MSN 622 FINAL EXAM NEWEST 2024 ACTUAL EXAM
COMPLETE 160 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
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? - 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)? - 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? - ANSWER: A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? -
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? - 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)? - 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? - 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? -
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? - 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? - 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? - 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? - 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? - 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 electrocardiogram are normal. What is the best
initial step in the management of this patient? - ANSWER: Hydrochlorothiazide
A 44-year-old man comes to the clinic for a follow-up. The patient was found to have
elevated blood pressure on his annual physical exam last week. He was thus asked to
keep a blood pressure diary for one week. Today, the diary reveals an average blood
pressure of between 125-135/80-85 mmHg over the past week. Which of the
following the best advice to this patient by the nurse? - ANSWER: Get about 150
minutes of moderate-intensity exercise per week
A 42-year-man with a past medical history of mitral stenosis due to rheumatic heart
disease dies during open-heart surgery. Autopsy findings were consistent with mitral
valve stenosis. Addtitionionally, it also revealed the presence of heart failure cells.
What is the most probable explanation for the presence of these cells? - ANSWER:
Passive congestion of pulmonary parenchyma
Which of the following abnormal types of respirations is seen in patients with heart
failure? - ANSWER: Paroxysmal nocturnal dyspnea
A 42-year-old male is brought to the emergency department after routine evening
exercise with chest tightness and severe pain radiating down the left arm. His blood
pressure is 130/90 mmHg, and his heart rate is 102 beats per minute. The patient
receives a medication that improves his symptoms immediately. Which of the
following medications was most likely given to the patient? - ANSWER: Sublingual
nitroglycerin
A 65-year-old man is diagnosed with ACC/AHA stage A heart failure. This stage is
characterized by which of the following? - ANSWER: Patients at high risk for heart
failure but have no symptoms or structural heart disease
A 65-year-old man presents with complaints of chest pain on exertion, which is
relieved on rest. The patient was diagnosed with asymptomatic coronary artery
disease 6 months ago. However, the patient has been noncompliant with his
COMPLETE 160 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
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? - 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)? - 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? - ANSWER: A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? -
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? - 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)? - 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? - 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? -
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? - 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? - 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? - 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? - 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? - 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 electrocardiogram are normal. What is the best
initial step in the management of this patient? - ANSWER: Hydrochlorothiazide
A 44-year-old man comes to the clinic for a follow-up. The patient was found to have
elevated blood pressure on his annual physical exam last week. He was thus asked to
keep a blood pressure diary for one week. Today, the diary reveals an average blood
pressure of between 125-135/80-85 mmHg over the past week. Which of the
following the best advice to this patient by the nurse? - ANSWER: Get about 150
minutes of moderate-intensity exercise per week
A 42-year-man with a past medical history of mitral stenosis due to rheumatic heart
disease dies during open-heart surgery. Autopsy findings were consistent with mitral
valve stenosis. Addtitionionally, it also revealed the presence of heart failure cells.
What is the most probable explanation for the presence of these cells? - ANSWER:
Passive congestion of pulmonary parenchyma
Which of the following abnormal types of respirations is seen in patients with heart
failure? - ANSWER: Paroxysmal nocturnal dyspnea
A 42-year-old male is brought to the emergency department after routine evening
exercise with chest tightness and severe pain radiating down the left arm. His blood
pressure is 130/90 mmHg, and his heart rate is 102 beats per minute. The patient
receives a medication that improves his symptoms immediately. Which of the
following medications was most likely given to the patient? - ANSWER: Sublingual
nitroglycerin
A 65-year-old man is diagnosed with ACC/AHA stage A heart failure. This stage is
characterized by which of the following? - ANSWER: Patients at high risk for heart
failure but have no symptoms or structural heart disease
A 65-year-old man presents with complaints of chest pain on exertion, which is
relieved on rest. The patient was diagnosed with asymptomatic coronary artery
disease 6 months ago. However, the patient has been noncompliant with his
