MDC 4 {NUR 2755} FINAL MULTIDIMENSIONAL CARE IV
FINAL EXAM
RASMUSSEN UNIVERSITY | 2026/2027 ACADEMIC YEAR
Medical-Surgical Nursing
100 Verified Questions and Answers with Expert Rationales | Comprehensive
Exam Information:
• Time Allowed: 180 minutes (3 hours)
• Number of Items: 100
• Points per Item: 1
• Total Possible Points: 100
.
UNIT 1: CARDIOVASCULAR DISORDERS (Questions 1-20)
Scenario 1: Heart Failure Exacerbation (Questions 1-3)
1. A 72-year-old patient with chronic heart failure presents to the ED with worsening
dyspnea, orthopnea, and 3+ pitting edema in both lower extremities. Vital signs: BP
168/94, HR 112, RR 28, O2 sat 86% on room air. Lung auscultation reveals crackles
bilaterally up to the mid-chest. Which assessment finding requires immediate notification
of the healthcare provider?
A. Bilateral 3+ pitting edema
B. Heart rate of 112 beats per minute
C. Oxygen saturation of 86% on room air
D. Blood pressure of 168/94 mmHg
Correct Answer: C. [CORRECT]
,Verified Explanation: Oxygen saturation of 86% indicates severe hypoxemia (normal
>94%) and imminent respiratory failure. This requires immediate intervention including
high-flow oxygen, possible non-invasive positive pressure ventilation (BiPAP), and
preparation for intubation if no response. While tachycardia (B) and hypertension (D)
indicate cardiac stress, and edema (A) indicates fluid overload, severe hypoxemia is
immediately life-threatening and takes priority according to the ABCs. Delayed
intervention risks end-organ damage, cardiac arrest from hypoxia, and respiratory arrest.
Distractor Analysis:
• A: Significant but chronic finding; does not require emergent notification
• B: Compensatory tachycardia for low cardiac output; concerning but not
immediately life-threatening
• D: Hypertension needs treatment but hypoxemia is priority
Rasmussen Tip: "ABCs always: Airway and Breathing before Circulation. 86% O2 =
Emergency."
2. The healthcare provider prescribes IV furosemide 40 mg now, oxygen at 4L via nasal
cannula, and a STAT chest x-ray. Fifteen minutes after furosemide administration, the
patient reports sudden onset of ringing in the ears. What is the nurse's priority action?
A. Administer the second dose of furosemide as scheduled
B. Reassure the patient this is a common side effect
C. Hold the next dose and contact the healthcare provider
D. Decrease the rate of oxygen delivery
Correct Answer: C. [CORRECT]
Verified Explanation: Tinnitus (ringing in the ears) is an early sign of ototoxicity from
loop diuretics like furosemide. This occurs when peak serum levels rise too quickly (rapid
IV push, high dose, renal impairment, or concurrent aminoglycoside use). Ototoxicity can
be permanent if drug continues. The nurse must hold subsequent doses immediately
and notify the provider to consider: dose reduction, slower infusion rate, alternative
diuretic, or audiologic evaluation. Reassurance or continuing the drug risks irreversible
hearing loss.
,Distractor Analysis:
• A: Continues the toxic agent; contraindicated
• B: Minimizes serious adverse effect; inappropriate reassurance
• D: Unrelated to ototoxicity; decreasing oxygen worsens hypoxemia
Rasmussen Tip: "Furosemide + Ringing ears = STOP the drug, Call the MD, Hearing at
risk"
3. The patient's chest x-ray confirms pulmonary edema, and IV furosemide 80 mg is
administered with good diuresis. Which laboratory value requires immediate follow-up 4
hours post-administration?
A. Serum sodium 138 mEq/L
B. Serum potassium 3.2 mEq/L
C. Serum creatinine 1.1 mg/dL
D. Blood glucose 110 mg/dL
Correct Answer: B. [CORRECT]
Verified Explanation: Hypokalemia (K+ 3.2 mEq/L, normal 3.5-5.0) is a critical
finding requiring immediate intervention. Loop diuretics cause significant potassium
wasting through the kidneys. Severe hypokalemia (<3.0) or rapid decline increases risk
of:
• Life-threatening ventricular dysrhythmias (PVCs, VT, VF)
• Digitalis toxicity (if patient on digoxin)
• Muscle weakness, rhabdomyolysis, paralysis
• Glucose intolerance
Treatment: Oral or IV potassium replacement depending on severity; cardiac monitoring;
recheck levels.
Distractor Analysis:
• A: Normal sodium; no action needed
• C: Normal creatinine; adequate renal function
• D: Slightly elevated glucose; not critical in this context
, Rasmussen Tip: "Lasix wastes Potassium, Check it often, Replace fast if low, Watch
the rhythm"
Scenario 2: Acute Myocardial Infarction (Questions 4-6)
4. A 55-year-old male presents to the ED with crushing substernal chest pain radiating to
his left arm, accompanied by diaphoresis and nausea. ECG reveals 3mm ST-segment
elevation in leads V1-V4. Which order should the nurse implement FIRST?
A. Obtain troponin levels
B. Administer sublingual nitroglycerin
C. Administer chewable aspirin 324 mg
D. Start supplemental oxygen at 2L via nasal cannula
Correct Answer: C. [CORRECT]
Verified Explanation: This patient has an anterior STEMI (ST elevation V1-V4 = left
anterior descending artery occlusion). ACC/AHA guidelines prioritize immediate
aspirin administration (162-325 mg chewed) for all patients with suspected ACS unless
true allergy. Aspirin:
• Inhibits platelet aggregation (cyclooxygenase inhibition)
• Reduces mortality by 25% in acute MI
• Should be given within minutes of arrival, before ECG confirmation if suspicion
high
Oxygen is no longer routine for all ACS patients—only if SpO2 <90%, respiratory distress,
or high-risk features. Nitroglycerin is second-line after aspirin (contraindicated if RV
infarct, SBP <90, or recent PDE5 inhibitor). Troponins are diagnostic but should not delay
reperfusion therapy.
Distractor Analysis:
• A: Important but should not delay aspirin or reperfusion
• B: Appropriate but aspirin has greater mortality benefit and fewer contraindications
• D: Not indicated if oxygen saturation adequate
FINAL EXAM
RASMUSSEN UNIVERSITY | 2026/2027 ACADEMIC YEAR
Medical-Surgical Nursing
100 Verified Questions and Answers with Expert Rationales | Comprehensive
Exam Information:
• Time Allowed: 180 minutes (3 hours)
• Number of Items: 100
• Points per Item: 1
• Total Possible Points: 100
.
UNIT 1: CARDIOVASCULAR DISORDERS (Questions 1-20)
Scenario 1: Heart Failure Exacerbation (Questions 1-3)
1. A 72-year-old patient with chronic heart failure presents to the ED with worsening
dyspnea, orthopnea, and 3+ pitting edema in both lower extremities. Vital signs: BP
168/94, HR 112, RR 28, O2 sat 86% on room air. Lung auscultation reveals crackles
bilaterally up to the mid-chest. Which assessment finding requires immediate notification
of the healthcare provider?
A. Bilateral 3+ pitting edema
B. Heart rate of 112 beats per minute
C. Oxygen saturation of 86% on room air
D. Blood pressure of 168/94 mmHg
Correct Answer: C. [CORRECT]
,Verified Explanation: Oxygen saturation of 86% indicates severe hypoxemia (normal
>94%) and imminent respiratory failure. This requires immediate intervention including
high-flow oxygen, possible non-invasive positive pressure ventilation (BiPAP), and
preparation for intubation if no response. While tachycardia (B) and hypertension (D)
indicate cardiac stress, and edema (A) indicates fluid overload, severe hypoxemia is
immediately life-threatening and takes priority according to the ABCs. Delayed
intervention risks end-organ damage, cardiac arrest from hypoxia, and respiratory arrest.
Distractor Analysis:
• A: Significant but chronic finding; does not require emergent notification
• B: Compensatory tachycardia for low cardiac output; concerning but not
immediately life-threatening
• D: Hypertension needs treatment but hypoxemia is priority
Rasmussen Tip: "ABCs always: Airway and Breathing before Circulation. 86% O2 =
Emergency."
2. The healthcare provider prescribes IV furosemide 40 mg now, oxygen at 4L via nasal
cannula, and a STAT chest x-ray. Fifteen minutes after furosemide administration, the
patient reports sudden onset of ringing in the ears. What is the nurse's priority action?
A. Administer the second dose of furosemide as scheduled
B. Reassure the patient this is a common side effect
C. Hold the next dose and contact the healthcare provider
D. Decrease the rate of oxygen delivery
Correct Answer: C. [CORRECT]
Verified Explanation: Tinnitus (ringing in the ears) is an early sign of ototoxicity from
loop diuretics like furosemide. This occurs when peak serum levels rise too quickly (rapid
IV push, high dose, renal impairment, or concurrent aminoglycoside use). Ototoxicity can
be permanent if drug continues. The nurse must hold subsequent doses immediately
and notify the provider to consider: dose reduction, slower infusion rate, alternative
diuretic, or audiologic evaluation. Reassurance or continuing the drug risks irreversible
hearing loss.
,Distractor Analysis:
• A: Continues the toxic agent; contraindicated
• B: Minimizes serious adverse effect; inappropriate reassurance
• D: Unrelated to ototoxicity; decreasing oxygen worsens hypoxemia
Rasmussen Tip: "Furosemide + Ringing ears = STOP the drug, Call the MD, Hearing at
risk"
3. The patient's chest x-ray confirms pulmonary edema, and IV furosemide 80 mg is
administered with good diuresis. Which laboratory value requires immediate follow-up 4
hours post-administration?
A. Serum sodium 138 mEq/L
B. Serum potassium 3.2 mEq/L
C. Serum creatinine 1.1 mg/dL
D. Blood glucose 110 mg/dL
Correct Answer: B. [CORRECT]
Verified Explanation: Hypokalemia (K+ 3.2 mEq/L, normal 3.5-5.0) is a critical
finding requiring immediate intervention. Loop diuretics cause significant potassium
wasting through the kidneys. Severe hypokalemia (<3.0) or rapid decline increases risk
of:
• Life-threatening ventricular dysrhythmias (PVCs, VT, VF)
• Digitalis toxicity (if patient on digoxin)
• Muscle weakness, rhabdomyolysis, paralysis
• Glucose intolerance
Treatment: Oral or IV potassium replacement depending on severity; cardiac monitoring;
recheck levels.
Distractor Analysis:
• A: Normal sodium; no action needed
• C: Normal creatinine; adequate renal function
• D: Slightly elevated glucose; not critical in this context
, Rasmussen Tip: "Lasix wastes Potassium, Check it often, Replace fast if low, Watch
the rhythm"
Scenario 2: Acute Myocardial Infarction (Questions 4-6)
4. A 55-year-old male presents to the ED with crushing substernal chest pain radiating to
his left arm, accompanied by diaphoresis and nausea. ECG reveals 3mm ST-segment
elevation in leads V1-V4. Which order should the nurse implement FIRST?
A. Obtain troponin levels
B. Administer sublingual nitroglycerin
C. Administer chewable aspirin 324 mg
D. Start supplemental oxygen at 2L via nasal cannula
Correct Answer: C. [CORRECT]
Verified Explanation: This patient has an anterior STEMI (ST elevation V1-V4 = left
anterior descending artery occlusion). ACC/AHA guidelines prioritize immediate
aspirin administration (162-325 mg chewed) for all patients with suspected ACS unless
true allergy. Aspirin:
• Inhibits platelet aggregation (cyclooxygenase inhibition)
• Reduces mortality by 25% in acute MI
• Should be given within minutes of arrival, before ECG confirmation if suspicion
high
Oxygen is no longer routine for all ACS patients—only if SpO2 <90%, respiratory distress,
or high-risk features. Nitroglycerin is second-line after aspirin (contraindicated if RV
infarct, SBP <90, or recent PDE5 inhibitor). Troponins are diagnostic but should not delay
reperfusion therapy.
Distractor Analysis:
• A: Important but should not delay aspirin or reperfusion
• B: Appropriate but aspirin has greater mortality benefit and fewer contraindications
• D: Not indicated if oxygen saturation adequate
