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MSN 622
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Exam study book Windows XP Unleashed of Terry William Ogletree, Walter J. Glenn, Rima Regas - ISBN: 9780672322808 (MSN 622)
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MSN 622 FINAL EXAM NEWEST 2024 ACTUAL EXAMCOMPLETE 160 QUESTIONS AND CORRECT DETAILED
ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
blowing - ANSWER: 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?
ultrasound every 3 years - ANSWER: What is the recommended management for a
patient with a 3.5 cm abdominal aortic aneurysm?
immediate surgery - ANSWER: 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 (101.3 F), and oxygen saturation 87% at
room air. On physical examination of the abdomen, generalized tenderness and
guarding are seen. There is a midline pulsatile mass. What is the next best step in the
management of this patient?
abdominal CT - ANSWER: A 67-year-old male with a history of hypertension and
nicotine dependence presents to the emergency department with sudden onset of
abdominal pain radiating to the back. There is no history of alcohol use. On
examination, he is thin, pale, and diaphoretic. His vital signs show a blood pressure
of 110/70 mmHg and a heart rate of 95 bpm. Which of the following is most likely to
confirm the diagnosis?
Surgery will improve 5-year survival - ANSWER: A 78-year-old is found to have an
asymptomatic pulsatile abdominal mass. The ultrasound shows an abdominal aortic
aneurysm measuring 5.5 cm. Which of the following statements concerning this
patient's condition is correct?
stress electrocardiogram - ANSWER: A 65-year-old man presents to the office with
complaints of occasional chest pain. The patient has a past medical history significant
for hypertension, diabetes mellitus, and hyperlipidemia. The patient states he
experiences chest pain on exertion, which is only relieved on rest. An
electrocardiogram is normal. Which of the following is the next step in
management?
Determining the precipitating factors for his condition - ANSWER: 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?
hypertensive emergency - ANSWER: 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
Losartan/hydrochlorothiazide and atorvastatin - ANSWER: 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?
Reassure him that this is expected from his ACE inhibitor and continue therapy with
periodic monitoring. - ANSWER: 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?
Reassurance - ANSWER: 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?
Assess the accuracy of his digital BP readings - ANSWER: 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?
, clopidogrel - ANSWER: 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?
uncontrolled malignant hypertension - ANSWER: 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?
troponin - ANSWER: 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?
Coronary artery atherosclerosis - ANSWER: 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?
chest pain while watching TV - ANSWER: 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?
aspirin 324 mg - ANSWER: 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;
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