MSN 622 final exam questions with correct
answers
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 |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? |- |CORRECT |ANSWER✔✔-
Sildenafil
A |55-year-old |asymptomatic, |female |smoker, |with |an |extensive |family |history |of |premature |
coronary |artery |disease, |presents |to |the |office |for |further |cardiovascular |risk |stratification. |Her
|10-year |ASCVD |risk |score |by |the |pool |cohort |equation |is |5.3%, |and |she |is |concerned |about |
testing |for |further |risk |stratification |as |she |is |reluctant |to |take |medications. |Which |of |the |
following |is |most |appropriate |to |order |to |assist |in |treatment |decision |making? |- |CORRECT |
ANSWER✔✔-Coronary |artery |calcium |scoring
A |50-year-old |man |presents |to |the |clinic |for |recurrent |headaches. |His |office |blood |pressure |
has |been |consistently |found |to |be |elevated. |He |is |not |on |any |hypertensive |agent. |Home |blood
|pressure |diary |measurements |reveal |an |average |systolic |blood |pressure |(SBP) |of |135 |mm |Hg |
and |diastolic |blood |pressure |(DBP) |of |85 |mm |Hg |over |3 |weeks. |The |chemistry |panel |and |
answers
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 |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? |- |CORRECT |ANSWER✔✔-
Sildenafil
A |55-year-old |asymptomatic, |female |smoker, |with |an |extensive |family |history |of |premature |
coronary |artery |disease, |presents |to |the |office |for |further |cardiovascular |risk |stratification. |Her
|10-year |ASCVD |risk |score |by |the |pool |cohort |equation |is |5.3%, |and |she |is |concerned |about |
testing |for |further |risk |stratification |as |she |is |reluctant |to |take |medications. |Which |of |the |
following |is |most |appropriate |to |order |to |assist |in |treatment |decision |making? |- |CORRECT |
ANSWER✔✔-Coronary |artery |calcium |scoring
A |50-year-old |man |presents |to |the |clinic |for |recurrent |headaches. |His |office |blood |pressure |
has |been |consistently |found |to |be |elevated. |He |is |not |on |any |hypertensive |agent. |Home |blood
|pressure |diary |measurements |reveal |an |average |systolic |blood |pressure |(SBP) |of |135 |mm |Hg |
and |diastolic |blood |pressure |(DBP) |of |85 |mm |Hg |over |3 |weeks. |The |chemistry |panel |and |
