MSN 621 UPDATED 2026 EXAM QUESTIONS AND
SOLUTIONS RATED A+
✔✔A 65-year-old man presents with a dry cough and wheezing, particularly at night. His
history is significant for asthma, and he is on inhaled formoterol and low-dose
budesonide twice a day and occasional use of an albuterol inhaler as required. He is
now more short of breath with morning drops in his peak flow readings. On physical
examination, he is mildly dyspneic but able to complete sentences. On auscultation,
there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in management? - ✔✔Increase
inhaled budesonide dose.
✔✔A 35-year-old woman presents to the out-patient department with complaints of
cough with whitish sputum production for the past 3 months. She mentions that the
cough worsens at night. She has no other complaints. The patient mentions that she
has tried chlorpheniramine for a week, and no improvement was noted. She has a
history of gastroesophageal reflux disease, for which she takes famotidine. She has
been smoking a pack of cigarettes daily for the past 7 years and drinks alcohol socially.
Vitals show blood pressure 133/85 mmHg, heart rate 79 bpm, respiratory rate 14
breaths/min, and temperature 98.6 °F (37 °C). Pulmonary examination reveals normal
breath sounds bilaterally. A chest x-ray is normal. Which of the following is the best next
step in the management of the patient's condition? - ✔✔Pulmonary function tests
✔✔A 78-year-old male presents to the clinic with complaints of a cough that started
three days ago. The cough is associated with sputum, which is scanty in volume and
yellow in color. He also complains of mild headaches and a stuffy nose for the last two
days. On further questioning, he reveals that he has had two similar episodes
previously, which subsided within a week. A detailed medical history reveals that he
was diagnosed with diabetes mellitus twenty years ago and is on metformin. His vital
signs show a blood pressure of 100/80 mmHg, a respiratory rate of 14/min, a heart rate
of 88/min, and a temperature of 99 F (37.1 C). Auscultation of the chest was performed,
which reveals bilateral coarse rhonchi, whereas a chest x-ray is normal. What is the
most appropriate next step in the management of his condition? - ✔✔Antibiotics and
antitussives
✔✔A nursing home patient with chronic obstructive pulmonary disease (COPD) and
chronic carbon dioxide retention is wheezing. The oxygen saturation drops from 93 to
90. Which of the following would be most appropriate? - ✔✔Treat with albuterol by
nebulizer
✔✔A 70-year-old man presents for a follow-up visit. His past medical history is
significant for severe chronic obstructive pulmonary disease (COPD) and multiple
hospital admissions for exacerbations. He uses a budesonide/formoterol combination
and tiotropium inhalers. He has a 40-pack-year smoking history. He is up-to-date with
, his influenza and pneumococcal vaccines. What should be advised to decrease his
COPD exacerbations? - ✔✔Start him on roflumilast.
✔✔A middle-aged man presents with an exacerbation of his chronic obstructive
pulmonary disease (COPD). He is coughing and moderately short of breath for the past
2 days. He says that his inhalers do work, but he ran out of supplies. He complains of
general malaise. You decide to start him on antibiotics after obtaining sputum for Gram
stain and culture. Which of the following organisms is involved in COPD exacerbation
according to the 2015 Global Initiative for Chronic Obstructive Lung Disease? -
✔✔Moraxella catarrhalis
✔✔A 65-year-old man presents with worsening shortness of breath and a productive
cough for 6 months. His medical history includes hypertension and chronic kidney
disease. He has a 30-pack-year smoking history. His vital signs are blood pressure
145/95 mm Hg, heart rate 88 bpm, and oxygen saturation 92% on room air. On physical
examination, he is not using his accessory muscles of respiration. On lung auscultation,
there is decreased air movement and prolonged expiration. There are no wheezes
heard and no S3 or S4 auscultated. There is no jugular vein distention. He has no lower
extremity edema and denies chest pain or calf tenderness. Chest x-ray reveals bilateral
hyperinflated lung fields. Which of the following is the next best step in evaluation? -
✔✔Spirometry
✔✔A 28-year-old man with a medical history significant for asthma presents to the
primary care office for complaints of cough and shortness of breath for 24 hours. His
symptoms started abruptly and are progressively worsening. He denies fevers or chills
and has had no known exposure to sick contacts. Vital signs are within normal limits,
including oxygen saturation. The peak flow is 400 LPM. Physical examination is
significant for mild expiratory wheezing. His asthma has been in remission, and he has
not used any inhalers for a few years. What is the next best step in the treatment of this
patient? - ✔✔Prescribe albuterol
✔✔A 26-year-old woman G1P0000 at 24 weeks gestation presents to the clinic in
October for evaluation of cough, rhinorrhea, and subjective fever for 24 hours. The
patient has no significant past medical history and takes only a prenatal vitamin daily.
Vital signs show temperature 38 °C (100.4 °F), blood pressure 120/80 mm Hg, heart
rate 90 bpm, respirations 18 breaths/min, and oxygen saturation 96% on room air.
Physical exam reveals a mildly ill-appearing gravid female in no acute distress with lung
fields that are clear to auscultation bilaterally. Continuous fetal monitoring is normal.
Nasal swab ELISA is positive for influenza A. Which of the following is the most
appropriate treatment for this patient to decrease the likelihood of progression to viral
pneumonia? - ✔✔Oseltamivir
✔✔A 35-year-old previously healthy male presents for evaluation of coryza, dry cough,
and fever for 4 days duration. The patient reports no significant past medical history,
takes no daily medications, and has no known drug allergies. He reports receiving
SOLUTIONS RATED A+
✔✔A 65-year-old man presents with a dry cough and wheezing, particularly at night. His
history is significant for asthma, and he is on inhaled formoterol and low-dose
budesonide twice a day and occasional use of an albuterol inhaler as required. He is
now more short of breath with morning drops in his peak flow readings. On physical
examination, he is mildly dyspneic but able to complete sentences. On auscultation,
there are wheezes scattered in his chest. His peak expiratory flow rate is 70% of
predicted. What is the most appropriate next step in management? - ✔✔Increase
inhaled budesonide dose.
✔✔A 35-year-old woman presents to the out-patient department with complaints of
cough with whitish sputum production for the past 3 months. She mentions that the
cough worsens at night. She has no other complaints. The patient mentions that she
has tried chlorpheniramine for a week, and no improvement was noted. She has a
history of gastroesophageal reflux disease, for which she takes famotidine. She has
been smoking a pack of cigarettes daily for the past 7 years and drinks alcohol socially.
Vitals show blood pressure 133/85 mmHg, heart rate 79 bpm, respiratory rate 14
breaths/min, and temperature 98.6 °F (37 °C). Pulmonary examination reveals normal
breath sounds bilaterally. A chest x-ray is normal. Which of the following is the best next
step in the management of the patient's condition? - ✔✔Pulmonary function tests
✔✔A 78-year-old male presents to the clinic with complaints of a cough that started
three days ago. The cough is associated with sputum, which is scanty in volume and
yellow in color. He also complains of mild headaches and a stuffy nose for the last two
days. On further questioning, he reveals that he has had two similar episodes
previously, which subsided within a week. A detailed medical history reveals that he
was diagnosed with diabetes mellitus twenty years ago and is on metformin. His vital
signs show a blood pressure of 100/80 mmHg, a respiratory rate of 14/min, a heart rate
of 88/min, and a temperature of 99 F (37.1 C). Auscultation of the chest was performed,
which reveals bilateral coarse rhonchi, whereas a chest x-ray is normal. What is the
most appropriate next step in the management of his condition? - ✔✔Antibiotics and
antitussives
✔✔A nursing home patient with chronic obstructive pulmonary disease (COPD) and
chronic carbon dioxide retention is wheezing. The oxygen saturation drops from 93 to
90. Which of the following would be most appropriate? - ✔✔Treat with albuterol by
nebulizer
✔✔A 70-year-old man presents for a follow-up visit. His past medical history is
significant for severe chronic obstructive pulmonary disease (COPD) and multiple
hospital admissions for exacerbations. He uses a budesonide/formoterol combination
and tiotropium inhalers. He has a 40-pack-year smoking history. He is up-to-date with
, his influenza and pneumococcal vaccines. What should be advised to decrease his
COPD exacerbations? - ✔✔Start him on roflumilast.
✔✔A middle-aged man presents with an exacerbation of his chronic obstructive
pulmonary disease (COPD). He is coughing and moderately short of breath for the past
2 days. He says that his inhalers do work, but he ran out of supplies. He complains of
general malaise. You decide to start him on antibiotics after obtaining sputum for Gram
stain and culture. Which of the following organisms is involved in COPD exacerbation
according to the 2015 Global Initiative for Chronic Obstructive Lung Disease? -
✔✔Moraxella catarrhalis
✔✔A 65-year-old man presents with worsening shortness of breath and a productive
cough for 6 months. His medical history includes hypertension and chronic kidney
disease. He has a 30-pack-year smoking history. His vital signs are blood pressure
145/95 mm Hg, heart rate 88 bpm, and oxygen saturation 92% on room air. On physical
examination, he is not using his accessory muscles of respiration. On lung auscultation,
there is decreased air movement and prolonged expiration. There are no wheezes
heard and no S3 or S4 auscultated. There is no jugular vein distention. He has no lower
extremity edema and denies chest pain or calf tenderness. Chest x-ray reveals bilateral
hyperinflated lung fields. Which of the following is the next best step in evaluation? -
✔✔Spirometry
✔✔A 28-year-old man with a medical history significant for asthma presents to the
primary care office for complaints of cough and shortness of breath for 24 hours. His
symptoms started abruptly and are progressively worsening. He denies fevers or chills
and has had no known exposure to sick contacts. Vital signs are within normal limits,
including oxygen saturation. The peak flow is 400 LPM. Physical examination is
significant for mild expiratory wheezing. His asthma has been in remission, and he has
not used any inhalers for a few years. What is the next best step in the treatment of this
patient? - ✔✔Prescribe albuterol
✔✔A 26-year-old woman G1P0000 at 24 weeks gestation presents to the clinic in
October for evaluation of cough, rhinorrhea, and subjective fever for 24 hours. The
patient has no significant past medical history and takes only a prenatal vitamin daily.
Vital signs show temperature 38 °C (100.4 °F), blood pressure 120/80 mm Hg, heart
rate 90 bpm, respirations 18 breaths/min, and oxygen saturation 96% on room air.
Physical exam reveals a mildly ill-appearing gravid female in no acute distress with lung
fields that are clear to auscultation bilaterally. Continuous fetal monitoring is normal.
Nasal swab ELISA is positive for influenza A. Which of the following is the most
appropriate treatment for this patient to decrease the likelihood of progression to viral
pneumonia? - ✔✔Oseltamivir
✔✔A 35-year-old previously healthy male presents for evaluation of coryza, dry cough,
and fever for 4 days duration. The patient reports no significant past medical history,
takes no daily medications, and has no known drug allergies. He reports receiving
