MSN 622 final (With complete solution)

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?correct answers 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)?correct answers 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?correct answers A S3 gallop Which of the following may be the initial presentation of long-term hypertension?correct answers 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?correct answers 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)?correct answers Troponin I A 65-year-old man presents with a 4-hour history of progressively worsening left chest pain that radiates to his left neck. A history of present illness reveals 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 pressure 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