MSN 622 FINAL EXAM NEWEST 2024/2025ACTUAL EXAM COMP
n n n n n n n
LETE 116 QUESTIONS AND CORRECT ANSWERS
n n n n n
(VERIFIED ANSWERS) n
blowing - CORRECT ANSWER A 67-year- n n n n n
old man with a history of hypertension and tobacco use presents with a two
n n n n n n n n n n n n n
-day history of hypogastric pain. An examination reveals a 5 cm, non-
n n n n n n n n n n n
tender, pulsatile abdominal mass above the umbilicus. Which of the follo
n n n n n n n n n n
wing type of sounds might be heard upon auscultation at the midline, two i
n n n n n n n n n n n n n
nches cephalad to the umbilicus?
n n n n
ultrasound every 3 years - n n n n
CORRECT ANSWER What is the recommended management for a patient
n n n n n n n n n n n
with a 3.5 cm abdominal aortic aneurysm?
n n n n n n
immediate surgery - CORRECT ANSWER A 75-year- n n n n n n
old man presents to the emergency department with complaints of severe a
n n n n n n n n n n n
bdominal pain and sweating. The pain started about an hour ago and is beco
n n n n n n n n n n n n n
ming worse with time. He has been diagnosed with hypertension and diabe
n n n n n n n n n n n
tes and is on amlodipine and metformin, respectively. On presentation, the
n n n n n n n n n n n
vital signs show blood pressure 70/40 mmHg, pulse 140/min, respiratory r
n n n n n n n n n n
ate 32/min, temperature 38.5 C (101.3 F), and oxygen saturation 87% at ro
n n n n n n n n n n n n
om air. On physical examination of the abdomen, generalized tenderness a
n n n n n n n n n n
nd guarding are seen. There is a midline pulsatile mass.
n n n n n n n n n
What is the next best step in the management of this patient?
n n n n n n n n n n n
,abdominal CT - CORRECT ANSWER A 67-year- n n n n n n
old male with a history of hypertension and nicotine dependence presents t
n n n n n n n n n n n
o the emergency department with sudden onset of abdominal pain radiatin
n n n n n n n n n n
g to the back. There is no history of alcohol use. On examination, he is thin,
n n n n n n n n n n n n n n n
npale, and diaphoretic. His vital signs show a blood pressure of 110/70 mm
n n n n n n n n n n n n
Hg and a heart rate of 95 bpm. Which of the following is most likely to conf
n n n n n n n n n n n n n n n n
irm the diagnosis? n n
Surgery will improve 5-year survival - CORRECT ANSWER A 78-
n n n n n n n n n
nyear-
old is found to have an asymptomatic pulsatile abdominal mass. The ultra
n n n n n n n n n n n
sound shows an abdominal aortic aneurysm measuring 5.5 cm. Which of t
n n n n n n n n n n n
he following statements concerning this patient's condition is correct?
n n n n n n n n
stress electrocardiogram - CORRECT ANSWER A 65-year-
n n n n n n
old man presents to the office with complaints of occasional chest pain. Th
n n n n n n n n n n n n
e patient has a past medical history significant for hypertension, diabetes
n n n n n n n n n n n
mellitus, and hyperlipidemia. The patient states he experiences chest pain
n n n n n n n n n n
on exertion, which is only relieved on rest. An electrocardiogram is normal
n n n n n n n n n n n
. Which of the following is the next step in management?
n n n n n n n n n n
Determining the precipitating factors for his condition - n n n n n n n
nCORRECT ANSWER A 65-year- n n n
old man presents with complaints of chest pain that started 30 mins ago but
n n n n n n n n n n n n n n
stopped on his way to the hospital. The patient has a past medical history si
n n n n n n n n n n n n n n
gnificant for hypertension and diabetes mellitus. An electrocardiogram (E
n n n n n n n n
CG) is normal. A stress ECG shows mild ST elevations after 12 minutes of
n n n n n n n n n n n n n n
exercise. A diagnosis of stable angina is made. Which of the following shou
n n n n n n n n n n n n
ld be the first step in counseling the patient about his condition?
n n n n n n n n n n n
,hypertensive emergency - CORRECT ANSWER A 47-year- n n n n n n
old male presents to the office for routine health maintenance. His blood pr
n n n n n n n n n n n n
essure is 182/138, with all other vital signs within normal limits. The patie
n n n n n n n n n n n n
nt is currently complaining of a headache and blurred vision but denies che
n n n n n n n n n n n n
st pain, shortness of breath, and abdominal pain. Under which of the follo
n n n n n n n n n n n n
wing forms of hypertension would this patient be classified
n n n n n n n n
Losartan/hydrochlorothiazide and atorvastatin - n n n
CORRECT ANSWER A 65-year-
n n n n
old male with a history of type 2 diabetes comes into the provider's office c
n n n n n n n n n n n n n n
omplaining of blurry vision, nosebleeds, and exertional chest pain for the p
n n n n n n n n n n n
ast six months. The blood pressure is measured to be 160/94 mmHg. A CT
n n n n n n n n n n n n n n
angiogram is performed, which reveals partially occlusive coronary artery
n n n n n n n n
plaques. Which of the following medication regimens would be most appr
n n n n n n n n n n n
opriate for this patient? n n n
Reassure him that this is expected from his ACE inhibitor and continue the
n n n n n n n n n n n n
rapy with periodic monitoring. - CORRECT ANSWER A 68-year-
n n n n n n n n
nold male with a past medical history of type 2 diabetes mellitus and diabeti
n n n n n n n n n n n n n
c nephropathy presented to the clinic for a follow-
n n n n n n n n
up appointment. His blood pressure on the last visit was 150/90 mmHg. He
n n n n n n n n n n n n
nwas called in for a follow-
n n n n n
up appointment in 4 weeks to monitor his blood pressure. The blood pressu
n n n n n n n n n n n n
re on this visit is 168/105 mmHg, and HbA1c is 8.9%. His antihypertensive
n n n n n n n n n n n n
nregimen was adjusted, and an ACE inhibitor was added. He is on metformi
n n n n n n n n n n n n
n and sitagliptin for diabetes mellitus. One week later, his blood pressure w
n n n n n n n n n n n n
as 130/80 mmHg, the patient's potassium was 5.1 mEq/L, sodium was 133
n n n n n n n n n n n n
mEq/L, and the rest of the renal panel was within normal limits. He reports
n n n n n n n n n n n n n n
no symptoms.n
What is the next best step in his care?
n n n n n n n n
, Reassurance - CORRECT ANSWER A 50-year- n n n n n
old man presents to the clinic for routine evaluation. His systolic blood pres
n n n n n n n n n n n n
sure has persistently been in the 150-
n n n n n n
160 mmHg range. Treatment with ramipril is initiated.
n n n n n n n
On the next visit, he complained of an itchy throat and a dry cough, which i
n n n n n n n n n n n n n n n
s not distressing for him, but he is concerned that there might be something
n n n n n n n n n n n n n n
serious as he used to smoke but quit 5 years ago. A chest x-
n n n n n n n n n n n n n
nray is within normal limits. What is the next best step in the management of
n n n n n n n n n n n n n n n
this patient? n
Assess the accuracy of his digital BP readings -
n n n n n n n n
CORRECT ANSWER A 65-year-
n n n n
old man presents for a review of his medications. The patient states his bloo
n n n n n n n n n n n n n
d pressure (BP) is always elevated whenever he checks it with his digital B
n n n n n n n n n n n n n
P monitoring machine, despite taking all of his medications. He has a past
n n n n n n n n n n n n n
medical history significant for hypertension, diabetes mellitus, and hyperli
n n n n n n n n
pidemia. Laboratory evaluation reveals a normal random blood glucose lev
n n n n n n n n n
el and a normal lipid profile. Which of the following is the most appropriate
n n n n n n n n n n n n n
initial step before changing the patient's antihypertensive medication?
n n n n n n n n
clopidogrel - CORRECT ANSWER A 65-year- n n n n n
old man presents with episodic substernal pain. Initially, he experienced ch
n n n n n n n n n n
est pain with physical activity, which remits with rest. But now it occurs at
n n n n n n n n n n n n n n
rest too. He has a history of hypertension and smokes 30 cigarettes/day. In
n n n n n n n n n n n n n
addition, he has aspirin hypersensitivity. His blood pressure is 145/90 mm
n n n n n n n n n n
Hg, pulse is 78/min, and oxygen saturation is 97%. Physical examination is
n n n n n n n n n n n
unremarkable. ECG reveals mild ST-segment depressions in V1-
n n n n n n n n
V2. Cardiac troponins are not elevated. Which of the following is the best o
n n n n n n n n n n n n n
ption for the management in this patient?
n n n n n n
n n n n n n n
LETE 116 QUESTIONS AND CORRECT ANSWERS
n n n n n
(VERIFIED ANSWERS) n
blowing - CORRECT ANSWER A 67-year- n n n n n
old man with a history of hypertension and tobacco use presents with a two
n n n n n n n n n n n n n
-day history of hypogastric pain. An examination reveals a 5 cm, non-
n n n n n n n n n n n
tender, pulsatile abdominal mass above the umbilicus. Which of the follo
n n n n n n n n n n
wing type of sounds might be heard upon auscultation at the midline, two i
n n n n n n n n n n n n n
nches cephalad to the umbilicus?
n n n n
ultrasound every 3 years - n n n n
CORRECT ANSWER What is the recommended management for a patient
n n n n n n n n n n n
with a 3.5 cm abdominal aortic aneurysm?
n n n n n n
immediate surgery - CORRECT ANSWER A 75-year- n n n n n n
old man presents to the emergency department with complaints of severe a
n n n n n n n n n n n
bdominal pain and sweating. The pain started about an hour ago and is beco
n n n n n n n n n n n n n
ming worse with time. He has been diagnosed with hypertension and diabe
n n n n n n n n n n n
tes and is on amlodipine and metformin, respectively. On presentation, the
n n n n n n n n n n n
vital signs show blood pressure 70/40 mmHg, pulse 140/min, respiratory r
n n n n n n n n n n
ate 32/min, temperature 38.5 C (101.3 F), and oxygen saturation 87% at ro
n n n n n n n n n n n n
om air. On physical examination of the abdomen, generalized tenderness a
n n n n n n n n n n
nd guarding are seen. There is a midline pulsatile mass.
n n n n n n n n n
What is the next best step in the management of this patient?
n n n n n n n n n n n
,abdominal CT - CORRECT ANSWER A 67-year- n n n n n n
old male with a history of hypertension and nicotine dependence presents t
n n n n n n n n n n n
o the emergency department with sudden onset of abdominal pain radiatin
n n n n n n n n n n
g to the back. There is no history of alcohol use. On examination, he is thin,
n n n n n n n n n n n n n n n
npale, and diaphoretic. His vital signs show a blood pressure of 110/70 mm
n n n n n n n n n n n n
Hg and a heart rate of 95 bpm. Which of the following is most likely to conf
n n n n n n n n n n n n n n n n
irm the diagnosis? n n
Surgery will improve 5-year survival - CORRECT ANSWER A 78-
n n n n n n n n n
nyear-
old is found to have an asymptomatic pulsatile abdominal mass. The ultra
n n n n n n n n n n n
sound shows an abdominal aortic aneurysm measuring 5.5 cm. Which of t
n n n n n n n n n n n
he following statements concerning this patient's condition is correct?
n n n n n n n n
stress electrocardiogram - CORRECT ANSWER A 65-year-
n n n n n n
old man presents to the office with complaints of occasional chest pain. Th
n n n n n n n n n n n n
e patient has a past medical history significant for hypertension, diabetes
n n n n n n n n n n n
mellitus, and hyperlipidemia. The patient states he experiences chest pain
n n n n n n n n n n
on exertion, which is only relieved on rest. An electrocardiogram is normal
n n n n n n n n n n n
. Which of the following is the next step in management?
n n n n n n n n n n
Determining the precipitating factors for his condition - n n n n n n n
nCORRECT ANSWER A 65-year- n n n
old man presents with complaints of chest pain that started 30 mins ago but
n n n n n n n n n n n n n n
stopped on his way to the hospital. The patient has a past medical history si
n n n n n n n n n n n n n n
gnificant for hypertension and diabetes mellitus. An electrocardiogram (E
n n n n n n n n
CG) is normal. A stress ECG shows mild ST elevations after 12 minutes of
n n n n n n n n n n n n n n
exercise. A diagnosis of stable angina is made. Which of the following shou
n n n n n n n n n n n n
ld be the first step in counseling the patient about his condition?
n n n n n n n n n n n
,hypertensive emergency - CORRECT ANSWER A 47-year- n n n n n n
old male presents to the office for routine health maintenance. His blood pr
n n n n n n n n n n n n
essure is 182/138, with all other vital signs within normal limits. The patie
n n n n n n n n n n n n
nt is currently complaining of a headache and blurred vision but denies che
n n n n n n n n n n n n
st pain, shortness of breath, and abdominal pain. Under which of the follo
n n n n n n n n n n n n
wing forms of hypertension would this patient be classified
n n n n n n n n
Losartan/hydrochlorothiazide and atorvastatin - n n n
CORRECT ANSWER A 65-year-
n n n n
old male with a history of type 2 diabetes comes into the provider's office c
n n n n n n n n n n n n n n
omplaining of blurry vision, nosebleeds, and exertional chest pain for the p
n n n n n n n n n n n
ast six months. The blood pressure is measured to be 160/94 mmHg. A CT
n n n n n n n n n n n n n n
angiogram is performed, which reveals partially occlusive coronary artery
n n n n n n n n
plaques. Which of the following medication regimens would be most appr
n n n n n n n n n n n
opriate for this patient? n n n
Reassure him that this is expected from his ACE inhibitor and continue the
n n n n n n n n n n n n
rapy with periodic monitoring. - CORRECT ANSWER A 68-year-
n n n n n n n n
nold male with a past medical history of type 2 diabetes mellitus and diabeti
n n n n n n n n n n n n n
c nephropathy presented to the clinic for a follow-
n n n n n n n n
up appointment. His blood pressure on the last visit was 150/90 mmHg. He
n n n n n n n n n n n n
nwas called in for a follow-
n n n n n
up appointment in 4 weeks to monitor his blood pressure. The blood pressu
n n n n n n n n n n n n
re on this visit is 168/105 mmHg, and HbA1c is 8.9%. His antihypertensive
n n n n n n n n n n n n
nregimen was adjusted, and an ACE inhibitor was added. He is on metformi
n n n n n n n n n n n n
n and sitagliptin for diabetes mellitus. One week later, his blood pressure w
n n n n n n n n n n n n
as 130/80 mmHg, the patient's potassium was 5.1 mEq/L, sodium was 133
n n n n n n n n n n n n
mEq/L, and the rest of the renal panel was within normal limits. He reports
n n n n n n n n n n n n n n
no symptoms.n
What is the next best step in his care?
n n n n n n n n
, Reassurance - CORRECT ANSWER A 50-year- n n n n n
old man presents to the clinic for routine evaluation. His systolic blood pres
n n n n n n n n n n n n
sure has persistently been in the 150-
n n n n n n
160 mmHg range. Treatment with ramipril is initiated.
n n n n n n n
On the next visit, he complained of an itchy throat and a dry cough, which i
n n n n n n n n n n n n n n n
s not distressing for him, but he is concerned that there might be something
n n n n n n n n n n n n n n
serious as he used to smoke but quit 5 years ago. A chest x-
n n n n n n n n n n n n n
nray is within normal limits. What is the next best step in the management of
n n n n n n n n n n n n n n n
this patient? n
Assess the accuracy of his digital BP readings -
n n n n n n n n
CORRECT ANSWER A 65-year-
n n n n
old man presents for a review of his medications. The patient states his bloo
n n n n n n n n n n n n n
d pressure (BP) is always elevated whenever he checks it with his digital B
n n n n n n n n n n n n n
P monitoring machine, despite taking all of his medications. He has a past
n n n n n n n n n n n n n
medical history significant for hypertension, diabetes mellitus, and hyperli
n n n n n n n n
pidemia. Laboratory evaluation reveals a normal random blood glucose lev
n n n n n n n n n
el and a normal lipid profile. Which of the following is the most appropriate
n n n n n n n n n n n n n
initial step before changing the patient's antihypertensive medication?
n n n n n n n n
clopidogrel - CORRECT ANSWER A 65-year- n n n n n
old man presents with episodic substernal pain. Initially, he experienced ch
n n n n n n n n n n
est pain with physical activity, which remits with rest. But now it occurs at
n n n n n n n n n n n n n n
rest too. He has a history of hypertension and smokes 30 cigarettes/day. In
n n n n n n n n n n n n n
addition, he has aspirin hypersensitivity. His blood pressure is 145/90 mm
n n n n n n n n n n
Hg, pulse is 78/min, and oxygen saturation is 97%. Physical examination is
n n n n n n n n n n n
unremarkable. ECG reveals mild ST-segment depressions in V1-
n n n n n n n n
V2. Cardiac troponins are not elevated. Which of the following is the best o
n n n n n n n n n n n n n
ption for the management in this patient?
n n n n n n
