NUR 2356 MULTIDIMENSIONAL CARE I (MDC 1) EXAM
2 – COMPREHENSIVE PRACTICE EXAM 360+
QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES
1. A client has a serum sodium level of 128 mEq/L. Which assessment finding is
most concerning?
A) Dry mucous membranes
B) Weight gain of 0.5 kg in 24 hours
C) Confusion and muscle twitching
D) Urine specific gravity of 1.030
Correct Answer: C
Rationale: A sodium level of 128 mEq/L indicates hyponatremia. Confusion and
muscle twitching suggest cerebral edema and neuromuscular irritability, which
can progress to seizures or coma. Dry mucous membranes and elevated urine
specific gravity are seen in hypernatremia or dehydration, not primarily in this
case.
2. Which IV fluid is isotonic and most appropriate for a hypovolemic client with
normal cardiac function?
A) 0.45% Normal Saline
B) 0.9% Normal Saline
C) 5% Dextrose in Water
D) 3% Normal Saline
Correct Answer: B
Rationale: 0.9% Normal Saline is isotonic and expands intravascular volume
without causing fluid shifts, making it first-line for hypovolemia. 0.45% NS is
,hypotonic, D5W becomes hypotonic after dextrose metabolism, and 3% NS is
hypertonic.
3. A client with heart failure has crackles in the lungs, jugular vein distention, and
3+ pitting edema. What is the priority intervention?
A) Restrict oral fluids to 1 L per day
B) Administer furosemide as ordered
C) Elevate the legs above heart level
D) Encourage a high-sodium diet
Correct Answer: B
Rationale: The client shows signs of fluid overload (crackles, JVD, edema).
Furosemide, a loop diuretic, rapidly reduces preload and relieves pulmonary
congestion. Fluid restriction is adjunctive, leg elevation worsens edema, and high
sodium is contraindicated.
4. Which electrocardiogram (ECG) change is characteristic of hyperkalemia?
A) U waves
B) Wide QRS complexes
C) Tall, peaked T waves
D) Prolonged PR interval
Correct Answer: C
Rationale: Tall, peaked T waves are the earliest ECG sign of hyperkalemia, typically
occurring when potassium exceeds 5.5 mEq/L. U waves suggest hypokalemia.
Wide QRS and prolonged PR occur in severe hyperkalemia but are not the earliest
characteristic change.
5. A client is receiving furosemide 40 mg IV push. Which laboratory value requires
immediate notification of the healthcare provider?
A) Serum sodium 138 mEq/L
,B) Serum potassium 2.9 mEq/L
C) Blood glucose 110 mg/dL
D) Serum creatinine 0.8 mg/dL
Correct Answer: B
Rationale: Furosemide causes potassium wasting. A potassium of 2.9 mEq/L is
severe hypokalemia, increasing risk of cardiac dysrhythmias. The other values are
within normal limits.
6. A client with vomiting and diarrhea for 3 days has a heart rate of 120 bpm,
blood pressure 90/60 mmHg, and dry mucous membranes. Which acid-base
imbalance is most likely?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: A
Rationale: Loss of bicarbonate-rich intestinal fluids from diarrhea causes
metabolic acidosis. Vomiting alone causes alkalosis, but diarrhea dominates here.
Tachycardia and hypotension indicate volume depletion, but the question asks for
acid-base imbalance.
7. A client’s arterial blood gas (ABG) shows pH 7.32, PaCO2 48 mm Hg, HCO3 24
mEq/L. Which condition does this reflect?
A) Uncompensated metabolic acidosis
B) Uncompensated respiratory acidosis
C) Compensated metabolic alkalosis
D) Compensated respiratory alkalosis
, Correct Answer: B
Rationale: pH is acidic (<7.35). PaCO2 is elevated (>45), indicating a respiratory
cause. HCO3 is normal (22-26), showing no metabolic compensation yet, so this is
uncompensated respiratory acidosis.
8. Which client is at highest risk for developing hypermagnesemia?
A) A client with chronic alcohol use disorder
B) A client taking magnesium citrate for constipation
C) A client with end-stage renal disease on magnesium-containing antacids
D) A client with diarrhea for 5 days
Correct Answer: C
Rationale: Hypermagnesemia occurs when kidneys cannot excrete magnesium.
ESRD patients on magnesium-containing products are at high risk. Alcohol use and
diarrhea cause hypomagnesemia. Magnesium citrate alone rarely causes toxicity
with normal renal function.
9. A client has a serum calcium level of 12.5 mg/dL. Which sign should the nurse
expect to find?
A) Positive Chvostek’s sign
B) Prolonged QT interval on ECG
C) Hyperactive deep tendon reflexes
D) Shortened ST segment
Correct Answer: D
Rationale: Hypercalcemia (normal 8.5-10.5 mg/dL) shortens the ST segment and
QT interval. Chvostek’s sign, prolonged QT, and hyperactive reflexes are seen in
hypocalcemia.
2 – COMPREHENSIVE PRACTICE EXAM 360+
QUESTIONS WITH CORRECT ANSWERS AND
RATIONALES
1. A client has a serum sodium level of 128 mEq/L. Which assessment finding is
most concerning?
A) Dry mucous membranes
B) Weight gain of 0.5 kg in 24 hours
C) Confusion and muscle twitching
D) Urine specific gravity of 1.030
Correct Answer: C
Rationale: A sodium level of 128 mEq/L indicates hyponatremia. Confusion and
muscle twitching suggest cerebral edema and neuromuscular irritability, which
can progress to seizures or coma. Dry mucous membranes and elevated urine
specific gravity are seen in hypernatremia or dehydration, not primarily in this
case.
2. Which IV fluid is isotonic and most appropriate for a hypovolemic client with
normal cardiac function?
A) 0.45% Normal Saline
B) 0.9% Normal Saline
C) 5% Dextrose in Water
D) 3% Normal Saline
Correct Answer: B
Rationale: 0.9% Normal Saline is isotonic and expands intravascular volume
without causing fluid shifts, making it first-line for hypovolemia. 0.45% NS is
,hypotonic, D5W becomes hypotonic after dextrose metabolism, and 3% NS is
hypertonic.
3. A client with heart failure has crackles in the lungs, jugular vein distention, and
3+ pitting edema. What is the priority intervention?
A) Restrict oral fluids to 1 L per day
B) Administer furosemide as ordered
C) Elevate the legs above heart level
D) Encourage a high-sodium diet
Correct Answer: B
Rationale: The client shows signs of fluid overload (crackles, JVD, edema).
Furosemide, a loop diuretic, rapidly reduces preload and relieves pulmonary
congestion. Fluid restriction is adjunctive, leg elevation worsens edema, and high
sodium is contraindicated.
4. Which electrocardiogram (ECG) change is characteristic of hyperkalemia?
A) U waves
B) Wide QRS complexes
C) Tall, peaked T waves
D) Prolonged PR interval
Correct Answer: C
Rationale: Tall, peaked T waves are the earliest ECG sign of hyperkalemia, typically
occurring when potassium exceeds 5.5 mEq/L. U waves suggest hypokalemia.
Wide QRS and prolonged PR occur in severe hyperkalemia but are not the earliest
characteristic change.
5. A client is receiving furosemide 40 mg IV push. Which laboratory value requires
immediate notification of the healthcare provider?
A) Serum sodium 138 mEq/L
,B) Serum potassium 2.9 mEq/L
C) Blood glucose 110 mg/dL
D) Serum creatinine 0.8 mg/dL
Correct Answer: B
Rationale: Furosemide causes potassium wasting. A potassium of 2.9 mEq/L is
severe hypokalemia, increasing risk of cardiac dysrhythmias. The other values are
within normal limits.
6. A client with vomiting and diarrhea for 3 days has a heart rate of 120 bpm,
blood pressure 90/60 mmHg, and dry mucous membranes. Which acid-base
imbalance is most likely?
A) Metabolic acidosis
B) Metabolic alkalosis
C) Respiratory acidosis
D) Respiratory alkalosis
Correct Answer: A
Rationale: Loss of bicarbonate-rich intestinal fluids from diarrhea causes
metabolic acidosis. Vomiting alone causes alkalosis, but diarrhea dominates here.
Tachycardia and hypotension indicate volume depletion, but the question asks for
acid-base imbalance.
7. A client’s arterial blood gas (ABG) shows pH 7.32, PaCO2 48 mm Hg, HCO3 24
mEq/L. Which condition does this reflect?
A) Uncompensated metabolic acidosis
B) Uncompensated respiratory acidosis
C) Compensated metabolic alkalosis
D) Compensated respiratory alkalosis
, Correct Answer: B
Rationale: pH is acidic (<7.35). PaCO2 is elevated (>45), indicating a respiratory
cause. HCO3 is normal (22-26), showing no metabolic compensation yet, so this is
uncompensated respiratory acidosis.
8. Which client is at highest risk for developing hypermagnesemia?
A) A client with chronic alcohol use disorder
B) A client taking magnesium citrate for constipation
C) A client with end-stage renal disease on magnesium-containing antacids
D) A client with diarrhea for 5 days
Correct Answer: C
Rationale: Hypermagnesemia occurs when kidneys cannot excrete magnesium.
ESRD patients on magnesium-containing products are at high risk. Alcohol use and
diarrhea cause hypomagnesemia. Magnesium citrate alone rarely causes toxicity
with normal renal function.
9. A client has a serum calcium level of 12.5 mg/dL. Which sign should the nurse
expect to find?
A) Positive Chvostek’s sign
B) Prolonged QT interval on ECG
C) Hyperactive deep tendon reflexes
D) Shortened ST segment
Correct Answer: D
Rationale: Hypercalcemia (normal 8.5-10.5 mg/dL) shortens the ST segment and
QT interval. Chvostek’s sign, prolonged QT, and hyperactive reflexes are seen in
hypocalcemia.
