NUR 2755 Multidimensional Care IV (MDC4) Final
Exam – High-Yield Review with Complete Questions,
Verified Answers & Detailed Rationales | Latest 2025–
2026 Edition | Rasmussen University | PDF Download
1. A patient with septic shock has a pulmonary artery catheter showing
cardiac output 8.0 L/min (high) and systemic vascular resistance 400 (low).
Which intervention is priority?
A. Administer a vasopressor (e.g., norepinephrine)
B. Administer a vasodilator (e.g., nitroglycerin)
C. Increase IV fluid bolus
D. Place in Trendelenburg position
Answer: A
Rationale: High CO and low SVR indicate distributive shock (septic).
Vasopressors increase SVR and BP. Fluids are given if CVP low; here CVP is not
given, but initial fluid resuscitation should be done. However, the question implies
persistent hypotension after fluids; vasopressor is correct.
2. A patient with cardiogenic shock has a pulmonary artery occlusion
pressure (PAOP) of 25 mm Hg (normal 6-12), cardiac index (CI) of 1.6
L/min/m², and blood pressure 80/50. Which medication does the nurse
anticipate?
A. Furosemide
B. Dobutamine
C. Nitroprusside
D. Epinephrine
Rationale: High PAOP indicates fluid overload; low CI indicates pump failure.
Dobutamine increases contractility and CI, reduces preload. Furosemide reduces
preload but does not improve CI. Epinephrine may increase afterload. Dobutamine
is first-line in cardiogenic shock with low CI.
3. A patient is on a mechanical ventilator with an FiO₂ of 0.8 and PEEP of 12
cm H₂O. The arterial blood gas (ABG) shows pH 7.30, PaCO₂ 55, PaO₂ 60,
HCO₃ 24. Which ventilator change should the nurse anticipate?
A. Increase FiO₂ to 1.0
B. Increase PEEP
,C. Decrease respiratory rate
D. Decrease tidal volume
Rationale: PaO₂ 60 on FiO₂ 0.8 and PEEP 12 is inadequate. Increasing PEEP
improves oxygenation by recruiting alveoli. Increasing FiO₂ above 0.8 risks
oxygen toxicity. PaCO₂ 55 indicates hypoventilation; need to increase rate or tidal
volume, not decrease.
4. A patient with an intra-aortic balloon pump (IABP) has a blood pressure of
100/60, heart rate 110, and urinary output of 20 mL/hr. The nurse notes that
the IABP is inflating at the dicrotic notch and deflating just before systole.
What action should the nurse take?
A. Increase the augmentation ratio
B. Assess for proper timing and ensure 1:1 augmentation
C. Increase the balloon volume
D. Notify the provider for possible thrombocytopenia
Rationale: Proper IABP timing: inflation at dicrotic notch (aortic valve closure)
and deflation just before systole. The described timing is correct. Low urine output
may indicate poor perfusion; check for mechanical issues or patient status. No
action needed for timing.
5. A patient with a central venous catheter develops new-onset dyspnea,
tachycardia, and hypotension during a dressing change. The nurse suspects
air embolism. What is the priority action?
A. Administer 100% oxygen
B. Position patient in left lateral Trendelenburg
C. Clamp the catheter
D. Remove the catheter
Rationale: Air embolism: place patient in left lateral decubitus with head down
(Durant maneuver) to trap air in the right atrium and prevent it from entering
pulmonary circulation. Clamp catheter, give oxygen, but positioning is priority.
6. A patient in the intensive care unit has an arterial line. The nurse notes a
dampened waveform and cannot flush the line. What should the nurse do?
A. Zero the transducer
B. Do not flush; check for clots or kinks, and notify provider
C. Increase the flush bag pressure
D. Remove the arterial line
Rationale: A dampened waveform with inability to flush suggests a clot or
, obstruction. Flushing could dislodge a clot. The line should be assessed, and if
clotted, removed. Never forcefully flush.
7. A patient with acute respiratory distress syndrome (ARDS) is on a
ventilator with low tidal volume (6 mL/kg ideal body weight). The plateau
pressure is 35 cm H₂O. What intervention is appropriate?
A. Increase tidal volume to 8 mL/kg
B. Decrease PEEP
C. Accept plateau pressure as is; goal is <30
D. Administer a neuromuscular blocker
Rationale: Lung-protective ventilation: plateau pressure should be <30 cm H₂O to
prevent barotrauma. 35 is high. Options: decrease tidal volume further (not
increase), decrease PEEP may help but could reduce oxygenation.
8. A patient with a traumatic brain injury (TBI) has an intracranial pressure
(ICP) monitor reading of 22 mm Hg. The nurse should first:
A. Administer mannitol
B. Ensure the head of bed is at 30 degrees and neck is midline
C. Hyperventilate to PaCO₂ 30
D. Notify the provider
Rationale: Normal ICP <20. First-line interventions: HOB 30°, neck midline,
avoid noxious stimuli, sedation. Mannitol is for sustained elevation.
Hyperventilation is reserved for herniation.
9. A patient after cardiac arrest has return of spontaneous circulation (ROSC)
and is comatose. Targeted temperature management (TTM) is initiated.
Which goal temperature is currently recommended?
A. 32°C to 34°C
B. 36°C
C. 37.5°C
D. 38°C
Rationale: Current AHA guidelines recommend maintaining temperature at 32-
36°C, but more recent evidence suggests 36°C is acceptable (no difference in
outcomes). Many protocols use 36°C (normothermia). The classic is 33°C, but the
question asks for currently recommended; the answer is 36°C as a target for
normothermia.
10. A patient with a pulmonary artery catheter has a mixed venous oxygen
saturation (SvO₂) of 50% (normal 60-80%). The nurse interprets this as:
Exam – High-Yield Review with Complete Questions,
Verified Answers & Detailed Rationales | Latest 2025–
2026 Edition | Rasmussen University | PDF Download
1. A patient with septic shock has a pulmonary artery catheter showing
cardiac output 8.0 L/min (high) and systemic vascular resistance 400 (low).
Which intervention is priority?
A. Administer a vasopressor (e.g., norepinephrine)
B. Administer a vasodilator (e.g., nitroglycerin)
C. Increase IV fluid bolus
D. Place in Trendelenburg position
Answer: A
Rationale: High CO and low SVR indicate distributive shock (septic).
Vasopressors increase SVR and BP. Fluids are given if CVP low; here CVP is not
given, but initial fluid resuscitation should be done. However, the question implies
persistent hypotension after fluids; vasopressor is correct.
2. A patient with cardiogenic shock has a pulmonary artery occlusion
pressure (PAOP) of 25 mm Hg (normal 6-12), cardiac index (CI) of 1.6
L/min/m², and blood pressure 80/50. Which medication does the nurse
anticipate?
A. Furosemide
B. Dobutamine
C. Nitroprusside
D. Epinephrine
Rationale: High PAOP indicates fluid overload; low CI indicates pump failure.
Dobutamine increases contractility and CI, reduces preload. Furosemide reduces
preload but does not improve CI. Epinephrine may increase afterload. Dobutamine
is first-line in cardiogenic shock with low CI.
3. A patient is on a mechanical ventilator with an FiO₂ of 0.8 and PEEP of 12
cm H₂O. The arterial blood gas (ABG) shows pH 7.30, PaCO₂ 55, PaO₂ 60,
HCO₃ 24. Which ventilator change should the nurse anticipate?
A. Increase FiO₂ to 1.0
B. Increase PEEP
,C. Decrease respiratory rate
D. Decrease tidal volume
Rationale: PaO₂ 60 on FiO₂ 0.8 and PEEP 12 is inadequate. Increasing PEEP
improves oxygenation by recruiting alveoli. Increasing FiO₂ above 0.8 risks
oxygen toxicity. PaCO₂ 55 indicates hypoventilation; need to increase rate or tidal
volume, not decrease.
4. A patient with an intra-aortic balloon pump (IABP) has a blood pressure of
100/60, heart rate 110, and urinary output of 20 mL/hr. The nurse notes that
the IABP is inflating at the dicrotic notch and deflating just before systole.
What action should the nurse take?
A. Increase the augmentation ratio
B. Assess for proper timing and ensure 1:1 augmentation
C. Increase the balloon volume
D. Notify the provider for possible thrombocytopenia
Rationale: Proper IABP timing: inflation at dicrotic notch (aortic valve closure)
and deflation just before systole. The described timing is correct. Low urine output
may indicate poor perfusion; check for mechanical issues or patient status. No
action needed for timing.
5. A patient with a central venous catheter develops new-onset dyspnea,
tachycardia, and hypotension during a dressing change. The nurse suspects
air embolism. What is the priority action?
A. Administer 100% oxygen
B. Position patient in left lateral Trendelenburg
C. Clamp the catheter
D. Remove the catheter
Rationale: Air embolism: place patient in left lateral decubitus with head down
(Durant maneuver) to trap air in the right atrium and prevent it from entering
pulmonary circulation. Clamp catheter, give oxygen, but positioning is priority.
6. A patient in the intensive care unit has an arterial line. The nurse notes a
dampened waveform and cannot flush the line. What should the nurse do?
A. Zero the transducer
B. Do not flush; check for clots or kinks, and notify provider
C. Increase the flush bag pressure
D. Remove the arterial line
Rationale: A dampened waveform with inability to flush suggests a clot or
, obstruction. Flushing could dislodge a clot. The line should be assessed, and if
clotted, removed. Never forcefully flush.
7. A patient with acute respiratory distress syndrome (ARDS) is on a
ventilator with low tidal volume (6 mL/kg ideal body weight). The plateau
pressure is 35 cm H₂O. What intervention is appropriate?
A. Increase tidal volume to 8 mL/kg
B. Decrease PEEP
C. Accept plateau pressure as is; goal is <30
D. Administer a neuromuscular blocker
Rationale: Lung-protective ventilation: plateau pressure should be <30 cm H₂O to
prevent barotrauma. 35 is high. Options: decrease tidal volume further (not
increase), decrease PEEP may help but could reduce oxygenation.
8. A patient with a traumatic brain injury (TBI) has an intracranial pressure
(ICP) monitor reading of 22 mm Hg. The nurse should first:
A. Administer mannitol
B. Ensure the head of bed is at 30 degrees and neck is midline
C. Hyperventilate to PaCO₂ 30
D. Notify the provider
Rationale: Normal ICP <20. First-line interventions: HOB 30°, neck midline,
avoid noxious stimuli, sedation. Mannitol is for sustained elevation.
Hyperventilation is reserved for herniation.
9. A patient after cardiac arrest has return of spontaneous circulation (ROSC)
and is comatose. Targeted temperature management (TTM) is initiated.
Which goal temperature is currently recommended?
A. 32°C to 34°C
B. 36°C
C. 37.5°C
D. 38°C
Rationale: Current AHA guidelines recommend maintaining temperature at 32-
36°C, but more recent evidence suggests 36°C is acceptable (no difference in
outcomes). Many protocols use 36°C (normothermia). The classic is 33°C, but the
question asks for currently recommended; the answer is 36°C as a target for
normothermia.
10. A patient with a pulmonary artery catheter has a mixed venous oxygen
saturation (SvO₂) of 50% (normal 60-80%). The nurse interprets this as:
