NUR2392: Multidimensional Care II MDC 2 Final Exam Actual Exam 2026/2027 –
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
SECTION 1: Fluid, Electrolyte, & Acid-Base Balance (Q1-Q15)
Q1: A 72-year-old male is admitted with vomiting and diarrhea for 3 days. His vital signs
are BP 92/58 mmHg, HR 118 bpm, RR 22/min, temperature 37.1°C. He has dry mucous
membranes, decreased skin turgor, and flat neck veins. His lab work shows BUN 42
mg/dL, creatinine 1.8 mg/dL, Hct 52%, and urine specific gravity 1.032. Which fluid order
should the nurse anticipate?
A. 0.45% NaCl at 125 mL/hr
B. 0.9% NaCl at 250 mL/hr [CORRECT]
C. D5W at 100 mL/hr
D. 3% NaCl at 50 mL/hr
Correct Answer: B
Rationale: This patient presents with fluid volume deficit (hypovolemia) evidenced by
hypotension, tachycardia, dry mucous membranes, elevated BUN/Cr ratio (>20:1),
elevated Hct, and high urine specific gravity. Isotonic 0.9% NaCl is the appropriate initial
resuscitation fluid as it expands intravascular volume without causing fluid shifts
between compartments. Hypotonic 0.45% NaCl or D5W would shift into cells and
worsen vascular depletion, while hypertonic 3% NaCl is reserved for severe
hyponatremia. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q2: A 58-year-old female with heart failure presents with 3+ pitting edema, crackles
bilaterally, JVD, and an S3 gallop. Her daily weight has increased by 4 lbs over 2 days.
Her lab work shows BUN 12 mg/dL, Hct 38%, and urine specific gravity 1.008. Which
intervention is the nurse's priority?
A. Administer furosemide 40 mg IV push
B. Restrict fluids to 1,500 mL/day and sodium to 2 g/day [CORRECT]
,C. Start 0.9% NaCl at 125 mL/hr
D. Administer 25% albumin 100 mL IV
Correct Answer: B
Rationale: This patient has fluid volume excess (hypervolemia) secondary to heart
failure, evidenced by edema, crackles, JVD, S3 gallop, weight gain, and dilute urine
(specific gravity <1.010). Priority management includes fluid and sodium restriction plus
diuretic therapy. While furosemide is indicated, comprehensive fluid and sodium
restriction addresses the underlying cause. Additional IV fluids would worsen overload,
and albumin is contraindicated as it expands intravascular volume further. [100%
VERIFIED – Rasmussen NUR2392 MDC2]
Q3: A 45-year-old female with small cell lung cancer develops confusion, headache, and
muscle cramps. Her serum sodium is 118 mEq/L. Which nursing intervention is most
appropriate?
A. Administer 3% NaCl at 100 mL/hr
B. Implement strict fluid restriction to 800-1,000 mL/day [CORRECT]
C. Start 0.9% NaCl at 150 mL/hr
D. Encourage oral fluid intake to 3,000 mL/day
Correct Answer: B
Rationale: This patient has hyponatremia likely secondary to SIADH from small cell lung
cancer. The primary management for SIADH-induced hyponatremia is fluid restriction
(800-1,000 mL/day) to allow the body to excrete excess water and correct sodium
gradually. Hypertonic saline is reserved for severe symptomatic hyponatremia with
seizures or coma. Isotonic fluids or increased oral intake would worsen dilutional
hyponatremia. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q4: A 62-year-old male with diabetes insipidus has a serum sodium of 156 mEq/L. He is
confused and extremely thirsty. Which intervention should the nurse implement?
A. Administer furosemide 20 mg IV
B. Provide free water replacement via oral or IV D5W [CORRECT]
,C. Start fluid restriction to 1,000 mL/day
D. Administer 3% NaCl at 50 mL/hr
Correct Answer: B
Rationale: This patient has hypernatremia secondary to diabetes insipidus,
characterized by water deficit and inadequate intake. The management focuses on free
water replacement to correct the water deficit gradually. Diuretics and fluid restriction
would worsen hypernatremia. Hypertonic saline is contraindicated as it would further
elevate sodium levels. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q5: A patient receiving IV furosemide and experiencing frequent loose stools develops
muscle weakness, fatigue, and ECG changes showing U waves. Which electrolyte
imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Hypocalcemia
Correct Answer: B
Rationale: Loop diuretics (furosemide) and GI losses (diarrhea) cause potassium
wasting, leading to hypokalemia. Classic manifestations include muscle weakness,
fatigue, and U waves on ECG (representing delayed ventricular repolarization).
Hyperkalemia would show peaked T waves and widened QRS complexes.
Hypocalcemia presents with tetany and prolonged QT interval. [100% VERIFIED –
Rasmussen NUR2392 MDC2]
Q6: A nurse is administering potassium chloride IV to a patient with hypokalemia (K+
2.8 mEq/L). Which action by the nurse requires immediate intervention?
A. Diluting KCl in 100 mL NS and infusing over 1 hour
B. Administering KCl via central line at 20 mEq/hr
C. Preparing to give KCl 40 mEq IV push over 2 minutes [CORRECT]
D. Monitoring the patient's cardiac rhythm during infusion
Correct Answer: C
, Rationale: Potassium chloride must NEVER be administered IV push as it causes
immediate cardiac arrest due to severe hyperkalemia. The maximum safe IV infusion
rate is 10-20 mEq/hr via peripheral line (up to 40 mEq/hr via central line with cardiac
monitoring). All other options represent safe nursing practice for potassium
administration. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q7: A patient with end-stage renal disease on hemodialysis presents with peaked T
waves on ECG, widened QRS complexes, and muscle weakness. His potassium is 7.2
mEq/L. Which intervention should the nurse prepare to administer first?
A. Sodium polystyrene sulfonate (Kayexalate) 15 g PO
B. Regular insulin 10 units IV with 50 mL D50W
C. Calcium gluconate 1 g IV over 5 minutes [CORRECT]
D. Albuterol nebulizer treatment
Correct Answer: C
Rationale: In severe hyperkalemia with ECG changes (peaked T waves, widened QRS),
calcium gluconate is administered first to stabilize cardiac membranes and prevent
life-threatening arrhythmias. While insulin/glucose, albuterol, and kayexalate all lower
potassium levels, they do not provide immediate cardiac protection. Calcium gluconate
is the priority intervention when ECG changes are present. [100% VERIFIED –
Rasmussen NUR2392 MDC2]
Q8: A 35-year-old female post-thyroidectomy develops perioral numbness, carpopedal
spasm, and a positive Chvostek sign. Her calcium level is 7.2 mg/dL. Which intervention
is the priority?
A. Administer oral calcium carbonate 1,250 mg TID
B. Administer IV calcium gluconate 1 g slowly [CORRECT]
C. Start vitamin D supplementation 2,000 IU daily
D. Encourage increased dairy product intake
Correct Answer: B
Complete Exam-Style Questions with Detailed Rationales | 100% Verified | Pass
Guaranteed – A+ Graded
SECTION 1: Fluid, Electrolyte, & Acid-Base Balance (Q1-Q15)
Q1: A 72-year-old male is admitted with vomiting and diarrhea for 3 days. His vital signs
are BP 92/58 mmHg, HR 118 bpm, RR 22/min, temperature 37.1°C. He has dry mucous
membranes, decreased skin turgor, and flat neck veins. His lab work shows BUN 42
mg/dL, creatinine 1.8 mg/dL, Hct 52%, and urine specific gravity 1.032. Which fluid order
should the nurse anticipate?
A. 0.45% NaCl at 125 mL/hr
B. 0.9% NaCl at 250 mL/hr [CORRECT]
C. D5W at 100 mL/hr
D. 3% NaCl at 50 mL/hr
Correct Answer: B
Rationale: This patient presents with fluid volume deficit (hypovolemia) evidenced by
hypotension, tachycardia, dry mucous membranes, elevated BUN/Cr ratio (>20:1),
elevated Hct, and high urine specific gravity. Isotonic 0.9% NaCl is the appropriate initial
resuscitation fluid as it expands intravascular volume without causing fluid shifts
between compartments. Hypotonic 0.45% NaCl or D5W would shift into cells and
worsen vascular depletion, while hypertonic 3% NaCl is reserved for severe
hyponatremia. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q2: A 58-year-old female with heart failure presents with 3+ pitting edema, crackles
bilaterally, JVD, and an S3 gallop. Her daily weight has increased by 4 lbs over 2 days.
Her lab work shows BUN 12 mg/dL, Hct 38%, and urine specific gravity 1.008. Which
intervention is the nurse's priority?
A. Administer furosemide 40 mg IV push
B. Restrict fluids to 1,500 mL/day and sodium to 2 g/day [CORRECT]
,C. Start 0.9% NaCl at 125 mL/hr
D. Administer 25% albumin 100 mL IV
Correct Answer: B
Rationale: This patient has fluid volume excess (hypervolemia) secondary to heart
failure, evidenced by edema, crackles, JVD, S3 gallop, weight gain, and dilute urine
(specific gravity <1.010). Priority management includes fluid and sodium restriction plus
diuretic therapy. While furosemide is indicated, comprehensive fluid and sodium
restriction addresses the underlying cause. Additional IV fluids would worsen overload,
and albumin is contraindicated as it expands intravascular volume further. [100%
VERIFIED – Rasmussen NUR2392 MDC2]
Q3: A 45-year-old female with small cell lung cancer develops confusion, headache, and
muscle cramps. Her serum sodium is 118 mEq/L. Which nursing intervention is most
appropriate?
A. Administer 3% NaCl at 100 mL/hr
B. Implement strict fluid restriction to 800-1,000 mL/day [CORRECT]
C. Start 0.9% NaCl at 150 mL/hr
D. Encourage oral fluid intake to 3,000 mL/day
Correct Answer: B
Rationale: This patient has hyponatremia likely secondary to SIADH from small cell lung
cancer. The primary management for SIADH-induced hyponatremia is fluid restriction
(800-1,000 mL/day) to allow the body to excrete excess water and correct sodium
gradually. Hypertonic saline is reserved for severe symptomatic hyponatremia with
seizures or coma. Isotonic fluids or increased oral intake would worsen dilutional
hyponatremia. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q4: A 62-year-old male with diabetes insipidus has a serum sodium of 156 mEq/L. He is
confused and extremely thirsty. Which intervention should the nurse implement?
A. Administer furosemide 20 mg IV
B. Provide free water replacement via oral or IV D5W [CORRECT]
,C. Start fluid restriction to 1,000 mL/day
D. Administer 3% NaCl at 50 mL/hr
Correct Answer: B
Rationale: This patient has hypernatremia secondary to diabetes insipidus,
characterized by water deficit and inadequate intake. The management focuses on free
water replacement to correct the water deficit gradually. Diuretics and fluid restriction
would worsen hypernatremia. Hypertonic saline is contraindicated as it would further
elevate sodium levels. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q5: A patient receiving IV furosemide and experiencing frequent loose stools develops
muscle weakness, fatigue, and ECG changes showing U waves. Which electrolyte
imbalance is most likely?
A. Hyperkalemia
B. Hypokalemia [CORRECT]
C. Hypernatremia
D. Hypocalcemia
Correct Answer: B
Rationale: Loop diuretics (furosemide) and GI losses (diarrhea) cause potassium
wasting, leading to hypokalemia. Classic manifestations include muscle weakness,
fatigue, and U waves on ECG (representing delayed ventricular repolarization).
Hyperkalemia would show peaked T waves and widened QRS complexes.
Hypocalcemia presents with tetany and prolonged QT interval. [100% VERIFIED –
Rasmussen NUR2392 MDC2]
Q6: A nurse is administering potassium chloride IV to a patient with hypokalemia (K+
2.8 mEq/L). Which action by the nurse requires immediate intervention?
A. Diluting KCl in 100 mL NS and infusing over 1 hour
B. Administering KCl via central line at 20 mEq/hr
C. Preparing to give KCl 40 mEq IV push over 2 minutes [CORRECT]
D. Monitoring the patient's cardiac rhythm during infusion
Correct Answer: C
, Rationale: Potassium chloride must NEVER be administered IV push as it causes
immediate cardiac arrest due to severe hyperkalemia. The maximum safe IV infusion
rate is 10-20 mEq/hr via peripheral line (up to 40 mEq/hr via central line with cardiac
monitoring). All other options represent safe nursing practice for potassium
administration. [100% VERIFIED – Rasmussen NUR2392 MDC2]
Q7: A patient with end-stage renal disease on hemodialysis presents with peaked T
waves on ECG, widened QRS complexes, and muscle weakness. His potassium is 7.2
mEq/L. Which intervention should the nurse prepare to administer first?
A. Sodium polystyrene sulfonate (Kayexalate) 15 g PO
B. Regular insulin 10 units IV with 50 mL D50W
C. Calcium gluconate 1 g IV over 5 minutes [CORRECT]
D. Albuterol nebulizer treatment
Correct Answer: C
Rationale: In severe hyperkalemia with ECG changes (peaked T waves, widened QRS),
calcium gluconate is administered first to stabilize cardiac membranes and prevent
life-threatening arrhythmias. While insulin/glucose, albuterol, and kayexalate all lower
potassium levels, they do not provide immediate cardiac protection. Calcium gluconate
is the priority intervention when ECG changes are present. [100% VERIFIED –
Rasmussen NUR2392 MDC2]
Q8: A 35-year-old female post-thyroidectomy develops perioral numbness, carpopedal
spasm, and a positive Chvostek sign. Her calcium level is 7.2 mg/dL. Which intervention
is the priority?
A. Administer oral calcium carbonate 1,250 mg TID
B. Administer IV calcium gluconate 1 g slowly [CORRECT]
C. Start vitamin D supplementation 2,000 IU daily
D. Encourage increased dairy product intake
Correct Answer: B
