MSN 622 final exam
MSN 622 FINAL EXAM 2025, NURSING LEADERSHIP EXAM, ADVANCED
PRACTICE NURSE FINAL, MSN 622 QUESTIONS AND ANSWERS,
GRADED A+ NURSING EXAM, MSN STUDY GUIDE PDF
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|Page
, MSN 622 final exam
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 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?
1. The patient has a buildup of gas and stool in her abdomen. Give the patient polyethylene
glycol and encourage increased fiber consumption.
2. Her peritoneum has a pathologic fluid buildup due to abnormal changes in her oncotic
pressure due to a CHF exacerbation. Her serum - ANSWER-3. There is a pathologic buildup of
fluid in the peritoneum due to abnormal changes in her hydrostatic pressure due to 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?
1. Trimethoprim
2. Metoprolol succinate
3. Nitrofurantoin
4. Sildenafil - ANSWER-4. 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
2|Page
, MSN 622 final exam
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?
1. Treadmill myocardial perfusion imaging
2. Coronary artery calcium scoring
3. Erythrocyte sedimentation rate
4. Genetic testing for hypercholesterolemia - ANSWER-2. Coronary artery calcium scoring
(answer)
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?
1. Hydrochlorothiazide
2. Metoprolol
3. Clonidine
4. Neurology referral - ANSWER-1. 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?
1. Get about 150 minutes of high-intensity exercise per week
2. Get about 150 minutes of moderate-intensity exercise per week
3. Get about 250 minutes of low-intensity exercise per week
4. Get about 250 minutes of high-intensity exercise per week - ANSWER-2. Get about 150
minutes of moderate-intensity exercise per week
3|Page
, MSN 622 final exam
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?
1. Activation of the coagulation cascade
2. Hypoxia myocardial injury
3. Passive congestion of pulmonary parenchyma
4. Increased systolic pressure - ANSWER-3. Passive congestion of pulmonary parenchyma
Which of the following abnormal types of respirations is seen in patients with heart failure?
1. Paroxysmal nocturnal dyspnea
2. Biot breathing
3. Agonal breathing
4. Kussmaul breathing - ANSWER-1. Paroxysmal nocturnal dyspnea
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?
1. Diffuse ST-segment elevation in all the leads
2. Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
3. - ANSWER-B. 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)?
4|Page
MSN 622 FINAL EXAM 2025, NURSING LEADERSHIP EXAM, ADVANCED
PRACTICE NURSE FINAL, MSN 622 QUESTIONS AND ANSWERS,
GRADED A+ NURSING EXAM, MSN STUDY GUIDE PDF
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|Page
, MSN 622 final exam
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 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?
1. The patient has a buildup of gas and stool in her abdomen. Give the patient polyethylene
glycol and encourage increased fiber consumption.
2. Her peritoneum has a pathologic fluid buildup due to abnormal changes in her oncotic
pressure due to a CHF exacerbation. Her serum - ANSWER-3. There is a pathologic buildup of
fluid in the peritoneum due to abnormal changes in her hydrostatic pressure due to 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?
1. Trimethoprim
2. Metoprolol succinate
3. Nitrofurantoin
4. Sildenafil - ANSWER-4. 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
2|Page
, MSN 622 final exam
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?
1. Treadmill myocardial perfusion imaging
2. Coronary artery calcium scoring
3. Erythrocyte sedimentation rate
4. Genetic testing for hypercholesterolemia - ANSWER-2. Coronary artery calcium scoring
(answer)
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?
1. Hydrochlorothiazide
2. Metoprolol
3. Clonidine
4. Neurology referral - ANSWER-1. 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?
1. Get about 150 minutes of high-intensity exercise per week
2. Get about 150 minutes of moderate-intensity exercise per week
3. Get about 250 minutes of low-intensity exercise per week
4. Get about 250 minutes of high-intensity exercise per week - ANSWER-2. Get about 150
minutes of moderate-intensity exercise per week
3|Page
, MSN 622 final exam
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?
1. Activation of the coagulation cascade
2. Hypoxia myocardial injury
3. Passive congestion of pulmonary parenchyma
4. Increased systolic pressure - ANSWER-3. Passive congestion of pulmonary parenchyma
Which of the following abnormal types of respirations is seen in patients with heart failure?
1. Paroxysmal nocturnal dyspnea
2. Biot breathing
3. Agonal breathing
4. Kussmaul breathing - ANSWER-1. Paroxysmal nocturnal dyspnea
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?
1. Diffuse ST-segment elevation in all the leads
2. Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
3. - ANSWER-B. 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)?
4|Page
