MSN 622 FINAL EXAM QUESTION AND ANSWERS
LATEST UPDATED
A 65-year-old man presents with complaints of chest pain that started 30 mins ago but
stopped on his way to the hospital. The patient has a past medical history 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? - ANSWER-Determining the precipitating factors for his condition
A 47-year-old male presents to the office for routine 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 breath, and abdominal pain. Under which of the following forms of
hypertension would this patient be classified - ANSWER-hypertensive emergency
A 65-year-old male with a history of type 2 diabetes comes into the provider's office
complaining of blurry 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? -
ANSWER-Losartan/hydrochlorothiazide and atorvastatin
A 68-year-old male with a past medical history of type 2 diabetes mellitus and diabetic
nephropathy presented to the clinic for a follow-up appointment. His blood pressure on the
last visit was 150/90 mmHg. He was called in for a follow-up appointment in 4 weeks to
monitor his blood pressure. The blood pressure on this visit is 168/105 mmHg, and HbA1c
is 8.9%. His antihypertensive regimen was adjusted, and an ACE inhibitor was added. He
is on metformin and sitagliptin for diabetes mellitus. One week later, his blood pressure
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? - ANSWER-Reassure him that this is expected from his ACE
inhibitor and continue therapy with periodic monitoring.
A 50-year-old man presents to the clinic for routine evaluation. His systolic blood
pressure has persistently been in the 150-160 mmHg range. Treatment with ramipril is
initiated. On the next visit, he complained of an itchy throat and a dry cough, which is
not distressing 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? - ANSWER-Reassurance
A 65-year-old man presents for a review of his medications. The patient states his blood
pressure (BP) is always elevated whenever he checks it with his digital BP monitoring
machine, despite taking all of his medications. 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? - ANSWER-Assess the accuracy of his digital BP readings
A 65-year-old man presents with episodic substernal 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 hypersensitivity. His blood pressure is 145/90 mmHg, pulse is 78/min, and
oxygen saturation is 97%. Physical examination is unremarkable. ECG reveals mild
ST-segment depressions in V1-V2. Cardiac troponins are not elevated. Which of the
following is the best option for the management in this patient? - ANSWER-clopidogrel
A 65-year-old female patient presents with worsening chest pain and blurring of vision.
She has a history of hypertension, diabetes mellitus, hyperlipidemia, renal
insufficiency, and atrial fibrillation. Vital signs show temperature 37.8°C (100 F), heart
rate 98 bpm, blood pressure 190/110 mmHg, respiratory rate 20 breaths/min, and
oxygen saturation 91%. Her complete blood count shows a WBC of 12.0 and
hematocrit 30%. Her eGFR is 39 ml/min/1.73 m2. What is the contraindication for
cardiac catheterization in this patient? - ANSWER-uncontrolled malignant hypertension
A 65-year-old male presents to the emergency department with chest pain for the past
two hours. The pain is located at the precordial region, described as sharp, 7/10
intensity, lasting for 20 minutes, radiating to the upper left upper limb and accompanied
by dyspnea. His past medical history is significant for hypertension and diabetes
mellitus type 2. His blood pressure is 120/80 mmHg, the pulse rate 72/min; the
temperature 98 F. EKG reveals ST-segment depression. What is the best enzyme
assay to diagnose this condition? - ANSWER-troponin
A 65-year-old male presents with severe substernal pain for 20 minutes, radiating to the
upper left limb and accompanied by dyspnea. He has a history of hypertension and
smokes 30 cigarettes/day. His blood pressure is 145/90 mmHg and his pulse is 78/min.
Physical examination is unremarkable. The pain settled promptly following 300 mg
aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray sublingually. What is the most
common underlying pathological cause for this patient's symptoms? - ANSWER-
Coronary artery atherosclerosis
A 65-year-old male client presents to the clinic for routine care after a year. The client
has a long-standing history of hypertension and diabetes. He is non-compliant with his
drug regimen. His vitals are remarkable for a heart rate of 80/min and blood pressure of
166/90 mmHg. The physical exam reveals a loss of sensation to light touch and
proprioception in the toes bilaterally. Which of the following would indicate that the
client has been experiencing episodes of unstable angina at home? - ANSWER-chest
pain while watching TV
A 68-year-old man calls emergency medical services (EMS) with a 20-minute episode
of shortness of breath and substernal chest pain. He has a past medical history of
, hypertension, type 1 diabetes, hyperlipidemia, coronary artery disease, and had a
coronary artery bypass grafting two years ago. His current medications include aspirin,
clopidogrel, atorvastatin, metoprolol, and lisinopril; however, he says he is non-
compliant with his drug regime. An ambulance is fifteen minutes away. The EMS crew
should advise the patient to take which medication before they arrive? - ANSWER-
aspirin 324 mg
A 65-year-old man presents for preoperative evaluation. He plans to undergo bilateral
total knee replacement for osteoarthritis, which has markedly limited his mobility. All
conservative measures for osteoarthritis treatment have failed. He has medical history
significant for hypertension, hyperlipidemia, and smoking. He received one drug-
eluting stent to the left anterior descending artery four months ago for stable ischemic
heart disease. Which of the following is the best step regarding this patient's clearance
for surgery? - ANSWER-defer surgery for at least 2 months
A 55-year-old man calls emergency medical services for sudden onset chest pain,
dizziness, and palpitations. He works as an office secretary and lives a sedentary
lifestyle. He is an active smoker and drinks alcohol only occasionally. Emergency
medical service arrives in a few minutes and gives full dose aspirin to the patient orally.
Current medications are sildenafil for erectile dysfunction and lisinopril for hypertension.
Vital signs show a temperature of 37 C, respiratory rate of 17/min, heart rate of 111/min,
and blood pressure of 88/60 mmHg. He has jugular venous distension, but his lungs are
clear to auscultation. EKG shows ST-segment elevations in leads II, III, and aVF. He
reports severe chest pain, which has not resolved with the aspirin he obtained
sublingually. Which of the following medications or interventions is absolutely
contraindicated in this patient? - ANSWER-Nitroglycerin
A 65-year-old male patient with a history of hypothyroidism, hypertension, and diabetes
mellitus presents to the clinic complaining of worsening weakness. On the physical
exam, he has cold extremities, bibasilar crackles, and wheezing. Which of the following
findings would be expected to be seen in this patient? - ANSWER-decreased urine
output
A 65-year-old man presents with complaints of exertional dyspnea, orthopnea, and
generalized edema. The patient has a past medical history significant for heart failure
with preserved ejection fraction. On examination, bilateral crepitations are present at the
lung bases. Which of the following urinary complaints is associated with the patient's
condition? - ANSWER-nocturia
A patient with congestive heart failure is started on furosemide. They should also be
prescribed which other medication? - ANSWER-lisinopril
A 65-year-old man presents with complaints of orthopnea, exertional dyspnea, and
fatigue. The patient has a past medical history significant for hypertension and diabetes
mellitus. He has been noncompliant with his medications and rarely visits his provider.
The patient is diagnosed with American College of Cardiology (ACC) stage A heart
LATEST UPDATED
A 65-year-old man presents with complaints of chest pain that started 30 mins ago but
stopped on his way to the hospital. The patient has a past medical history 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? - ANSWER-Determining the precipitating factors for his condition
A 47-year-old male presents to the office for routine 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 breath, and abdominal pain. Under which of the following forms of
hypertension would this patient be classified - ANSWER-hypertensive emergency
A 65-year-old male with a history of type 2 diabetes comes into the provider's office
complaining of blurry 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? -
ANSWER-Losartan/hydrochlorothiazide and atorvastatin
A 68-year-old male with a past medical history of type 2 diabetes mellitus and diabetic
nephropathy presented to the clinic for a follow-up appointment. His blood pressure on the
last visit was 150/90 mmHg. He was called in for a follow-up appointment in 4 weeks to
monitor his blood pressure. The blood pressure on this visit is 168/105 mmHg, and HbA1c
is 8.9%. His antihypertensive regimen was adjusted, and an ACE inhibitor was added. He
is on metformin and sitagliptin for diabetes mellitus. One week later, his blood pressure
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? - ANSWER-Reassure him that this is expected from his ACE
inhibitor and continue therapy with periodic monitoring.
A 50-year-old man presents to the clinic for routine evaluation. His systolic blood
pressure has persistently been in the 150-160 mmHg range. Treatment with ramipril is
initiated. On the next visit, he complained of an itchy throat and a dry cough, which is
not distressing 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? - ANSWER-Reassurance
A 65-year-old man presents for a review of his medications. The patient states his blood
pressure (BP) is always elevated whenever he checks it with his digital BP monitoring
machine, despite taking all of his medications. 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? - ANSWER-Assess the accuracy of his digital BP readings
A 65-year-old man presents with episodic substernal 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 hypersensitivity. His blood pressure is 145/90 mmHg, pulse is 78/min, and
oxygen saturation is 97%. Physical examination is unremarkable. ECG reveals mild
ST-segment depressions in V1-V2. Cardiac troponins are not elevated. Which of the
following is the best option for the management in this patient? - ANSWER-clopidogrel
A 65-year-old female patient presents with worsening chest pain and blurring of vision.
She has a history of hypertension, diabetes mellitus, hyperlipidemia, renal
insufficiency, and atrial fibrillation. Vital signs show temperature 37.8°C (100 F), heart
rate 98 bpm, blood pressure 190/110 mmHg, respiratory rate 20 breaths/min, and
oxygen saturation 91%. Her complete blood count shows a WBC of 12.0 and
hematocrit 30%. Her eGFR is 39 ml/min/1.73 m2. What is the contraindication for
cardiac catheterization in this patient? - ANSWER-uncontrolled malignant hypertension
A 65-year-old male presents to the emergency department with chest pain for the past
two hours. The pain is located at the precordial region, described as sharp, 7/10
intensity, lasting for 20 minutes, radiating to the upper left upper limb and accompanied
by dyspnea. His past medical history is significant for hypertension and diabetes
mellitus type 2. His blood pressure is 120/80 mmHg, the pulse rate 72/min; the
temperature 98 F. EKG reveals ST-segment depression. What is the best enzyme
assay to diagnose this condition? - ANSWER-troponin
A 65-year-old male presents with severe substernal pain for 20 minutes, radiating to the
upper left limb and accompanied by dyspnea. He has a history of hypertension and
smokes 30 cigarettes/day. His blood pressure is 145/90 mmHg and his pulse is 78/min.
Physical examination is unremarkable. The pain settled promptly following 300 mg
aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray sublingually. What is the most
common underlying pathological cause for this patient's symptoms? - ANSWER-
Coronary artery atherosclerosis
A 65-year-old male client presents to the clinic for routine care after a year. The client
has a long-standing history of hypertension and diabetes. He is non-compliant with his
drug regimen. His vitals are remarkable for a heart rate of 80/min and blood pressure of
166/90 mmHg. The physical exam reveals a loss of sensation to light touch and
proprioception in the toes bilaterally. Which of the following would indicate that the
client has been experiencing episodes of unstable angina at home? - ANSWER-chest
pain while watching TV
A 68-year-old man calls emergency medical services (EMS) with a 20-minute episode
of shortness of breath and substernal chest pain. He has a past medical history of
, hypertension, type 1 diabetes, hyperlipidemia, coronary artery disease, and had a
coronary artery bypass grafting two years ago. His current medications include aspirin,
clopidogrel, atorvastatin, metoprolol, and lisinopril; however, he says he is non-
compliant with his drug regime. An ambulance is fifteen minutes away. The EMS crew
should advise the patient to take which medication before they arrive? - ANSWER-
aspirin 324 mg
A 65-year-old man presents for preoperative evaluation. He plans to undergo bilateral
total knee replacement for osteoarthritis, which has markedly limited his mobility. All
conservative measures for osteoarthritis treatment have failed. He has medical history
significant for hypertension, hyperlipidemia, and smoking. He received one drug-
eluting stent to the left anterior descending artery four months ago for stable ischemic
heart disease. Which of the following is the best step regarding this patient's clearance
for surgery? - ANSWER-defer surgery for at least 2 months
A 55-year-old man calls emergency medical services for sudden onset chest pain,
dizziness, and palpitations. He works as an office secretary and lives a sedentary
lifestyle. He is an active smoker and drinks alcohol only occasionally. Emergency
medical service arrives in a few minutes and gives full dose aspirin to the patient orally.
Current medications are sildenafil for erectile dysfunction and lisinopril for hypertension.
Vital signs show a temperature of 37 C, respiratory rate of 17/min, heart rate of 111/min,
and blood pressure of 88/60 mmHg. He has jugular venous distension, but his lungs are
clear to auscultation. EKG shows ST-segment elevations in leads II, III, and aVF. He
reports severe chest pain, which has not resolved with the aspirin he obtained
sublingually. Which of the following medications or interventions is absolutely
contraindicated in this patient? - ANSWER-Nitroglycerin
A 65-year-old male patient with a history of hypothyroidism, hypertension, and diabetes
mellitus presents to the clinic complaining of worsening weakness. On the physical
exam, he has cold extremities, bibasilar crackles, and wheezing. Which of the following
findings would be expected to be seen in this patient? - ANSWER-decreased urine
output
A 65-year-old man presents with complaints of exertional dyspnea, orthopnea, and
generalized edema. The patient has a past medical history significant for heart failure
with preserved ejection fraction. On examination, bilateral crepitations are present at the
lung bases. Which of the following urinary complaints is associated with the patient's
condition? - ANSWER-nocturia
A patient with congestive heart failure is started on furosemide. They should also be
prescribed which other medication? - ANSWER-lisinopril
A 65-year-old man presents with complaints of orthopnea, exertional dyspnea, and
fatigue. The patient has a past medical history significant for hypertension and diabetes
mellitus. He has been noncompliant with his medications and rarely visits his provider.
The patient is diagnosed with American College of Cardiology (ACC) stage A heart
