,NUR 2502 Final Exam | Multidimensional Care III
(2026) Q&A | Rasmussen College
1. A client with left‑sided heart failure is admitted with increasing dyspnea.
Which assessment finding is most indicative of pulmonary congestion?
A) Jugular vein distention
B) Dependent edema
C) Crackles in the lung bases
D) Ascites
Correct Answer: C) Crackles in the lung bases
Rationale: Left‑sided heart failure causes blood to back up into the pulmonary
circulation, leading to fluid‑filled alveoli and crackles (rales). Jugular vein
distention, dependent edema, and ascites are signs of right‑sided heart failure
from systemic congestion.
2. The nurse is teaching a client with heart failure about daily weight
monitoring. The client should weigh themselves
A) once a week, after a large meal
B) every morning at the same time, after voiding, wearing similar clothing
C) twice a day, before meals
D) every evening before bed
Correct Answer: B) every morning at the same time, after voiding, wearing
similar clothing
,Rationale: Consistent daily weights provide the most accurate reflection of fluid
status. A weight gain of 2–3 lb in 24 hours or 5 lb in a week should be reported
promptly. Weighing at different times or with different clothing leads to
inaccurate trends.
3. A client with heart failure has a brain natriuretic peptide (BNP) level of 900
pg/mL. The nurse interprets this result as
A) normal, ruling out heart failure
B) slightly elevated, indicating mild anxiety
C) markedly elevated, consistent with heart failure
D) diagnostic of a pulmonary embolism
Correct Answer: C) markedly elevated, consistent with heart failure
Rationale: BNP is released when the ventricles stretch due to volume overload.
Levels above 100 pg/mL suggest heart failure; levels above 400 pg/mL are
significantly elevated. This value supports the diagnosis of decompensated
heart failure.
4. The nurse is teaching a client with heart failure about dietary sodium
restriction. The client should be instructed to limit sodium intake to
A) 4,000 mg per day
B) 3,000 mg per day
C) 2,000–2,400 mg per day
D) 500 mg per day
Correct Answer: C) 2,000–2,400 mg per day
, Rationale: The American Heart Association recommends limiting sodium to no
more than 2,300 mg per day, with an ideal limit of 1,500 mg for most adults,
especially those with heart failure. Excessive sodium leads to fluid retention and
worsened symptoms.
5. A client with heart failure is prescribed furosemide. The nurse should monitor
for which electrolyte imbalance?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Correct Answer: B) Hypokalemia
Rationale: Furosemide is a loop diuretic that promotes potassium excretion in
the distal tubule, leading to hypokalemia. Signs include muscle weakness,
cardiac arrhythmias, and flattened T waves. Potassium levels must be
monitored closely.
6. The nurse is caring for a client with right‑sided heart failure. Which finding is
expected?
A) Pulmonary crackles and orthopnea
B) Paroxysmal nocturnal dyspnea
C) Hepatomegaly and peripheral edema
D) Frothy, pink‑tinged sputum
(2026) Q&A | Rasmussen College
1. A client with left‑sided heart failure is admitted with increasing dyspnea.
Which assessment finding is most indicative of pulmonary congestion?
A) Jugular vein distention
B) Dependent edema
C) Crackles in the lung bases
D) Ascites
Correct Answer: C) Crackles in the lung bases
Rationale: Left‑sided heart failure causes blood to back up into the pulmonary
circulation, leading to fluid‑filled alveoli and crackles (rales). Jugular vein
distention, dependent edema, and ascites are signs of right‑sided heart failure
from systemic congestion.
2. The nurse is teaching a client with heart failure about daily weight
monitoring. The client should weigh themselves
A) once a week, after a large meal
B) every morning at the same time, after voiding, wearing similar clothing
C) twice a day, before meals
D) every evening before bed
Correct Answer: B) every morning at the same time, after voiding, wearing
similar clothing
,Rationale: Consistent daily weights provide the most accurate reflection of fluid
status. A weight gain of 2–3 lb in 24 hours or 5 lb in a week should be reported
promptly. Weighing at different times or with different clothing leads to
inaccurate trends.
3. A client with heart failure has a brain natriuretic peptide (BNP) level of 900
pg/mL. The nurse interprets this result as
A) normal, ruling out heart failure
B) slightly elevated, indicating mild anxiety
C) markedly elevated, consistent with heart failure
D) diagnostic of a pulmonary embolism
Correct Answer: C) markedly elevated, consistent with heart failure
Rationale: BNP is released when the ventricles stretch due to volume overload.
Levels above 100 pg/mL suggest heart failure; levels above 400 pg/mL are
significantly elevated. This value supports the diagnosis of decompensated
heart failure.
4. The nurse is teaching a client with heart failure about dietary sodium
restriction. The client should be instructed to limit sodium intake to
A) 4,000 mg per day
B) 3,000 mg per day
C) 2,000–2,400 mg per day
D) 500 mg per day
Correct Answer: C) 2,000–2,400 mg per day
, Rationale: The American Heart Association recommends limiting sodium to no
more than 2,300 mg per day, with an ideal limit of 1,500 mg for most adults,
especially those with heart failure. Excessive sodium leads to fluid retention and
worsened symptoms.
5. A client with heart failure is prescribed furosemide. The nurse should monitor
for which electrolyte imbalance?
A) Hyperkalemia
B) Hypokalemia
C) Hypercalcemia
D) Hypermagnesemia
Correct Answer: B) Hypokalemia
Rationale: Furosemide is a loop diuretic that promotes potassium excretion in
the distal tubule, leading to hypokalemia. Signs include muscle weakness,
cardiac arrhythmias, and flattened T waves. Potassium levels must be
monitored closely.
6. The nurse is caring for a client with right‑sided heart failure. Which finding is
expected?
A) Pulmonary crackles and orthopnea
B) Paroxysmal nocturnal dyspnea
C) Hepatomegaly and peripheral edema
D) Frothy, pink‑tinged sputum
