©THESTAR 2025 ALL RIGHTS RESERVED 11:41 AM A+
MSN 621 Final number 2 Exam Questions
And Answers |Latest 2025 | Guaranteed Pass.
A decrease in the forced expiratory volume in one second (FEV1) to forced vital capacity (FVC)
ratio is most likely to be seen in a patient with which of the following? - Answer✔Asthma
A middle-aged male presents to the emergency department with an exacerbation of his chronic
obstructive pulmonary disease (COPD). He has been coughing and been moderately short of
breath for the past 2 days. He says that his inhalers do work, but he ran out of supplies. He
complains of general malaise. After examining him, you decide to start him on antibiotics.
However, you first decide to send the sputum for gram stain and culture. According to the 2015
Global Initiative for Chronic Obstructive Lung Disease report, which of the following organisms
is most likely to be involved in COPD exacerbation? - Answer✔Moraxella catarrhalis
A 65-year-old male is evaluated for worsening shortness of breath and a productive cough for 6
months. He is a current smoker with a 30-pack-year smoking history. His other medical history
includes hypertension and chronic kidney disease. On examination, his blood pressure is 145/95
mmHg, pulse 88/min, and oxygen saturation of 92% on room air. He does not have accessory
muscle use. On lung auscultation, there is decreased air movement and prolonged expiration.
There are no wheezes detected. No S3 or S4 auscultated. There is no jugular vein distention. He
has no lower extremity edema and denies chest pain or calf tenderness. Chest x-ray reveals
bilateral hyperinflated lung fields. Which of the following is the next best step in the diagnosis
of this patient's condition? - Answer✔Spirometry
A 65-year-old male patient presents to the hospital with the complaint of increasing shortness
of breath. His condition has been progressively worsening over the past six months. He is a
smoker and a bird keeper. He has one son and one daughter with asthma. On examination,
there is a wheeze and coarse end-inspiratory crackles in the chest. A chest radiograph reveals
diffuse non-specific changes consistent with lung disease. What investigation is most likely to
yield the diagnosis in this case? - Answer✔Spirometry with reversibility
A 65-year-old male patient presents to the clinic with complaints of a dry cough and wheezing,
particularly at night. He has had asthma. Six months ago, his symptoms were well-controlled on
1|Page
, ©THESTAR 2025 ALL RIGHTS RESERVED 11:41 AM A+
inhaled fomoterol and low dose budesonide twice a day and occasional use of an albuterol
inhaler as required. However, now he is more short of breath with morning dipping of his peak
flow readings. On examination, he is mildly dyspneic but able to complete sentences. On
auscultation, there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in the management of this patient? -
Answer✔Inhaled budesonide dose
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? - Answer✔Medium dose inhaled corticosteroid
A 37-year-old woman presents with complaints of intermittent dry cough and chest tightness
since she started a new job as a chambermaid at a hotel 5-weeks ago. Her symptoms are worst
at night. She does not have any rhinitis, postnasal drip, or history of allergic rhinitis. She has
never smoked and doe not take any medicine. On physical examination, the patient appears
comfortable and speaks full sentences without any problem. Oral and nasal mucosa appears
normal. On auscultation of lungs, wheeze is reported in the left lung. The chest x-ray report
comes out normal. Which of the following is the next best step in identifying the cause of the
patient's current symptoms? - Answer✔Spirometry with pre and post bronchodilator testing
A 40-year-old male patient comes in with a chief complaint of difficulty breathing. His cardiac
function test results are normal. He shows airway hyperresponsiveness to the methacholine
challenge test. His lung spirometry test reveals a lower-than-predicted level of forced
expiratory volume in the first second (FEV1). Based on the most likely diagnosis, what is the
most appropriate first-line therapy for a patient with infrequent episodes of mild symptoms? -
Answer✔Albuterol alone
A 78-year-old male presents to the clinic with complaints of a cough that started three days
ago. The cough is associated with sputum, which is scanty in volume and yellow in color. He
also complains of mild headaches and a stuffy nose for the last two days. On further
questioning, he reveals that he has had two similar episodes previously, which subsided within
a week. A detailed medical history reveals that he was diagnosed with diabetes mellitus twenty
years ago and is on metformin. His vital signs show a blood pressure of 100/80 mmHg, a
respiratory rate of 14/min, a heart rate of 88/min, and a temperature of 99 F (37.1 C).
Auscultation of the chest was performed, which reveals bilateral coarse rhonchi, whereas a
chest x-ray is normal. What is the most appropriate next step in the management of his
condition? - Answer✔Abx and antitussives
2|Page
, ©THESTAR 2025 ALL RIGHTS RESERVED 11:41 AM A+
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? - Answer✔Guaifensen
A 28-year-old male patient with a past medical history significant for asthma presents to the
primary care office for complaints of cough, shortness of breath for 24 hours duration. His
symptoms started abruptly and are progressively worsening. He denies fevers or chills and has
had no known exposure to sick contacts. Vital signs are within normal limits. Physical
examination is significant for mild expiratory wheezing. His asthma is well controlled, and he
has not used any inhalers for a few years. What is the next best step in the management of this
patient? - Answer✔Prescribe albuterol
A 35-year-old female presents to the out-patient department with complaints of cough with
whitish sputum production for the past three months. She mentions that the cough worsens at
night. She has no other complaints. The patient mentions that she has tried chlorpheniramine
for a week, and no improvement was noted. She has a history of gastroesophageal reflux
disease, for which she takes famotidine. She has been smoking a pack of cigarettes a day for the
past seven years and drinks alcohol socially. Vitals show a blood pressure of 133/85 mm Hg,
pulse of 79/min, respiratory rate of 14/min, and temperature of 98.6 F (37 C). Pulmonary
examination reveals normal breath sounds bilaterally. A chest x-ray is normal. Which of the
following is the best next step in the management of the patient's condition? - Answer✔Pulm
fxn tests
A 20-year-old man presents to the clinic with two months history of cough and right-sided chest
pain. On examination, his chest movement on the right side is diminished, the trachea is shifted
to the left, and a stony dull percussion note is present on the right side. His breath sounds are
impaired, and vocal fremitus is present. Which of the following is the most likely diagnosis? -
Answer✔Right pleural effusion
A 62-year-old man presents with general malaise, occasional cough, and weight loss of 10 lbs
(4.5 kg) over the last two months. History is significant for prediabetes managed with diet and
cigarette smoking. Physical examination findings include mild edema in the extremities and
clubbing bilaterally. Blood work shows mild anemia and sodium of 122 mg/dL. What test should
be done next? - Answer✔Chest radiograph
3|Page
, ©THESTAR 2025 ALL RIGHTS RESERVED 11:41 AM A+
A patient with chronic obstructive pulmonary disease (COPD) and chronic carbon dioxide
retention in a nursing home is wheezing. The oxygen saturation drops from 93 to 90. Which of
the following would be most appropriate? - Answer✔Albuterol by neb
A 70-year-old man with severe chronic obstructive pulmonary disease (COPD) has had multiple
hospital admission for exacerbations. He is an ex-smoker of 40 pack years. He takes
budesonide/formoterol combination and tiotropium inhalers. He is up-to-date with his
Influenza and pneumococcal vaccine. What should be advised to decrease his COPD
exacerbations? - Answer✔Start on roflumilast
A 65-year-old female is evaluated for shortness of breath with exertion and a chronic cough.
She is often unable to walk farther than 200 feet without stopping to catch her breath. She is a
current smoker with a 33-pack-year smoking history. She has no prior hospitalizations. On
physical examination, her vital signs are within normal limits at rest. Auscultation of her lungs
reveals bilateral expiratory wheezes. The remainder of her physical examination is normal.
Spirometry is performed and shows an FEV1 of 72% of predicted. Her post-bronchodilator
FEV1/FVC ratio is 60%. Her modified medical research council (mMRC) dyspnea score is 3. She is
counseled on smoking cessation. Which of the following is the most appropriate
pharmacological treatment for this patient? - Answer✔Short acting bronchodilator as needed
and a long acting bronchodilator
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? - Answer✔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? - Answer✔Oseltamivir
4|Page
MSN 621 Final number 2 Exam Questions
And Answers |Latest 2025 | Guaranteed Pass.
A decrease in the forced expiratory volume in one second (FEV1) to forced vital capacity (FVC)
ratio is most likely to be seen in a patient with which of the following? - Answer✔Asthma
A middle-aged male presents to the emergency department with an exacerbation of his chronic
obstructive pulmonary disease (COPD). He has been coughing and been moderately short of
breath for the past 2 days. He says that his inhalers do work, but he ran out of supplies. He
complains of general malaise. After examining him, you decide to start him on antibiotics.
However, you first decide to send the sputum for gram stain and culture. According to the 2015
Global Initiative for Chronic Obstructive Lung Disease report, which of the following organisms
is most likely to be involved in COPD exacerbation? - Answer✔Moraxella catarrhalis
A 65-year-old male is evaluated for worsening shortness of breath and a productive cough for 6
months. He is a current smoker with a 30-pack-year smoking history. His other medical history
includes hypertension and chronic kidney disease. On examination, his blood pressure is 145/95
mmHg, pulse 88/min, and oxygen saturation of 92% on room air. He does not have accessory
muscle use. On lung auscultation, there is decreased air movement and prolonged expiration.
There are no wheezes detected. No S3 or S4 auscultated. There is no jugular vein distention. He
has no lower extremity edema and denies chest pain or calf tenderness. Chest x-ray reveals
bilateral hyperinflated lung fields. Which of the following is the next best step in the diagnosis
of this patient's condition? - Answer✔Spirometry
A 65-year-old male patient presents to the hospital with the complaint of increasing shortness
of breath. His condition has been progressively worsening over the past six months. He is a
smoker and a bird keeper. He has one son and one daughter with asthma. On examination,
there is a wheeze and coarse end-inspiratory crackles in the chest. A chest radiograph reveals
diffuse non-specific changes consistent with lung disease. What investigation is most likely to
yield the diagnosis in this case? - Answer✔Spirometry with reversibility
A 65-year-old male patient presents to the clinic with complaints of a dry cough and wheezing,
particularly at night. He has had asthma. Six months ago, his symptoms were well-controlled on
1|Page
, ©THESTAR 2025 ALL RIGHTS RESERVED 11:41 AM A+
inhaled fomoterol and low dose budesonide twice a day and occasional use of an albuterol
inhaler as required. However, now he is more short of breath with morning dipping of his peak
flow readings. On examination, he is mildly dyspneic but able to complete sentences. On
auscultation, there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in the management of this patient? -
Answer✔Inhaled budesonide dose
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? - Answer✔Medium dose inhaled corticosteroid
A 37-year-old woman presents with complaints of intermittent dry cough and chest tightness
since she started a new job as a chambermaid at a hotel 5-weeks ago. Her symptoms are worst
at night. She does not have any rhinitis, postnasal drip, or history of allergic rhinitis. She has
never smoked and doe not take any medicine. On physical examination, the patient appears
comfortable and speaks full sentences without any problem. Oral and nasal mucosa appears
normal. On auscultation of lungs, wheeze is reported in the left lung. The chest x-ray report
comes out normal. Which of the following is the next best step in identifying the cause of the
patient's current symptoms? - Answer✔Spirometry with pre and post bronchodilator testing
A 40-year-old male patient comes in with a chief complaint of difficulty breathing. His cardiac
function test results are normal. He shows airway hyperresponsiveness to the methacholine
challenge test. His lung spirometry test reveals a lower-than-predicted level of forced
expiratory volume in the first second (FEV1). Based on the most likely diagnosis, what is the
most appropriate first-line therapy for a patient with infrequent episodes of mild symptoms? -
Answer✔Albuterol alone
A 78-year-old male presents to the clinic with complaints of a cough that started three days
ago. The cough is associated with sputum, which is scanty in volume and yellow in color. He
also complains of mild headaches and a stuffy nose for the last two days. On further
questioning, he reveals that he has had two similar episodes previously, which subsided within
a week. A detailed medical history reveals that he was diagnosed with diabetes mellitus twenty
years ago and is on metformin. His vital signs show a blood pressure of 100/80 mmHg, a
respiratory rate of 14/min, a heart rate of 88/min, and a temperature of 99 F (37.1 C).
Auscultation of the chest was performed, which reveals bilateral coarse rhonchi, whereas a
chest x-ray is normal. What is the most appropriate next step in the management of his
condition? - Answer✔Abx and antitussives
2|Page
, ©THESTAR 2025 ALL RIGHTS RESERVED 11:41 AM A+
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? - Answer✔Guaifensen
A 28-year-old male patient with a past medical history significant for asthma presents to the
primary care office for complaints of cough, shortness of breath for 24 hours duration. His
symptoms started abruptly and are progressively worsening. He denies fevers or chills and has
had no known exposure to sick contacts. Vital signs are within normal limits. Physical
examination is significant for mild expiratory wheezing. His asthma is well controlled, and he
has not used any inhalers for a few years. What is the next best step in the management of this
patient? - Answer✔Prescribe albuterol
A 35-year-old female presents to the out-patient department with complaints of cough with
whitish sputum production for the past three months. She mentions that the cough worsens at
night. She has no other complaints. The patient mentions that she has tried chlorpheniramine
for a week, and no improvement was noted. She has a history of gastroesophageal reflux
disease, for which she takes famotidine. She has been smoking a pack of cigarettes a day for the
past seven years and drinks alcohol socially. Vitals show a blood pressure of 133/85 mm Hg,
pulse of 79/min, respiratory rate of 14/min, and temperature of 98.6 F (37 C). Pulmonary
examination reveals normal breath sounds bilaterally. A chest x-ray is normal. Which of the
following is the best next step in the management of the patient's condition? - Answer✔Pulm
fxn tests
A 20-year-old man presents to the clinic with two months history of cough and right-sided chest
pain. On examination, his chest movement on the right side is diminished, the trachea is shifted
to the left, and a stony dull percussion note is present on the right side. His breath sounds are
impaired, and vocal fremitus is present. Which of the following is the most likely diagnosis? -
Answer✔Right pleural effusion
A 62-year-old man presents with general malaise, occasional cough, and weight loss of 10 lbs
(4.5 kg) over the last two months. History is significant for prediabetes managed with diet and
cigarette smoking. Physical examination findings include mild edema in the extremities and
clubbing bilaterally. Blood work shows mild anemia and sodium of 122 mg/dL. What test should
be done next? - Answer✔Chest radiograph
3|Page
, ©THESTAR 2025 ALL RIGHTS RESERVED 11:41 AM A+
A patient with chronic obstructive pulmonary disease (COPD) and chronic carbon dioxide
retention in a nursing home is wheezing. The oxygen saturation drops from 93 to 90. Which of
the following would be most appropriate? - Answer✔Albuterol by neb
A 70-year-old man with severe chronic obstructive pulmonary disease (COPD) has had multiple
hospital admission for exacerbations. He is an ex-smoker of 40 pack years. He takes
budesonide/formoterol combination and tiotropium inhalers. He is up-to-date with his
Influenza and pneumococcal vaccine. What should be advised to decrease his COPD
exacerbations? - Answer✔Start on roflumilast
A 65-year-old female is evaluated for shortness of breath with exertion and a chronic cough.
She is often unable to walk farther than 200 feet without stopping to catch her breath. She is a
current smoker with a 33-pack-year smoking history. She has no prior hospitalizations. On
physical examination, her vital signs are within normal limits at rest. Auscultation of her lungs
reveals bilateral expiratory wheezes. The remainder of her physical examination is normal.
Spirometry is performed and shows an FEV1 of 72% of predicted. Her post-bronchodilator
FEV1/FVC ratio is 60%. Her modified medical research council (mMRC) dyspnea score is 3. She is
counseled on smoking cessation. Which of the following is the most appropriate
pharmacological treatment for this patient? - Answer✔Short acting bronchodilator as needed
and a long acting bronchodilator
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? - Answer✔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? - Answer✔Oseltamivir
4|Page
