MSN 622 FINAL NEWEST 2024-2025 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
A 65-year-old female patient presents with complaints of progressive dyspnea on exertion for the past
two weeks. The patient has a past medical history of hypertension. She has a 25-year smoking history
but quit smoking 4 years ago. The patient reveals further that she initially had dyspnea only on moderate
exertion, but now it occurs with activities like showering. The patient denies chest pain, cough, or
wheezing. Her medications include metformin, amlodipine, and simvastatin. The patient appears
comfortable at rest. Currently, she is afebrile and hemodynamically stable. Physical examination reveals
bibasilar crackles. The patient's troponin-T level is normal. What changes are more likely to be seen on
an electrocardiogram (ECG) if this patient is a suspected case of unstable angina? - (answer) Deep,
symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
What heart sound would one hear in a patient with systolic congestive heart failure (CHF)? - (answer)
S3 heart sound
A 72-year-old man with a recent history of a large anterior wall myocardial infarction complains of
dyspnea on exertion, orthopnea, and increasing pedal edema. There is concern about congestive heart
failure. Which of the following would support the diagnosis? - (answer) A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? - (answer)
Cerebrovascular accident
A patient presents with shortness of breath. Rales are heard in the lower lung fields. There is an S4.
Hepatojugular reflux is present. The chest x-ray shows cardiomegaly and enlargement of the mediastinal
veins. Congestive heart failure is suspected. Reduced bloodflow in the ascending aorta would not cause
decreased blood flow in which of the following arteries? - (answer) Pulmonary artery
A 65-year-old woman presents with intermittent, sudden-onset chest pain and shortness of breath,
which radiates to her left jaw and arm. A history of present illness reveals that the pain initially occurred
with activity, but now it occurs throughout the day. A review of systems is positive for tiring easily with
mild physical activity. Her medical history is significant for hypertension and type 2 diabetes mellitus. An
electrocardiogram (ECG) and cardiac enzyme markers are ordered. Which of the following tests will be
most helpful in differentiating unstable angina from a non-ST segment elevation myocardial infarction
(NSTEMI)? - (answer) Troponin I
A 65-year-old man presents with a 4-hour history of progressively worsening left chest pain that radiates
to his left neck. A history of present illness reveals minor episodes of transient chest pain over the last 6
months after climbing 2 flights of stairs or running. His past medical history includes hypertension, type 2
,MSN 622 FINAL NEWEST 2024-2025 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
diabetes mellitus, and hyperlipidemia. His vital signs are oxygen saturation 98% on room air, respiratory
rate 18 breaths/min, heart rate 91 bpm, blood pressure 131/91 mm Hg, and temperature 98.6 °F (37 °C).
A 12-lead electrocardiogram (ECG) demonstrates ST depressions in leads V5, V6, and aVL. The patient is
administered oxygen, morphine, nitroglycerin, and aspirin. What is the principle behind giving this
patient nitroglycerin? - (answer) To dilate the venous system and decrease cardiac preload.
A 70-year-old patient comes to the clinic with complaints of increased blood pressure. He was diagnosed
with hypertension 10 years ago. His other problems include osteoporosis and hyperlipidemia. His
readings range from systolic 160 mmHg to 170 mmHg while diastolic falling in between 70 mmHg to 90
mmHg. His current blood pressure is 160/80 mmHg. His medications include lisinopril, amlodipine,
atorvastatin, calcium and vitamin D supplements, and bisphosphonates. He does not exercise and
smokes a pack of cigarettes daily. He drinks two glasses of beer every day. Family history is significant for
stroke in father and MI in his sister. Which of the following is the most likely effect of increased blood
pressure on his heart? - (answer) Left ventricular (concentric) hypertrophy
A middle-aged patient with diabetes mellitus is referred to the clinic by his primary care provider to
diagnose heart failure. The patient states that he does not have any documentation or labs from his
previous medical encounters. Which of the following is the most significant and earliest sign of heart
failure? - (answer) An S3 gallop
A woman presents with chronic fatigue and trouble breathing. Upon inspection, there is peripheral
edema and significant jugular venous pressure. She has had longstanding hypertension with exertional
fatigue, which has been worsening over the past several years. She has not been adherent to
medications. What is the most common cause of her symptoms? - (answer) Left-sided heart failure
A 60-year-old woman with obesity and congestive heart failure (CHF) presents with a complaint of
increased abdominal girth. She has noticed this occur over the last week, making her self-conscious
about her appearance. She reports shortness of breath, constipation, and abdominal discomfort but
denies nausea and vomiting or any changes in appetite. She also reports a history of cholecystectomy
and frequently experiences constipation. Physical examination reveals jugular venous distension,
pulmonary crackles, a non-tender distended abdomen, and bulging flanks. The liver is non-palpable.
Which of the following is the best assessment of this patient? - (answer) There is a pathologic buildup
of fluid in her peritoneum due to abnormal changes in her hydrostatic pressure due to a CHF
exacerbation. Her serum albumin is 4 g/dL, and ascitic fluid albumin is 2 g/dL.
A 65-year-old male patient with a medical history of hypertension, diabetes mellitus, and coronary
artery disease is being evaluated for chronic stable anginal symptoms. He was prescribed sublingual
, MSN 622 FINAL NEWEST 2024-2025 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
nitroglycerin as needed for chest pain. Which of the following medications should be avoided in this
patient due to this drug? - (answer) Sildenafil
A 55-year-old asymptomatic, female smoker, with an extensive family history of premature coronary
artery disease, presents to the office for further cardiovascular risk stratification. Her 10-year ASCVD risk
score by the pool cohort equation is 5.3%, and she is concerned about testing for further risk
stratification as she is reluctant to take medications. Which of the following is most appropriate to order
to assist in treatment decision making? - (answer) Coronary artery calcium scoring
A 50-year-old man presents to the clinic for recurrent headaches. His office blood pressure has been
consistently found to be elevated. He is not on any hypertensive agent. Home blood pressure diary
measurements reveal an average systolic blood pressure (SBP) of 135 mm Hg and diastolic blood
pressure (DBP) of 85 mm Hg over 3 weeks. The chemistry panel and electrocardiogram are normal. What
is the best initial step in the management of this patient? - (answer) Hydrochlorothiazide
A 44-year-old man comes to the clinic for a follow-up. The patient was found to have elevated blood
pressure on his annual physical exam last week. He was thus asked to keep a blood pressure diary for
one week. Today, the diary reveals an average blood pressure of between 125-135/80-85 mmHg over the
past week. Which of the following the best advice to this patient by the nurse? - (answer) Get about
150 minutes of moderate-intensity exercise per week
A 42-year-man with a past medical history of mitral stenosis due to rheumatic heart disease dies during
open-heart surgery. Autopsy findings were consistent with mitral valve stenosis. Addtitionionally, it also
revealed the presence of heart failure cells. What is the most probable explanation for the presence of
these cells? - (answer) Passive congestion of pulmonary parenchyma
Which of the following abnormal types of respirations is seen in patients with heart failure? - (answer)
Paroxysmal nocturnal dyspnea
A 42-year-old male is brought to the emergency department after routine evening exercise with chest
tightness and severe pain radiating down the left arm. His blood pressure is 130/90 mmHg, and his heart
rate is 102 beats per minute. The patient receives a medication that improves his symptoms
immediately. Which of the following medications was most likely given to the patient? - (answer)
Sublingual nitroglycerin
ANSWERS
A 65-year-old female patient presents with complaints of progressive dyspnea on exertion for the past
two weeks. The patient has a past medical history of hypertension. She has a 25-year smoking history
but quit smoking 4 years ago. The patient reveals further that she initially had dyspnea only on moderate
exertion, but now it occurs with activities like showering. The patient denies chest pain, cough, or
wheezing. Her medications include metformin, amlodipine, and simvastatin. The patient appears
comfortable at rest. Currently, she is afebrile and hemodynamically stable. Physical examination reveals
bibasilar crackles. The patient's troponin-T level is normal. What changes are more likely to be seen on
an electrocardiogram (ECG) if this patient is a suspected case of unstable angina? - (answer) Deep,
symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
What heart sound would one hear in a patient with systolic congestive heart failure (CHF)? - (answer)
S3 heart sound
A 72-year-old man with a recent history of a large anterior wall myocardial infarction complains of
dyspnea on exertion, orthopnea, and increasing pedal edema. There is concern about congestive heart
failure. Which of the following would support the diagnosis? - (answer) A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? - (answer)
Cerebrovascular accident
A patient presents with shortness of breath. Rales are heard in the lower lung fields. There is an S4.
Hepatojugular reflux is present. The chest x-ray shows cardiomegaly and enlargement of the mediastinal
veins. Congestive heart failure is suspected. Reduced bloodflow in the ascending aorta would not cause
decreased blood flow in which of the following arteries? - (answer) Pulmonary artery
A 65-year-old woman presents with intermittent, sudden-onset chest pain and shortness of breath,
which radiates to her left jaw and arm. A history of present illness reveals that the pain initially occurred
with activity, but now it occurs throughout the day. A review of systems is positive for tiring easily with
mild physical activity. Her medical history is significant for hypertension and type 2 diabetes mellitus. An
electrocardiogram (ECG) and cardiac enzyme markers are ordered. Which of the following tests will be
most helpful in differentiating unstable angina from a non-ST segment elevation myocardial infarction
(NSTEMI)? - (answer) Troponin I
A 65-year-old man presents with a 4-hour history of progressively worsening left chest pain that radiates
to his left neck. A history of present illness reveals minor episodes of transient chest pain over the last 6
months after climbing 2 flights of stairs or running. His past medical history includes hypertension, type 2
,MSN 622 FINAL NEWEST 2024-2025 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
diabetes mellitus, and hyperlipidemia. His vital signs are oxygen saturation 98% on room air, respiratory
rate 18 breaths/min, heart rate 91 bpm, blood pressure 131/91 mm Hg, and temperature 98.6 °F (37 °C).
A 12-lead electrocardiogram (ECG) demonstrates ST depressions in leads V5, V6, and aVL. The patient is
administered oxygen, morphine, nitroglycerin, and aspirin. What is the principle behind giving this
patient nitroglycerin? - (answer) To dilate the venous system and decrease cardiac preload.
A 70-year-old patient comes to the clinic with complaints of increased blood pressure. He was diagnosed
with hypertension 10 years ago. His other problems include osteoporosis and hyperlipidemia. His
readings range from systolic 160 mmHg to 170 mmHg while diastolic falling in between 70 mmHg to 90
mmHg. His current blood pressure is 160/80 mmHg. His medications include lisinopril, amlodipine,
atorvastatin, calcium and vitamin D supplements, and bisphosphonates. He does not exercise and
smokes a pack of cigarettes daily. He drinks two glasses of beer every day. Family history is significant for
stroke in father and MI in his sister. Which of the following is the most likely effect of increased blood
pressure on his heart? - (answer) Left ventricular (concentric) hypertrophy
A middle-aged patient with diabetes mellitus is referred to the clinic by his primary care provider to
diagnose heart failure. The patient states that he does not have any documentation or labs from his
previous medical encounters. Which of the following is the most significant and earliest sign of heart
failure? - (answer) An S3 gallop
A woman presents with chronic fatigue and trouble breathing. Upon inspection, there is peripheral
edema and significant jugular venous pressure. She has had longstanding hypertension with exertional
fatigue, which has been worsening over the past several years. She has not been adherent to
medications. What is the most common cause of her symptoms? - (answer) Left-sided heart failure
A 60-year-old woman with obesity and congestive heart failure (CHF) presents with a complaint of
increased abdominal girth. She has noticed this occur over the last week, making her self-conscious
about her appearance. She reports shortness of breath, constipation, and abdominal discomfort but
denies nausea and vomiting or any changes in appetite. She also reports a history of cholecystectomy
and frequently experiences constipation. Physical examination reveals jugular venous distension,
pulmonary crackles, a non-tender distended abdomen, and bulging flanks. The liver is non-palpable.
Which of the following is the best assessment of this patient? - (answer) There is a pathologic buildup
of fluid in her peritoneum due to abnormal changes in her hydrostatic pressure due to a CHF
exacerbation. Her serum albumin is 4 g/dL, and ascitic fluid albumin is 2 g/dL.
A 65-year-old male patient with a medical history of hypertension, diabetes mellitus, and coronary
artery disease is being evaluated for chronic stable anginal symptoms. He was prescribed sublingual
, MSN 622 FINAL NEWEST 2024-2025 ACTUAL EXAM COMPLETE 100 QUESTIONS AND CORRECT DETAILED
ANSWERS
nitroglycerin as needed for chest pain. Which of the following medications should be avoided in this
patient due to this drug? - (answer) Sildenafil
A 55-year-old asymptomatic, female smoker, with an extensive family history of premature coronary
artery disease, presents to the office for further cardiovascular risk stratification. Her 10-year ASCVD risk
score by the pool cohort equation is 5.3%, and she is concerned about testing for further risk
stratification as she is reluctant to take medications. Which of the following is most appropriate to order
to assist in treatment decision making? - (answer) Coronary artery calcium scoring
A 50-year-old man presents to the clinic for recurrent headaches. His office blood pressure has been
consistently found to be elevated. He is not on any hypertensive agent. Home blood pressure diary
measurements reveal an average systolic blood pressure (SBP) of 135 mm Hg and diastolic blood
pressure (DBP) of 85 mm Hg over 3 weeks. The chemistry panel and electrocardiogram are normal. What
is the best initial step in the management of this patient? - (answer) Hydrochlorothiazide
A 44-year-old man comes to the clinic for a follow-up. The patient was found to have elevated blood
pressure on his annual physical exam last week. He was thus asked to keep a blood pressure diary for
one week. Today, the diary reveals an average blood pressure of between 125-135/80-85 mmHg over the
past week. Which of the following the best advice to this patient by the nurse? - (answer) Get about
150 minutes of moderate-intensity exercise per week
A 42-year-man with a past medical history of mitral stenosis due to rheumatic heart disease dies during
open-heart surgery. Autopsy findings were consistent with mitral valve stenosis. Addtitionionally, it also
revealed the presence of heart failure cells. What is the most probable explanation for the presence of
these cells? - (answer) Passive congestion of pulmonary parenchyma
Which of the following abnormal types of respirations is seen in patients with heart failure? - (answer)
Paroxysmal nocturnal dyspnea
A 42-year-old male is brought to the emergency department after routine evening exercise with chest
tightness and severe pain radiating down the left arm. His blood pressure is 130/90 mmHg, and his heart
rate is 102 beats per minute. The patient receives a medication that improves his symptoms
immediately. Which of the following medications was most likely given to the patient? - (answer)
Sublingual nitroglycerin
