NUR2755 / NUR 2755 FINAL
EXAM 2025-2026 |
Multidimensional Care IV |
MDC 4 Exam Questions &
Answers | Pass Guaranteed -
A+ Graded
art A Multiple Choice (Q1‑75)
P
Q1 (Neurological – ICP): A patient with a traumatic brain injury has a GCS of 6. The nurse notes
a systolic blood pressure of 170 mm Hg and a heart rate of 52 bpm. What additional
assessment is most important?
A. Check pupil response to light.
B. Reassess GCS in 15 minutes.
C. Administer a fluid bolus.
D. Prepare for immediate intubation.
[CORRECT] A
Rationale: Cushing's triad (hypertension + bradycardia + irregular respirations) indicates
increased ICP. Pupillary changes (blown or sluggish pupil) signal uncal herniation and require
immediate intervention. Distractor D is incorrect – intubation may be needed, but pupil
assessment is the priority for localizing herniation. Clinical pearl: Cushing's triad is a late sign –
treat ICP early.
Q2 (Neurological – Stroke): A 68-year-old patient arrives at the ED 2.5 hours after sudden onset
of left-sided weakness and aphasia. CT scan shows no hemorrhage. What is the nurse's priority
action?
A. Obtain a detailed medication history.
B. Prepare for IV thrombolytic (tPA) administration.
C. Insert a nasogastric tube for feeding.
D. Start antihypertensive therapy to lower BP to <140/90.
[CORRECT] B
, ationale: Per the 2019 AHA/ASA stroke guidelines, IV tPA is indicated for ischemic stroke
R
within 4.5 hours of symptom onset with no hemorrhage on CT. Distractor D is incorrect –
aggressive BP lowering is contraindicated before tPA (permissive hypertension up to 220/120 is
allowed). Clinical pearl: "Time is brain" – every minute of delayed tPA costs 1.9 million neurons.
Q3 (Neurological – Seizures): A patient in status epilepticus has received lorazepam 4 mg IV
without cessation of seizure activity. What is the next appropriate medication?
A. Phenytoin 20 mg/kg IV at maximum rate of 50 mg/min.
B. Levetiracetam 1000 mg IV over 5 minutes.
C. Diazepam 10 mg IM.
D. Phenobarbital 20 mg/kg IV push.
[CORRECT] A
Rationale: Per the Neurocritical Care Society 2012 guidelines, after benzodiazepine failure,
phenytoin or fosphenytoin is second-line therapy for status epilepticus. Distractor B is incorrect
– levetiracetam is effective but phenytoin has more robust evidence for refractory status. Clinical
pearl: Remember "L-P-F-P" – Lorazepam → Phenytoin → Fosphenytoin → Phenobarbital.
Q4 (Neurological – Spinal Cord Injury): A patient with a T6 spinal cord injury reports a severe
pounding headache, diaphoresis, and flushing above the level of injury. BP is 220/110 mm Hg.
What is the priority nursing intervention?
A. Administer sublingual nitroglycerin.
B. Sit the patient upright and loosen tight clothing.
C. Insert a urinary catheter immediately.
D. Give oral nifedipine.
[CORRECT] B
Rationale: Autonomic dysreflexia is triggered by noxious stimuli below the injury level
(commonly bladder distension). Sitting upright lowers BP by inducing orthostatic pooling, and
removing the stimulus is critical. Distractor A is incorrect – nitrates may worsen hypotension
when the stimulus is removed. Clinical pearl: AD is a medical emergency – think "up, loose, and
find the cause."
Q5 (Neurological – GCS): A trauma patient opens eyes to painful stimulus, makes
incomprehensible sounds, and withdraws from pain. What is the GCS score?
A. 9
B. 10
C. 11
D. 8
[CORRECT] D
Rationale: Eye opening to pain = 2, incomprehensible sounds = 2, withdrawal from pain = 4.
Total GCS = 8 (2+2+4). Distractor B is incorrect – this would require localizing to pain (5) instead
of withdrawal (4). Clinical pearl: Remember GCS by "4-5-6 eyes, verbal, motor" – eyes 1-4,
verbal 1-5, motor 1-6.
Q6 (Shock – Classification): A patient post-MI has a cardiac output of 4.0 L/min, PCWP of 22
mm Hg, and SVR of 1800 dynes/sec/cm⁻⁵. What type of shock is present?
A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive shock
, . Obstructive shock
D
[CORRECT] B
Rationale: Cardiogenic shock is characterized by elevated PCWP (>18 mm Hg) and elevated
SVR due to compensatory vasoconstriction. Distractor A is incorrect – hypovolemic shock
presents with low PCWP. Clinical pearl: "Cold and wet = cardiogenic; warm and wet =
distributive; cold and dry = hypovolemic."
Q7 (Shock – Sepsis): A patient with suspected sepsis has a lactate of 4.2 mmol/L, HR 118, RR
28, and BP 88/52 mm Hg. According to the Surviving Sepsis Campaign, what is the priority
intervention within the first hour?
A. Obtain blood cultures and administer broad-spectrum antibiotics.
B. Start norepinephrine to maintain MAP >65 mm Hg.
C. Administer 30 mL/kg crystalloid fluid bolus.
D. Insert a central line for vasopressor administration.
[CORRECT] A
Rationale: Per the 2021 Surviving Sepsis Campaign, the Hour-1 bundle prioritizes measuring
lactate, obtaining blood cultures, administering broad-spectrum antibiotics, and beginning rapid
fluid administration. Distractor C is important but antibiotics must not be delayed. Clinical pearl:
"Time to antibiotics" is the strongest predictor of mortality in sepsis – every hour of delay
increases mortality by 7.6%.
Q8 (Shock – Vasopressors): A patient in septic shock remains hypotensive (MAP 58 mm Hg)
after receiving 30 mL/kg of crystalloid. What is the first-line vasopressor?
A. Dopamine 5 mcg/kg/min.
B. Norepinephrine 0.05 mcg/kg/min.
C. Epinephrine 0.1 mcg/kg/min.
D. Phenylephrine 100 mcg/min.
[CORRECT] B
Rationale: Per the 2021 Surviving Sepsis Campaign, norepinephrine is the first-line vasopressor
for septic shock due to its potent alpha-1 effects and lower risk of arrhythmias compared to
dopamine. Distractor A is incorrect – dopamine is associated with increased mortality and
arrhythmias in septic shock. Clinical pearl: "Norepi first, epi second, vaso third" – add
vasopressin when norepinephrine >0.5 mcg/kg/min.
Q9 (Respiratory – ARDS): A patient with ARDS is on mechanical ventilation. The physician
orders lung-protective ventilation. What tidal volume should the nurse expect?
A. 10 mL/kg of actual body weight.
B. 6 mL/kg of predicted body weight.
C. 8 mL/kg of actual body weight.
D. 12 mL/kg of predicted body weight.
[CORRECT] B
Rationale: Per the ARDSNet protocol, lung-protective ventilation uses 6 mL/kg of predicted body
weight (PBW) to prevent volutrauma. Distractor A is incorrect – 10 mL/kg increases mortality in
ARDS. Clinical pearl: PBW is calculated using height and gender, not actual weight – this
prevents overdistension in obese patients.
Q10 (Respiratory – Chest Tube): A patient with a pneumothorax has a chest tube to water seal.
The nurse notes continuous bubbling in the water seal chamber. What is the appropriate action?
, . Apply padded clamps to the tubing and notify the provider.
A
B. Check the tubing connections for an air leak.
C. Increase the suction pressure.
D. Milk the tubing to clear any obstruction.
[CORRECT] B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system,
usually from loose connections. Distractor A is incorrect – clamping a chest tube with an air leak
can cause tension pneumothorax. Clinical pearl: "Intermittent bubbling = normal; continuous
bubbling = air leak; no bubbling = lung re-expanded or obstruction."
Q11 (Respiratory – PE): A patient with sudden-onset dyspnea and pleuritic chest pain has a
Wells score of 6.5. What is the most appropriate next step?
A. Start heparin infusion immediately.
B. Order a D-dimer test.
C. Obtain a CT pulmonary angiogram (CTPA).
D. Begin warfarin therapy.
[CORRECT] C
Rationale: A Wells score >4 indicates high probability of PE; CTPA is the gold standard
diagnostic test. Distractor B is incorrect – D-dimer is not useful in high-probability patients (it will
be elevated). Clinical pearl: Wells score ≤4 = D-dimer first; >4 = imaging first.
Q12 (Burns – Parkland Formula): A 70-kg patient has 40% TBSA deep partial-thickness burns.
Using the Parkland formula, how much fluid should be administered in the first 8 hours?
A. 2,800 mL
B. 5,600 mL
C. 11,200 mL
D. 4,000 mL
[CORRECT] B
Rationale: Parkland formula = 4 mL × %TBSA × kg. Total = 4 × 40 × 70 = 11,200 mL. Half is
given in first 8 hours = 5,600 mL. Distractor C is incorrect – this is the total 24-hour requirement.
Clinical pearl: Start the clock from time of injury, not time of arrival – adjust the first 8-hour rate
accordingly.
Q13 (Endocrine – DKA): A patient in DKA has a serum glucose of 480 mg/dL, pH 7.18, and
potassium 3.2 mEq/L. What is the priority intervention?
A. Start regular insulin infusion at 0.1 units/kg/hr.
B. Administer 0.9% NaCl 1 L over 1 hour.
C. Add potassium to IV fluids.
D. Administer sodium bicarbonate.
[CORRECT] C
Rationale: Per ADA guidelines, insulin drives potassium intracellularly; with K+ <3.3 mEq/L,
insulin is contraindicated until potassium is replaced to prevent fatal arrhythmias. Distractor A is
incorrect – insulin before potassium replacement can cause life-threatening hypokalemia.
Clinical pearl: "Potassium first, then insulin" when K+ <3.3; "insulin first" when K+ 3.3-5.2.
Q14 (Endocrine – Thyroid Storm): A patient with Graves' disease presents with temperature
104°F, HR 160 bpm, and agitation. Which medication should be administered FIRST?
A. Propylthiouracil (PTU) 600 mg via NG tube.
EXAM 2025-2026 |
Multidimensional Care IV |
MDC 4 Exam Questions &
Answers | Pass Guaranteed -
A+ Graded
art A Multiple Choice (Q1‑75)
P
Q1 (Neurological – ICP): A patient with a traumatic brain injury has a GCS of 6. The nurse notes
a systolic blood pressure of 170 mm Hg and a heart rate of 52 bpm. What additional
assessment is most important?
A. Check pupil response to light.
B. Reassess GCS in 15 minutes.
C. Administer a fluid bolus.
D. Prepare for immediate intubation.
[CORRECT] A
Rationale: Cushing's triad (hypertension + bradycardia + irregular respirations) indicates
increased ICP. Pupillary changes (blown or sluggish pupil) signal uncal herniation and require
immediate intervention. Distractor D is incorrect – intubation may be needed, but pupil
assessment is the priority for localizing herniation. Clinical pearl: Cushing's triad is a late sign –
treat ICP early.
Q2 (Neurological – Stroke): A 68-year-old patient arrives at the ED 2.5 hours after sudden onset
of left-sided weakness and aphasia. CT scan shows no hemorrhage. What is the nurse's priority
action?
A. Obtain a detailed medication history.
B. Prepare for IV thrombolytic (tPA) administration.
C. Insert a nasogastric tube for feeding.
D. Start antihypertensive therapy to lower BP to <140/90.
[CORRECT] B
, ationale: Per the 2019 AHA/ASA stroke guidelines, IV tPA is indicated for ischemic stroke
R
within 4.5 hours of symptom onset with no hemorrhage on CT. Distractor D is incorrect –
aggressive BP lowering is contraindicated before tPA (permissive hypertension up to 220/120 is
allowed). Clinical pearl: "Time is brain" – every minute of delayed tPA costs 1.9 million neurons.
Q3 (Neurological – Seizures): A patient in status epilepticus has received lorazepam 4 mg IV
without cessation of seizure activity. What is the next appropriate medication?
A. Phenytoin 20 mg/kg IV at maximum rate of 50 mg/min.
B. Levetiracetam 1000 mg IV over 5 minutes.
C. Diazepam 10 mg IM.
D. Phenobarbital 20 mg/kg IV push.
[CORRECT] A
Rationale: Per the Neurocritical Care Society 2012 guidelines, after benzodiazepine failure,
phenytoin or fosphenytoin is second-line therapy for status epilepticus. Distractor B is incorrect
– levetiracetam is effective but phenytoin has more robust evidence for refractory status. Clinical
pearl: Remember "L-P-F-P" – Lorazepam → Phenytoin → Fosphenytoin → Phenobarbital.
Q4 (Neurological – Spinal Cord Injury): A patient with a T6 spinal cord injury reports a severe
pounding headache, diaphoresis, and flushing above the level of injury. BP is 220/110 mm Hg.
What is the priority nursing intervention?
A. Administer sublingual nitroglycerin.
B. Sit the patient upright and loosen tight clothing.
C. Insert a urinary catheter immediately.
D. Give oral nifedipine.
[CORRECT] B
Rationale: Autonomic dysreflexia is triggered by noxious stimuli below the injury level
(commonly bladder distension). Sitting upright lowers BP by inducing orthostatic pooling, and
removing the stimulus is critical. Distractor A is incorrect – nitrates may worsen hypotension
when the stimulus is removed. Clinical pearl: AD is a medical emergency – think "up, loose, and
find the cause."
Q5 (Neurological – GCS): A trauma patient opens eyes to painful stimulus, makes
incomprehensible sounds, and withdraws from pain. What is the GCS score?
A. 9
B. 10
C. 11
D. 8
[CORRECT] D
Rationale: Eye opening to pain = 2, incomprehensible sounds = 2, withdrawal from pain = 4.
Total GCS = 8 (2+2+4). Distractor B is incorrect – this would require localizing to pain (5) instead
of withdrawal (4). Clinical pearl: Remember GCS by "4-5-6 eyes, verbal, motor" – eyes 1-4,
verbal 1-5, motor 1-6.
Q6 (Shock – Classification): A patient post-MI has a cardiac output of 4.0 L/min, PCWP of 22
mm Hg, and SVR of 1800 dynes/sec/cm⁻⁵. What type of shock is present?
A. Hypovolemic shock
B. Cardiogenic shock
C. Distributive shock
, . Obstructive shock
D
[CORRECT] B
Rationale: Cardiogenic shock is characterized by elevated PCWP (>18 mm Hg) and elevated
SVR due to compensatory vasoconstriction. Distractor A is incorrect – hypovolemic shock
presents with low PCWP. Clinical pearl: "Cold and wet = cardiogenic; warm and wet =
distributive; cold and dry = hypovolemic."
Q7 (Shock – Sepsis): A patient with suspected sepsis has a lactate of 4.2 mmol/L, HR 118, RR
28, and BP 88/52 mm Hg. According to the Surviving Sepsis Campaign, what is the priority
intervention within the first hour?
A. Obtain blood cultures and administer broad-spectrum antibiotics.
B. Start norepinephrine to maintain MAP >65 mm Hg.
C. Administer 30 mL/kg crystalloid fluid bolus.
D. Insert a central line for vasopressor administration.
[CORRECT] A
Rationale: Per the 2021 Surviving Sepsis Campaign, the Hour-1 bundle prioritizes measuring
lactate, obtaining blood cultures, administering broad-spectrum antibiotics, and beginning rapid
fluid administration. Distractor C is important but antibiotics must not be delayed. Clinical pearl:
"Time to antibiotics" is the strongest predictor of mortality in sepsis – every hour of delay
increases mortality by 7.6%.
Q8 (Shock – Vasopressors): A patient in septic shock remains hypotensive (MAP 58 mm Hg)
after receiving 30 mL/kg of crystalloid. What is the first-line vasopressor?
A. Dopamine 5 mcg/kg/min.
B. Norepinephrine 0.05 mcg/kg/min.
C. Epinephrine 0.1 mcg/kg/min.
D. Phenylephrine 100 mcg/min.
[CORRECT] B
Rationale: Per the 2021 Surviving Sepsis Campaign, norepinephrine is the first-line vasopressor
for septic shock due to its potent alpha-1 effects and lower risk of arrhythmias compared to
dopamine. Distractor A is incorrect – dopamine is associated with increased mortality and
arrhythmias in septic shock. Clinical pearl: "Norepi first, epi second, vaso third" – add
vasopressin when norepinephrine >0.5 mcg/kg/min.
Q9 (Respiratory – ARDS): A patient with ARDS is on mechanical ventilation. The physician
orders lung-protective ventilation. What tidal volume should the nurse expect?
A. 10 mL/kg of actual body weight.
B. 6 mL/kg of predicted body weight.
C. 8 mL/kg of actual body weight.
D. 12 mL/kg of predicted body weight.
[CORRECT] B
Rationale: Per the ARDSNet protocol, lung-protective ventilation uses 6 mL/kg of predicted body
weight (PBW) to prevent volutrauma. Distractor A is incorrect – 10 mL/kg increases mortality in
ARDS. Clinical pearl: PBW is calculated using height and gender, not actual weight – this
prevents overdistension in obese patients.
Q10 (Respiratory – Chest Tube): A patient with a pneumothorax has a chest tube to water seal.
The nurse notes continuous bubbling in the water seal chamber. What is the appropriate action?
, . Apply padded clamps to the tubing and notify the provider.
A
B. Check the tubing connections for an air leak.
C. Increase the suction pressure.
D. Milk the tubing to clear any obstruction.
[CORRECT] B
Rationale: Continuous bubbling in the water seal chamber indicates an air leak in the system,
usually from loose connections. Distractor A is incorrect – clamping a chest tube with an air leak
can cause tension pneumothorax. Clinical pearl: "Intermittent bubbling = normal; continuous
bubbling = air leak; no bubbling = lung re-expanded or obstruction."
Q11 (Respiratory – PE): A patient with sudden-onset dyspnea and pleuritic chest pain has a
Wells score of 6.5. What is the most appropriate next step?
A. Start heparin infusion immediately.
B. Order a D-dimer test.
C. Obtain a CT pulmonary angiogram (CTPA).
D. Begin warfarin therapy.
[CORRECT] C
Rationale: A Wells score >4 indicates high probability of PE; CTPA is the gold standard
diagnostic test. Distractor B is incorrect – D-dimer is not useful in high-probability patients (it will
be elevated). Clinical pearl: Wells score ≤4 = D-dimer first; >4 = imaging first.
Q12 (Burns – Parkland Formula): A 70-kg patient has 40% TBSA deep partial-thickness burns.
Using the Parkland formula, how much fluid should be administered in the first 8 hours?
A. 2,800 mL
B. 5,600 mL
C. 11,200 mL
D. 4,000 mL
[CORRECT] B
Rationale: Parkland formula = 4 mL × %TBSA × kg. Total = 4 × 40 × 70 = 11,200 mL. Half is
given in first 8 hours = 5,600 mL. Distractor C is incorrect – this is the total 24-hour requirement.
Clinical pearl: Start the clock from time of injury, not time of arrival – adjust the first 8-hour rate
accordingly.
Q13 (Endocrine – DKA): A patient in DKA has a serum glucose of 480 mg/dL, pH 7.18, and
potassium 3.2 mEq/L. What is the priority intervention?
A. Start regular insulin infusion at 0.1 units/kg/hr.
B. Administer 0.9% NaCl 1 L over 1 hour.
C. Add potassium to IV fluids.
D. Administer sodium bicarbonate.
[CORRECT] C
Rationale: Per ADA guidelines, insulin drives potassium intracellularly; with K+ <3.3 mEq/L,
insulin is contraindicated until potassium is replaced to prevent fatal arrhythmias. Distractor A is
incorrect – insulin before potassium replacement can cause life-threatening hypokalemia.
Clinical pearl: "Potassium first, then insulin" when K+ <3.3; "insulin first" when K+ 3.3-5.2.
Q14 (Endocrine – Thyroid Storm): A patient with Graves' disease presents with temperature
104°F, HR 160 bpm, and agitation. Which medication should be administered FIRST?
A. Propylthiouracil (PTU) 600 mg via NG tube.
