MSN 622 final ACTUAL UPDATED Exam
Questions and CORRECT Answers
blowing - CORRECT ANSWER - 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 - CORRECT ANSWER - What is the recommended management
for a patient with a 3.5 cm abdominal aortic aneurysm?
immediate surgery - CORRECT ANSWER - 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 - CORRECT ANSWER - 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?
Surgery will improve 5-year survival - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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. - CORRECT ANSWER - 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 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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?
troponin - CORRECT ANSWER - A 65-year-old male presents to the emergency
department with chest pain for the past two hours. The pain is located at the precordial region,
described as sharp, 7/10 intensity, lasting for 20 minutes, radiating to the upper left upper limb
and accompanied by dyspnea. His past medical history is significant for hypertension and
diabetes mellitus type 2. His blood pressure is 120/80 mmHg, the pulse rate 72/min; the
temperature 98 F. EKG reveals ST-segment depression. What is the best enzyme assay to
diagnose this condition?
Questions and CORRECT Answers
blowing - CORRECT ANSWER - 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 - CORRECT ANSWER - What is the recommended management
for a patient with a 3.5 cm abdominal aortic aneurysm?
immediate surgery - CORRECT ANSWER - 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 - CORRECT ANSWER - 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?
Surgery will improve 5-year survival - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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. - CORRECT ANSWER - 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 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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 - CORRECT ANSWER - 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?
troponin - CORRECT ANSWER - A 65-year-old male presents to the emergency
department with chest pain for the past two hours. The pain is located at the precordial region,
described as sharp, 7/10 intensity, lasting for 20 minutes, radiating to the upper left upper limb
and accompanied by dyspnea. His past medical history is significant for hypertension and
diabetes mellitus type 2. His blood pressure is 120/80 mmHg, the pulse rate 72/min; the
temperature 98 F. EKG reveals ST-segment depression. What is the best enzyme assay to
diagnose this condition?
