NUR 2502 MULTIDIMENSIONAL CARE III (MDC 3) – QUESTIONS AND ANSWERS
| VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE
Core Domains
Cardiovascular Disorders
Respiratory Disorders
Neurological Disorders
Renal and Genitourinary Disorders
Endocrine and Metabolic Disorders
Hematologic and Oncologic Disorders
Gastrointestinal and Hepatic Disorders
Fluid, Electrolyte, and Acid-Base Imbalances
Pharmacological and Parenteral Therapies
Prioritization, Delegation, and Clinical Judgment
Introduction
This comprehensive assessment evaluates the advanced clinical judgment and
applied knowledge required for safe, effective nursing care of adult patients with
complex, multidimensional health alterations. The examination integrates
foundational theory with applied professional practice, emphasizing regulatory
compliance, ethical standards, and evidence-based decision-making. Questions are
designed to test understanding rather than rote memorization, utilizing realistic
scenario-based items that require critical thinking, prioritization, and practical
application of professional judgment. This assessment prepares learners for the rigor
of contemporary nursing practice and licensure examinations.
SECTION ONE: QUESTIONS 1–50
,Question 1
A nurse is caring for a patient with systolic heart failure and a serum potassium
level of 5.8 mEq/L. The provider has ordered spironolactone. Which action reflects
the most accurate clinical judgment?
A. Administer the medication as prescribed and recheck potassium in 24 hours
B. Hold the medication and notify the provider of the elevated potassium level
C. Administer the medication and prepare to give sodium polystyrene sulfonate
D. Hold the medication and obtain a stat 12-lead ECG before notifying the
provider
🟢 Correct Answer: B. Hold the medication and notify the provider of the elevated
potassium level
🔴 Rationale: Spironolactone is a potassium-sparing diuretic that retains
potassium. Administering it to a patient with a potassium of 5.8 mEq/L creates a
serious risk for life-threatening hyperkalemia and cardiac dysrhythmias. The
priority action is to withhold the medication and inform the provider immediately.
Waiting to recheck potassium or administering concurrently with a potassium-
lowering agent does not address the immediate safety risk.
Question 2
A patient in the intensive care unit suddenly becomes unresponsive. The bedside
monitor shows ventricular fibrillation. After calling for assistance and starting chest
compressions, what is the priority intervention?
A. Prepare for endotracheal intubation
B. Administer intravenous epinephrine
C. Deliver a shock with the defibrillator as soon as it is available
D. Administer intravenous amiodarone
🟢 Correct Answer: C. Deliver a shock with the defibrillator as soon as it is
available
🔴 Rationale: Ventricular fibrillation is a shockable rhythm. The definitive
,treatment is early defibrillation, which provides the best chance of restoring an
organized perfusing rhythm. High-quality CPR is maintained while the defibrillator
is retrieved and applied. Intubation, epinephrine, and amiodarone are subsequent
interventions that do not replace the immediate need for defibrillation.
Question 3
A patient with left-sided heart failure reports severe dyspnea and has crackles
audible at the lung bases extending halfway up. The nurse positions the patient
upright. Which assessment finding best indicates the patient is responding to this
intervention?
A. Heart rate decreases from 118 to 96 beats per minute
B. Respiratory rate decreases and oxygen saturation improves
C. Urine output increases within the next hour
D. Blood pressure decreases from 148/88 to 132/78 mm Hg
🟢 Correct Answer: B. Respiratory rate decreases and oxygen saturation improves
🔴 Rationale: Positioning the patient upright in high-Fowler's position reduces
venous return to the heart and decreases pulmonary congestion, directly relieving
dyspnea. Improvement in respiratory rate and oxygen saturation reflects reduced
pulmonary fluid and improved gas exchange. While other vital sign changes may
occur, respiratory improvement is the most direct indicator that the positioning
intervention has addressed the primary problem of pulmonary congestion.
Question 4
The nurse is interpreting arterial blood gas results for a patient with a chronic
obstructive pulmonary disease exacerbation. Results are: pH 7.31, PaCO₂ 58 mm
Hg, HCO₃ 27 mEq/L, PaO₂ 62 mm Hg. Which interpretation is correct?
A. Metabolic acidosis with respiratory compensation
B. Respiratory alkalosis with metabolic compensation
C. Respiratory acidosis with metabolic compensation
D. Combined metabolic and respiratory acidosis
, 🟢 Correct Answer: C. Respiratory acidosis with metabolic compensation
🔴 Rationale: The pH is low (acidotic). The PaCO₂ is elevated (normal 35–45 mm
Hg), indicating a respiratory cause. The HCO₃ is slightly elevated (normal 22–26
mEq/L), indicating the kidneys are retaining bicarbonate to compensate for the
chronic respiratory acidosis. This pattern is characteristic of COPD exacerbation
with chronic CO₂ retention.
Question 5
A patient with type 1 diabetes presents with glucose 520 mg/dL, pH 7.18, HCO₃ 9
mEq/L, positive serum ketones, and Kussmaul respirations. After initiating fluid
resuscitation, which order should the nurse anticipate next?
A. Administer intravenous sodium bicarbonate
B. Begin continuous intravenous insulin infusion
C. Administer a bolus of potassium chloride
D. Give subcutaneous insulin glargine
🟢 Correct Answer: B. Begin continuous intravenous insulin infusion
🔴 Rationale: The patient is in diabetic ketoacidosis. After initial fluid resuscitation,
the priority pharmacologic intervention is a continuous intravenous regular insulin
infusion, which suppresses ketone production and lowers glucose. Bicarbonate is
reserved for severe acidosis (pH < 6.9). Potassium is replaced once levels fall below
5.2 mEq/L after insulin therapy begins, as insulin drives potassium intracellularly.
Subcutaneous long-acting insulin is not appropriate for acute DKA management.
Question 6
A patient with acute ischemic stroke has a blood pressure of 198/112 mm Hg and
is not receiving thrombolytic therapy. Based on current guidelines, what is the
appropriate nursing action?
A. Administer intravenous labetalol to lower blood pressure by 25% within one
hour
B. Withhold antihypertensive medication unless blood pressure exceeds 220/120
| VERIFIED AND WELL DETAILED ANSWERS | PLUS RATIONALES | GUARANTEED
PASS | LATEST EXAM UPDATE
Core Domains
Cardiovascular Disorders
Respiratory Disorders
Neurological Disorders
Renal and Genitourinary Disorders
Endocrine and Metabolic Disorders
Hematologic and Oncologic Disorders
Gastrointestinal and Hepatic Disorders
Fluid, Electrolyte, and Acid-Base Imbalances
Pharmacological and Parenteral Therapies
Prioritization, Delegation, and Clinical Judgment
Introduction
This comprehensive assessment evaluates the advanced clinical judgment and
applied knowledge required for safe, effective nursing care of adult patients with
complex, multidimensional health alterations. The examination integrates
foundational theory with applied professional practice, emphasizing regulatory
compliance, ethical standards, and evidence-based decision-making. Questions are
designed to test understanding rather than rote memorization, utilizing realistic
scenario-based items that require critical thinking, prioritization, and practical
application of professional judgment. This assessment prepares learners for the rigor
of contemporary nursing practice and licensure examinations.
SECTION ONE: QUESTIONS 1–50
,Question 1
A nurse is caring for a patient with systolic heart failure and a serum potassium
level of 5.8 mEq/L. The provider has ordered spironolactone. Which action reflects
the most accurate clinical judgment?
A. Administer the medication as prescribed and recheck potassium in 24 hours
B. Hold the medication and notify the provider of the elevated potassium level
C. Administer the medication and prepare to give sodium polystyrene sulfonate
D. Hold the medication and obtain a stat 12-lead ECG before notifying the
provider
🟢 Correct Answer: B. Hold the medication and notify the provider of the elevated
potassium level
🔴 Rationale: Spironolactone is a potassium-sparing diuretic that retains
potassium. Administering it to a patient with a potassium of 5.8 mEq/L creates a
serious risk for life-threatening hyperkalemia and cardiac dysrhythmias. The
priority action is to withhold the medication and inform the provider immediately.
Waiting to recheck potassium or administering concurrently with a potassium-
lowering agent does not address the immediate safety risk.
Question 2
A patient in the intensive care unit suddenly becomes unresponsive. The bedside
monitor shows ventricular fibrillation. After calling for assistance and starting chest
compressions, what is the priority intervention?
A. Prepare for endotracheal intubation
B. Administer intravenous epinephrine
C. Deliver a shock with the defibrillator as soon as it is available
D. Administer intravenous amiodarone
🟢 Correct Answer: C. Deliver a shock with the defibrillator as soon as it is
available
🔴 Rationale: Ventricular fibrillation is a shockable rhythm. The definitive
,treatment is early defibrillation, which provides the best chance of restoring an
organized perfusing rhythm. High-quality CPR is maintained while the defibrillator
is retrieved and applied. Intubation, epinephrine, and amiodarone are subsequent
interventions that do not replace the immediate need for defibrillation.
Question 3
A patient with left-sided heart failure reports severe dyspnea and has crackles
audible at the lung bases extending halfway up. The nurse positions the patient
upright. Which assessment finding best indicates the patient is responding to this
intervention?
A. Heart rate decreases from 118 to 96 beats per minute
B. Respiratory rate decreases and oxygen saturation improves
C. Urine output increases within the next hour
D. Blood pressure decreases from 148/88 to 132/78 mm Hg
🟢 Correct Answer: B. Respiratory rate decreases and oxygen saturation improves
🔴 Rationale: Positioning the patient upright in high-Fowler's position reduces
venous return to the heart and decreases pulmonary congestion, directly relieving
dyspnea. Improvement in respiratory rate and oxygen saturation reflects reduced
pulmonary fluid and improved gas exchange. While other vital sign changes may
occur, respiratory improvement is the most direct indicator that the positioning
intervention has addressed the primary problem of pulmonary congestion.
Question 4
The nurse is interpreting arterial blood gas results for a patient with a chronic
obstructive pulmonary disease exacerbation. Results are: pH 7.31, PaCO₂ 58 mm
Hg, HCO₃ 27 mEq/L, PaO₂ 62 mm Hg. Which interpretation is correct?
A. Metabolic acidosis with respiratory compensation
B. Respiratory alkalosis with metabolic compensation
C. Respiratory acidosis with metabolic compensation
D. Combined metabolic and respiratory acidosis
, 🟢 Correct Answer: C. Respiratory acidosis with metabolic compensation
🔴 Rationale: The pH is low (acidotic). The PaCO₂ is elevated (normal 35–45 mm
Hg), indicating a respiratory cause. The HCO₃ is slightly elevated (normal 22–26
mEq/L), indicating the kidneys are retaining bicarbonate to compensate for the
chronic respiratory acidosis. This pattern is characteristic of COPD exacerbation
with chronic CO₂ retention.
Question 5
A patient with type 1 diabetes presents with glucose 520 mg/dL, pH 7.18, HCO₃ 9
mEq/L, positive serum ketones, and Kussmaul respirations. After initiating fluid
resuscitation, which order should the nurse anticipate next?
A. Administer intravenous sodium bicarbonate
B. Begin continuous intravenous insulin infusion
C. Administer a bolus of potassium chloride
D. Give subcutaneous insulin glargine
🟢 Correct Answer: B. Begin continuous intravenous insulin infusion
🔴 Rationale: The patient is in diabetic ketoacidosis. After initial fluid resuscitation,
the priority pharmacologic intervention is a continuous intravenous regular insulin
infusion, which suppresses ketone production and lowers glucose. Bicarbonate is
reserved for severe acidosis (pH < 6.9). Potassium is replaced once levels fall below
5.2 mEq/L after insulin therapy begins, as insulin drives potassium intracellularly.
Subcutaneous long-acting insulin is not appropriate for acute DKA management.
Question 6
A patient with acute ischemic stroke has a blood pressure of 198/112 mm Hg and
is not receiving thrombolytic therapy. Based on current guidelines, what is the
appropriate nursing action?
A. Administer intravenous labetalol to lower blood pressure by 25% within one
hour
B. Withhold antihypertensive medication unless blood pressure exceeds 220/120
