1|Page
MSN 622 Final Exam| 2025-2026 LATEST UPDATED | ACTUAL EXAM
QUESTIONS WITH SOLUTIONS | 100% RATED CORRECT | 100%
VERFIED SOLTIONS | ALREADY GRADED A+
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? - (ANSWER)blowing
What is the recommended management for a patient with a 3.5 cm abdominal aortic aneurysm? -
(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? -
(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? - (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? - (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? -
(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 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
,3|Page
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? -
, 4|Page
(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
MSN 622 Final Exam| 2025-2026 LATEST UPDATED | ACTUAL EXAM
QUESTIONS WITH SOLUTIONS | 100% RATED CORRECT | 100%
VERFIED SOLTIONS | ALREADY GRADED A+
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? - (ANSWER)blowing
What is the recommended management for a patient with a 3.5 cm abdominal aortic aneurysm? -
(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? -
(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? - (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? - (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? -
(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 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
,3|Page
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? -
, 4|Page
(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
