FINAL EXAM
NUR2392 / NUR 2392 (Latest )
MULTIDIMENSIONAL CARE II / MDC 2
Rasmussen University
Aligned with NUR 2392 Course Syllabus • NCLEX-RN Test Plan • QSEN Competencies
150 Questions | Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis | Includes 20 Priority-Setting, 15
Pharmacology, and 10 Lab Interpretation Items
Section 1: Perioperative Nursing
Q1: A 67-year-old male client is scheduled for an elective cholecystectomy. Which of the following findings
during the preoperative assessment should the nurse report to the surgeon immediately before proceeding with
surgery?
A. Hemoglobin of 13.2 g/dL
B. International Normalized Ratio (INR) of 3.2 *[CORRECT]*
C. Blood pressure of 128/76 mmHg
D. Platelet count of 220,000/mm³
Correct Answer: B
Rationale: An INR of 3.2 indicates a significant coagulopathy that drastically increases the risk of intraoperative and
postoperative hemorrhage. Normal INR is approximately 0.8-1.2; a value above 1.5 in a non-anticoagulated patient, or
above the therapeutic range in anticoagulated patients, requires surgical postponement and correction. The hemoglobin,
blood pressure, and platelet count listed are within acceptable perioperative ranges per NUR 2392 preoperative screening
standards and NCLEX-RN Safe and Effective Care Environment domain.
Q2: The nurse is preparing to witness the informed consent for a 54-year-old female scheduled for a total
abdominal hysterectomy. The client received midazolam (Versed) 2 mg IV for anxiety 15 minutes ago. What is
the most appropriate nursing action?
A. Proceed with obtaining the consent since the client is calm
B. Notify the surgeon that the consent cannot be obtained at this time *[CORRECT]*
C. Ask the client to sign the consent with a witness present
D. Wait 30 minutes and then proceed with consent
Correct Answer: B
Rationale: Midazolam is a benzodiazepine that impairs cognition and judgment, invalidating informed consent. The nurse
has an ethical and legal obligation to notify the surgeon so consent is obtained before sedation is administered or after the
medication effects have fully resolved (typically 4-6 hours). Proceeding with consent while the client is sedated violates the
ethical principle of autonomy and constitutes battery per NUR 2392 perioperative nursing standards and the ANA Code of
Ethics.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 1
,Q3: A client is brought to the PACU following general anesthesia with endotracheal intubation. The nurse
assesses an oxygen saturation of 88%, weak respiratory effort, and an end-tidal CO₂ of 58 mmHg. Which
intervention should the nurse implement first?
A. Administer naloxone 0.4 mg IV push
B. Apply a non-rebreather mask at 15 L/min
C. Ventilate with a bag-valve-mask at 100% oxygen *[CORRECT]*
D. Suction the oropharynx and reposition the airway
Correct Answer: C
Rationale: The client is exhibiting hypoventilation and respiratory depression secondary to general anesthesia. The priority
action using the ABC framework is to ventilate with a bag-valve-mask delivering 100% oxygen, which both oxygenates and
provides positive pressure ventilation to eliminate CO₂. Naloxone reverses opioids, not general anesthetics. A
non-rebreather does not address hypoventilation, and suction/repositioning alone will not correct the underlying
respiratory depression per PACU Phase I recovery standards.
Q4: A postoperative client who underwent an open colectomy 24 hours ago reports sudden chest pain, dyspnea,
and a respiratory rate of 32/min. The nurse notes a heart rate of 122/min and an SpO₂ of 90% on room air.
Which complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism *[CORRECT]*
C. Wound dehiscence
D. Paralytic ileus
Correct Answer: B
Rationale: The classic triad of pulmonary embolism includes sudden onset dyspnea, chest pain, and tachycardia, often with
hypoxemia. Postoperative immobility and venous stasis place the client at high risk for DVT and subsequent PE within
24-72 hours of surgery. Atelectasis typically presents with low-grade fever and crackles without the acute severe dyspnea;
wound dehiscence presents with serosanguineous drainage; paralytic ileus presents with abdominal distension and absent
bowel sounds.
Q5: A client is 4 hours postoperative following an abdominal hernia repair. The nurse notes 75 mL of bright red
blood in the Jackson-Pratt drain within the last hour, and the dressing is saturated. What is the priority nursing
action?
A. Reinforce the dressing and document the findings
B. Notify the surgeon immediately *[CORRECT]*
C. Apply direct pressure to the incision site
D. Increase the IV fluid rate and reassess in 15 minutes
Correct Answer: B
Rationale: Bright red blood exceeding 100 mL/hr in surgical drains, or sudden hemorrhage through the dressing, indicates
active postoperative hemorrhage — a surgical emergency. The nurse must notify the surgeon immediately while monitoring
vital signs, IV access, and preparing for potential return to surgery. Simply reinforcing the dressing delays intervention;
applying pressure may disrupt the surgical site; increasing IV fluids without surgeon notification masks hypovolemia per
NUR 2392 hemorrhage management protocols.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 2
,Q6: The nurse is preparing a client for surgery who has been taking prednisone 20 mg daily for rheumatoid
arthritis for the past 3 years. Which perioperative consideration is most critical?
A. Discontinue the prednisone 24 hours before surgery
B. Administer an additional dose of prednisone IV before surgery *[CORRECT]*
C. Monitor for hypoglycemia during surgery
D. Place the client on strict intake and output measurement
Correct Answer: B
Rationale: Long-term corticosteroid therapy suppresses the hypothalamic-pituitary-adrenal (HPA) axis, preventing the
normal stress response to surgery and increasing the risk of acute adrenal crisis. Perioperative 'stress-dose' steroids (such
as IV hydrocortisone) must be administered to prevent life-threatening adrenal insufficiency. Abrupt discontinuation can
precipitate Addisonian crisis. Steroids cause hyperglycemia, not hypoglycemia, and strict I&O; is routine but not the
priority.
Q7: A client in the PACU has just been extubated. The nurse assesses stridor, suprasternal retractions, and a
hoarse voice. Which action should the nurse take first?
A. Administer racemic epinephrine via nebulizer
B. Prepare for emergency reintubation *[CORRECT]*
C. Suction the airway to clear secretions
D. Position the client in high Fowler's
Correct Answer: B
Rationale: Stridor, suprasternal retractions, and hoarseness following extubation indicate laryngeal edema — a
life-threatening airway emergency. While racemic epinephrine may reduce edema, the priority is to ensure a patent airway
by preparing for emergency reintubation per ABC prioritization. Suction will not address edema, and repositioning alone is
insufficient for an obstructed airway. This represents the NUR 2392 NCLEX-RN airway-priority framework.
Q8: Which of the following clients is at the highest risk for developing postoperative wound dehiscence?
A. A 45-year-old with a laparoscopic appendectomy
B. A 62-year-old obese male with chronic cough following bowel resection *[CORRECT]*
C. A 28-year-old female with a cesarean section
D. A 70-year-old with a hip replacement
Correct Answer: B
Rationale: Wound dehiscence risk factors include obesity, advanced age, poor nutrition, chronic cough (increases
intra-abdominal pressure), and emergency surgery. The 62-year-old obese male with chronic cough following an open
bowel resection presents the greatest combination of risk factors. Laparoscopic procedures have smaller incisions and
lower risk; cesarean and hip replacement are different surgical sites with less tension. Dehiscence typically occurs 5-8 days
postoperatively when collagen deposition is incomplete.
Q9: A client asks the nurse about the purpose of using an incentive spirometer postoperatively. Which response
by the nurse is most appropriate?
A. It prevents blood clots from forming in your legs
B. It helps expand your lungs and prevent pneumonia *[CORRECT]*
C. It reduces swelling at the incision site
D. It improves circulation to your surgical wound
Correct Answer: B
Rationale: Incentive spirometry promotes sustained maximal inspiration, preventing alveolar collapse (atelectasis) and
reducing the risk of postoperative pneumonia — common complications due to anesthesia, immobility, and pain-splinting.
Sequential compression devices prevent DVT, not incentive spirometry. The other options describe unrelated purposes. The
client should perform 10 breaths per hour while awake per NUR 2392 perioperative patient education standards.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 3
, Q10: A client who underwent a total knee replacement 12 hours ago reports a pain level of 8/10. The client has
orders for morphine 4 mg IV q4h PRN and acetaminophen 650 mg PO q6h PRN. Which action is most
appropriate?
A. Administer only acetaminophen to avoid opioid side effects
B. Administer morphine 4 mg IV as ordered *[CORRECT]*
C. Wait until pain reaches 10/10 before administering morphine
D. Administer half the morphine dose to test tolerance
Correct Answer: B
Rationale: Adequate postoperative pain management is essential for early ambulation, deep breathing, and prevention of
complications. The ordered morphine dose is appropriate for severe pain. Withholding opioids, delaying treatment until
pain reaches 10/10, or altering the dose without provider order violates pain management principles and the Joint
Commission pain standards. Around-the-clock multimodal analgesia is the NUR 2392 standard.
Q11: A client returns from surgery with a Penrose drain in place. Which nursing action is appropriate for this
type of drain?
A. Connect the drain to low continuous suction
B. Apply a sterile safety pin to the end of the drain *[CORRECT]*
C. Empty the drainage container every shift
D. Irrigate the drain with normal saline q8h
Correct Answer: B
Rationale: A Penrose drain is an open, passive drain that relies on gravity and capillary action. A safety pin is placed
through the distal end to prevent it from slipping into the wound. Penrose drains do not have suction, do not have a closed
collection container to empty, and are not typically irrigated. The pin must remain in place until the surgeon advances or
removes the drain per NUR 2392 drain management protocol.
Q12: The nurse is caring for a client who received spinal anesthesia for a cesarean section. The client suddenly
complains of a severe headache when sitting up to breastfeed. Which nursing intervention is most appropriate?
A. Administer acetaminophen 650 mg PO
B. Keep the client flat in bed and notify the provider *[CORRECT]*
C. Encourage ambulation to relieve the headache
D. Apply a cold compress to the forehead
Correct Answer: B
Rationale: A post-dural puncture headache (spinal headache) results from CSF leakage at the puncture site, causing
traction on meninges when the client sits or stands. Treatment includes keeping the client flat, hydration, caffeine, and
possibly an epidural blood patch. Acetaminophen alone is insufficient, ambulation worsens symptoms, and cold compresses
do not address the underlying cause. This is a hallmark NUR 2392 regional anesthesia complication.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 4
NUR2392 / NUR 2392 (Latest )
MULTIDIMENSIONAL CARE II / MDC 2
Rasmussen University
Aligned with NUR 2392 Course Syllabus • NCLEX-RN Test Plan • QSEN Competencies
150 Questions | Cognitive Distribution: 20% Recall, 50% Application, 30% Analysis | Includes 20 Priority-Setting, 15
Pharmacology, and 10 Lab Interpretation Items
Section 1: Perioperative Nursing
Q1: A 67-year-old male client is scheduled for an elective cholecystectomy. Which of the following findings
during the preoperative assessment should the nurse report to the surgeon immediately before proceeding with
surgery?
A. Hemoglobin of 13.2 g/dL
B. International Normalized Ratio (INR) of 3.2 *[CORRECT]*
C. Blood pressure of 128/76 mmHg
D. Platelet count of 220,000/mm³
Correct Answer: B
Rationale: An INR of 3.2 indicates a significant coagulopathy that drastically increases the risk of intraoperative and
postoperative hemorrhage. Normal INR is approximately 0.8-1.2; a value above 1.5 in a non-anticoagulated patient, or
above the therapeutic range in anticoagulated patients, requires surgical postponement and correction. The hemoglobin,
blood pressure, and platelet count listed are within acceptable perioperative ranges per NUR 2392 preoperative screening
standards and NCLEX-RN Safe and Effective Care Environment domain.
Q2: The nurse is preparing to witness the informed consent for a 54-year-old female scheduled for a total
abdominal hysterectomy. The client received midazolam (Versed) 2 mg IV for anxiety 15 minutes ago. What is
the most appropriate nursing action?
A. Proceed with obtaining the consent since the client is calm
B. Notify the surgeon that the consent cannot be obtained at this time *[CORRECT]*
C. Ask the client to sign the consent with a witness present
D. Wait 30 minutes and then proceed with consent
Correct Answer: B
Rationale: Midazolam is a benzodiazepine that impairs cognition and judgment, invalidating informed consent. The nurse
has an ethical and legal obligation to notify the surgeon so consent is obtained before sedation is administered or after the
medication effects have fully resolved (typically 4-6 hours). Proceeding with consent while the client is sedated violates the
ethical principle of autonomy and constitutes battery per NUR 2392 perioperative nursing standards and the ANA Code of
Ethics.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 1
,Q3: A client is brought to the PACU following general anesthesia with endotracheal intubation. The nurse
assesses an oxygen saturation of 88%, weak respiratory effort, and an end-tidal CO₂ of 58 mmHg. Which
intervention should the nurse implement first?
A. Administer naloxone 0.4 mg IV push
B. Apply a non-rebreather mask at 15 L/min
C. Ventilate with a bag-valve-mask at 100% oxygen *[CORRECT]*
D. Suction the oropharynx and reposition the airway
Correct Answer: C
Rationale: The client is exhibiting hypoventilation and respiratory depression secondary to general anesthesia. The priority
action using the ABC framework is to ventilate with a bag-valve-mask delivering 100% oxygen, which both oxygenates and
provides positive pressure ventilation to eliminate CO₂. Naloxone reverses opioids, not general anesthetics. A
non-rebreather does not address hypoventilation, and suction/repositioning alone will not correct the underlying
respiratory depression per PACU Phase I recovery standards.
Q4: A postoperative client who underwent an open colectomy 24 hours ago reports sudden chest pain, dyspnea,
and a respiratory rate of 32/min. The nurse notes a heart rate of 122/min and an SpO₂ of 90% on room air.
Which complication should the nurse suspect?
A. Atelectasis
B. Pulmonary embolism *[CORRECT]*
C. Wound dehiscence
D. Paralytic ileus
Correct Answer: B
Rationale: The classic triad of pulmonary embolism includes sudden onset dyspnea, chest pain, and tachycardia, often with
hypoxemia. Postoperative immobility and venous stasis place the client at high risk for DVT and subsequent PE within
24-72 hours of surgery. Atelectasis typically presents with low-grade fever and crackles without the acute severe dyspnea;
wound dehiscence presents with serosanguineous drainage; paralytic ileus presents with abdominal distension and absent
bowel sounds.
Q5: A client is 4 hours postoperative following an abdominal hernia repair. The nurse notes 75 mL of bright red
blood in the Jackson-Pratt drain within the last hour, and the dressing is saturated. What is the priority nursing
action?
A. Reinforce the dressing and document the findings
B. Notify the surgeon immediately *[CORRECT]*
C. Apply direct pressure to the incision site
D. Increase the IV fluid rate and reassess in 15 minutes
Correct Answer: B
Rationale: Bright red blood exceeding 100 mL/hr in surgical drains, or sudden hemorrhage through the dressing, indicates
active postoperative hemorrhage — a surgical emergency. The nurse must notify the surgeon immediately while monitoring
vital signs, IV access, and preparing for potential return to surgery. Simply reinforcing the dressing delays intervention;
applying pressure may disrupt the surgical site; increasing IV fluids without surgeon notification masks hypovolemia per
NUR 2392 hemorrhage management protocols.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 2
,Q6: The nurse is preparing a client for surgery who has been taking prednisone 20 mg daily for rheumatoid
arthritis for the past 3 years. Which perioperative consideration is most critical?
A. Discontinue the prednisone 24 hours before surgery
B. Administer an additional dose of prednisone IV before surgery *[CORRECT]*
C. Monitor for hypoglycemia during surgery
D. Place the client on strict intake and output measurement
Correct Answer: B
Rationale: Long-term corticosteroid therapy suppresses the hypothalamic-pituitary-adrenal (HPA) axis, preventing the
normal stress response to surgery and increasing the risk of acute adrenal crisis. Perioperative 'stress-dose' steroids (such
as IV hydrocortisone) must be administered to prevent life-threatening adrenal insufficiency. Abrupt discontinuation can
precipitate Addisonian crisis. Steroids cause hyperglycemia, not hypoglycemia, and strict I&O; is routine but not the
priority.
Q7: A client in the PACU has just been extubated. The nurse assesses stridor, suprasternal retractions, and a
hoarse voice. Which action should the nurse take first?
A. Administer racemic epinephrine via nebulizer
B. Prepare for emergency reintubation *[CORRECT]*
C. Suction the airway to clear secretions
D. Position the client in high Fowler's
Correct Answer: B
Rationale: Stridor, suprasternal retractions, and hoarseness following extubation indicate laryngeal edema — a
life-threatening airway emergency. While racemic epinephrine may reduce edema, the priority is to ensure a patent airway
by preparing for emergency reintubation per ABC prioritization. Suction will not address edema, and repositioning alone is
insufficient for an obstructed airway. This represents the NUR 2392 NCLEX-RN airway-priority framework.
Q8: Which of the following clients is at the highest risk for developing postoperative wound dehiscence?
A. A 45-year-old with a laparoscopic appendectomy
B. A 62-year-old obese male with chronic cough following bowel resection *[CORRECT]*
C. A 28-year-old female with a cesarean section
D. A 70-year-old with a hip replacement
Correct Answer: B
Rationale: Wound dehiscence risk factors include obesity, advanced age, poor nutrition, chronic cough (increases
intra-abdominal pressure), and emergency surgery. The 62-year-old obese male with chronic cough following an open
bowel resection presents the greatest combination of risk factors. Laparoscopic procedures have smaller incisions and
lower risk; cesarean and hip replacement are different surgical sites with less tension. Dehiscence typically occurs 5-8 days
postoperatively when collagen deposition is incomplete.
Q9: A client asks the nurse about the purpose of using an incentive spirometer postoperatively. Which response
by the nurse is most appropriate?
A. It prevents blood clots from forming in your legs
B. It helps expand your lungs and prevent pneumonia *[CORRECT]*
C. It reduces swelling at the incision site
D. It improves circulation to your surgical wound
Correct Answer: B
Rationale: Incentive spirometry promotes sustained maximal inspiration, preventing alveolar collapse (atelectasis) and
reducing the risk of postoperative pneumonia — common complications due to anesthesia, immobility, and pain-splinting.
Sequential compression devices prevent DVT, not incentive spirometry. The other options describe unrelated purposes. The
client should perform 10 breaths per hour while awake per NUR 2392 perioperative patient education standards.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 3
, Q10: A client who underwent a total knee replacement 12 hours ago reports a pain level of 8/10. The client has
orders for morphine 4 mg IV q4h PRN and acetaminophen 650 mg PO q6h PRN. Which action is most
appropriate?
A. Administer only acetaminophen to avoid opioid side effects
B. Administer morphine 4 mg IV as ordered *[CORRECT]*
C. Wait until pain reaches 10/10 before administering morphine
D. Administer half the morphine dose to test tolerance
Correct Answer: B
Rationale: Adequate postoperative pain management is essential for early ambulation, deep breathing, and prevention of
complications. The ordered morphine dose is appropriate for severe pain. Withholding opioids, delaying treatment until
pain reaches 10/10, or altering the dose without provider order violates pain management principles and the Joint
Commission pain standards. Around-the-clock multimodal analgesia is the NUR 2392 standard.
Q11: A client returns from surgery with a Penrose drain in place. Which nursing action is appropriate for this
type of drain?
A. Connect the drain to low continuous suction
B. Apply a sterile safety pin to the end of the drain *[CORRECT]*
C. Empty the drainage container every shift
D. Irrigate the drain with normal saline q8h
Correct Answer: B
Rationale: A Penrose drain is an open, passive drain that relies on gravity and capillary action. A safety pin is placed
through the distal end to prevent it from slipping into the wound. Penrose drains do not have suction, do not have a closed
collection container to empty, and are not typically irrigated. The pin must remain in place until the surgeon advances or
removes the drain per NUR 2392 drain management protocol.
Q12: The nurse is caring for a client who received spinal anesthesia for a cesarean section. The client suddenly
complains of a severe headache when sitting up to breastfeed. Which nursing intervention is most appropriate?
A. Administer acetaminophen 650 mg PO
B. Keep the client flat in bed and notify the provider *[CORRECT]*
C. Encourage ambulation to relieve the headache
D. Apply a cold compress to the forehead
Correct Answer: B
Rationale: A post-dural puncture headache (spinal headache) results from CSF leakage at the puncture site, causing
traction on meninges when the client sits or stands. Treatment includes keeping the client flat, hydration, caffeine, and
possibly an epidural blood patch. Acetaminophen alone is insufficient, ambulation worsens symptoms, and cold compresses
do not address the underlying cause. This is a hallmark NUR 2392 regional anesthesia complication.
NUR 2392 Multidimensional Care II — Final Exam (2026/2027 Edition) | Page 4
