NUR2356 Multidimensional Care I (MDC 1) Final Exam
- Rasmussen College 2026-2027 Academic Year |
Comprehensive Patient Care Assessment
| 65 Applied Questions & 100 % Correct Rationales
DOMAIN 1 – CARDIOVASCULAR & RESPIRATORY CARE (20 Qs)
Q1
A patient admitted with heart-failure exacerbation is receiving IV furosemide. One hour
later urine output is 600 mL. Which assessment is the PRIORITY?
A. Patient’s level of comfort and pain score
B. Breath sounds and work of breathing
C. Serum potassium level from morning labs
D. Ability to ambulate to the bathroom independently
Correct: B
Rationale: Primary goal of diuresis in HF is to reduce pulmonary congestion; immediate
evaluation of respiratory status determines medication effectiveness and guides next
interventions. Hypokalemia (C) is important but not immediate; comfort (A) and
ambulation (D) are secondary.
Q2
,A client with newly diagnosed hypertension asks why lifestyle changes are needed
when “the pills will fix it.” Which therapeutic response by the nurse is BEST?
A. “Medication alone can’t overcome a poor diet or smoking.”
B. “Lifestyle changes may reduce or eliminate the need for medication.”
C. “You’ll have a heart attack if you don’t change your habits.”
D. “Your doctor ordered diet and exercise teaching, so we have to do it.”
Correct: B
Rationale: Offers motivation by linking self-management to tangible benefit (possible
dose reduction). Option A is confrontational; C uses scare tactics; D is authoritarian.
Q3
A patient with COPD is receiving 2 L/min via nasal cannula. His SpO₂ is 93 % but he
reports new-onset headache and his ABG shows PaCO₂ 68 mmHg (baseline 54). Which
action should the nurse take FIRST?
A. Increase O₂ to 4 L/min to improve oxygenation.
B. Notify provider and prepare for NIV or ventilator adjustment.
C. Coach the patient in pursed-lip breathing.
D. Obtain a stat chest X-ray.
Correct: B
Rationale: Rising PaCO₂ with neuro symptoms (headache) signals acute hypercapnic
failure; requires immediate physician evaluation and possible ventilatory support.
,Increasing O₂ (A) can worsen CO₂ retention; pursed-lip (C) is supportive but not
emergent.
Q4
A nurse auscultates loud, harsh crackles bilaterally in a HF patient 2 days
post-admission. Which evaluation should be performed NEXT?
A. Obtain daily weight and compare to admission.
B. Check JVP and lower-extremity edema.
C. Assess oxygen saturation and respiratory rate.
D. Review serum BNP level.
Correct: C
Rationale: Crackles indicate pulmonary edema; assessing oxygenation and work of
breathing determines urgency of intervention. Weight (A) and JVP (B) are useful but not
immediate; BNP (D) is confirmatory, not actionable.
Q5
A patient with asthma uses a fluticasone/salmeterol DPI. The nurse observes that the
patient exhales directly into the device before inhalation. Which instruction is
CORRECT?
A. “Exhaling into the device helps to aerosolize the powder.”
B. “Exhale away from the device, then seal lips and inhale deeply.”
C. “You should shake the diskus before each puff.”
, D. “Hold your breath for 3 seconds only.”
Correct: B
Rationale: Exhaling into a DPI scatters powder and introduces moisture; patient should
exhale away, seal lips, and inhale forcefully. Shaking (C) is not needed; breath-hold (D)
should be 10 s.
Q6
A nurse is reviewing discharge meds for a HF patient prescribed lisinopril 5 mg PO daily.
Which finding requires IMMEDIATE follow-up before administration?
A. BP 98/62 mmHg
B. HR 88 bpm
C. K⁺ 3.2 mEq/L
D. Serum creatinine 1.4 mg/dL (baseline 1.3)
Correct: A
Rationale: Systolic BP <100 mmHg is a red flag for ACE-I-induced hypotension; hold
medication and contact provider. Hypokalemia (C) and slight creatinine rise (D) are
monitor, not hold, issues.
Q7
A patient with COPD has an SpO₂ of 88 % on room air and is placed on 2 L NC. After 30
min SpO₂ is 94 %. Which nursing action is MOST appropriate?
A. Titrate O₂ to maintain SpO₂ 88–92 %.
- Rasmussen College 2026-2027 Academic Year |
Comprehensive Patient Care Assessment
| 65 Applied Questions & 100 % Correct Rationales
DOMAIN 1 – CARDIOVASCULAR & RESPIRATORY CARE (20 Qs)
Q1
A patient admitted with heart-failure exacerbation is receiving IV furosemide. One hour
later urine output is 600 mL. Which assessment is the PRIORITY?
A. Patient’s level of comfort and pain score
B. Breath sounds and work of breathing
C. Serum potassium level from morning labs
D. Ability to ambulate to the bathroom independently
Correct: B
Rationale: Primary goal of diuresis in HF is to reduce pulmonary congestion; immediate
evaluation of respiratory status determines medication effectiveness and guides next
interventions. Hypokalemia (C) is important but not immediate; comfort (A) and
ambulation (D) are secondary.
Q2
,A client with newly diagnosed hypertension asks why lifestyle changes are needed
when “the pills will fix it.” Which therapeutic response by the nurse is BEST?
A. “Medication alone can’t overcome a poor diet or smoking.”
B. “Lifestyle changes may reduce or eliminate the need for medication.”
C. “You’ll have a heart attack if you don’t change your habits.”
D. “Your doctor ordered diet and exercise teaching, so we have to do it.”
Correct: B
Rationale: Offers motivation by linking self-management to tangible benefit (possible
dose reduction). Option A is confrontational; C uses scare tactics; D is authoritarian.
Q3
A patient with COPD is receiving 2 L/min via nasal cannula. His SpO₂ is 93 % but he
reports new-onset headache and his ABG shows PaCO₂ 68 mmHg (baseline 54). Which
action should the nurse take FIRST?
A. Increase O₂ to 4 L/min to improve oxygenation.
B. Notify provider and prepare for NIV or ventilator adjustment.
C. Coach the patient in pursed-lip breathing.
D. Obtain a stat chest X-ray.
Correct: B
Rationale: Rising PaCO₂ with neuro symptoms (headache) signals acute hypercapnic
failure; requires immediate physician evaluation and possible ventilatory support.
,Increasing O₂ (A) can worsen CO₂ retention; pursed-lip (C) is supportive but not
emergent.
Q4
A nurse auscultates loud, harsh crackles bilaterally in a HF patient 2 days
post-admission. Which evaluation should be performed NEXT?
A. Obtain daily weight and compare to admission.
B. Check JVP and lower-extremity edema.
C. Assess oxygen saturation and respiratory rate.
D. Review serum BNP level.
Correct: C
Rationale: Crackles indicate pulmonary edema; assessing oxygenation and work of
breathing determines urgency of intervention. Weight (A) and JVP (B) are useful but not
immediate; BNP (D) is confirmatory, not actionable.
Q5
A patient with asthma uses a fluticasone/salmeterol DPI. The nurse observes that the
patient exhales directly into the device before inhalation. Which instruction is
CORRECT?
A. “Exhaling into the device helps to aerosolize the powder.”
B. “Exhale away from the device, then seal lips and inhale deeply.”
C. “You should shake the diskus before each puff.”
, D. “Hold your breath for 3 seconds only.”
Correct: B
Rationale: Exhaling into a DPI scatters powder and introduces moisture; patient should
exhale away, seal lips, and inhale forcefully. Shaking (C) is not needed; breath-hold (D)
should be 10 s.
Q6
A nurse is reviewing discharge meds for a HF patient prescribed lisinopril 5 mg PO daily.
Which finding requires IMMEDIATE follow-up before administration?
A. BP 98/62 mmHg
B. HR 88 bpm
C. K⁺ 3.2 mEq/L
D. Serum creatinine 1.4 mg/dL (baseline 1.3)
Correct: A
Rationale: Systolic BP <100 mmHg is a red flag for ACE-I-induced hypotension; hold
medication and contact provider. Hypokalemia (C) and slight creatinine rise (D) are
monitor, not hold, issues.
Q7
A patient with COPD has an SpO₂ of 88 % on room air and is placed on 2 L NC. After 30
min SpO₂ is 94 %. Which nursing action is MOST appropriate?
A. Titrate O₂ to maintain SpO₂ 88–92 %.
