MSN 622 FINAL EXAM QUESTIONS AND
ANSWERS 100% CORRECT!!
,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 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 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
ANSWERS 100% CORRECT!!
,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 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 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
