UR 2502 / NUR2502
N
MULTIDIMENSIONAL CARE III EXAM
1 REVIEW | Latest 2020 | Rasmussen
College | Verified Q&A | Pass
Guaranteed - A+ Graded
ART A: MULTIPLE CHOICE (Q1–Q55)
P
Q1 (Respiratory – COPD): A 68-year-old male with a 40 pack-year smoking history presents
with progressive dyspnea, barrel chest, and pursed-lip breathing. His ABG shows pH 7.36,
PaCO₂ 52 mmHg, PaO₂ 62 mmHg, HCO₃⁻ 30 mEq/L. The nurse is titrating oxygen therapy.
What is the target SpO₂ range for this patient?
A. 94–98%
B. 88–92%
C. 85–90%
D. 90–95%
[CORRECT] B
Rationale: In COPD with chronic hypercapnia (evidenced by elevated PaCO₂ and compensatory
metabolic alkalosis), oxygen should be titrated to maintain SpO₂ 88–92%. Higher oxygen targets
suppress the hypoxic drive, worsening hypercapnia and respiratory acidosis. The ABG confirms
chronic compensated respiratory acidosis typical of COPD. Option A is appropriate for normal
patients but dangerous in COPD. Options C and D are outside evidence-based targets.
Q2 (Respiratory – COPD): Which medication class is considered first-line maintenance therapy
for a patient with COPD who experiences frequent exacerbations?
A. Long-acting beta-agonist (LABA) monotherapy
B. Long-acting muscarinic antagonist (LAMA) monotherapy
C. LAMA/LABA combination therapy
D. Inhaled corticosteroid (ICS) monotherapy
[CORRECT] C
Rationale: Per GOLD 2020 guidelines, patients with COPD and frequent exacerbations (≥2
moderate or 1 severe exacerbation in past year) benefit from dual bronchodilation with
LAMA/LABA combination as first-line maintenance. LABA or LAMA monotherapy (options A and
B) are insufficient for frequent exacerbators. ICS monotherapy (option D) is not recommended
as standalone COPD therapy due to pneumonia risk and limited bronchodilation benefit.
, 3 (Respiratory – Asthma): A 24-year-old with moderate persistent asthma is using albuterol
Q
more than twice weekly for symptom relief. According to the 2020 stepwise asthma guidelines,
what is the most appropriate next step in therapy?
A. Increase albuterol frequency to PRN every 4 hours
B. Add a low-dose inhaled corticosteroid (ICS)
C. Add a leukotriene receptor antagonist
D. Begin oral corticosteroid burst
[CORRECT] B
Rationale: Per NHLBI/EPR-3 2020 updates, moderate persistent asthma requires daily
low-dose ICS plus as-needed SABA. Using rescue inhaler >2 times weekly indicates poor
control and mandates controller therapy escalation. Option A increases rescue use without
addressing inflammation. Option C is adjunctive, not first add-on. Option D is reserved for acute
exacerbations, not maintenance.
Q4 (Respiratory – Asthma): During an acute asthma exacerbation, a patient receives nebulized
albuterol and ipratropium bromide. The nurse understands that ipratropium is added because it:
A. Provides faster bronchodilation than albuterol alone
B. Reduces the need for systemic corticosteroids
C. Blocks muscarinic receptors to reduce bronchospasm via different mechanism
D. Prevents late-phase allergic response
[CORRECT] C
Rationale: Ipratropium is an anticholinergic that blocks muscarinic receptors, reducing
vagally-mediated bronchospasm through a mechanism distinct from beta-2 agonists. Combined
therapy provides additive bronchodilation in acute exacerbations. Option A is
incorrect—albuterol acts faster. Option B is incorrect—systemic steroids are still required for
moderate-severe exacerbations. Option D describes mast cell stabilizers, not anticholinergics.
Q5 (Respiratory – Pneumonia): A 72-year-old is admitted with community-acquired pneumonia
(CAP). Which assessment finding would most concern the nurse regarding severity and need
for ICU admission?
A. Temperature 101.2°F
B. Respiratory rate 32 breaths/min
C. Heart rate 96 bpm
D. Blood pressure 128/78 mmHg
[CORRECT] B
Rationale: Per CURB-65 and IDSA/ATS 2019 CAP guidelines, respiratory rate ≥30 breaths/min
is a major severity criterion indicating potential ICU need. Confusion, Urea >20 mg/dL, Blood
pressure <90/60, and age ≥65 complete CURB-65. Option A is moderate fever. Option C is
mildly elevated. Option D is normal blood pressure—hypotension would be concerning.
Q6 (Respiratory – Pneumonia): The nurse is caring for a patient with CAP and CURB-65 score
of 3. Which antibiotic regimen is most appropriate per 2020 IDSA/ATS guidelines?
A. Azithromycin monotherapy
B. Amoxicillin monotherapy
C. Ceftriaxone plus azithromycin
D. Vancomycin plus piperacillin-tazobactam
[CORRECT] C
, ationale: For hospitalized non-ICU CAP with comorbidities or CURB-65 ≥2, IDSA/ATS
R
recommends beta-lactam (ceftriaxone) plus macrolide (azithromycin) or respiratory
fluoroquinolone monotherapy. Option A (macrolide monotherapy) is reserved for healthy
outpatients without comorbidities. Option B is outpatient therapy. Option D is broad-spectrum
ICU coverage for HAP/VAP, not appropriate initial CAP therapy.
Q7 (Respiratory – PE): A patient with sudden-onset dyspnea and pleuritic chest pain has a
Wells score of 6.5. What is the next diagnostic step?
A. Begin empiric heparin and observe
B. Order D-dimer testing
C. Proceed directly to CT pulmonary angiography (CTPA)
D. Perform ventilation-perfusion (V/Q) scan
[CORRECT] C
Rationale: Wells score >4 indicates intermediate-high probability of PE. In intermediate-high
probability patients, D-dimer is not useful (will be elevated, low specificity) and CTPA is the
diagnostic test of choice with high sensitivity and specificity. Option A delays definitive
diagnosis. Option B is appropriate for low-probability (Wells ≤4) to rule out PE. Option D is
reserved for patients with renal failure or contrast allergy where CTPA is contraindicated.
Q8 (Respiratory – PE): A patient with massive pulmonary embolism (systolic BP 72 mmHg,
altered mental status) is receiving heparin infusion. The physician orders alteplase. The nurse
should:
A. Stop heparin 6 hours before and 24 hours after alteplase
B. Continue heparin during and after alteplase administration
C. Stop heparin during alteplase infusion, resume without bolus when PTT <80 seconds
D. Switch to warfarin before alteplase
[CORRECT] C
Rationale: For massive PE with thrombolytics, heparin is stopped during infusion to reduce
bleeding risk, then resumed without bolus when PTT falls below 2× upper limit of normal
(typically <80 seconds). Option A is excessive—heparin can be resumed sooner. Option B
increases bleeding risk significantly. Option D is inappropriate—warfarin requires days to
achieve therapeutic effect and is not used in acute massive PE.
Q9 (Respiratory – ARDS): A patient with ARDS is on mechanical ventilation. The ventilator is
set to deliver 550 mL tidal volume for a patient with predicted body weight (PBW) of 70 kg. The
nurse should:
A. Maintain current settings—this is appropriate
B. Increase tidal volume to 650 mL to improve oxygenation
C. Decrease tidal volume to 420 mL per ARDSNet protocol
D. Increase PEEP to 15 cm H₂O immediately
[CORRECT] C
Rationale: ARDSNet protocol (Berlin definition/ARDS 2020) recommends low tidal volume
ventilation at 6 mL/kg PBW (70 kg × 6 = 420 mL) to prevent ventilator-induced lung injury (VILI).
Current 550 mL equals ~7.9 mL/kg, exceeding safe limits. Option B would worsen lung injury.
Option D may be needed later but tidal volume reduction is the immediate priority per
lung-protective ventilation strategy.
N
MULTIDIMENSIONAL CARE III EXAM
1 REVIEW | Latest 2020 | Rasmussen
College | Verified Q&A | Pass
Guaranteed - A+ Graded
ART A: MULTIPLE CHOICE (Q1–Q55)
P
Q1 (Respiratory – COPD): A 68-year-old male with a 40 pack-year smoking history presents
with progressive dyspnea, barrel chest, and pursed-lip breathing. His ABG shows pH 7.36,
PaCO₂ 52 mmHg, PaO₂ 62 mmHg, HCO₃⁻ 30 mEq/L. The nurse is titrating oxygen therapy.
What is the target SpO₂ range for this patient?
A. 94–98%
B. 88–92%
C. 85–90%
D. 90–95%
[CORRECT] B
Rationale: In COPD with chronic hypercapnia (evidenced by elevated PaCO₂ and compensatory
metabolic alkalosis), oxygen should be titrated to maintain SpO₂ 88–92%. Higher oxygen targets
suppress the hypoxic drive, worsening hypercapnia and respiratory acidosis. The ABG confirms
chronic compensated respiratory acidosis typical of COPD. Option A is appropriate for normal
patients but dangerous in COPD. Options C and D are outside evidence-based targets.
Q2 (Respiratory – COPD): Which medication class is considered first-line maintenance therapy
for a patient with COPD who experiences frequent exacerbations?
A. Long-acting beta-agonist (LABA) monotherapy
B. Long-acting muscarinic antagonist (LAMA) monotherapy
C. LAMA/LABA combination therapy
D. Inhaled corticosteroid (ICS) monotherapy
[CORRECT] C
Rationale: Per GOLD 2020 guidelines, patients with COPD and frequent exacerbations (≥2
moderate or 1 severe exacerbation in past year) benefit from dual bronchodilation with
LAMA/LABA combination as first-line maintenance. LABA or LAMA monotherapy (options A and
B) are insufficient for frequent exacerbators. ICS monotherapy (option D) is not recommended
as standalone COPD therapy due to pneumonia risk and limited bronchodilation benefit.
, 3 (Respiratory – Asthma): A 24-year-old with moderate persistent asthma is using albuterol
Q
more than twice weekly for symptom relief. According to the 2020 stepwise asthma guidelines,
what is the most appropriate next step in therapy?
A. Increase albuterol frequency to PRN every 4 hours
B. Add a low-dose inhaled corticosteroid (ICS)
C. Add a leukotriene receptor antagonist
D. Begin oral corticosteroid burst
[CORRECT] B
Rationale: Per NHLBI/EPR-3 2020 updates, moderate persistent asthma requires daily
low-dose ICS plus as-needed SABA. Using rescue inhaler >2 times weekly indicates poor
control and mandates controller therapy escalation. Option A increases rescue use without
addressing inflammation. Option C is adjunctive, not first add-on. Option D is reserved for acute
exacerbations, not maintenance.
Q4 (Respiratory – Asthma): During an acute asthma exacerbation, a patient receives nebulized
albuterol and ipratropium bromide. The nurse understands that ipratropium is added because it:
A. Provides faster bronchodilation than albuterol alone
B. Reduces the need for systemic corticosteroids
C. Blocks muscarinic receptors to reduce bronchospasm via different mechanism
D. Prevents late-phase allergic response
[CORRECT] C
Rationale: Ipratropium is an anticholinergic that blocks muscarinic receptors, reducing
vagally-mediated bronchospasm through a mechanism distinct from beta-2 agonists. Combined
therapy provides additive bronchodilation in acute exacerbations. Option A is
incorrect—albuterol acts faster. Option B is incorrect—systemic steroids are still required for
moderate-severe exacerbations. Option D describes mast cell stabilizers, not anticholinergics.
Q5 (Respiratory – Pneumonia): A 72-year-old is admitted with community-acquired pneumonia
(CAP). Which assessment finding would most concern the nurse regarding severity and need
for ICU admission?
A. Temperature 101.2°F
B. Respiratory rate 32 breaths/min
C. Heart rate 96 bpm
D. Blood pressure 128/78 mmHg
[CORRECT] B
Rationale: Per CURB-65 and IDSA/ATS 2019 CAP guidelines, respiratory rate ≥30 breaths/min
is a major severity criterion indicating potential ICU need. Confusion, Urea >20 mg/dL, Blood
pressure <90/60, and age ≥65 complete CURB-65. Option A is moderate fever. Option C is
mildly elevated. Option D is normal blood pressure—hypotension would be concerning.
Q6 (Respiratory – Pneumonia): The nurse is caring for a patient with CAP and CURB-65 score
of 3. Which antibiotic regimen is most appropriate per 2020 IDSA/ATS guidelines?
A. Azithromycin monotherapy
B. Amoxicillin monotherapy
C. Ceftriaxone plus azithromycin
D. Vancomycin plus piperacillin-tazobactam
[CORRECT] C
, ationale: For hospitalized non-ICU CAP with comorbidities or CURB-65 ≥2, IDSA/ATS
R
recommends beta-lactam (ceftriaxone) plus macrolide (azithromycin) or respiratory
fluoroquinolone monotherapy. Option A (macrolide monotherapy) is reserved for healthy
outpatients without comorbidities. Option B is outpatient therapy. Option D is broad-spectrum
ICU coverage for HAP/VAP, not appropriate initial CAP therapy.
Q7 (Respiratory – PE): A patient with sudden-onset dyspnea and pleuritic chest pain has a
Wells score of 6.5. What is the next diagnostic step?
A. Begin empiric heparin and observe
B. Order D-dimer testing
C. Proceed directly to CT pulmonary angiography (CTPA)
D. Perform ventilation-perfusion (V/Q) scan
[CORRECT] C
Rationale: Wells score >4 indicates intermediate-high probability of PE. In intermediate-high
probability patients, D-dimer is not useful (will be elevated, low specificity) and CTPA is the
diagnostic test of choice with high sensitivity and specificity. Option A delays definitive
diagnosis. Option B is appropriate for low-probability (Wells ≤4) to rule out PE. Option D is
reserved for patients with renal failure or contrast allergy where CTPA is contraindicated.
Q8 (Respiratory – PE): A patient with massive pulmonary embolism (systolic BP 72 mmHg,
altered mental status) is receiving heparin infusion. The physician orders alteplase. The nurse
should:
A. Stop heparin 6 hours before and 24 hours after alteplase
B. Continue heparin during and after alteplase administration
C. Stop heparin during alteplase infusion, resume without bolus when PTT <80 seconds
D. Switch to warfarin before alteplase
[CORRECT] C
Rationale: For massive PE with thrombolytics, heparin is stopped during infusion to reduce
bleeding risk, then resumed without bolus when PTT falls below 2× upper limit of normal
(typically <80 seconds). Option A is excessive—heparin can be resumed sooner. Option B
increases bleeding risk significantly. Option D is inappropriate—warfarin requires days to
achieve therapeutic effect and is not used in acute massive PE.
Q9 (Respiratory – ARDS): A patient with ARDS is on mechanical ventilation. The ventilator is
set to deliver 550 mL tidal volume for a patient with predicted body weight (PBW) of 70 kg. The
nurse should:
A. Maintain current settings—this is appropriate
B. Increase tidal volume to 650 mL to improve oxygenation
C. Decrease tidal volume to 420 mL per ARDSNet protocol
D. Increase PEEP to 15 cm H₂O immediately
[CORRECT] C
Rationale: ARDSNet protocol (Berlin definition/ARDS 2020) recommends low tidal volume
ventilation at 6 mL/kg PBW (70 kg × 6 = 420 mL) to prevent ventilator-induced lung injury (VILI).
Current 550 mL equals ~7.9 mL/kg, exceeding safe limits. Option B would worsen lung injury.
Option D may be needed later but tidal volume reduction is the immediate priority per
lung-protective ventilation strategy.
