MSN 622 Complete Questions And Answers With Latest Study Solutions
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Course
MSN 622
Institution
MSN 622
MSN 622 Complete Questions And Answers With Latest Study Solutions
A 65-year-old man presents with an episode of gross hematuria. He has no significant history. An abdominal CT incidentally demonstrates a 6 cm abdominal aortic aneurysm (AAA). What is the next step in the management of the AAA?
A....
MSN 622 Complete Questions And Answers With
Latest Study Solutions
A 65-year-old man presents with an episode of gross hematuria. He has no significant history. An
abdominal CT incidentally demonstrates a 6 cm abdominal aortic aneurysm (AAA). What is the next
step in the management of the AAA?
A.
Observation with annual follow-up.
B.
Elective abdominal aortic aneurysm surgery.
C.
Emergency surgery to replace the aneurysm.
D.
Angiogram to determine the size of the abdominal aortic aneurysm. ANS B.
Elective abdominal aortic aneurysm surgery.
According to the Society for Vascular Surgery (SVS) 2018 guidelines, what is the recommended
management for a patient with a 3.5 cm abdominal aortic aneurysm?
A.
Open repair
B.
Duplex ultrasound every 3 years
C.
Endovascular stenting
D.
CT scan every 12 months ANS B.
Duplex ultrasound every 3 years
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?(Click Image to Enlarge)
1. Metoprolol
2. Digoxin
3. Ivabradine
4. Atropine ANS 1. 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 hypotensive. What is the next best step?
1. Give 10 mg IV push of diltiazem bolus for rate control
2. Give 150 mg IV push of amiodarone for rhythm control
3. Immediate cardioversion
4. Begin transcutaneous pacing ANS 3. Immediate cardioversion
A 65-year-old female patient presents with complaints of periodic, intermittent, sudden-onset chest
pain and shortness of breath, which radiates to her left jaw and arm. She reports that she tires easily
with mild physical activity. Initially, she experienced chest pain with activity, but now it occurs
throughout the day. 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)?
A. Troponin I
B. Echocardiogram
C. Electrocardiogram
D. Creatine kinase (CK) ANS A. Troponin I
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?
A. Diffuse ST-segment elevation in all the leads
B. Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
C. ANS B. Deep, symmetric T-wave inversions in V2 and V3 accompanied by flat ST-segment
A 73-year-old patient presents with a 6-month history of progressive fatigue, with difficulty climbing
stairs and brushing her hair. These symptoms are different than her usual symptoms. Her medical
history is significant for rheumatoid arthritis diagnosed 15 years ago. During this time, the patient has
tried multiple biological agents with most of these medications discontinued because of adverse
effects or loss of efficacy. The patient declined to try rituximab and requested to continue steroids.
She has been on 10 mg of prednisone daily for about 10 years. Her dose is increased to 15 mg daily
when the patient experiences an increase in joint pain, which happens about twice a month. What is
the most likely etiology of the patient's symptoms?
Well done!You answered successfully
A.
The patient has overextended herself and pulled a muscle.
B.
The patient most likely has an infection secondary to steroid use.
C.
The pa ANS C.
The patient probably has proximal muscle weakness secondary to corticosteroids.
What heart sound would one hear in a patient with systolic congestive heart failure (CHF)?
1. A systolic murmur
2. A diastolic murmur
3. S3 heart sound
4. A snap in early diastole ANS 3. S3 heart sound
, 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?
1. To dilate the venous system and decrease cardiac preload.
2. To increase cardiac afterload and ejection fraction.
3. To dilate the systemic arteries to decrease cardiac ANS 1. 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?
1. Left ventricular dilatation
2. Left ventricular (concentric) hypertrophy
3. Right ventricular hypertrophy
4. Diffuse myocardial fibrosis ANS 2. 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?
1. Peripheral edema
2. Pulmonary rales
3. An S3 gallop
4. Kussmaul sign ANS 3. An S3 gallop
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