MSN 622 FINAL EXAM, NURSING LEADERSHIP EXAM, ADVANCED PRACTICE
NURSE FINAL -
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: 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
Question 2: 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
Question 3: 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 of this
patient's treatment?
,Answer:
Decrease the ventricular rate below 100/min
Question 4: A 65-year-old man presents to the emergency
department with palpitations, lightheadedness, and chest
discomfort. He has a history of hypertension and mitral stenosis.
His vital signs include a heart rate of 141/minute, blood pressure of
110/78 mm Hg, and oxygen saturation of 97% on room air. A 12-lead
electrocardiogram is shown. Which of the following best describes
the rate of atrial activity associated with this patient's condition?
Answer:
More than 350/minute
Question 5: A 45-year-old man presents for a two-month history of
worsening dyspnea. He denies a history of fever and sore throat
with joint pain during childhood. On examination, he is found to
have displaced, thrusting apex beats and a systolic murmur. His
echocardiographic images are shown below. What is the definitive
management for this patient's condition?
Answer:
Mitral valve repair or replacement
Question 6: A 65-year-old man presents with complaints of
palpitation, dizziness, and dyspnea for the past 2 hours. The patient
has a past medical history significant for hypertension, diabetes
mellitus, and hyperthyroidism. An electrocardiogram (ECG) is
shown. After initial stabilization, the patient is discharged with a
Holter monitor and asked to return after 7 days. At his next visit,
ECG tracings show similar findings as seen on his first visit. The
patient's condition can be classified as which of the following?
Answer:
,Persistent atrial fibrillation
Question 7: A 65-year-old man presents with complaints of
palpitations, dyspnea, and chest discomfort. The patient has
hypertension and diabetes mellitus. His blood pressure is 140/90
mmHg, heart rate 120/min, and respiratory rate 23/min. An
electrocardiogram is performed, which is shown in the image.
Which of the following valvular diseases is associated with this
patient's condition?
Answer:
Mitral stenosis
Question 8: A 75-year-old man with a history of hypertension
presents to the emergency department with dizziness,
lightheadedness, and palpitations that started this morning. He
reports occasional palpitations at home while climbing stairs or
doing heavy work, but these episodes do not last more than a few
minutes. His blood pressure is 95/70 mm Hg, heart rate 125 bpm,
respiratory rate 22 breaths/min, and oxygen saturation 95% on
room air. The physical examination findings are unremarkable. An
electrocardiogram is negative for ST-segment changes or T-wave
abnormalities. A rhythm strip is shown below. What is the best next
step in the management of this patient?
Answer:
Intravenous fluid bolus followed by intravenous metoprolol
Question 9: What is the most appropriate goal while treating a
patient with atrial fibrillation?
Answer:
To reduce the ventricular response rate below 100 beats/minute
, Question 10: A 65-year-old man presents with an enlarging,
painless thyroid nodule. Laboratory testing shows an elevated
thyroid stimulating hormone level and a positive anti-thyroid
peroxidase and anti-thyroglobulin antibodies. Histological exam
shows dense lymphoplasmacytic infiltrate with the formation of
lymphoid follicles. What is this patient at risk for developing?
Answer:
Lymphoma
Question 11: A 67-year-old woman is newly diagnosed with type 2
diabetes mellitus. Her blood pressure is above 140/90 mmHg on 3
separate occasions, 2 weeks apart. Laboratory tests show a BUN of
15 mg/dL, creatinine of 1.1 mg/dL, and spot urine microalbumin of
100 mcg/mg creatinine. Which of the following medications would
be most appropriate?
Answer:
Angiotensin-converting enzyme (ACE) inhibitor
Question 12: A patient is admitted with acute appendicitis. He is to
receive nothing by mouth (NPO). The patient says, "I am supposed
to take glyburide 5 mg by mouth daily." His glucose level on
admission is 362 mg/dlL He is to receive 10 units of regular human
insulin subcutaneously without delay. Which of the following
explanations should be given to the patient?
Answer:
Subcutaneous insulin is only temporary while the patient is NPO.
Question 13: A 55-year-old woman presents to the clinic for a
follow-up. Her past medical history is significant for hypertension
and type 2 diabetes mellitus. She is currently taking lisinopril and
metformin. She reports feeling well and exercising 3-4 times per
NURSE FINAL -
COMPLETE QUESTIONS AND DETAILED SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: 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
Question 2: 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
Question 3: 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 of this
patient's treatment?
,Answer:
Decrease the ventricular rate below 100/min
Question 4: A 65-year-old man presents to the emergency
department with palpitations, lightheadedness, and chest
discomfort. He has a history of hypertension and mitral stenosis.
His vital signs include a heart rate of 141/minute, blood pressure of
110/78 mm Hg, and oxygen saturation of 97% on room air. A 12-lead
electrocardiogram is shown. Which of the following best describes
the rate of atrial activity associated with this patient's condition?
Answer:
More than 350/minute
Question 5: A 45-year-old man presents for a two-month history of
worsening dyspnea. He denies a history of fever and sore throat
with joint pain during childhood. On examination, he is found to
have displaced, thrusting apex beats and a systolic murmur. His
echocardiographic images are shown below. What is the definitive
management for this patient's condition?
Answer:
Mitral valve repair or replacement
Question 6: A 65-year-old man presents with complaints of
palpitation, dizziness, and dyspnea for the past 2 hours. The patient
has a past medical history significant for hypertension, diabetes
mellitus, and hyperthyroidism. An electrocardiogram (ECG) is
shown. After initial stabilization, the patient is discharged with a
Holter monitor and asked to return after 7 days. At his next visit,
ECG tracings show similar findings as seen on his first visit. The
patient's condition can be classified as which of the following?
Answer:
,Persistent atrial fibrillation
Question 7: A 65-year-old man presents with complaints of
palpitations, dyspnea, and chest discomfort. The patient has
hypertension and diabetes mellitus. His blood pressure is 140/90
mmHg, heart rate 120/min, and respiratory rate 23/min. An
electrocardiogram is performed, which is shown in the image.
Which of the following valvular diseases is associated with this
patient's condition?
Answer:
Mitral stenosis
Question 8: A 75-year-old man with a history of hypertension
presents to the emergency department with dizziness,
lightheadedness, and palpitations that started this morning. He
reports occasional palpitations at home while climbing stairs or
doing heavy work, but these episodes do not last more than a few
minutes. His blood pressure is 95/70 mm Hg, heart rate 125 bpm,
respiratory rate 22 breaths/min, and oxygen saturation 95% on
room air. The physical examination findings are unremarkable. An
electrocardiogram is negative for ST-segment changes or T-wave
abnormalities. A rhythm strip is shown below. What is the best next
step in the management of this patient?
Answer:
Intravenous fluid bolus followed by intravenous metoprolol
Question 9: What is the most appropriate goal while treating a
patient with atrial fibrillation?
Answer:
To reduce the ventricular response rate below 100 beats/minute
, Question 10: A 65-year-old man presents with an enlarging,
painless thyroid nodule. Laboratory testing shows an elevated
thyroid stimulating hormone level and a positive anti-thyroid
peroxidase and anti-thyroglobulin antibodies. Histological exam
shows dense lymphoplasmacytic infiltrate with the formation of
lymphoid follicles. What is this patient at risk for developing?
Answer:
Lymphoma
Question 11: A 67-year-old woman is newly diagnosed with type 2
diabetes mellitus. Her blood pressure is above 140/90 mmHg on 3
separate occasions, 2 weeks apart. Laboratory tests show a BUN of
15 mg/dL, creatinine of 1.1 mg/dL, and spot urine microalbumin of
100 mcg/mg creatinine. Which of the following medications would
be most appropriate?
Answer:
Angiotensin-converting enzyme (ACE) inhibitor
Question 12: A patient is admitted with acute appendicitis. He is to
receive nothing by mouth (NPO). The patient says, "I am supposed
to take glyburide 5 mg by mouth daily." His glucose level on
admission is 362 mg/dlL He is to receive 10 units of regular human
insulin subcutaneously without delay. Which of the following
explanations should be given to the patient?
Answer:
Subcutaneous insulin is only temporary while the patient is NPO.
Question 13: A 55-year-old woman presents to the clinic for a
follow-up. Her past medical history is significant for hypertension
and type 2 diabetes mellitus. She is currently taking lisinopril and
metformin. She reports feeling well and exercising 3-4 times per
