NUR 2356 / NUR2356:
MULTIDIMENSIONAL CARE I / MDC 1
FINAL EXAMINATION
Latest Edition | Rasmussen University
Examination: Multidimensional Care I (MDC 1) - Final Exam
Course Code: NUR 2356 / NUR2356
Institution: Rasmussen University
Total Questions: 150 (Multiple Choice, Single Best Answer)
Cognitive Mix: 20% Recall | 50% Application | 30% Analysis
Format: 75% Scenario-based | 25% Direct Knowledge
Aligned With: NCLEX-RN Test Plan, QSEN Competencies,
NUR 2356 Course Syllabus (2026/2027)
Special Inclusions: 20 Priority-Setting Questions
15 Pharmacology Questions
10 Infection Control & Safety Questions
Answer Key: Inline with Each Question (with Rationale)
This examination is designed to assess the student’s integration of nursing knowledge, clinical
reasoning, and prioritization across the eleven core domains of Multidimensional Care I. Each
question includes a rationale anchored in the NUR 2356 curriculum, NCLEX-RN test plan, and
evidence-based nursing practice.
Instructions: Select the single best answer for each question. Rationales are provided immediately
beneath each item for review and remediation.
, Section 1: Health Assessment & Physical Examination
Questions 1–15 cover the comprehensive nursing health history, focused and head-to-toe physical examination, the four cardinal
examination techniques (inspection, palpation, percussion, auscultation), system-specific findings, age-related and cultural
considerations, and documentation of assessment data.
Q1: A nurse is preparing to perform a complete physical examination on an adult client. In which sequence
should the nurse perform the four fundamental examination techniques for the abdomen?
A. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation [CORRECT]
C. Inspection, palpation, percussion, auscultation
D. Auscultation, inspection, palpation, percussion
Correct Answer: B
Rationale: For the abdomen, the correct sequence is inspection, auscultation, percussion, and palpation. Auscultation is
performed before palpation and percussion because manipulating the abdomen can alter bowel sounds and produce false
findings. For all other body systems, the typical order is inspection, palpation, percussion, and auscultation. This sequence is
consistent with the NUR 2356 health assessment curriculum and NCLEX-RN fundamentals standards.
Q2: A 68-year-old client is admitted with dehydration. During the general survey, the nurse notes the client
appears older than the stated age, skin turgor returns slowly, and mucous membranes are dry. Which action
should the nurse take next?
A. Document the findings as normal age-related changes
B. Notify the provider and request an order for IV fluids
C. Complete the head-to-toe assessment before intervening [CORRECT]
D. Encourage the client to drink 8 ounces of water immediately
Correct Answer: C
Rationale: The nurse must complete the head-to-toe assessment to gather all pertinent data before intervening. While the
findings are concerning for dehydration, intervening prematurely interrupts the systematic data collection required for an
accurate, comprehensive assessment. After assessment is complete, the nurse can prioritize notification of the provider. The
general survey is only one component; QSEN patient-centered care requires holistic data collection first.
Q3: A nurse is assigned to four clients on a medical-surgical unit. Which client should the nurse assess first?
A. A 45-year-old client 2 days postoperative with a temperature of 99.4°F (37.4°C)
B. A 72-year-old client with chronic obstructive pulmonary disease whose oxygen saturation is 91%
C. A 60-year-old client with new-onset confusion and a respiratory rate of 28 breaths/min [CORRECT]
D. A 50-year-old client requesting pain medication for incisional pain rated 6/10
Correct Answer: C
Rationale: New-onset confusion combined with tachypnea (RR 28) suggests acute cerebral hypoxia, hypoxemia, infection, or
another life-threatening change in neurologic or respiratory status. Using the ABC (Airway, Breathing, Circulation) and
acute-versus-chronic priority framework, an acute change in mental status is prioritized over stable chronic findings or
expected postoperative discomfort. The other clients have findings within expected or non-emergent ranges that allow for
later assessment.
,NUR 2356 | Multidimensional Care I | MDC 1 Final Exam (2026/2027) Rasmussen University
Q4: During a head and neck assessment, the nurse observes that the client’s thyroid gland is enlarged,
asymmetric, and has visible nodules. Which action is most appropriate?
A. Document the finding as a normal variation in older adults
B. Auscultate the thyroid for a bruit and palpate for thrills
C. Notify the healthcare provider for further evaluation of the thyroid [CORRECT]
D. Reassess the thyroid in 24 hours before reporting
Correct Answer: C
Rationale: An enlarged, asymmetric thyroid with visible nodules is an abnormal finding that may indicate a goiter, thyroid
cyst, or malignancy and requires provider evaluation, often with ultrasound and laboratory testing (TSH, free T4).
Auscultating for a bruit is appropriate only after notifying the provider if hyperthyroidism is suspected. Documenting as
normal or waiting 24 hours delays necessary evaluation and violates the nurse’s responsibility to communicate abnormal
findings promptly.
Q5: A nurse is assessing a client’s cranial nerves. Which cranial nerve is being tested when the nurse asks the
client to stick out the tongue and move it from side to side?
A. Cranial nerve V (trigeminal)
B. Cranial nerve VII (facial)
C. Cranial nerve IX (glossopharyngeal)
D. Cranial nerve XII (hypoglossal) [CORRECT]
Correct Answer: D
Rationale: Cranial nerve XII (hypoglossal) controls movement of the tongue. The nurse assesses it by asking the client to
protrude the tongue and move it side to side; deviation toward one side indicates weakness on that side (lower motor neuron
lesion). Cranial nerve V is tested through jaw clench and facial sensation; CN VII through facial expressions; CN IX through
swallowing and taste on the posterior tongue. Knowledge of cranial nerve assessment is a core neurologic assessment
competency in NUR 2356.
Q6: A nurse is performing a cardiovascular assessment on a 55-year-old client. Where should the nurse place
the stethoscope to best auscultate the mitral (apical) valve area?
A. Second intercostal space, right sternal border
B. Second intercostal space, left sternal border
C. Third intercostal space, left sternal border
D. Fifth intercostal space, midclavicular line [CORRECT]
Correct Answer: D
Rationale: The mitral area is auscultated at the fifth intercostal space at the midclavicular line (the apical impulse or point of
maximal impulse, PMI). This is the location for evaluating the mitral valve and S1 and is the recommended site for
auscultating the apical pulse for a full minute, especially when administering cardiac medications. The other options describe
the aortic, pulmonic, and Erb’s point auscultation areas respectively.
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, NUR 2356 | Multidimensional Care I | MDC 1 Final Exam (2026/2027) Rasmussen University
Q7: A nurse is caring for a 78-year-old client admitted with pneumonia. During the shift assessment, the
client becomes difficult to arouse and responds only to verbal commands after being shaken. Which action
should the nurse take first?
A. Reassess the client’s level of consciousness in 30 minutes
B. Obtain a full set of vital signs and pulse oximetry [CORRECT]
C. Document the change and notify the provider at shift change
D. Increase the client’s oral fluid intake to prevent dehydration
Correct Answer: B
Rationale: A sudden decline in level of consciousness is a critical change requiring immediate assessment of oxygenation,
perfusion, and vital signs. Obtaining a full set of vital signs including pulse oximetry allows the nurse to identify hypoxemia,
hypercapnia, hypotension, or fever that may explain the change. Delayed reassessment, documentation only, or fluids without
assessment fail to address the urgent physiologic concern and may delay life-saving interventions.
Q8: A nurse is assessing a client’s abdomen and notes high-pitched, tinkling bowel sounds in all four
quadrants. The client reports abdominal pain and vomiting. How should the nurse interpret these findings?
A. Normal findings; no further action needed
B. Hypoactive bowels indicating paralytic ileus
C. Hyperactive bowels indicating early intestinal obstruction [CORRECT]
D. A surgical abdomen requiring immediate surgical consult
Correct Answer: C
Rationale: High-pitched, tinkling, or rushing bowel sounds are characteristic of hyperactive or obstructed bowel, often
associated with early intestinal obstruction as the intestine attempts to push contents past a blockage. The accompanying
symptoms of abdominal pain and vomiting further support an obstructive process. The nurse should notify the provider and
prepare for imaging (abdominal x-ray or CT). Hypoactive or absent sounds occur with paralytic ileus or peritonitis.
Q9: Which percussion sound is normally heard when percussing a healthy adult lung field?
A. Tympany
B. Resonance [CORRECT]
C. Hyperresonance
D. Dullness
Correct Answer: B
Rationale: Normal lung tissue produces a resonant percussion sound—a low-pitched, clear, hollow tone. Tympany is heard
over air-filled viscera such as the stomach; hyperresonance is heard over hyperinflated lungs (emphysema) or
pneumothorax; dullness is heard over solid tissue such as the liver or fluid-filled spaces (pleural effusion). Differentiating
percussion sounds is essential for accurate respiratory assessment per NUR 2356 curriculum.
Confidential - For Educational Use Page 4
MULTIDIMENSIONAL CARE I / MDC 1
FINAL EXAMINATION
Latest Edition | Rasmussen University
Examination: Multidimensional Care I (MDC 1) - Final Exam
Course Code: NUR 2356 / NUR2356
Institution: Rasmussen University
Total Questions: 150 (Multiple Choice, Single Best Answer)
Cognitive Mix: 20% Recall | 50% Application | 30% Analysis
Format: 75% Scenario-based | 25% Direct Knowledge
Aligned With: NCLEX-RN Test Plan, QSEN Competencies,
NUR 2356 Course Syllabus (2026/2027)
Special Inclusions: 20 Priority-Setting Questions
15 Pharmacology Questions
10 Infection Control & Safety Questions
Answer Key: Inline with Each Question (with Rationale)
This examination is designed to assess the student’s integration of nursing knowledge, clinical
reasoning, and prioritization across the eleven core domains of Multidimensional Care I. Each
question includes a rationale anchored in the NUR 2356 curriculum, NCLEX-RN test plan, and
evidence-based nursing practice.
Instructions: Select the single best answer for each question. Rationales are provided immediately
beneath each item for review and remediation.
, Section 1: Health Assessment & Physical Examination
Questions 1–15 cover the comprehensive nursing health history, focused and head-to-toe physical examination, the four cardinal
examination techniques (inspection, palpation, percussion, auscultation), system-specific findings, age-related and cultural
considerations, and documentation of assessment data.
Q1: A nurse is preparing to perform a complete physical examination on an adult client. In which sequence
should the nurse perform the four fundamental examination techniques for the abdomen?
A. Palpation, percussion, auscultation, inspection
B. Inspection, auscultation, percussion, palpation [CORRECT]
C. Inspection, palpation, percussion, auscultation
D. Auscultation, inspection, palpation, percussion
Correct Answer: B
Rationale: For the abdomen, the correct sequence is inspection, auscultation, percussion, and palpation. Auscultation is
performed before palpation and percussion because manipulating the abdomen can alter bowel sounds and produce false
findings. For all other body systems, the typical order is inspection, palpation, percussion, and auscultation. This sequence is
consistent with the NUR 2356 health assessment curriculum and NCLEX-RN fundamentals standards.
Q2: A 68-year-old client is admitted with dehydration. During the general survey, the nurse notes the client
appears older than the stated age, skin turgor returns slowly, and mucous membranes are dry. Which action
should the nurse take next?
A. Document the findings as normal age-related changes
B. Notify the provider and request an order for IV fluids
C. Complete the head-to-toe assessment before intervening [CORRECT]
D. Encourage the client to drink 8 ounces of water immediately
Correct Answer: C
Rationale: The nurse must complete the head-to-toe assessment to gather all pertinent data before intervening. While the
findings are concerning for dehydration, intervening prematurely interrupts the systematic data collection required for an
accurate, comprehensive assessment. After assessment is complete, the nurse can prioritize notification of the provider. The
general survey is only one component; QSEN patient-centered care requires holistic data collection first.
Q3: A nurse is assigned to four clients on a medical-surgical unit. Which client should the nurse assess first?
A. A 45-year-old client 2 days postoperative with a temperature of 99.4°F (37.4°C)
B. A 72-year-old client with chronic obstructive pulmonary disease whose oxygen saturation is 91%
C. A 60-year-old client with new-onset confusion and a respiratory rate of 28 breaths/min [CORRECT]
D. A 50-year-old client requesting pain medication for incisional pain rated 6/10
Correct Answer: C
Rationale: New-onset confusion combined with tachypnea (RR 28) suggests acute cerebral hypoxia, hypoxemia, infection, or
another life-threatening change in neurologic or respiratory status. Using the ABC (Airway, Breathing, Circulation) and
acute-versus-chronic priority framework, an acute change in mental status is prioritized over stable chronic findings or
expected postoperative discomfort. The other clients have findings within expected or non-emergent ranges that allow for
later assessment.
,NUR 2356 | Multidimensional Care I | MDC 1 Final Exam (2026/2027) Rasmussen University
Q4: During a head and neck assessment, the nurse observes that the client’s thyroid gland is enlarged,
asymmetric, and has visible nodules. Which action is most appropriate?
A. Document the finding as a normal variation in older adults
B. Auscultate the thyroid for a bruit and palpate for thrills
C. Notify the healthcare provider for further evaluation of the thyroid [CORRECT]
D. Reassess the thyroid in 24 hours before reporting
Correct Answer: C
Rationale: An enlarged, asymmetric thyroid with visible nodules is an abnormal finding that may indicate a goiter, thyroid
cyst, or malignancy and requires provider evaluation, often with ultrasound and laboratory testing (TSH, free T4).
Auscultating for a bruit is appropriate only after notifying the provider if hyperthyroidism is suspected. Documenting as
normal or waiting 24 hours delays necessary evaluation and violates the nurse’s responsibility to communicate abnormal
findings promptly.
Q5: A nurse is assessing a client’s cranial nerves. Which cranial nerve is being tested when the nurse asks the
client to stick out the tongue and move it from side to side?
A. Cranial nerve V (trigeminal)
B. Cranial nerve VII (facial)
C. Cranial nerve IX (glossopharyngeal)
D. Cranial nerve XII (hypoglossal) [CORRECT]
Correct Answer: D
Rationale: Cranial nerve XII (hypoglossal) controls movement of the tongue. The nurse assesses it by asking the client to
protrude the tongue and move it side to side; deviation toward one side indicates weakness on that side (lower motor neuron
lesion). Cranial nerve V is tested through jaw clench and facial sensation; CN VII through facial expressions; CN IX through
swallowing and taste on the posterior tongue. Knowledge of cranial nerve assessment is a core neurologic assessment
competency in NUR 2356.
Q6: A nurse is performing a cardiovascular assessment on a 55-year-old client. Where should the nurse place
the stethoscope to best auscultate the mitral (apical) valve area?
A. Second intercostal space, right sternal border
B. Second intercostal space, left sternal border
C. Third intercostal space, left sternal border
D. Fifth intercostal space, midclavicular line [CORRECT]
Correct Answer: D
Rationale: The mitral area is auscultated at the fifth intercostal space at the midclavicular line (the apical impulse or point of
maximal impulse, PMI). This is the location for evaluating the mitral valve and S1 and is the recommended site for
auscultating the apical pulse for a full minute, especially when administering cardiac medications. The other options describe
the aortic, pulmonic, and Erb’s point auscultation areas respectively.
Confidential - For Educational Use Page 3
, NUR 2356 | Multidimensional Care I | MDC 1 Final Exam (2026/2027) Rasmussen University
Q7: A nurse is caring for a 78-year-old client admitted with pneumonia. During the shift assessment, the
client becomes difficult to arouse and responds only to verbal commands after being shaken. Which action
should the nurse take first?
A. Reassess the client’s level of consciousness in 30 minutes
B. Obtain a full set of vital signs and pulse oximetry [CORRECT]
C. Document the change and notify the provider at shift change
D. Increase the client’s oral fluid intake to prevent dehydration
Correct Answer: B
Rationale: A sudden decline in level of consciousness is a critical change requiring immediate assessment of oxygenation,
perfusion, and vital signs. Obtaining a full set of vital signs including pulse oximetry allows the nurse to identify hypoxemia,
hypercapnia, hypotension, or fever that may explain the change. Delayed reassessment, documentation only, or fluids without
assessment fail to address the urgent physiologic concern and may delay life-saving interventions.
Q8: A nurse is assessing a client’s abdomen and notes high-pitched, tinkling bowel sounds in all four
quadrants. The client reports abdominal pain and vomiting. How should the nurse interpret these findings?
A. Normal findings; no further action needed
B. Hypoactive bowels indicating paralytic ileus
C. Hyperactive bowels indicating early intestinal obstruction [CORRECT]
D. A surgical abdomen requiring immediate surgical consult
Correct Answer: C
Rationale: High-pitched, tinkling, or rushing bowel sounds are characteristic of hyperactive or obstructed bowel, often
associated with early intestinal obstruction as the intestine attempts to push contents past a blockage. The accompanying
symptoms of abdominal pain and vomiting further support an obstructive process. The nurse should notify the provider and
prepare for imaging (abdominal x-ray or CT). Hypoactive or absent sounds occur with paralytic ileus or peritonitis.
Q9: Which percussion sound is normally heard when percussing a healthy adult lung field?
A. Tympany
B. Resonance [CORRECT]
C. Hyperresonance
D. Dullness
Correct Answer: B
Rationale: Normal lung tissue produces a resonant percussion sound—a low-pitched, clear, hollow tone. Tympany is heard
over air-filled viscera such as the stomach; hyperresonance is heard over hyperinflated lungs (emphysema) or
pneumothorax; dullness is heard over solid tissue such as the liver or fluid-filled spaces (pleural effusion). Differentiating
percussion sounds is essential for accurate respiratory assessment per NUR 2356 curriculum.
Confidential - For Educational Use Page 4
