MSN 622 FINAL EXAM NEWEST 2024-2025 ACTUAL EXAM COMPLETE 116
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
1. A 67-year-old man with a history of hypertension blowing
and tobacco use presents with a two-day history of
hypogastric pain. An examination reveals a 5 cm,
non-tender, pulsatile abdominal mass above the um-
bilicus. Which of the following type of sounds might
be heard upon auscultation at the midline, two inches
cephalad to the umbilicus?
2. What is the recommended management for a patient ultrasound every 3 years
with a 3.5 cm abdominal aortic aneurysm?
3. A 75-year-old man presents to the emergency depart- immediate surgery
ment with complaints of severe abdominal pain and
sweating. The pain started about an hour ago and is
becoming worse with time. He has been diagnosed
with hypertension and diabetes and is on amlodip-
ine and metformin, respectively. On presentation, the
vital signs show blood pressure 70/40 mmHg, pulse
140/min, respiratory rate 32/min, temperature 38.5
C (101.3 F), and oxygen saturation 87% at room air.
On physical examination of the abdomen, generalized
tenderness and guarding are seen. There is a midline
pulsatile mass. What is the next best step in the man-
agement of this patient?
4. A 67-year-old male with a history of hypertension and abdominal CT
nicotine dependence presents to the emergency de-
partment with sudden onset of abdominal pain radi-
ating to the back. There is no history of alcohol use. On
examination, he is thin, pale, and diaphoretic. His vital
signs show a blood pressure of 110/70 mmHg and a
, MSN 622 FINAL EXAM NEWEST 2024-2025 ACTUAL EXAM COMPLETE 116
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
heart rate of 95 bpm. Which of the following is most
likely to confirm the diagnosis?
5. A 78-year-old is found to have an asymptomatic pul- Surgery will improve
satile abdominal mass. The ultrasound shows an ab- 5-year survival
dominal aortic aneurysm measuring 5.5 cm. Which
of the following statements concerning this patient's
condition is correct?
6. A 65-year-old man presents to the office with com- stress electrocardiogram
plaints of occasional chest pain. The patient has a past
medical history significant for hypertension, diabetes
mellitus, and hyperlipidemia. The patient states he
experiences chest pain on exertion, which is only re-
lieved on rest. An electrocardiogram is normal. Which
of the following is the next step in management?
7. A 65-year-old man presents with complaints of chest Determining the precipi-
pain that started 30 mins ago but stopped on his way tating factors for his con-
to the hospital. The patient has a past medical histo- dition
ry significant for hypertension and diabetes mellitus.
An electrocardiogram (ECG) is normal. A stress ECG
shows mild ST elevations after 12 minutes of exercise.
A diagnosis of stable angina is made. Which of the
following should be the first step in counseling the
patient about his condition?
8. A 47-year-old male presents to the office for routine hypertensive emergency
health maintenance. His blood pressure is 182/138,
with all other vital signs within normal limits. The
patient is currently complaining of a headache and
blurred vision but denies chest pain, shortness of
, MSN 622 FINAL EXAM NEWEST 2024-2025 ACTUAL EXAM COMPLETE 116
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
breath, and abdominal pain. Under which of the fol-
lowing forms of hypertension would this patient be
classified
9. A 65-year-old male with a history of type 2 diabetes Losartan/hydrochloroth-
comes into the provider's office complaining of blurry iazide and atorvastatin
vision, nosebleeds, and exertional chest pain for the
past six months. The blood pressure is measured to be
160/94 mmHg. A CT angiogram is performed, which
reveals partially occlusive coronary artery plaques.
Which of the following medication regimens would be
most appropriate for this patient?
10. A 68-year-old male with a past medical history of type Reassure him that this is
2 diabetes mellitus and diabetic nephropathy present- expected from his ACE in-
ed to the clinic for a follow-up appointment. His blood hibitor and continue ther-
pressure on the last visit was 150/90 mmHg. He was apy with periodic moni-
called in for a follow-up appointment in 4 weeks to toring.
monitor his blood pressure. The blood pressure on
this visit is 168/105 mmHg, and HbA1c is 8.9%. His an-
tihypertensive regimen was adjusted, and an ACE in-
hibitor was added. He is on metformin and sitagliptin
for diabetes mellitus. One week later, his blood pres-
sure was 130/80 mmHg, the patient's potassium was
5.1 mEq/L, sodium was 133 mEq/L, and the rest of the
renal panel was within normal limits. He reports no
symptoms. What is the next best step in his care?
11. A 50-year-old man presents to the clinic for routine Reassurance
evaluation. His systolic blood pressure has persistent-
ly been in the 150-160 mmHg range. Treatment with
, MSN 622 FINAL EXAM NEWEST 2024-2025 ACTUAL EXAM COMPLETE 116
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
ramipril is initiated. On the next visit, he complained
of an itchy throat and a dry cough, which is not dis-
tressing for him, but he is concerned that there might
be something serious as he used to smoke but quit 5
years ago. A chest x-ray is within normal limits. What is
the next best step in the management of this patient?
12. A 65-year-old man presents for a review of his med- Assess the accuracy of his
ications. The patient states his blood pressure (BP) is digital BP readings
always elevated whenever he checks it with his digital
BP monitoring machine, despite taking all of his med-
ications. He has a past medical history significant for
hypertension, diabetes mellitus, and hyperlipidemia.
Laboratory evaluation reveals a normal random blood
glucose level and a normal lipid profile. Which of the
following is the most appropriate initial step before
changing the patient's antihypertensive medication?
13. A 65-year-old man presents with episodic substernal clopidogrel
pain. Initially, he experienced chest pain with physical
activity, which remits with rest. But now it occurs at
rest too. He has a history of hypertension and smokes
30 cigarettes/day. In addition, he has aspirin hyper-
sensitivity. His blood pressure is 145/90 mmHg, pulse
is 78/min, and oxygen saturation is 97%. Physical ex-
amination is unremarkable. ECG reveals mild ST-seg-
ment depressions in V1-V2. Cardiac troponins are not
elevated. Which of the following is the best option for
the management in this patient?
14.
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
1. A 67-year-old man with a history of hypertension blowing
and tobacco use presents with a two-day history of
hypogastric pain. An examination reveals a 5 cm,
non-tender, pulsatile abdominal mass above the um-
bilicus. Which of the following type of sounds might
be heard upon auscultation at the midline, two inches
cephalad to the umbilicus?
2. What is the recommended management for a patient ultrasound every 3 years
with a 3.5 cm abdominal aortic aneurysm?
3. A 75-year-old man presents to the emergency depart- immediate surgery
ment with complaints of severe abdominal pain and
sweating. The pain started about an hour ago and is
becoming worse with time. He has been diagnosed
with hypertension and diabetes and is on amlodip-
ine and metformin, respectively. On presentation, the
vital signs show blood pressure 70/40 mmHg, pulse
140/min, respiratory rate 32/min, temperature 38.5
C (101.3 F), and oxygen saturation 87% at room air.
On physical examination of the abdomen, generalized
tenderness and guarding are seen. There is a midline
pulsatile mass. What is the next best step in the man-
agement of this patient?
4. A 67-year-old male with a history of hypertension and abdominal CT
nicotine dependence presents to the emergency de-
partment with sudden onset of abdominal pain radi-
ating to the back. There is no history of alcohol use. On
examination, he is thin, pale, and diaphoretic. His vital
signs show a blood pressure of 110/70 mmHg and a
, MSN 622 FINAL EXAM NEWEST 2024-2025 ACTUAL EXAM COMPLETE 116
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
heart rate of 95 bpm. Which of the following is most
likely to confirm the diagnosis?
5. A 78-year-old is found to have an asymptomatic pul- Surgery will improve
satile abdominal mass. The ultrasound shows an ab- 5-year survival
dominal aortic aneurysm measuring 5.5 cm. Which
of the following statements concerning this patient's
condition is correct?
6. A 65-year-old man presents to the office with com- stress electrocardiogram
plaints of occasional chest pain. The patient has a past
medical history significant for hypertension, diabetes
mellitus, and hyperlipidemia. The patient states he
experiences chest pain on exertion, which is only re-
lieved on rest. An electrocardiogram is normal. Which
of the following is the next step in management?
7. A 65-year-old man presents with complaints of chest Determining the precipi-
pain that started 30 mins ago but stopped on his way tating factors for his con-
to the hospital. The patient has a past medical histo- dition
ry significant for hypertension and diabetes mellitus.
An electrocardiogram (ECG) is normal. A stress ECG
shows mild ST elevations after 12 minutes of exercise.
A diagnosis of stable angina is made. Which of the
following should be the first step in counseling the
patient about his condition?
8. A 47-year-old male presents to the office for routine hypertensive emergency
health maintenance. His blood pressure is 182/138,
with all other vital signs within normal limits. The
patient is currently complaining of a headache and
blurred vision but denies chest pain, shortness of
, MSN 622 FINAL EXAM NEWEST 2024-2025 ACTUAL EXAM COMPLETE 116
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
breath, and abdominal pain. Under which of the fol-
lowing forms of hypertension would this patient be
classified
9. A 65-year-old male with a history of type 2 diabetes Losartan/hydrochloroth-
comes into the provider's office complaining of blurry iazide and atorvastatin
vision, nosebleeds, and exertional chest pain for the
past six months. The blood pressure is measured to be
160/94 mmHg. A CT angiogram is performed, which
reveals partially occlusive coronary artery plaques.
Which of the following medication regimens would be
most appropriate for this patient?
10. A 68-year-old male with a past medical history of type Reassure him that this is
2 diabetes mellitus and diabetic nephropathy present- expected from his ACE in-
ed to the clinic for a follow-up appointment. His blood hibitor and continue ther-
pressure on the last visit was 150/90 mmHg. He was apy with periodic moni-
called in for a follow-up appointment in 4 weeks to toring.
monitor his blood pressure. The blood pressure on
this visit is 168/105 mmHg, and HbA1c is 8.9%. His an-
tihypertensive regimen was adjusted, and an ACE in-
hibitor was added. He is on metformin and sitagliptin
for diabetes mellitus. One week later, his blood pres-
sure was 130/80 mmHg, the patient's potassium was
5.1 mEq/L, sodium was 133 mEq/L, and the rest of the
renal panel was within normal limits. He reports no
symptoms. What is the next best step in his care?
11. A 50-year-old man presents to the clinic for routine Reassurance
evaluation. His systolic blood pressure has persistent-
ly been in the 150-160 mmHg range. Treatment with
, MSN 622 FINAL EXAM NEWEST 2024-2025 ACTUAL EXAM COMPLETE 116
QUESTIONS AND CORRECT DETAILED ANSWERS (VERIFIED ANSWERS)
ramipril is initiated. On the next visit, he complained
of an itchy throat and a dry cough, which is not dis-
tressing for him, but he is concerned that there might
be something serious as he used to smoke but quit 5
years ago. A chest x-ray is within normal limits. What is
the next best step in the management of this patient?
12. A 65-year-old man presents for a review of his med- Assess the accuracy of his
ications. The patient states his blood pressure (BP) is digital BP readings
always elevated whenever he checks it with his digital
BP monitoring machine, despite taking all of his med-
ications. He has a past medical history significant for
hypertension, diabetes mellitus, and hyperlipidemia.
Laboratory evaluation reveals a normal random blood
glucose level and a normal lipid profile. Which of the
following is the most appropriate initial step before
changing the patient's antihypertensive medication?
13. A 65-year-old man presents with episodic substernal clopidogrel
pain. Initially, he experienced chest pain with physical
activity, which remits with rest. But now it occurs at
rest too. He has a history of hypertension and smokes
30 cigarettes/day. In addition, he has aspirin hyper-
sensitivity. His blood pressure is 145/90 mmHg, pulse
is 78/min, and oxygen saturation is 97%. Physical ex-
amination is unremarkable. ECG reveals mild ST-seg-
ment depressions in V1-V2. Cardiac troponins are not
elevated. Which of the following is the best option for
the management in this patient?
14.
