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MSN 622 FINAL EXAM QUESTIONS AND
ANSWERS 2025
A 67-year-old man with a history of hypertension 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 umbilicus. Which of the following type of
sounds might be heard upon auscultation at the midline, two
inches cephalad to the umbilicus? - correct answer- blowing
What is the recommended management for a patient with a 3.5
cm abdominal aortic aneurysm? - correct answer- ultrasound
every 3 years
A 75-year-old man presents to the emergency department 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
amlodipine 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 management of this patient? - correct answer- immediate
surgery
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A 67-year-old male with a history of hypertension and nicotine
dependence presents to the emergency department with
sudden onset of abdominal pain radiating 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 heart rate of 95 bpm. Which of the following is
most likely to confirm the diagnosis? - correct answer-
abdominal CT
A 78-year-old is found to have an asymptomatic pulsatile
abdominal mass. The ultrasound shows an abdominal aortic
aneurysm measuring 5.5 cm. Which of the following statements
concerning this patient's condition is correct? - correct answer-
Surgery will improve 5-year survival
A 65-year-old man presents to the office with complaints 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 relieved on rest. An
electrocardiogram is normal. Which of the following is the next
step in management? - correct answer- stress
electrocardiogram
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
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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? - correct 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 -
correct 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? - correct 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
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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? - correct 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? - correct 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
MSN 622 FINAL EXAM QUESTIONS AND
ANSWERS 2025
A 67-year-old man with a history of hypertension 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 umbilicus. Which of the following type of
sounds might be heard upon auscultation at the midline, two
inches cephalad to the umbilicus? - correct answer- blowing
What is the recommended management for a patient with a 3.5
cm abdominal aortic aneurysm? - correct answer- ultrasound
every 3 years
A 75-year-old man presents to the emergency department 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
amlodipine 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 management of this patient? - correct answer- immediate
surgery
,2 | Page
A 67-year-old male with a history of hypertension and nicotine
dependence presents to the emergency department with
sudden onset of abdominal pain radiating 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 heart rate of 95 bpm. Which of the following is
most likely to confirm the diagnosis? - correct answer-
abdominal CT
A 78-year-old is found to have an asymptomatic pulsatile
abdominal mass. The ultrasound shows an abdominal aortic
aneurysm measuring 5.5 cm. Which of the following statements
concerning this patient's condition is correct? - correct answer-
Surgery will improve 5-year survival
A 65-year-old man presents to the office with complaints 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 relieved on rest. An
electrocardiogram is normal. Which of the following is the next
step in management? - correct answer- stress
electrocardiogram
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
,3 | Page
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? - correct 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 -
correct 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? - correct 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
, 4 | Page
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? - correct 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? - correct 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
