MSN 622 FINAL NEWEST ACTUAL EXAM COMPLETE 100
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
A 65-year-old man presents with an episode of gross hematuria. He has no
significant history. An abdominal CT incidentally demonstrates a 6 cm abdominal
aortic aneurysm (AAA). What is the next step in the management of the AAA?
A.
Observation with annual follow-up.
B.
Elective abdominal aortic aneurysm surgery.
C.
Emergency surgery to replace the aneurysm.
D.
Angiogram to determine the size of the abdominal aortic aneurysm. - ANSWER: B.
Elective abdominal aortic aneurysm surgery.
According to the Society for Vascular Surgery (SVS) 2018 guidelines, what is the
recommended management for a patient with a 3.5 cm abdominal aortic aneurysm?
A.
Open repair
B.
Duplex ultrasound every 3 years
C.
Endovascular stenting
D.
CT scan every 12 months - ANSWER: B.
Duplex ultrasound every 3 years
A 65-year-old female is admitted to the hospital with palpitations and shortness of
breath. Her past medical history includes congestive heart failure with an ejection
fraction of 28%, hypertension, and asthma. She reports smoking 4 to 5 cigarettes a
day but no illicit drug use. She takes amlodipine 10 mg once a day, lisinopril 10 mg a
day and uses an albuterol inhaler about once a month in the spring and fall). Physical
exam reveals blood pressure 140/80 mmHg, heart rate 164 bpm, irregular,
respiratory rate 20. EKG results are shown. What is an appropriate rate control
medication for her that would also be useful for her congestive heart failure?(Click
Image to Enlarge)
1. Metoprolol
2. Digoxin
3. Ivabradine
4. Atropine - ANSWER: 1. Metoprolol
A 76-year-old male comes into the emergency department with a complaint of chest
pain. The patient was placed on telemetry monitoring that showed an abnormal
,rhythm at a rate of 160 beats per minute. A 12 lead EKG was performed showing an
irregularly irregular rhythm. He has a history of atrial fibrillation and has been taking
rivaroxaban for the past four months. The patient soon becomes diaphoretic,
unresponsive, and hypotensive. What is the next best step?
1. Give 10 mg IV push of diltiazem bolus for rate control
2. Give 150 mg IV push of amiodarone for rhythm control
3. Immediate cardioversion
4. Begin transcutaneous pacing - ANSWER: 3. Immediate cardioversion
A 65-year-old female patient presents with complaints of periodic, intermittent,
sudden-onset chest pain and shortness of breath, which radiates to her left jaw and
arm. She reports that she tires easily with mild physical activity. Initially, she
experienced chest pain with activity, but now it occurs throughout the day. 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)?
A. Troponin I
B. Echocardiogram
C. Electrocardiogram
D. Creatine kinase (CK) - ANSWER: A. Troponin I
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?
A. Diffuse ST-segment elevation in all the leads
B. Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
C. - ANSWER: B. Deep, symmetric T-wave inversions in V2 and V3 accompanied by
flat ST-segment
A 73-year-old patient presents with a 6-month history of progressive fatigue, with
difficulty climbing stairs and brushing her hair. These symptoms are different than
her usual symptoms. Her medical history is significant for rheumatoid arthritis
diagnosed 15 years ago. During this time, the patient has tried multiple biological
agents with most of these medications discontinued because of adverse effects or
loss of efficacy. The patient declined to try rituximab and requested to continue
steroids. She has been on 10 mg of prednisone daily for about 10 years. Her dose is
increased to 15 mg daily when the patient experiences an increase in joint pain,
,which happens about twice a month. What is the most likely etiology of the patient's
symptoms?
Well done!You answered successfully
A.
The patient has overextended herself and pulled a muscle.
B.
The patient most likely has an infection secondary to steroid use.
C.
The pa - ANSWER: C.
The patient probably has proximal muscle weakness secondary to corticosteroids.
What heart sound would one hear in a patient with systolic congestive heart failure
(CHF)?
1. A systolic murmur
2. A diastolic murmur
3. S3 heart sound
4. A snap in early diastole - ANSWER: 3. S3 heart sound
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?
1. To dilate the venous system and decrease cardiac preload.
2. To increase cardiac afterload and ejection fraction.
3. To dilate the systemic arteries to decrease cardiac - ANSWER: 1. 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?
1. Left ventricular dilatation
2. Left ventricular (concentric) hypertrophy
3. Right ventricular hypertrophy
4. Diffuse myocardial fibrosis - ANSWER: 2. 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?
1. Peripheral edema
2. Pulmonary rales
3. An S3 gallop
4. Kussmaul sign - ANSWER: 3. 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?
1. Left-sided heart failure
2. Pulmonary hypertension
3. Myocardial infarction
4. Chronic obstructive pulmonary disease - ANSWER: 1. Left-sided heart failure
A 60-year-old obese female with congestive heart failure (CHF) presents to her
primary care provider with a complaint of increased abdominal girth. She has
noticed this take place over the last week and is making her feel self-conscious of 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
distended abdomen that is non-tender, and bulging flanks. The liver is non-palpable.
Which of the following is the best assessment of this patient?
1. The patient has a buildup of gas and stool in her abdomen. Give the patient
polyethylene glycol and encourage increased fiber consumption
2. There is a pathologic buildup of fluid in her peritoneum due to abnormal changes
in - ANSWER: 3. 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 patient presents with the complaint of polyphagia and polydipsia. After the
relevant tests, he is diagnosed with diabetes mellitus. Which is the most appropriate
nursing diagnosis?
A.
Ineffective airway clearance
B.
Impaired gas exchange
C.
Knowledge deficit
D.
Self-care deficit - ANSWER: C.
Knowledge deficit
QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
A 65-year-old man presents with an episode of gross hematuria. He has no
significant history. An abdominal CT incidentally demonstrates a 6 cm abdominal
aortic aneurysm (AAA). What is the next step in the management of the AAA?
A.
Observation with annual follow-up.
B.
Elective abdominal aortic aneurysm surgery.
C.
Emergency surgery to replace the aneurysm.
D.
Angiogram to determine the size of the abdominal aortic aneurysm. - ANSWER: B.
Elective abdominal aortic aneurysm surgery.
According to the Society for Vascular Surgery (SVS) 2018 guidelines, what is the
recommended management for a patient with a 3.5 cm abdominal aortic aneurysm?
A.
Open repair
B.
Duplex ultrasound every 3 years
C.
Endovascular stenting
D.
CT scan every 12 months - ANSWER: B.
Duplex ultrasound every 3 years
A 65-year-old female is admitted to the hospital with palpitations and shortness of
breath. Her past medical history includes congestive heart failure with an ejection
fraction of 28%, hypertension, and asthma. She reports smoking 4 to 5 cigarettes a
day but no illicit drug use. She takes amlodipine 10 mg once a day, lisinopril 10 mg a
day and uses an albuterol inhaler about once a month in the spring and fall). Physical
exam reveals blood pressure 140/80 mmHg, heart rate 164 bpm, irregular,
respiratory rate 20. EKG results are shown. What is an appropriate rate control
medication for her that would also be useful for her congestive heart failure?(Click
Image to Enlarge)
1. Metoprolol
2. Digoxin
3. Ivabradine
4. Atropine - ANSWER: 1. Metoprolol
A 76-year-old male comes into the emergency department with a complaint of chest
pain. The patient was placed on telemetry monitoring that showed an abnormal
,rhythm at a rate of 160 beats per minute. A 12 lead EKG was performed showing an
irregularly irregular rhythm. He has a history of atrial fibrillation and has been taking
rivaroxaban for the past four months. The patient soon becomes diaphoretic,
unresponsive, and hypotensive. What is the next best step?
1. Give 10 mg IV push of diltiazem bolus for rate control
2. Give 150 mg IV push of amiodarone for rhythm control
3. Immediate cardioversion
4. Begin transcutaneous pacing - ANSWER: 3. Immediate cardioversion
A 65-year-old female patient presents with complaints of periodic, intermittent,
sudden-onset chest pain and shortness of breath, which radiates to her left jaw and
arm. She reports that she tires easily with mild physical activity. Initially, she
experienced chest pain with activity, but now it occurs throughout the day. 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)?
A. Troponin I
B. Echocardiogram
C. Electrocardiogram
D. Creatine kinase (CK) - ANSWER: A. Troponin I
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?
A. Diffuse ST-segment elevation in all the leads
B. Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
C. - ANSWER: B. Deep, symmetric T-wave inversions in V2 and V3 accompanied by
flat ST-segment
A 73-year-old patient presents with a 6-month history of progressive fatigue, with
difficulty climbing stairs and brushing her hair. These symptoms are different than
her usual symptoms. Her medical history is significant for rheumatoid arthritis
diagnosed 15 years ago. During this time, the patient has tried multiple biological
agents with most of these medications discontinued because of adverse effects or
loss of efficacy. The patient declined to try rituximab and requested to continue
steroids. She has been on 10 mg of prednisone daily for about 10 years. Her dose is
increased to 15 mg daily when the patient experiences an increase in joint pain,
,which happens about twice a month. What is the most likely etiology of the patient's
symptoms?
Well done!You answered successfully
A.
The patient has overextended herself and pulled a muscle.
B.
The patient most likely has an infection secondary to steroid use.
C.
The pa - ANSWER: C.
The patient probably has proximal muscle weakness secondary to corticosteroids.
What heart sound would one hear in a patient with systolic congestive heart failure
(CHF)?
1. A systolic murmur
2. A diastolic murmur
3. S3 heart sound
4. A snap in early diastole - ANSWER: 3. S3 heart sound
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?
1. To dilate the venous system and decrease cardiac preload.
2. To increase cardiac afterload and ejection fraction.
3. To dilate the systemic arteries to decrease cardiac - ANSWER: 1. 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?
1. Left ventricular dilatation
2. Left ventricular (concentric) hypertrophy
3. Right ventricular hypertrophy
4. Diffuse myocardial fibrosis - ANSWER: 2. 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?
1. Peripheral edema
2. Pulmonary rales
3. An S3 gallop
4. Kussmaul sign - ANSWER: 3. 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?
1. Left-sided heart failure
2. Pulmonary hypertension
3. Myocardial infarction
4. Chronic obstructive pulmonary disease - ANSWER: 1. Left-sided heart failure
A 60-year-old obese female with congestive heart failure (CHF) presents to her
primary care provider with a complaint of increased abdominal girth. She has
noticed this take place over the last week and is making her feel self-conscious of 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
distended abdomen that is non-tender, and bulging flanks. The liver is non-palpable.
Which of the following is the best assessment of this patient?
1. The patient has a buildup of gas and stool in her abdomen. Give the patient
polyethylene glycol and encourage increased fiber consumption
2. There is a pathologic buildup of fluid in her peritoneum due to abnormal changes
in - ANSWER: 3. 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 patient presents with the complaint of polyphagia and polydipsia. After the
relevant tests, he is diagnosed with diabetes mellitus. Which is the most appropriate
nursing diagnosis?
A.
Ineffective airway clearance
B.
Impaired gas exchange
C.
Knowledge deficit
D.
Self-care deficit - ANSWER: C.
Knowledge deficit
