Page 1 of 40
MSN 622 final exam 2025, nursing leadership exam,
advanced practice nurse final, MSN 622 questions and
answers, graded A+ nursing exam, MSN study guide
PDF
A 17-year-old, previously healthy girl presents with an acute flu-
like illness, fever, myalgias, shortness of breath, and chest pain.
Her ECG shows sinus tachycardia. Her labs show elevated white
blood cells and an abnormally elevated troponin. Her chest x-ray
shows mild pulmonary edema, with findings consistent with
congestive heart failure. What is her likely diagnosis? -
ANSWER-Acute myocarditis
A 65-year-old female is admitted to the hospital with
palpitations and shortness of breath. Her past medical history
includes congestive heart failure with an ejection fraction of
28%, hypertension, and asthma. She reports smoking 4 to 5
cigarettes a day but no illicit drug use. She takes amlodipine 10
mg once a day, lisinopril 10 mg a day and uses an albuterol
inhaler about once a month in the spring and fall). Physical
exam reveals blood pressure 140/80 mmHg, heart rate 164 bpm,
irregular, respiratory rate 20. EKG results are shown. What is an
,Page 2 of 40
appropriate rate control medication for her that would also be
useful for her congestive heart failure? - ANSWER-Metoprolol
A 76-year-old male comes into the emergency department with a
complaint of chest pain. The patient was placed on telemetry
monitoring that showed an abnormal rhythm at a rate of 160
beats per minute. A 12 lead EKG was performed showing an
irregularly irregular rhythm. He has a history of atrial fibrillation
and has been taking rivaroxaban for the past four months. The
patient soon becomes diaphoretic, unresponsive, and
hypotensive. What is the next best step? - ANSWER-Immediate
cardioversion
A 56-year-old man was admitted to the hospital for new-onset
atrial fibrillation. After failed attempts of pharmacologic therapy
to return his heart to normal sinus rhythm, the decision was
made to perform a transesophageal echocardiogram (TEE) and
cardioversion. When performing the TEE, he was found to have
a left atrial appendage thrombus, so the cardioversion was
aborted. He was then started on rivaroxaban. When should
cardioversion be considered again? - ANSWER-After he has
been taking rivaroxaban for 3 to 4 weeks
A 75-year-old male presents with a complaint of palpitations for
the past 1 week. He denies any associated symptoms. He has a
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past medical history of hypertension and diabetes mellitus type
2, for which he takes lisinopril and metformin at home. He
smokes 1 pack of cigarettes per day and drinks 1-2 beers daily.
On physical exam, his blood pressure is 158/90 mmHg, his pulse
is irregularly irregular with a rate of 110/min, his respirations are
16/min, his temperature is 99.4°F (37.4 °C), and his pulse
oximetry is 97% on room air. A rhythm strip from his
examination is provided. A complete blood count (CBC) and
thyroid function tests are normal. A bedside echocardiogram
shows no structural abnormalities. Which of the following
treatments is most appropriate at this time to prevent adverse
effects from his arrhythmia? - ANSWER-Apixaban
A 59-year-old female with a past medical history of coronary
artery disease, hypertension, hyperlipidemia, obesity,
gastroesophageal reflux disease, and alcohol dependence
presents to the emergency department with acute onset shortness
of breath for one day. She has dry cough and nausea. Vitals
shows heart rate of 138/min, respiratory rate 32/min,
temperature 99 F, and blood pressure is 142/92 mmHg. Oral
mucosa is dry, and her breath smells of alcohol. Lungs exam
reveals fine bibasilar crackles and the neck exam is
unremarkable. Also, the EKG shows an irregularly irregular
rhythm. Labs indicate a raised blood alcohol level and TSH is
0.36 mU/L. Diltiazem infusion is initiated along with fluids.
Which of the following is the best management plan for this
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patient? - ANSWER-Continue diltiazem drip, IV fluids, and
consult cardiology
A 65-year-old woman with claudication symptoms for the last
six months presents to the clinic for evaluation. The patient has a
history of diabetes and hypertension. She denies smoking.
Physical exam shows palpable pulses on the bilateral lower
extremities. Ankle-brachial index done at bedside shows a 1.1
on the right and 1.0 on the left lower extremity. What is the next
best step in the management of this patient? - ANSWER-Repeat
ankle-brachial index after exercise
A 65-year-old man presents with palpitations and dyspnea
without chest pain or lightheadedness. His medical history is
significant for hypertension and hyperthyroidism. A 12-lead
ECG is shown below. What is the mechanism of this patient's
arrhythmia? - ANSWER-Micro-reentry
A 65-year-old man presents to the emergency department with
chest pain, palpitations, and dyspnea. The client has a past
medical history significant for hypertension and
hyperthyroidism. An electrocardiogram (EKG) is performed, as
shown in the figure. Initial medical management is initiated.
Which of the following is the most appropriate initial objective
MSN 622 final exam 2025, nursing leadership exam,
advanced practice nurse final, MSN 622 questions and
answers, graded A+ nursing exam, MSN study guide
A 17-year-old, previously healthy girl presents with an acute flu-
like illness, fever, myalgias, shortness of breath, and chest pain.
Her ECG shows sinus tachycardia. Her labs show elevated white
blood cells and an abnormally elevated troponin. Her chest x-ray
shows mild pulmonary edema, with findings consistent with
congestive heart failure. What is her likely diagnosis? -
ANSWER-Acute myocarditis
A 65-year-old female is admitted to the hospital with
palpitations and shortness of breath. Her past medical history
includes congestive heart failure with an ejection fraction of
28%, hypertension, and asthma. She reports smoking 4 to 5
cigarettes a day but no illicit drug use. She takes amlodipine 10
mg once a day, lisinopril 10 mg a day and uses an albuterol
inhaler about once a month in the spring and fall). Physical
exam reveals blood pressure 140/80 mmHg, heart rate 164 bpm,
irregular, respiratory rate 20. EKG results are shown. What is an
,Page 2 of 40
appropriate rate control medication for her that would also be
useful for her congestive heart failure? - ANSWER-Metoprolol
A 76-year-old male comes into the emergency department with a
complaint of chest pain. The patient was placed on telemetry
monitoring that showed an abnormal rhythm at a rate of 160
beats per minute. A 12 lead EKG was performed showing an
irregularly irregular rhythm. He has a history of atrial fibrillation
and has been taking rivaroxaban for the past four months. The
patient soon becomes diaphoretic, unresponsive, and
hypotensive. What is the next best step? - ANSWER-Immediate
cardioversion
A 56-year-old man was admitted to the hospital for new-onset
atrial fibrillation. After failed attempts of pharmacologic therapy
to return his heart to normal sinus rhythm, the decision was
made to perform a transesophageal echocardiogram (TEE) and
cardioversion. When performing the TEE, he was found to have
a left atrial appendage thrombus, so the cardioversion was
aborted. He was then started on rivaroxaban. When should
cardioversion be considered again? - ANSWER-After he has
been taking rivaroxaban for 3 to 4 weeks
A 75-year-old male presents with a complaint of palpitations for
the past 1 week. He denies any associated symptoms. He has a
,Page 3 of 40
past medical history of hypertension and diabetes mellitus type
2, for which he takes lisinopril and metformin at home. He
smokes 1 pack of cigarettes per day and drinks 1-2 beers daily.
On physical exam, his blood pressure is 158/90 mmHg, his pulse
is irregularly irregular with a rate of 110/min, his respirations are
16/min, his temperature is 99.4°F (37.4 °C), and his pulse
oximetry is 97% on room air. A rhythm strip from his
examination is provided. A complete blood count (CBC) and
thyroid function tests are normal. A bedside echocardiogram
shows no structural abnormalities. Which of the following
treatments is most appropriate at this time to prevent adverse
effects from his arrhythmia? - ANSWER-Apixaban
A 59-year-old female with a past medical history of coronary
artery disease, hypertension, hyperlipidemia, obesity,
gastroesophageal reflux disease, and alcohol dependence
presents to the emergency department with acute onset shortness
of breath for one day. She has dry cough and nausea. Vitals
shows heart rate of 138/min, respiratory rate 32/min,
temperature 99 F, and blood pressure is 142/92 mmHg. Oral
mucosa is dry, and her breath smells of alcohol. Lungs exam
reveals fine bibasilar crackles and the neck exam is
unremarkable. Also, the EKG shows an irregularly irregular
rhythm. Labs indicate a raised blood alcohol level and TSH is
0.36 mU/L. Diltiazem infusion is initiated along with fluids.
Which of the following is the best management plan for this
, Page 4 of 40
patient? - ANSWER-Continue diltiazem drip, IV fluids, and
consult cardiology
A 65-year-old woman with claudication symptoms for the last
six months presents to the clinic for evaluation. The patient has a
history of diabetes and hypertension. She denies smoking.
Physical exam shows palpable pulses on the bilateral lower
extremities. Ankle-brachial index done at bedside shows a 1.1
on the right and 1.0 on the left lower extremity. What is the next
best step in the management of this patient? - ANSWER-Repeat
ankle-brachial index after exercise
A 65-year-old man presents with palpitations and dyspnea
without chest pain or lightheadedness. His medical history is
significant for hypertension and hyperthyroidism. A 12-lead
ECG is shown below. What is the mechanism of this patient's
arrhythmia? - ANSWER-Micro-reentry
A 65-year-old man presents to the emergency department with
chest pain, palpitations, and dyspnea. The client has a past
medical history significant for hypertension and
hyperthyroidism. An electrocardiogram (EKG) is performed, as
shown in the figure. Initial medical management is initiated.
Which of the following is the most appropriate initial objective
