MSN 622 FINAL EXAM STUDY GUIDE | MSN 622 FINAL EXAM PRACTICE
QUESTIONS & ANSWERS | COMPREHENSIVE ADVANCED NURSING REVIEW
2026/2027
Troponin I - ✔✔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)?
Coronary artery calcium scoring - ✔✔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?
Coronary artery bypass graft (CABG) - ✔✔A 51-year-old female patient presents with a chief complaint
to shortness of breath, which is present only on exertion. She is a cashier in a local bank. Her history
includes type 1 diabetes mellitus and hypertension. She is an active smoker for fifteen years and smokes
one pack per day. Her BMI is 32.2. Her current medications include insulin, empagliflozin, and lisinopril.
An EKG is obtained in the office, which shows normal sinus rhythm with heart rate 77/min. Evidence of
left ventricular hypertrophy is also present on the EKG. An exercise stress test is scheduled, and the
patient gets chest pain on the treadmill soon after it is started. Her echo shows a left ventricular ejection
fraction of 30%. Cardiac catheterization is performed, which shows 3-vessel coronary artery disease.
Which of the following is the best strategy for this patient's mechanical heart disease?
Defer surgery for at least 2 months. - ✔✔A 65-year-old man presents for preoperative evaluation. He
plans to undergo bilateral total knee replacement for osteoarthritis, which has markedly limited his
mobility. All conservative measures for osteoarthritis treatment have failed. He has medical history
significant for hypertension, hyperlipidemia, and smoking. He received one drug-eluting stent to the left
anterior descending artery four months ago for stable ischemic heart disease. Which of the following is
the best step regarding this patient's clearance for surgery?
Lifestyle modification - ✔✔What is the most appropriate initial intervention for an older male who
complains of leg pain with walking and at night who has weak pulses in both lower extremities and a
reduced ankle-brachial index?
Smoking cessation - ✔✔A 74-year-old woman smoker with hypertension was found to have weak right
lower extremity pulses with a right ankle-brachial index (ABI) of 0.75. She denies any pain with walking.
What is the most appropriate treatment?
Start patient on aspirin or clopidogrel - ✔✔A 65-year-old man who is a heavy smoker presents with a
complaint of pain in both legs when he walks. He claims he can only walk half a block over the past few
years without pain. He has been a smoker for 35 years and also drinks alcohol. He does not have a
, history of hypertension or heart disease. The ankle-brachial index in both legs is 0.70. What should be
done to lower this patient's myocardial infarction risk?
The ratio of systolic ankle blood pressure to systolic brachial blood pressure - ✔✔A 65-year-old woman
presents to the clinic for a 1-year follow-up and medication management. Her medical history is
significant for congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus type 2, and
chronic obstructive pulmonary disease (COPD). She has smoked 2 packs of cigarettes for 45 years. She
drinks alcohol socially. Her current medications include lisinopril, hydrochlorothiazide, atorvastatin,
metformin, albuterol, and inhaled fluticasone. Per the patient, she feels fine other than "some mild
tingling in my feet." She denies chest pain, dyspnea, palpitations, dizziness, and weakness. She has not
had laboratory work done in over 1 year. Her vital signs are temperature 37 °C (98.6 °F), heart rate 77
bpm, respiratory rate 16 breaths/min, and blood pressure 155/89 mm Hg. A physical exam is significant
for absent bilateral pedal and posterior tibial artery pulses, significant edema, and brownish
discoloration of her lower extremities and ankles bilaterally. Which of the following would be the most
appropriate initial step in the diagnosis of this patient's disease?
Repeat ankle-brachial index after exercise - ✔✔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?
Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment - ✔✔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?
S3 heart sound - ✔✔What heart sound would one hear in a patient with systolic congestive heart
failure (CHF)?
.
A S3 gallop - ✔✔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?
Cerebrovascular accident - ✔✔Which of the following may be the initial presentation of long-term
hypertension?
.
Pulmonary artery - ✔✔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?
QUESTIONS & ANSWERS | COMPREHENSIVE ADVANCED NURSING REVIEW
2026/2027
Troponin I - ✔✔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)?
Coronary artery calcium scoring - ✔✔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?
Coronary artery bypass graft (CABG) - ✔✔A 51-year-old female patient presents with a chief complaint
to shortness of breath, which is present only on exertion. She is a cashier in a local bank. Her history
includes type 1 diabetes mellitus and hypertension. She is an active smoker for fifteen years and smokes
one pack per day. Her BMI is 32.2. Her current medications include insulin, empagliflozin, and lisinopril.
An EKG is obtained in the office, which shows normal sinus rhythm with heart rate 77/min. Evidence of
left ventricular hypertrophy is also present on the EKG. An exercise stress test is scheduled, and the
patient gets chest pain on the treadmill soon after it is started. Her echo shows a left ventricular ejection
fraction of 30%. Cardiac catheterization is performed, which shows 3-vessel coronary artery disease.
Which of the following is the best strategy for this patient's mechanical heart disease?
Defer surgery for at least 2 months. - ✔✔A 65-year-old man presents for preoperative evaluation. He
plans to undergo bilateral total knee replacement for osteoarthritis, which has markedly limited his
mobility. All conservative measures for osteoarthritis treatment have failed. He has medical history
significant for hypertension, hyperlipidemia, and smoking. He received one drug-eluting stent to the left
anterior descending artery four months ago for stable ischemic heart disease. Which of the following is
the best step regarding this patient's clearance for surgery?
Lifestyle modification - ✔✔What is the most appropriate initial intervention for an older male who
complains of leg pain with walking and at night who has weak pulses in both lower extremities and a
reduced ankle-brachial index?
Smoking cessation - ✔✔A 74-year-old woman smoker with hypertension was found to have weak right
lower extremity pulses with a right ankle-brachial index (ABI) of 0.75. She denies any pain with walking.
What is the most appropriate treatment?
Start patient on aspirin or clopidogrel - ✔✔A 65-year-old man who is a heavy smoker presents with a
complaint of pain in both legs when he walks. He claims he can only walk half a block over the past few
years without pain. He has been a smoker for 35 years and also drinks alcohol. He does not have a
, history of hypertension or heart disease. The ankle-brachial index in both legs is 0.70. What should be
done to lower this patient's myocardial infarction risk?
The ratio of systolic ankle blood pressure to systolic brachial blood pressure - ✔✔A 65-year-old woman
presents to the clinic for a 1-year follow-up and medication management. Her medical history is
significant for congestive heart failure, hypertension, hyperlipidemia, diabetes mellitus type 2, and
chronic obstructive pulmonary disease (COPD). She has smoked 2 packs of cigarettes for 45 years. She
drinks alcohol socially. Her current medications include lisinopril, hydrochlorothiazide, atorvastatin,
metformin, albuterol, and inhaled fluticasone. Per the patient, she feels fine other than "some mild
tingling in my feet." She denies chest pain, dyspnea, palpitations, dizziness, and weakness. She has not
had laboratory work done in over 1 year. Her vital signs are temperature 37 °C (98.6 °F), heart rate 77
bpm, respiratory rate 16 breaths/min, and blood pressure 155/89 mm Hg. A physical exam is significant
for absent bilateral pedal and posterior tibial artery pulses, significant edema, and brownish
discoloration of her lower extremities and ankles bilaterally. Which of the following would be the most
appropriate initial step in the diagnosis of this patient's disease?
Repeat ankle-brachial index after exercise - ✔✔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?
Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment - ✔✔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?
S3 heart sound - ✔✔What heart sound would one hear in a patient with systolic congestive heart
failure (CHF)?
.
A S3 gallop - ✔✔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?
Cerebrovascular accident - ✔✔Which of the following may be the initial presentation of long-term
hypertension?
.
Pulmonary artery - ✔✔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?
