NUR2755 / NUR 2755 FINAL EXAM (LATEST 2025
/ 2026): MULTIDIMENSIONAL CARE IV / MDC 4 -
RASMUSSEN
Introduction
This 125-item simulation mirrors the 2025-2026 Rasmussen University NUR2755
Multidimensional Care IV final comprehensive examination.
Content spans seven weighted domains: complex patient-care management, leadership
& delegation, emergency & trauma response, advanced clinical judgment, ethical & legal
considerations, health policy & advocacy, and professional nursing practice.
Every question is original, scenario-based, and aligned with current QSEN, AACN, ANA,
and Rasmussen MDC 4 curricular outcomes to support mastery-level performance.
Examination-length set: 125 original questions
Question 1:
A 67-year-old post-cholecystectomy patient with DM, HTN, and COPD is on POD #2.
Overnight BP ranged 88–94/50–58 mmHg (MAP 62–65), HR 102–110, UOP 15–20
mL/hr. Current labs: Na 133 mEq/L, K 3.2 mEq/L, SCr 1.6 mg/dL (baseline 0.9). Which
action is the nurse’s priority?
A. Administer prescribed lisinopril 10 mg PO now
B. Page the surgeon for new insulin sliding-scale parameters
C. Initiate a 500 mL isotonic crystalloid bolus and reassess in 30 min
D. Teach the patient to use the incentive spirometer q1h while awake
Answer: C. Initiate a 500 mL isotonic crystalloid bolus and reassess in 30 min
Solution: Hypotension, tachycardia, oliguria, and rising creatinine signal hypovolemia
and early AKI; volume resuscitation is the first-line, evidence-based response. Holding
an ACE-i (A) is reasonable but not the priority action, insulin (B) is unrelated to the
perfusion issue, and teaching (D) can occur after hemodynamic stability.
Question 2:
The charge nurse on a 28-bed medical unit is making shift assignments. Which patient is
most appropriate to assign to a float LPN who is familiar with the unit?
A. New admission with chest pain awaiting cardiac catheterization
B. Stable COPD patient needing a Duo-Neb and oral steroids prior to discharge teaching
C. Post-MI patient on a heparin drip requiring q2h PTT draws
D. New tracheostomy patient admitted 2 h ago needing frequent suctioning
Answer: B. Stable COPD patient needing a Duo-Neb and oral steroids prior to
,discharge teaching
Solution: LPN scope includes stable respiratory treatments and reinforce teaching
under RN supervision; no IV titration, unstable cardiac conditions, or fresh surgical
airways. Options A, C, and D require ongoing RN assessment and titration.
Question 3:
During a rapid-response call, the team finds a patient post-op day 1 from hip ORIF with
new-onset chest pain, SpO₂ 86 % on 4 L NC, RR 32, clear lungs, and sinus tachycardia
118. Which order should the nurse implement first?
A. Obtain stat 12-lead ECG
B. Apply high-flow nasal cannula at 60 L/100 %
C. Draw stat cardiac enzymes and BNP
D. Give 324 mg aspirin PO per protocol
Answer: B. Apply high-flow nasal cannula at 60 L/100 %
Solution: Oxygenation is an immediate life-saving intervention; high-flow can deliver up
to 100 % FiO₂ with PEEP effect. ECG (A) is second, labs (C) diagnostic, aspirin (D)
therapeutic but only after airway/breathing addressed.
Question 4:
An RN delegates morning vital signs to an experienced UAP. Which instruction best
ensures patient safety?
A. “Let me know if any value is outside the normal range listed on the chart.”
B. “Report any SBP < 100 or > 160, DBP < 60 or > 90, HR < 50 or > 100.”
C. “Tell me if the patient looks different from yesterday or has new complaints.”
D. “Document everything first, then we’ll review together after breakfast.”
Answer: C. “Tell me if the patient looks different from yesterday or has new
complaints.”
Solution: UAP scope includes recognition and reporting of change in condition; this
prompt captures both objective and subjective cues. Option A is too narrow (values
only), B uses arbitrary numbers, D delays communication.
Question 5:
A patient with ESRD on hemodialysis MWF receives a new order for ceftriaxone 2 g IV
q24h. Which lab value requires the nurse to contact the prescriber before
administration?
A. WBC 14 000/mm³
B. Hemoglobin 9.8 g/dL
C. SCr 4.1 mg/dL (baseline 4.0)
D. INR 1.3
Answer: C. SCr 4.1 mg/dL (baseline 4.0)
,Solution: Ceftriaxone is renally eliminated; even small increases in SCr can necessitate
dose adjustment or alternative antibiotic. WBC (A) is expected with infection, Hgb (B) is
chronic, INR (D) is within normal.
Question 6:
An 82-year-old with advanced dementia, aspiration pneumonia, and new feeding
intolerance is full code. The family insists on inserting a PEG tube “so Dad doesn’t
starve.” Which ethical action best reflects ANA Code of Ethics?
A. Schedule the PEG procedure per family request; starvation is inhumane
B. Request an ethics consult and provide evidence on aspiration risk with PEG
C. Refuse the request outright, stating PEGs are never appropriate in dementia
D. Ask the attending to change the code status to DNR first
Answer: B. Request an ethics consult and provide evidence on aspiration risk with
PEG
Solution: Provision 1.4 requires nurses to facilitate informed decision-making; evidence
shows PEG does not improve survival or nutrition in advanced dementia and increases
aspiration risk. Option A violates non-maleficence, C is paternalistic, D links unrelated
issues.
Question 7:
A rapid-response is called for a patient with new atrial fibrillation, HR 188, BP 88/48
mmHg, clear lungs, no chest pain. Which medication order should the nurse prepare
first?
A. Diltiazem 20 mg IV push over 2 min
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV over 10 min
D. Metoprolol 5 mg IV q5min × 3
Answer: C. Amiodarone 150 mg IV over 10 min
Solution: Unstable AF with hypotension requires rhythm control; amiodarone is safe in
hypotension and effective for chemical cardioversion. Diltiazem (A) and metoprolol (D)
drop BP, adenosine (B) is for re-entry SVT, not AF.
Question 8:
The nurse is prioritizing morning care for four post-surgical patients. Which patient
should be assessed first?
A. POD #1 appendectomy, PCA morphine, pain 6/10, last morphine 30 min ago
B. POD #0 laparoscopic cholecystectomy, c/o “a little sore throat,” vitals stable
C. POD #1 colectomy, new colostomy, no stoma output × 12 h, mild distension
D. POD #2 TKR, on call to physical therapy, pain 3/10, last Percocet 6 h ago
Answer: C. POD #1 colectomy, new colostomy, no stoma output × 12 h, mild
, distension
Solution: Absent stoma output with distension may signal early ischemia or
obstruction—requires immediate evaluation. Pain (A, D) is important but not life-
threatening, sore throat (B) is minor.
Question 9:
A patient with heart failure and diabetes is started on empagliflozin. Which lab should
the nurse monitor most closely during the first week?
A. Serum creatinine
B. Hemoglobin A1C
C. B-type natriuretic peptide
D. Serum potassium
Answer: A. Serum creatinine
Solution: SGLT-2 inhibitors can cause transient eGFR decline and volume depletion;
early creatinine trending is essential. HbA1c (B) changes over months, BNP (C) is
longer-term marker, potassium (D) is generally unaffected.
Question 10:
During a fire alarm on the unit, smoke is visible from a utility room. Which action should
the charge nurse implement first according to RACE?
A. Close all patient-room doors
B. Pull the fire alarm box again
C. Evacuate patients horizontally behind fire doors
D. Extinguish the fire if possible
Answer: A. Close all patient-room doors
Solution: RACE = Rescue/Remove, Alarm, Confine, Extinguish/Evacuate. Confining the
fire (close doors) is the immediate step after alarm activation and before evacuation or
extinguishment. Re-pulling alarm (B) is redundant, evacuation (C) comes after confine,
extinguish (D) only if trained and safe.
Question 11:
A patient with acute stroke (NIHSS 14) arrives 90 min after onset. BP is 185/105 mmHg.
Which BP target is most appropriate before potential tPA administration?
A. < 185/110 mmHg
B. < 160/90 mmHg
C. < 140/80 mmHg
D. Allow spontaneous decline
Answer: A. < 185/110 mmHg
Solution: AHA/ASA guidelines require BP ≤ 185/110 mmHg for IV tPA eligibility; lower
/ 2026): MULTIDIMENSIONAL CARE IV / MDC 4 -
RASMUSSEN
Introduction
This 125-item simulation mirrors the 2025-2026 Rasmussen University NUR2755
Multidimensional Care IV final comprehensive examination.
Content spans seven weighted domains: complex patient-care management, leadership
& delegation, emergency & trauma response, advanced clinical judgment, ethical & legal
considerations, health policy & advocacy, and professional nursing practice.
Every question is original, scenario-based, and aligned with current QSEN, AACN, ANA,
and Rasmussen MDC 4 curricular outcomes to support mastery-level performance.
Examination-length set: 125 original questions
Question 1:
A 67-year-old post-cholecystectomy patient with DM, HTN, and COPD is on POD #2.
Overnight BP ranged 88–94/50–58 mmHg (MAP 62–65), HR 102–110, UOP 15–20
mL/hr. Current labs: Na 133 mEq/L, K 3.2 mEq/L, SCr 1.6 mg/dL (baseline 0.9). Which
action is the nurse’s priority?
A. Administer prescribed lisinopril 10 mg PO now
B. Page the surgeon for new insulin sliding-scale parameters
C. Initiate a 500 mL isotonic crystalloid bolus and reassess in 30 min
D. Teach the patient to use the incentive spirometer q1h while awake
Answer: C. Initiate a 500 mL isotonic crystalloid bolus and reassess in 30 min
Solution: Hypotension, tachycardia, oliguria, and rising creatinine signal hypovolemia
and early AKI; volume resuscitation is the first-line, evidence-based response. Holding
an ACE-i (A) is reasonable but not the priority action, insulin (B) is unrelated to the
perfusion issue, and teaching (D) can occur after hemodynamic stability.
Question 2:
The charge nurse on a 28-bed medical unit is making shift assignments. Which patient is
most appropriate to assign to a float LPN who is familiar with the unit?
A. New admission with chest pain awaiting cardiac catheterization
B. Stable COPD patient needing a Duo-Neb and oral steroids prior to discharge teaching
C. Post-MI patient on a heparin drip requiring q2h PTT draws
D. New tracheostomy patient admitted 2 h ago needing frequent suctioning
Answer: B. Stable COPD patient needing a Duo-Neb and oral steroids prior to
,discharge teaching
Solution: LPN scope includes stable respiratory treatments and reinforce teaching
under RN supervision; no IV titration, unstable cardiac conditions, or fresh surgical
airways. Options A, C, and D require ongoing RN assessment and titration.
Question 3:
During a rapid-response call, the team finds a patient post-op day 1 from hip ORIF with
new-onset chest pain, SpO₂ 86 % on 4 L NC, RR 32, clear lungs, and sinus tachycardia
118. Which order should the nurse implement first?
A. Obtain stat 12-lead ECG
B. Apply high-flow nasal cannula at 60 L/100 %
C. Draw stat cardiac enzymes and BNP
D. Give 324 mg aspirin PO per protocol
Answer: B. Apply high-flow nasal cannula at 60 L/100 %
Solution: Oxygenation is an immediate life-saving intervention; high-flow can deliver up
to 100 % FiO₂ with PEEP effect. ECG (A) is second, labs (C) diagnostic, aspirin (D)
therapeutic but only after airway/breathing addressed.
Question 4:
An RN delegates morning vital signs to an experienced UAP. Which instruction best
ensures patient safety?
A. “Let me know if any value is outside the normal range listed on the chart.”
B. “Report any SBP < 100 or > 160, DBP < 60 or > 90, HR < 50 or > 100.”
C. “Tell me if the patient looks different from yesterday or has new complaints.”
D. “Document everything first, then we’ll review together after breakfast.”
Answer: C. “Tell me if the patient looks different from yesterday or has new
complaints.”
Solution: UAP scope includes recognition and reporting of change in condition; this
prompt captures both objective and subjective cues. Option A is too narrow (values
only), B uses arbitrary numbers, D delays communication.
Question 5:
A patient with ESRD on hemodialysis MWF receives a new order for ceftriaxone 2 g IV
q24h. Which lab value requires the nurse to contact the prescriber before
administration?
A. WBC 14 000/mm³
B. Hemoglobin 9.8 g/dL
C. SCr 4.1 mg/dL (baseline 4.0)
D. INR 1.3
Answer: C. SCr 4.1 mg/dL (baseline 4.0)
,Solution: Ceftriaxone is renally eliminated; even small increases in SCr can necessitate
dose adjustment or alternative antibiotic. WBC (A) is expected with infection, Hgb (B) is
chronic, INR (D) is within normal.
Question 6:
An 82-year-old with advanced dementia, aspiration pneumonia, and new feeding
intolerance is full code. The family insists on inserting a PEG tube “so Dad doesn’t
starve.” Which ethical action best reflects ANA Code of Ethics?
A. Schedule the PEG procedure per family request; starvation is inhumane
B. Request an ethics consult and provide evidence on aspiration risk with PEG
C. Refuse the request outright, stating PEGs are never appropriate in dementia
D. Ask the attending to change the code status to DNR first
Answer: B. Request an ethics consult and provide evidence on aspiration risk with
PEG
Solution: Provision 1.4 requires nurses to facilitate informed decision-making; evidence
shows PEG does not improve survival or nutrition in advanced dementia and increases
aspiration risk. Option A violates non-maleficence, C is paternalistic, D links unrelated
issues.
Question 7:
A rapid-response is called for a patient with new atrial fibrillation, HR 188, BP 88/48
mmHg, clear lungs, no chest pain. Which medication order should the nurse prepare
first?
A. Diltiazem 20 mg IV push over 2 min
B. Adenosine 6 mg rapid IV push
C. Amiodarone 150 mg IV over 10 min
D. Metoprolol 5 mg IV q5min × 3
Answer: C. Amiodarone 150 mg IV over 10 min
Solution: Unstable AF with hypotension requires rhythm control; amiodarone is safe in
hypotension and effective for chemical cardioversion. Diltiazem (A) and metoprolol (D)
drop BP, adenosine (B) is for re-entry SVT, not AF.
Question 8:
The nurse is prioritizing morning care for four post-surgical patients. Which patient
should be assessed first?
A. POD #1 appendectomy, PCA morphine, pain 6/10, last morphine 30 min ago
B. POD #0 laparoscopic cholecystectomy, c/o “a little sore throat,” vitals stable
C. POD #1 colectomy, new colostomy, no stoma output × 12 h, mild distension
D. POD #2 TKR, on call to physical therapy, pain 3/10, last Percocet 6 h ago
Answer: C. POD #1 colectomy, new colostomy, no stoma output × 12 h, mild
, distension
Solution: Absent stoma output with distension may signal early ischemia or
obstruction—requires immediate evaluation. Pain (A, D) is important but not life-
threatening, sore throat (B) is minor.
Question 9:
A patient with heart failure and diabetes is started on empagliflozin. Which lab should
the nurse monitor most closely during the first week?
A. Serum creatinine
B. Hemoglobin A1C
C. B-type natriuretic peptide
D. Serum potassium
Answer: A. Serum creatinine
Solution: SGLT-2 inhibitors can cause transient eGFR decline and volume depletion;
early creatinine trending is essential. HbA1c (B) changes over months, BNP (C) is
longer-term marker, potassium (D) is generally unaffected.
Question 10:
During a fire alarm on the unit, smoke is visible from a utility room. Which action should
the charge nurse implement first according to RACE?
A. Close all patient-room doors
B. Pull the fire alarm box again
C. Evacuate patients horizontally behind fire doors
D. Extinguish the fire if possible
Answer: A. Close all patient-room doors
Solution: RACE = Rescue/Remove, Alarm, Confine, Extinguish/Evacuate. Confining the
fire (close doors) is the immediate step after alarm activation and before evacuation or
extinguishment. Re-pulling alarm (B) is redundant, evacuation (C) comes after confine,
extinguish (D) only if trained and safe.
Question 11:
A patient with acute stroke (NIHSS 14) arrives 90 min after onset. BP is 185/105 mmHg.
Which BP target is most appropriate before potential tPA administration?
A. < 185/110 mmHg
B. < 160/90 mmHg
C. < 140/80 mmHg
D. Allow spontaneous decline
Answer: A. < 185/110 mmHg
Solution: AHA/ASA guidelines require BP ≤ 185/110 mmHg for IV tPA eligibility; lower
