MSN 622 final exam with solutions
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 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)? - correct 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? - correct answer -✔A S3 gallop
| | | | | | | | | |
Which of the following may be the initial presentation of long-term
| | | | | | | | | |
hypertension? - correct 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? - correct 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)? - correct answer -✔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, morphine, nitroglycerin, and aspirin. What
| | | | | | | | | |
is the principle behind giving this patient nitroglycerin? - correct answer -✔To
| | | | | | | | | | | |
dilate the venous system and decrease cardiac preload.
| | | | | | | |
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? - correct 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?
| | | | | | | | | | | | | |
- correct 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? - correct 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? - correct 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 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 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)? - correct 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? - correct answer -✔A S3 gallop
| | | | | | | | | |
Which of the following may be the initial presentation of long-term
| | | | | | | | | |
hypertension? - correct 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? - correct 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)? - correct answer -✔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, morphine, nitroglycerin, and aspirin. What
| | | | | | | | | |
is the principle behind giving this patient nitroglycerin? - correct answer -✔To
| | | | | | | | | | | |
dilate the venous system and decrease cardiac preload.
| | | | | | | |
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? - correct 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?
| | | | | | | | | | | | | |
- correct 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? - correct 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? - correct 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.
| | | | | | | | | | |
