Page 1 of 181
MDC III EXAM 2 - COMPREHENSIVE EXAM WITH
COMPLETE QUESTIONS AND CORRECT DETAILED
SOLUTIONS ALL WITH RATIONALES LATEST THIS YEAR
MDC III EXAM 2 - COMPREHENSIVE COVERAGE SUMMARY
Exam Focus: Medical-Surgical Nursing III covering cardiovascular disorders, respiratory
disorders, renal disorders, endocrine disorders, gastrointestinal disorders, neurological
disorders, musculoskeletal disorders, hematologic disorders, immunologic disorders, and critical
care nursing principles.
Exam Format: 300 randomized multiple-choice questions with scenario-based clinical
presentations, focusing on pathophysiology, nursing interventions, medication management,
and clinical decision-making.
1. A 65-year-old patient with heart failure presents with dyspnea, orthopnea, and peripheral
edema. His ejection fraction is 25%. Which medication class is most appropriate for improving
survival?
A) Calcium channel blockers
B) Beta-blockers
C) Digoxin
D) Diuretics
E) Nitrates
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Answer: B Beta-blockers like carvedilol improve survival in heart failure with reduced ejection
fraction by reducing myocardial oxygen demand and preventing remodeling.
2. A 58-year-old patient with COPD presents with worsening dyspnea, productive cough, and
fever. Arterial blood gas shows pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg. What is the most
appropriate initial intervention?
A) Intubation and mechanical ventilation
B) Non-invasive positive pressure ventilation
C) Oxygen via nasal cannula at 2 L/min
D) Bronchodilators and corticosteroids
E) Antibiotics and chest physiotherapy
Answer: B Non-invasive positive pressure ventilation is first-line for acute hypercapnic
respiratory failure in COPD, improving gas exchange and preventing intubation.
3. A 72-year-old patient with chronic kidney disease stage 4 presents with fatigue, anorexia, and
pruritus. Laboratory shows BUN 85 mg/dL, creatinine 4.5 mg/dL, and GFR 18 mL/min. What is
the most appropriate treatment?
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A) Hemodialysis initiation
B) Peritoneal dialysis
C) Conservative management
D) Erythropoietin therapy
E) Renal transplant evaluation
Answer: D Erythropoietin therapy is indicated for anemia of CKD when hemoglobin <10 g/dL,
with dialysis initiation when GFR <15 mL/min or symptoms of uremia.
4. A 45-year-old patient with type 2 diabetes presents with polyuria, polydipsia, and weight loss.
Hemoglobin A1c is 10.2%. What is the most appropriate initial pharmacologic therapy?
A) Metformin
B) Insulin
C) Sulfonylureas
D) DPP-4 inhibitors
E) SGLT2 inhibitors
Answer: A Metformin is first-line therapy for type 2 diabetes, improving glycemic control and
reducing cardiovascular events without causing hypoglycemia.
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5. A 68-year-old patient presents with acute onset of severe headache, nausea, and
photophobia. Lumbar puncture shows elevated opening pressure and xanthochromia. What is
the most likely diagnosis?
A) Meningitis
B) Subarachnoid hemorrhage
C) Migraine
D) Brain tumor
E) Stroke
Answer: B Subarachnoid hemorrhage presents with sudden severe headache, elevated opening
pressure, and xanthochromia on lumbar puncture due to blood breakdown products.
6. A 55-year-old patient with cirrhosis develops ascites, jaundice, and confusion. Laboratory
shows elevated ammonia and bilirubin. What is the most likely diagnosis?
A) Hepatic encephalopathy
B) Hepatocellular carcinoma
C) Acute liver failure
MDC III EXAM 2 - COMPREHENSIVE EXAM WITH
COMPLETE QUESTIONS AND CORRECT DETAILED
SOLUTIONS ALL WITH RATIONALES LATEST THIS YEAR
MDC III EXAM 2 - COMPREHENSIVE COVERAGE SUMMARY
Exam Focus: Medical-Surgical Nursing III covering cardiovascular disorders, respiratory
disorders, renal disorders, endocrine disorders, gastrointestinal disorders, neurological
disorders, musculoskeletal disorders, hematologic disorders, immunologic disorders, and critical
care nursing principles.
Exam Format: 300 randomized multiple-choice questions with scenario-based clinical
presentations, focusing on pathophysiology, nursing interventions, medication management,
and clinical decision-making.
1. A 65-year-old patient with heart failure presents with dyspnea, orthopnea, and peripheral
edema. His ejection fraction is 25%. Which medication class is most appropriate for improving
survival?
A) Calcium channel blockers
B) Beta-blockers
C) Digoxin
D) Diuretics
E) Nitrates
, Page 2 of 181
Answer: B Beta-blockers like carvedilol improve survival in heart failure with reduced ejection
fraction by reducing myocardial oxygen demand and preventing remodeling.
2. A 58-year-old patient with COPD presents with worsening dyspnea, productive cough, and
fever. Arterial blood gas shows pH 7.28, PaCO2 65 mmHg, PaO2 55 mmHg. What is the most
appropriate initial intervention?
A) Intubation and mechanical ventilation
B) Non-invasive positive pressure ventilation
C) Oxygen via nasal cannula at 2 L/min
D) Bronchodilators and corticosteroids
E) Antibiotics and chest physiotherapy
Answer: B Non-invasive positive pressure ventilation is first-line for acute hypercapnic
respiratory failure in COPD, improving gas exchange and preventing intubation.
3. A 72-year-old patient with chronic kidney disease stage 4 presents with fatigue, anorexia, and
pruritus. Laboratory shows BUN 85 mg/dL, creatinine 4.5 mg/dL, and GFR 18 mL/min. What is
the most appropriate treatment?
, Page 3 of 181
A) Hemodialysis initiation
B) Peritoneal dialysis
C) Conservative management
D) Erythropoietin therapy
E) Renal transplant evaluation
Answer: D Erythropoietin therapy is indicated for anemia of CKD when hemoglobin <10 g/dL,
with dialysis initiation when GFR <15 mL/min or symptoms of uremia.
4. A 45-year-old patient with type 2 diabetes presents with polyuria, polydipsia, and weight loss.
Hemoglobin A1c is 10.2%. What is the most appropriate initial pharmacologic therapy?
A) Metformin
B) Insulin
C) Sulfonylureas
D) DPP-4 inhibitors
E) SGLT2 inhibitors
Answer: A Metformin is first-line therapy for type 2 diabetes, improving glycemic control and
reducing cardiovascular events without causing hypoglycemia.
, Page 4 of 181
5. A 68-year-old patient presents with acute onset of severe headache, nausea, and
photophobia. Lumbar puncture shows elevated opening pressure and xanthochromia. What is
the most likely diagnosis?
A) Meningitis
B) Subarachnoid hemorrhage
C) Migraine
D) Brain tumor
E) Stroke
Answer: B Subarachnoid hemorrhage presents with sudden severe headache, elevated opening
pressure, and xanthochromia on lumbar puncture due to blood breakdown products.
6. A 55-year-old patient with cirrhosis develops ascites, jaundice, and confusion. Laboratory
shows elevated ammonia and bilirubin. What is the most likely diagnosis?
A) Hepatic encephalopathy
B) Hepatocellular carcinoma
C) Acute liver failure
