MSN 621 END OF COURSE EXAM QUESTIONS AND
SOLUTIONS RATED A+
✔✔A 56-year-old man with a past medical history of uncontrolled hypertension, poorly
controlled diabetes mellitus and hyperlipidemia presents with a 1-hour history of sudden
onset, sharp left shoulder pain. He states that the pain is exacerbated by deep
breathing, and coughing. The patient is diaphoretic. He does not take any medication
except aspirin which he took today when the chest pain began. On examination, his
oxygen saturation is 99% on room air, respiratory rate 20/minute, heart rate 88/min, and
blood pressure 110/50 mmHg. A chest x-ray is unremarkable. Which of the following is
the next best step in the management of this patient? - ✔✔EKG
✔✔A 26-year-old woman G1P0000 at 24 weeks gestation presents to the clinic in
October for evaluation of cough, rhinorrhea, and subjective fever for 24 hours. The
patient has no significant past medical history and takes only a prenatal vitamin daily.
Vital signs show oral temperature 38 C (100.4 F), blood pressure 120/80 mmHg, pulse
90/minute, respirations 18/minute, and oxygen saturation 96% on room air. Physical
exam reveals a mildly ill-appearing gravid female in no acute distress with lung fields
that are clear to auscultation bilaterally. Continuous fetal monitoring is normal. Nasal
swab ELISA is positive for influenza A. Which of the following is the most appropriate
treatment for this patient to decrease the likelihood of progression to viral pneumonia? -
✔✔Oseltamivir
✔✔A 17-year-old male patient presents to the hospital with severe shortness of breath,
audible wheeze, and fatigue. He has had asthma for ten years, controlled on
beclomethasone 500 mcg inhaled twice a day. On examination, he looks tired and has
decreased air entry on auscultation. His arterial blood gases reveal a pH of 7.35, paO2
of 54 mmHg, and paCO2 of 39 mmHg. What is the most appropriate next step in the
management of this patient? - ✔✔Back to back nebulization with albuterol, IV
corticosteroids, and admission to the high-dependency unit
✔✔A patient with mild, persistent asthma has been well controlled with low-dose
inhaled corticosteroids. He presents for follow up complaining of some limitation with
normal activities and needing albuterol for symptom relief 3 to 4 days per week over the
past month. Which of the following is the preferred next step? - ✔✔Medium dose steroid
✔✔A 5-year-old male with a history of asthma was brought to the emergency
department by his parents with the complaint of flu and fever. The child had four
episodes of asthma in the last 8 months. Which one of the following conditions could be
life-threatening for this patient? - ✔✔SOB
✔✔A child presented to the clinic with a complaint of recurrent episodes of shortness of
breath. The spirometry showed FEV1 less than 80% predicted and FEV1/FVC ratio
,reduced by 5%. Which one of the following is the most common etiology of this
condition? - ✔✔Family hx of atopy
✔✔A 4-year-old child with asthma presented to the clinic with the complaint of
shortness of breath and cough. Which of the following will be present in case of acute
exacerbation of asthma? - ✔✔Pulsus paradoxous
✔✔A 3-year-old child presented to the clinic with the complaint of shortness of breath. A
pulmonary function test was advised. Which one of the following findings is consistent
with asthma? - ✔✔FEV1/FVC less than 85% and improvement after the use of
bronchodilators
✔✔A pulmonary function test of a 5-year-old child showed FEV1/FVC less than 85%. A
diagnosis of asthma was made. What will be the effect of salbutamol on FEV1/FVC? -
✔✔More than 85%
✔✔A 3-year-old child with asthma presented to the clinic with shortness of breath and
chest tightness. Inhalation of albuterol and ipratropium was advised. Why are these two
medications combined? - ✔✔Albuterol causes relaxation of the bronchial smooth
muscles, while ipratropium causes bronchodilation.
✔✔A 6-year-old child presented to the emergency department with an acute
exacerbation of asthma. Which one of the following would be an indication of
mechanical ventilation? - ✔✔Sudden absence of paradoxical
✔✔A 5-year-old child has complaints of shortness of breath. The child has a history of
asthma and is not compliant with her medications. The nurse is performing her
assessment. Which of the following sign and symptoms would be most concerning
during the examination? - ✔✔No wheezing
✔✔A 17-year-old male presents with a two-day history of fever, runny nose, and cough
productive of clear sputum. His past medical history is unremarkable, and he takes no
medication. His blood pressure is 110/70 mmHg, respiratory rate 16 breaths per minute,
heart rate 102 beats per minute, temperature 101.8 F (38.8 C), and oxygen saturation
98% on room air. The lung examination demonstrates clear breath sounds bilaterally. In
addition to an antipyretic, what is the most appropriate treatment for this patient? -
✔✔Guaifenesin
✔✔An 18-year-old boy with a history of asthma for five years is admitted to the hospital
with a history of sudden onset of right-sided chest pain and breathlessness. On
examination he is cyanosed, tachypneic, having hyper resonant percussion note on
right side of chest with absent breath sounds on same side. Trachea is shifted to left
side. Which of the following is the most likely cause of the patient's current condition? -
✔✔Right side pneumo
,✔✔A 65-year-old female with a past medical history of hypertension and high
cholesterol presents to the emergency department in winter with a six-day history of
cough and a fever. The maximum temperature was 101 F on the day before the
presentation. She denies any sick contacts or recent illness. Vital signs on presentation
were significant for a heart rate of 102/min, blood pressure 130/84 mmHg, pulse
oximetry of 90%, and temperature 99.1 F. The physical exam was notable for an ill-
looking female with scattered rhonchi on lung auscultation. The patient reports recent
travel on an airplane back from England. She has a dry cough and muscle aches and
no other complaints. What is the most appropriate management for the probable
condition? - ✔✔Bloodf work, cxr, infu, tx with antiviral if postitive
✔✔A patient with lung cancer presented with sudden onset pleuritic chest pain on the
left side. She is dyspneic and exhibits tachypnea, tachycardia, and cough. On
auscultation, there are decreased breath sounds on the left. After a brief period of
stabilization, the patient becomes hemodynamically unstable and develops cyanosis.
What is the likely diagnosis? - ✔✔Tension pneumo
✔✔A 65-year-old man with metastatic lung cancer presents with complaints of dyspnea,
dry cough, and chest pain that is exacerbated on inspiration. His blood pressure is
110/70 mmHg, heart rate 90/min, respiratory rate 26/min, and he is afebrile. A chest x-
ray shows hyperinflation of the left lung. The patient has most likely developed which of
the following complications? - ✔✔2ndary spontaneous pneumo
✔✔A 65-year-old male patient presents to the emergency department for evaluation of
cough, rhinorrhea, and undocumented fever for three days. His past medical history is
significant only for hypertension controlled on hydrochlorothiazide 12.5 mg daily. His
oral temperature is 37 C (98.6 F), blood pressure 125/80 mmHg, pulse 108/minute,
respiratory rate 24/minute, and oxygen saturation 88% on room air. Physical exam
reveals an ill-appearing, diaphoretic, thin male in marked respiratory distress with
retractions present in rib spaces and scattered rhonchi in all lung fields bilaterally. His
respiratory rate decreases to 20/minute, and oxygen saturation increases to 98% on 2
liters of oxygen administered via nasal cannula. A complete blood count and
comprehensive metabolic profile are within normal limits. Which of the following imaging
studies and corresponding findings supports the suspected diagnosis of viral
pneumonia - ✔✔Thin section CT that demos parenchymal defects bilaterally
✔✔A 17-year-old girl presents to the hospital complaining of severe shortness of breath.
She has a history of poorly controlled asthma, for which she takes a combination inhaler
of corticosteroids and long-acting beta-agonists, and montelukast 10 mg at night. She
has had two ICU admissions in the past six months for asthma exacerbations. On
examination, she looks tired, and her blood pressure is 135/75 mmHg, the pulse is
104/min regular. On auscultation, there is decreased air entry and wheeze all over the
chest. Peak flow has only improved from 160 l/min on admission to 210 l/min after three
salbutamol nebulizers. Her predicted peak expiratory flow is 590. A chest radiograph
, reveals left basal non-homogenous haziness. Arterial blood gases show a PaO2 of 58
mmHg. Which of the following indicates life-threatening asthma? - ✔✔paO2 55
✔✔A 17-year-old male patient presents to the hospital with severe shortness of breath,
audible wheeze, and fatigue. He has had asthma for ten years, controlled on
beclomethasone 500 mcg inhaled twice a day. On examination, he looks tired and has
decreased air entry on auscultation. His arterial blood gases reveal a pH of 7.35, paO2
of 54 mmHg, and paCO2 of 39 mmHg. What is the most appropriate next step in the
management of this patient? - ✔✔Bacl tp back nemb with albu IV steroids and
admission
✔✔A 75-year-old female with a 50-pack-year history of tobacco use presents with a 2-
week history of worsening dyspnea on exertion. She has had a dry cough but no fever,
night sweats, or chills. Her neck shows no jugular venous distention. Heart tones are
distant but regular without murmurs. A lung exam reveals right lower lung dullness to
percussion and decreased breath sounds. A chest radiograph shows a pleural effusion
but no infiltrates or lymphadenopathy. Laboratories are normal. What is the appropriate
management? - ✔✔Thora
✔✔A 35-year-old previously healthy male presents for evaluation of coryza, dry cough,
and fever for 4 days duration. The patient reports no significant past medical history,
takes no daily medications, and has no known drug allergies. He reports receiving
COVID-19 and influenza vaccines this season. Of note, upon obtaining a travel history,
the patient stated that he recently returned from Saudi Arabia. He had petted a dog and
visited a camel farm while on his trip. His vital signs show a temperature of 101 F (38.3
C), blood pressure of 102/64 mmHg, respiratory rate of 20 breaths per minute, heart
rate of 115 beats per minute, and SpO2 of 95% on room air. Significant findings on the
exam include tachycardia, tachypnea, and mild use of accessory respiratory muscles.
Which of the following diagnoses is most important to consider in this patient? -
✔✔MERS cov
✔✔A 75-year-old male with advanced lung cancer complains of dyspnea despite
receiving supplemental oxygen. Which of the following should be done by the hospice
nurse in an effort to relieve the patient's dyspnea? - ✔✔Morphine
✔✔A 58-year-old patient with lung cancer and constipation reports episodes of stool
incontinence with loss of occasional small volume liquid stools without prior warning or
signs of discomfort. Which of the following best explains this situation? - ✔✔Overflow
incont
✔✔A 62-year-old man with a history of end-stage chronic obstructive pulmonary
disease is undergoing palliative therapy. His past medical history is significant for
asthma and he used to live a sedentary life. He suddenly develops shortness of breath.
On examination, he is very dyspneic, confused, and his pulse oximetry reading is 72%
SOLUTIONS RATED A+
✔✔A 56-year-old man with a past medical history of uncontrolled hypertension, poorly
controlled diabetes mellitus and hyperlipidemia presents with a 1-hour history of sudden
onset, sharp left shoulder pain. He states that the pain is exacerbated by deep
breathing, and coughing. The patient is diaphoretic. He does not take any medication
except aspirin which he took today when the chest pain began. On examination, his
oxygen saturation is 99% on room air, respiratory rate 20/minute, heart rate 88/min, and
blood pressure 110/50 mmHg. A chest x-ray is unremarkable. Which of the following is
the next best step in the management of this patient? - ✔✔EKG
✔✔A 26-year-old woman G1P0000 at 24 weeks gestation presents to the clinic in
October for evaluation of cough, rhinorrhea, and subjective fever for 24 hours. The
patient has no significant past medical history and takes only a prenatal vitamin daily.
Vital signs show oral temperature 38 C (100.4 F), blood pressure 120/80 mmHg, pulse
90/minute, respirations 18/minute, and oxygen saturation 96% on room air. Physical
exam reveals a mildly ill-appearing gravid female in no acute distress with lung fields
that are clear to auscultation bilaterally. Continuous fetal monitoring is normal. Nasal
swab ELISA is positive for influenza A. Which of the following is the most appropriate
treatment for this patient to decrease the likelihood of progression to viral pneumonia? -
✔✔Oseltamivir
✔✔A 17-year-old male patient presents to the hospital with severe shortness of breath,
audible wheeze, and fatigue. He has had asthma for ten years, controlled on
beclomethasone 500 mcg inhaled twice a day. On examination, he looks tired and has
decreased air entry on auscultation. His arterial blood gases reveal a pH of 7.35, paO2
of 54 mmHg, and paCO2 of 39 mmHg. What is the most appropriate next step in the
management of this patient? - ✔✔Back to back nebulization with albuterol, IV
corticosteroids, and admission to the high-dependency unit
✔✔A patient with mild, persistent asthma has been well controlled with low-dose
inhaled corticosteroids. He presents for follow up complaining of some limitation with
normal activities and needing albuterol for symptom relief 3 to 4 days per week over the
past month. Which of the following is the preferred next step? - ✔✔Medium dose steroid
✔✔A 5-year-old male with a history of asthma was brought to the emergency
department by his parents with the complaint of flu and fever. The child had four
episodes of asthma in the last 8 months. Which one of the following conditions could be
life-threatening for this patient? - ✔✔SOB
✔✔A child presented to the clinic with a complaint of recurrent episodes of shortness of
breath. The spirometry showed FEV1 less than 80% predicted and FEV1/FVC ratio
,reduced by 5%. Which one of the following is the most common etiology of this
condition? - ✔✔Family hx of atopy
✔✔A 4-year-old child with asthma presented to the clinic with the complaint of
shortness of breath and cough. Which of the following will be present in case of acute
exacerbation of asthma? - ✔✔Pulsus paradoxous
✔✔A 3-year-old child presented to the clinic with the complaint of shortness of breath. A
pulmonary function test was advised. Which one of the following findings is consistent
with asthma? - ✔✔FEV1/FVC less than 85% and improvement after the use of
bronchodilators
✔✔A pulmonary function test of a 5-year-old child showed FEV1/FVC less than 85%. A
diagnosis of asthma was made. What will be the effect of salbutamol on FEV1/FVC? -
✔✔More than 85%
✔✔A 3-year-old child with asthma presented to the clinic with shortness of breath and
chest tightness. Inhalation of albuterol and ipratropium was advised. Why are these two
medications combined? - ✔✔Albuterol causes relaxation of the bronchial smooth
muscles, while ipratropium causes bronchodilation.
✔✔A 6-year-old child presented to the emergency department with an acute
exacerbation of asthma. Which one of the following would be an indication of
mechanical ventilation? - ✔✔Sudden absence of paradoxical
✔✔A 5-year-old child has complaints of shortness of breath. The child has a history of
asthma and is not compliant with her medications. The nurse is performing her
assessment. Which of the following sign and symptoms would be most concerning
during the examination? - ✔✔No wheezing
✔✔A 17-year-old male presents with a two-day history of fever, runny nose, and cough
productive of clear sputum. His past medical history is unremarkable, and he takes no
medication. His blood pressure is 110/70 mmHg, respiratory rate 16 breaths per minute,
heart rate 102 beats per minute, temperature 101.8 F (38.8 C), and oxygen saturation
98% on room air. The lung examination demonstrates clear breath sounds bilaterally. In
addition to an antipyretic, what is the most appropriate treatment for this patient? -
✔✔Guaifenesin
✔✔An 18-year-old boy with a history of asthma for five years is admitted to the hospital
with a history of sudden onset of right-sided chest pain and breathlessness. On
examination he is cyanosed, tachypneic, having hyper resonant percussion note on
right side of chest with absent breath sounds on same side. Trachea is shifted to left
side. Which of the following is the most likely cause of the patient's current condition? -
✔✔Right side pneumo
,✔✔A 65-year-old female with a past medical history of hypertension and high
cholesterol presents to the emergency department in winter with a six-day history of
cough and a fever. The maximum temperature was 101 F on the day before the
presentation. She denies any sick contacts or recent illness. Vital signs on presentation
were significant for a heart rate of 102/min, blood pressure 130/84 mmHg, pulse
oximetry of 90%, and temperature 99.1 F. The physical exam was notable for an ill-
looking female with scattered rhonchi on lung auscultation. The patient reports recent
travel on an airplane back from England. She has a dry cough and muscle aches and
no other complaints. What is the most appropriate management for the probable
condition? - ✔✔Bloodf work, cxr, infu, tx with antiviral if postitive
✔✔A patient with lung cancer presented with sudden onset pleuritic chest pain on the
left side. She is dyspneic and exhibits tachypnea, tachycardia, and cough. On
auscultation, there are decreased breath sounds on the left. After a brief period of
stabilization, the patient becomes hemodynamically unstable and develops cyanosis.
What is the likely diagnosis? - ✔✔Tension pneumo
✔✔A 65-year-old man with metastatic lung cancer presents with complaints of dyspnea,
dry cough, and chest pain that is exacerbated on inspiration. His blood pressure is
110/70 mmHg, heart rate 90/min, respiratory rate 26/min, and he is afebrile. A chest x-
ray shows hyperinflation of the left lung. The patient has most likely developed which of
the following complications? - ✔✔2ndary spontaneous pneumo
✔✔A 65-year-old male patient presents to the emergency department for evaluation of
cough, rhinorrhea, and undocumented fever for three days. His past medical history is
significant only for hypertension controlled on hydrochlorothiazide 12.5 mg daily. His
oral temperature is 37 C (98.6 F), blood pressure 125/80 mmHg, pulse 108/minute,
respiratory rate 24/minute, and oxygen saturation 88% on room air. Physical exam
reveals an ill-appearing, diaphoretic, thin male in marked respiratory distress with
retractions present in rib spaces and scattered rhonchi in all lung fields bilaterally. His
respiratory rate decreases to 20/minute, and oxygen saturation increases to 98% on 2
liters of oxygen administered via nasal cannula. A complete blood count and
comprehensive metabolic profile are within normal limits. Which of the following imaging
studies and corresponding findings supports the suspected diagnosis of viral
pneumonia - ✔✔Thin section CT that demos parenchymal defects bilaterally
✔✔A 17-year-old girl presents to the hospital complaining of severe shortness of breath.
She has a history of poorly controlled asthma, for which she takes a combination inhaler
of corticosteroids and long-acting beta-agonists, and montelukast 10 mg at night. She
has had two ICU admissions in the past six months for asthma exacerbations. On
examination, she looks tired, and her blood pressure is 135/75 mmHg, the pulse is
104/min regular. On auscultation, there is decreased air entry and wheeze all over the
chest. Peak flow has only improved from 160 l/min on admission to 210 l/min after three
salbutamol nebulizers. Her predicted peak expiratory flow is 590. A chest radiograph
, reveals left basal non-homogenous haziness. Arterial blood gases show a PaO2 of 58
mmHg. Which of the following indicates life-threatening asthma? - ✔✔paO2 55
✔✔A 17-year-old male patient presents to the hospital with severe shortness of breath,
audible wheeze, and fatigue. He has had asthma for ten years, controlled on
beclomethasone 500 mcg inhaled twice a day. On examination, he looks tired and has
decreased air entry on auscultation. His arterial blood gases reveal a pH of 7.35, paO2
of 54 mmHg, and paCO2 of 39 mmHg. What is the most appropriate next step in the
management of this patient? - ✔✔Bacl tp back nemb with albu IV steroids and
admission
✔✔A 75-year-old female with a 50-pack-year history of tobacco use presents with a 2-
week history of worsening dyspnea on exertion. She has had a dry cough but no fever,
night sweats, or chills. Her neck shows no jugular venous distention. Heart tones are
distant but regular without murmurs. A lung exam reveals right lower lung dullness to
percussion and decreased breath sounds. A chest radiograph shows a pleural effusion
but no infiltrates or lymphadenopathy. Laboratories are normal. What is the appropriate
management? - ✔✔Thora
✔✔A 35-year-old previously healthy male presents for evaluation of coryza, dry cough,
and fever for 4 days duration. The patient reports no significant past medical history,
takes no daily medications, and has no known drug allergies. He reports receiving
COVID-19 and influenza vaccines this season. Of note, upon obtaining a travel history,
the patient stated that he recently returned from Saudi Arabia. He had petted a dog and
visited a camel farm while on his trip. His vital signs show a temperature of 101 F (38.3
C), blood pressure of 102/64 mmHg, respiratory rate of 20 breaths per minute, heart
rate of 115 beats per minute, and SpO2 of 95% on room air. Significant findings on the
exam include tachycardia, tachypnea, and mild use of accessory respiratory muscles.
Which of the following diagnoses is most important to consider in this patient? -
✔✔MERS cov
✔✔A 75-year-old male with advanced lung cancer complains of dyspnea despite
receiving supplemental oxygen. Which of the following should be done by the hospice
nurse in an effort to relieve the patient's dyspnea? - ✔✔Morphine
✔✔A 58-year-old patient with lung cancer and constipation reports episodes of stool
incontinence with loss of occasional small volume liquid stools without prior warning or
signs of discomfort. Which of the following best explains this situation? - ✔✔Overflow
incont
✔✔A 62-year-old man with a history of end-stage chronic obstructive pulmonary
disease is undergoing palliative therapy. His past medical history is significant for
asthma and he used to live a sedentary life. He suddenly develops shortness of breath.
On examination, he is very dyspneic, confused, and his pulse oximetry reading is 72%
