MSN 622 Final Exam Questions With
Correct Answers
blowing b- bcorrect banswers✔✔A b67-year-old bman bwith ba bhistory bof bhypertension
band btobacco buse bpresents bwith ba btwo-day bhistory bof bhypogastric bpain. bAn
bexamination breveals ba b5 bcm, bnon-tender, bpulsatile babdominal bmass babove bthe
bumbilicus. bWhich bof bthe bfollowing btype bof bsounds bmight bbe bheard bupon
bauscultation bat bthe bmidline, btwo binches bcephalad bto bthe bumbilicus?
ultrasound bevery b3 byears b- bcorrect banswers✔✔What bis bthe brecommended
bmanagement bfor ba bpatient bwith ba b3.5 bcm babdominal baortic baneurysm?
immediate bsurgery b- bcorrect banswers✔✔A b75-year-old bman bpresents bto bthe
bemergency bdepartment bwith bcomplaints bof bsevere babdominal bpain band bsweating.
bThe bpain bstarted babout ban bhour bago band bis bbecoming bworse bwith btime. bHe bhas
bbeen bdiagnosed bwith bhypertension band bdiabetes band bis bon bamlodipine band
bmetformin, brespectively. bOn bpresentation, bthe bvital bsigns bshow bblood bpressure
b70/40 bmmHg, bpulse b140/min, brespiratory brate b32/min, btemperature b38.5 bC b(101.3
bF), band boxygen bsaturation b87% bat broom bair. bOn bphysical bexamination bof bthe
babdomen, bgeneralized btenderness band bguarding bare bseen. bThere bis ba bmidline
bpulsatile bmass. bWhat bis bthe bnext bbest bstep bin bthe bmanagement bof bthis bpatient?
abdominal bCT b- bcorrect banswers✔✔A b67-year-old bmale bwith ba bhistory bof
bhypertension band bnicotine bdependence bpresents bto bthe bemergency bdepartment
bwith bsudden bonset bof babdominal bpain bradiating bto bthe bback. bThere bis bno bhistory
bof balcohol buse. bOn bexamination, bhe bis bthin, bpale, band bdiaphoretic. bHis bvital bsigns
bshow ba bblood bpressure bof b110/70 bmmHg band ba bheart brate bof b95 bbpm. bWhich bof
bthe bfollowing bis bmost blikely bto bconfirm bthe bdiagnosis?
Surgery bwill bimprove b5-year bsurvival b- bcorrect banswers✔✔A b78-year-old bis bfound
bto bhave ban basymptomatic bpulsatile babdominal bmass. bThe bultrasound bshows ban
babdominal baortic baneurysm bmeasuring b5.5 bcm. bWhich bof bthe bfollowing bstatements
bconcerning bthis bpatient's bcondition bis bcorrect?
stress belectrocardiogram b- bcorrect banswers✔✔A b65-year-old bman bpresents bto bthe
boffice bwith bcomplaints bof boccasional bchest bpain. bThe bpatient bhas ba bpast bmedical
bhistory bsignificant bfor bhypertension, bdiabetes bmellitus, band bhyperlipidemia. bThe
,bpatient bstates bhe bexperiences bchest bpain bon bexertion, bwhich bis bonly brelieved bon
brest. bAn belectrocardiogram bis bnormal. bWhich bof bthe bfollowing bis bthe bnext bstep bin
bmanagement?
Determining bthe bprecipitating bfactors bfor bhis bcondition b- bcorrect banswers✔✔A b65-
year-old bman bpresents bwith bcomplaints bof bchest bpain bthat bstarted b30 bmins bago
bbut bstopped bon bhis bway bto bthe bhospital. bThe bpatient bhas ba bpast bmedical bhistory
bsignificant bfor bhypertension band bdiabetes bmellitus. bAn belectrocardiogram b(ECG) bis
bnormal. bA bstress bECG bshows bmild bST belevations bafter b12 bminutes bof bexercise.
bA bdiagnosis bof bstable bangina bis bmade. bWhich bof bthe bfollowing bshould bbe bthe
bfirst bstep bin bcounseling bthe bpatient babout bhis bcondition?
hypertensive bemergency b- bcorrect banswers✔✔A b47-year-old bmale bpresents bto bthe
boffice bfor broutine bhealth bmaintenance. bHis bblood bpressure bis b182/138, bwith ball
bother bvital bsigns bwithin bnormal blimits. bThe bpatient bis bcurrently bcomplaining bof ba
bheadache band bblurred bvision bbut bdenies bchest bpain, bshortness bof bbreath, band
babdominal bpain. bUnder bwhich bof bthe bfollowing bforms bof bhypertension bwould bthis
bpatient bbe bclassified
Losartan/hydrochlorothiazide band batorvastatin b- bcorrect banswers✔✔A b65-year-old
bmale bwith ba bhistory bof btype b2 bdiabetes bcomes binto bthe bprovider's boffice
bcomplaining bof bblurry bvision, bnosebleeds, band bexertional bchest bpain bfor bthe bpast
bsix bmonths. bThe bblood bpressure bis bmeasured bto bbe b160/94 bmmHg. bA bCT
bangiogram bis bperformed, bwhich breveals bpartially bocclusive bcoronary bartery
bplaques. bWhich bof bthe bfollowing bmedication bregimens bwould bbe bmost bappropriate
bfor bthis bpatient?
Reassure bhim bthat bthis bis bexpected bfrom bhis bACE binhibitor band bcontinue btherapy
bwith bperiodic bmonitoring. b- bcorrect banswers✔✔A b68-year-old bmale bwith ba bpast
bmedical bhistory bof btype b2 bdiabetes bmellitus band bdiabetic bnephropathy bpresented
bto bthe bclinic bfor ba bfollow-up bappointment. bHis bblood bpressure bon bthe blast bvisit
bwas b150/90 bmmHg. bHe bwas bcalled bin bfor ba bfollow-up bappointment bin b4 bweeks bto
bmonitor bhis bblood bpressure. bThe bblood bpressure bon bthis bvisit bis b168/105 bmmHg,
band bHbA1c bis b8.9%. bHis bantihypertensive bregimen bwas badjusted, band ban bACE
binhibitor bwas badded. bHe bis bon bmetformin band bsitagliptin bfor bdiabetes bmellitus.
bOne bweek blater, bhis bblood bpressure bwas b130/80 bmmHg, bthe bpatient's bpotassium
bwas b5.1 bmEq/L, bsodium bwas b133 bmEq/L, band bthe brest bof bthe brenal bpanel bwas
bwithin bnormal blimits. bHe breports bno bsymptoms. bWhat bis bthe bnext bbest bstep bin bhis
bcare?
Reassurance b- bcorrect banswers✔✔A b50-year-old bman bpresents bto bthe bclinic bfor
broutine bevaluation. bHis bsystolic bblood bpressure bhas bpersistently bbeen bin bthe b150-
160 bmmHg brange. bTreatment bwith bramipril bis binitiated. bOn bthe bnext bvisit, bhe
bcomplained bof ban bitchy bthroat band ba bdry bcough, bwhich bis bnot bdistressing bfor bhim,
bbut bhe bis bconcerned bthat bthere bmight bbe bsomething bserious bas bhe bused bto
, bsmoke bbut bquit b5 byears bago. bA bchest bx-ray bis bwithin bnormal blimits. bWhat bis bthe
bnext bbest bstep bin bthe bmanagement bof bthis bpatient?
Assess bthe baccuracy bof bhis bdigital bBP breadings b- bcorrect banswers✔✔A b65-year-
old bman bpresents bfor ba breview bof bhis bmedications. bThe bpatient bstates bhis bblood
bpressure b(BP) bis balways belevated bwhenever bhe bchecks bit bwith bhis bdigital bBP
bmonitoring bmachine, bdespite btaking ball bof bhis bmedications. bHe bhas ba bpast
bmedical bhistory bsignificant bfor bhypertension, bdiabetes bmellitus, band bhyperlipidemia.
bLaboratory bevaluation breveals ba bnormal brandom bblood bglucose blevel band ba
bnormal blipid bprofile. bWhich bof bthe bfollowing bis bthe bmost bappropriate binitial bstep
bbefore bchanging bthe bpatient's bantihypertensive bmedication?
clopidogrel b- bcorrect banswers✔✔A b65-year-old bman bpresents bwith bepisodic
bsubsternal bpain. bInitially, bhe bexperienced bchest bpain bwith bphysical bactivity, bwhich
bremits bwith brest. bBut bnow bit boccurs bat brest btoo. bHe bhas ba bhistory bof
bhypertension band bsmokes b30 bcigarettes/day. bIn baddition, bhe bhas baspirin
bhypersensitivity. bHis bblood bpressure bis b145/90 bmmHg, bpulse bis b78/min, band
boxygen bsaturation bis b97%. bPhysical bexamination bis bunremarkable. bECG breveals
bmild bST-segment bdepressions bin bV1-V2. bCardiac btroponins bare bnot belevated.
bWhich bof bthe bfollowing bis bthe bbest boption bfor bthe bmanagement bin bthis bpatient?
uncontrolled bmalignant bhypertension b- bcorrect banswers✔✔A b65-year-old bfemale
bpatient bpresents bwith bworsening bchest bpain band bblurring bof bvision. bShe bhas ba
bhistory bof bhypertension, bdiabetes bmellitus, bhyperlipidemia, brenal binsufficiency, band
batrial bfibrillation. bVital bsigns bshow btemperature b37.8°C b(100 bF), bheart brate b98
bbpm, bblood bpressure b190/110 bmmHg, brespiratory brate b20 bbreaths/min, band
boxygen bsaturation b91%. bHer bcomplete bblood bcount bshows ba bWBC bof b12.0 band
bhematocrit b30%. bHer beGFR bis b39 bml/min/1.73 bm2. bWhat bis bthe bcontraindication
bfor bcardiac bcatheterization bin bthis bpatient?
troponin b- bcorrect banswers✔✔A b65-year-old bmale bpresents bto bthe bemergency
bdepartment bwith bchest bpain bfor bthe bpast btwo bhours. bThe bpain bis blocated bat bthe
bprecordial bregion, bdescribed bas bsharp, b7/10 bintensity, blasting bfor b20 bminutes,
bradiating bto bthe bupper bleft bupper blimb band baccompanied bby bdyspnea. bHis bpast
bmedical bhistory bis bsignificant bfor bhypertension band bdiabetes bmellitus btype b2. bHis
bblood bpressure bis b120/80 bmmHg, bthe bpulse brate b72/min; bthe btemperature b98 bF.
bEKG breveals bST-segment bdepression. bWhat bis bthe bbest benzyme bassay bto
bdiagnose bthis bcondition?
Coronary bartery batherosclerosis b- bcorrect banswers✔✔A b65-year-old bmale bpresents
bwith bsevere bsubsternal bpain bfor b20 bminutes, bradiating bto bthe bupper bleft blimb band
baccompanied bby bdyspnea. bHe bhas ba bhistory bof bhypertension band bsmokes b30
bcigarettes/day. bHis bblood bpressure bis b145/90 bmmHg band bhis bpulse bis b78/min.
bPhysical bexamination bis bunremarkable. bThe bpain bsettled bpromptly bfollowing b300
bmg baspirin borally band b800 bmcg bglyceryl btrinitrate b(GTN) bspray bsublingually. bWhat
bis bthe bmost bcommon bunderlying bpathological bcause bfor bthis bpatient's bsymptoms?
Correct Answers
blowing b- bcorrect banswers✔✔A b67-year-old bman bwith ba bhistory bof bhypertension
band btobacco buse bpresents bwith ba btwo-day bhistory bof bhypogastric bpain. bAn
bexamination breveals ba b5 bcm, bnon-tender, bpulsatile babdominal bmass babove bthe
bumbilicus. bWhich bof bthe bfollowing btype bof bsounds bmight bbe bheard bupon
bauscultation bat bthe bmidline, btwo binches bcephalad bto bthe bumbilicus?
ultrasound bevery b3 byears b- bcorrect banswers✔✔What bis bthe brecommended
bmanagement bfor ba bpatient bwith ba b3.5 bcm babdominal baortic baneurysm?
immediate bsurgery b- bcorrect banswers✔✔A b75-year-old bman bpresents bto bthe
bemergency bdepartment bwith bcomplaints bof bsevere babdominal bpain band bsweating.
bThe bpain bstarted babout ban bhour bago band bis bbecoming bworse bwith btime. bHe bhas
bbeen bdiagnosed bwith bhypertension band bdiabetes band bis bon bamlodipine band
bmetformin, brespectively. bOn bpresentation, bthe bvital bsigns bshow bblood bpressure
b70/40 bmmHg, bpulse b140/min, brespiratory brate b32/min, btemperature b38.5 bC b(101.3
bF), band boxygen bsaturation b87% bat broom bair. bOn bphysical bexamination bof bthe
babdomen, bgeneralized btenderness band bguarding bare bseen. bThere bis ba bmidline
bpulsatile bmass. bWhat bis bthe bnext bbest bstep bin bthe bmanagement bof bthis bpatient?
abdominal bCT b- bcorrect banswers✔✔A b67-year-old bmale bwith ba bhistory bof
bhypertension band bnicotine bdependence bpresents bto bthe bemergency bdepartment
bwith bsudden bonset bof babdominal bpain bradiating bto bthe bback. bThere bis bno bhistory
bof balcohol buse. bOn bexamination, bhe bis bthin, bpale, band bdiaphoretic. bHis bvital bsigns
bshow ba bblood bpressure bof b110/70 bmmHg band ba bheart brate bof b95 bbpm. bWhich bof
bthe bfollowing bis bmost blikely bto bconfirm bthe bdiagnosis?
Surgery bwill bimprove b5-year bsurvival b- bcorrect banswers✔✔A b78-year-old bis bfound
bto bhave ban basymptomatic bpulsatile babdominal bmass. bThe bultrasound bshows ban
babdominal baortic baneurysm bmeasuring b5.5 bcm. bWhich bof bthe bfollowing bstatements
bconcerning bthis bpatient's bcondition bis bcorrect?
stress belectrocardiogram b- bcorrect banswers✔✔A b65-year-old bman bpresents bto bthe
boffice bwith bcomplaints bof boccasional bchest bpain. bThe bpatient bhas ba bpast bmedical
bhistory bsignificant bfor bhypertension, bdiabetes bmellitus, band bhyperlipidemia. bThe
,bpatient bstates bhe bexperiences bchest bpain bon bexertion, bwhich bis bonly brelieved bon
brest. bAn belectrocardiogram bis bnormal. bWhich bof bthe bfollowing bis bthe bnext bstep bin
bmanagement?
Determining bthe bprecipitating bfactors bfor bhis bcondition b- bcorrect banswers✔✔A b65-
year-old bman bpresents bwith bcomplaints bof bchest bpain bthat bstarted b30 bmins bago
bbut bstopped bon bhis bway bto bthe bhospital. bThe bpatient bhas ba bpast bmedical bhistory
bsignificant bfor bhypertension band bdiabetes bmellitus. bAn belectrocardiogram b(ECG) bis
bnormal. bA bstress bECG bshows bmild bST belevations bafter b12 bminutes bof bexercise.
bA bdiagnosis bof bstable bangina bis bmade. bWhich bof bthe bfollowing bshould bbe bthe
bfirst bstep bin bcounseling bthe bpatient babout bhis bcondition?
hypertensive bemergency b- bcorrect banswers✔✔A b47-year-old bmale bpresents bto bthe
boffice bfor broutine bhealth bmaintenance. bHis bblood bpressure bis b182/138, bwith ball
bother bvital bsigns bwithin bnormal blimits. bThe bpatient bis bcurrently bcomplaining bof ba
bheadache band bblurred bvision bbut bdenies bchest bpain, bshortness bof bbreath, band
babdominal bpain. bUnder bwhich bof bthe bfollowing bforms bof bhypertension bwould bthis
bpatient bbe bclassified
Losartan/hydrochlorothiazide band batorvastatin b- bcorrect banswers✔✔A b65-year-old
bmale bwith ba bhistory bof btype b2 bdiabetes bcomes binto bthe bprovider's boffice
bcomplaining bof bblurry bvision, bnosebleeds, band bexertional bchest bpain bfor bthe bpast
bsix bmonths. bThe bblood bpressure bis bmeasured bto bbe b160/94 bmmHg. bA bCT
bangiogram bis bperformed, bwhich breveals bpartially bocclusive bcoronary bartery
bplaques. bWhich bof bthe bfollowing bmedication bregimens bwould bbe bmost bappropriate
bfor bthis bpatient?
Reassure bhim bthat bthis bis bexpected bfrom bhis bACE binhibitor band bcontinue btherapy
bwith bperiodic bmonitoring. b- bcorrect banswers✔✔A b68-year-old bmale bwith ba bpast
bmedical bhistory bof btype b2 bdiabetes bmellitus band bdiabetic bnephropathy bpresented
bto bthe bclinic bfor ba bfollow-up bappointment. bHis bblood bpressure bon bthe blast bvisit
bwas b150/90 bmmHg. bHe bwas bcalled bin bfor ba bfollow-up bappointment bin b4 bweeks bto
bmonitor bhis bblood bpressure. bThe bblood bpressure bon bthis bvisit bis b168/105 bmmHg,
band bHbA1c bis b8.9%. bHis bantihypertensive bregimen bwas badjusted, band ban bACE
binhibitor bwas badded. bHe bis bon bmetformin band bsitagliptin bfor bdiabetes bmellitus.
bOne bweek blater, bhis bblood bpressure bwas b130/80 bmmHg, bthe bpatient's bpotassium
bwas b5.1 bmEq/L, bsodium bwas b133 bmEq/L, band bthe brest bof bthe brenal bpanel bwas
bwithin bnormal blimits. bHe breports bno bsymptoms. bWhat bis bthe bnext bbest bstep bin bhis
bcare?
Reassurance b- bcorrect banswers✔✔A b50-year-old bman bpresents bto bthe bclinic bfor
broutine bevaluation. bHis bsystolic bblood bpressure bhas bpersistently bbeen bin bthe b150-
160 bmmHg brange. bTreatment bwith bramipril bis binitiated. bOn bthe bnext bvisit, bhe
bcomplained bof ban bitchy bthroat band ba bdry bcough, bwhich bis bnot bdistressing bfor bhim,
bbut bhe bis bconcerned bthat bthere bmight bbe bsomething bserious bas bhe bused bto
, bsmoke bbut bquit b5 byears bago. bA bchest bx-ray bis bwithin bnormal blimits. bWhat bis bthe
bnext bbest bstep bin bthe bmanagement bof bthis bpatient?
Assess bthe baccuracy bof bhis bdigital bBP breadings b- bcorrect banswers✔✔A b65-year-
old bman bpresents bfor ba breview bof bhis bmedications. bThe bpatient bstates bhis bblood
bpressure b(BP) bis balways belevated bwhenever bhe bchecks bit bwith bhis bdigital bBP
bmonitoring bmachine, bdespite btaking ball bof bhis bmedications. bHe bhas ba bpast
bmedical bhistory bsignificant bfor bhypertension, bdiabetes bmellitus, band bhyperlipidemia.
bLaboratory bevaluation breveals ba bnormal brandom bblood bglucose blevel band ba
bnormal blipid bprofile. bWhich bof bthe bfollowing bis bthe bmost bappropriate binitial bstep
bbefore bchanging bthe bpatient's bantihypertensive bmedication?
clopidogrel b- bcorrect banswers✔✔A b65-year-old bman bpresents bwith bepisodic
bsubsternal bpain. bInitially, bhe bexperienced bchest bpain bwith bphysical bactivity, bwhich
bremits bwith brest. bBut bnow bit boccurs bat brest btoo. bHe bhas ba bhistory bof
bhypertension band bsmokes b30 bcigarettes/day. bIn baddition, bhe bhas baspirin
bhypersensitivity. bHis bblood bpressure bis b145/90 bmmHg, bpulse bis b78/min, band
boxygen bsaturation bis b97%. bPhysical bexamination bis bunremarkable. bECG breveals
bmild bST-segment bdepressions bin bV1-V2. bCardiac btroponins bare bnot belevated.
bWhich bof bthe bfollowing bis bthe bbest boption bfor bthe bmanagement bin bthis bpatient?
uncontrolled bmalignant bhypertension b- bcorrect banswers✔✔A b65-year-old bfemale
bpatient bpresents bwith bworsening bchest bpain band bblurring bof bvision. bShe bhas ba
bhistory bof bhypertension, bdiabetes bmellitus, bhyperlipidemia, brenal binsufficiency, band
batrial bfibrillation. bVital bsigns bshow btemperature b37.8°C b(100 bF), bheart brate b98
bbpm, bblood bpressure b190/110 bmmHg, brespiratory brate b20 bbreaths/min, band
boxygen bsaturation b91%. bHer bcomplete bblood bcount bshows ba bWBC bof b12.0 band
bhematocrit b30%. bHer beGFR bis b39 bml/min/1.73 bm2. bWhat bis bthe bcontraindication
bfor bcardiac bcatheterization bin bthis bpatient?
troponin b- bcorrect banswers✔✔A b65-year-old bmale bpresents bto bthe bemergency
bdepartment bwith bchest bpain bfor bthe bpast btwo bhours. bThe bpain bis blocated bat bthe
bprecordial bregion, bdescribed bas bsharp, b7/10 bintensity, blasting bfor b20 bminutes,
bradiating bto bthe bupper bleft bupper blimb band baccompanied bby bdyspnea. bHis bpast
bmedical bhistory bis bsignificant bfor bhypertension band bdiabetes bmellitus btype b2. bHis
bblood bpressure bis b120/80 bmmHg, bthe bpulse brate b72/min; bthe btemperature b98 bF.
bEKG breveals bST-segment bdepression. bWhat bis bthe bbest benzyme bassay bto
bdiagnose bthis bcondition?
Coronary bartery batherosclerosis b- bcorrect banswers✔✔A b65-year-old bmale bpresents
bwith bsevere bsubsternal bpain bfor b20 bminutes, bradiating bto bthe bupper bleft blimb band
baccompanied bby bdyspnea. bHe bhas ba bhistory bof bhypertension band bsmokes b30
bcigarettes/day. bHis bblood bpressure bis b145/90 bmmHg band bhis bpulse bis b78/min.
bPhysical bexamination bis bunremarkable. bThe bpain bsettled bpromptly bfollowing b300
bmg baspirin borally band b800 bmcg bglyceryl btrinitrate b(GTN) bspray bsublingually. bWhat
bis bthe bmost bcommon bunderlying bpathological bcause bfor bthis bpatient's bsymptoms?
