MSN 622 Final Exam Questions with
Correct Answers
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, or 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 normal. What
changes are more likely to be seen on an electrocardiogram (ECG) if this patient is a
suspected case of unstable angina? - Answer-Deep, symmetric T-wave inversions in V2
and V3 accompanied by flat ST-segment
What heart sound would one hear in a patient with systolic congestive heart failure
(CHF)? - 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? - Answer-A S3 gallop
Which of the following may be the initial presentation of long-term hypertension? -
Answer-Cerebrovascular 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 suspected.
Reduced bloodflow in the ascending aorta would not cause decreased blood flow in
which of the following arteries? - 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 myocardial
infarction (NSTEMI)? - 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 stairs 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 temperature
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? - 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 hyperlipidemia. 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 supplements, 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 increased blood pressure on his heart? - 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 not have any
documentation or labs from his previous medical encounters. Which of the following is
the most significant and earliest sign of heart failure? - Answer-An S3 gallop
A woman presents with chronic fatigue and trouble breathing. Upon inspection, 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 common cause of
her symptoms? - 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. Physical 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? - Answer-There
is a pathologic 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, diabetes 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? - 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? - Answer-Coronary artery 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 systolic 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? - Answer-Hydrochlorothiazide
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? - 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 the presence of these cells? - Answer-Passive
congestion of pulmonary parenchyma
Which of the following abnormal types of respirations is seen in patients with heart
failure? - Answer-Paroxysmal nocturnal dyspnea
A 42-year-old male is 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 improves his symptoms immediately. Which of the following
medications was most likely given to the patient? - Answer-Sublingual nitroglycerin
A 65-year-old man is diagnosed with ACC/AHA stage A heart failure. This stage is
characterized by which of the following? - Answer-Patients at high risk for heart failure
but have no symptoms or structural heart disease
A 65-year-old man presents with complaints of chest pain on exertion, which is relieved
on rest. The patient was diagnosed with asymptomatic coronary artery disease 6
months ago. However, the patient has been noncompliant with his medication. The
patient's coronary arteries are most likely occluded by which of the following? - Answer-
70%
