NUR 2392 / NUR2392 Final Exam
Multidimensional Care II (MDC 2)
Rasmussen University | 2026/2027 Curriculum
150 Questions | Comprehensive Review with Detailed Rationales
Content Areas: Endocrine Disorders | Cancer Care and Oncology Nursing | Fluid, Electrolyte and Acid-Base Imbalances
Cardiovascular and Respiratory Emergencies | Renal, GI and Hepatic Disorders | Perioperative and Postoperative Care
Multisystem Management and Prioritization | Integrated Clinical Scenarios (NGN Style)
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Types: 70% Scenario-Based | 20% Direct Recall | 10% Clinical Judgment/Prioritization
Aligned with 2026-2027 Rasmussen University NUR 2392 MDC 2 curriculum standards.
EXAM CONTENT OUTLINE
Section 1: Endocrine Disorders (Q1-Q25)
Section 2: Cancer Care and Oncology Nursing (Q26-Q45)
Section 3: Fluid, Electrolyte, and Acid-Base Imbalances (Q46-Q65)
Section 4: Cardiovascular and Respiratory Emergencies (Q66-Q90)
Section 5: Renal, Gastrointestinal, and Hepatic Disorders (Q91-Q110)
Section 6: Perioperative and Postoperative Care (Q111-Q125)
Section 7: Multisystem Management and Prioritization (Q126-Q140)
,NUR 2392 MDC 2 Final Exam (2026/2027) 150 Questions | Comprehensive Review
Section 8: Integrated Clinical Scenarios - NGN Style (Q141-Q150)
Total: 150 Questions
Section 1: Endocrine Disorders (Q1-Q25)
Q1: A patient with diabetes insipidus is being evaluated. Which finding would the nurse expect?
A. Urine specific gravity of 1.030
B. Urine output of 50 mL/hr
C. Urine specific gravity less than 1.005 **[CORRECT]**
D. Serum sodium of 135 mEq/L
Correct Answer: C
Rationale: DI is caused by ADH deficiency or resistance, leading to dilute urine with specific gravity below 1.005, polyuria (3-20
L/day), and polydipsia. SG of 1.030 indicates concentrated urine. Output of 50 mL/hr is normal. Na 135 is normal; DI patients
often have hypernatremia from free water loss.
Q2: The nurse is caring for a patient diagnosed with SIADH. Which intervention is the priority?
A. Administer hypertonic saline
B. Initiate fluid restriction **[CORRECT]**
C. Administer desmopressin (DDAVP)
D. Encourage increased fluid intake
Correct Answer: B
Rationale: SIADH causes water retention and dilutional hyponatremia. First-line treatment is fluid restriction (800-1000 mL/day).
Hypertonic saline is for severe symptomatic hyponatremia with seizures. DDAVP treats DI, not SIADH, and would worsen it.
Q3: A patient with Graves' disease presents with exophthalmos, tachycardia, and goiter. Graves' disease is classified
as which type of disorder?
A. Congenital thyroid anomaly
B. Autoimmune disorder **[CORRECT]**
C. Malignant neoplasm of the thyroid
D. Iodine deficiency disorder
Correct Answer: B
Rationale: Graves' disease is an autoimmune disorder where TSI activate TSH receptors, causing hyperthyroidism. Classic triad:
goiter, exophthalmos, pretibial myxedema. It is not congenital, malignant, or from iodine deficiency.
Q4: Which nursing intervention is most appropriate for a patient with Graves' disease experiencing tachycardia and
anxiety?
A. Provide a warm environment
B. Administer methimazole and maintain a calm, cool environment **[CORRECT]**
C. Encourage vigorous exercise
D. Restrict iodine-containing foods only
Correct Answer: B
Rationale: Hyperthyroidism increases metabolic rate causing heat intolerance and tachycardia. A calm, cool environment reduces
metabolic demand. Methimazole inhibits thyroid hormone synthesis. Warm environments and vigorous exercise increase metabolic
Page 2
,NUR 2392 MDC 2 Final Exam (2026/2027) 150 Questions | Comprehensive Review
demands and are contraindicated.
Q5: A patient with hypothyroidism is prescribed levothyroxine. Which instruction should the nurse include?
A. Take with a high-fiber breakfast
B. Take on an empty stomach, 30-60 minutes before breakfast **[CORRECT]**
C. Double the dose if a dose is missed
D. Expect therapeutic effects within 24 hours
Correct Answer: B
Rationale: Levothyroxine must be taken on an empty stomach 30-60 minutes before breakfast for optimal absorption. Fiber,
calcium, and iron interfere with absorption. Never double missed doses due to cardiac toxicity risk. Full effects take 4-6 weeks
with TSH monitoring.
Q6: The nurse assesses a patient with suspected Cushing syndrome. Which manifestation is most consistent?
A. Weight loss and muscle hypertrophy
B. Moon face, buffalo hump, and purple striae **[CORRECT]**
C. Hypotension and bradycardia
D. Hyperpigmentation of the skin
Correct Answer: B
Rationale: Cushing syndrome from excess cortisol causes moon face, buffalo hump, truncal obesity, purple striae, hypertension,
and hyperglycemia. Weight loss, hypotension, and hyperpigmentation are seen in Addison disease, not Cushing syndrome.
Q7: A patient with Addison disease has fatigue, hypotension, and hyperkalemia. Addison disease results from which
process?
A. Excess cortisol production
B. Adrenal cortex insufficiency **[CORRECT]**
C. Pituitary hyperfunction
D. Excess aldosterone production
Correct Answer: B
Rationale: Addison disease (primary adrenal insufficiency) results from adrenal cortex destruction causing cortisol, aldosterone,
and androgen deficiency. Aldosterone deficiency causes hyponatremia, hyperkalemia, and hypotension. Excess cortisol is Cushing
syndrome.
Q8: Which laboratory finding would the nurse expect in a patient with Addison disease?
A. Hypernatremia and hypokalemia
B. Hyponatremia and hyperkalemia **[CORRECT]**
C. Hyperglycemia and hypernatremia
D. Hypocalcemia and hyponatremia
Correct Answer: B
Rationale: Addison disease causes hyponatremia (sodium wasting) and hyperkalemia (potassium retention) from aldosterone
deficiency. Hypernatremia with hypokalemia is hyperaldosteronism. Hyperglycemia suggests Cushing syndrome.
Q9: A patient with type 1 diabetes is found unconscious with blood glucose 42 mg/dL. Priority action?
A. Administer 10-15 grams of oral glucose
B. Administer IV dextrose (D50W) as prescribed **[CORRECT]**
C. Give subcutaneous regular insulin
Page 3
, NUR 2392 MDC 2 Final Exam (2026/2027) 150 Questions | Comprehensive Review
D. Provide a protein snack
Correct Answer: B
Rationale: Unconscious patients cannot safely swallow oral glucose (aspiration risk). IV dextrose (D50W) is the priority for
unresponsive hypoglycemia. Oral glucose is for alert patients only. Insulin would worsen hypoglycemia. This alert vs. unresponsive
distinction is critical in Rasmussen MDC 2.
Q10: A patient with type 1 diabetes is alert with blood glucose 58 mg/dL. What instruction is correct?
A. Wait 30 minutes and recheck
B. Consume 10-15 grams of fast-acting glucose and recheck in 15 minutes **[CORRECT]**
C. Administer glucagon subcutaneously immediately
D. Drink a diet soda to raise blood sugar
Correct Answer: B
Rationale: For an alert hypoglycemic patient (below 70 mg/dL), use the 15-15 rule: 10-15 grams of fast-acting glucose, recheck in
15 minutes. Glucagon is for unconscious patients. Diet soda has no sugar.
Q11: A patient with DI is started on desmopressin (DDAVP). What is the mechanism of action?
A. Blocks ADH receptors in the kidneys
B. Provides synthetic antidiuretic hormone replacement **[CORRECT]**
C. Increases blood glucose levels
D. Inhibits thyroid hormone synthesis
Correct Answer: B
Rationale: DDAVP is a synthetic ADH analogue acting on V2 receptors in renal collecting ducts to increase water reabsorption,
reducing urine output and concentrating urine. It is effective for central DI where the body does not produce enough ADH.
Q12: A patient with SIADH has serum sodium 118 mEq/L with confusion and seizures. Priority intervention?
A. Initiate fluid restriction to 1000 mL/day
B. Administer 3% hypertonic saline via IV pump as prescribed **[CORRECT]**
C. Administer normal saline at 250 mL/hr
D. Encourage oral sodium replacement
Correct Answer: B
Rationale: Severe symptomatic hyponatremia (Na 118) with neurologic symptoms is a medical emergency requiring 3% hypertonic
saline via IV pump. Fluid restriction is for mild SIADH. Normal saline can worsen SIADH. Hypertonic saline must use an IV pump
to prevent rapid overcorrection and osmotic demyelination.
Q13: The nurse monitors a patient on methimazole for Graves' disease. Which adverse effect requires immediate
notification?
A. Mild skin rash
B. Sore throat and fever **[CORRECT]**
C. Mild nausea
D. Weight gain of 1 lb
Correct Answer: B
Rationale: Sore throat and fever with methimazole may indicate agranulocytosis, a life-threatening decrease in WBCs. This
requires immediate provider notification and CBC. Agranulocytosis occurs in 0.2-0.5% of patients on antithyroid drugs and is a
critical safety concern.
Page 4
Multidimensional Care II (MDC 2)
Rasmussen University | 2026/2027 Curriculum
150 Questions | Comprehensive Review with Detailed Rationales
Content Areas: Endocrine Disorders | Cancer Care and Oncology Nursing | Fluid, Electrolyte and Acid-Base Imbalances
Cardiovascular and Respiratory Emergencies | Renal, GI and Hepatic Disorders | Perioperative and Postoperative Care
Multisystem Management and Prioritization | Integrated Clinical Scenarios (NGN Style)
Cognitive Levels: 25% Recall | 55% Application | 20% Analysis
Question Types: 70% Scenario-Based | 20% Direct Recall | 10% Clinical Judgment/Prioritization
Aligned with 2026-2027 Rasmussen University NUR 2392 MDC 2 curriculum standards.
EXAM CONTENT OUTLINE
Section 1: Endocrine Disorders (Q1-Q25)
Section 2: Cancer Care and Oncology Nursing (Q26-Q45)
Section 3: Fluid, Electrolyte, and Acid-Base Imbalances (Q46-Q65)
Section 4: Cardiovascular and Respiratory Emergencies (Q66-Q90)
Section 5: Renal, Gastrointestinal, and Hepatic Disorders (Q91-Q110)
Section 6: Perioperative and Postoperative Care (Q111-Q125)
Section 7: Multisystem Management and Prioritization (Q126-Q140)
,NUR 2392 MDC 2 Final Exam (2026/2027) 150 Questions | Comprehensive Review
Section 8: Integrated Clinical Scenarios - NGN Style (Q141-Q150)
Total: 150 Questions
Section 1: Endocrine Disorders (Q1-Q25)
Q1: A patient with diabetes insipidus is being evaluated. Which finding would the nurse expect?
A. Urine specific gravity of 1.030
B. Urine output of 50 mL/hr
C. Urine specific gravity less than 1.005 **[CORRECT]**
D. Serum sodium of 135 mEq/L
Correct Answer: C
Rationale: DI is caused by ADH deficiency or resistance, leading to dilute urine with specific gravity below 1.005, polyuria (3-20
L/day), and polydipsia. SG of 1.030 indicates concentrated urine. Output of 50 mL/hr is normal. Na 135 is normal; DI patients
often have hypernatremia from free water loss.
Q2: The nurse is caring for a patient diagnosed with SIADH. Which intervention is the priority?
A. Administer hypertonic saline
B. Initiate fluid restriction **[CORRECT]**
C. Administer desmopressin (DDAVP)
D. Encourage increased fluid intake
Correct Answer: B
Rationale: SIADH causes water retention and dilutional hyponatremia. First-line treatment is fluid restriction (800-1000 mL/day).
Hypertonic saline is for severe symptomatic hyponatremia with seizures. DDAVP treats DI, not SIADH, and would worsen it.
Q3: A patient with Graves' disease presents with exophthalmos, tachycardia, and goiter. Graves' disease is classified
as which type of disorder?
A. Congenital thyroid anomaly
B. Autoimmune disorder **[CORRECT]**
C. Malignant neoplasm of the thyroid
D. Iodine deficiency disorder
Correct Answer: B
Rationale: Graves' disease is an autoimmune disorder where TSI activate TSH receptors, causing hyperthyroidism. Classic triad:
goiter, exophthalmos, pretibial myxedema. It is not congenital, malignant, or from iodine deficiency.
Q4: Which nursing intervention is most appropriate for a patient with Graves' disease experiencing tachycardia and
anxiety?
A. Provide a warm environment
B. Administer methimazole and maintain a calm, cool environment **[CORRECT]**
C. Encourage vigorous exercise
D. Restrict iodine-containing foods only
Correct Answer: B
Rationale: Hyperthyroidism increases metabolic rate causing heat intolerance and tachycardia. A calm, cool environment reduces
metabolic demand. Methimazole inhibits thyroid hormone synthesis. Warm environments and vigorous exercise increase metabolic
Page 2
,NUR 2392 MDC 2 Final Exam (2026/2027) 150 Questions | Comprehensive Review
demands and are contraindicated.
Q5: A patient with hypothyroidism is prescribed levothyroxine. Which instruction should the nurse include?
A. Take with a high-fiber breakfast
B. Take on an empty stomach, 30-60 minutes before breakfast **[CORRECT]**
C. Double the dose if a dose is missed
D. Expect therapeutic effects within 24 hours
Correct Answer: B
Rationale: Levothyroxine must be taken on an empty stomach 30-60 minutes before breakfast for optimal absorption. Fiber,
calcium, and iron interfere with absorption. Never double missed doses due to cardiac toxicity risk. Full effects take 4-6 weeks
with TSH monitoring.
Q6: The nurse assesses a patient with suspected Cushing syndrome. Which manifestation is most consistent?
A. Weight loss and muscle hypertrophy
B. Moon face, buffalo hump, and purple striae **[CORRECT]**
C. Hypotension and bradycardia
D. Hyperpigmentation of the skin
Correct Answer: B
Rationale: Cushing syndrome from excess cortisol causes moon face, buffalo hump, truncal obesity, purple striae, hypertension,
and hyperglycemia. Weight loss, hypotension, and hyperpigmentation are seen in Addison disease, not Cushing syndrome.
Q7: A patient with Addison disease has fatigue, hypotension, and hyperkalemia. Addison disease results from which
process?
A. Excess cortisol production
B. Adrenal cortex insufficiency **[CORRECT]**
C. Pituitary hyperfunction
D. Excess aldosterone production
Correct Answer: B
Rationale: Addison disease (primary adrenal insufficiency) results from adrenal cortex destruction causing cortisol, aldosterone,
and androgen deficiency. Aldosterone deficiency causes hyponatremia, hyperkalemia, and hypotension. Excess cortisol is Cushing
syndrome.
Q8: Which laboratory finding would the nurse expect in a patient with Addison disease?
A. Hypernatremia and hypokalemia
B. Hyponatremia and hyperkalemia **[CORRECT]**
C. Hyperglycemia and hypernatremia
D. Hypocalcemia and hyponatremia
Correct Answer: B
Rationale: Addison disease causes hyponatremia (sodium wasting) and hyperkalemia (potassium retention) from aldosterone
deficiency. Hypernatremia with hypokalemia is hyperaldosteronism. Hyperglycemia suggests Cushing syndrome.
Q9: A patient with type 1 diabetes is found unconscious with blood glucose 42 mg/dL. Priority action?
A. Administer 10-15 grams of oral glucose
B. Administer IV dextrose (D50W) as prescribed **[CORRECT]**
C. Give subcutaneous regular insulin
Page 3
, NUR 2392 MDC 2 Final Exam (2026/2027) 150 Questions | Comprehensive Review
D. Provide a protein snack
Correct Answer: B
Rationale: Unconscious patients cannot safely swallow oral glucose (aspiration risk). IV dextrose (D50W) is the priority for
unresponsive hypoglycemia. Oral glucose is for alert patients only. Insulin would worsen hypoglycemia. This alert vs. unresponsive
distinction is critical in Rasmussen MDC 2.
Q10: A patient with type 1 diabetes is alert with blood glucose 58 mg/dL. What instruction is correct?
A. Wait 30 minutes and recheck
B. Consume 10-15 grams of fast-acting glucose and recheck in 15 minutes **[CORRECT]**
C. Administer glucagon subcutaneously immediately
D. Drink a diet soda to raise blood sugar
Correct Answer: B
Rationale: For an alert hypoglycemic patient (below 70 mg/dL), use the 15-15 rule: 10-15 grams of fast-acting glucose, recheck in
15 minutes. Glucagon is for unconscious patients. Diet soda has no sugar.
Q11: A patient with DI is started on desmopressin (DDAVP). What is the mechanism of action?
A. Blocks ADH receptors in the kidneys
B. Provides synthetic antidiuretic hormone replacement **[CORRECT]**
C. Increases blood glucose levels
D. Inhibits thyroid hormone synthesis
Correct Answer: B
Rationale: DDAVP is a synthetic ADH analogue acting on V2 receptors in renal collecting ducts to increase water reabsorption,
reducing urine output and concentrating urine. It is effective for central DI where the body does not produce enough ADH.
Q12: A patient with SIADH has serum sodium 118 mEq/L with confusion and seizures. Priority intervention?
A. Initiate fluid restriction to 1000 mL/day
B. Administer 3% hypertonic saline via IV pump as prescribed **[CORRECT]**
C. Administer normal saline at 250 mL/hr
D. Encourage oral sodium replacement
Correct Answer: B
Rationale: Severe symptomatic hyponatremia (Na 118) with neurologic symptoms is a medical emergency requiring 3% hypertonic
saline via IV pump. Fluid restriction is for mild SIADH. Normal saline can worsen SIADH. Hypertonic saline must use an IV pump
to prevent rapid overcorrection and osmotic demyelination.
Q13: The nurse monitors a patient on methimazole for Graves' disease. Which adverse effect requires immediate
notification?
A. Mild skin rash
B. Sore throat and fever **[CORRECT]**
C. Mild nausea
D. Weight gain of 1 lb
Correct Answer: B
Rationale: Sore throat and fever with methimazole may indicate agranulocytosis, a life-threatening decrease in WBCs. This
requires immediate provider notification and CBC. Agranulocytosis occurs in 0.2-0.5% of patients on antithyroid drugs and is a
critical safety concern.
Page 4
