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MSN 621 Final Exam Questions and Answers 2025.
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MSN 621 Final Exam Questions and Answers 2025.A decrease in the forced expiratory volume in one second (FEV1) to forced vital
capacity (FVC) ratio is most likely to be seen in a patient with which of the following? -
ANSWERAsthma
A middle-aged male presents to the emergency department with an exacerbation of his
chronic obstructive pulmonary disease (COPD). He has been coughing and been
moderately short of breath for the past 2 days. He says that his inhalers do work, but he
ran out of supplies. He complains of general malaise. After examining him, you decide
to start him on antibiotics. However, you first decide to send the sputum for gram stain
and culture. According to the 2015 Global Initiative for Chronic Obstructive Lung
Disease report, which of the following organisms is most likely to be involved in COPD
exacerbation? - ANSWERMoraxella catarrhalis
A 65-year-old male is evaluated for worsening shortness of breath and a productive
cough for 6 months. He is a current smoker with a 30-pack-year smoking history. His
other medical history includes hypertension and chronic kidney disease. On
examination, his blood pressure is 145/95 mmHg, pulse 88/min, and oxygen saturation
of 92% on room air. He does not have accessory muscle use. On lung auscultation,
there is decreased air movement and prolonged expiration. There are no wheezes
detected. No S3 or S4 auscultated. There is no jugular vein distention. He has no lower
extremity edema and denies chest pain or calf tenderness. Chest x-ray reveals bilateral
hyperinflated lung fields. Which of the following is the next best step in the diagnosis of
this patient's condition? - ANSWERSpirometry
A 65-year-old male patient presents to the hospital with the complaint of increasing
shortness of breath. His condition has been progressively worsening over the past six
months. He is a smoker and a bird keeper. He has one son and one daughter with
asthma. On examination, there is a wheeze and coarse end-inspiratory crackles in the
chest. A chest radiograph reveals diffuse non-specific changes consistent with lung
disease. What investigation is most likely to yield the diagnosis in this case? -
ANSWERSpirometry with reversibility
A 65-year-old male patient presents to the clinic with complaints of a dry cough and
wheezing, particularly at night. He has had asthma. Six months ago, his symptoms were
,well-controlled on inhaled fomoterol and low dose budesonide twice a day and
occasional use of an albuterol inhaler as required. However, now he is more short of
breath with morning dipping of his peak flow readings. On examination, he is mildly
dyspneic but able to complete sentences. On auscultation, there are wheezes scattered
in his chest. His peak expiratory flow rate is 70% of predicted. What is the most
appropriate next step in the management of this patient? - ANSWERInhaled
budesonide dose
A patient with mild, persistent asthma has been well controlled with low-dose inhaled
corticosteroids. He presents for follow up complaining of some limitation with normal
activities and needing albuterol for symptom relief 3 to 4 days per week over the past
month. Which of the following is the preferred next step? - ANSWERMedium dose
inhaled corticosteroid
A 37-year-old woman presents with complaints of intermittent dry cough and chest
tightness since she started a new job as a chambermaid at a hotel 5-weeks ago. Her
symptoms are worst at night. She does not have any rhinitis, postnasal drip, or history
of allergic rhinitis. She has never smoked and doe not take any medicine. On physical
examination, the patient appears comfortable and speaks full sentences without any
problem. Oral and nasal mucosa appears normal. On auscultation of lungs, wheeze is
reported in the left lung. The chest x-ray report comes out normal. Which of the
following is the next best step in identifying the cause of the patient's current
symptoms? - ANSWERSpirometry with pre and post bronchodilator testing
A 40-year-old male patient comes in with a chief complaint of difficulty breathing. His
cardiac function test results are normal. He shows airway hyperresponsiveness to the
methacholine challenge test. His lung spirometry test reveals a lower-than-predicted
level of forced expiratory volume in the first second (FEV1). Based on the most likely
diagnosis, what is the most appropriate first-line therapy for a patient with infrequent
episodes of mild symptoms? - ANSWERAlbuterol alone
A 78-year-old male presents to the clinic with complaints of a cough that started three
days ago. The cough is associated with sputum, which is scanty in volume and yellow in
color. He also complains of mild headaches and a stuffy nose for the last two days. On
further questioning, he reveals that he has had two similar episodes previously, which
subsided within a week. A detailed medical history reveals that he was diagnosed with
diabetes mellitus twenty years ago and is on metformin. His vital signs show a blood
pressure of 100/80 mmHg, a respiratory rate of 14/min, a heart rate of 88/min, and a
temperature of 99 F (37.1 C). Auscultation of the chest was performed, which reveals
bilateral coarse rhonchi, whereas a chest x-ray is normal. What is the most appropriate
next step in the management of his condition? - ANSWERAbx and antitussives
A 17-year-old male presents with a two-day history of fever, runny nose, and cough
productive of clear sputum. His past medical history is unremarkable, and he takes no
medication. His blood pressure is 110/70 mmHg, respiratory rate 16 breaths per minute,
heart rate 102 beats per minute, temperature 101.8 F (38.8 C), and oxygen saturation
,98% on room air. The lung examination demonstrates clear breath sounds bilaterally. In
addition to an antipyretic, what is the most appropriate treatment for this patient? -
ANSWERGuaifensen
A 28-year-old male patient with a past medical history significant for asthma presents to
the primary care office for complaints of cough, shortness of breath for 24 hours
duration. His symptoms started abruptly and are progressively worsening. He denies
fevers or chills and has had no known exposure to sick contacts. Vital signs are within
normal limits. Physical examination is significant for mild expiratory wheezing. His
asthma is well controlled, and he has not used any inhalers for a few years. What is the
next best step in the management of this patient? - ANSWERPrescribe albuterol
A 35-year-old female presents to the out-patient department with complaints of cough
with whitish sputum production for the past three months. She mentions that the cough
worsens at night. She has no other complaints. The patient mentions that she has tried
chlorpheniramine for a week, and no improvement was noted. She has a history of
gastroesophageal reflux disease, for which she takes famotidine. She has been
smoking a pack of cigarettes a day for the past seven years and drinks alcohol socially.
Vitals show a blood pressure of 133/85 mm Hg, pulse of 79/min, respiratory rate of
14/min, and temperature of 98.6 F (37 C). Pulmonary examination reveals normal
breath sounds bilaterally. A chest x-ray is normal. Which of the following is the best next
step in the management of the patient's condition? - ANSWERPulm fxn tests
A 20-year-old man presents to the clinic with two months history of cough and right-
sided chest pain. On examination, his chest movement on the right side is diminished,
the trachea is shifted to the left, and a stony dull percussion note is present on the right
side. His breath sounds are impaired, and vocal fremitus is present. Which of the
following is the most likely diagnosis? - ANSWERRight pleural effusion
A 62-year-old man presents with general malaise, occasional cough, and weight loss of
10 lbs (4.5 kg) over the last two months. History is significant for prediabetes managed
with diet and cigarette smoking. Physical examination findings include mild edema in
the extremities and clubbing bilaterally. Blood work shows mild anemia and sodium of
122 mg/dL. What test should be done next? - ANSWERChest radiograph
A patient with chronic obstructive pulmonary disease (COPD) and chronic carbon
dioxide retention in a nursing home is wheezing. The oxygen saturation drops from 93
to 90. Which of the following would be most appropriate? - ANSWERAlbuterol by neb
A 70-year-old man with severe chronic obstructive pulmonary disease (COPD) has had
multiple hospital admission for exacerbations. He is an ex-smoker of 40 pack years. He
takes budesonide/formoterol combination and tiotropium inhalers. He is up-to-date with
his Influenza and pneumococcal vaccine. What should be advised to decrease his
COPD exacerbations? - ANSWERStart on roflumilast
, A 65-year-old female is evaluated for shortness of breath with exertion and a chronic
cough. She is often unable to walk farther than 200 feet without stopping to catch her
breath. She is a current smoker with a 33-pack-year smoking history. She has no prior
hospitalizations. On physical examination, her vital signs are within normal limits at rest.
Auscultation of her lungs reveals bilateral expiratory wheezes. The remainder of her
physical examination is normal. Spirometry is performed and shows an FEV1 of 72% of
predicted. Her post-bronchodilator FEV1/FVC ratio is 60%. Her modified medical
research council (mMRC) dyspnea score is 3. She is counseled on smoking cessation.
Which of the following is the most appropriate pharmacological treatment for this
patient? - ANSWERShort acting bronchodilator as needed and a long acting
bronchodilator
A 56-year-old man with a past medical history of uncontrolled hypertension, poorly
controlled diabetes mellitus and hyperlipidemia presents with a 1-hour history of sudden
onset, sharp left shoulder pain. He states that the pain is exacerbated by deep
breathing, and coughing. The patient is diaphoretic. He does not take any medication
except aspirin which he took today when the chest pain began. On examination, his
oxygen saturation is 99% on room air, respiratory rate 20/minute, heart rate 88/min, and
blood pressure 110/50 mmHg. A chest x-ray is unremarkable. Which of the following is
the next best step in the management of this patient? - ANSWEREKG
A 26-year-old woman G1P0000 at 24 weeks gestation presents to the clinic in October
for evaluation of cough, rhinorrhea, and subjective fever for 24 hours. The patient has
no significant past medical history and takes only a prenatal vitamin daily. Vital signs
show oral temperature 38 C (100.4 F), blood pressure 120/80 mmHg, pulse 90/minute,
respirations 18/minute, and oxygen saturation 96% on room air. Physical exam reveals
a mildly ill-appearing gravid female in no acute distress with lung fields that are clear to
auscultation bilaterally. Continuous fetal monitoring is normal. Nasal swab ELISA is
positive for influenza A. Which of the following is the most appropriate treatment for this
patient to decrease the likelihood of progression to viral pneumonia? -
ANSWEROseltamivir
A 17-year-old male patient presents to the hospital with severe shortness of breath,
audible wheeze, and fatigue. He has had asthma for ten years, controlled on
beclomethasone 500 mcg inhaled twice a day. On examination, he looks tired and has
decreased air entry on auscultation. His arterial blood gases reveal a pH of 7.35, paO2
of 54 mmHg, and paCO2 of 39 mmHg. What is the most appropriate next step in the
management of this patient? - ANSWERBack to back nebulization with albuterol, IV
corticosteroids, and admission to the high-dependency unit
A patient with mild, persistent asthma has been well controlled with low-dose inhaled
corticosteroids. He presents for follow up complaining of some limitation with normal
activities and needing albuterol for symptom relief 3 to 4 days per week over the past
month. Which of the following is the preferred next step? - ANSWERMedium dose
steroid
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