NUR 2502 / NUR2502
Multidimensional Care III (MDC 3)
Final Exam Questions and Answers
Edition — Verified Answers
150 Multiple-Choice Questions with Comprehensive Rationales
Aligned with NUR 2502 MDC 3 Course Objectives
Cognitive Distribution: 25% Recall | 55% Application | 20% Analysis
Format: 80% Scenario-Based | 20% Direct Recall
1. Cardiovascular 2. Respiratory 3. Neurological 4. Renal/GU 5. Endocrine
6. GI/Hepatic 7. Heme/Onc 8. Multisystem 9. Pharmacology
Prepared for Nursing Education Use — Evidence-Based Practice Aligned
,NUR 2502 / MDC 3 Final Exam — (Verified Answers) Multidimensional Care III
NUR 2502 / NUR2502:
Multidimensional Care III (MDC 3)
Final Exam Questions and Answers — (Verified Answers)
Examination Overview. This examination contains 150 multiple-choice questions distributed
across nine content domains that reflect the NUR 2502 Multidimensional Care III curriculum.
Questions are designed to assess complex, multisystem clinical reasoning across the lifespan,
with cognitive level distribution of approximately 25% recall, 55% application, and 20% analysis.
Approximately 80% of items are scenario-based and 20% are direct recall of complex care
concepts. Each question provides four answer choices (A–D) with one correct response clearly
identified, followed by a comprehensive rationale that integrates pathophysiologic mechanisms,
current evidence-based practice standards, and next-generation NCLEX clinical judgment
principles.
Instructions for Use. This verified answer key is intended to support student preparation for
the NUR 2502 / MDC 3 final examination. Each item includes the correct answer, marked
[CORRECT], and a rationale that explains why the correct response is best while identifying the
clinical reasoning errors represented by the distractors. Review the entire stem carefully,
identify key assessment findings and laboratory values, integrate pathophysiology with
prioritization frameworks (ABC, CAB, Maslow, Survival Triggers), and confirm your
understanding against the rationale before moving to the next item.
Topic Coverage. The exam is structured into nine sections: (1) Complex Cardiovascular Care;
(2) Advanced Respiratory Care; (3) Neurological Critical Care; (4) Renal and Genitourinary
Complex Care; (5) Endocrine and Metabolic Crises; (6) Gastrointestinal and Hepatic Complex
Care; (7) Hematologic and Oncologic Care; (8) Complex Multisystem Care; and (9) Complex
Pharmacological and Parenteral Therapies. Section question ranges are indicated in each
section header.
SECTION 1: Complex Cardiovascular Care — Acute Coronary
Syndrome, Heart Failure, Cardiomyopathy, Valvular Disease,
and Cardiac Surgery (Q1–Q22)
This section evaluates the nurse's ability to integrate hemodynamic monitoring, ECG
interpretation, and cardiac output concepts into the management of acute coronary syndrome,
decompensated heart failure, cardiomyopathies, valvular dysfunction, and post–cardiac surgery
care. Prioritization using the ABC framework and recognition of life-threatening rhythms are
emphasized.
Q1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating to
the left jaw, diaphoresis, and dyspnea. The 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF with reciprocal ST depression in I and aVL. Which intervention must
the nurse anticipate FIRST to meet the door-to-reperfusion benchmark?
NUR 2502 / NUR2502 — MDC 3 Page 2
,NUR 2502 / MDC 3 Final Exam — (Verified Answers) Multidimensional Care III
A. Administer a beta-blocker intravenously to reduce myocardial oxygen demand
B. Initiate a weight-based heparin infusion and arrange for urgent cardiac
catheterization with PCI [CORRECT]
C. Administer morphine 4 mg IV push for pain control and anxiety reduction
D. Begin a nitroglycerin infusion at 10 mcg/min and titrate for chest pain
Correct Answer: B
Rationale: The ECG findings indicate an acute inferior STEMI, and current ACC/AHA guidelines
call for primary PCI within 90 minutes of first medical contact (or fibrinolytics within 30 minutes
if PCI is unavailable). The nurse should anticipate concurrent antithrombotic therapy (heparin +
P2Y12 inhibitor) and immediate transport to the cath lab. Beta-blockers are withheld in
hemodynamically unstable or acutely decompensated patients, morphine is associated with
delayed absorption of oral antiplatelets and is no longer routine first-line, and nitroglycerin is
contraindicated in inferior STEMI due to the risk of coexisting right ventricular infarction and
preload dependence.
Q2. A patient post–primary PCI for STEMI is receiving a continuous IV heparin drip. The
activated partial thromboplastin time (aPTT) returns at 110 seconds (control 30). The
patient has new oozing from the femoral sheath site. Which provider order should the nurse
implement FIRST?
A. Increase the heparin rate to keep the aPTT 1.5–2.0× control
B. Discontinue the heparin infusion and notify the provider; anticipate
protamine sulfate [CORRECT]
C. Apply a pressure dressing and continue the heparin at the current rate
D. Switch the heparin to a low-molecular-weight heparin subcutaneously
Correct Answer: B
Rationale: An aPTT of 110 seconds reflects supratherapeutic anticoagulation with active
bleeding. The safest action is to stop the infusion immediately and notify the provider; protamine
sulfate (1 mg per 100 units of heparin given in the prior 2–4 hours, max 50 mg) is the specific
reversal agent. Increasing or continuing heparin worsens bleeding, and switching to LMWH
does not address the current supratherapeutic state.
Q3. A 72-year-old female with a history of hypertension and chronic kidney disease is
admitted with acute decompensated heart failure. Hemodynamic monitoring reveals BP
84/50, HR 118, PA pressure 32/18 mmHg, PCWP 28 mmHg, CI 1.8 L/min/m², SVR 1400
dynes·s/cm⁵. Which pharmacologic strategy best addresses this patient's for low-output,
high-fill state?
A. Begin IV furosemide boluses to reduce preload and improve PCWP
B. Initiate dobutamine at 2.5 mcg/kg/min plus low-dose nitroprusside to
augment forward flow and unload the LV [CORRECT]
C. Administer 500 mL crystalloid bolus to support blood pressure
D. Start norepinephrine at 0.05 mcg/kg/min to raise SVR and perfusion pressure
Correct Answer: B
Rationale: The profile is cardiogenic shock with low cardiac index, elevated filling pressures,
and acceptable SVR. The priority is inotropic support (dobutamine) to improve contractility and
forward flow, plus an afterload reducer (nitroprusside) to decrease LV workload and PCWP.
NUR 2502 / NUR2502 — MDC 3 Page 3
, NUR 2502 / MDC 3 Final Exam — (Verified Answers) Multidimensional Care III
Furosemide alone worsens the already low preload and could precipitate collapse. Fluid bolus is
contraindicated with PCWP of 28. Norepinephrine alone raises SVR, further reducing stroke
volume in this failing ventricle.
Q4. A patient with systolic heart failure has been started on sacubitril/valsartan 49/51 mg
BID after stabilization. Which laboratory change requires the nurse to hold the next dose
and notify the provider?
A. Serum potassium of 5.0 mEq/L from a baseline of 4.3 mEq/L
B. Serum potassium of 5.9 mEq/L with a mild increase in serum creatinine
[CORRECT]
C. Serum sodium of 134 mEq/L from a baseline of 138 mEq/L
D. Mild dizziness when changing from supine to sitting position
Correct Answer: B
Rationale: Sacubitril/valsartan inhibits neprilysin and blocks the AT1 receptor, which raises
renin-aldosterone inhibition and increases potassium and creatinine. Hyperkalemia ≥5.5 mEq/L
is a contraindication to initiation or continuation and increases the risk of life-threatening
arrhythmias. A potassium of 5.0 warrants monitoring but not holding; mild hyponatremia and
transient orthostatic hypotension are common and managed symptomatically.
Q5. A patient with a biventricular pacemaker (CRT-D) is admitted for diuretic titration.
Which assessment finding most strongly suggests loss of biventricular capture that requires
interrogation of the device?
A. A widened QRS complex on the bedside monitor with a rate of 70 bpm
[CORRECT]
B. An apical rate of 64 with a paced rhythm and regular R-R intervals
C. Intermittent premature ventricular contractions during sleep
D. A patient report of mild pulsing sensation over the generator pocket
Correct Answer: A
Rationale: CRT relies on simultaneous pacing of the right and left ventricles to resynchronize
contraction; loss of left ventricular capture produces a widened QRS (typically LBBB pattern),
negating the hemodynamic benefit of the device. Paced rhythms at expected rate with narrow
QRS indicate functioning capture. PVCs and pocket sensations are not indications of capture
loss.
Q6. A 64-year-old male is admitted with hypertrophic cardiomyopathy and reports
exertional chest pain and syncope. Physical examination reveals a harsh
crescendo-decrescendo systolic murmur at the left sternal border that increases with
Valsalva. Which medication order should the nurse question?
A. Metoprolol 25 mg PO daily
B. Verapamil 80 mg PO TID
C. Lisinopril 10 mg PO daily [CORRECT]
D. Amiodarone 200 mg PO daily
Correct Answer: C
Rationale: Hypertrophic cardiomyopathy with dynamic outflow obstruction worsens with
decreased preload/afterload. Vasodilators such as ACE inhibitors, nitrates, and dihydropyridine
NUR 2502 / NUR2502 — MDC 3 Page 4
Multidimensional Care III (MDC 3)
Final Exam Questions and Answers
Edition — Verified Answers
150 Multiple-Choice Questions with Comprehensive Rationales
Aligned with NUR 2502 MDC 3 Course Objectives
Cognitive Distribution: 25% Recall | 55% Application | 20% Analysis
Format: 80% Scenario-Based | 20% Direct Recall
1. Cardiovascular 2. Respiratory 3. Neurological 4. Renal/GU 5. Endocrine
6. GI/Hepatic 7. Heme/Onc 8. Multisystem 9. Pharmacology
Prepared for Nursing Education Use — Evidence-Based Practice Aligned
,NUR 2502 / MDC 3 Final Exam — (Verified Answers) Multidimensional Care III
NUR 2502 / NUR2502:
Multidimensional Care III (MDC 3)
Final Exam Questions and Answers — (Verified Answers)
Examination Overview. This examination contains 150 multiple-choice questions distributed
across nine content domains that reflect the NUR 2502 Multidimensional Care III curriculum.
Questions are designed to assess complex, multisystem clinical reasoning across the lifespan,
with cognitive level distribution of approximately 25% recall, 55% application, and 20% analysis.
Approximately 80% of items are scenario-based and 20% are direct recall of complex care
concepts. Each question provides four answer choices (A–D) with one correct response clearly
identified, followed by a comprehensive rationale that integrates pathophysiologic mechanisms,
current evidence-based practice standards, and next-generation NCLEX clinical judgment
principles.
Instructions for Use. This verified answer key is intended to support student preparation for
the NUR 2502 / MDC 3 final examination. Each item includes the correct answer, marked
[CORRECT], and a rationale that explains why the correct response is best while identifying the
clinical reasoning errors represented by the distractors. Review the entire stem carefully,
identify key assessment findings and laboratory values, integrate pathophysiology with
prioritization frameworks (ABC, CAB, Maslow, Survival Triggers), and confirm your
understanding against the rationale before moving to the next item.
Topic Coverage. The exam is structured into nine sections: (1) Complex Cardiovascular Care;
(2) Advanced Respiratory Care; (3) Neurological Critical Care; (4) Renal and Genitourinary
Complex Care; (5) Endocrine and Metabolic Crises; (6) Gastrointestinal and Hepatic Complex
Care; (7) Hematologic and Oncologic Care; (8) Complex Multisystem Care; and (9) Complex
Pharmacological and Parenteral Therapies. Section question ranges are indicated in each
section header.
SECTION 1: Complex Cardiovascular Care — Acute Coronary
Syndrome, Heart Failure, Cardiomyopathy, Valvular Disease,
and Cardiac Surgery (Q1–Q22)
This section evaluates the nurse's ability to integrate hemodynamic monitoring, ECG
interpretation, and cardiac output concepts into the management of acute coronary syndrome,
decompensated heart failure, cardiomyopathies, valvular dysfunction, and post–cardiac surgery
care. Prioritization using the ABC framework and recognition of life-threatening rhythms are
emphasized.
Q1. A 58-year-old male presents to the ED with crushing substernal chest pain radiating to
the left jaw, diaphoresis, and dyspnea. The 12-lead ECG shows ST-segment elevation in
leads II, III, and aVF with reciprocal ST depression in I and aVL. Which intervention must
the nurse anticipate FIRST to meet the door-to-reperfusion benchmark?
NUR 2502 / NUR2502 — MDC 3 Page 2
,NUR 2502 / MDC 3 Final Exam — (Verified Answers) Multidimensional Care III
A. Administer a beta-blocker intravenously to reduce myocardial oxygen demand
B. Initiate a weight-based heparin infusion and arrange for urgent cardiac
catheterization with PCI [CORRECT]
C. Administer morphine 4 mg IV push for pain control and anxiety reduction
D. Begin a nitroglycerin infusion at 10 mcg/min and titrate for chest pain
Correct Answer: B
Rationale: The ECG findings indicate an acute inferior STEMI, and current ACC/AHA guidelines
call for primary PCI within 90 minutes of first medical contact (or fibrinolytics within 30 minutes
if PCI is unavailable). The nurse should anticipate concurrent antithrombotic therapy (heparin +
P2Y12 inhibitor) and immediate transport to the cath lab. Beta-blockers are withheld in
hemodynamically unstable or acutely decompensated patients, morphine is associated with
delayed absorption of oral antiplatelets and is no longer routine first-line, and nitroglycerin is
contraindicated in inferior STEMI due to the risk of coexisting right ventricular infarction and
preload dependence.
Q2. A patient post–primary PCI for STEMI is receiving a continuous IV heparin drip. The
activated partial thromboplastin time (aPTT) returns at 110 seconds (control 30). The
patient has new oozing from the femoral sheath site. Which provider order should the nurse
implement FIRST?
A. Increase the heparin rate to keep the aPTT 1.5–2.0× control
B. Discontinue the heparin infusion and notify the provider; anticipate
protamine sulfate [CORRECT]
C. Apply a pressure dressing and continue the heparin at the current rate
D. Switch the heparin to a low-molecular-weight heparin subcutaneously
Correct Answer: B
Rationale: An aPTT of 110 seconds reflects supratherapeutic anticoagulation with active
bleeding. The safest action is to stop the infusion immediately and notify the provider; protamine
sulfate (1 mg per 100 units of heparin given in the prior 2–4 hours, max 50 mg) is the specific
reversal agent. Increasing or continuing heparin worsens bleeding, and switching to LMWH
does not address the current supratherapeutic state.
Q3. A 72-year-old female with a history of hypertension and chronic kidney disease is
admitted with acute decompensated heart failure. Hemodynamic monitoring reveals BP
84/50, HR 118, PA pressure 32/18 mmHg, PCWP 28 mmHg, CI 1.8 L/min/m², SVR 1400
dynes·s/cm⁵. Which pharmacologic strategy best addresses this patient's for low-output,
high-fill state?
A. Begin IV furosemide boluses to reduce preload and improve PCWP
B. Initiate dobutamine at 2.5 mcg/kg/min plus low-dose nitroprusside to
augment forward flow and unload the LV [CORRECT]
C. Administer 500 mL crystalloid bolus to support blood pressure
D. Start norepinephrine at 0.05 mcg/kg/min to raise SVR and perfusion pressure
Correct Answer: B
Rationale: The profile is cardiogenic shock with low cardiac index, elevated filling pressures,
and acceptable SVR. The priority is inotropic support (dobutamine) to improve contractility and
forward flow, plus an afterload reducer (nitroprusside) to decrease LV workload and PCWP.
NUR 2502 / NUR2502 — MDC 3 Page 3
, NUR 2502 / MDC 3 Final Exam — (Verified Answers) Multidimensional Care III
Furosemide alone worsens the already low preload and could precipitate collapse. Fluid bolus is
contraindicated with PCWP of 28. Norepinephrine alone raises SVR, further reducing stroke
volume in this failing ventricle.
Q4. A patient with systolic heart failure has been started on sacubitril/valsartan 49/51 mg
BID after stabilization. Which laboratory change requires the nurse to hold the next dose
and notify the provider?
A. Serum potassium of 5.0 mEq/L from a baseline of 4.3 mEq/L
B. Serum potassium of 5.9 mEq/L with a mild increase in serum creatinine
[CORRECT]
C. Serum sodium of 134 mEq/L from a baseline of 138 mEq/L
D. Mild dizziness when changing from supine to sitting position
Correct Answer: B
Rationale: Sacubitril/valsartan inhibits neprilysin and blocks the AT1 receptor, which raises
renin-aldosterone inhibition and increases potassium and creatinine. Hyperkalemia ≥5.5 mEq/L
is a contraindication to initiation or continuation and increases the risk of life-threatening
arrhythmias. A potassium of 5.0 warrants monitoring but not holding; mild hyponatremia and
transient orthostatic hypotension are common and managed symptomatically.
Q5. A patient with a biventricular pacemaker (CRT-D) is admitted for diuretic titration.
Which assessment finding most strongly suggests loss of biventricular capture that requires
interrogation of the device?
A. A widened QRS complex on the bedside monitor with a rate of 70 bpm
[CORRECT]
B. An apical rate of 64 with a paced rhythm and regular R-R intervals
C. Intermittent premature ventricular contractions during sleep
D. A patient report of mild pulsing sensation over the generator pocket
Correct Answer: A
Rationale: CRT relies on simultaneous pacing of the right and left ventricles to resynchronize
contraction; loss of left ventricular capture produces a widened QRS (typically LBBB pattern),
negating the hemodynamic benefit of the device. Paced rhythms at expected rate with narrow
QRS indicate functioning capture. PVCs and pocket sensations are not indications of capture
loss.
Q6. A 64-year-old male is admitted with hypertrophic cardiomyopathy and reports
exertional chest pain and syncope. Physical examination reveals a harsh
crescendo-decrescendo systolic murmur at the left sternal border that increases with
Valsalva. Which medication order should the nurse question?
A. Metoprolol 25 mg PO daily
B. Verapamil 80 mg PO TID
C. Lisinopril 10 mg PO daily [CORRECT]
D. Amiodarone 200 mg PO daily
Correct Answer: C
Rationale: Hypertrophic cardiomyopathy with dynamic outflow obstruction worsens with
decreased preload/afterload. Vasodilators such as ACE inhibitors, nitrates, and dihydropyridine
NUR 2502 / NUR2502 — MDC 3 Page 4
