. The ICD has not discharged. Which action
should the nurse take first?
A. Call the rapid response team and wait at the bedside for its arrival
B. Administer IV amiodarone as prescribed
C. Initiate CPR and prepare to defibrillate the client [CORRECT]
D. Obtain a manual blood pressure to confirm the monitor reading
Correct Answer: C
Rationale: Ventricular fibrillation produces no cardiac output, and immediate high-quality CPR with external
defibrillation is the only intervention that can restore an organized rhythm; an ICD that fails to fire must be
overridden with manual defibrillation. Waiting for the rapid response team or confirming the rhythm with a blood
pressure wastes critical seconds, and antidysrhythmics such as amiodarone are given after defibrillation attempts, not
instead of them.
4
RASMUSSEN UNIVERSITY | NUR 2755 | MULTIDIMENSIONAL CARE IV (MDC 4)
NUR2755 / NUR 2755 EXAM 1 (LATEST ):
MULTIDIMENSIONAL CARE IV / MDC 4 - RASMUSSEN
Comprehensive Examination | 120 Questions | Sections 1-8 | NCLEX-RN Test Plan Aligned | Complete Answer Key with
Rationales
Section 1: Complex Cardiovascular & Hematological Disorders (Questions 1-20)
Q1: A 62-year-old female client with type 2 diabetes arrives at the emergency department reporting 3 hours
of progressive fatigue, shortness of breath, and "indigestion." She denies any chest pain. Which assessment
finding should the nurse recognize as most suggestive of an acute myocardial infarction?
A. Blood pressure 118/74 mm Hg with a regular apical pulse of 76/min
B. Complete relief of symptoms after taking an over-the-counter antacid
C. Diaphoresis, pallor, and new bibasilar crackles on auscultation [CORRECT]
D. Oral temperature 37.2 C (99 F) with a productive cough of yellow sputum
Correct Answer: C
Rationale: Women and clients with diabetes frequently present with atypical MI symptoms such as fatigue, dyspnea,
and epigastric discomfort without chest pain; sympathetic activation causes diaphoresis and pallor, and acute left
ventricular dysfunction produces pulmonary congestion with crackles. Antacid relief points to a gastrointestinal cause,
and unremarkable vital signs are nonspecific for MI. Fever with purulent sputum suggests an infectious respiratory
process instead.
Q2: A 66-year-old male client arrives at the emergency department with acute substernal chest pressure that
began 45 minutes ago. Laboratory studies are drawn on arrival. Which result should the nurse report to the
provider immediately?
A. Troponin I of 4.2 ng/mL (reference range less than 0.04 ng/mL) [CORRECT]
B. B-type natriuretic peptide of 480 pg/mL
C. White blood cell count of 12,000/mm3
D. Potassium of 4.2 mEq/L
Correct Answer: A
Rationale: Troponin I is the most specific serum marker of myocardial injury, and a markedly elevated level in a
client with active chest pain indicates an acute MI that mandates immediate activation of the reperfusion pathway.
Mild BNP elevation can reflect ventricular strain and mild leukocytosis commonly accompanies physiologic stress,
but neither takes priority over the troponin. The potassium value is within normal limits.
1
,NUR2755 / NUR 2755 EXAM 1 | Multidimensional Care IV (MDC 4) | Rasmussen University
Q3: A 54-year-old male client reports chest pain unrelieved by nitroglycerin. The 12-lead ECG shows
ST-segment elevation in leads II, III, and aVF, blood pressure is 142/88 mm Hg, and SpO2 is 95% on room
air. Which action should the nurse take first?
A. Administer IV morphine as prescribed for pain control
B. Obtain serial troponin levels at 0 and 3 hours
C. Apply transcutaneous pacing pads to the client's chest
D. Activate the cardiac catheterization team for emergent percutaneous coronary intervention
[CORRECT]
Correct Answer: D
Rationale: ST-elevation MI requires urgent reperfusion with a door-to-balloon goal of 90 minutes or less, so
activating the catheterization team is the time-critical first action. Morphine and serial troponins are appropriate
supportive measures but must never delay reperfusion, and troponin results are not required to activate the STEMI
pathway. Pacing pads are unnecessary because the client has no bradycardia or heart block.
Q4: A 74-year-old female client admitted with acute decompensated heart failure is receiving IV
furosemide 40 mg every 12 hours. Which assessment finding 24 hours after admission indicates the
treatment is producing the desired effect?
A. Weight gain of 1 kg (2.2 lb) with increasing peripheral edema
B. Weight loss of 1.5 kg (3.3 lb) with decreased crackles in both lung bases [CORRECT]
C. Decreased urine output with dark amber concentrated urine
D. Jugular venous distention increased from 6 to 9 cm above the sternal angle
Correct Answer: B
Rationale: Loop diuretics promote sodium and water excretion, so a therapeutic response is demonstrated by
increased urine output, daily weight loss, and clearing of pulmonary crackles as preload and pulmonary congestion
decrease. Continued weight gain, worsening edema, falling urine output, and rising jugular venous distention all
indicate persistent fluid volume excess and an inadequate diuretic response.
2
,NUR2755 / NUR 2755 EXAM 1 | Multidimensional Care IV (MDC 4) | Rasmussen University
Q5: Two hours after admission for an acute MI, a 60-year-old male client's blood pressure drops to 84/52
mm Hg, heart rate rises to 118/min, and urine output falls to 15 mL/hr with cool, clammy skin. Which
additional finding should the nurse anticipate that distinguishes cardiogenic shock from hypovolemic
shock?
A. Flat neck veins with poor skin turgor
B. Dry mucous membranes with weak, thready peripheral pulses
C. Distended neck veins with worsening pulmonary crackles [CORRECT]
D. Bounding peripheral pulses with warm, flushed skin
Correct Answer: C
Rationale: In cardiogenic shock, pump failure causes blood to back up into the pulmonary and systemic venous
circulations, producing high filling pressures, distended neck veins, and pulmonary crackles. Flat neck veins, dry
mucous membranes, and thready pulses characterize hypovolemic shock from volume loss, while bounding pulses
with warm, flushed skin describe early septic or distributive shock.
Q6: A 55-year-old female client with heart failure is newly prescribed lisinopril 10 mg daily at the
cardiology clinic. Which instruction is most important for the nurse to include in the discharge teaching?
A. Report swelling of the lips, face, or tongue to the provider immediately [CORRECT]
B. Increase intake of potassium-rich foods such as bananas and orange juice
C. Stop taking the medication if dizziness occurs after the first dose
D. Use an over-the-counter NSAID such as ibuprofen for joint pain
Correct Answer: A
Rationale: Angioedema of the lips, face, or tongue is a potentially life-threatening adverse effect of ACE inhibitors
that can obstruct the airway and requires emergency care, so clients must report it immediately. ACE inhibitors
promote potassium retention, so increasing potassium intake is unsafe, dizziness should be reported rather than
prompting abrupt discontinuation, and NSAIDs impair renal perfusion and reduce the effectiveness of ACE
inhibitors.
Q7: A 70-year-old male client with new-onset atrial fibrillation and a ventricular rate of 138/min is
receiving an IV diltiazem infusion on the telemetry unit. Which assessment finding during the infusion
requires immediate notification of the provider?
A. Apical pulse 88/min with an irregularly irregular rhythm
B. Blood pressure decrease from 128/78 to 106/68 mm Hg
C. Client report that palpitations have improved
D. Systolic blood pressure of 78 mm Hg with an apical pulse of 48/min [CORRECT]
Correct Answer: D
Rationale: Diltiazem slows AV nodal conduction, and severe hypotension with bradycardia indicates excessive
calcium channel blockade requiring immediate discontinuation of the infusion and provider notification. A rate near
88/min with an irregularly irregular rhythm reflects effective rate control, a modest blood pressure decline is an
anticipated effect, and improved palpitations signal a therapeutic response.
3
, NUR2755 / NUR 2755 EXAM 1 | Multidimensional Care IV (MDC 4) | Rasmussen University
Q8: The nurse should recognize that defibrillation differs from synchronized cardioversion in that
defibrillation:
A. Uses lower energy levels and does not require client sedation
B. Delivers a shock not timed to the R wave and is indicated for ventricular fibrillation and pulseless
ventricular tachycardia [CORRECT]
C. Is the treatment of choice for stable atrial fibrillation with rapid ventricular response
D. Requires the synchronize button to be activated before shock delivery
Correct Answer: B
Rationale: Defibrillation delivers an unsynchronized shock at a random point in the cardiac cycle and is the treatment
for pulseless lethal rhythms such as ventricular fibrillation and pulseless ventricular tachycardia. Synchronized
cardioversion times the shock to the R wave to avoid inducing ventricular fibrillation during the vulnerable T wave
and is used for unstable tachydysrhythmias with a pulse, such as atrial fibrillation, typically requiring higher energy,
sedation, and activation of the sync function.
Q9: A 45-year-old client with an implanted cardioverter-defibrillator (ICD) is found unresponsive and
apneic, and the telemetry monitor shows ventricular fibrillation. The ICD has not discharged. Which action
should the nurse take first?
A. Call the rapid response team and wait at the bedside for its arrival
B. Administer IV amiodarone as prescribed
C. Initiate CPR and prepare to defibrillate the client [CORRECT]
D. Obtain a manual blood pressure to confirm the monitor reading
Correct Answer: C
Rationale: Ventricular fibrillation produces no cardiac output, and immediate high-quality CPR with external
defibrillation is the only intervention that can restore an organized rhythm; an ICD that fails to fire must be
overridden with manual defibrillation. Waiting for the rapid response team or confirming the rhythm with a blood
pressure wastes critical seconds, and antidysrhythmics such as amiodarone are given after defibrillation attempts, not
instead of them.
4
