Final Exam
NUR2392 / NUR 2392 (Latest )
Multidimensional Care II / MDC 2
Rasmussen University
100 Multiple-Choice Questions
Cardiovascular | Peripheral Vascular | Hematologic | Renal/Urinary | Endocrine | Fluid & Electrolytes | Integrated Clinical
Scenarios
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Styles: 75% Scenario-Based | 20% Direct Recall | 5% Clinical Judgment/Lab Analysis
Format: Four options (A-D) per question | One correct answer | Detailed rationales included
NUR 2392 / MDC 2 Final Exam - Page 1
,Section 1: Cardiovascular Disorders (Q1-Q25)
CAD, Heart Failure, Hypertension, Valvular Disorders, Dysrhythmias
Q1: A 58-year-old male presents to the emergency department with crushing substernal chest pain that began 2 hours
ago. The pain radiates to his left arm and jaw. He is diaphoretic and nauseated. An ECG reveals ST-segment
elevation in leads II, III, and aVF. Which of the following cardiac biomarkers is the gold standard for confirming the
diagnosis of acute myocardial infarction in this patient?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I
D. Brain natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the gold standard cardiac biomarker for diagnosing acute myocardial infarction (MI) because of its
high sensitivity and cardiac specificity. Troponin levels rise within 3-4 hours after myocardial injury and can remain elevated
for 7-10 days, making it both early and persistent. CK-MB is less specific to cardiac muscle and returns to normal within
48-72 hours, while myoglobin is very early but lacks cardiac specificity. BNP is used for heart failure assessment, not acute
MI diagnosis.
Q2: A nurse is providing discharge teaching to a patient who underwent percutaneous coronary intervention (PCI)
with stent placement. The patient received a drug-eluting stent. Which of the following instructions is most critical
for the nurse to include regarding antiplatelet therapy?
A. Take aspirin 81 mg daily for 2 weeks, then discontinue
B. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for at least 6-12 months
C. Discontinue aspirin if mild gastrointestinal upset occurs
D. Take ibuprofen as needed for chest discomfort instead of prescribed medications
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel is essential for 6-12
months after drug-eluting stent placement to prevent stent thrombosis, a life-threatening complication. Premature
discontinuation of DAPT significantly increases the risk of stent thrombosis, which can lead to acute MI or death. The patient
should never discontinue antiplatelet therapy without consulting the cardiologist, and NSAIDs like ibuprofen are
contraindicated as they increase cardiovascular risk.
Q3: A 72-year-old female with a history of hypertension and type 2 diabetes is admitted to the hospital with
shortness of breath, fatigue, and bilateral ankle edema. Physical examination reveals bilateral crackles in the lung
bases, an S3 gallop, and jugular venous distension (JVD). Her current weight is 4 pounds above her documented dry
weight from last week. Which type of heart failure does this presentation most likely indicate?
A. Right-sided heart failure only
B. Left-sided heart failure with secondary right-sided failure (biventricular failure)
C. Isolated diastolic heart failure
D. Acute cor pulmonale
Correct Answer: B
Rationale: This patient presents with signs of both left-sided heart failure (pulmonary congestion: crackles, S3 gallop,
dyspnea, orthopnea) and right-sided heart failure (peripheral edema, JVD, weight gain). Left-sided heart failure is the most
common form and typically progresses to involve the right ventricle, resulting in biventricular failure. The S3 gallop is a
hallmark of left-sided ventricular dysfunction, while JVD and peripheral edema indicate right-sided failure. Daily weight
measurement is the best indicator of fluid volume status and is essential for monitoring heart failure progression.
NUR 2392 / MDC 2 Final Exam - Page 2
, Q4: A patient with chronic heart failure is prescribed furosemide (Lasix) 40 mg IV. The nurse reviews the patient's
morning laboratory results and notes a serum potassium level of 3.1 mEq/L. Which of the following nursing
interventions is the priority?
A. Administer the furosemide as prescribed and recheck potassium in 24 hours
B. Hold the furosemide, notify the healthcare provider, and obtain an order for potassium replacement
C. Administer the furosemide and encourage the patient to eat potassium-rich foods
D. Administer the furosemide with a glass of orange juice
Correct Answer: B
Rationale: A serum potassium level of 3.1 mEq/L indicates moderate hypokalemia, which is below the normal range of 3.5-5.0
mEq/L. Furosemide is a loop diuretic that causes potassium wasting, and administering it to a patient who is already
hypokalemic increases the risk of life-threatening cardiac dysrhythmias. The priority action is to hold the furosemide, notify
the healthcare provider, and obtain an order for potassium replacement. Hypokalemia can lead to U waves on ECG,
ventricular dysrhythmias, and cardiac arrest if left untreated.
Q5: A nurse is caring for a patient with hypertension whose blood pressure has been consistently 158/96 mmHg
despite lifestyle modifications. The healthcare provider prescribes lisinopril, an ACE inhibitor. The nurse should
teach the patient to monitor for which of the following potential adverse effects of this medication?
A. Bradycardia and bronchospasm
B. Persistent dry cough and hyperkalemia
C. Tachycardia and hypoglycemia
D. Urinary retention and constipation
Correct Answer: B
Rationale: ACE inhibitors like lisinopril are first-line medications for hypertension and heart failure. Two common adverse
effects are a persistent dry cough (occurring in up to 20% of patients due to bradykinin accumulation) and hyperkalemia (due
to reduced aldosterone secretion). If the cough is intolerable, the provider may switch to an ARB, which does not cause the
cough but has similar efficacy. The nurse should also educate the patient to avoid potassium supplements and salt substitutes,
which contain potassium chloride and can worsen hyperkalemia.
Q6: A 65-year-old patient with a history of angina reports experiencing chest discomfort at rest that is not relieved
by sublingual nitroglycerin. The episodes have become more frequent and occur with less exertion over the past 2
weeks. Which type of angina does this presentation most likely indicate?
A. Stable angina (predictable pattern)
B. Unstable angina (medical emergency)
C. Prinzmetal (variant) angina
D. Microvascular angina
Correct Answer: B
Rationale: Unstable angina is characterized by chest pain that is new in onset, occurs at rest, is more frequent or severe, or is
not relieved by rest or nitroglycerin. It represents a medical emergency because it indicates that atherosclerotic plaque has
become unstable, with increased risk of complete vessel occlusion and progression to myocardial infarction. Unlike stable
angina, which follows a predictable pattern triggered by exertion or stress, unstable angina is unpredictable and requires
immediate medical evaluation, often including hospital admission and anticoagulation.
Q7: A patient is admitted with acute decompensated heart failure. The nurse positions the patient in high Fowler's
position. What is the primary rationale for this intervention?
A. To promote venous return from the lower extremities and reduce peripheral edema
B. To reduce preload and decrease the work of breathing by maximizing lung expansion
C. To lower blood pressure by inducing vasodilation
D. To prevent aspiration in patients with impaired swallowing
Correct Answer: B
NUR 2392 / MDC 2 Final Exam - Page 3
NUR2392 / NUR 2392 (Latest )
Multidimensional Care II / MDC 2
Rasmussen University
100 Multiple-Choice Questions
Cardiovascular | Peripheral Vascular | Hematologic | Renal/Urinary | Endocrine | Fluid & Electrolytes | Integrated Clinical
Scenarios
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Styles: 75% Scenario-Based | 20% Direct Recall | 5% Clinical Judgment/Lab Analysis
Format: Four options (A-D) per question | One correct answer | Detailed rationales included
NUR 2392 / MDC 2 Final Exam - Page 1
,Section 1: Cardiovascular Disorders (Q1-Q25)
CAD, Heart Failure, Hypertension, Valvular Disorders, Dysrhythmias
Q1: A 58-year-old male presents to the emergency department with crushing substernal chest pain that began 2 hours
ago. The pain radiates to his left arm and jaw. He is diaphoretic and nauseated. An ECG reveals ST-segment
elevation in leads II, III, and aVF. Which of the following cardiac biomarkers is the gold standard for confirming the
diagnosis of acute myocardial infarction in this patient?
A. Creatine kinase-MB (CK-MB)
B. Myoglobin
C. Troponin I
D. Brain natriuretic peptide (BNP)
Correct Answer: C
Rationale: Troponin I is the gold standard cardiac biomarker for diagnosing acute myocardial infarction (MI) because of its
high sensitivity and cardiac specificity. Troponin levels rise within 3-4 hours after myocardial injury and can remain elevated
for 7-10 days, making it both early and persistent. CK-MB is less specific to cardiac muscle and returns to normal within
48-72 hours, while myoglobin is very early but lacks cardiac specificity. BNP is used for heart failure assessment, not acute
MI diagnosis.
Q2: A nurse is providing discharge teaching to a patient who underwent percutaneous coronary intervention (PCI)
with stent placement. The patient received a drug-eluting stent. Which of the following instructions is most critical
for the nurse to include regarding antiplatelet therapy?
A. Take aspirin 81 mg daily for 2 weeks, then discontinue
B. Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel for at least 6-12 months
C. Discontinue aspirin if mild gastrointestinal upset occurs
D. Take ibuprofen as needed for chest discomfort instead of prescribed medications
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor such as clopidogrel is essential for 6-12
months after drug-eluting stent placement to prevent stent thrombosis, a life-threatening complication. Premature
discontinuation of DAPT significantly increases the risk of stent thrombosis, which can lead to acute MI or death. The patient
should never discontinue antiplatelet therapy without consulting the cardiologist, and NSAIDs like ibuprofen are
contraindicated as they increase cardiovascular risk.
Q3: A 72-year-old female with a history of hypertension and type 2 diabetes is admitted to the hospital with
shortness of breath, fatigue, and bilateral ankle edema. Physical examination reveals bilateral crackles in the lung
bases, an S3 gallop, and jugular venous distension (JVD). Her current weight is 4 pounds above her documented dry
weight from last week. Which type of heart failure does this presentation most likely indicate?
A. Right-sided heart failure only
B. Left-sided heart failure with secondary right-sided failure (biventricular failure)
C. Isolated diastolic heart failure
D. Acute cor pulmonale
Correct Answer: B
Rationale: This patient presents with signs of both left-sided heart failure (pulmonary congestion: crackles, S3 gallop,
dyspnea, orthopnea) and right-sided heart failure (peripheral edema, JVD, weight gain). Left-sided heart failure is the most
common form and typically progresses to involve the right ventricle, resulting in biventricular failure. The S3 gallop is a
hallmark of left-sided ventricular dysfunction, while JVD and peripheral edema indicate right-sided failure. Daily weight
measurement is the best indicator of fluid volume status and is essential for monitoring heart failure progression.
NUR 2392 / MDC 2 Final Exam - Page 2
, Q4: A patient with chronic heart failure is prescribed furosemide (Lasix) 40 mg IV. The nurse reviews the patient's
morning laboratory results and notes a serum potassium level of 3.1 mEq/L. Which of the following nursing
interventions is the priority?
A. Administer the furosemide as prescribed and recheck potassium in 24 hours
B. Hold the furosemide, notify the healthcare provider, and obtain an order for potassium replacement
C. Administer the furosemide and encourage the patient to eat potassium-rich foods
D. Administer the furosemide with a glass of orange juice
Correct Answer: B
Rationale: A serum potassium level of 3.1 mEq/L indicates moderate hypokalemia, which is below the normal range of 3.5-5.0
mEq/L. Furosemide is a loop diuretic that causes potassium wasting, and administering it to a patient who is already
hypokalemic increases the risk of life-threatening cardiac dysrhythmias. The priority action is to hold the furosemide, notify
the healthcare provider, and obtain an order for potassium replacement. Hypokalemia can lead to U waves on ECG,
ventricular dysrhythmias, and cardiac arrest if left untreated.
Q5: A nurse is caring for a patient with hypertension whose blood pressure has been consistently 158/96 mmHg
despite lifestyle modifications. The healthcare provider prescribes lisinopril, an ACE inhibitor. The nurse should
teach the patient to monitor for which of the following potential adverse effects of this medication?
A. Bradycardia and bronchospasm
B. Persistent dry cough and hyperkalemia
C. Tachycardia and hypoglycemia
D. Urinary retention and constipation
Correct Answer: B
Rationale: ACE inhibitors like lisinopril are first-line medications for hypertension and heart failure. Two common adverse
effects are a persistent dry cough (occurring in up to 20% of patients due to bradykinin accumulation) and hyperkalemia (due
to reduced aldosterone secretion). If the cough is intolerable, the provider may switch to an ARB, which does not cause the
cough but has similar efficacy. The nurse should also educate the patient to avoid potassium supplements and salt substitutes,
which contain potassium chloride and can worsen hyperkalemia.
Q6: A 65-year-old patient with a history of angina reports experiencing chest discomfort at rest that is not relieved
by sublingual nitroglycerin. The episodes have become more frequent and occur with less exertion over the past 2
weeks. Which type of angina does this presentation most likely indicate?
A. Stable angina (predictable pattern)
B. Unstable angina (medical emergency)
C. Prinzmetal (variant) angina
D. Microvascular angina
Correct Answer: B
Rationale: Unstable angina is characterized by chest pain that is new in onset, occurs at rest, is more frequent or severe, or is
not relieved by rest or nitroglycerin. It represents a medical emergency because it indicates that atherosclerotic plaque has
become unstable, with increased risk of complete vessel occlusion and progression to myocardial infarction. Unlike stable
angina, which follows a predictable pattern triggered by exertion or stress, unstable angina is unpredictable and requires
immediate medical evaluation, often including hospital admission and anticoagulation.
Q7: A patient is admitted with acute decompensated heart failure. The nurse positions the patient in high Fowler's
position. What is the primary rationale for this intervention?
A. To promote venous return from the lower extremities and reduce peripheral edema
B. To reduce preload and decrease the work of breathing by maximizing lung expansion
C. To lower blood pressure by inducing vasodilation
D. To prevent aspiration in patients with impaired swallowing
Correct Answer: B
NUR 2392 / MDC 2 Final Exam - Page 3
