NUR 2502 Multidimensional Care III | Rasmussen
University NUR2502 MDC 3 Study Guide & Exam
Prep 2026/2027 | Multidimensional Nursing Care,
Adult Medical-Surgical Nursing, Cardiovascular,
Respiratory, Hematologic, Renal & Urinary,
Reproductive, Neurological, Endocrine,
Gastrointestinal, Immune & Oncologic Conditions,
Fluid & Electrolyte Balance, Clinical Judgment,
Pharmacology, Patient Assessment, Practice
Questions, Answers & Detailed Rationales
Question 1: A 68-year-old patient with a history of hypertension and type 2
diabetes is admitted with acute decompensated heart failure. The nurse notes
jugular venous distention, 3+ pitting edema in the lower extremities, and
crackles halfway up the posterior lung fields. Which of the following is the
priority nursing intervention?
A. Administer a 500 mL normal saline bolus as prescribed.
B. Position the patient in a high-Fowler's position.
C. Encourage the patient to increase oral fluid intake to 2 L per day.
D. Apply sequential compression devices to both lower extremities.
CORRECT ANSWER: B. Position the patient in a high-Fowler's position.
Rationale: High-Fowler's position reduces venous return to the heart (preload) and
promotes lung expansion, alleviating pulmonary congestion and dyspnea. Administering
normal saline (A) would worsen fluid overload. Increased oral fluids (C) are
contraindicated in acute decompensated heart failure. Sequential compression devices
(D) are for venous thromboembolism prophylaxis and do not address acute pulmonary
edema.
Question 2: A nurse is caring for a patient who is 24 hours post-renal
transplant. The patient's urine output has decreased from 80 mL/hr to 20
mL/hr over the last 3 hours. The patient's blood pressure is 142/90 mm Hg,
and the central venous pressure is 12 mm Hg. Which laboratory value should
the nurse prioritize in assessing the cause of this decreased urine output?
A. Serum creatinine level
B. Serum sodium level
C. Serum tacrolimus level
D. Serum BUN-to-creatinine ratio
CORRECT ANSWER: C. Serum tacrolimus level.
Rationale: Tacrolimus, a calcineurin inhibitor used post-transplant, is nephrotoxic and
can cause decreased urine output due to acute kidney injury. Monitoring its serum level
,is critical. Serum creatinine (A) is important but reflects kidney function, not the specific
cause. Serum sodium (B) is less specific. BUN-to-creatinine ratio (D) is more useful in
prerenal azotemia.
Question 3: A patient with severe sepsis is receiving norepinephrine via
continuous infusion. The nurse assesses a cold, mottled left foot with a faint
dorsalis pedis pulse. What is the nurse's priority action?
A. Apply a warming blanket to the left foot.
B. Assess the patient's central venous pressure.
C. Notify the healthcare provider immediately.
D. Decrease the norepinephrine infusion rate by half.
CORRECT ANSWER: C. Notify the healthcare provider immediately.
Rationale: Cold, mottled extremities with a faint pulse indicate compromised peripheral
perfusion and potential ischemia due to vasoconstriction from norepinephrine. The
provider must be notified for assessment and possible dose adjustment or alternative
therapies. Applying a warming blanket (A) is a comfort measure that does not address
the root cause. Assessing CVP (B) assesses volume status but is not the priority.
Decreasing the infusion rate without an order (D) could precipitate severe hypotension.
Question 4: A patient with cirrhosis and ascites is scheduled for a
paracentesis. Which assessment finding is most indicative of a complication
following the procedure?
A. A 2-kg weight loss
B. A blood pressure of 100/64 mm Hg and heart rate of 110 bpm
C. A decrease in abdominal girth by 4 cm
D. The patient reports feeling less short of breath
CORRECT ANSWER: B. A blood pressure of 100/64 mm Hg and heart rate of
110 bpm.
Rationale: Hypotension and tachycardia following paracentesis can indicate
intravascular volume depletion or hypovolemic shock. Weight loss (A), decreased girth
(C), and improved breathing (D) are expected positive outcomes.
Question 5: A patient is receiving a continuous tube feeding via a nasogastric
tube. The nurse notes the gastric residual volume is 350 mL. Which action
should the nurse take first?
A. Discard the residual and continue the feeding at the same rate.
B. Stop the feeding and notify the healthcare provider.
,C. Reinstill the residual and increase the infusion rate to compensate.
D. Check the patient's bowel sounds and abdominal distention.
CORRECT ANSWER: D. Check the patient's bowel sounds and abdominal
distention.
Rationale: Before making a decision about a high gastric residual volume (generally
>250-500 mL per policy), the nurse must perform a clinical assessment (bowel sounds,
distention, nausea, vomiting) to determine if it indicates intolerance or gastroparesis.
Discarding (A) or stopping without assessment (B) is premature. Reinstilling and
increasing the rate (C) could worsen the issue if the patient has ileus.
Question 6: A 72-year-old patient is admitted with a diagnosis of acute
pancreatitis. The patient has a nasogastric tube to low intermittent suction.
Which laboratory value is most concerning for the development of pancreatic
necrosis?
A. Serum lipase of 450 U/L
B. Serum amylase of 220 U/L
C. Serum glucose of 185 mg/dL
D. Serum calcium of 7.2 mg/dL
CORRECT ANSWER: D. Serum calcium of 7.2 mg/dL.
Rationale: Hypocalcemia in acute pancreatitis is a poor prognostic sign associated with
saponification and pancreatic necrosis. Lipase (A) and amylase (B) are elevated in
pancreatitis but do not indicate necrosis. Hyperglycemia (C) is common but less specific
for necrosis than hypocalcemia.
Question 7: The nurse is providing discharge teaching for a patient with a new
diagnosis of heart failure with reduced ejection fraction. Which statement by
the patient indicates a need for further teaching?
A. "I will weigh myself every morning before breakfast."
B. "I should limit my sodium intake to less than 2 grams per day."
C. "I can stop taking my ACE inhibitor if I develop a dry cough."
D. "I will report any sudden weight gain of 2 pounds in one day."
CORRECT ANSWER: C. "I can stop taking my ACE inhibitor if I develop a dry
cough."
Rationale: A dry cough is a common side effect of ACE inhibitors, but the patient should
not stop the medication abruptly without consulting their provider, as it can lead to
worsening heart failure. Daily weights (A), sodium restriction (B), and reporting rapid
weight gain (D) are all correct components of heart failure self-management.
, Question 8: A patient with end-stage renal disease is receiving hemodialysis.
During treatment, the patient develops muscle cramps and reports feeling
dizzy. The patient's blood pressure is 90/58 mm Hg. Which intervention
should the nurse anticipate?
A. Increasing the blood flow rate
B. Administering a 250 mL bolus of 0.9% normal saline
C. Increasing the ultrafiltration rate
D. Administering a heparin bolus
CORRECT ANSWER: B. Administering a 250 mL bolus of 0.9% normal saline.
Rationale: Hypotension and muscle cramps during hemodialysis are often due to
excessive fluid removal (hypovolemia). A small bolus of normal saline can help restore
intravascular volume. Increasing blood flow rate (A) could worsen hypotension.
Increasing ultrafiltration (C) would remove more fluid. Heparin (D) is not indicated for
hypotension.
Question 9: The nurse is caring for a patient with a chest tube connected to a
three-chamber water-seal drainage system. Which finding indicates that the
chest tube is functioning correctly?
A. Continuous bubbling in the water-seal chamber
B. Gentle bubbling in the suction-control chamber
C. Absence of tidaling in the water-seal chamber with inhalation
D. The fluid level in the water-seal chamber is fluctuating wildly
CORRECT ANSWER: B. Gentle bubbling in the suction-control chamber.
Rationale: Gentle bubbling in the suction-control chamber indicates that the prescribed
suction is being applied and the system is functioning correctly. Continuous bubbling in
the water-seal chamber (A) indicates an air leak. Absence of tidaling (C) with inhalation
may indicate a blockage, re-expansion, or a problem with the system. Wild fluctuations
(D) are not an expected finding.
Question 10: A patient with a history of chronic obstructive pulmonary disease
(COPD) is prescribed home oxygen therapy at 2 L/min via nasal cannula.
Which assessment finding indicates the patient is receiving the appropriate
oxygen dose?
A. A respiratory rate of 24 breaths per minute
B. An oxygen saturation of 88% on room air
C. An oxygen saturation of 92% on 2 L/min
D. A PaCO2 of 58 mm Hg on 2 L/min
CORRECT ANSWER: C. An oxygen saturation of 92% on 2 L/min.
University NUR2502 MDC 3 Study Guide & Exam
Prep 2026/2027 | Multidimensional Nursing Care,
Adult Medical-Surgical Nursing, Cardiovascular,
Respiratory, Hematologic, Renal & Urinary,
Reproductive, Neurological, Endocrine,
Gastrointestinal, Immune & Oncologic Conditions,
Fluid & Electrolyte Balance, Clinical Judgment,
Pharmacology, Patient Assessment, Practice
Questions, Answers & Detailed Rationales
Question 1: A 68-year-old patient with a history of hypertension and type 2
diabetes is admitted with acute decompensated heart failure. The nurse notes
jugular venous distention, 3+ pitting edema in the lower extremities, and
crackles halfway up the posterior lung fields. Which of the following is the
priority nursing intervention?
A. Administer a 500 mL normal saline bolus as prescribed.
B. Position the patient in a high-Fowler's position.
C. Encourage the patient to increase oral fluid intake to 2 L per day.
D. Apply sequential compression devices to both lower extremities.
CORRECT ANSWER: B. Position the patient in a high-Fowler's position.
Rationale: High-Fowler's position reduces venous return to the heart (preload) and
promotes lung expansion, alleviating pulmonary congestion and dyspnea. Administering
normal saline (A) would worsen fluid overload. Increased oral fluids (C) are
contraindicated in acute decompensated heart failure. Sequential compression devices
(D) are for venous thromboembolism prophylaxis and do not address acute pulmonary
edema.
Question 2: A nurse is caring for a patient who is 24 hours post-renal
transplant. The patient's urine output has decreased from 80 mL/hr to 20
mL/hr over the last 3 hours. The patient's blood pressure is 142/90 mm Hg,
and the central venous pressure is 12 mm Hg. Which laboratory value should
the nurse prioritize in assessing the cause of this decreased urine output?
A. Serum creatinine level
B. Serum sodium level
C. Serum tacrolimus level
D. Serum BUN-to-creatinine ratio
CORRECT ANSWER: C. Serum tacrolimus level.
Rationale: Tacrolimus, a calcineurin inhibitor used post-transplant, is nephrotoxic and
can cause decreased urine output due to acute kidney injury. Monitoring its serum level
,is critical. Serum creatinine (A) is important but reflects kidney function, not the specific
cause. Serum sodium (B) is less specific. BUN-to-creatinine ratio (D) is more useful in
prerenal azotemia.
Question 3: A patient with severe sepsis is receiving norepinephrine via
continuous infusion. The nurse assesses a cold, mottled left foot with a faint
dorsalis pedis pulse. What is the nurse's priority action?
A. Apply a warming blanket to the left foot.
B. Assess the patient's central venous pressure.
C. Notify the healthcare provider immediately.
D. Decrease the norepinephrine infusion rate by half.
CORRECT ANSWER: C. Notify the healthcare provider immediately.
Rationale: Cold, mottled extremities with a faint pulse indicate compromised peripheral
perfusion and potential ischemia due to vasoconstriction from norepinephrine. The
provider must be notified for assessment and possible dose adjustment or alternative
therapies. Applying a warming blanket (A) is a comfort measure that does not address
the root cause. Assessing CVP (B) assesses volume status but is not the priority.
Decreasing the infusion rate without an order (D) could precipitate severe hypotension.
Question 4: A patient with cirrhosis and ascites is scheduled for a
paracentesis. Which assessment finding is most indicative of a complication
following the procedure?
A. A 2-kg weight loss
B. A blood pressure of 100/64 mm Hg and heart rate of 110 bpm
C. A decrease in abdominal girth by 4 cm
D. The patient reports feeling less short of breath
CORRECT ANSWER: B. A blood pressure of 100/64 mm Hg and heart rate of
110 bpm.
Rationale: Hypotension and tachycardia following paracentesis can indicate
intravascular volume depletion or hypovolemic shock. Weight loss (A), decreased girth
(C), and improved breathing (D) are expected positive outcomes.
Question 5: A patient is receiving a continuous tube feeding via a nasogastric
tube. The nurse notes the gastric residual volume is 350 mL. Which action
should the nurse take first?
A. Discard the residual and continue the feeding at the same rate.
B. Stop the feeding and notify the healthcare provider.
,C. Reinstill the residual and increase the infusion rate to compensate.
D. Check the patient's bowel sounds and abdominal distention.
CORRECT ANSWER: D. Check the patient's bowel sounds and abdominal
distention.
Rationale: Before making a decision about a high gastric residual volume (generally
>250-500 mL per policy), the nurse must perform a clinical assessment (bowel sounds,
distention, nausea, vomiting) to determine if it indicates intolerance or gastroparesis.
Discarding (A) or stopping without assessment (B) is premature. Reinstilling and
increasing the rate (C) could worsen the issue if the patient has ileus.
Question 6: A 72-year-old patient is admitted with a diagnosis of acute
pancreatitis. The patient has a nasogastric tube to low intermittent suction.
Which laboratory value is most concerning for the development of pancreatic
necrosis?
A. Serum lipase of 450 U/L
B. Serum amylase of 220 U/L
C. Serum glucose of 185 mg/dL
D. Serum calcium of 7.2 mg/dL
CORRECT ANSWER: D. Serum calcium of 7.2 mg/dL.
Rationale: Hypocalcemia in acute pancreatitis is a poor prognostic sign associated with
saponification and pancreatic necrosis. Lipase (A) and amylase (B) are elevated in
pancreatitis but do not indicate necrosis. Hyperglycemia (C) is common but less specific
for necrosis than hypocalcemia.
Question 7: The nurse is providing discharge teaching for a patient with a new
diagnosis of heart failure with reduced ejection fraction. Which statement by
the patient indicates a need for further teaching?
A. "I will weigh myself every morning before breakfast."
B. "I should limit my sodium intake to less than 2 grams per day."
C. "I can stop taking my ACE inhibitor if I develop a dry cough."
D. "I will report any sudden weight gain of 2 pounds in one day."
CORRECT ANSWER: C. "I can stop taking my ACE inhibitor if I develop a dry
cough."
Rationale: A dry cough is a common side effect of ACE inhibitors, but the patient should
not stop the medication abruptly without consulting their provider, as it can lead to
worsening heart failure. Daily weights (A), sodium restriction (B), and reporting rapid
weight gain (D) are all correct components of heart failure self-management.
, Question 8: A patient with end-stage renal disease is receiving hemodialysis.
During treatment, the patient develops muscle cramps and reports feeling
dizzy. The patient's blood pressure is 90/58 mm Hg. Which intervention
should the nurse anticipate?
A. Increasing the blood flow rate
B. Administering a 250 mL bolus of 0.9% normal saline
C. Increasing the ultrafiltration rate
D. Administering a heparin bolus
CORRECT ANSWER: B. Administering a 250 mL bolus of 0.9% normal saline.
Rationale: Hypotension and muscle cramps during hemodialysis are often due to
excessive fluid removal (hypovolemia). A small bolus of normal saline can help restore
intravascular volume. Increasing blood flow rate (A) could worsen hypotension.
Increasing ultrafiltration (C) would remove more fluid. Heparin (D) is not indicated for
hypotension.
Question 9: The nurse is caring for a patient with a chest tube connected to a
three-chamber water-seal drainage system. Which finding indicates that the
chest tube is functioning correctly?
A. Continuous bubbling in the water-seal chamber
B. Gentle bubbling in the suction-control chamber
C. Absence of tidaling in the water-seal chamber with inhalation
D. The fluid level in the water-seal chamber is fluctuating wildly
CORRECT ANSWER: B. Gentle bubbling in the suction-control chamber.
Rationale: Gentle bubbling in the suction-control chamber indicates that the prescribed
suction is being applied and the system is functioning correctly. Continuous bubbling in
the water-seal chamber (A) indicates an air leak. Absence of tidaling (C) with inhalation
may indicate a blockage, re-expansion, or a problem with the system. Wild fluctuations
(D) are not an expected finding.
Question 10: A patient with a history of chronic obstructive pulmonary disease
(COPD) is prescribed home oxygen therapy at 2 L/min via nasal cannula.
Which assessment finding indicates the patient is receiving the appropriate
oxygen dose?
A. A respiratory rate of 24 breaths per minute
B. An oxygen saturation of 88% on room air
C. An oxygen saturation of 92% on 2 L/min
D. A PaCO2 of 58 mm Hg on 2 L/min
CORRECT ANSWER: C. An oxygen saturation of 92% on 2 L/min.
