MSN 622 FINAL EXAM ACTUAL 100+ QUESTION AND
ANSWERS LATEST 2023.
A 65-year-old man presents with complaints of chest pain that started 30 mins ago but
stopped on his way to the hospital. The patient has a past medical history significant for
hypertension and diabetes mellitus. An electrocardiogram (ECG) is normal. A stress
ECG shows mild ST elevations after 12 minutes of exercise. A diagnosis of stable
angina is made. Which of the following should be the first step in counseling the patient
about his condition? - ANSWER-Determining the precipitating factors for his condition
A 47-year-old male presents to the office for routine health maintenance. His blood
pressure is 182/138, with all other vital signs within normal limits. The patient is
currently complaining of a headache and blurred vision but denies chest pain, shortness
of breath, and abdominal pain. Under which of the following forms of hypertension
would this patient be classified - ANSWER-hypertensive emergency
A 65-year-old male with a history of type 2 diabetes comes into the provider's office
complaining of blurry vision, nosebleeds, and exertional chest pain for the past six
months. The blood pressure is measured to be 160/94 mmHg. A CT angiogram is
performed, which reveals partially occlusive coronary artery plaques. Which of the
following medication regimens would be most appropriate for this patient? - ANSWER-
Losartan/hydrochlorothiazide and atorvastatin
A 68-year-old male with a past medical history of type 2 diabetes mellitus and diabetic
nephropathy presented to the clinic for a follow-up appointment. His blood pressure on
the last visit was 150/90 mmHg. He was called in for a follow-up appointment in 4
weeks to monitor his blood pressure. The blood pressure on this visit is 168/105 mmHg,
and HbA1c is 8.9%. His antihypertensive regimen was adjusted, and an ACE inhibitor
was added. He is on metformin and sitagliptin for diabetes mellitus. One week later, his
blood pressure was 130/80 mmHg, the patient's potassium was 5.1 mEq/L, sodium was
133 mEq/L, and the rest of the renal panel was within normal limits. He reports no
symptoms. What is the next best step in his care? - ANSWER-Reassure him that this is
expected from his ACE inhibitor and continue therapy with periodic monitoring.
A 50-year-old man presents to the clinic for routine evaluation. His systolic blood
pressure has persistently been in the 150-160 mmHg range. Treatment with ramipril is
initiated. On the next visit, he complained of an itchy throat and a dry cough, which is
not distressing for him, but he is concerned that there might be something serious as he
used to smoke but quit 5 years ago. A chest x-ray is within normal limits. What is the
next best step in the management of this patient? - ANSWER-Reassurance
A 65-year-old man presents for a review of his medications. The patient states his blood
pressure (BP) is always elevated whenever he checks it with his digital BP monitoring
machine, despite taking all of his medications. He has a past medical history significant
for hypertension, diabetes mellitus, and hyperlipidemia. Laboratory evaluation reveals a

normal random blood glucose level and a normal lipid profile. Which of the following is
the most appropriate initial step before changing the patient's antihypertensive
medication? - ANSWER-Assess the accuracy of his digital BP readings
A 65-year-old man presents with episodic substernal pain. Initially, he experienced
chest pain with physical activity, which remits with rest. But now it occurs at rest too. He
has a history of hypertension and smokes 30 cigarettes/day. In addition, he has aspirin
hypersensitivity. His blood pressure is 145/90 mmHg, pulse is 78/min, and oxygen
saturation is 97%. Physical examination is unremarkable. ECG reveals mild ST-
segment depressions in V1-V2. Cardiac troponins are not elevated. Which of the
following is the best option for the management in this patient? - ANSWER-clopidogrel
A 65-year-old female patient presents with worsening chest pain and blurring of vision.
She has a history of hypertension, diabetes mellitus, hyperlipidemia, renal insufficiency,
and atrial fibrillation. Vital signs show temperature 37.8°C (100 F), heart rate 98 bpm,
blood pressure 190/110 mmHg, respiratory rate 20 breaths/min, and oxygen saturation
91%. Her complete blood count shows a WBC of 12.0 and hematocrit 30%. Her eGFR
is 39 ml/min/1.73 m2. What is the contraindication for cardiac catheterization in this
patient? - ANSWER-uncontrolled malignant hypertension
A 65-year-old male presents to the emergency department with chest pain for the past
two hours. The pain is located at the precordial region, described as sharp, 7/10
intensity, lasting for 20 minutes, radiating to the upper left upper limb and accompanied
by dyspnea. His past medical history is significant for hypertension and diabetes
mellitus type 2. His blood pressure is 120/80 mmHg, the pulse rate 72/min; the
temperature 98 F. EKG reveals ST-segment depression. What is the best enzyme
assay to diagnose this condition? - ANSWER-troponin
A 65-year-old male presents with severe substernal pain for 20 minutes, radiating to the
upper left limb and accompanied by dyspnea. He has a history of hypertension and
smokes 30 cigarettes/day. His blood pressure is 145/90 mmHg and his pulse is 78/min.
Physical examination is unremarkable. The pain settled promptly following 300 mg
aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray sublingually. What is the most
common underlying pathological cause for this patient's symptoms? - ANSWER-
Coronary artery atherosclerosis
A 65-year-old male client presents to the clinic for routine care after a year. The client
has a long-standing history of hypertension and diabetes. He is non-compliant with his
drug regimen. His vitals are remarkable for a heart rate of 80/min and blood pressure of
166/90 mmHg. The physical exam reveals a loss of sensation to light touch and
proprioception in the toes bilaterally. Which of the following would indicate that the client
has been experiencing episodes of unstable angina at home? - ANSWER-chest pain
while watching TV
A 68-year-old man calls emergency medical services (EMS) with a 20-minute episode
of shortness of breath and substernal chest pain. He has a past medical history of

hypertension, type 1 diabetes, hyperlipidemia, coronary artery disease, and had a
coronary artery bypass grafting two years ago. His current medications include aspirin,
clopidogrel, atorvastatin, metoprolol, and lisinopril; however, he says he is non-
compliant with his drug regime. An ambulance is fifteen minutes away. The EMS crew
should advise the patient to take which medication before they arrive? - ANSWER-
aspirin 324 mg
A 65-year-old man presents for preoperative evaluation. He plans to undergo bilateral
total knee replacement for osteoarthritis, which has markedly limited his mobility. All
conservative measures for osteoarthritis treatment have failed. He has medical history
significant for hypertension, hyperlipidemia, and smoking. He received one drug-eluting
stent to the left anterior descending artery four months ago for stable ischemic heart
disease. Which of the following is the best step regarding this patient's clearance for
surgery? - ANSWER-defer surgery for at least 2 months
A 55-year-old man calls emergency medical services for sudden onset chest pain,
dizziness, and palpitations. He works as an office secretary and lives a sedentary
lifestyle. He is an active smoker and drinks alcohol only occasionally. Emergency
medical service arrives in a few minutes and gives full dose aspirin to the patient orally.
Current medications are sildenafil for erectile dysfunction and lisinopril for hypertension.
Vital signs show a temperature of 37 C, respiratory rate of 17/min, heart rate of 111/min,
and blood pressure of 88/60 mmHg. He has jugular venous distension, but his lungs are
clear to auscultation. EKG shows ST-segment elevations in leads II, III, and aVF. He
reports severe chest pain, which has not resolved with the aspirin he obtained
sublingually. Which of the following medications or interventions is absolutely
contraindicated in this patient? - ANSWER-Nitroglycerin
A 65-year-old male patient with a history of hypothyroidism, hypertension, and diabetes
mellitus presents to the clinic complaining of worsening weakness. On the physical
exam, he has cold extremities, bibasilar crackles, and wheezing. Which of the following
findings would be expected to be seen in this patient? - ANSWER-decreased urine
output
A 65-year-old man presents with complaints of exertional dyspnea, orthopnea, and
generalized edema. The patient has a past medical history significant for heart failure
with preserved ejection fraction. On examination, bilateral crepitations are present at the
lung bases. Which of the following urinary complaints is associated with the patient's
condition? - ANSWER-nocturia
A patient with congestive heart failure is started on furosemide. They should also be
prescribed which other medication? - ANSWER-lisinopril
A 65-year-old man presents with complaints of orthopnea, exertional dyspnea, and
fatigue. The patient has a past medical history significant for hypertension and diabetes
mellitus. He has been noncompliant with his medications and rarely visits his provider.
The patient is diagnosed with American College of Cardiology (ACC) stage A heart

failure. Which of the following medication should be started in this patient? - ANSWER-
Angiotensin-converting enzyme inhibitor
A 17-year-old male presents for a sports physical. He has been healthy up to this point.
His blood pressure is 145/95 mmHg bilaterally on three separate occasions. Lower
extremity blood pressure is also elevated. The patient's father, uncle, and grandfather
all have hypertension, and his father and grandfather have chronic kidney disease as
well. Based on this information, the clinician ordered an echocardiogram and abdominal
ultrasound. The echocardiogram was unremarkable. What is the most likely reason for
ordering an abdominal ultrasound? - ANSWER-Polycystic kidneys
A 65-year-old woman presents with a transient ischemic attack. Her medical history is
significant for hypertension and congestive heart failure, with an ejection fraction of
35%. Current medications include lisinopril, bisoprolol, and empagliflozin. Her blood
pressure is 110/70 mmHg, and her heart rate is 70 beats per minute. Telemetry
monitoring reveals new-onset atrial fibrillation. Which antiarrhythmic drug is the best
initial therapy for treating this patient? - ANSWER-Amiodarone
What is the most appropriate initial intervention for an older male who complains of leg
pain with walking and at night who is found to have weak pulses in bilateral lower
extremities and a reduced ankle-brachial index? - ANSWER-Lifestyle modification
A 42-year-old male is evaluated for the presence of a holosystolic murmur with a
diastolic rumble. Echocardiography shows mitral regurgitation with a dilated left ventricle
and left atrium as well as an ejection fraction of 40%. He says he feels fine. What
should be recommended? - ANSWER-Surgery consult
A 28-year-old female with no significant past medical history presents to the clinic with a
complaint of feeling tired more than usual. She states that for the past few months, she
has also been short of breath more frequently and that she feels her "heart is racing out
of her chest." As per the patient, her only family history is anemia in her mother and
breast cancer in her maternal grandmother. She is concerned that she is anemic as her
mother complained of similar symptoms in the past. On physical examination, her vitals
are stable. She is 6'1" with a body mass index (BMI) of 21 and has long slender arms
and legs. On cardiopulmonary examination, the lungs were clear to auscultation, and
there was a grade 2/6 systolic murmur with a mid-systolic click present. Pulses were 2+
and equal bilaterally, and there is no peripheral edema appreciated. Which of the
following is the likely cause of this patient's symptoms? - ANSWER-Marfan syndrome
A 74-year-old woman smoker with hypertension was found to have weak right lower
extremity pulses with a right ankle-brachial index (ABI) of 0.75. She denies any pain
with walking. What is the most appropriate treatment? - ANSWER-Smoking cessation
A 17-year-old woman presents to the clinic with a complaint of feeling light-headed
when she stands up from a sitting position. She also reports feeling a flutter in her chest
during the episodes. Her symptoms have been progressively worsening over the past

couple of months. She has a past medical history of generalized anxiety disorder and
asthma. She denies chest pain, abdominal complaints, cough, or diaphoresis. She has
no history of recent travel or sick contacts. On physical exam, her heart rate is 104/min,
blood pressure 106/72 mmHg, temperature 98.6 F, and oxygen saturation of 98% on
room air. Her BMI is 18 kg/m2. Cardiac auscultation reveals a systolic-ejection murmur
with a mid-systolic click. On pulmonary exam, wheezes are heard throughout the lung
fields, no crackles or rales appreciated. The abdomen is soft, nontender, nondistended,
with bowel sounds, heard equally in all quadrants. She does not have limb edema.
What is the most likely cause of this patient's findings? - ANSWER-mitral valve prolapse
A 65-year-old male patient who is a heavy smoker presents with a complaint of pain in
his legs when he walks. He claims that over the past few years he can only walk half a
block without pain. He has been a smoker for 35 years and also drinks alcohol. He does
have hypertension or heart disease. The ankle-brachial index in both legs is 0.70. To
lower the risk of myocardial infarction in this patient what should be done? - ANSWER-
start patient on aspirin or clopidogrel
A 65-year-old female with a history of hypertension, obesity, and a 10-pack-year
smoking history presents with severe chest pain that started the previous night. Her
chest x-ray revealed an enlarged cardiac silhouette and interstitial edema. Her vital
signs are stable on admission. Her physical exam is unremarkable except for a
diminished S1 and a high-pitched blowing systolic murmur that is best heard at the apex
that radiates to the axilla. At the same time, the provider also hears an extra heart
sound. What is the cause of this extra heart sound? - ANSWER-continuous filling of the
left ventricle with blood
A 79-year-old female with hypertension and diabetes mellitus is found to have
paroxysmal atrial fibrillation. She has limited funds and no coverage for prescription
medications. What is the current recommended treatment for primary stroke
prophylaxis? - ANSWER-warfarin
A 45-year-old male comes to the emergency room with a complaint of chest pain, runny
nose, and fever. Past medical history is significant for diabetes mellitus. Vital signs are
pulse rate 108/min, blood pressure 105/68 mmHg, respiratory rate 22/min, and
temperature 101 F (38.3 °C). Physical examination is remarkable for a holosystolic
murmur on auscultation. ECG shows sinus tachycardia with a low voltage complex.
What is the next best step in the management of this patient? - ANSWER-supportive
care and observation
A 65-year-old woman with type 2 diabetes mellitus and hyperlipidemia presents with
dizziness and palpitations. She denies fever, weight loss, heat intolerance, and
excessive sweating. Her heart rate is 116 bpm, blood pressure 120/76 mmHg,
respiratory rate 18 breaths/minute, and temperature 98.6°F (37°C). An
electrocardiogram shows a narrow QRS complex tachycardia with an irregularly
irregular rhythm. What is the best next step in the evaluation of this patient? -
ANSWER-transthoracic echocardiogram

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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? - ANSWER-metoprolol
A 48-year-old male with peripheral artery disease is being evaluated for a possible
angiogram of the right lower extremity. He currently complains of severe right thigh
claudication and had minimal improvement with maximal medical therapy and exercise.
What level of disease is most likely to be found based on the symptoms described? -
ANSWER-aortoiliac stenosis
A 70-year-old man presents to the emergency department with sudden pain in the left
leg. On examination, his leg appears white and cold to touch in comparison to the other
leg. His radial pulse is irregularly irregular in character, while peripheral pulses of the left
lower limbs are not palpable. The abdominal examination is normal. An EKG shows
arrhythmia but no sign of ischemia. Which of the following best explains the symptoms
of this patient? - ANSWER-atrial fibrillation
A 49-year-old man undergoes a right upper lobectomy for a neoplasm. The
perioperative course was uncomplicated. He has a history of COPD and a 40 pack-year
history of smoking. His routine medications include a salbutamol inhaler and
theophylline tablet. On the second postoperative day in the high dependency unit, the
patient suddenly develops atrial fibrillation with a ventricular rate of 150 to 170
beats/min. His blood pressure falls to 80/40 mmHg from a near-normal level for his age.
His oxygen saturation is 96% on 2 L/min oxygen via nasal cannula. Which of the
following is the best initial step in the management of this patient? - ANSWER-
synchronized DC shock
A 67-year-old man with a history of hypertension and tobacco use presents with a two-
day history of hypogastric pain. An examination reveals a 5 cm, non-tender, pulsatile
abdominal mass above the umbilicus. Which of the following type of sounds might be
heard upon auscultation at the midline, two inches cephalad to the umbilicus? -
ANSWER-blowing
What is the recommended management for a patient with a 3.5 cm abdominal aortic
aneurysm? - ANSWER-ultrasound every 3 years
A 75-year-old man presents to the emergency department with complaints of severe
abdominal pain and sweating. The pain started about an hour ago and is becoming
worse with time. He has been diagnosed with hypertension and diabetes and is on
amlodipine and metformin, respectively. On presentation, the vital signs show blood
pressure 70/40 mmHg, pulse 140/min, respiratory rate 32/min, temperature 38.5 C

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2023 MSN622 Final Exam with Answers (117 Solved Questions)

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