NUR 2502 / NUR2502
MULTIDIMENSIONAL CARE III
MDC 3 – Exam 3
Latest Edition
Rasmussen College
Total Questions: 120
Sections: 8 Clinical Specialty Areas
Cognitive Levels: 20% Recall | 50% Application | 30% Analysis
Format: Multiple Choice (4 options, one best answer)
Aligned with NCLEX-RN Test Plan, QSEN Competencies,
and Multidimensional Care III Nursing Standards
Comprehensive Examination for Course Preparation Use
,NUR 2502 / Multidimensional Care III | MDC 3 Exam 3 () Rasmussen College
NUR 2502 / NUR2502: MULTIDIMENSIONAL CARE III /
MDC 3 EXAM 3
Latest Edition | Rasmussen College
Section Topic Q Range Count
1 Complex Cardiovascular Disorders Q1–Q20 20
2 Complex Respiratory Disorders Q21–Q38 18
3 Neurological & Neurosurgical Disorders Q39–Q56 18
4 Renal & Genitourinary Disorders Q57–Q71 15
5 Endocrine & Metabolic Disorders Q72–Q86 15
6 Gastrointestinal & Hepatic Disorders Q87–Q98 12
7 Hematological & Oncological Disorders Q99–Q110 12
8 Multisystem & Critical Care Concepts Q111–Q120 10
TOTAL Q1–Q120 120
Exam Blueprint: 120 multiple-choice questions • 20% Recall • 50% Application • 30% Analysis (including 20 priority-setting
questions, 15 pharmacology questions, 10 laboratory value interpretation questions) • Aligned with NCLEX-RN Test Plan, QSEN
Competencies, and Multidimensional Care III Nursing Standards. Select the ONE best answer for each question.
Section 1: Complex Cardiovascular Disorders
Q1: The nurse is caring for four clients on a telemetry unit. Which client should the nurse assess first?
A. A client with atrial fibrillation reporting mild fatigue
B. A client 6 hours post-cardiac catheterization with a palpable femoral pulse
C. A client with ST elevation in leads II, III, and aVF reporting substernal chest pain [CORRECT]
D. A client with a heart rate of 56/min after taking metoprolol
Correct Answer: C
Rationale: ST elevation in inferior leads (II, III, aVF) with chest pain indicates an acute inferior STEMI requiring
immediate reperfusion therapy (PCI or fibrinolytics). The NUR 2502 curriculum and NCLEX-RN prioritize
life-threatening acute coronary syndromes first. Atrial fibrillation with mild fatigue, stable post-catheterization findings,
and asymptomatic beta-blocker bradycardia are lower priority and do not require immediate intervention.
Comprehensive Examination | 120 Questions Page 2
,NUR 2502 / Multidimensional Care III | MDC 3 Exam 3 () Rasmussen College
Q2: A client with acute decompensated heart failure is receiving IV furosemide. Which laboratory value requires the
nurse to hold the next dose and notify the provider?
A. Sodium 134 mEq/L
B. Magnesium 1.6 mg/dL
C. Potassium 2.9 mEq/L [CORRECT]
D. BUN 28 mg/dL
Correct Answer: C
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting; a potassium of 2.9 mEq/L (normal
3.5–5.0) places the client at high risk for life-threatening dysrhythmias, especially in heart failure. The NUR 2502
curriculum emphasizes holding loop diuretics and repleting potassium when hypokalemia is severe. Mild hyponatremia,
hypomagnesemia, and slightly elevated BUN warrant monitoring but are not absolute hold indications.
Q3: A client who had a percutaneous coronary intervention (PCI) with stent placement is prescribed clopidogrel and
aspirin. What is the most important teaching point?
A. Discontinue clopidogrel if bruising occurs
B. Take both medications exactly as prescribed to prevent in-stent thrombosis [CORRECT]
C. Stop aspirin one month after stent placement
D. Take clopidogrel only when chest pain occurs
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor (clopidogrel) is mandatory after stent
placement to prevent catastrophic in-stent thrombosis, which carries a mortality rate approaching 45%. Premature
discontinuation, even for bruising, dramatically increases thrombosis risk. The NUR 2502 curriculum and ACC/AHA
guidelines require DAPT for a minimum of 12 months after drug-eluting stent placement.
Q4: A client arrives at the emergency department with severe chest pain, blood pressure 80/46 mmHg, heart rate
124/min, and cool, clammy skin. The ECG shows sinus tachycardia with ST elevation in V1–V4. Which action
should the nurse take first?
A. Administer ordered IV morphine for pain
B. Establish IV access and begin crystalloid infusion per protocol [CORRECT]
C. Obtain a 12-lead ECG and cardiac biomarkers
D. Administer sublingual nitroglycerin for chest pain
Correct Answer: B
Rationale: The client is in cardiogenic shock with anterior STEMI; the immediate priority is establishing IV access and
supporting hemodynamics with crystalloid (cautiously) and preparing for emergent reperfusion. Nitroglycerin is
contraindicated with hypotension (SBP < 90). Morphine can worsen hypotension. ECG and biomarkers are important but
secondary to stabilization. The NUR 2502 curriculum emphasizes ABCs and the shock sequence before diagnostic
completion in hemodynamically unstable clients.
Comprehensive Examination | 120 Questions Page 3
, NUR 2502 / Multidimensional Care III | MDC 3 Exam 3 () Rasmussen College
Q5: A client with chest pain has serial troponin I levels drawn. The first result is 0.02 ng/mL, the second (4 hours
later) is 0.8 ng/mL, and the third is 1.2 ng/mL. What do these values indicate?
A. Stable angina with no myocardial damage
B. Acute myocardial infarction with ongoing myocardial injury [CORRECT]
C. Pulmonary embolism causing right heart strain
D. Renal failure causing falsely elevated troponin
Correct Answer: B
Rationale: A rise and fall of cardiac troponin I with at least one value above the 99th percentile upper reference limit
(typically >0.04 ng/mL) is diagnostic of acute myocardial infarction per the universal definition of MI. The progressive
rise from 0.02 to 1.2 ng/mL indicates ongoing myocardial necrosis. Stable angina does not elevate troponin. PE and renal
failure can mildly elevate troponin but typically not in this rising-and-falling pattern.
Q6: A client is 2 hours post-coronary artery bypass grafting (CABG) and has mediastinal chest tube drainage of 250
mL in the last hour. What is the most appropriate nursing action?
A. Document the finding; this is an expected postoperative drainage rate
B. Notify the surgeon immediately and prepare for possible re-exploration [CORRECT]
C. Milch the chest tube to improve drainage flow
D. Clamp the chest tube for 30 minutes to assess for air leak
Correct Answer: B
Rationale: Chest tube drainage >200 mL/hr in the first few hours after CABG is a critical sign of hemorrhage and may
indicate surgical bleeding requiring re-exploration. The NUR 2502 curriculum and CABG postoperative protocols
require immediate surgeon notification when drainage exceeds 200 mL/hr or 500 mL in any 8-hour period. Milking or
clamping chest tubes is contraindicated and can cause complications.
Q7: A client with a permanent pacemaker is being evaluated for proper function. The ECG shows a pacing spike
before each QRS complex, but no QRS complex follows. What is this phenomenon called and what does it indicate?
A. Failure to capture – the pacemaker is firing but not stimulating the ventricle [CORRECT]
B. Failure to sense – the pacemaker is not detecting intrinsic activity
C. Undersensing – the pacemaker is firing too frequently
D. Normal pacemaker function – expected after implantation
Correct Answer: A
Rationale: A pacing spike not followed by a QRS complex indicates failure to capture, meaning the pacemaker output is
not generating a myocardial depolarization. Causes include lead dislodgement, battery depletion, fiber-optic fracture, or
threshold elevation. This is a medical emergency requiring immediate provider notification. The NUR 2502 curriculum
requires nurses to recognize pacemaker malfunction patterns and initiate appropriate interventions.
Comprehensive Examination | 120 Questions Page 4
MULTIDIMENSIONAL CARE III
MDC 3 – Exam 3
Latest Edition
Rasmussen College
Total Questions: 120
Sections: 8 Clinical Specialty Areas
Cognitive Levels: 20% Recall | 50% Application | 30% Analysis
Format: Multiple Choice (4 options, one best answer)
Aligned with NCLEX-RN Test Plan, QSEN Competencies,
and Multidimensional Care III Nursing Standards
Comprehensive Examination for Course Preparation Use
,NUR 2502 / Multidimensional Care III | MDC 3 Exam 3 () Rasmussen College
NUR 2502 / NUR2502: MULTIDIMENSIONAL CARE III /
MDC 3 EXAM 3
Latest Edition | Rasmussen College
Section Topic Q Range Count
1 Complex Cardiovascular Disorders Q1–Q20 20
2 Complex Respiratory Disorders Q21–Q38 18
3 Neurological & Neurosurgical Disorders Q39–Q56 18
4 Renal & Genitourinary Disorders Q57–Q71 15
5 Endocrine & Metabolic Disorders Q72–Q86 15
6 Gastrointestinal & Hepatic Disorders Q87–Q98 12
7 Hematological & Oncological Disorders Q99–Q110 12
8 Multisystem & Critical Care Concepts Q111–Q120 10
TOTAL Q1–Q120 120
Exam Blueprint: 120 multiple-choice questions • 20% Recall • 50% Application • 30% Analysis (including 20 priority-setting
questions, 15 pharmacology questions, 10 laboratory value interpretation questions) • Aligned with NCLEX-RN Test Plan, QSEN
Competencies, and Multidimensional Care III Nursing Standards. Select the ONE best answer for each question.
Section 1: Complex Cardiovascular Disorders
Q1: The nurse is caring for four clients on a telemetry unit. Which client should the nurse assess first?
A. A client with atrial fibrillation reporting mild fatigue
B. A client 6 hours post-cardiac catheterization with a palpable femoral pulse
C. A client with ST elevation in leads II, III, and aVF reporting substernal chest pain [CORRECT]
D. A client with a heart rate of 56/min after taking metoprolol
Correct Answer: C
Rationale: ST elevation in inferior leads (II, III, aVF) with chest pain indicates an acute inferior STEMI requiring
immediate reperfusion therapy (PCI or fibrinolytics). The NUR 2502 curriculum and NCLEX-RN prioritize
life-threatening acute coronary syndromes first. Atrial fibrillation with mild fatigue, stable post-catheterization findings,
and asymptomatic beta-blocker bradycardia are lower priority and do not require immediate intervention.
Comprehensive Examination | 120 Questions Page 2
,NUR 2502 / Multidimensional Care III | MDC 3 Exam 3 () Rasmussen College
Q2: A client with acute decompensated heart failure is receiving IV furosemide. Which laboratory value requires the
nurse to hold the next dose and notify the provider?
A. Sodium 134 mEq/L
B. Magnesium 1.6 mg/dL
C. Potassium 2.9 mEq/L [CORRECT]
D. BUN 28 mg/dL
Correct Answer: C
Rationale: Furosemide is a loop diuretic that causes significant potassium wasting; a potassium of 2.9 mEq/L (normal
3.5–5.0) places the client at high risk for life-threatening dysrhythmias, especially in heart failure. The NUR 2502
curriculum emphasizes holding loop diuretics and repleting potassium when hypokalemia is severe. Mild hyponatremia,
hypomagnesemia, and slightly elevated BUN warrant monitoring but are not absolute hold indications.
Q3: A client who had a percutaneous coronary intervention (PCI) with stent placement is prescribed clopidogrel and
aspirin. What is the most important teaching point?
A. Discontinue clopidogrel if bruising occurs
B. Take both medications exactly as prescribed to prevent in-stent thrombosis [CORRECT]
C. Stop aspirin one month after stent placement
D. Take clopidogrel only when chest pain occurs
Correct Answer: B
Rationale: Dual antiplatelet therapy (DAPT) with aspirin and a P2Y12 inhibitor (clopidogrel) is mandatory after stent
placement to prevent catastrophic in-stent thrombosis, which carries a mortality rate approaching 45%. Premature
discontinuation, even for bruising, dramatically increases thrombosis risk. The NUR 2502 curriculum and ACC/AHA
guidelines require DAPT for a minimum of 12 months after drug-eluting stent placement.
Q4: A client arrives at the emergency department with severe chest pain, blood pressure 80/46 mmHg, heart rate
124/min, and cool, clammy skin. The ECG shows sinus tachycardia with ST elevation in V1–V4. Which action
should the nurse take first?
A. Administer ordered IV morphine for pain
B. Establish IV access and begin crystalloid infusion per protocol [CORRECT]
C. Obtain a 12-lead ECG and cardiac biomarkers
D. Administer sublingual nitroglycerin for chest pain
Correct Answer: B
Rationale: The client is in cardiogenic shock with anterior STEMI; the immediate priority is establishing IV access and
supporting hemodynamics with crystalloid (cautiously) and preparing for emergent reperfusion. Nitroglycerin is
contraindicated with hypotension (SBP < 90). Morphine can worsen hypotension. ECG and biomarkers are important but
secondary to stabilization. The NUR 2502 curriculum emphasizes ABCs and the shock sequence before diagnostic
completion in hemodynamically unstable clients.
Comprehensive Examination | 120 Questions Page 3
, NUR 2502 / Multidimensional Care III | MDC 3 Exam 3 () Rasmussen College
Q5: A client with chest pain has serial troponin I levels drawn. The first result is 0.02 ng/mL, the second (4 hours
later) is 0.8 ng/mL, and the third is 1.2 ng/mL. What do these values indicate?
A. Stable angina with no myocardial damage
B. Acute myocardial infarction with ongoing myocardial injury [CORRECT]
C. Pulmonary embolism causing right heart strain
D. Renal failure causing falsely elevated troponin
Correct Answer: B
Rationale: A rise and fall of cardiac troponin I with at least one value above the 99th percentile upper reference limit
(typically >0.04 ng/mL) is diagnostic of acute myocardial infarction per the universal definition of MI. The progressive
rise from 0.02 to 1.2 ng/mL indicates ongoing myocardial necrosis. Stable angina does not elevate troponin. PE and renal
failure can mildly elevate troponin but typically not in this rising-and-falling pattern.
Q6: A client is 2 hours post-coronary artery bypass grafting (CABG) and has mediastinal chest tube drainage of 250
mL in the last hour. What is the most appropriate nursing action?
A. Document the finding; this is an expected postoperative drainage rate
B. Notify the surgeon immediately and prepare for possible re-exploration [CORRECT]
C. Milch the chest tube to improve drainage flow
D. Clamp the chest tube for 30 minutes to assess for air leak
Correct Answer: B
Rationale: Chest tube drainage >200 mL/hr in the first few hours after CABG is a critical sign of hemorrhage and may
indicate surgical bleeding requiring re-exploration. The NUR 2502 curriculum and CABG postoperative protocols
require immediate surgeon notification when drainage exceeds 200 mL/hr or 500 mL in any 8-hour period. Milking or
clamping chest tubes is contraindicated and can cause complications.
Q7: A client with a permanent pacemaker is being evaluated for proper function. The ECG shows a pacing spike
before each QRS complex, but no QRS complex follows. What is this phenomenon called and what does it indicate?
A. Failure to capture – the pacemaker is firing but not stimulating the ventricle [CORRECT]
B. Failure to sense – the pacemaker is not detecting intrinsic activity
C. Undersensing – the pacemaker is firing too frequently
D. Normal pacemaker function – expected after implantation
Correct Answer: A
Rationale: A pacing spike not followed by a QRS complex indicates failure to capture, meaning the pacemaker output is
not generating a myocardial depolarization. Causes include lead dislodgement, battery depletion, fiber-optic fracture, or
threshold elevation. This is a medical emergency requiring immediate provider notification. The NUR 2502 curriculum
requires nurses to recognize pacemaker malfunction patterns and initiate appropriate interventions.
Comprehensive Examination | 120 Questions Page 4
