RASMUSSEN UNIVERSITY | SCHOOL OF NURSING
NUR 2356 / NUR2356: MULTIDIMENSIONAL CARE I / MDC 1
EXAM 2 (LATEST )
Comprehensive Examination
Total Questions: 120 | Suggested Time: 150 Minutes | Cognitive Mix: 20% Recall - 50% Application - 30% Analysis
Aligned with the Rasmussen University NUR 2356 Course Syllabus, the NCLEX-RN Test Plan, QSEN Competencies, and
Multidimensional Care I Nursing Standards (2026/2027 Edition)
DIRECTIONS: Read each question carefully and select the ONE best answer (A, B, C, or D). Each question is followed
by the correct answer marked [CORRECT] and an evidence-based rationale aligned with the NUR 2356 curriculum, the
NCLEX-RN test plan, and current evidence-based nursing practice. The examination includes 20 priority-setting items, 15
pharmacology items, and 10 infection-control and safety items; approximately 75% of questions are scenario-based.
Section 1: Health Assessment & Physical Examination
Questions 1 - 12
Q1. When performing an abdominal assessment on an adult client, which sequence of examination techniques
should the nurse follow?
A. Inspect, palpate, percuss, auscultate
B. Auscultate, palpate, inspect, percuss
C. Inspect, auscultate, percuss, palpate [CORRECT]
D. Percuss, auscultate, inspect, palpate
Correct Answer: C
Rationale: The abdomen is the exception to the standard examination order because palpation and percussion stimulate
the bowel and can alter or falsely exaggerate bowel sounds. The nurse always inspects first, then auscultates, then
percusses, and palpates last (light before deep). For every other body system the order is inspection, palpation, percussion,
and auscultation, per the NUR 2356 physical assessment module and NCLEX-RN health assessment content.
Q2. The nurse begins a shift assessment of a 68-year-old client admitted with dehydration. Which finding
identified during the general survey requires immediate follow-up?
A. Skin tenting over the sternum and dry mucous membranes [CORRECT]
B. Oral temperature of 36.8 degrees C (98.2 degrees F)
C. Regular apical heart rate of 78 beats/min
D. Client oriented to person, place, and time
Correct Answer: A
Rationale: Tenting of the skin and dry mucous membranes are classic objective indicators of fluid volume deficit and
require prompt intervention with prescribed fluid replacement and intake monitoring. The remaining findings are within
expected reference ranges and do not indicate acute compromise. This reflects the NCLEX-RN expectation to act first on
abnormal assessment data rather than stable findings.
Rasmussen University | School of Nursing 1
,NUR 2356: Multidimensional Care I (MDC 1) - Exam 2 (Latest 2026/2027) - Rasmussen
Q3. The nurse receives the following four clients at shift change. Which client should the nurse assess first?
A. A client with pneumonia who reports a productive cough and a temperature of 38.1 degrees C (100.6
degrees F)
B. A client 1 day postoperative who requests pain medication before ambulating
C. A client with diabetes whose fasting capillary blood glucose is 178 mg/dL
D. A client with new-onset slurred speech and right-sided facial drooping noticed 30 minutes ago
[CORRECT]
Correct Answer: D
Rationale: New-onset neurologic deficits indicate a possible acute ischemic stroke, which is time-critical because
thrombolytic therapy is only effective within a narrow window; airway, breathing, and circulation needs always take
priority. The other clients have important but stable or expected findings that can be addressed after the emergency is
managed. This question applies the NCLEX-RN prioritization framework of acute-untreated-before-chronic and Maslow
hierarchy of needs.
Q4. While assessing an older adult client, the nurse notes that skin on the forearm lifts easily and returns slowly to
position. Which action should the nurse take first based on this finding?
A. Document the finding as an expected age-related change
B. Assess the client for other indicators of fluid volume deficit [CORRECT]
C. Report suspected elder physical neglect to the charge nurse
D. Apply an emollient cream and recheck skin turgor in 4 hours
Correct Answer: B
Rationale: Slow turgor return in an older adult may result from decreased skin elasticity, but it can also signal
dehydration, so the nurse gathers additional data such as mucous membrane moisture, urine output, vital signs, and intake
trends before drawing conclusions. Prematurely documenting the finding as normal (option A) risks missing a fluid
deficit. There is no evidence supporting abuse (option C), and treatment without assessment violates the nursing process.
Q5. Which technique should the nurse use to assess for costovertebral angle (CVA) tenderness during a renal
assessment?
A. Deep palpation of the left lower quadrant
B. Auscultation of the renal arteries with the diaphragm of the stethoscope
C. Indirect fist percussion over the twelfth rib at the flank area of the back [CORRECT]
D. Light palpation of the suprapubic region
Correct Answer: C
Rationale: CVA tenderness is elicited with indirect fist percussion over the costovertebral angle at the level of the twelfth
rib; pain with this maneuver suggests kidney inflammation such as pyelonephritis. Auscultating the renal arteries screens
for bruits, and palpation of the lower quadrants does not access the kidney region. This is core NUR 2356
assessment-technique knowledge tested on the NCLEX-RN.
Rasmussen University | School of Nursing 2
,NUR 2356: Multidimensional Care I (MDC 1) - Exam 2 (Latest 2026/2027) - Rasmussen
Q6. During lung auscultation of a postoperative client, the nurse hears short, popping, crackling sounds at the
bilateral lung bases that do not clear with coughing. How should the nurse interpret this finding?
A. Fine crackles, possibly associated with atelectasis or fluid in the alveoli [CORRECT]
B. Wheezes associated with bronchospasm
C. A pleural friction rub associated with pleural inflammation
D. Bronchophony, which is an expected breath sound
Correct Answer: A
Rationale: Fine crackles are discontinuous, high-pitched popping sounds heard during inspiration that persist despite
coughing and commonly reflect atelectasis or fluid-filled alveoli, a frequent postoperative concern. Wheezes are
continuous musical sounds of narrowed airways, a friction rub is a grating sound timed with respirations, and
bronchophony is an assessment maneuver for voice transmission rather than an adventitious breath sound. Accurate
interpretation drives interventions such as incentive spirometry and early ambulation.
Q7. The nurse assesses a client and documents distended neck veins, bilateral peripheral edema, and
hepatomegaly. The nurse recognizes that these findings are most consistent with which condition?
A. Left-sided heart failure
B. Hypovolemic shock
C. Pericarditis
D. Right-sided heart failure [CORRECT]
Correct Answer: D
Rationale: Right-sided heart failure produces systemic venous congestion, which manifests as jugular venous distention,
peripheral edema, hepatomegaly, and ascites. Left-sided failure produces pulmonary congestion with crackles, dyspnea,
and orthopnea, and hypovolemia causes flat neck veins rather than distention. Differentiating these assessment clusters is a
core NUR 2356 perfusion-concept competency.
Q8. While counting a client's radial pulse, the nurse notes that the rhythm is irregular. Which action should the
nurse take first?
A. Notify the health care provider immediately of an irregular pulse
B. Auscultate the apical pulse for a full 60 seconds [CORRECT]
C. Document the radial pulse rate and rhythm in the medical record
D. Ask another nurse to take the pulse in the opposite arm
Correct Answer: B
Rationale: An irregular radial pulse requires apical assessment for a full 60 seconds to accurately determine rate and
rhythm and to detect a pulse deficit between the apical and radial rates. Assessment always precedes notification and
documentation because the provider needs complete, accurate data. This follows the NCLEX-RN principle of
assessment-before-intervention.
Rasmussen University | School of Nursing 3
, NUR 2356: Multidimensional Care I (MDC 1) - Exam 2 (Latest 2026/2027) - Rasmussen
Q9. Which assessment technique should the nurse always perform first when examining any body system except
the abdomen?
A. Palpation
B. Percussion
C. Inspection [CORRECT]
D. Auscultation
Correct Answer: C
Rationale: Inspection is always performed first because it is noninvasive and uses the senses of vision and smell, and
beginning with touch-based techniques could alter or obscure observable findings. Palpation, percussion, and auscultation
follow inspection in the standard sequence. This foundational assessment principle from the NUR 2356 curriculum is
frequently tested on the NCLEX-RN.
Q10. A nurse prepares to complete a comprehensive health history for a client who speaks a language the nurse
does not understand. Which action is most appropriate?
A. Request a professional medical interpreter through the facility [CORRECT]
B. Ask the client's visiting adult child to interpret the interview
C. Use a bilingual co-worker who is passing through the hallway
D. Proceed using English written materials and hand gestures
Correct Answer: A
Rationale: Professional medical interpreters are trained in terminology, maintain confidentiality, and satisfy legal and
accreditation requirements for clients with limited English proficiency. Family members and untrained staff may filter,
omit, or distort critical information, and gesture-based communication is unsafe and unreliable. This aligns with QSEN
patient-centered care and the NCLEX-RN cultural-competency content.
Q11. Which statement from the shift assessment should the nurse document as an objective finding?
A. The client reports feeling dizzy when standing up this morning
B. Blood pressure decreases from 128/76 to 96/54 mm Hg when the client stands [CORRECT]
C. The client states the headache pain is throbbing and severe
D. The client describes nausea that began after breakfast
Correct Answer: B
Rationale: Objective findings are measurable and observable data such as blood pressure readings, wound appearance,
and laboratory values; the standing drop to 96/54 mm Hg is directly measured evidence of orthostatic hypotension. The
other statements are subjective symptoms reported by the client and are documented using the client's own words.
Distinguishing subjective from objective data is essential for accurate NUR 2356 documentation.
Rasmussen University | School of Nursing 4
NUR 2356 / NUR2356: MULTIDIMENSIONAL CARE I / MDC 1
EXAM 2 (LATEST )
Comprehensive Examination
Total Questions: 120 | Suggested Time: 150 Minutes | Cognitive Mix: 20% Recall - 50% Application - 30% Analysis
Aligned with the Rasmussen University NUR 2356 Course Syllabus, the NCLEX-RN Test Plan, QSEN Competencies, and
Multidimensional Care I Nursing Standards (2026/2027 Edition)
DIRECTIONS: Read each question carefully and select the ONE best answer (A, B, C, or D). Each question is followed
by the correct answer marked [CORRECT] and an evidence-based rationale aligned with the NUR 2356 curriculum, the
NCLEX-RN test plan, and current evidence-based nursing practice. The examination includes 20 priority-setting items, 15
pharmacology items, and 10 infection-control and safety items; approximately 75% of questions are scenario-based.
Section 1: Health Assessment & Physical Examination
Questions 1 - 12
Q1. When performing an abdominal assessment on an adult client, which sequence of examination techniques
should the nurse follow?
A. Inspect, palpate, percuss, auscultate
B. Auscultate, palpate, inspect, percuss
C. Inspect, auscultate, percuss, palpate [CORRECT]
D. Percuss, auscultate, inspect, palpate
Correct Answer: C
Rationale: The abdomen is the exception to the standard examination order because palpation and percussion stimulate
the bowel and can alter or falsely exaggerate bowel sounds. The nurse always inspects first, then auscultates, then
percusses, and palpates last (light before deep). For every other body system the order is inspection, palpation, percussion,
and auscultation, per the NUR 2356 physical assessment module and NCLEX-RN health assessment content.
Q2. The nurse begins a shift assessment of a 68-year-old client admitted with dehydration. Which finding
identified during the general survey requires immediate follow-up?
A. Skin tenting over the sternum and dry mucous membranes [CORRECT]
B. Oral temperature of 36.8 degrees C (98.2 degrees F)
C. Regular apical heart rate of 78 beats/min
D. Client oriented to person, place, and time
Correct Answer: A
Rationale: Tenting of the skin and dry mucous membranes are classic objective indicators of fluid volume deficit and
require prompt intervention with prescribed fluid replacement and intake monitoring. The remaining findings are within
expected reference ranges and do not indicate acute compromise. This reflects the NCLEX-RN expectation to act first on
abnormal assessment data rather than stable findings.
Rasmussen University | School of Nursing 1
,NUR 2356: Multidimensional Care I (MDC 1) - Exam 2 (Latest 2026/2027) - Rasmussen
Q3. The nurse receives the following four clients at shift change. Which client should the nurse assess first?
A. A client with pneumonia who reports a productive cough and a temperature of 38.1 degrees C (100.6
degrees F)
B. A client 1 day postoperative who requests pain medication before ambulating
C. A client with diabetes whose fasting capillary blood glucose is 178 mg/dL
D. A client with new-onset slurred speech and right-sided facial drooping noticed 30 minutes ago
[CORRECT]
Correct Answer: D
Rationale: New-onset neurologic deficits indicate a possible acute ischemic stroke, which is time-critical because
thrombolytic therapy is only effective within a narrow window; airway, breathing, and circulation needs always take
priority. The other clients have important but stable or expected findings that can be addressed after the emergency is
managed. This question applies the NCLEX-RN prioritization framework of acute-untreated-before-chronic and Maslow
hierarchy of needs.
Q4. While assessing an older adult client, the nurse notes that skin on the forearm lifts easily and returns slowly to
position. Which action should the nurse take first based on this finding?
A. Document the finding as an expected age-related change
B. Assess the client for other indicators of fluid volume deficit [CORRECT]
C. Report suspected elder physical neglect to the charge nurse
D. Apply an emollient cream and recheck skin turgor in 4 hours
Correct Answer: B
Rationale: Slow turgor return in an older adult may result from decreased skin elasticity, but it can also signal
dehydration, so the nurse gathers additional data such as mucous membrane moisture, urine output, vital signs, and intake
trends before drawing conclusions. Prematurely documenting the finding as normal (option A) risks missing a fluid
deficit. There is no evidence supporting abuse (option C), and treatment without assessment violates the nursing process.
Q5. Which technique should the nurse use to assess for costovertebral angle (CVA) tenderness during a renal
assessment?
A. Deep palpation of the left lower quadrant
B. Auscultation of the renal arteries with the diaphragm of the stethoscope
C. Indirect fist percussion over the twelfth rib at the flank area of the back [CORRECT]
D. Light palpation of the suprapubic region
Correct Answer: C
Rationale: CVA tenderness is elicited with indirect fist percussion over the costovertebral angle at the level of the twelfth
rib; pain with this maneuver suggests kidney inflammation such as pyelonephritis. Auscultating the renal arteries screens
for bruits, and palpation of the lower quadrants does not access the kidney region. This is core NUR 2356
assessment-technique knowledge tested on the NCLEX-RN.
Rasmussen University | School of Nursing 2
,NUR 2356: Multidimensional Care I (MDC 1) - Exam 2 (Latest 2026/2027) - Rasmussen
Q6. During lung auscultation of a postoperative client, the nurse hears short, popping, crackling sounds at the
bilateral lung bases that do not clear with coughing. How should the nurse interpret this finding?
A. Fine crackles, possibly associated with atelectasis or fluid in the alveoli [CORRECT]
B. Wheezes associated with bronchospasm
C. A pleural friction rub associated with pleural inflammation
D. Bronchophony, which is an expected breath sound
Correct Answer: A
Rationale: Fine crackles are discontinuous, high-pitched popping sounds heard during inspiration that persist despite
coughing and commonly reflect atelectasis or fluid-filled alveoli, a frequent postoperative concern. Wheezes are
continuous musical sounds of narrowed airways, a friction rub is a grating sound timed with respirations, and
bronchophony is an assessment maneuver for voice transmission rather than an adventitious breath sound. Accurate
interpretation drives interventions such as incentive spirometry and early ambulation.
Q7. The nurse assesses a client and documents distended neck veins, bilateral peripheral edema, and
hepatomegaly. The nurse recognizes that these findings are most consistent with which condition?
A. Left-sided heart failure
B. Hypovolemic shock
C. Pericarditis
D. Right-sided heart failure [CORRECT]
Correct Answer: D
Rationale: Right-sided heart failure produces systemic venous congestion, which manifests as jugular venous distention,
peripheral edema, hepatomegaly, and ascites. Left-sided failure produces pulmonary congestion with crackles, dyspnea,
and orthopnea, and hypovolemia causes flat neck veins rather than distention. Differentiating these assessment clusters is a
core NUR 2356 perfusion-concept competency.
Q8. While counting a client's radial pulse, the nurse notes that the rhythm is irregular. Which action should the
nurse take first?
A. Notify the health care provider immediately of an irregular pulse
B. Auscultate the apical pulse for a full 60 seconds [CORRECT]
C. Document the radial pulse rate and rhythm in the medical record
D. Ask another nurse to take the pulse in the opposite arm
Correct Answer: B
Rationale: An irregular radial pulse requires apical assessment for a full 60 seconds to accurately determine rate and
rhythm and to detect a pulse deficit between the apical and radial rates. Assessment always precedes notification and
documentation because the provider needs complete, accurate data. This follows the NCLEX-RN principle of
assessment-before-intervention.
Rasmussen University | School of Nursing 3
, NUR 2356: Multidimensional Care I (MDC 1) - Exam 2 (Latest 2026/2027) - Rasmussen
Q9. Which assessment technique should the nurse always perform first when examining any body system except
the abdomen?
A. Palpation
B. Percussion
C. Inspection [CORRECT]
D. Auscultation
Correct Answer: C
Rationale: Inspection is always performed first because it is noninvasive and uses the senses of vision and smell, and
beginning with touch-based techniques could alter or obscure observable findings. Palpation, percussion, and auscultation
follow inspection in the standard sequence. This foundational assessment principle from the NUR 2356 curriculum is
frequently tested on the NCLEX-RN.
Q10. A nurse prepares to complete a comprehensive health history for a client who speaks a language the nurse
does not understand. Which action is most appropriate?
A. Request a professional medical interpreter through the facility [CORRECT]
B. Ask the client's visiting adult child to interpret the interview
C. Use a bilingual co-worker who is passing through the hallway
D. Proceed using English written materials and hand gestures
Correct Answer: A
Rationale: Professional medical interpreters are trained in terminology, maintain confidentiality, and satisfy legal and
accreditation requirements for clients with limited English proficiency. Family members and untrained staff may filter,
omit, or distort critical information, and gesture-based communication is unsafe and unreliable. This aligns with QSEN
patient-centered care and the NCLEX-RN cultural-competency content.
Q11. Which statement from the shift assessment should the nurse document as an objective finding?
A. The client reports feeling dizzy when standing up this morning
B. Blood pressure decreases from 128/76 to 96/54 mm Hg when the client stands [CORRECT]
C. The client states the headache pain is throbbing and severe
D. The client describes nausea that began after breakfast
Correct Answer: B
Rationale: Objective findings are measurable and observable data such as blood pressure readings, wound appearance,
and laboratory values; the standing drop to 96/54 mm Hg is directly measured evidence of orthostatic hypotension. The
other statements are subjective symptoms reported by the client and are documented using the client's own words.
Distinguishing subjective from objective data is essential for accurate NUR 2356 documentation.
Rasmussen University | School of Nursing 4
