MSN 622 FINAL EXAM || 100
QUESTIONS AND CORRECT ANSWERS
2025 A+ GUARANTEED
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 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? -
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? - 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
QUESTIONS AND CORRECT ANSWERS
2025 A+ GUARANTEED
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 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? -
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? - 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
