EXAM 1 - NUR 2502: Multidimensional Care III / MDC 3 (2026/2027) Rasmussen University
EXAM 1 - NUR 2502 / NUR2502
(LATEST ): MULTIDIMENSIONAL CARE III / MDC 3
Rasmussen University | School of Nursing
Total Questions: 120 Format: Multiple Choice (4-option)
Cognitive Levels: 20% Recall / 50% Application / 30% Analysis
Style: 75% Scenario / 25% Direct
Aligned To: NCLEX-RN Test Plan, QSEN, MDC III Standards
Edition:
This examination assesses the graduate nursing student's clinical reasoning across eight high-acuity domains. Each item
includes the correct answer and an evidence-based rationale referencing the NUR 2502 curriculum, the NCLEX-RN Test
Plan, and current medical-surgical nursing standards.
Section Domain Items Cognitive Focus
1 Complex Cardiovascular Disorders Q1-Q20 (20) ACS, HF, dysrhythmias, shock, anticoagulants
2 Complex Respiratory Disorders Q21-Q38 (18) ARDS, vent, ABG, PE, chest tubes
3 Neurological & Neurosurgical Disorders Q39-Q56 (18) Stroke, ICP, TBI, SCI, seizures
4 Renal & Genitourinary Disorders Q57-Q71 (15) AKI, CKD, dialysis, transplant
5 Endocrine & Metabolic Disorders Q72-Q86 (15) DKA, thyroid, adrenal, SIADH/DI
6 Gastrointestinal & Hepatic Disorders Q87-Q98 (12) GI bleed, cirrhosis, pancreatitis
7 Hematological & Oncological Disorders Q99-Q110 (12) Anemia, onc emergencies, chemo
8 Multisystem & Critical Care Concepts Q111-Q120 (10) Sepsis, SIRS, shock, ACLS, burns
DIRECTIONS: Read each item carefully. Select the ONE best response. Rationales follow each item and cite the NUR
2502 curriculum, NCLEX-RN Test Plan, and current evidence-based medical-surgical nursing practice.
Section 1: Complex Cardiovascular Disorders
ACS, MI, Heart Failure, Cardiogenic Shock, Dysrhythmias, Valvular & Surgical Cardiac Care
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 1
,EXAM 1 - NUR 2502: Multidimensional Care III / MDC 3 (2026/2027) Rasmussen University
Q1: A 58-year-old male presents to the ED with crushing substernal chest pain rated 9/10, diaphoresis, and
nausea. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. Which pathophysiological
process is the priority concern driving the plan of care?
A. Coronary artery vasospasm causing transient ischemia
B. Complete occlusion of the right coronary artery producing transmural injury *[CORRECT]*
C. Non-ST elevation plaque rupture with microembolization
D. Pericardial inflammation producing referred chest discomfort
Correct Answer: B
Rationale: ST-segment elevation in II, III, and aVF indicates an inferior-wall STEMI, which reflects transmural
ischemia most commonly caused by complete occlusion of the right coronary artery (NUR 2502 ACS module;
NCLEX-RN Physiological Adaptation). STEMI is a time-critical event requiring immediate reperfusion (PCI within 90
min or thrombolytics). Vasospasm (Prinzmetal) and non-STEMI produce different ECG patterns; pericarditis produces
diffuse PR depression and ST elevation.
Q2: The nurse is caring for four cardiac telemetry clients. Which client must the nurse assess FIRST?
A. Client 4 hours post-PCI with a palpable femoral pulse and warm extremity
B. Client with new-onset atrial fibrillation and a ventricular response of 152 bpm reporting chest tightness
*[CORRECT]*
C. Client with a paced rhythm at 70 bpm and a BP of 118/72 mmHg
D. Client with first-degree AV block, HR 68, awaiting cardiology consult
Correct Answer: B
Rationale: Using ABC and acute-vs-chronic prioritization (Maslow + NCLEX prioritization framework), the client with
uncontrolled atrial fibrillation and a rapid ventricular response reporting chest tightness is hemodynamically unstable
and experiencing ongoing myocardial ischemia. This client is at risk for cardiogenic shock and stroke and must be seen
first. The other clients are stable or have lower-acuity rhythms.
Q3: A client with a history of MI is ordered to start clopidogrel 75 mg daily. Which laboratory value must the
nurse verify before administration and during therapy?
A. Serum potassium and magnesium
B. Activated partial thromboplastin time (aPTT) only
C. Platelet count and signs of bleeding; monitor for thrombocytopenia *[CORRECT]*
D. International normalized ratio (INR) daily
Correct Answer: C
Rationale: Clopidogrel is an antiplatelet (P2Y12 inhibitor) that does not require INR monitoring (that is warfarin).
However, the nurse must monitor platelet counts and assess for bleeding, including the rare but serious thrombotic
thrombocytopenic purpura. aPTT monitors heparin, not clopidogrel. Potassium and magnesium are tracked for
dysrhythmia risk, not antiplatelet therapy.
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 2
,EXAM 1 - NUR 2502: Multidimensional Care III / MDC 3 (2026/2027) Rasmussen University
Q4: A client is receiving IV heparin for acute coronary syndrome. The aPTT is 110 seconds (control 30).
Which action is most appropriate?
A. Increase the heparin drip rate by 2 units/kg/hr
B. Discontinue the heparin drip and start protamine sulfate 50 mg IV push
C. Hold the next dose and notify the provider; anticipate rate per protocol *[CORRECT]*
D. Administer vitamin K 10 mg IV slowly
Correct Answer: C
Rationale: An aPTT of 110 sec is supratherapeutic (therapeutic range is typically 1.5-2.5 times control, or about 45-75
sec). The correct response is to hold/notify and adjust per the institution's weight-based heparin nomogram. Stopping
entirely and giving protamine is reserved for significant bleeding. Vitamin K reverses warfarin, not heparin. Increasing
the rate would worsen the supratherapeutic state.
Q5: A client with heart failure has a BNP of 1,820 pg/mL, crackles halfway up both lung fields, and an SpO2
of 90% on room air. Which assessment finding most strongly indicates progression to cardiogenic shock?
A. Bounding radial pulse and flushed skin
B. Cold, clammy skin with urine output of 15 mL/hr *[CORRECT]*
C. Jugular venous distension of 6 cm above the sternal angle
D. Bilateral 2+ peripheral edema of the lower extremities
Correct Answer: B
Rationale: Cardiogenic shock is defined by inadequate tissue perfusion from pump failure. Cold, clammy skin reflects
vasoconstrictive compensation, and urine output of 15 mL/hr indicates hypoperfusion (renal threshold <0.5 mL/kg/hr).
JVD and edema reflect right-sided failure but do not by themselves diagnose shock. A bounding pulse is inconsistent
with shock physiology.
Q6: A nurse is interpreting the ECG of a client reporting palpitations. The rhythm shows absent P waves, an
irregularly irregular R-R interval, and a ventricular rate of 142. Which interpretation is correct?
A. Atrial flutter with rapid ventricular response
B. Ventricular tachycardia
C. Atrial fibrillation with rapid ventricular response *[CORRECT]*
D. Supraventricular tachycardia
Correct Answer: C
Rationale: Atrial fibrillation is characterized by the absence of distinct P waves, a chaotic atrial baseline, and an
irregularly irregular R-R pattern. Atrial flutter shows a sawtooth pattern; ventricular tachycardia shows wide QRS
complexes without P waves; SVT is typically regular and narrow-complex. AF with RVR increases stroke risk,
requiring anticoagulation assessment via CHA2DS2-VASc.
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 3
, EXAM 1 - NUR 2502: Multidimensional Care III / MDC 3 (2026/2027) Rasmussen University
Q7: A client with a permanent pacemaker is scheduled for MRI of the lumbar spine. Which action by the
nurse is most appropriate?
A. Cancel the MRI; conventional pacemakers are an absolute contraindication unless MRI-conditional
*[CORRECT]*
B. Apply a magnetic shield over the generator and proceed
C. Reprogram the pacemaker to asynchronous mode (VOO/DOO) just before the scan
D. Reduce the MRI field strength to 0.5 Tesla and proceed with monitoring
Correct Answer: A
Rationale: MRI is contraindicated in clients with conventional pacemakers due to risks of lead displacement, generator
malfunction, and arrhythmia. Only MRI-conditional devices are permitted under strict protocols. Shielding,
reprogramming, or lowering field strength does not eliminate the risk and is not the standard of care.
Q8: A client is 6 hours post-CABG. The mediastinal chest tube output was 220 mL in the last hour. Which
finding warrants immediate provider notification?
A. Serosanguineous drainage with a stable hemoglobin
B. Sudden cessation of drainage with signs of cardiac tamponade *[CORRECT]*
C. Drainage that decreases from 220 to 120 mL the next hour
D. Presence of dark clot in the tubing
Correct Answer: B
Rationale: Sudden cessation of mediastinal drainage combined with signs of tamponade (muffled heart sounds, JVD,
hypotension, pulsus paradoxus) indicates obstructive shock from accumulated blood in the pericardial space. This is a
surgical emergency. Decreasing output, stable labs, and small clots are expected postoperative findings.
Q9: A client with decompensated heart failure is receiving furosemide 40 mg IV twice daily. The morning
potassium is 3.0 mEq/L. Which provider order should the nurse anticipate?
A. Discontinue furosemide and start spironolactone 25 mg PO daily
B. Administer potassium chloride 40 mEq IV over 4 hours with cardiac monitoring *[CORRECT]*
C. Increase the furosemide dose and restrict potassium intake
D. Administer digoxin 0.25 mg IV for added inotropic support
Correct Answer: B
Rationale: Hypokalemia (3.0 mEq/L) is dangerous in heart failure, particularly if the client is on digoxin, because it
precipitates digoxin toxicity and ventricular dysrhythmias. The expected order is IV potassium replacement with
cardiac monitoring due to the risk of arrhythmias during infusion. Discontinuing loop diuretics entirely may worsen
HF; spironolactone is potassium-sparing but not a replacement for acute correction.
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 4
EXAM 1 - NUR 2502 / NUR2502
(LATEST ): MULTIDIMENSIONAL CARE III / MDC 3
Rasmussen University | School of Nursing
Total Questions: 120 Format: Multiple Choice (4-option)
Cognitive Levels: 20% Recall / 50% Application / 30% Analysis
Style: 75% Scenario / 25% Direct
Aligned To: NCLEX-RN Test Plan, QSEN, MDC III Standards
Edition:
This examination assesses the graduate nursing student's clinical reasoning across eight high-acuity domains. Each item
includes the correct answer and an evidence-based rationale referencing the NUR 2502 curriculum, the NCLEX-RN Test
Plan, and current medical-surgical nursing standards.
Section Domain Items Cognitive Focus
1 Complex Cardiovascular Disorders Q1-Q20 (20) ACS, HF, dysrhythmias, shock, anticoagulants
2 Complex Respiratory Disorders Q21-Q38 (18) ARDS, vent, ABG, PE, chest tubes
3 Neurological & Neurosurgical Disorders Q39-Q56 (18) Stroke, ICP, TBI, SCI, seizures
4 Renal & Genitourinary Disorders Q57-Q71 (15) AKI, CKD, dialysis, transplant
5 Endocrine & Metabolic Disorders Q72-Q86 (15) DKA, thyroid, adrenal, SIADH/DI
6 Gastrointestinal & Hepatic Disorders Q87-Q98 (12) GI bleed, cirrhosis, pancreatitis
7 Hematological & Oncological Disorders Q99-Q110 (12) Anemia, onc emergencies, chemo
8 Multisystem & Critical Care Concepts Q111-Q120 (10) Sepsis, SIRS, shock, ACLS, burns
DIRECTIONS: Read each item carefully. Select the ONE best response. Rationales follow each item and cite the NUR
2502 curriculum, NCLEX-RN Test Plan, and current evidence-based medical-surgical nursing practice.
Section 1: Complex Cardiovascular Disorders
ACS, MI, Heart Failure, Cardiogenic Shock, Dysrhythmias, Valvular & Surgical Cardiac Care
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 1
,EXAM 1 - NUR 2502: Multidimensional Care III / MDC 3 (2026/2027) Rasmussen University
Q1: A 58-year-old male presents to the ED with crushing substernal chest pain rated 9/10, diaphoresis, and
nausea. The 12-lead ECG reveals ST-segment elevation in leads II, III, and aVF. Which pathophysiological
process is the priority concern driving the plan of care?
A. Coronary artery vasospasm causing transient ischemia
B. Complete occlusion of the right coronary artery producing transmural injury *[CORRECT]*
C. Non-ST elevation plaque rupture with microembolization
D. Pericardial inflammation producing referred chest discomfort
Correct Answer: B
Rationale: ST-segment elevation in II, III, and aVF indicates an inferior-wall STEMI, which reflects transmural
ischemia most commonly caused by complete occlusion of the right coronary artery (NUR 2502 ACS module;
NCLEX-RN Physiological Adaptation). STEMI is a time-critical event requiring immediate reperfusion (PCI within 90
min or thrombolytics). Vasospasm (Prinzmetal) and non-STEMI produce different ECG patterns; pericarditis produces
diffuse PR depression and ST elevation.
Q2: The nurse is caring for four cardiac telemetry clients. Which client must the nurse assess FIRST?
A. Client 4 hours post-PCI with a palpable femoral pulse and warm extremity
B. Client with new-onset atrial fibrillation and a ventricular response of 152 bpm reporting chest tightness
*[CORRECT]*
C. Client with a paced rhythm at 70 bpm and a BP of 118/72 mmHg
D. Client with first-degree AV block, HR 68, awaiting cardiology consult
Correct Answer: B
Rationale: Using ABC and acute-vs-chronic prioritization (Maslow + NCLEX prioritization framework), the client with
uncontrolled atrial fibrillation and a rapid ventricular response reporting chest tightness is hemodynamically unstable
and experiencing ongoing myocardial ischemia. This client is at risk for cardiogenic shock and stroke and must be seen
first. The other clients are stable or have lower-acuity rhythms.
Q3: A client with a history of MI is ordered to start clopidogrel 75 mg daily. Which laboratory value must the
nurse verify before administration and during therapy?
A. Serum potassium and magnesium
B. Activated partial thromboplastin time (aPTT) only
C. Platelet count and signs of bleeding; monitor for thrombocytopenia *[CORRECT]*
D. International normalized ratio (INR) daily
Correct Answer: C
Rationale: Clopidogrel is an antiplatelet (P2Y12 inhibitor) that does not require INR monitoring (that is warfarin).
However, the nurse must monitor platelet counts and assess for bleeding, including the rare but serious thrombotic
thrombocytopenic purpura. aPTT monitors heparin, not clopidogrel. Potassium and magnesium are tracked for
dysrhythmia risk, not antiplatelet therapy.
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 2
,EXAM 1 - NUR 2502: Multidimensional Care III / MDC 3 (2026/2027) Rasmussen University
Q4: A client is receiving IV heparin for acute coronary syndrome. The aPTT is 110 seconds (control 30).
Which action is most appropriate?
A. Increase the heparin drip rate by 2 units/kg/hr
B. Discontinue the heparin drip and start protamine sulfate 50 mg IV push
C. Hold the next dose and notify the provider; anticipate rate per protocol *[CORRECT]*
D. Administer vitamin K 10 mg IV slowly
Correct Answer: C
Rationale: An aPTT of 110 sec is supratherapeutic (therapeutic range is typically 1.5-2.5 times control, or about 45-75
sec). The correct response is to hold/notify and adjust per the institution's weight-based heparin nomogram. Stopping
entirely and giving protamine is reserved for significant bleeding. Vitamin K reverses warfarin, not heparin. Increasing
the rate would worsen the supratherapeutic state.
Q5: A client with heart failure has a BNP of 1,820 pg/mL, crackles halfway up both lung fields, and an SpO2
of 90% on room air. Which assessment finding most strongly indicates progression to cardiogenic shock?
A. Bounding radial pulse and flushed skin
B. Cold, clammy skin with urine output of 15 mL/hr *[CORRECT]*
C. Jugular venous distension of 6 cm above the sternal angle
D. Bilateral 2+ peripheral edema of the lower extremities
Correct Answer: B
Rationale: Cardiogenic shock is defined by inadequate tissue perfusion from pump failure. Cold, clammy skin reflects
vasoconstrictive compensation, and urine output of 15 mL/hr indicates hypoperfusion (renal threshold <0.5 mL/kg/hr).
JVD and edema reflect right-sided failure but do not by themselves diagnose shock. A bounding pulse is inconsistent
with shock physiology.
Q6: A nurse is interpreting the ECG of a client reporting palpitations. The rhythm shows absent P waves, an
irregularly irregular R-R interval, and a ventricular rate of 142. Which interpretation is correct?
A. Atrial flutter with rapid ventricular response
B. Ventricular tachycardia
C. Atrial fibrillation with rapid ventricular response *[CORRECT]*
D. Supraventricular tachycardia
Correct Answer: C
Rationale: Atrial fibrillation is characterized by the absence of distinct P waves, a chaotic atrial baseline, and an
irregularly irregular R-R pattern. Atrial flutter shows a sawtooth pattern; ventricular tachycardia shows wide QRS
complexes without P waves; SVT is typically regular and narrow-complex. AF with RVR increases stroke risk,
requiring anticoagulation assessment via CHA2DS2-VASc.
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 3
, EXAM 1 - NUR 2502: Multidimensional Care III / MDC 3 (2026/2027) Rasmussen University
Q7: A client with a permanent pacemaker is scheduled for MRI of the lumbar spine. Which action by the
nurse is most appropriate?
A. Cancel the MRI; conventional pacemakers are an absolute contraindication unless MRI-conditional
*[CORRECT]*
B. Apply a magnetic shield over the generator and proceed
C. Reprogram the pacemaker to asynchronous mode (VOO/DOO) just before the scan
D. Reduce the MRI field strength to 0.5 Tesla and proceed with monitoring
Correct Answer: A
Rationale: MRI is contraindicated in clients with conventional pacemakers due to risks of lead displacement, generator
malfunction, and arrhythmia. Only MRI-conditional devices are permitted under strict protocols. Shielding,
reprogramming, or lowering field strength does not eliminate the risk and is not the standard of care.
Q8: A client is 6 hours post-CABG. The mediastinal chest tube output was 220 mL in the last hour. Which
finding warrants immediate provider notification?
A. Serosanguineous drainage with a stable hemoglobin
B. Sudden cessation of drainage with signs of cardiac tamponade *[CORRECT]*
C. Drainage that decreases from 220 to 120 mL the next hour
D. Presence of dark clot in the tubing
Correct Answer: B
Rationale: Sudden cessation of mediastinal drainage combined with signs of tamponade (muffled heart sounds, JVD,
hypotension, pulsus paradoxus) indicates obstructive shock from accumulated blood in the pericardial space. This is a
surgical emergency. Decreasing output, stable labs, and small clots are expected postoperative findings.
Q9: A client with decompensated heart failure is receiving furosemide 40 mg IV twice daily. The morning
potassium is 3.0 mEq/L. Which provider order should the nurse anticipate?
A. Discontinue furosemide and start spironolactone 25 mg PO daily
B. Administer potassium chloride 40 mEq IV over 4 hours with cardiac monitoring *[CORRECT]*
C. Increase the furosemide dose and restrict potassium intake
D. Administer digoxin 0.25 mg IV for added inotropic support
Correct Answer: B
Rationale: Hypokalemia (3.0 mEq/L) is dangerous in heart failure, particularly if the client is on digoxin, because it
precipitates digoxin toxicity and ventricular dysrhythmias. The expected order is IV potassium replacement with
cardiac monitoring due to the risk of arrhythmias during infusion. Discontinuing loop diuretics entirely may worsen
HF; spironolactone is potassium-sparing but not a replacement for acute correction.
Aligned to NCLEX-RN Test Plan, QSEN Competencies & MDC III Standards Page 4
