NUR 2502 Multidimensional Care III - Rasmussen College -
Academic Year 2026/2027 - Examination 1 Comprehensive
Examination with 50 Verified Questions and Correct Answer
Rationales
About This Exam Bank
This comprehensive 142-question exam bank is designed to prepare candidates for NUR 2502 Multidimensional
Care III - Rasmussen College - Academic Year 2026/2027 - Examination 1 Comprehensive Examination with 50
Verified Questions and Correct Answer Rationales. Every question is aligned with the latest official content outline
and includes a detailed, evidence-based rationale, an explanation of why each remaining option is incorrect, and a
supporting reference.
Keywords
NUR 2502 Multidimensional Care III - Rasmussen College - Academic Year 2026/2027 - Examination 1
Comprehensive Examination with 50 Verified Questions and Correct Answer Rationales, exam bank, practice
questions, verified answers, detailed rationales, test prep, study guide, review questions, certification exam, latest
update, NUR 2502 Multidimensional Care III - Rasmussen College - Academic Year 2026/2027 - Examination 1
Comprehensive Examination with 50 Verified Questions and Correct Answer Rationales, exam bank, practice
questions, verified answers, detailed rationales
PART 1: APPLY ADVANCED PATHOPHYSIOLOGY TO PRIORITIZE NURSING
INTERVENTIONS FOR COMPLEX, MULTISYSTEM ADULT HEALTH ALTERATIONS
1. A patient with acute decompensated heart failure is receiving IV furosemide. Which assessment finding best
indicates a therapeutic response to the medication?
A) Urine output of 40 mL/hr with decreased dyspnea
B) Serum potassium increase from 3.2 to 4.0 mEq/L
C) Weight gain of 1 kg over 24 hours
D) Bilateral crackles unchanged from admission
' Correct Answer: A
Rationale: Diuresis with improved breathing reflects reduced preload and pulmonary congestion. B is unrelated
(furosemide lowers K+). C indicates worsening fluid retention. D shows no improvement.
2. A patient with COPD exacerbation has ABG: pH 7.28, PaCO2 60 mm Hg, HCO3- 26 mEq/L. Which nursing
action is the priority?
A) Administer oxygen at 4 L/min via nasal cannula
B) Prepare for noninvasive positive pressure ventilation (NIV)
C) Encourage pursed-lip breathing and reposition
D) Obtain a sputum culture and await results
' Correct Answer: B
Rationale: The ABG indicates acute respiratory acidosis (uncompensated). NIV supports ventilation and reduces
intubation risk. High-flow O2 may worsen CO2 retention. Pursed-lip breathing is adjunctive. Awaiting cultures
delays critical support.
Page 1
,3. A patient with acute ischemic stroke presents 5 hours after symptom onset. Which intervention is contraindicated?
A) Administering IV alteplase
B) Maintaining blood pressure <185/110 mm Hg
C) Performing a noncontrast CT scan
D) Elevating the head of bed to 30 degrees
' Correct Answer: A
Rationale: IV alteplase is approved within 4.5 hours of symptom onset; at 5 hours it is contraindicated. Blood
pressure control, CT, and HOB elevation are standard supportive measures.
4. A patient with acute kidney injury (AKI) has serum potassium 6.8 mEq/L and peaked T waves. Which
prescription should the nurse implement first?
A) Administer IV calcium gluconate
B) Give oral sodium polystyrene sulfonate
C) Start continuous renal replacement therapy
D) Administer regular insulin with dextrose
' Correct Answer: A
Rationale: Calcium gluconate stabilizes cardiac membranes immediately, preventing lethal arrhythmias.
Insulin/dextrose and polystyrene shift or remove potassium but have delayed onset. CRRT is definitive but not
first-line for immediate stabilization.
5. A patient with diabetic ketoacidosis (DKA) has blood glucose 480 mg/dL, pH 7.15, and K+ 5.2 mEq/L. After
starting an insulin infusion, which assessment is most critical?
A) Monitor for hypokalemia
B) Monitor for hyperkalemia
C) Monitor for hypernatremia
D) Monitor for hypoglycemia
' Correct Answer: A
Rationale: Insulin drives potassium intracellularly, risking hypokalemia. Initial K+ is elevated due to acidosis but
will drop. Hyperkalemia is not expected after insulin. Hypernatremia and hypoglycemia are less immediate
concerns.
6. A patient with cirrhosis and ascites is scheduled for large-volume paracentesis. Which post-procedure intervention
is essential?
A) Administer IV albumin as prescribed
B) Place the patient in high Fowler's position
C) Restrict fluid intake to 1 L/day
D) Apply pressure dressing to the puncture site
' Correct Answer: A
Rationale: Albumin replacement prevents circulatory dysfunction after large-volume paracentesis. Positioning and
pressure dressing are supportive but not essential. Fluid restriction is not routine post-procedure.
7. A patient receiving chemotherapy has an absolute neutrophil count (ANC) of 450/mm³. Which instruction is most
important for the nurse to include?
A) Avoid crowds and report any fever immediately
B) Increase intake of fresh fruits and vegetables
C) Use a soft toothbrush and avoid flossing
D) Take acetaminophen for any temperature >38°C
' Correct Answer: A
Page 2
,Rationale: Severe neutropenia increases infection risk; avoiding crowds and reporting fever is critical. Fresh
produce may harbor pathogens. Soft toothbrush is for thrombocytopenia. Acetaminophen may mask fever.
8. A patient with a new colostomy has liquid stool and skin excoriation. Which action should the nurse take first?
A) Apply a skin barrier powder and seal with barrier film
B) Change the pouching system every 2 hours
C) Increase dietary fiber to thicken stool
D) Use an alcohol-based cleanser to dry the skin
' Correct Answer: A
Rationale: Skin barrier powder with film protects excoriated skin and promotes healing. Frequent changes worsen
skin breakdown. Fiber may help but is not immediate. Alcohol is irritating.
9. A patient with a traumatic brain injury has ICP 22 mm Hg and MAP 70 mm Hg. What is the cerebral perfusion
pressure (CPP)?
A) 48 mm Hg
B) 92 mm Hg
C) 70 mm Hg
D) 22 mm Hg
' Correct Answer: A
Rationale: CPP = MAP - ICP = 70 - 22 = 48 mm Hg. Normal CPP is 60–80 mm Hg; 48 indicates risk of ischemia.
Other options miscalculate.
10. Which finding in a patient with a chest tube indicates a tension pneumothorax?
A) Tracheal deviation away from the affected side
B) Continuous bubbling in the water seal chamber
C) Serosanguineous drainage of 50 mL/hr
D) Tidaling in the water seal chamber
' Correct Answer: A
Rationale: Tracheal deviation indicates mediastinal shift from tension pneumothorax. Continuous bubbling
indicates air leak. Drainage is expected. Tidaling is normal with respiration.
11. A patient with septic shock is receiving norepinephrine at 12 mcg/min via a central line. The provider orders
vasopressin to be added. Which principle best justifies this combination therapy?
A) Vasopressin enhances norepinephrine release from sympathetic nerve terminals, producing synergistic
vasoconstriction.
B) Vasopressin acts on V1 receptors independent of adrenergic pathways, allowing norepinephrine dose reduction
and limiting adrenergic toxicity.
C) Vasopressin increases renal perfusion by selectively dilating afferent arterioles, counteracting
norepinephrine-induced acute kidney injury.
D) Vasopressin inhibits phosphodiesterase-3, increasing intracellular cAMP and augmenting myocardial
contractility alongside norepinephrine.
' Correct Answer: B
Rationale: Vasopressin produces vasoconstriction via V1 receptors on vascular smooth muscle through a
non-adrenergic mechanism, and its addition in septic shock (per Surviving Sepsis Campaign) is used to raise MAP
while reducing catecholamine requirements and related toxicity. Option A is incorrect because vasopressin does not
primarily act by enhancing norepinephrine release; C is wrong because vasopressin is a vasoconstrictor, not a
selective renal afferent dilator; D describes milrinone's mechanism, not vasopressin's.
Page 3
, 12. A patient with acute decompensated heart failure has the following labs: Na 133, K 3.1, BNP 1,850, creatinine
1.9. Which loop diuretic regimen is most appropriate to initiate?
A) Furosemide 40 mg IV push once, then reassess in 24 hours
B) Furosemide continuous IV infusion at 10 mg/hr after a 40 mg bolus
C) Spironolactone 25 mg PO daily with furosemide 20 mg PO daily
D) Metolazone 5 mg PO daily as monotherapy
' Correct Answer: B
Rationale: In acute decompensated heart failure with volume overload and renal impairment, continuous IV loop
diuretic infusion after a bolus provides more consistent diuresis than intermittent boluses and is recommended when
bolus dosing is inadequate or renal function is reduced. A single 40 mg IV push with 24-hour reassessment delays
needed decongestion; spironolactone is contraindicated with K 3.1 and is not first-line for acute decongestion;
metolazone monotherapy is not standard initial therapy.
13. A patient with an acute ischemic stroke is being evaluated for thrombolytic therapy. Which finding would most
strongly contraindicate IV alteplase?
A) Blood pressure 178/98 mm Hg on presentation
B) INR of 1.1 and platelet count of 210,000
C) Intracranial hemorrhage on non-contrast CT
D) Mild dysarthria with NIHSS score of 4
' Correct Answer: C
Rationale: Intracranial hemorrhage on non-contrast CT is an absolute contraindication to IV thrombolysis in acute
ischemic stroke. Blood pressure of 178/98 is below the 185/110 threshold and can be managed; normal INR and
platelets are not contraindications; a mild NIHSS of 4 with dysarthria does not preclude treatment.
14. A patient with a new diagnosis of type 1 diabetes is started on an insulin pump. Which statement by the patient
indicates correct understanding of pump therapy?
A) I will check my blood glucose only before meals and at bedtime.
B) I should rotate the infusion site every 2 to 3 days to prevent lipohypertrophy.
C) I can skip bolus insulin if I am not eating carbohydrates.
D) I will disconnect the pump for 2 hours when I exercise.
' Correct Answer: B
Rationale: Infusion site rotation every 2 to 3 days is essential in pump therapy to prevent lipohypertrophy and
absorption variability. Checking glucose only four times daily is inadequate for pump management; bolus insulin is
still required for meals and corrections; and disconnecting the pump for 2 hours risks ketosis because there is no
basal insulin.
15. A patient with chronic kidney disease stage 4 is prescribed epoetin alfa. Which lab value must be assessed before
administration?
A) Serum potassium
B) Serum ferritin and transferrin saturation
C) Serum calcium
D) Serum phosphorus
' Correct Answer: B
Rationale: Erythropoiesis-stimulating agents require adequate iron stores; ferritin and transferrin saturation must be
evaluated and corrected before and during therapy to ensure effectiveness. Potassium, calcium, and phosphorus are
important in CKD but do not determine epoetin alfa readiness.
Page 4
Academic Year 2026/2027 - Examination 1 Comprehensive
Examination with 50 Verified Questions and Correct Answer
Rationales
About This Exam Bank
This comprehensive 142-question exam bank is designed to prepare candidates for NUR 2502 Multidimensional
Care III - Rasmussen College - Academic Year 2026/2027 - Examination 1 Comprehensive Examination with 50
Verified Questions and Correct Answer Rationales. Every question is aligned with the latest official content outline
and includes a detailed, evidence-based rationale, an explanation of why each remaining option is incorrect, and a
supporting reference.
Keywords
NUR 2502 Multidimensional Care III - Rasmussen College - Academic Year 2026/2027 - Examination 1
Comprehensive Examination with 50 Verified Questions and Correct Answer Rationales, exam bank, practice
questions, verified answers, detailed rationales, test prep, study guide, review questions, certification exam, latest
update, NUR 2502 Multidimensional Care III - Rasmussen College - Academic Year 2026/2027 - Examination 1
Comprehensive Examination with 50 Verified Questions and Correct Answer Rationales, exam bank, practice
questions, verified answers, detailed rationales
PART 1: APPLY ADVANCED PATHOPHYSIOLOGY TO PRIORITIZE NURSING
INTERVENTIONS FOR COMPLEX, MULTISYSTEM ADULT HEALTH ALTERATIONS
1. A patient with acute decompensated heart failure is receiving IV furosemide. Which assessment finding best
indicates a therapeutic response to the medication?
A) Urine output of 40 mL/hr with decreased dyspnea
B) Serum potassium increase from 3.2 to 4.0 mEq/L
C) Weight gain of 1 kg over 24 hours
D) Bilateral crackles unchanged from admission
' Correct Answer: A
Rationale: Diuresis with improved breathing reflects reduced preload and pulmonary congestion. B is unrelated
(furosemide lowers K+). C indicates worsening fluid retention. D shows no improvement.
2. A patient with COPD exacerbation has ABG: pH 7.28, PaCO2 60 mm Hg, HCO3- 26 mEq/L. Which nursing
action is the priority?
A) Administer oxygen at 4 L/min via nasal cannula
B) Prepare for noninvasive positive pressure ventilation (NIV)
C) Encourage pursed-lip breathing and reposition
D) Obtain a sputum culture and await results
' Correct Answer: B
Rationale: The ABG indicates acute respiratory acidosis (uncompensated). NIV supports ventilation and reduces
intubation risk. High-flow O2 may worsen CO2 retention. Pursed-lip breathing is adjunctive. Awaiting cultures
delays critical support.
Page 1
,3. A patient with acute ischemic stroke presents 5 hours after symptom onset. Which intervention is contraindicated?
A) Administering IV alteplase
B) Maintaining blood pressure <185/110 mm Hg
C) Performing a noncontrast CT scan
D) Elevating the head of bed to 30 degrees
' Correct Answer: A
Rationale: IV alteplase is approved within 4.5 hours of symptom onset; at 5 hours it is contraindicated. Blood
pressure control, CT, and HOB elevation are standard supportive measures.
4. A patient with acute kidney injury (AKI) has serum potassium 6.8 mEq/L and peaked T waves. Which
prescription should the nurse implement first?
A) Administer IV calcium gluconate
B) Give oral sodium polystyrene sulfonate
C) Start continuous renal replacement therapy
D) Administer regular insulin with dextrose
' Correct Answer: A
Rationale: Calcium gluconate stabilizes cardiac membranes immediately, preventing lethal arrhythmias.
Insulin/dextrose and polystyrene shift or remove potassium but have delayed onset. CRRT is definitive but not
first-line for immediate stabilization.
5. A patient with diabetic ketoacidosis (DKA) has blood glucose 480 mg/dL, pH 7.15, and K+ 5.2 mEq/L. After
starting an insulin infusion, which assessment is most critical?
A) Monitor for hypokalemia
B) Monitor for hyperkalemia
C) Monitor for hypernatremia
D) Monitor for hypoglycemia
' Correct Answer: A
Rationale: Insulin drives potassium intracellularly, risking hypokalemia. Initial K+ is elevated due to acidosis but
will drop. Hyperkalemia is not expected after insulin. Hypernatremia and hypoglycemia are less immediate
concerns.
6. A patient with cirrhosis and ascites is scheduled for large-volume paracentesis. Which post-procedure intervention
is essential?
A) Administer IV albumin as prescribed
B) Place the patient in high Fowler's position
C) Restrict fluid intake to 1 L/day
D) Apply pressure dressing to the puncture site
' Correct Answer: A
Rationale: Albumin replacement prevents circulatory dysfunction after large-volume paracentesis. Positioning and
pressure dressing are supportive but not essential. Fluid restriction is not routine post-procedure.
7. A patient receiving chemotherapy has an absolute neutrophil count (ANC) of 450/mm³. Which instruction is most
important for the nurse to include?
A) Avoid crowds and report any fever immediately
B) Increase intake of fresh fruits and vegetables
C) Use a soft toothbrush and avoid flossing
D) Take acetaminophen for any temperature >38°C
' Correct Answer: A
Page 2
,Rationale: Severe neutropenia increases infection risk; avoiding crowds and reporting fever is critical. Fresh
produce may harbor pathogens. Soft toothbrush is for thrombocytopenia. Acetaminophen may mask fever.
8. A patient with a new colostomy has liquid stool and skin excoriation. Which action should the nurse take first?
A) Apply a skin barrier powder and seal with barrier film
B) Change the pouching system every 2 hours
C) Increase dietary fiber to thicken stool
D) Use an alcohol-based cleanser to dry the skin
' Correct Answer: A
Rationale: Skin barrier powder with film protects excoriated skin and promotes healing. Frequent changes worsen
skin breakdown. Fiber may help but is not immediate. Alcohol is irritating.
9. A patient with a traumatic brain injury has ICP 22 mm Hg and MAP 70 mm Hg. What is the cerebral perfusion
pressure (CPP)?
A) 48 mm Hg
B) 92 mm Hg
C) 70 mm Hg
D) 22 mm Hg
' Correct Answer: A
Rationale: CPP = MAP - ICP = 70 - 22 = 48 mm Hg. Normal CPP is 60–80 mm Hg; 48 indicates risk of ischemia.
Other options miscalculate.
10. Which finding in a patient with a chest tube indicates a tension pneumothorax?
A) Tracheal deviation away from the affected side
B) Continuous bubbling in the water seal chamber
C) Serosanguineous drainage of 50 mL/hr
D) Tidaling in the water seal chamber
' Correct Answer: A
Rationale: Tracheal deviation indicates mediastinal shift from tension pneumothorax. Continuous bubbling
indicates air leak. Drainage is expected. Tidaling is normal with respiration.
11. A patient with septic shock is receiving norepinephrine at 12 mcg/min via a central line. The provider orders
vasopressin to be added. Which principle best justifies this combination therapy?
A) Vasopressin enhances norepinephrine release from sympathetic nerve terminals, producing synergistic
vasoconstriction.
B) Vasopressin acts on V1 receptors independent of adrenergic pathways, allowing norepinephrine dose reduction
and limiting adrenergic toxicity.
C) Vasopressin increases renal perfusion by selectively dilating afferent arterioles, counteracting
norepinephrine-induced acute kidney injury.
D) Vasopressin inhibits phosphodiesterase-3, increasing intracellular cAMP and augmenting myocardial
contractility alongside norepinephrine.
' Correct Answer: B
Rationale: Vasopressin produces vasoconstriction via V1 receptors on vascular smooth muscle through a
non-adrenergic mechanism, and its addition in septic shock (per Surviving Sepsis Campaign) is used to raise MAP
while reducing catecholamine requirements and related toxicity. Option A is incorrect because vasopressin does not
primarily act by enhancing norepinephrine release; C is wrong because vasopressin is a vasoconstrictor, not a
selective renal afferent dilator; D describes milrinone's mechanism, not vasopressin's.
Page 3
, 12. A patient with acute decompensated heart failure has the following labs: Na 133, K 3.1, BNP 1,850, creatinine
1.9. Which loop diuretic regimen is most appropriate to initiate?
A) Furosemide 40 mg IV push once, then reassess in 24 hours
B) Furosemide continuous IV infusion at 10 mg/hr after a 40 mg bolus
C) Spironolactone 25 mg PO daily with furosemide 20 mg PO daily
D) Metolazone 5 mg PO daily as monotherapy
' Correct Answer: B
Rationale: In acute decompensated heart failure with volume overload and renal impairment, continuous IV loop
diuretic infusion after a bolus provides more consistent diuresis than intermittent boluses and is recommended when
bolus dosing is inadequate or renal function is reduced. A single 40 mg IV push with 24-hour reassessment delays
needed decongestion; spironolactone is contraindicated with K 3.1 and is not first-line for acute decongestion;
metolazone monotherapy is not standard initial therapy.
13. A patient with an acute ischemic stroke is being evaluated for thrombolytic therapy. Which finding would most
strongly contraindicate IV alteplase?
A) Blood pressure 178/98 mm Hg on presentation
B) INR of 1.1 and platelet count of 210,000
C) Intracranial hemorrhage on non-contrast CT
D) Mild dysarthria with NIHSS score of 4
' Correct Answer: C
Rationale: Intracranial hemorrhage on non-contrast CT is an absolute contraindication to IV thrombolysis in acute
ischemic stroke. Blood pressure of 178/98 is below the 185/110 threshold and can be managed; normal INR and
platelets are not contraindications; a mild NIHSS of 4 with dysarthria does not preclude treatment.
14. A patient with a new diagnosis of type 1 diabetes is started on an insulin pump. Which statement by the patient
indicates correct understanding of pump therapy?
A) I will check my blood glucose only before meals and at bedtime.
B) I should rotate the infusion site every 2 to 3 days to prevent lipohypertrophy.
C) I can skip bolus insulin if I am not eating carbohydrates.
D) I will disconnect the pump for 2 hours when I exercise.
' Correct Answer: B
Rationale: Infusion site rotation every 2 to 3 days is essential in pump therapy to prevent lipohypertrophy and
absorption variability. Checking glucose only four times daily is inadequate for pump management; bolus insulin is
still required for meals and corrections; and disconnecting the pump for 2 hours risks ketosis because there is no
basal insulin.
15. A patient with chronic kidney disease stage 4 is prescribed epoetin alfa. Which lab value must be assessed before
administration?
A) Serum potassium
B) Serum ferritin and transferrin saturation
C) Serum calcium
D) Serum phosphorus
' Correct Answer: B
Rationale: Erythropoiesis-stimulating agents require adequate iron stores; ferritin and transferrin saturation must be
evaluated and corrected before and during therapy to ensure effectiveness. Potassium, calcium, and phosphorus are
important in CKD but do not determine epoetin alfa readiness.
Page 4
