MSN 611 final exam
MSN 611 FINAL EXAM 2025, MSN NURSING FINAL QUESTIONS,
GRADED A+ MSN EXAM, ADVANCED NURSING STUDY GUIDE,
MSN 611 PHARMACOLOGY/PATHOPHYSIOLOGY QUESTIONS,
NURSE PRACTITIONER EXAM PREP
A 50-year-old male with a history of congestive heart failure with reduced ejection fraction,
coronary artery disease, hypertension, dyslipidemia, CKD stage III presented to the physician's
clinic with complaints of decreased hearing in both ears for last 4 weeks. Patient denies any
history of ear infection, trauma to the ear or head, ear fullness, nausea, headache or tinnitus.
The patient also mentions that 2 months ago the patient was admitted with septic shock
secondary to UTI and was treated with broad-spectrum antibiotics including gentamicin and
cefepime. Current home medications are aspirin 81 mg/day, metoprolol 50 mg twice a day,
atorvastatin 40 mg/day, lisinopril 10 mg/day, furosemide 40 mg twice a day. Patient report no
change in heart failure medications since last 6 months. Which of the following is the most
likely cause of hearing impairment?
gentamicin and furosemide
A 65-year-old woman diagnosed with chronic stable angina presents for a refill of
nitroglycerine. Her past medical history is significant for hypertension. Nitroglycerin should be
prescribed in what manner for this patient?
intermittent use of nitroglycerin with nitrate free intervals
A 55-year-old man presented to the emergency department complaining of difficulty
breathing after little exertion. Upon further questioning, he states the dyspnea is worst on
lying down and improves in sitting position. The patient also has a significant past medical
history of diabetes mellitus, hypertension, and hyperlipidemia. He further adds that last
month he was admitted for acute myocardial infarction. The physician suspects the diagnosis
of congestive heart failure and starts furosemide. Which of the following symptoms is most
likely to be observed after administering furosemide?
high urine output
A 60-year old man comes to the emergency department with severe sub-sternal chest pain
that radiates to his left arm, neck, and jaw and is associated with nausea and diaphoresis. The
pain started 2 hours ago and is progressively getting worse. Emergency department ECG
reveals ST elevation in the anterior chest wall leads. The patient is transferred to the coronary
1|Page
, MSN 611 final exam
intervention unit under the supportive protocol, where he undergoes percutaneous
intervention and stent placement. Along with aspirin, the patient is started on another
antiplatelet agent to prevent premature stent thrombosis. What is the mechanism of action of
the second agent?
inhibit ADP receptors on the platelets
A 65-year-old woman presents to the healthcare provider for an evaluation. The patient had
been placed on digoxin for atrial fibrillation. Which of the following drugs, if given, can
significantly increase the levels of digoxin in the patient's serum?
amiodorone
A 65-year-old woman visits her primary care provider for her annual checkup. The nurse
measures her blood pressure, which is 152/89 mmHg. She has no history of high blood
pressure, diabetes, or dyslipidemia. The provider decides to start the patient on amlodipine
besylate, 5 mg once daily. How should the patient be counseled about the mechanism of
action of this medication?
"Amlodipine will widen blood vessels by blocking calcium from going into the cells and make it
easier for blood to flow through and reduce blood pressure."
A 74-year-old man with a past medical history of atrial fibrillation, dyslipidemia, diabetes
mellitus, gout, and sick sinus syndrome is admitted to the telemetry unit after a syncopal
event. His vitals upon presentation are blood pressure of 100/70 mmHg and heart rate of 75
beats per minute. Diltiazem therapy is being considered. Which of the following is the
strongest contraindication for diltiazem therapy in this patient?
sick sinus syndrome
A 65-year-old man presents to the emergency department with chest pain and diaphoresis for
the past one and a half-hour that developed while he was doing work in his garage. Over the
past few months, he has had two similar episodes occurring after physical exertion, each
lasting for 10 to 15 minutes. The patient has a past medical history of diabetes mellitus,
hypertension, and gastroesophageal reflux disease, for which he takes famotidine,
amlodipine, and metformin. Vital signs show blood pressure of 138/92 mmHg, pulse 110/min,
and temperature 98.6 F (37 C). On physical examination, the patient is in acute distress and
marked diaphoresis is noted. He is given a chewable drug as part of standard protocol. What
role does this drug play in the management of the patient’s acute condition?
antiplatelet coagulation
2|Page
, MSN 611 final exam
A 67-year-old man presents to the emergency department with bradycardia with a heart rate
of 44 beats per minute and blood pressure of 100/60 mmHg. Which of the following
medication should be held to ensure his heart rate rises?
Diltiazem
A 55-year-old male patient with a history of type 2 diabetes mellitus and hyperlipidemia
presents to the emergency room for evaluation of substernal chest pain that he states began 1
hour ago after playing outside with his son. The patient reports that this pain has been
transient for the past 3 months, but is usually provoked whenever he goes outside to do yard
work. He states that this pain is typically relieved once he goes inside to take a break. A
medication is given to the patient and he reports a rapid relief of his pain. Which medication
was given?
Nitroglycerin
A 71-year-old man presents to the clinic for his monthly check-up. His vital signs show blood
pressure of 133/92 mmHg, a temperature of 98.7 F, and a pulse of 104/minute. The patient
has a history of atrial fibrillation. The physical exam is unremarkable. He is currently
prescribed several medications, including warfarin. The patient's international normalized
ratio (INR) has changed from his last visit from 2.3 to currently 6.2. Which of the following is
the next best step in managing this patient?
Phytonadione
A 65-year-old man presents to the office with increased frequency, urgency, nocturia, and
hesitancy in micturition for the past week. He also complains of pain in ejaculation. He has no
flank pain, dysuria, hematuria, or fever. He is in a monogamous relationship and uses
condoms regularly. His temperature is 98.6 F (37 C), pulse rate is 77 beats/ minute, respiration
is 14 breaths/minute, and blood pressure is 130/80 mmHg. There is no costovertebral angle
tenderness or suprapubic tenderness, and external genitalia examination is normal. Digital
rectal examination shows normal sphincter tone and reflexes with slightly enlarged and
tender prostate. Urinalysis shows many WBCs with no RBCs or casts. Urine culture grows E.
coli. Serum prostate-specific antigen is 8ng/mL (reference range of less than 3.5 ng/mL).
Which of the following drug class can be used to treat the patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days pregnant presents for late prenatal testing. She is
found to have IgM-positive antibodies for HSV-2. The patient desires to deliver vaginally.
3|Page
, MSN 611 final exam
Which of the following statements is correct regarding the treatment of choice for this
patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with complaints of frequent burning
micturition and suprapubic discomfort from the past two days. The patient is sexually active
and has no significant past medical history. Urinalysis reveals the presence of leukocyte
esterase and a high level of nitrites. The clinician prescribes her a combination antibiotic that
inhibits two steps in the bacterial biosynthesis of tetrahydrofolate. Which of the following is a
contraindication to the use of this medication?
pregnancy
A 35-year-old woman comes to the office for pain and burning during urination for the past
few days. She denies fever, abdominal or flank pain, bloody urine, or passing any stones while
urinating. She has a medical history of gastroesophageal reflux disease, diabetes mellitus type
2, and hyperlipidemia. She takes over-the-counter antacids, pantoprazole, metformin, and
atorvastatin. She is para 2 with both normal vaginal delivery and her last menstrual period
was three weeks ago. She uses oral contraceptive pills for contraception. Her temperature is
37.2 C, her pulse is 70 beats/min, her respiratory rate is 12 breaths/min, and her blood
pressure is 130/80 mmHg. On examination, she denies suprapubic pain or costovertebral
angle tenderness. Urinalysis reveals white blood cells of 20-25/hpf and red blood cells of 5-
10/hpf with no casts. Urinary nitrites and leukocyte esterase are positive, and glucose and
ketone are absent. White blood cell count is 7800/mm3. Serum creatinine is 1.1 mg/dL and
blood urea nitrogen is 17 mg/dL. Urine culture grows Escherichia coli. The patient is started
on a drug that inhibits an enzyme required in bacterial DNA replication. The patient is
counseled about adherence and the adverse effect of this drug. About which of her other
medications should she be counseled?
antacid
A 27-year-old male with a past medical history of tuberculosis presents to the outpatient
clinic with complaints of diarrhea and crampy abdominal pain. The patient was diagnosed
with tuberculosis 16 weeks ago and is currently on treatment with isoniazid and rifampicin.
Complete blood count shows an elevated WBC count. Blood testing shows that liver function
tests are normal. Which of the following is the best next step in the management of this
patient?
testing for clostridium difficle
4|Page
MSN 611 FINAL EXAM 2025, MSN NURSING FINAL QUESTIONS,
GRADED A+ MSN EXAM, ADVANCED NURSING STUDY GUIDE,
MSN 611 PHARMACOLOGY/PATHOPHYSIOLOGY QUESTIONS,
NURSE PRACTITIONER EXAM PREP
A 50-year-old male with a history of congestive heart failure with reduced ejection fraction,
coronary artery disease, hypertension, dyslipidemia, CKD stage III presented to the physician's
clinic with complaints of decreased hearing in both ears for last 4 weeks. Patient denies any
history of ear infection, trauma to the ear or head, ear fullness, nausea, headache or tinnitus.
The patient also mentions that 2 months ago the patient was admitted with septic shock
secondary to UTI and was treated with broad-spectrum antibiotics including gentamicin and
cefepime. Current home medications are aspirin 81 mg/day, metoprolol 50 mg twice a day,
atorvastatin 40 mg/day, lisinopril 10 mg/day, furosemide 40 mg twice a day. Patient report no
change in heart failure medications since last 6 months. Which of the following is the most
likely cause of hearing impairment?
gentamicin and furosemide
A 65-year-old woman diagnosed with chronic stable angina presents for a refill of
nitroglycerine. Her past medical history is significant for hypertension. Nitroglycerin should be
prescribed in what manner for this patient?
intermittent use of nitroglycerin with nitrate free intervals
A 55-year-old man presented to the emergency department complaining of difficulty
breathing after little exertion. Upon further questioning, he states the dyspnea is worst on
lying down and improves in sitting position. The patient also has a significant past medical
history of diabetes mellitus, hypertension, and hyperlipidemia. He further adds that last
month he was admitted for acute myocardial infarction. The physician suspects the diagnosis
of congestive heart failure and starts furosemide. Which of the following symptoms is most
likely to be observed after administering furosemide?
high urine output
A 60-year old man comes to the emergency department with severe sub-sternal chest pain
that radiates to his left arm, neck, and jaw and is associated with nausea and diaphoresis. The
pain started 2 hours ago and is progressively getting worse. Emergency department ECG
reveals ST elevation in the anterior chest wall leads. The patient is transferred to the coronary
1|Page
, MSN 611 final exam
intervention unit under the supportive protocol, where he undergoes percutaneous
intervention and stent placement. Along with aspirin, the patient is started on another
antiplatelet agent to prevent premature stent thrombosis. What is the mechanism of action of
the second agent?
inhibit ADP receptors on the platelets
A 65-year-old woman presents to the healthcare provider for an evaluation. The patient had
been placed on digoxin for atrial fibrillation. Which of the following drugs, if given, can
significantly increase the levels of digoxin in the patient's serum?
amiodorone
A 65-year-old woman visits her primary care provider for her annual checkup. The nurse
measures her blood pressure, which is 152/89 mmHg. She has no history of high blood
pressure, diabetes, or dyslipidemia. The provider decides to start the patient on amlodipine
besylate, 5 mg once daily. How should the patient be counseled about the mechanism of
action of this medication?
"Amlodipine will widen blood vessels by blocking calcium from going into the cells and make it
easier for blood to flow through and reduce blood pressure."
A 74-year-old man with a past medical history of atrial fibrillation, dyslipidemia, diabetes
mellitus, gout, and sick sinus syndrome is admitted to the telemetry unit after a syncopal
event. His vitals upon presentation are blood pressure of 100/70 mmHg and heart rate of 75
beats per minute. Diltiazem therapy is being considered. Which of the following is the
strongest contraindication for diltiazem therapy in this patient?
sick sinus syndrome
A 65-year-old man presents to the emergency department with chest pain and diaphoresis for
the past one and a half-hour that developed while he was doing work in his garage. Over the
past few months, he has had two similar episodes occurring after physical exertion, each
lasting for 10 to 15 minutes. The patient has a past medical history of diabetes mellitus,
hypertension, and gastroesophageal reflux disease, for which he takes famotidine,
amlodipine, and metformin. Vital signs show blood pressure of 138/92 mmHg, pulse 110/min,
and temperature 98.6 F (37 C). On physical examination, the patient is in acute distress and
marked diaphoresis is noted. He is given a chewable drug as part of standard protocol. What
role does this drug play in the management of the patient’s acute condition?
antiplatelet coagulation
2|Page
, MSN 611 final exam
A 67-year-old man presents to the emergency department with bradycardia with a heart rate
of 44 beats per minute and blood pressure of 100/60 mmHg. Which of the following
medication should be held to ensure his heart rate rises?
Diltiazem
A 55-year-old male patient with a history of type 2 diabetes mellitus and hyperlipidemia
presents to the emergency room for evaluation of substernal chest pain that he states began 1
hour ago after playing outside with his son. The patient reports that this pain has been
transient for the past 3 months, but is usually provoked whenever he goes outside to do yard
work. He states that this pain is typically relieved once he goes inside to take a break. A
medication is given to the patient and he reports a rapid relief of his pain. Which medication
was given?
Nitroglycerin
A 71-year-old man presents to the clinic for his monthly check-up. His vital signs show blood
pressure of 133/92 mmHg, a temperature of 98.7 F, and a pulse of 104/minute. The patient
has a history of atrial fibrillation. The physical exam is unremarkable. He is currently
prescribed several medications, including warfarin. The patient's international normalized
ratio (INR) has changed from his last visit from 2.3 to currently 6.2. Which of the following is
the next best step in managing this patient?
Phytonadione
A 65-year-old man presents to the office with increased frequency, urgency, nocturia, and
hesitancy in micturition for the past week. He also complains of pain in ejaculation. He has no
flank pain, dysuria, hematuria, or fever. He is in a monogamous relationship and uses
condoms regularly. His temperature is 98.6 F (37 C), pulse rate is 77 beats/ minute, respiration
is 14 breaths/minute, and blood pressure is 130/80 mmHg. There is no costovertebral angle
tenderness or suprapubic tenderness, and external genitalia examination is normal. Digital
rectal examination shows normal sphincter tone and reflexes with slightly enlarged and
tender prostate. Urinalysis shows many WBCs with no RBCs or casts. Urine culture grows E.
coli. Serum prostate-specific antigen is 8ng/mL (reference range of less than 3.5 ng/mL).
Which of the following drug class can be used to treat the patient's condition?
fluroquinolone
A 41-year-old G5P4004 at 38 weeks, 0 days pregnant presents for late prenatal testing. She is
found to have IgM-positive antibodies for HSV-2. The patient desires to deliver vaginally.
3|Page
, MSN 611 final exam
Which of the following statements is correct regarding the treatment of choice for this
patient's condition?
it is generally safe in pregnancy
A 25-year-old woman presents to the clinician with complaints of frequent burning
micturition and suprapubic discomfort from the past two days. The patient is sexually active
and has no significant past medical history. Urinalysis reveals the presence of leukocyte
esterase and a high level of nitrites. The clinician prescribes her a combination antibiotic that
inhibits two steps in the bacterial biosynthesis of tetrahydrofolate. Which of the following is a
contraindication to the use of this medication?
pregnancy
A 35-year-old woman comes to the office for pain and burning during urination for the past
few days. She denies fever, abdominal or flank pain, bloody urine, or passing any stones while
urinating. She has a medical history of gastroesophageal reflux disease, diabetes mellitus type
2, and hyperlipidemia. She takes over-the-counter antacids, pantoprazole, metformin, and
atorvastatin. She is para 2 with both normal vaginal delivery and her last menstrual period
was three weeks ago. She uses oral contraceptive pills for contraception. Her temperature is
37.2 C, her pulse is 70 beats/min, her respiratory rate is 12 breaths/min, and her blood
pressure is 130/80 mmHg. On examination, she denies suprapubic pain or costovertebral
angle tenderness. Urinalysis reveals white blood cells of 20-25/hpf and red blood cells of 5-
10/hpf with no casts. Urinary nitrites and leukocyte esterase are positive, and glucose and
ketone are absent. White blood cell count is 7800/mm3. Serum creatinine is 1.1 mg/dL and
blood urea nitrogen is 17 mg/dL. Urine culture grows Escherichia coli. The patient is started
on a drug that inhibits an enzyme required in bacterial DNA replication. The patient is
counseled about adherence and the adverse effect of this drug. About which of her other
medications should she be counseled?
antacid
A 27-year-old male with a past medical history of tuberculosis presents to the outpatient
clinic with complaints of diarrhea and crampy abdominal pain. The patient was diagnosed
with tuberculosis 16 weeks ago and is currently on treatment with isoniazid and rifampicin.
Complete blood count shows an elevated WBC count. Blood testing shows that liver function
tests are normal. Which of the following is the best next step in the management of this
patient?
testing for clostridium difficle
4|Page
