- | P a g e
MSN 622 FINAL NEWEST 2024-2025 ACTUAL EXAM
COMPLETE 100 QUESTIONS AND CORRECT
DETAILED ANSWERS (VERIFIED ANSWERS)
|ALREADY GRADED A+
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 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 past four months. The patient soon becomes diaphoretic, unresponsive, and 1 / 4
- | P a g e
hypotensive. What is the next best step? - ANSWER- Immediate cardioversion
A 56-year-old man was admitted to the hospital for new-onset atrial fibrillation. After failed attempts of pharmacologic therapy to return his heart to normal sinus rhythm, the decision was made to perform a transesophageal echocardiogram (TEE) and cardioversion. When performing the TEE, he was found to have a left atrial appendage thrombus, so the cardioversion was aborted. He was then started on rivaroxaban. When should cardioversion be considered again? - ANSWER- After he has been taking rivaroxaban for 3 to 4 weeks
A 75-year-old male presents with a complaint of palpitations for the past 1 week. He denies any associated symptoms. He has a past medical history of hypertension and diabetes mellitus type 2, for which he takes lisinopril and metformin at home. He smokes 1 pack of cigarettes per day and drinks 1-2 beers daily.On physical exam, his blood pressure is 158/90 mmHg, his pulse is irregularly irregular with a rate of 110/min, his respirations are 16/min, his temperature is 99.4°F (37.4 °C), and his pulse oximetry is 97% on room air. A rhythm strip from his examination is provided. A complete blood count (CBC) and thyroid function tests are normal. A bedside echocardiogram shows no structural abnormalities. Which of the following treatments is most appropriate at this time to prevent adverse effects from his arrhythmia? - ANSWER- Apixaban 2 / 4
- | P a g e
A 59-year-old female with a past medical history of coronary artery disease, hypertension, hyperlipidemia, obesity, gastroesophageal reflux disease, and alcohol dependence presents to the emergency department with acute onset shortness of breath for one day. She has dry cough and nausea. Vitals shows heart rate of 138/min, respiratory rate 32/min, temperature 99 F, and blood pressure is 142/92 mmHg. Oral mucosa is dry, and her breath smells of alcohol. Lungs exam reveals fine bibasilar crackles and the neck exam is unremarkable. Also, the EKG shows an irregularly irregular rhythm. Labs indicate a raised blood alcohol level and TSH is 0.36 mU/L. Diltiazem infusion is initiated along with fluids.Which of the following is the best management plan for this patient? - ANSWER- Continue diltiazem drip, IV fluids, and consult cardiology
A 65-year-old woman with claudication symptoms for the last six months presents to the clinic for evaluation. The patient has a history of diabetes and hypertension. She denies smoking.Physical exam shows palpable pulses on the bilateral lower extremities. Ankle-brachial index done at bedside shows a 1.1 on the right and 1.0 on the left lower extremity. What is the next best step in the management of this patient? - ANSWER- Repeat ankle-brachial index after exercise
- / 4
- | P a g e
A 65-year-old man presents with palpitations and dyspnea without chest pain or lightheadedness. His medical history is significant for hypertension and hyperthyroidism. A 12-lead ECG is shown below. What is the mechanism of this patient's arrhythmia? - ANSWER- Micro-reentry
A 65-year-old man presents to the emergency department with chest pain, palpitations, and dyspnea. The client has a past medical history significant for hypertension and hyperthyroidism. An electrocardiogram (EKG) is performed, as shown in the figure. Initial medical management is initiated.Which of the following is the most appropriate initial objective of this patient's treatment? - ANSWER- Decrease the ventricular rate below 100/min
A 65-year-old man presents to the emergency department with palpitations, lightheadedness, and chest discomfort. He has a history of hypertension and mitral stenosis. His vital signs include a heart rate of 141/minute, blood pressure of 110/78 mm Hg, and oxygen saturation of 97% on room air. A 12-lead electrocardiogram is shown. Which of the following best describes the rate of atrial activity associated with this patient's condition? - ANSWER- More than 350/minute
A 45-year-old man presents for a two-month history of worsening dyspnea. He denies a history of fever and sore throat
- / 4