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MSN 622 FINAL EXAM QUESTIONS AND
ANSWERS 100% PASS
Blowing - ANS A 67-year-old man with a history of hypertension and tobacco use presents
with a two-day history of hypogastric pain. An examination reveals a 5 cm, non-tender, pulsatile
abdominal mass above the umbilicus. Which of the following type of sounds might be heard
upon auscultation at the midline, two inches cephalad to the umbilicus?
ultrasound every 3 years - ANS What is the recommended management for a patient with a
3.5 cm abdominal aortic aneurysm?
immediate surgery - ANS A 75-year-old man presents to the emergency department with
complaints of severe abdominal pain and sweating. The pain started about an hour ago and is
becoming worse with time. He has been diagnosed with hypertension and diabetes and is on
amlodipine and metformin, respectively. On presentation, the vital signs show blood pressure
70/40 mmHg, pulse 140/min, respiratory rate 32/min, temperature 38.5 C (101.3 F), and
oxygen saturation 87% at room air. On physical examination of the abdomen, generalized
tenderness and guarding are seen. There is a midline pulsatile mass. What is the next best step
in the management of this patient?
abdominal CT - ANS A 67-year-old male with a history of hypertension and nicotine
dependence presents to the emergency department with sudden onset of abdominal pain
radiating to the back. There is no history of alcohol use. On examination, he is thin, pale, and
diaphoretic. His vital signs show a blood pressure of 110/70 mmHg and a heart rate of 95 bpm.
Which of the following is most likely to confirm the diagnosis?
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Surgery will improve 5-year survival - ANS A 78-year-old is found to have an asymptomatic
pulsatile abdominal mass. The ultrasound shows an abdominal aortic aneurysm measuring 5.5
cm. Which of the following statements concerning this patient's condition is correct?
stress electrocardiogram - ANS A 65-year-old man presents to the office with complaints of
occasional chest pain. The patient has a past medical history significant for hypertension,
diabetes mellitus, and hyperlipidemia. The patient states he experiences chest pain on exertion,
which is only relieved on rest. An electrocardiogram is normal. Which of the following is the
next step in management?
Determining the precipitating factors for his condition - ANS A 65-year-old man presents
with complaints of chest pain that started 30 mins ago but stopped on his way to the hospital.
The patient has a past medical history significant for hypertension and diabetes mellitus. An
electrocardiogram (ECG) is normal. A stress ECG shows mild ST elevations after 12 minutes of
exercise. A diagnosis of stable angina is made. Which of the following should be the first step in
counseling the patient about his condition?
hypertensive emergency - ANS A 47-year-old male presents to the office for routine health
maintenance. His blood pressure is 182/138, with all other vital signs within normal limits. The
patient is currently complaining of a headache and blurred vision but denies chest pain,
shortness of breath, and abdominal pain. Under which of the following forms of hypertension
would this patient be classified
Losartan/hydrochlorothiazide and atorvastatin - ANS A 65-year-old male with a history of
type 2 diabetes comes into the provider's office complaining of blurry vision, nosebleeds, and
exertional chest pain for the past six months. The blood pressure is measured to be 160/94
mmHg. A CT angiogram is performed, which reveals partially occlusive coronary artery plaques.
Which of the following medication regimens would be most appropriate for this patient?
Reassure him that this is expected from his ACE inhibitor and continue therapy with periodic
monitoring. - ANS A 68-year-old male with a past medical history of type 2 diabetes mellitus
and diabetic nephropathy presented to the clinic for a follow-up appointment. His blood
pressure on the last visit was 150/90 mmHg. He was called in for a follow-up appointment in 4
weeks to monitor his blood pressure. The blood pressure on this visit is 168/105 mmHg, and
, ©THESTAR 2025 ALL RIGHTS RESERVED
HbA1c is 8.9%. His antihypertensive regimen was adjusted, and an ACE inhibitor was added. He
is on metformin and sitagliptin for diabetes mellitus. One week later, his blood pressure was
130/80 mmHg, the patient's potassium was 5.1 mEq/L, sodium was 133 mEq/L, and the rest of
the renal panel was within normal limits. He reports no symptoms. What is the next best step in
his care?
Reassurance - ANS A 50-year-old man presents to the clinic for routine evaluation. His
systolic blood pressure has persistently been in the 150-160 mmHg range. Treatment with
ramipril is initiated. On the next visit, he complained of an itchy throat and a dry cough, which is
not distressing for him, but he is concerned that there might be something serious as he used
to smoke but quit 5 years ago. A chest x-ray is within normal limits. What is the next best step
in the management of this patient?
Assess the accuracy of his digital BP readings - ANS A 65-year-old man presents for a review
of his medications. The patient states his blood pressure (BP) is always elevated whenever he
checks it with his digital BP monitoring machine, despite taking all of his medications. He has a
past medical history significant for hypertension, diabetes mellitus, and hyperlipidemia.
Laboratory evaluation reveals a normal random blood glucose level and a normal lipid profile.
Which of the following is the most appropriate initial step before changing the patient's
antihypertensive medication?
clopidogrel - ANS A 65-year-old man presents with episodic substernal pain. Initially, he
experienced chest pain with physical activity, which remits with rest. But now it occurs at rest
too. He has a history of hypertension and smokes 30 cigarettes/day. In addition, he has aspirin
hypersensitivity. His blood pressure is 145/90 mmHg, pulse is 78/min, and oxygen saturation is
97%. Physical examination is unremarkable. ECG reveals mild ST-segment depressions in V1-V2.
Cardiac troponins are not elevated. Which of the following is the best option for the
management in this patient?
uncontrolled malignant hypertension - ANS A 65-year-old female patient presents with
worsening chest pain and blurring of vision. She has a history of hypertension, diabetes
mellitus, hyperlipidemia, renal insufficiency, and atrial fibrillation. Vital signs show temperature
37.8°C (100 F), heart rate 98 bpm, blood pressure 190/110 mmHg, respiratory rate 20
breaths/min, and oxygen saturation 91%. Her complete blood count shows a WBC of 12.0 and
hematocrit 30%. Her eGFR is 39 ml/min/1.73 m2. What is the contraindication for cardiac
catheterization in this patient?
MSN 622 FINAL EXAM QUESTIONS AND
ANSWERS 100% PASS
Blowing - ANS A 67-year-old man with a history of hypertension and tobacco use presents
with a two-day history of hypogastric pain. An examination reveals a 5 cm, non-tender, pulsatile
abdominal mass above the umbilicus. Which of the following type of sounds might be heard
upon auscultation at the midline, two inches cephalad to the umbilicus?
ultrasound every 3 years - ANS What is the recommended management for a patient with a
3.5 cm abdominal aortic aneurysm?
immediate surgery - ANS A 75-year-old man presents to the emergency department with
complaints of severe abdominal pain and sweating. The pain started about an hour ago and is
becoming worse with time. He has been diagnosed with hypertension and diabetes and is on
amlodipine and metformin, respectively. On presentation, the vital signs show blood pressure
70/40 mmHg, pulse 140/min, respiratory rate 32/min, temperature 38.5 C (101.3 F), and
oxygen saturation 87% at room air. On physical examination of the abdomen, generalized
tenderness and guarding are seen. There is a midline pulsatile mass. What is the next best step
in the management of this patient?
abdominal CT - ANS A 67-year-old male with a history of hypertension and nicotine
dependence presents to the emergency department with sudden onset of abdominal pain
radiating to the back. There is no history of alcohol use. On examination, he is thin, pale, and
diaphoretic. His vital signs show a blood pressure of 110/70 mmHg and a heart rate of 95 bpm.
Which of the following is most likely to confirm the diagnosis?
, ©THESTAR 2025 ALL RIGHTS RESERVED
Surgery will improve 5-year survival - ANS A 78-year-old is found to have an asymptomatic
pulsatile abdominal mass. The ultrasound shows an abdominal aortic aneurysm measuring 5.5
cm. Which of the following statements concerning this patient's condition is correct?
stress electrocardiogram - ANS A 65-year-old man presents to the office with complaints of
occasional chest pain. The patient has a past medical history significant for hypertension,
diabetes mellitus, and hyperlipidemia. The patient states he experiences chest pain on exertion,
which is only relieved on rest. An electrocardiogram is normal. Which of the following is the
next step in management?
Determining the precipitating factors for his condition - ANS A 65-year-old man presents
with complaints of chest pain that started 30 mins ago but stopped on his way to the hospital.
The patient has a past medical history significant for hypertension and diabetes mellitus. An
electrocardiogram (ECG) is normal. A stress ECG shows mild ST elevations after 12 minutes of
exercise. A diagnosis of stable angina is made. Which of the following should be the first step in
counseling the patient about his condition?
hypertensive emergency - ANS A 47-year-old male presents to the office for routine health
maintenance. His blood pressure is 182/138, with all other vital signs within normal limits. The
patient is currently complaining of a headache and blurred vision but denies chest pain,
shortness of breath, and abdominal pain. Under which of the following forms of hypertension
would this patient be classified
Losartan/hydrochlorothiazide and atorvastatin - ANS A 65-year-old male with a history of
type 2 diabetes comes into the provider's office complaining of blurry vision, nosebleeds, and
exertional chest pain for the past six months. The blood pressure is measured to be 160/94
mmHg. A CT angiogram is performed, which reveals partially occlusive coronary artery plaques.
Which of the following medication regimens would be most appropriate for this patient?
Reassure him that this is expected from his ACE inhibitor and continue therapy with periodic
monitoring. - ANS A 68-year-old male with a past medical history of type 2 diabetes mellitus
and diabetic nephropathy presented to the clinic for a follow-up appointment. His blood
pressure on the last visit was 150/90 mmHg. He was called in for a follow-up appointment in 4
weeks to monitor his blood pressure. The blood pressure on this visit is 168/105 mmHg, and
, ©THESTAR 2025 ALL RIGHTS RESERVED
HbA1c is 8.9%. His antihypertensive regimen was adjusted, and an ACE inhibitor was added. He
is on metformin and sitagliptin for diabetes mellitus. One week later, his blood pressure was
130/80 mmHg, the patient's potassium was 5.1 mEq/L, sodium was 133 mEq/L, and the rest of
the renal panel was within normal limits. He reports no symptoms. What is the next best step in
his care?
Reassurance - ANS A 50-year-old man presents to the clinic for routine evaluation. His
systolic blood pressure has persistently been in the 150-160 mmHg range. Treatment with
ramipril is initiated. On the next visit, he complained of an itchy throat and a dry cough, which is
not distressing for him, but he is concerned that there might be something serious as he used
to smoke but quit 5 years ago. A chest x-ray is within normal limits. What is the next best step
in the management of this patient?
Assess the accuracy of his digital BP readings - ANS A 65-year-old man presents for a review
of his medications. The patient states his blood pressure (BP) is always elevated whenever he
checks it with his digital BP monitoring machine, despite taking all of his medications. He has a
past medical history significant for hypertension, diabetes mellitus, and hyperlipidemia.
Laboratory evaluation reveals a normal random blood glucose level and a normal lipid profile.
Which of the following is the most appropriate initial step before changing the patient's
antihypertensive medication?
clopidogrel - ANS A 65-year-old man presents with episodic substernal pain. Initially, he
experienced chest pain with physical activity, which remits with rest. But now it occurs at rest
too. He has a history of hypertension and smokes 30 cigarettes/day. In addition, he has aspirin
hypersensitivity. His blood pressure is 145/90 mmHg, pulse is 78/min, and oxygen saturation is
97%. Physical examination is unremarkable. ECG reveals mild ST-segment depressions in V1-V2.
Cardiac troponins are not elevated. Which of the following is the best option for the
management in this patient?
uncontrolled malignant hypertension - ANS A 65-year-old female patient presents with
worsening chest pain and blurring of vision. She has a history of hypertension, diabetes
mellitus, hyperlipidemia, renal insufficiency, and atrial fibrillation. Vital signs show temperature
37.8°C (100 F), heart rate 98 bpm, blood pressure 190/110 mmHg, respiratory rate 20
breaths/min, and oxygen saturation 91%. Her complete blood count shows a WBC of 12.0 and
hematocrit 30%. Her eGFR is 39 ml/min/1.73 m2. What is the contraindication for cardiac
catheterization in this patient?
