MSN 622 FIN AL COMPLETE EXAM QUESTIONS WITH CORRECT ANSWERS HIGHGRADE VERIFIED 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, o r 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 n ormal. What changes are more likely to be seen on an electrocardiogram (ECG) if this patient is a suspected case of unstable angina? - CORRECT ANSWER>>>> Deep, symmetric T -
wave inversions in V2 and V3 accompanied by flat ST -segment What heart sound would o ne hear in a patient with systolic congestive heart failure (CHF)? - CORRECT ANSWER>>>> S3 heart sound A 72-year-old man with a recent history of a large anterior wall myocardial infarction complains of dyspnea on exertion, orthopnea, and increasing pedal edema. There is concern about congestive heart failure. Which of the following would support the diagnosis? - CORRECT ANSWER>>>> A S3 gallop Which of the following may be the initial presentation of long -term hypertension? - CORRECT ANSWER>>>> Cerebrovascul ar accident A patient presents with shortness of breath. Rales are heard in the lower lung fields. There is an S4. Hepatojugular reflux is present. The chest x -ray shows cardiomegaly and enlargement of the mediastinal veins. Congestive heart failure is su spected. Reduced bloodflow in the ascending aorta would not cause decreased blood flow in which of the following arteries? - CORRECT ANSWER>>>> Pulmonary artery A 65-year-old woman presents with intermittent, sudden -onset chest pain and shortness of breath , which radiates to her left jaw and arm. A history of present illness reveals that the pain initially occurred with activity, but now it occurs throughout the day. A review of systems is positive for tiring easily with mild physical activity. Her medical history is significant for hypertension and type 2 diabetes mellitus. An electrocardiogram (ECG) and cardiac enzyme markers are ordered. Which of the following tests will be most helpful in differentiating unstable angina from a non -ST segment elevation my ocardial infarction (NSTEMI)? - CORRECT ANSWER>>>> Troponin I A 65-year-old man presents with a 4 -hour history of progressively worsening left chest pain that radiates to his left neck. A history of present illness reveals minor episodes of transient chest pain over the last 6 months after climbing 2 flights of stair s or running. His past medical history includes hypertension, type 2 diabetes mellitus, and hyperlipidemia. His vital signs are oxygen saturation 98% on room air, respiratory rate 18 breaths/min, heart rate 91 bpm, blood pressure 131/91 mm Hg, and temperat ure 98.6 °F (37 °C). A 12 -lead electrocardiogram (ECG) demonstrates ST depressions in leads V5, V6, and aVL. The patient is administered oxygen, morphine, nitroglycerin, and aspirin. What is the principle behind giving this patient nitroglycerin? - CORRECT ANSWER>>>> To dilate the venous system and decrease cardiac preload. 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 hyperl ipidemia. 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 supplement s, 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 increa sed blood pressure on his heart? - CORRECT ANSWER>>>> 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 n ot have any documentation or labs from his previous medical encounters. Which of the following is the most significant and earliest sign of heart failure? - CORRECT ANSWER>>>> An S3 gallop A woman presents with chronic fatigue and trouble breathing. Upon i nspection, 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 co mmon cause of her symptoms? - CORRECT ANSWER>>>> 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. P hysical 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? - CORRECT ANSWER>>>> There is a patholog ic buildup of fluid in her peritoneum due to abnormal changes in her hydrostatic pressure due to a 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, diabe tes 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? - CORRECT ANSWER>>>> 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 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? - CORRECT ANSWER>>>> Coronary ar tery calcium scoring 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 syst olic 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? - CORRECT ANSWER>>>>H ydrochlorothiazi de 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? - CORRECT ANSWER>>>> Get about 150 minutes of moderate -intensity exercise per week 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 t he presence of these cells? - CORRECT ANSWER>>>> Passive congestion of pulmonary parenchyma Which of the following abnormal types of respirations is seen in patients with heart failure? - CORRECT ANSWER>>>> Paroxysmal nocturnal dyspnea A 42-year-old male i s brought to the emergency department after routine evening exercise with chest tightness and severe pain radiating down the left arm. His blood pressure is 130/90 mmHg, and his heart rate is 102 beats per minute. The patient receives a medication that imp roves his symptoms immediately. Which of the following medications was most likely given to the patient? - CORRECT ANSWER>>>> Sublingual nitroglycerin
