,NUR 2392 / NUR 2392 Exam 1 —
Multidimensional Care II (MDC II) | Rasmussen
University | 2026/2027 Exam Prep + Q&A +
Detailed Rationales
Q1. A client receiving chemotherapy for breast cancer has a white blood cell count of
1,800/mm³ and a temperature of 100.8°F. Which action should the nurse take first?
A. Administer acetaminophen for fever
B. Obtain blood cultures and notify the provider
C. Encourage the client to increase oral fluids
D. Place the client in a private room and implement neutropenic precautions
Correct Answer: B. Obtain blood cultures and notify the provider
Rationale: The client has neutropenia (absolute neutrophil count below 1,500/mm³) and a
fever, which indicates possible neutropenic sepsis, a life-threatening emergency. The priority
is to obtain blood cultures before administering antibiotics and to notify the provider
immediately. Administering acetaminophen masks the fever and delays diagnosis.
Encouraging fluids is supportive but not the priority. Placing the client in a private room and
implementing neutropenic precautions is appropriate but does not take precedence over
obtaining cultures and notifying the provider. The nurse should also monitor for signs of
infection and administer antibiotics as prescribed.
Key Takeaway: Fever in a neutropenic client requires immediate blood cultures and provider
notification for suspected sepsis.
Q2. A client with syndrome of inappropriate antidiuretic hormone has a serum sodium level
of 118 mEq/L and is confused. Which action should the nurse take first?
A. Administer 0.9% sodium chloride IV bolus
B. Restrict fluid intake
C. Monitor neurologic status and seizure precautions
D. Administer 3% sodium chloride IV as prescribed
,Correct Answer: C. Monitor neurologic status and seizure precautions
Rationale: Severe hyponatremia (serum sodium below 120 mEq/L) can cause cerebral edema,
seizures, and coma. The priority is to monitor neurologic status and implement seizure
precautions. Administering 0.9% sodium chloride is not appropriate for SIADH because it can
worsen hyponatremia. Fluid restriction is a treatment for SIADH but is not the first action
during acute neurologic deterioration. Hypertonic saline (3%) may be prescribed but requires
careful monitoring and is not the initial nursing action. The nurse should also monitor serum
sodium levels closely.
Key Takeaway: Severe hyponatremia requires immediate neurologic monitoring and seizure
precautions.
Q3. A client with a peptic ulcer suddenly develops severe abdominal pain, a rigid board-like
abdomen, and absent bowel sounds. Which action should the nurse take first?
A. Administer a PRN antacid
B. Prepare the client for emergency surgery
C. Insert a nasogastric tube
D. Obtain an abdominal x-ray
Correct Answer: B. Prepare the client for emergency surgery
Rationale: The client is exhibiting signs of a perforated peptic ulcer with chemical peritonitis,
which requires emergency surgical intervention. The nurse should prepare the client for
surgery immediately. Administering an antacid does not address the perforation. Inserting a
nasogastric tube may be part of preoperative preparation but is not the first action. Obtaining
an abdominal x-ray confirms the diagnosis but should not delay surgical preparation. The
nurse should also maintain NPO status and administer IV fluids and antibiotics as prescribed.
Key Takeaway: A rigid board-like abdomen with sudden severe pain indicates perforated
peptic ulcer and requires emergency surgery.
Q4. A client with type 1 diabetes mellitus is admitted with a blood glucose of 520 mg/dL, pH
7.22, HCO₃⁻ 12 mEq/L, and positive serum ketones. Which pathophysiologic process is
primarily responsible for this client's acid-base imbalance?
A. Excessive bicarbonate retention by the kidneys
, B. Increased ketone body production from uncontrolled lipolysis
C. Hypoventilation from respiratory muscle fatigue
D. Lactic acid accumulation from anaerobic metabolism
Correct Answer: B. Increased ketone body production from uncontrolled lipolysis
Rationale: The client is in diabetic ketoacidosis (DKA), characterized by severe hyperglycemia,
metabolic acidosis (low pH, low HCO₃⁻), and positive ketones. In DKA, absolute insulin
deficiency causes uncontrolled lipolysis, producing large quantities of ketone bodies
(acetoacetic acid and beta-hydroxybutyric acid), which are strong acids that consume
bicarbonate buffers. Excessive bicarbonate retention would cause metabolic alkalosis, not
acidosis. Hypoventilation would cause respiratory acidosis with an elevated PaCO₂. Lactic
acidosis occurs with tissue hypoperfusion, not primarily in DKA. The nurse should expect to
administer IV fluids, insulin, and potassium as prescribed.
Key Takeaway: DKA causes metabolic acidosis from excessive ketone body production due to
absolute insulin deficiency.
Q5. A client with cirrhosis has a serum ammonia level of 186 mcg/dL and increasing
confusion. The nurse understands that which pathophysiologic process is primarily
responsible for this client's neurologic symptoms?
A. Decreased cerebral perfusion from portal hypertension
B. Accumulation of ammonia in the brain from impaired hepatic conversion
C. Hypoglycemia from decreased hepatic gluconeogenesis
D. Hyponatremia from fluid shifts into the peritoneal cavity
Correct Answer: B. Accumulation of ammonia in the brain from impaired hepatic conversion
Rationale: Hepatic encephalopathy occurs when the damaged liver cannot convert ammonia
to urea for renal excretion. Ammonia accumulates in the bloodstream and crosses the blood-
brain barrier, where it interferes with neurotransmission and cerebral energy metabolism,
causing confusion, asterixis, and eventually coma. Decreased cerebral perfusion from portal
hypertension is not the primary mechanism. Hypoglycemia and hyponatremia can occur in
cirrhosis but are not the primary cause of encephalopathy. The nurse should administer
lactulose as prescribed to reduce ammonia absorption.
Key Takeaway: Hepatic encephalopathy is caused by ammonia accumulation due to impaired
hepatic conversion to urea.
Multidimensional Care II (MDC II) | Rasmussen
University | 2026/2027 Exam Prep + Q&A +
Detailed Rationales
Q1. A client receiving chemotherapy for breast cancer has a white blood cell count of
1,800/mm³ and a temperature of 100.8°F. Which action should the nurse take first?
A. Administer acetaminophen for fever
B. Obtain blood cultures and notify the provider
C. Encourage the client to increase oral fluids
D. Place the client in a private room and implement neutropenic precautions
Correct Answer: B. Obtain blood cultures and notify the provider
Rationale: The client has neutropenia (absolute neutrophil count below 1,500/mm³) and a
fever, which indicates possible neutropenic sepsis, a life-threatening emergency. The priority
is to obtain blood cultures before administering antibiotics and to notify the provider
immediately. Administering acetaminophen masks the fever and delays diagnosis.
Encouraging fluids is supportive but not the priority. Placing the client in a private room and
implementing neutropenic precautions is appropriate but does not take precedence over
obtaining cultures and notifying the provider. The nurse should also monitor for signs of
infection and administer antibiotics as prescribed.
Key Takeaway: Fever in a neutropenic client requires immediate blood cultures and provider
notification for suspected sepsis.
Q2. A client with syndrome of inappropriate antidiuretic hormone has a serum sodium level
of 118 mEq/L and is confused. Which action should the nurse take first?
A. Administer 0.9% sodium chloride IV bolus
B. Restrict fluid intake
C. Monitor neurologic status and seizure precautions
D. Administer 3% sodium chloride IV as prescribed
,Correct Answer: C. Monitor neurologic status and seizure precautions
Rationale: Severe hyponatremia (serum sodium below 120 mEq/L) can cause cerebral edema,
seizures, and coma. The priority is to monitor neurologic status and implement seizure
precautions. Administering 0.9% sodium chloride is not appropriate for SIADH because it can
worsen hyponatremia. Fluid restriction is a treatment for SIADH but is not the first action
during acute neurologic deterioration. Hypertonic saline (3%) may be prescribed but requires
careful monitoring and is not the initial nursing action. The nurse should also monitor serum
sodium levels closely.
Key Takeaway: Severe hyponatremia requires immediate neurologic monitoring and seizure
precautions.
Q3. A client with a peptic ulcer suddenly develops severe abdominal pain, a rigid board-like
abdomen, and absent bowel sounds. Which action should the nurse take first?
A. Administer a PRN antacid
B. Prepare the client for emergency surgery
C. Insert a nasogastric tube
D. Obtain an abdominal x-ray
Correct Answer: B. Prepare the client for emergency surgery
Rationale: The client is exhibiting signs of a perforated peptic ulcer with chemical peritonitis,
which requires emergency surgical intervention. The nurse should prepare the client for
surgery immediately. Administering an antacid does not address the perforation. Inserting a
nasogastric tube may be part of preoperative preparation but is not the first action. Obtaining
an abdominal x-ray confirms the diagnosis but should not delay surgical preparation. The
nurse should also maintain NPO status and administer IV fluids and antibiotics as prescribed.
Key Takeaway: A rigid board-like abdomen with sudden severe pain indicates perforated
peptic ulcer and requires emergency surgery.
Q4. A client with type 1 diabetes mellitus is admitted with a blood glucose of 520 mg/dL, pH
7.22, HCO₃⁻ 12 mEq/L, and positive serum ketones. Which pathophysiologic process is
primarily responsible for this client's acid-base imbalance?
A. Excessive bicarbonate retention by the kidneys
, B. Increased ketone body production from uncontrolled lipolysis
C. Hypoventilation from respiratory muscle fatigue
D. Lactic acid accumulation from anaerobic metabolism
Correct Answer: B. Increased ketone body production from uncontrolled lipolysis
Rationale: The client is in diabetic ketoacidosis (DKA), characterized by severe hyperglycemia,
metabolic acidosis (low pH, low HCO₃⁻), and positive ketones. In DKA, absolute insulin
deficiency causes uncontrolled lipolysis, producing large quantities of ketone bodies
(acetoacetic acid and beta-hydroxybutyric acid), which are strong acids that consume
bicarbonate buffers. Excessive bicarbonate retention would cause metabolic alkalosis, not
acidosis. Hypoventilation would cause respiratory acidosis with an elevated PaCO₂. Lactic
acidosis occurs with tissue hypoperfusion, not primarily in DKA. The nurse should expect to
administer IV fluids, insulin, and potassium as prescribed.
Key Takeaway: DKA causes metabolic acidosis from excessive ketone body production due to
absolute insulin deficiency.
Q5. A client with cirrhosis has a serum ammonia level of 186 mcg/dL and increasing
confusion. The nurse understands that which pathophysiologic process is primarily
responsible for this client's neurologic symptoms?
A. Decreased cerebral perfusion from portal hypertension
B. Accumulation of ammonia in the brain from impaired hepatic conversion
C. Hypoglycemia from decreased hepatic gluconeogenesis
D. Hyponatremia from fluid shifts into the peritoneal cavity
Correct Answer: B. Accumulation of ammonia in the brain from impaired hepatic conversion
Rationale: Hepatic encephalopathy occurs when the damaged liver cannot convert ammonia
to urea for renal excretion. Ammonia accumulates in the bloodstream and crosses the blood-
brain barrier, where it interferes with neurotransmission and cerebral energy metabolism,
causing confusion, asterixis, and eventually coma. Decreased cerebral perfusion from portal
hypertension is not the primary mechanism. Hypoglycemia and hyponatremia can occur in
cirrhosis but are not the primary cause of encephalopathy. The nurse should administer
lactulose as prescribed to reduce ammonia absorption.
Key Takeaway: Hepatic encephalopathy is caused by ammonia accumulation due to impaired
hepatic conversion to urea.
