NUR 2502 / MDC 3 - Exam 2 (2026/2027) Rasmussen University | Multidimensional Care III
EXAM 2 — NUR 2502 / NUR2502 (LATEST 2026 /
2027)
MULTIDIMENSIONAL CARE III / MDC 3 — RASMUSSEN UNIVERSITY
Comprehensive 120-Question Examination • NCLEX-RN Test Plan Aligned • QSEN Competencies •
Med-Surg Nursing Standards (2026/2027 Edition)
Total Questions 120 Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Time Allotted 180 minutes Question Style 75% Scenario-based / 25% Direct Knowledge
Format Multiple Choice (4 options)
Special Items 20 Priority / 15 Pharmacology / 10 Lab Values
Passing Standard
NCLEX-RN aligned (75%+)
Curriculum Rasmussen NUR 2502 MDC 3
Instructions to the Candidate: Select the ONE best answer for each question. Each question is
followed by the correct answer and a 2–4 sentence rationale linking the item to the NUR 2502
curriculum, the NCLEX-RN Test Plan, and evidence-based medical-surgical nursing practice. Use the
rationales for review and remediation across all eight content domains.
Section 1: Complex Cardiovascular Disorders (20 questions)
Q1: The telemetry nurse is receiving handoff report on four assigned clients.
Which client should the nurse assess FIRST?
A. A client who is 2 days post-MI with occasional unifocal PVCs and a heart rate of 88/min.
B. A client reporting chest pain rated 4/10 with BP 130/85 and a normal saline infusion at 75
mL/hr.
C. A client with new-onset atrial fibrillation with rapid ventricular response, heart
rate 142/min, and BP 100/60. *[CORRECT]*
D. A client who is 4 hours post-cardiac catheterization with bilateral equal pedal pulses and
dry dressing.
Correct Answer: C
Rationale: New-onset atrial fibrillation with a ventricular rate of 142/min and falling BP signals
hemodynamic instability and risk of cardiogenic shock or stroke; this client is the priority using the
ABC and acute-versus-chronic prioritization framework. The other clients are stable or have
lower-acuity findings requiring surveillance, not immediate intervention. NCLEX-RN Test Plan:
Management of Care, prioritization.
120-Question Comprehensive Examination Page 1 NCLEX-RN Aligned | QSEN Competencies
,NUR 2502 / MDC 3 - Exam 2 (2026/2027) Rasmussen University | Multidimensional Care III
Q2: A client presents to the ED with suspected acute coronary syndrome (ACS).
Which medication should the nurse administer FIRST after establishing IV access
and oxygen?
A. Sublingual nitroglycerin 0.4 mg
B. Chewable aspirin 324 mg *[CORRECT]*
C. IV morphine 2 mg
D. IV metoprolol 5 mg
Correct Answer: B
Rationale: Aspirin 324 mg chewed is the first-line antiplatelet therapy in suspected ACS because it
rapidly inhibits platelet aggregation and reduces mortality, per AHA/ACC guidelines. Nitroglycerin,
morphine, and beta-blockers are adjuncts but aspirin has the strongest mortality benefit and is
given immediately. NUR 2502 curriculum: ACS pathway.
Q3: A client receiving IV heparin for a pulmonary embolism has an aPTT of 110
seconds (control 30 sec). The client has no visible bleeding. Which action should
the nurse take FIRST?
A. Increase the heparin infusion rate.
B. Document the finding; the value is therapeutic.
C. Stop the heparin infusion and notify the provider. *[CORRECT]*
D. Administer protamine sulfate 50 mg IV push.
Correct Answer: C
Rationale: An aPTT of 110 sec is supratherapeutic (therapeutic range 1.5–2.5 × control, roughly
46–70 sec) and places the client at risk for hemorrhage; the first action is to stop the infusion and
notify the provider for an order to hold or adjust. Protamine is the antidote but is given only with
significant bleeding or per provider order, not automatically. This is a pharmacology and
lab-interpretation item.
Q4: A client is admitted with cardiogenic shock following an extensive anterior
wall MI. Which assessment finding is the MOST reliable indicator of inadequate
tissue perfusion?
A. Blood pressure 88/52 mmHg
B. Serum lactate 5.2 mmol/L *[CORRECT]*
C. Urine output 25 mL/hr
D. Heart rate 118/min
Correct Answer: B
Rationale: A rising serum lactate reflects anaerobic metabolism from inadequate tissue oxygen
delivery and is the most reliable marker of cellular hypoxia in shock, regardless of compensatory
BP. Hypotension, oliguria, and tachycardia are important but are downstream compensatory signs
that can lag behind lactate. NUR 2502: shock and perfusion concepts.
120-Question Comprehensive Examination Page 2 NCLEX-RN Aligned | QSEN Competencies
,NUR 2502 / MDC 3 - Exam 2 (2026/2027) Rasmussen University | Multidimensional Care III
Q5: A client with heart failure has a BNP of 1,820 pg/mL, crackles halfway up both
lung fields, and 2+ pitting edema to the knees. Which provider order should the
nurse implement FIRST?
A. Administer furosemide 40 mg IV push.
B. Obtain a 12-lead ECG.
C. Restrict fluids to 1,500 mL/day.
D. Place the client in high-Fowler's position with oxygen. *[CORRECT]*
Correct Answer: D
Rationale: Placing the client in high-Fowler's and applying oxygen is the first priority because it
immediately reduces preload and improves oxygenation before medication administration; this
follows the ABC framework. Furosemide is essential but follows oxygen and positioning. NUR 2502:
heart failure exacerbation management.
Q6: A client returns from insertion of a permanent transvenous pacemaker. Which
client statement indicates that discharge teaching has been effective?
A. "I will keep my cell phone in my shirt pocket over the pacemaker."
B. "I should avoid lifting the arm on the pacemaker side above shoulder height for
4 weeks." *[CORRECT]*
C. "I can resume playing golf and tennis next week."
D. "I will not need to wear a medical alert bracelet."
Correct Answer: B
Rationale: Avoiding raising the affected arm above shoulder level for 4 weeks prevents pacemaker
lead dislodgement during the lead maturation period. Cell phones should be held to the opposite
ear, contact sports are contraindicated, and a medical alert bracelet is recommended. NUR 2502:
pacemaker patient education.
Q7: A client is receiving IV nitroglycerin for unstable angina. The nurse notes the
client's BP has dropped from 124/76 to 84/48 and the client reports dizziness.
Which action should the nurse take FIRST?
A. Administer a 500 mL normal saline bolus.
B. Reduce the nitroglycerin infusion rate.
C. Stop the nitroglycerin infusion. *[CORRECT]*
D. Place the client in Trendelenburg position.
Correct Answer: C
Rationale: The first action with symptomatic hypotension during IV nitroglycerin therapy is to stop
the infusion, because the drug has a very short half-life and BP typically recovers within minutes.
Saline bolus, rate adjustment, and Trendelenburg may follow but stopping the vasodilator is the
priority. NUR 2502: cardiovascular pharmacology.
120-Question Comprehensive Examination Page 3 NCLEX-RN Aligned | QSEN Competencies
, NUR 2502 / MDC 3 - Exam 2 (2026/2027) Rasmussen University | Multidimensional Care III
Q8: A client is 6 hours post-CABG surgery. The chest tube output was 150 mL in
the last hour, and the mediastinal drainage has now slowed to 10 mL/hr with
intermittent dark clots. The client's BP is 96/60, HR 122, and CVP 14 mmHg. Which
complication should the nurse suspect?
A. Cardiac tamponade *[CORRECT]*
B. Hypovolemia from hemorrhage
C. Surgical site infection
D. Acute renal failure
Correct Answer: A
Rationale: Sudden cessation of chest tube output with clots, falling BP, tachycardia, and elevated
CVP (Beck's triad variant) is classic for cardiac tamponade from clot obstruction of the chest tube.
Hypovolemia would have low CVP; infection and renal failure would not produce this acute
presentation. NUR 2502: post-cardiac surgery complications.
Q9: A client with a pulmonary artery catheter has a pulmonary artery wedge
pressure (PAWP) of 22 mmHg. The nurse understands this value is MOST
consistent with which condition?
A. Hypovolemia
B. Left ventricular failure *[CORRECT]*
C. Pulmonary embolism
D. Right ventricular infarct
Correct Answer: B
Rationale: A PAWP of 22 mmHg is elevated (normal 6–12 mmHg) and reflects increased left
ventricular end-diastolic pressure, indicating left ventricular failure and risk of pulmonary edema.
Hypovolemia would lower PAWP, while PE and right-sided infarct primarily affect right-sided
pressures. NUR 2502: hemodynamic monitoring.
Q10: A client is receiving warfarin 5 mg daily for atrial fibrillation. The INR is 5.8
with no bleeding. Which provider order should the nurse anticipate?
A. Administer vitamin K 10 mg IV.
B. Hold the next warfarin dose and recheck INR tomorrow. *[CORRECT]*
C. Administer fresh frozen plasma 2 units.
D. Increase the warfarin dose.
Correct Answer: B
Rationale: For an INR of 5.8 without bleeding, the CHEST guideline recommendation is to hold the
next dose(s) and monitor closely; high-dose vitamin K is reserved for INR >10 or major bleeding.
FFP is given only with active serious bleeding. NUR 2502: anticoagulant therapy and lab
interpretation.
120-Question Comprehensive Examination Page 4 NCLEX-RN Aligned | QSEN Competencies
EXAM 2 — NUR 2502 / NUR2502 (LATEST 2026 /
2027)
MULTIDIMENSIONAL CARE III / MDC 3 — RASMUSSEN UNIVERSITY
Comprehensive 120-Question Examination • NCLEX-RN Test Plan Aligned • QSEN Competencies •
Med-Surg Nursing Standards (2026/2027 Edition)
Total Questions 120 Cognitive Distribution 20% Recall / 50% Application / 30% Analysis
Time Allotted 180 minutes Question Style 75% Scenario-based / 25% Direct Knowledge
Format Multiple Choice (4 options)
Special Items 20 Priority / 15 Pharmacology / 10 Lab Values
Passing Standard
NCLEX-RN aligned (75%+)
Curriculum Rasmussen NUR 2502 MDC 3
Instructions to the Candidate: Select the ONE best answer for each question. Each question is
followed by the correct answer and a 2–4 sentence rationale linking the item to the NUR 2502
curriculum, the NCLEX-RN Test Plan, and evidence-based medical-surgical nursing practice. Use the
rationales for review and remediation across all eight content domains.
Section 1: Complex Cardiovascular Disorders (20 questions)
Q1: The telemetry nurse is receiving handoff report on four assigned clients.
Which client should the nurse assess FIRST?
A. A client who is 2 days post-MI with occasional unifocal PVCs and a heart rate of 88/min.
B. A client reporting chest pain rated 4/10 with BP 130/85 and a normal saline infusion at 75
mL/hr.
C. A client with new-onset atrial fibrillation with rapid ventricular response, heart
rate 142/min, and BP 100/60. *[CORRECT]*
D. A client who is 4 hours post-cardiac catheterization with bilateral equal pedal pulses and
dry dressing.
Correct Answer: C
Rationale: New-onset atrial fibrillation with a ventricular rate of 142/min and falling BP signals
hemodynamic instability and risk of cardiogenic shock or stroke; this client is the priority using the
ABC and acute-versus-chronic prioritization framework. The other clients are stable or have
lower-acuity findings requiring surveillance, not immediate intervention. NCLEX-RN Test Plan:
Management of Care, prioritization.
120-Question Comprehensive Examination Page 1 NCLEX-RN Aligned | QSEN Competencies
,NUR 2502 / MDC 3 - Exam 2 (2026/2027) Rasmussen University | Multidimensional Care III
Q2: A client presents to the ED with suspected acute coronary syndrome (ACS).
Which medication should the nurse administer FIRST after establishing IV access
and oxygen?
A. Sublingual nitroglycerin 0.4 mg
B. Chewable aspirin 324 mg *[CORRECT]*
C. IV morphine 2 mg
D. IV metoprolol 5 mg
Correct Answer: B
Rationale: Aspirin 324 mg chewed is the first-line antiplatelet therapy in suspected ACS because it
rapidly inhibits platelet aggregation and reduces mortality, per AHA/ACC guidelines. Nitroglycerin,
morphine, and beta-blockers are adjuncts but aspirin has the strongest mortality benefit and is
given immediately. NUR 2502 curriculum: ACS pathway.
Q3: A client receiving IV heparin for a pulmonary embolism has an aPTT of 110
seconds (control 30 sec). The client has no visible bleeding. Which action should
the nurse take FIRST?
A. Increase the heparin infusion rate.
B. Document the finding; the value is therapeutic.
C. Stop the heparin infusion and notify the provider. *[CORRECT]*
D. Administer protamine sulfate 50 mg IV push.
Correct Answer: C
Rationale: An aPTT of 110 sec is supratherapeutic (therapeutic range 1.5–2.5 × control, roughly
46–70 sec) and places the client at risk for hemorrhage; the first action is to stop the infusion and
notify the provider for an order to hold or adjust. Protamine is the antidote but is given only with
significant bleeding or per provider order, not automatically. This is a pharmacology and
lab-interpretation item.
Q4: A client is admitted with cardiogenic shock following an extensive anterior
wall MI. Which assessment finding is the MOST reliable indicator of inadequate
tissue perfusion?
A. Blood pressure 88/52 mmHg
B. Serum lactate 5.2 mmol/L *[CORRECT]*
C. Urine output 25 mL/hr
D. Heart rate 118/min
Correct Answer: B
Rationale: A rising serum lactate reflects anaerobic metabolism from inadequate tissue oxygen
delivery and is the most reliable marker of cellular hypoxia in shock, regardless of compensatory
BP. Hypotension, oliguria, and tachycardia are important but are downstream compensatory signs
that can lag behind lactate. NUR 2502: shock and perfusion concepts.
120-Question Comprehensive Examination Page 2 NCLEX-RN Aligned | QSEN Competencies
,NUR 2502 / MDC 3 - Exam 2 (2026/2027) Rasmussen University | Multidimensional Care III
Q5: A client with heart failure has a BNP of 1,820 pg/mL, crackles halfway up both
lung fields, and 2+ pitting edema to the knees. Which provider order should the
nurse implement FIRST?
A. Administer furosemide 40 mg IV push.
B. Obtain a 12-lead ECG.
C. Restrict fluids to 1,500 mL/day.
D. Place the client in high-Fowler's position with oxygen. *[CORRECT]*
Correct Answer: D
Rationale: Placing the client in high-Fowler's and applying oxygen is the first priority because it
immediately reduces preload and improves oxygenation before medication administration; this
follows the ABC framework. Furosemide is essential but follows oxygen and positioning. NUR 2502:
heart failure exacerbation management.
Q6: A client returns from insertion of a permanent transvenous pacemaker. Which
client statement indicates that discharge teaching has been effective?
A. "I will keep my cell phone in my shirt pocket over the pacemaker."
B. "I should avoid lifting the arm on the pacemaker side above shoulder height for
4 weeks." *[CORRECT]*
C. "I can resume playing golf and tennis next week."
D. "I will not need to wear a medical alert bracelet."
Correct Answer: B
Rationale: Avoiding raising the affected arm above shoulder level for 4 weeks prevents pacemaker
lead dislodgement during the lead maturation period. Cell phones should be held to the opposite
ear, contact sports are contraindicated, and a medical alert bracelet is recommended. NUR 2502:
pacemaker patient education.
Q7: A client is receiving IV nitroglycerin for unstable angina. The nurse notes the
client's BP has dropped from 124/76 to 84/48 and the client reports dizziness.
Which action should the nurse take FIRST?
A. Administer a 500 mL normal saline bolus.
B. Reduce the nitroglycerin infusion rate.
C. Stop the nitroglycerin infusion. *[CORRECT]*
D. Place the client in Trendelenburg position.
Correct Answer: C
Rationale: The first action with symptomatic hypotension during IV nitroglycerin therapy is to stop
the infusion, because the drug has a very short half-life and BP typically recovers within minutes.
Saline bolus, rate adjustment, and Trendelenburg may follow but stopping the vasodilator is the
priority. NUR 2502: cardiovascular pharmacology.
120-Question Comprehensive Examination Page 3 NCLEX-RN Aligned | QSEN Competencies
, NUR 2502 / MDC 3 - Exam 2 (2026/2027) Rasmussen University | Multidimensional Care III
Q8: A client is 6 hours post-CABG surgery. The chest tube output was 150 mL in
the last hour, and the mediastinal drainage has now slowed to 10 mL/hr with
intermittent dark clots. The client's BP is 96/60, HR 122, and CVP 14 mmHg. Which
complication should the nurse suspect?
A. Cardiac tamponade *[CORRECT]*
B. Hypovolemia from hemorrhage
C. Surgical site infection
D. Acute renal failure
Correct Answer: A
Rationale: Sudden cessation of chest tube output with clots, falling BP, tachycardia, and elevated
CVP (Beck's triad variant) is classic for cardiac tamponade from clot obstruction of the chest tube.
Hypovolemia would have low CVP; infection and renal failure would not produce this acute
presentation. NUR 2502: post-cardiac surgery complications.
Q9: A client with a pulmonary artery catheter has a pulmonary artery wedge
pressure (PAWP) of 22 mmHg. The nurse understands this value is MOST
consistent with which condition?
A. Hypovolemia
B. Left ventricular failure *[CORRECT]*
C. Pulmonary embolism
D. Right ventricular infarct
Correct Answer: B
Rationale: A PAWP of 22 mmHg is elevated (normal 6–12 mmHg) and reflects increased left
ventricular end-diastolic pressure, indicating left ventricular failure and risk of pulmonary edema.
Hypovolemia would lower PAWP, while PE and right-sided infarct primarily affect right-sided
pressures. NUR 2502: hemodynamic monitoring.
Q10: A client is receiving warfarin 5 mg daily for atrial fibrillation. The INR is 5.8
with no bleeding. Which provider order should the nurse anticipate?
A. Administer vitamin K 10 mg IV.
B. Hold the next warfarin dose and recheck INR tomorrow. *[CORRECT]*
C. Administer fresh frozen plasma 2 units.
D. Increase the warfarin dose.
Correct Answer: B
Rationale: For an INR of 5.8 without bleeding, the CHEST guideline recommendation is to hold the
next dose(s) and monitor closely; high-dose vitamin K is reserved for INR >10 or major bleeding.
FFP is given only with active serious bleeding. NUR 2502: anticoagulant therapy and lab
interpretation.
120-Question Comprehensive Examination Page 4 NCLEX-RN Aligned | QSEN Competencies
