NUR 2755 Multidimensional Care IV (MDC4)
Final Exam | Complete Questions with Verified
Answers & Detailed Rationales | Latest 2025–
2026 Edition | Rasmussen University
Category Topics Included
DKA, HHS, diabetes types, thyroid disorders (Graves',
Hashimoto's, thyroid storm, myxedema), adrenal
disorders (Addison's, Cushing's, pheochromocytoma,
Endocrine Disorders
adrenal crisis), parathyroid (hyper/hypo), pituitary
disorders (acromegaly, SIADH, diabetes insipidus,
panhypopituitarism), MEN syndromes
SLE, RA, polymyalgia rheumatica, sarcoidosis,
vasculitis (Wegener's, Churg-Strauss, Takayasu's),
Immunology/Autoimmune
myasthenia gravis, Lambert-Eaton, multiple sclerosis,
Guillain-Barré, anti-phospholipid syndrome
Multiple myeloma, Burkitt's lymphoma, CLL,
Oncology polycythemia vera, hemochromatosis, PNH, essential
thrombocythemia, Wilson's disease, alpha-1 antitrypsin
Cardiogenic shock, septic shock, compartment
Cardiovascular/Critical
syndrome, DIC, thrombosis disorders (HIT, hemophilia,
Care
von Willebrand, hereditary spherocytosis, thalassemia)
Osteoarthritis, osteoporosis, gout,
Musculoskeletal
hypercalcemia/hypocalcemia, bone disorders
CKD complications, hyperkalemia/hypokalemia,
Renal/Electrolytes hypernatremia/hyponatremia, hyperphosphatemia,
acid-base disorders
Insulin, levothyroxine, methimazole, hydrocortisone,
pyridostigmine, colchicine, allopurinol, methotrexate,
Medications
bisphosphonates, phosphate binders, calcium/Vit D,
desmopressin
GCS, electrolytes, ABG, coagulation studies,
Assessment/Labs autoimmune antibodies (ANA, anti-CCP, ANCA, anti-
dsDNA, anti-Scl-70), hormone levels
,Question 1
A patient with Type 1 diabetes presents with blood glucose of 450 mg/dL,
Kussmaul respirations, and fruity breath odor. Which condition is the nurse most
suspicious of?
A. Hyperosmolar Hyperglycemic State (HHS)
B. Diabetic Ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
Correct Answer: B
Rationale: Diabetic Ketoacidosis (DKA) is characterized by blood glucose >250
mg/dL, Kussmaul respirations (deep, rapid breathing), and fruity breath
odor (acetone) due to ketone production. DKA occurs primarily in Type 1 diabetes
when insulin is absent, leading to ketosis and metabolic acidosis. HHS occurs in
Type 2 diabetes with glucose >600 mg/dL and NO ketones. Hypoglycemia has
low glucose (<70 mg/dL). Lactic acidosis is from tissue hypoxia, not ketones.
DKA requires insulin, fluids, and electrolyte replacement.
Question 2
Which laboratory finding is most concerning for a patient with Addison's disease
(adrenal insufficiency)?
A. Hyperglycemia (glucose 180 mg/dL)
B. Hyperkalemia (potassium 5.8 mEq/L)
C. Hypocalcemia (calcium 8.0 mg/dL)
D. Hypermagnesemia
Correct Answer: B
Rationale: Hyperkalemia (potassium 5.8 mEq/L) is most concerning
in Addison's disease because adrenal insufficiency causes decreased aldosterone,
which fails to excrete potassium, leading to dangerous hyperkalemia. Normal
potassium is 3.5-5.0 mEq/L. Hyperglycemia is seen in cortisol excess (not
insufficiency). Hypocalcemia is not characteristic. Hypermagnesemia is less
,common. Hyperkalemia can cause life-threatening cardiac arrhythmias and
requires immediate treatment.
Question 3
A patient with Graves' disease (hyperthyroidism) is experiencing thyroid storm.
Which intervention is the priority?
A. Administer beta-blockers and antithyroid medications
B. Give oral glucose
C. Apply warm blankets
D. Administer insulin
Correct Answer: A
Rationale: Thyroid storm (severe hyperthyroidism) requires beta-blockers
(propranolol) and antithyroid medications (propylthiouracil, methimazole) as
priority to block thyroid hormone effects and production. Beta-blockers control
tachycardia and symptoms; antithyroid drugs stop hormone synthesis. Oral
glucose treats hypoglycemia. Warm blankets worsen hyperthermia (use cooling
measures). Insulin treats hyperglycemia/DKA. Thyroid storm is life-threatening
with fever, tachycardia, and CNS changes requiring ICU care.
Question 4
Which assessment finding indicates compartment syndrome in a patient with a
tibial fracture?
A. Mild pain with movement
B. Pain unrelieved by opioids, paresthesia, and pale limb
C. Swelling without pain
D. Normal capillary refill
Correct Answer: B
Rationale: Compartment syndrome is indicated by pain unrelieved by opioids,
paresthesia (numbness/tingling), and pale limb due to increased pressure in
muscle compartment restricting blood flow. The "6 P's": Pain (unrelieved),
Paresthesia, Pallor, Paralysis, Pulselessness, Poikilothermia (cold). Mild pain is
normal. Swelling without pain is not concerning. Normal capillary
, refill suggests no compromise. Compartment syndrome requires immediate
fasciotomy to prevent permanent damage.
Question 5
A patient with multiple myeloma is at risk for which complication?
A. Hypercalcemia
B. Hypocalcemia
C. Hypoglycemia
D. Hyponatremia
Correct Answer: A
Rationale: Multiple myeloma causes hypercalcemia due to bone destruction
from malignant plasma cells, releasing calcium into bloodstream. Normal calcium
is 8.5-10.5 mg/dL; hypercalcemia >10.5 mg/dL. Symptoms: confusion, weakness,
kidney stones, cardiac arrhythmias. Hypocalcemia is low
calcium. Hypoglycemia is low glucose. Hyponatremia is low sodium.
Hypercalcemia requires hydration, bisphosphonates, and dialysis if severe.
Question 6
Which medication is used to treat myasthenia gravis by increasing acetylcholine
availability?
A. Prednisone
B. Pyridostigmine (Mestinon)
C. Methotrexate
D. Cyclosporine
Correct Answer: B
Rationale: Pyridostigmine (Mestinon) is used to treat myasthenia gravis by
inhibiting acetylcholinesterase, increasing acetylcholine availability at muscle
receptors, improving muscle strength. Prednisone is an
immunosuppressant. Methotrexate and cyclosporine are immunosuppressants for
other conditions. Myasthenia gravis is autoimmune with antibodies against
acetylcholine receptors; pyridostigmine compensates for reduced receptor function.
Final Exam | Complete Questions with Verified
Answers & Detailed Rationales | Latest 2025–
2026 Edition | Rasmussen University
Category Topics Included
DKA, HHS, diabetes types, thyroid disorders (Graves',
Hashimoto's, thyroid storm, myxedema), adrenal
disorders (Addison's, Cushing's, pheochromocytoma,
Endocrine Disorders
adrenal crisis), parathyroid (hyper/hypo), pituitary
disorders (acromegaly, SIADH, diabetes insipidus,
panhypopituitarism), MEN syndromes
SLE, RA, polymyalgia rheumatica, sarcoidosis,
vasculitis (Wegener's, Churg-Strauss, Takayasu's),
Immunology/Autoimmune
myasthenia gravis, Lambert-Eaton, multiple sclerosis,
Guillain-Barré, anti-phospholipid syndrome
Multiple myeloma, Burkitt's lymphoma, CLL,
Oncology polycythemia vera, hemochromatosis, PNH, essential
thrombocythemia, Wilson's disease, alpha-1 antitrypsin
Cardiogenic shock, septic shock, compartment
Cardiovascular/Critical
syndrome, DIC, thrombosis disorders (HIT, hemophilia,
Care
von Willebrand, hereditary spherocytosis, thalassemia)
Osteoarthritis, osteoporosis, gout,
Musculoskeletal
hypercalcemia/hypocalcemia, bone disorders
CKD complications, hyperkalemia/hypokalemia,
Renal/Electrolytes hypernatremia/hyponatremia, hyperphosphatemia,
acid-base disorders
Insulin, levothyroxine, methimazole, hydrocortisone,
pyridostigmine, colchicine, allopurinol, methotrexate,
Medications
bisphosphonates, phosphate binders, calcium/Vit D,
desmopressin
GCS, electrolytes, ABG, coagulation studies,
Assessment/Labs autoimmune antibodies (ANA, anti-CCP, ANCA, anti-
dsDNA, anti-Scl-70), hormone levels
,Question 1
A patient with Type 1 diabetes presents with blood glucose of 450 mg/dL,
Kussmaul respirations, and fruity breath odor. Which condition is the nurse most
suspicious of?
A. Hyperosmolar Hyperglycemic State (HHS)
B. Diabetic Ketoacidosis (DKA)
C. Hypoglycemia
D. Lactic acidosis
Correct Answer: B
Rationale: Diabetic Ketoacidosis (DKA) is characterized by blood glucose >250
mg/dL, Kussmaul respirations (deep, rapid breathing), and fruity breath
odor (acetone) due to ketone production. DKA occurs primarily in Type 1 diabetes
when insulin is absent, leading to ketosis and metabolic acidosis. HHS occurs in
Type 2 diabetes with glucose >600 mg/dL and NO ketones. Hypoglycemia has
low glucose (<70 mg/dL). Lactic acidosis is from tissue hypoxia, not ketones.
DKA requires insulin, fluids, and electrolyte replacement.
Question 2
Which laboratory finding is most concerning for a patient with Addison's disease
(adrenal insufficiency)?
A. Hyperglycemia (glucose 180 mg/dL)
B. Hyperkalemia (potassium 5.8 mEq/L)
C. Hypocalcemia (calcium 8.0 mg/dL)
D. Hypermagnesemia
Correct Answer: B
Rationale: Hyperkalemia (potassium 5.8 mEq/L) is most concerning
in Addison's disease because adrenal insufficiency causes decreased aldosterone,
which fails to excrete potassium, leading to dangerous hyperkalemia. Normal
potassium is 3.5-5.0 mEq/L. Hyperglycemia is seen in cortisol excess (not
insufficiency). Hypocalcemia is not characteristic. Hypermagnesemia is less
,common. Hyperkalemia can cause life-threatening cardiac arrhythmias and
requires immediate treatment.
Question 3
A patient with Graves' disease (hyperthyroidism) is experiencing thyroid storm.
Which intervention is the priority?
A. Administer beta-blockers and antithyroid medications
B. Give oral glucose
C. Apply warm blankets
D. Administer insulin
Correct Answer: A
Rationale: Thyroid storm (severe hyperthyroidism) requires beta-blockers
(propranolol) and antithyroid medications (propylthiouracil, methimazole) as
priority to block thyroid hormone effects and production. Beta-blockers control
tachycardia and symptoms; antithyroid drugs stop hormone synthesis. Oral
glucose treats hypoglycemia. Warm blankets worsen hyperthermia (use cooling
measures). Insulin treats hyperglycemia/DKA. Thyroid storm is life-threatening
with fever, tachycardia, and CNS changes requiring ICU care.
Question 4
Which assessment finding indicates compartment syndrome in a patient with a
tibial fracture?
A. Mild pain with movement
B. Pain unrelieved by opioids, paresthesia, and pale limb
C. Swelling without pain
D. Normal capillary refill
Correct Answer: B
Rationale: Compartment syndrome is indicated by pain unrelieved by opioids,
paresthesia (numbness/tingling), and pale limb due to increased pressure in
muscle compartment restricting blood flow. The "6 P's": Pain (unrelieved),
Paresthesia, Pallor, Paralysis, Pulselessness, Poikilothermia (cold). Mild pain is
normal. Swelling without pain is not concerning. Normal capillary
, refill suggests no compromise. Compartment syndrome requires immediate
fasciotomy to prevent permanent damage.
Question 5
A patient with multiple myeloma is at risk for which complication?
A. Hypercalcemia
B. Hypocalcemia
C. Hypoglycemia
D. Hyponatremia
Correct Answer: A
Rationale: Multiple myeloma causes hypercalcemia due to bone destruction
from malignant plasma cells, releasing calcium into bloodstream. Normal calcium
is 8.5-10.5 mg/dL; hypercalcemia >10.5 mg/dL. Symptoms: confusion, weakness,
kidney stones, cardiac arrhythmias. Hypocalcemia is low
calcium. Hypoglycemia is low glucose. Hyponatremia is low sodium.
Hypercalcemia requires hydration, bisphosphonates, and dialysis if severe.
Question 6
Which medication is used to treat myasthenia gravis by increasing acetylcholine
availability?
A. Prednisone
B. Pyridostigmine (Mestinon)
C. Methotrexate
D. Cyclosporine
Correct Answer: B
Rationale: Pyridostigmine (Mestinon) is used to treat myasthenia gravis by
inhibiting acetylcholinesterase, increasing acetylcholine availability at muscle
receptors, improving muscle strength. Prednisone is an
immunosuppressant. Methotrexate and cyclosporine are immunosuppressants for
other conditions. Myasthenia gravis is autoimmune with antibodies against
acetylcholine receptors; pyridostigmine compensates for reduced receptor function.
