MDC II/ Multidimensional Care II exam 2 spring 2026 | 100% latest questions and answers.

MDC 2 Exam 2 (version 2) 50 Questions and Answers_ Latest Winter 26. 1. A patient with COPD and chronic hypercapnia is found unresponsive. ABG: pH 7.28, PaCO₂ 68 mm Hg, HCO₃ 32 mEq/L. Which interpretation is correct? o A) Uncompensated respiratory acidosis with hypoxemia o B) Partially compensated respiratory acidosis with renal compensation o C) Fully compensated metabolic alkalosis o D) Mixed respiratory acidosis and metabolic alkalosis 2. A patient with aspirin overdose initially presents with tachypnea and respiratory alkalosis. Twelve hours later, ABG shows pH 7.30, HCO₃ 14 mEq/L, PaCO₂ 30 mm Hg. What has occurred? o A) Full compensation of respiratory alkalosis o B) Development of metabolic acidosis with partial respiratory compensation o C) Uncompensated metabolic alkalosis o D) Respiratory acidosis from hypoventilation 3. A patient on a loop diuretic develops lethargy and confusion. ABG: pH 7.50, PaCO₂ 48 mm Hg, HCO₃ 34 mEq/L. What is the most likely primary disorder and compensation? o A) Metabolic alkalosis with partial respiratory compensation o B) Respiratory acidosis with renal compensation o C) Metabolic acidosis with respiratory compensation o D) Mixed metabolic and respiratory alkalosis 4. A patient with severe diarrhea has ABG: pH 7.32, HCO₃ 18 mEq/L, PaCO₂ 35 mm Hg. The nurse notes the patient is alert with Kussmaul respirations. What is the best interpretation? o A) Uncompensated metabolic acidosis o B) Partially compensated respiratory alkalosis o C) Compensated metabolic acidosis o D) Uncompensated respiratory acidosis 5. Which patient is at highest risk for developing acute respiratory acidosis within the next hour? o A) Patient with anxiety disorder hyperventilating o B) Postoperative patient receiving high-flow oxygen o C) Patient with opioid overdose and respiratory rate of 6 o D) Patient with diabetic ketoacidosis and vomiting 6. A patient on chemotherapy for leukemia develops painful oral lesions with white patches that bleed when scraped. The patient refuses to eat or drink. What is the priority nursing intervention? o A) Administer IV antibiotics o B) Provide topical antifungals and pain management before meals o C) Insert an NG tube for feeding o D) Encourage commercial alcohol-based mouthwash 7. A patient with HIV presents with fuzzy white patches on the lateral tongue that cannot be scraped off. This is most consistent with: o A) Candidiasis o B) Hairy leukoplakia o C) Erythroplakia o D) Aphthous stomatitis 8. A patient with xerostomia from head and neck radiation reports difficulty swallowing and a sensation of food sticking in the throat. What is the most serious immediate concern? o A) Dental caries o B) Aspiration pneumonia o C) Oral candidiasis o D) Malnutrition 9. A patient with acute sialadenitis of the parotid gland has facial asymmetry when asked to smile. What is the nurse’s priority action? o A) Apply warm compresses o B) Administer IV antibiotics o C) Assess facial nerve function and notify provider o D) Massage the edematous gland 10. A patient with known GERD reports chest pain radiating to the back, worse when lying down, and relief when sitting up. The patient also has dysphagia and unintentional weight loss. Which condition should the nurse suspect first? o A) Typical GERD exacerbation o B) Myocardial infarction o C) Esophageal cancer o D) Paraesophageal hernia with possible strangulation 11. A patient with Barrett’s esophagus asks, “Why is this a problem? I feel fine.” What is the nurse’s best response? o A) “Barrett’s esophagus increases your risk of developing esophageal cancer.” o B) “It means your stomach is paralyzed and won’t empty.” o C) “You will need a permanent feeding tube.” o D) “It only causes bad breath and is not serious.”) 12. A patient post-Nissen fundoplication reports severe bloating and inability to vomit. What is the priority nursing action? o A) Insert an NG tube immediately o B) Reassure the patient this is normal o C) Assess for signs of gastric volvulus or obstruction o D) Administer a prokinetic agent 13. A patient with GERD asks why they should sleep on their right side. What is the correct rationale? o A) It reduces acid reflux compared to lying flat or on left side o B) It prevents aspiration during sleep o C) It increases lower esophageal sphincter pressure o D) It is an old myth with no evidence 14. A patient is admitted with melena, epigastric pain, and history of daily ibuprofen use for arthritis. Vital signs: HR 110, BP 90/60. What is the priority nursing action? o A) Administer oral antacids o B) Start a PPI IV and prepare for possible transfusion o C) Encourage clear liquids o D) Schedule an EGD for next week 15. A patient with a duodenal ulcer reports pain that wakes them at 2 AM. Which statement best explains this pattern? o A) Increased gastric acid secretion when stomach is empty o B) Food irritating the ulcer directly o C) Stress-related cortisol spikes at night o D) NSAID peak effect at midnight 16. A patient with a gastric ulcer asks why their pain worsens with eating, unlike a friend with duodenal ulcer. What is the best explanation? o A) Gastric ulcers are caused by stress only o B) Food increases acid secretion and irritates the gastric ulcer o C) Duodenal ulcers are not real ulcers o D) Gastric ulcers heal faster with food 17. A patient with PUD on triple therapy (bismuth, amoxicillin, metronidazole) reports black stools. What is the nurse’s best response? o A) Stop the medication immediately o B) Report to provider for possible GI bleed o C) Reassure that bismuth causes harmless black stools o D) Increase fiber intake 18. A patient with PUD suddenly develops severe, tearing epigastric pain radiating to the shoulder, with absent bowel sounds and a rigid abdomen. What complication is most likely? o A) Gastric outlet obstruction o B) Perforation with peritonitis o C) Hemorrhage o D) Dumping syndrome 19. A patient with chronic type A gastritis has peripheral neuropathy and difficulty walking. Which lab abnormality is the likely cause? o A) Iron deficiency o B) Vitamin B12 deficiency o C) Hyperkalemia o D) Folate deficiency 20. A 55-year-old male with H. pylori infection, pickled food intake, and smoking presents with early satiety and weight loss. EGD shows a gastric mass. Which finding is most concerning for advanced disease? o A) Mild epigastric pain after meals o B) Anemia and progressive weight loss o C) Positive H. pylori serology o D) Family history of GERD 21. A patient post-gastrectomy reports dizziness, tachycardia, and sweating 30 minutes after eating a high-carbohydrate meal. What is the most likely diagnosis and timing? o A) Late dumping syndrome o B) Early dumping syndrome o C) Alkaline reflux gastropathy o D) Achlorhydria 22. A patient with dumping syndrome asks why they should eat a high-protein, high-fat, low-carbohydrate diet. What is the best rationale? o A) Fat and protein slow gastric emptying and reduce rapid fluid shift o B) Carbohydrates increase bile reflux o C) Protein prevents stomach cancer 23. D) Fat increases insulin release A patient with progressive solid food dysphagia and 20-lb weight loss has a barium swallow showing a “bird beak” tapering of the distal esophagus. What is the most likely diagnosis? o A) GERD with stricture o B) Achalasia o C) Esophageal cancer o D) Paraesophageal hernia 24. A patient undergoes EGD for dysphagia. Post-procedure, the patient is alert but unable to swallow saliva. What is the nurse’s priority? o A) Give small sips of water o B) Keep NPO and assess gag reflex o C) Position supine o D) Administer IV morphine 25. A patient with known esophageal varices vomits 500 mL of bright red blood. What is the priority intervention? o A) Insert NG tube for lavage o B) Establish two large-bore IVs and prepare for blood transfusion o C) Administer oral vitamin K o D) Position patient flat 26. A patient with melena and hematocrit of 18% is on a PPI drip. The patient becomes confused and hypotensive. What should the nurse do first? o A) Repeat CBC o B) Increase PPI rate o C) Notify provider and prepare for emergency transfusion o D) Insert Foley catheter 27. A patient with a GI bleed is NPO and has an NG tube. The nurse notes coffee-ground output. What does this indicate? o A) Active arterial bleeding o B) Digested blood from slow bleeding o C) Tube is in the lung o D) Normal finding 28. Which patient with upper GI bleeding requires the most immediate endoscopy? o A) Stable patient with melena and Hgb 10 o B) Patient with hematemesis and HR 130, BP 80/50 o C) Patient with coffee-ground emesis and normal vitals o D) Patient with history of PUD and mild epigastric pain 29. A patient has a non-healing ulcer on the lateral tongue, painless, with a red velvety appearance. The nurse knows this description is most consistent with: o A) Benign aphthous ulcer o B) Erythroplakia — high risk for squamous cell carcinoma o C) Herpes simplex lesion o D) Traumatic ulcer from cheek biting 30. A patient with leukoplakia on the lip asks, “Is this cancer?” What is the nurse’s best response? o A) “Leukoplakia is always benign, don’t worry.” o B) “Most are benign, but lesions on the lip and tongue are more likely to become cancerous.” o C) “You need immediate chemotherapy.” o D) “Only hairy leukoplakia is dangerous.”) 31. A patient with oral cancer undergoing radiation therapy reports severe mouth pain and thick saliva. What intervention is most appropriate? o A) Encourage commercial mouthwash with alcohol o B) Provide saline or sodium bicarbonate rinses q2-3h o C) Limit oral intake to prevent aspiration o D) Discontinue radiation therapy ________________________________________ 32. A patient 2 weeks post-gastrectomy reports sweating, palpitations, and confusion 2 hours after a meal. Blood glucose is 45 mg/dL. What is the most likely cause? o A) Early dumping syndrome o B) Late dumping syndrome with reactive hypoglycemia o C) Hyperglycemia from high fat intake o D) Gastric outlet obstruction 33. A patient with alkaline reflux gastropathy post-gastric surgery reports persistent vomiting of bile and epigastric pain. What is the priority assessment? o A) Electrolyte imbalance and dehydration o B) Signs of GI perforation o C) Oral mucosal integrity o D) Capillary blood glucose 34. A patient with dumping syndrome is prescribed octreotide before meals. What is the expected therapeutic effect? o A) Increases gastric emptying o B) Decreases insulin release and slows gastric emptying o C) Increases carbohydrate absorption o D) Neutralizes stomach acid ________________________________________ 35. A patient with severe pneumonia has ABG: pH 7.33, PaCO₂ 58 mm Hg, HCO₃ 30 mEq/L. Which statement best describes this patient’s status? o A) Acute respiratory acidosis with no compensation o B) Chronic respiratory acidosis with partial renal compensation o C) Primary metabolic alkalosis with respiratory compensation o D) Mixed respiratory and metabolic acidosis 36. A patient with anxiety hyperventilates. ABG: pH 7.52, PaCO₂ 28 mm Hg, HCO₃ 24 mEq/L. The nurse expects which physical finding? o A) Warm, dry skin o B) Positive Chvostek’s sign o C) Bradycardia o D) Hyporeflexia 37. A patient with DKA has ABG: pH 7.25, HCO₃ 14 mEq/L, PaCO₂ 30 mm Hg. The nurse notes Kussmaul respirations. This breathing pattern indicates: o A) The patient is trying to compensate by blowing off CO₂ o B) The patient has a brain injury o C) The patient is septic o D) The patient is in respiratory failure 38. A patient with renal failure and severe metabolic acidosis has a serum potassium of 6.8 mEq/L. What is the priority intervention? o A) Administer sodium bicarbonate o B) Prepare for emergent hemodialysis and cardiac monitoring o C) Give oral kayexalate only o D) Restrict fluids ________________________________________ 39. A patient with severe vomiting after alcohol binging now reports sudden severe chest pain, subcutaneous emphysema, and dysphagia. What is the most likely diagnosis? o A) GERD exacerbation o B) Boerhaave syndrome (esophageal rupture) o C) Myocardial infarction o D) Paraesophageal hernia 40. A patient with suspected esophageal trauma from blunt injury has hoarseness, dysphagia, and neck crepitus. What is the nurse’s priority action? o A) Give oral fluids to test swallowing o B) Keep NPO and prepare for imaging o C) Apply cervical collar o D) Administer antacids ________________________________________ 41. The nurse receives report on four patients. Which patient should be seen first? o A) Post-EGD patient with gag reflex present o B) Patient with GERD reporting heartburn after pizza o C) Patient with PUD and melena, HR 120, BP 85/50 o D) Patient with stomatitis requesting pain medication 42. A UAP reports that a patient with a known hiatal hernia is complaining of sudden severe chest pain and difficulty breathing. What should the nurse do first? o A) Ask UAP to give antacids o B) Assess patient immediately and call rapid response if unstable o C) Reassure patient it’s just reflux o D) Schedule a barium swallow 43. A patient post-gastrectomy has an NG tube to low intermittent suction. The nurse notes bright red blood output of 200 mL in 1 hour. What is the priority action? o A) Clamp the NG tube o B) Irrigate with cold saline o C) Notify provider and monitor vital signs o D) Increase suction pressure ________________________________________ 44. A patient with H. pylori-positive PUD is prescribed amoxicillin, metronidazole, bismuth, and omeprazole. The patient asks why so many medications. What is the best explanation? o A) Triple therapy reduces side effects o B) Eradication requires acid suppression + antibiotics + mucosal protection o C) One medication is a placebo o D) The patient has a resistant infection 45. A patient with GERD on omeprazole (PPI) for 5 years asks about long-term risks. What should the nurse mention? o A) Increased risk of vitamin B12 deficiency and fractures o B) Increased risk of oral cancer o C) Guaranteed cure of GERD o D) No long-term risks Answer: A (Long-term PPI use → B12 malabsorption, osteoporosis risk) 46. A patient with metabolic alkalosis from NG suction is receiving IV fluids. Which fluid order would the nurse question? o A) 0.9% normal saline o B) Lactated Ringer’s o C) Potassium chloride IV o D) Sodium bicarbonate IV ________________________________________ 47. A patient reports epigastric pain. Which finding best distinguishes duodenal ulcer from gastric ulcer? o A) Pain relieved by food o B) Pain worsened by food o C) Pain only after spicy food o D) Pain radiating to the back 48. A patient with dysphagia has a normal EGD but manometry shows absent peristalsis and incomplete LES relaxation. What is the diagnosis? o A) GERD o B) Achalasia o C) Esophageal cancer o D) Hiatal hernia 49. A patient with HIV and odynophagia has white plaques in the esophagus on EGD that scrape off easily. This is most likely: o A) Esophageal cancer o B) Candida esophagitis o C) Herpes esophagitis o D) Barrett’s esophagus 50. A patient after bariatric surgery reports dizziness, diarrhea, and palpitations after eating ice cream. What is the most likely mechanism? o A) Rapid gastric emptying into small intestine → fluid shift o B) Lactose intolerance o C) Bacterial overgrowth o D) Anastomotic leak