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MSN 622 FINAL EXAM NEWEST 2024 ACTUAL EXAM
COMPLETE 160 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
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 1 / 4
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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 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 70-year-old man with chronic non-ischemic cardiomyopathy and hypertension presents to the emergency department with shortness of 2 / 4
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breath that started 2 days ago. His last known ejection fraction is 40%.His vitals are blood pressure 110/60 mmHg, heart rate 125 bpm, respiratory rate 20 breaths/min, and oxygen saturation 94% on ambient air. An ECG rhythm strip is shown below. What is the most appropriate treatment for this patient's arrhythmia at this time? - ANSWER- Diltiazem
Which of the following findings indicates critical peripheral arterial disease? - ANSWER- .An ankle-brachial index <0.3
A 2-month-old male is brought to the emergency department in distress.He had a normal birth history. He had a history of viral illness 4 weeks ago, which resolved with time. His vital signs are a heart rate of 180 beats per minute, a blood pressure of 85/52 mmHg, a respiratory rate of 50 breaths per minute, and a temperature of 37 C (98.6 F). Physical examination reveals a pale-looking infant. The heart sounds are distant, and there is a gallop. A chest x-ray shows an enlarged cardiac shadow.The electrocardiogram has low voltage. Which of the following explains his presentation? - ANSWER- Dilated cardiomyopathy secondary to myocarditis
Which of the following is the next step in managing a patient with claudication who has failed smoking cessation, cilostazol, and walking- trial therapy? - ANSWER- CT angiography
A 78-year-old patient with a history of hypertension, coronary artery disease, New York Heart Association (NYHA) Functional Class 2, diabetes mellitus type 2, and Parkinson disease presents with 3 / 4
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intermittent claudication of the left leg. The arterial brachial index is decreased on the left. The patient is refractory to non-invasive therapy of full-dose aspirin and cilostazol. Angiography shows stenosis in the superficial femoral artery. What is the next best step in management? - ANSWER- Attempt endovascular revascularization
A 65-year-old female is admitted to the hospital with palpitations and shortness of breath. Her past medical history includes congestive heart failure with an ejection fraction of 28%, hypertension, and asthma. She reports smoking 4 to 5 cigarettes a day but no illicit drug use. She takes amlodipine 10 mg once a day, lisinopril 10 mg a day and uses an albuterol inhaler about once a month in the spring and fall). Physical exam reveals blood pressure 140/80 mmHg, heart rate 164 bpm, irregular, respiratory rate 20. EKG results are shown. What is an appropriate rate control medication for her that would also be useful for her congestive heart failure? - ANSWER- Metoprolol
A 17-year-old, previously healthy girl presents with an acute flu-like illness, fever, myalgias, shortness of breath, and chest pain. Her ECG shows sinus tachycardia. Her labs show elevated white blood cells and an abnormally elevated troponin. Her chest x-ray shows mild pulmonary edema, with findings consistent with congestive heart failure. What is her likely diagnosis? - ANSWER- Acute myocarditis
A 76-year-old male comes into the emergency department with a complaint of chest pain. The patient was placed on telemetry monitoring that showed an abnormal rhythm at a rate of 160 beats per minute. A 12 lead EKG was performed showing an irregularly irregular rhythm. He has a history of atrial fibrillation and has been taking rivaroxaban for the
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