MSN 622 final
Study online at https://quizlet.com/_ds5jvc
1. A 65-year-old female patient presents with complaints Deep, symmetric T-wave
of progressive dyspnea on exertion for the past two inversions in V2 and V3 ac-
weeks. The patient has a past medical history of hy- companied by flat ST-seg-
pertension. She has a 25-year smoking history but ment
quit smoking 4 years ago. The patient reveals further
that she initially had dyspnea only on moderate exer-
tion, 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?
2. What heart sound would one hear in a patient with S3 heart sound
systolic congestive heart failure (CHF)?
3. A 72-year-old man with a recent history of a large an- A S3 gallop
terior 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?
4. Which of the following may be the initial presentation Cerebrovascular accident
of long-term hypertension?
5. A patient presents with shortness of breath. Rales are Pulmonary artery
heard in the lower lung fields. There is an S4. He-
patojugular reflux is present. The chest x-ray shows
cardiomegaly and enlargement of the mediastinal
, MSN 622 final
Study online at https://quizlet.com/_ds5jvc
veins. Congestive heart failure is suspected. Reduced
bloodflow in the ascending aorta would not cause de-
creased blood flow in which of the following arteries?
6. A 65-year-old woman presents with intermittent, sud- Troponin I
den-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 ac-
tivity, but now it occurs throughout the day. A review
of systems is positive for tiring easily with mild physi-
cal activity. Her medical history is significant for hyper-
tension and type 2 diabetes mellitus. An electrocardio-
gram (ECG) and cardiac enzyme markers are ordered.
Which of the following tests will be most helpful in dif-
ferentiating unstable angina from a non-ST segment
elevation myocardial infarction (NSTEMI)?
7. A 65-year-old man presents with a 4-hour history of To dilate the venous sys-
progressively worsening left chest pain that radiates tem and decrease cardiac
to his left neck. A history of present illness reveals preload.
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
diabetes mellitus, and hyperlipidemia. His vital signs
are oxygen saturation 98% on room air, respiratory
rate 18 breaths/min, heart rate 91 bpm, blood pres-
sure 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?
, MSN 622 final
Study online at https://quizlet.com/_ds5jvc
8. A 70-year-old patient comes to the clinic with com- Left ventricular (concen-
plaints of increased blood pressure. He was diag- tric) hypertrophy
nosed 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?
9. A middle-aged patient with diabetes mellitus is re- An S3 gallop
ferred 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 previ-
ous medical encounters. Which of the following is the
most significant and earliest sign of heart failure?
10. A woman presents with chronic fatigue and trou- Left-sided heart failure
ble 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 sev-
eral years. She has not been adherent to medications.
What is the most common cause of her symptoms?
11.
, MSN 622 final
Study online at https://quizlet.com/_ds5jvc
A 60-year-old woman with obesity and congestive There is a pathologic
heart failure (CHF) presents with a complaint of in- buildup of fluid in her
creased abdominal girth. She has noticed this occur peritoneum due to abnor-
over the last week, making her self-conscious about mal changes in her hy-
her appearance. She reports shortness of breath, con- drostatic pressure due to
stipation, and abdominal discomfort but denies nau- a CHF exacerbation. Her
sea and vomiting or any changes in appetite. She also serum albumin is 4 g/dL,
reports a history of cholecystectomy and frequent- and ascitic fluid albumin is
ly experiences constipation. Physical examination re- 2 g/dL.
veals 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?
12. A 65-year-old male patient with a medical history of Sildenafil
hypertension, diabetes mellitus, and coronary artery
disease is being evaluated for chronic stable anginal
symptoms. He was prescribed sublingual nitroglyc-
erin as needed for chest pain. Which of the following
medications should be avoided in this patient due to
this drug?
13. A 55-year-old asymptomatic, female smoker, with an Coronary artery calcium
extensive family history of premature coronary artery scoring
disease, presents to the office for further cardiovascu-
lar 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?
Study online at https://quizlet.com/_ds5jvc
1. A 65-year-old female patient presents with complaints Deep, symmetric T-wave
of progressive dyspnea on exertion for the past two inversions in V2 and V3 ac-
weeks. The patient has a past medical history of hy- companied by flat ST-seg-
pertension. She has a 25-year smoking history but ment
quit smoking 4 years ago. The patient reveals further
that she initially had dyspnea only on moderate exer-
tion, 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?
2. What heart sound would one hear in a patient with S3 heart sound
systolic congestive heart failure (CHF)?
3. A 72-year-old man with a recent history of a large an- A S3 gallop
terior 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?
4. Which of the following may be the initial presentation Cerebrovascular accident
of long-term hypertension?
5. A patient presents with shortness of breath. Rales are Pulmonary artery
heard in the lower lung fields. There is an S4. He-
patojugular reflux is present. The chest x-ray shows
cardiomegaly and enlargement of the mediastinal
, MSN 622 final
Study online at https://quizlet.com/_ds5jvc
veins. Congestive heart failure is suspected. Reduced
bloodflow in the ascending aorta would not cause de-
creased blood flow in which of the following arteries?
6. A 65-year-old woman presents with intermittent, sud- Troponin I
den-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 ac-
tivity, but now it occurs throughout the day. A review
of systems is positive for tiring easily with mild physi-
cal activity. Her medical history is significant for hyper-
tension and type 2 diabetes mellitus. An electrocardio-
gram (ECG) and cardiac enzyme markers are ordered.
Which of the following tests will be most helpful in dif-
ferentiating unstable angina from a non-ST segment
elevation myocardial infarction (NSTEMI)?
7. A 65-year-old man presents with a 4-hour history of To dilate the venous sys-
progressively worsening left chest pain that radiates tem and decrease cardiac
to his left neck. A history of present illness reveals preload.
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
diabetes mellitus, and hyperlipidemia. His vital signs
are oxygen saturation 98% on room air, respiratory
rate 18 breaths/min, heart rate 91 bpm, blood pres-
sure 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?
, MSN 622 final
Study online at https://quizlet.com/_ds5jvc
8. A 70-year-old patient comes to the clinic with com- Left ventricular (concen-
plaints of increased blood pressure. He was diag- tric) hypertrophy
nosed 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?
9. A middle-aged patient with diabetes mellitus is re- An S3 gallop
ferred 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 previ-
ous medical encounters. Which of the following is the
most significant and earliest sign of heart failure?
10. A woman presents with chronic fatigue and trou- Left-sided heart failure
ble 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 sev-
eral years. She has not been adherent to medications.
What is the most common cause of her symptoms?
11.
, MSN 622 final
Study online at https://quizlet.com/_ds5jvc
A 60-year-old woman with obesity and congestive There is a pathologic
heart failure (CHF) presents with a complaint of in- buildup of fluid in her
creased abdominal girth. She has noticed this occur peritoneum due to abnor-
over the last week, making her self-conscious about mal changes in her hy-
her appearance. She reports shortness of breath, con- drostatic pressure due to
stipation, and abdominal discomfort but denies nau- a CHF exacerbation. Her
sea and vomiting or any changes in appetite. She also serum albumin is 4 g/dL,
reports a history of cholecystectomy and frequent- and ascitic fluid albumin is
ly experiences constipation. Physical examination re- 2 g/dL.
veals 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?
12. A 65-year-old male patient with a medical history of Sildenafil
hypertension, diabetes mellitus, and coronary artery
disease is being evaluated for chronic stable anginal
symptoms. He was prescribed sublingual nitroglyc-
erin as needed for chest pain. Which of the following
medications should be avoided in this patient due to
this drug?
13. A 55-year-old asymptomatic, female smoker, with an Coronary artery calcium
extensive family history of premature coronary artery scoring
disease, presents to the office for further cardiovascu-
lar 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?
