MDC 2 (Multidimensional Care II)
Rasmussen University | 2026/2027 ACADEMIC YEAR
Newly Released
50 Questions with Detailed Rationales | Comprehensive Medical-Surgical
Nursing Exam
• Time Allowed: 90 minutes
• Number of Items: 50
• Points per Item: 2
• Total Possible Points: 100
Academic Integrity Statement: Academic dishonesty includes copying from or
collaborating with another student, selling or illegally obtaining exam materials, discussing
the test with students who have not yet taken it, and using unauthorized materials. By signing
above, I affirm that I will complete this examination independently and in accordance with
the Rasmussen University academic integrity policy
UNIT 1: CRITICAL CARE/EMERGENCY NURSING (Questions 1-10)
Q1: A 68-year-old patient presents to the ED with suspected septic shock. Vital signs: BP
78/52 mmHg, HR 128 bpm, RR 26, Temp 38.9°C (102°F). Hemodynamic monitoring
shows CVP 4 mmHg, MAP 58 mmHg, ScvO2 58%. Current interventions include 30
mL/kg crystalloid bolus completed. Which intervention is the nurse's priority?
A. Administer broad-spectrum antibiotics within 6 hours of recognition
B. Initiate norepinephrine at 2 mcg/min to maintain MAP >65 mmHg
C. [CORRECT] Administer additional fluid bolus of 250-500 mL crystalloid with
reassessment of dynamic responsiveness, then initiate norepinephrine if MAP
remains <65 mmHg
D. Begin hydrocortisone 50 mg IV every 6 hours immediately
,Correct Answer: C
Rationale: The Surviving Sepsis Campaign Hour-1 Bundle requires immediate fluid
resuscitation (30 mL/kg) followed by vasopressors if hypotension persists after initial
fluid challenge. This patient has completed initial bolus but remains hypotensive (MAP
58) with low CVP (4 mmHg indicates inadequate preload) and low ScvO2 (58% vs
normal 70% indicating inadequate oxygen delivery). Additional fluid with dynamic
assessment (passive leg raise or stroke volume variation) precedes vasopressor initiation.
Option A is incorrect because antibiotics must be administered within 1 hour (not 6
hours) for septic shock—this is a critical time-sensitive intervention already delayed.
Option B is premature without assessing fluid responsiveness; norepinephrine without
adequate preload increases myocardial oxygen demand without improving perfusion.
Option D is incorrect because corticosteroids are adjunctive therapy for refractory shock
after fluid resuscitation and vasopressors, not first-line; they do not address the
immediate perfusion deficit.
Q2: A patient with gram-negative sepsis develops oozing from IV sites, petechiae, and
hypotension refractory to fluids. Laboratory studies show: platelets 45,000/mm³, PT 18
seconds (control 12), PTT 68 seconds (control 32), fibrinogen 85 mg/dL, D-dimer
>20,000 ng/mL, fibrin split products elevated. Which nursing intervention takes priority?
A. Administer cryoprecipitate alone to replace fibrinogen
B. [CORRECT] Prepare to administer platelets, fresh frozen plasma, and
cryoprecipitate while maintaining hemodynamic support and treating underlying
sepsis
C. Initiate therapeutic heparin to prevent microthrombi formation
D. Focus solely on fluid resuscitation to improve perfusion
Correct Answer: B
Rationale: Disseminated intravascular coagulation (DIC) involves simultaneous
thrombosis (consumption of clotting factors) and bleeding (fibrinolysis). Laboratory
findings confirm consumption coagulopathy: thrombocytopenia, prolonged PT/PTT, low
fibrinogen, elevated D-dimer/FSP. Management requires blood product replacement
based on component deficiency (platelets for <50,000 with bleeding, FFP for PT >1.5x
control, cryoprecipitate for fibrinogen <100) while treating the trigger (sepsis). Option A
,is insufficient because single-component replacement ignores multiple deficiencies
causing bleeding. Option C is dangerous because heparin worsens bleeding in acute DIC
with hemorrhagic presentation; low-dose heparin is only considered for chronic or
thrombotic-predominant DIC without active bleeding. Option D is inadequate because
fluid resuscitation does not replace consumed clotting factors; bleeding will continue
despite hemodynamic optimization.
Q3: [SELECT ALL THAT APPLY] The nurse is caring for a patient receiving a heparin
infusion for massive pulmonary embolism. Which findings require immediate action by
the nurse? (Select all that apply)
A. [CORRECT] aPTT of 110 seconds (therapeutic range 60-80 seconds)
B. Platelet count of 180,000/mm³ (baseline 175,000)
C. [CORRECT] New onset of severe flank pain and gross hematuria
D. [CORRECT] Platelet count decreased from 200,000 to 55,000/mm³ over 48 hours
E. [CORRECT] Patient reports melena and coffee-ground emesis
F. [CORRECT] Sudden severe headache with vomiting and altered mental status
Correct Answers: A, C, D, E, F
Rationale:
A (CORRECT): Supratherapeutic aPTT (>2x control or above range) indicates excessive
anticoagulation with bleeding risk; requires stopping infusion, rechecking in 4 hours,
and dose adjustment per protocol.
B (INCORRECT): Platelet count stable within normal range (150,000-400,000) does not
indicate heparin-induced thrombocytopenia (HIT) or bleeding risk; monitoring continues
but no immediate action required.
C (CORRECT): Flank pain with hematuria suggests retroperitoneal hemorrhage, a serious
complication of anticoagulation; requires immediate heparin discontinuation, imaging
(CT), and possible reversal.
D (CORRECT): >50% platelet decrease or absolute count <100,000 indicates probable
HIT (immune-mediated prothrombotic condition); requires immediate heparin cessation
and non-heparin anticoagulant (argatroban, fondaparinux).
, E (CORRECT): Melena and coffee-ground emesis indicate upper GI bleeding; requires
heparin discontinuation, proton pump inhibitor, possible endoscopy, and blood product
support.
F (CORRECT): Thunderclap headache with neuro deficits suggests intracranial
hemorrhage; emergency CT, neurosurgery consultation, and reversal agents (protamine
sulfate) indicated.
Q4: A rapid response is called for a patient who became unresponsive. The nurse finds
no pulse, no breathing, and the monitor shows ventricular fibrillation. The crash cart
arrives. What is the nurse's immediate first action?
A. Establish IV access and administer epinephrine 1 mg IV push
B. Perform immediate defibrillation at 200 joules biphasic
C. [CORRECT] Initiate high-quality CPR beginning with chest compressions (30:2
ratio) while defibrillator is charging, then deliver shock as soon as available
D. Administer amiodarone 300 mg IV push immediately
Correct Answer: C
Rationale: ACLS protocol for cardiac arrest prioritizes immediate CPR and early
defibrillation. For witnessed collapse with VF, chest compressions should begin within 10
seconds while defibrillator pads are applied. Shock should be delivered as soon as
possible (within 3-5 minutes for best survival). The 2020 AHA Guidelines emphasize
minimal interruption in compressions; charging during CPR ensures immediate shock
when ready. Option A is incorrect because epinephrine is administered after second
shock and every 3-5 minutes during CPR, not before defibrillation; early defibrillation is
the priority for shockable rhythms. Option B is partially correct but incomplete;
defibrillation without immediate preceding or concurrent CPR allows myocardial and
cerebral perfusion to cease, reducing shock success; CPR should not be delayed for
defibrillator setup. Option D is incorrect because amiodarone is given after third shock
for refractory VF/VT, not as initial treatment; it has no role in pulseless arrest until after
defibrillation attempts and epinephrine.
Q5: [PRIORITY/FIRST ACTION] A patient admitted for pneumonia develops sudden
severe respiratory distress. Assessment reveals: HR 142, BP 88/60, RR 38, SpO2 82% on
6L NC, asymmetric chest wall movement, absent breath sounds on left, tracheal
Rasmussen University | 2026/2027 ACADEMIC YEAR
Newly Released
50 Questions with Detailed Rationales | Comprehensive Medical-Surgical
Nursing Exam
• Time Allowed: 90 minutes
• Number of Items: 50
• Points per Item: 2
• Total Possible Points: 100
Academic Integrity Statement: Academic dishonesty includes copying from or
collaborating with another student, selling or illegally obtaining exam materials, discussing
the test with students who have not yet taken it, and using unauthorized materials. By signing
above, I affirm that I will complete this examination independently and in accordance with
the Rasmussen University academic integrity policy
UNIT 1: CRITICAL CARE/EMERGENCY NURSING (Questions 1-10)
Q1: A 68-year-old patient presents to the ED with suspected septic shock. Vital signs: BP
78/52 mmHg, HR 128 bpm, RR 26, Temp 38.9°C (102°F). Hemodynamic monitoring
shows CVP 4 mmHg, MAP 58 mmHg, ScvO2 58%. Current interventions include 30
mL/kg crystalloid bolus completed. Which intervention is the nurse's priority?
A. Administer broad-spectrum antibiotics within 6 hours of recognition
B. Initiate norepinephrine at 2 mcg/min to maintain MAP >65 mmHg
C. [CORRECT] Administer additional fluid bolus of 250-500 mL crystalloid with
reassessment of dynamic responsiveness, then initiate norepinephrine if MAP
remains <65 mmHg
D. Begin hydrocortisone 50 mg IV every 6 hours immediately
,Correct Answer: C
Rationale: The Surviving Sepsis Campaign Hour-1 Bundle requires immediate fluid
resuscitation (30 mL/kg) followed by vasopressors if hypotension persists after initial
fluid challenge. This patient has completed initial bolus but remains hypotensive (MAP
58) with low CVP (4 mmHg indicates inadequate preload) and low ScvO2 (58% vs
normal 70% indicating inadequate oxygen delivery). Additional fluid with dynamic
assessment (passive leg raise or stroke volume variation) precedes vasopressor initiation.
Option A is incorrect because antibiotics must be administered within 1 hour (not 6
hours) for septic shock—this is a critical time-sensitive intervention already delayed.
Option B is premature without assessing fluid responsiveness; norepinephrine without
adequate preload increases myocardial oxygen demand without improving perfusion.
Option D is incorrect because corticosteroids are adjunctive therapy for refractory shock
after fluid resuscitation and vasopressors, not first-line; they do not address the
immediate perfusion deficit.
Q2: A patient with gram-negative sepsis develops oozing from IV sites, petechiae, and
hypotension refractory to fluids. Laboratory studies show: platelets 45,000/mm³, PT 18
seconds (control 12), PTT 68 seconds (control 32), fibrinogen 85 mg/dL, D-dimer
>20,000 ng/mL, fibrin split products elevated. Which nursing intervention takes priority?
A. Administer cryoprecipitate alone to replace fibrinogen
B. [CORRECT] Prepare to administer platelets, fresh frozen plasma, and
cryoprecipitate while maintaining hemodynamic support and treating underlying
sepsis
C. Initiate therapeutic heparin to prevent microthrombi formation
D. Focus solely on fluid resuscitation to improve perfusion
Correct Answer: B
Rationale: Disseminated intravascular coagulation (DIC) involves simultaneous
thrombosis (consumption of clotting factors) and bleeding (fibrinolysis). Laboratory
findings confirm consumption coagulopathy: thrombocytopenia, prolonged PT/PTT, low
fibrinogen, elevated D-dimer/FSP. Management requires blood product replacement
based on component deficiency (platelets for <50,000 with bleeding, FFP for PT >1.5x
control, cryoprecipitate for fibrinogen <100) while treating the trigger (sepsis). Option A
,is insufficient because single-component replacement ignores multiple deficiencies
causing bleeding. Option C is dangerous because heparin worsens bleeding in acute DIC
with hemorrhagic presentation; low-dose heparin is only considered for chronic or
thrombotic-predominant DIC without active bleeding. Option D is inadequate because
fluid resuscitation does not replace consumed clotting factors; bleeding will continue
despite hemodynamic optimization.
Q3: [SELECT ALL THAT APPLY] The nurse is caring for a patient receiving a heparin
infusion for massive pulmonary embolism. Which findings require immediate action by
the nurse? (Select all that apply)
A. [CORRECT] aPTT of 110 seconds (therapeutic range 60-80 seconds)
B. Platelet count of 180,000/mm³ (baseline 175,000)
C. [CORRECT] New onset of severe flank pain and gross hematuria
D. [CORRECT] Platelet count decreased from 200,000 to 55,000/mm³ over 48 hours
E. [CORRECT] Patient reports melena and coffee-ground emesis
F. [CORRECT] Sudden severe headache with vomiting and altered mental status
Correct Answers: A, C, D, E, F
Rationale:
A (CORRECT): Supratherapeutic aPTT (>2x control or above range) indicates excessive
anticoagulation with bleeding risk; requires stopping infusion, rechecking in 4 hours,
and dose adjustment per protocol.
B (INCORRECT): Platelet count stable within normal range (150,000-400,000) does not
indicate heparin-induced thrombocytopenia (HIT) or bleeding risk; monitoring continues
but no immediate action required.
C (CORRECT): Flank pain with hematuria suggests retroperitoneal hemorrhage, a serious
complication of anticoagulation; requires immediate heparin discontinuation, imaging
(CT), and possible reversal.
D (CORRECT): >50% platelet decrease or absolute count <100,000 indicates probable
HIT (immune-mediated prothrombotic condition); requires immediate heparin cessation
and non-heparin anticoagulant (argatroban, fondaparinux).
, E (CORRECT): Melena and coffee-ground emesis indicate upper GI bleeding; requires
heparin discontinuation, proton pump inhibitor, possible endoscopy, and blood product
support.
F (CORRECT): Thunderclap headache with neuro deficits suggests intracranial
hemorrhage; emergency CT, neurosurgery consultation, and reversal agents (protamine
sulfate) indicated.
Q4: A rapid response is called for a patient who became unresponsive. The nurse finds
no pulse, no breathing, and the monitor shows ventricular fibrillation. The crash cart
arrives. What is the nurse's immediate first action?
A. Establish IV access and administer epinephrine 1 mg IV push
B. Perform immediate defibrillation at 200 joules biphasic
C. [CORRECT] Initiate high-quality CPR beginning with chest compressions (30:2
ratio) while defibrillator is charging, then deliver shock as soon as available
D. Administer amiodarone 300 mg IV push immediately
Correct Answer: C
Rationale: ACLS protocol for cardiac arrest prioritizes immediate CPR and early
defibrillation. For witnessed collapse with VF, chest compressions should begin within 10
seconds while defibrillator pads are applied. Shock should be delivered as soon as
possible (within 3-5 minutes for best survival). The 2020 AHA Guidelines emphasize
minimal interruption in compressions; charging during CPR ensures immediate shock
when ready. Option A is incorrect because epinephrine is administered after second
shock and every 3-5 minutes during CPR, not before defibrillation; early defibrillation is
the priority for shockable rhythms. Option B is partially correct but incomplete;
defibrillation without immediate preceding or concurrent CPR allows myocardial and
cerebral perfusion to cease, reducing shock success; CPR should not be delayed for
defibrillator setup. Option D is incorrect because amiodarone is given after third shock
for refractory VF/VT, not as initial treatment; it has no role in pulseless arrest until after
defibrillation attempts and epinephrine.
Q5: [PRIORITY/FIRST ACTION] A patient admitted for pneumonia develops sudden
severe respiratory distress. Assessment reveals: HR 142, BP 88/60, RR 38, SpO2 82% on
6L NC, asymmetric chest wall movement, absent breath sounds on left, tracheal
