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MSN 622 Final Exam latest
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MSN 622 Final Exam latest MSN 622 Final Exam latest MSN 622 Final Exam latest
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MSN 622 Final Exam latestblowing - ANS 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 - ANS What is the recommended management for a patient with a 3.5 cm
abdominal aortic aneurysm?
immediate surgery - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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. - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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 - ANS 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?
defer surgery for at least 2 months - ANS 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
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