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MSN 622 final Exam with Complete Solutions
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MSN 622 final Exam with Complete Solutions
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MSN 622 final Exam with CompleteSolutions
A 50-year-old man complains of a lack of energy. He nods off during the day, usually when
reading or watching television. He goes to bed at 11 pm and wakes up at 8 am. He has no
medical illnesses and takes no medication. He drinks a glass of wine daily, usually with dinner,
and denies smoking. He states that his wife complains about his snoring. His vital signs show
blood pressure of 130/85 mmHg, heart rate of 67 beats/minute, respiratory rate of 16
breaths/minute, and body mass index of 27 kg/m^2. Which of the following is the gold standard
test for diagnosing this patient's condition? Correct Ans-Nocturnal polysomnography
A 39-year-old man is accompanied by his wife to the clinic. The wife says her husband has
episodes of passing out during the daytime, even when doing important work. She states that
the patient has reduced attentiveness and has become more irritable over the past few months.
The patient and his wife have also stopped sharing a bed because of his loud snoring. On further
questioning the patient after sending his wife out of the office, the patient confirms everything.
He further adds that he is embarrassed about his behavior and wishes that there was something
he could do to fix everything. He admits to falling asleep even during office meetings and
describes these episodes as involuntary. His body mass index is 35 kg/m2. His vitals are blood
pressure 135/88 mmHg, pulse 95/min, and respiratory rate 19/min. A nighttime arterial blood
sample is sent for acid-base analysis. What abnormality is most likely to be seen in a Correct
Ans-Respiratory acidosis
A 65-year-old male presents to the clinic with difficulty staying up during the day. He works as a
sales representative and often finds himself dozing off during meetings with clients. He feels
irritable, and reports decreased concentration and memory problems. He also states that his
loud snoring is causing problems as his wife prefers sleeping in a different room. His medical
history is significant for ischemic heart disease and diabetes mellitus type 2. Vital signs show
blood pressure 135/90 mmHg, pulse 92/min, temperature 37 C (97.6 F), and respiratory rate
17/min. His body mass index is 33 kg/m2. Physical examination shows no significant findings.
Polysomnography is done, confirming the likely diagnosis. What is the treatment of choice for
this patient? Correct Ans-Aggressive weight reduction
An 18-year-old football player presents to the emergency department (ED) complaining of
nausea after a training session at high heat. His coach was concerned because he was very
,warm to the touch and was sweating profusely. A couple of minutes after arrival at the ED, the
patient has an episode of vomiting. His uniform and padding are quickly removed as he is laid
on a stretcher. His vital signs demonstrate a core temperature 102.2 °F (38.9 °C), heart rate 118
bpm, blood pressure 119/82 mmHg, and respiration rate 22 breaths/min. His point-of-care
glucose was 80 mg/dL, and his skin remains very sweaty. Which of the following is the most
appropriate treatment to initiate now? Correct Ans-IV fluids with normal saline
A 14-year-old girl is brought to the emergency department by her parents. Her parents state
that she was playing outside during a softball game when she developed nausea and started
complaining of fatigue and mild headache. Further evaluation reveals that she has a heart rate
of 120 beats/min and a temperature of 103 degrees Fahrenheit. However, she has no mental
status changes or muscle fasciculations but is sweating profusely. What is the most likely
diagnosis? Correct Ans-Heat exhaustion
A 6-year-old boy is brought to the outpatient department by his parents due to snoring during
his sleep. They state that his snoring has progressively gotten worse over three months. They
have also noticed that their son randomly stops breathing during the night. These episodes of
absent breathing last 10 to 15 seconds before he gasps and resumes his normal breathing. They
also claim that their child has become more irritable and less social over the past few months.
He has no significant past medical history other than the occasional sore throat and flu. His
family history is positive for diabetes mellitus type 1 in an elder brother and diabetes mellitus
type 2 in his father. His vaccinations are up to date, and his vital signs are normal. On
examination, the abdomen is soft and non-tender with no organomegaly, S1 and S2 are audible
with no added sounds, and the pulse has a normal volume, character, and rhythm. Exam
Correct Ans-Polysomnography
A 49-year-old otherwise healthy male with no past medical history apart from hypertension well
controlled with medications presents to the emergency department with a friend after having
an episode in which he lost consciousness. The patient stated that they were outside taking
their dog for a walk at a local dog park when he got dizzy, sat on the ground, and then passed
out. The friend states the patient was out for about 30 seconds. The patient is currently feeling
normal. He does admit he hasn't been drinking much water today. Which of the following will
help prevent this from happening in the future? Correct Ans-Staying well hydrated during
periods of heat exposure
, A 30-year-old woman comes to the emergency department at midnight. She is tearful and upset
and complains of abdominal pain. She is disheveled and confides in the provider that she was
assaulted. Her examination is unremarkable, and she agrees to testing. The testing kit is
obtained, and the patient is moved to a quiet room. There are stains on her garments that look
like blood. She agrees to submit them as evidence. She removes her jeans and places them on a
sheet on the floor. The clinician then collects the item in a labeled bag. Which of the following
steps is essential during the processing of the item? Correct Ans-Allowing it to air dry on a
table
A 32-year-old woman presents for examination, evidence collection, and treatment after being
sexually assaulted by her golf instructor. For which of the following bacterial infections should
she be routinely tested before beginning prophylaxis? Correct Ans-No routine testing
indicated
A 17-year-old female presents to the emergency department after having an episode of
syncope. She was out watching fireworks during the day and drinking alcohol. She reports that
she took ibuprofen earlier in the day for a mild headache. Her vital signs are normal, and she
has no symptoms at this time. Which of the following is a risk factor for what happened to the
patient? Correct Ans-Alcohol consumption
A 35-year-old woman presents for a pregnancy test and sexually transmitted infection
screening. She tearfully admits that she went out with friends 10 days ago and was sexually
assaulted. On exam, vital signs are within normal limits. No physical signs of trauma are noted.
An appropriate workup has been ordered. Which of the following is the next best step in the
treatment of this patient? Correct Ans-Mental health evaluation
A 16-year-old girl presents to the emergency department to be evaluated after being sexually
assaulted the night prior. Once in the exam room with the sexual assault nurse examiner (SANE),
the patient tearfully exclaims that she does not want anyone to know, but she wants to make
sure she's not pregnant. Which of the following is the next most appropriate course of action?
Correct Ans-Report the incident to the relevant authorities
A 23-year-old male presents with penile discharge for three days. He also reports urinary
urgency and cloudy urine. When asked about his sexual history, the patient reports that he was
recently sexually assaulted but did not report the assault. He worried that his girlfriend would
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