Exam 1 - NUR 2502 / NUR2502: Multidimensional Care
III / MDC 3 – Rasmussen Actual Exam Complete
Questions & Rationales | Complex Care | Pass
Guaranteed - A+ Graded
Complex Pathophysiology & Assessment
Q1: A 68-year-old male with a 40-pack-year smoking history presents to the ED with
worsening dyspnea, barrel chest, and pursed-lip breathing. His ABG shows pH 7.34,
PaCO₂ 58 mmHg, PaO₂ 62 mmHg, and HCO₃⁻ 32 mEq/L. Based on these findings, which
acid-base imbalance is this patient most likely experiencing?
A. Uncompensated respiratory acidosis with normal bicarbonate levels
B. Metabolic alkalosis caused by chronic diuretic overuse
C. Compensated respiratory acidosis with elevated bicarbonate reflecting chronic CO₂
retention [CORRECT]
D. Acute respiratory alkalosis secondary to hyperventilation
Correct Answer: C
Rationale: The best answer is C. In MDC 3 we focus on recognizing chronic versus acute
respiratory changes. This patient has a near-normal pH with an elevated PaCO₂ and an
elevated bicarbonate—that's the classic picture of compensated respiratory acidosis,
which is what we see in long-standing COPD where the kidneys have had time to retain
,bicarbonate to buffer the chronic CO₂ retention. Remember the priority framework: when
pH is close to normal but both CO₂ and bicarbonate are abnormal, think compensation,
not an acute process.
Q2: A nurse is reviewing morning labs for a patient with stage 4 chronic kidney disease.
Which set of laboratory findings would be most consistent with this diagnosis?
A. BUN 12 mg/dL, creatinine 0.8 mg/dL, GFR 95 mL/min
B. BUN 45 mg/dL, creatinine 4.2 mg/dL, GFR 22 mL/min, potassium 5.8 mEq/L
[CORRECT]
C. BUN 18 mg/dL, creatinine 1.1 mg/dL, GFR 78 mL/min, calcium 9.2 mg/dL
D. BUN 8 mg/dL, creatinine 0.6 mg/dL, GFR 120 mL/min, phosphorus 2.8 mg/dL
Correct Answer: B
Rationale: The best answer is B. In MDC 3 we focus on tracking the progressive lab
derangements as CKD advances. Stage 4 CKD means a GFR between 15 and 29, so
you're looking for significantly elevated BUN and creatinine along with electrolyte
imbalances like hyperkalemia that the failing kidneys can't regulate anymore. This aligns
with safe practice because catching these trends early helps you anticipate cardiac
complications from potassium buildup and plan appropriate dietary and medication
adjustments before dialysis becomes necessary.
Q3: A patient with heart failure has the following assessment findings: bilateral crackles
in lung bases, 3+ pitting edema in lower extremities, jugular venous distension at 45
degrees, and reports waking up breathless three times last night. Which stage of heart
failure is this patient most likely experiencing based on the NYHA classification?
,A. Class I with no limitation of physical activity
B. Class II with slight limitation and symptoms only with ordinary exertion
C. Class III with marked limitation and symptoms with less-than-ordinary activity
D. Class IV with symptoms at rest and inability to carry out any physical activity without
discomfort [CORRECT]
Correct Answer: D
Rationale: The best answer is D. In MDC 3 we focus on connecting the clinical picture to
the classification system so you can communicate severity accurately to the team. This
patient has orthopnea, JVD, significant edema, and crackles—all signs of
decompensation even at rest, which puts them in NYHA Class IV. Remember the priority
framework: when a patient has symptoms at rest, that's the most severe class and
requires the most aggressive intervention and monitoring.
Q4: A nurse is caring for a patient with diabetic ketoacidosis. Which arterial blood gas
result would be most expected in the early phase of this condition?
A. pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.18, PaCO₂ 22 mmHg, HCO₃⁻ 8 mEq/L [CORRECT]
C. pH 7.38, PaCO₂ 40 mmHg, HCO₃⁻ 22 mEq/L
D. pH 7.42, PaCO₂ 48 mmHg, HCO₃⁻ 30 mEq/L
Correct Answer: B
Rationale: The best answer is B. In MDC 3 we focus on the pathophysiology behind
DKA—unchecked ketone production creates a metabolic acidosis, so you're looking for a
, low pH with a low bicarbonate. The body tries to compensate by blowing off CO₂
through Kussmaul respirations, so the PaCO₂ drops too. This aligns with safe practice
because recognizing this pattern quickly guides your priority interventions: insulin,
fluids, and electrolyte monitoring while watching for the transition out of acidosis as
treatment works.
Q5: During morning assessment, a nurse notes a post-operative patient has developed
new-onset confusion, tachycardia, and cool, clammy skin. Blood pressure is 92/58
mmHg. Which type of shock should the nurse suspect first?
A. Anaphylactic shock triggered by a latent medication allergy
B. Cardiogenic shock from an undiagnosed myocardial infarction
C. Hypovolemic shock from internal bleeding or fluid shifts [CORRECT]
D. Neurogenic shock due to spinal anesthesia effects
Correct Answer: C
Rationale: The best answer is C. In MDC 3 we focus on pattern recognition in the
post-op patient—new confusion with hypotension, tachycardia, and cool clammy skin in
someone who just had surgery screams hypovolemia until proven otherwise, whether
from bleeding, third-spacing, or inadequate fluid replacement. Remember the priority
framework: post-op patients are at high risk for hypovolemic shock, and your first job is
to assess for hemorrhage, check dressings and drains, and get fluids going while you
figure out the source.
III / MDC 3 – Rasmussen Actual Exam Complete
Questions & Rationales | Complex Care | Pass
Guaranteed - A+ Graded
Complex Pathophysiology & Assessment
Q1: A 68-year-old male with a 40-pack-year smoking history presents to the ED with
worsening dyspnea, barrel chest, and pursed-lip breathing. His ABG shows pH 7.34,
PaCO₂ 58 mmHg, PaO₂ 62 mmHg, and HCO₃⁻ 32 mEq/L. Based on these findings, which
acid-base imbalance is this patient most likely experiencing?
A. Uncompensated respiratory acidosis with normal bicarbonate levels
B. Metabolic alkalosis caused by chronic diuretic overuse
C. Compensated respiratory acidosis with elevated bicarbonate reflecting chronic CO₂
retention [CORRECT]
D. Acute respiratory alkalosis secondary to hyperventilation
Correct Answer: C
Rationale: The best answer is C. In MDC 3 we focus on recognizing chronic versus acute
respiratory changes. This patient has a near-normal pH with an elevated PaCO₂ and an
elevated bicarbonate—that's the classic picture of compensated respiratory acidosis,
which is what we see in long-standing COPD where the kidneys have had time to retain
,bicarbonate to buffer the chronic CO₂ retention. Remember the priority framework: when
pH is close to normal but both CO₂ and bicarbonate are abnormal, think compensation,
not an acute process.
Q2: A nurse is reviewing morning labs for a patient with stage 4 chronic kidney disease.
Which set of laboratory findings would be most consistent with this diagnosis?
A. BUN 12 mg/dL, creatinine 0.8 mg/dL, GFR 95 mL/min
B. BUN 45 mg/dL, creatinine 4.2 mg/dL, GFR 22 mL/min, potassium 5.8 mEq/L
[CORRECT]
C. BUN 18 mg/dL, creatinine 1.1 mg/dL, GFR 78 mL/min, calcium 9.2 mg/dL
D. BUN 8 mg/dL, creatinine 0.6 mg/dL, GFR 120 mL/min, phosphorus 2.8 mg/dL
Correct Answer: B
Rationale: The best answer is B. In MDC 3 we focus on tracking the progressive lab
derangements as CKD advances. Stage 4 CKD means a GFR between 15 and 29, so
you're looking for significantly elevated BUN and creatinine along with electrolyte
imbalances like hyperkalemia that the failing kidneys can't regulate anymore. This aligns
with safe practice because catching these trends early helps you anticipate cardiac
complications from potassium buildup and plan appropriate dietary and medication
adjustments before dialysis becomes necessary.
Q3: A patient with heart failure has the following assessment findings: bilateral crackles
in lung bases, 3+ pitting edema in lower extremities, jugular venous distension at 45
degrees, and reports waking up breathless three times last night. Which stage of heart
failure is this patient most likely experiencing based on the NYHA classification?
,A. Class I with no limitation of physical activity
B. Class II with slight limitation and symptoms only with ordinary exertion
C. Class III with marked limitation and symptoms with less-than-ordinary activity
D. Class IV with symptoms at rest and inability to carry out any physical activity without
discomfort [CORRECT]
Correct Answer: D
Rationale: The best answer is D. In MDC 3 we focus on connecting the clinical picture to
the classification system so you can communicate severity accurately to the team. This
patient has orthopnea, JVD, significant edema, and crackles—all signs of
decompensation even at rest, which puts them in NYHA Class IV. Remember the priority
framework: when a patient has symptoms at rest, that's the most severe class and
requires the most aggressive intervention and monitoring.
Q4: A nurse is caring for a patient with diabetic ketoacidosis. Which arterial blood gas
result would be most expected in the early phase of this condition?
A. pH 7.48, PaCO₂ 30 mmHg, HCO₃⁻ 24 mEq/L
B. pH 7.18, PaCO₂ 22 mmHg, HCO₃⁻ 8 mEq/L [CORRECT]
C. pH 7.38, PaCO₂ 40 mmHg, HCO₃⁻ 22 mEq/L
D. pH 7.42, PaCO₂ 48 mmHg, HCO₃⁻ 30 mEq/L
Correct Answer: B
Rationale: The best answer is B. In MDC 3 we focus on the pathophysiology behind
DKA—unchecked ketone production creates a metabolic acidosis, so you're looking for a
, low pH with a low bicarbonate. The body tries to compensate by blowing off CO₂
through Kussmaul respirations, so the PaCO₂ drops too. This aligns with safe practice
because recognizing this pattern quickly guides your priority interventions: insulin,
fluids, and electrolyte monitoring while watching for the transition out of acidosis as
treatment works.
Q5: During morning assessment, a nurse notes a post-operative patient has developed
new-onset confusion, tachycardia, and cool, clammy skin. Blood pressure is 92/58
mmHg. Which type of shock should the nurse suspect first?
A. Anaphylactic shock triggered by a latent medication allergy
B. Cardiogenic shock from an undiagnosed myocardial infarction
C. Hypovolemic shock from internal bleeding or fluid shifts [CORRECT]
D. Neurogenic shock due to spinal anesthesia effects
Correct Answer: C
Rationale: The best answer is C. In MDC 3 we focus on pattern recognition in the
post-op patient—new confusion with hypotension, tachycardia, and cool clammy skin in
someone who just had surgery screams hypovolemia until proven otherwise, whether
from bleeding, third-spacing, or inadequate fluid replacement. Remember the priority
framework: post-op patients are at high risk for hypovolemic shock, and your first job is
to assess for hemorrhage, check dressings and drains, and get fluids going while you
figure out the source.
