MSN 621 FINAL EXAM 3 2026 COMPLETE
QUESTIONS AND SOLUTIONS GRADED A PLUS
ADVANCED NURSING PRACTICE STUDY GUIDE
◉ A 16-year-old female presents with complaints of fever, lethargy,
and night sweats. The patient also reports a 6-kilogram (13.2
pound) weight loss in the past 3 months. On examination, painless,
enlarged cervical and supraclavicular lymph nodes are palpated. A
fine-needle aspiration biopsy of one of the lymph nodes is shown in
the image. The patient's findings are most suggestive of which of the
following? (see photo)
Answer: Hodgkin lymphoma
◉ A 16-year-old male presents with fatigue, easy bruisability, and
weight loss. On examination, hepatosplenomegaly is noted. After a
detailed evaluation, the patient is diagnosed with acute lymphocytic
leukemia. Which of the following is used in the management of this
patient's condition
Answer: L-asparaginase
◉ A 57-year-old patient with lymphoma complains of nausea after
starting morphine. Which of the following is most accurate
regarding nausea and vomiting due to opioids?
Answer: After starting opioids, nausea, often improves within a few
days
,◉ A 43-year-old man presents to the clinic for evaluation after
abnormalities noted on a routine set of labs. CBC with differential
demonstrated hemoglobin 14 g/dL, WBC count 26,000/microL,
lymphocytes 21,000/microL, neutrophils 4500/microL, and
platelets 260,000/microL. The basic metabolic panel demonstrates
normal electrolytes and renal function. LFTs show total bilirubin 1.2
mg/dL and normal liver enzymes. On examination in office, his
examination is normal, with no palpable lymph nodes or
hepatosplenomegaly. He denies any B symptoms. Peripheral smear
shows lymphocytosis with many small lymphocytes and smudge
cells. Which of the following is the next best step in the management
of this patient?
Answer: Observation and close follow up
◉ A 65-year-old woman presents with an 8-month history of
recurrent low-grade fevers, a 3-month history of abdominal fullness,
and more recently, fatigue and moderately reduced exercise
tolerance. Before this, she was in good health with no major medical
conditions. Upon examination, she appeared to be stable and in no
acute distress. She has a heart rate of 95 bpm and blood pressure of
128/60 mmHg. She had several palpable cervical and axillary lymph
nodes (1-2 cm) that were non-tender and freely mobile. She also had
palpable splenomegaly. No other abdominal masses/hepatomegaly
appreciated on examination. Her complete blood count showed a
leukocyte count of 32,000/mm3, hemoglobin of 9.8 g/dL, platelet
count of 145,000/mm3, neutrophil count 1,900/mm3, lymphocyte
count 30,000/mm3, elevated LDH, and elevated reticulocyte count.
,Peripheral blood smear showed an increasing number of mature
lymphocytes, spherocytes, and pol
Answer: Autoimmune hemolytic anemia
◉ A 67-year-old female with a performance status of 0, is brought to
the clinic with symptomatic anemia and has required several
transfusions over the past 2 to 3 months. Currently, her hemoglobin
is 7.5 g/dL, absolute neutrophil count 1500/microL and platelet
count is 119,000/microL. She had a bone marrow biopsy performed
that reveals myelodysplastic syndrome (MDS) with 6% blasts and
cytogenetics positive for 5q deletion. She did not have any mutations
or other cytogenetic abnormalities. Which of the following is the
best initial course of treatment?
Answer: A thalidomide derivative
◉ A 36-year-old woman with a past medical history significant for
menorrhagia from uterine fibroids presents with exertional dyspnea
and fatigue. Examination shows conjunctival pallor. Laboratory tests
reveal a hemoglobin of 6.2 grams/dL, mean corpuscular volume
(MCV) 60 fl (normal: 80-100 fl), and normal liver function tests.
What is the most likely diagnosis?
Answer: Iron deficiency anemia
◉ A 59-year-old male patient with a history of non-Hodgkins
lymphoma treated with cyclophosphamide, adriamycin, vincristine,
and prednisone eight years ago presents with a new diagnosis of
, myelodysplastic syndrome. Bone marrow biopsy reveals 12% blasts
and greater than 10% dysplasia in the erythroid and granulocytic
lineages. Fluorescence in situ hybridization (FISH) revealed
monosomy 7. He asks you about the risk of transformation into
acute myeloid leukemia (AML). What is the risk of treatment-related
myelodysplastic syndrome transforming into AML
Answer: 50% of patients will transform into AML
◉ A 45-year-old asymptomatic man is found to have leukocytosis on
a preoperative complete blood count. His physical examination is
significant for the spleen tip being palpable 2 cm below the left
costal margin. Enlarged, rubbery, nontender lymph nodes up to 1.5
cm in size are present in the axillae and inguinal regions. Laboratory
workup reveals a hemoglobin of 13.3 g/dL, leukocytes
40,000/microliter, and platelets 238,000/microliter. His peripheral
blood smear shows mature lymphocytes with smudge cells. If he
fails first-line therapy, which of the following cytogenetic changes
would be an indication for stem cell transplant in this patient?
Answer: 17p deletion
◉ A 60-year-old asymptomatic man is found to have leukocytosis on
a preoperative CBC. Physical examination shows the spleen tip to be
palpable 2 cm below the left costal margin. Rubbery, nontender
lymph nodes up to 1.5 cm in size are present in the axillae and
inguinal regions. Laboratory data include the following: Hgb: 13.3
g/dL (normal 14 to 18) Leukocytes: 40,000/microL (normal 4300 to
10,800) Platelet count: 238,000 (normal 150,000 to 400,000) His
QUESTIONS AND SOLUTIONS GRADED A PLUS
ADVANCED NURSING PRACTICE STUDY GUIDE
◉ A 16-year-old female presents with complaints of fever, lethargy,
and night sweats. The patient also reports a 6-kilogram (13.2
pound) weight loss in the past 3 months. On examination, painless,
enlarged cervical and supraclavicular lymph nodes are palpated. A
fine-needle aspiration biopsy of one of the lymph nodes is shown in
the image. The patient's findings are most suggestive of which of the
following? (see photo)
Answer: Hodgkin lymphoma
◉ A 16-year-old male presents with fatigue, easy bruisability, and
weight loss. On examination, hepatosplenomegaly is noted. After a
detailed evaluation, the patient is diagnosed with acute lymphocytic
leukemia. Which of the following is used in the management of this
patient's condition
Answer: L-asparaginase
◉ A 57-year-old patient with lymphoma complains of nausea after
starting morphine. Which of the following is most accurate
regarding nausea and vomiting due to opioids?
Answer: After starting opioids, nausea, often improves within a few
days
,◉ A 43-year-old man presents to the clinic for evaluation after
abnormalities noted on a routine set of labs. CBC with differential
demonstrated hemoglobin 14 g/dL, WBC count 26,000/microL,
lymphocytes 21,000/microL, neutrophils 4500/microL, and
platelets 260,000/microL. The basic metabolic panel demonstrates
normal electrolytes and renal function. LFTs show total bilirubin 1.2
mg/dL and normal liver enzymes. On examination in office, his
examination is normal, with no palpable lymph nodes or
hepatosplenomegaly. He denies any B symptoms. Peripheral smear
shows lymphocytosis with many small lymphocytes and smudge
cells. Which of the following is the next best step in the management
of this patient?
Answer: Observation and close follow up
◉ A 65-year-old woman presents with an 8-month history of
recurrent low-grade fevers, a 3-month history of abdominal fullness,
and more recently, fatigue and moderately reduced exercise
tolerance. Before this, she was in good health with no major medical
conditions. Upon examination, she appeared to be stable and in no
acute distress. She has a heart rate of 95 bpm and blood pressure of
128/60 mmHg. She had several palpable cervical and axillary lymph
nodes (1-2 cm) that were non-tender and freely mobile. She also had
palpable splenomegaly. No other abdominal masses/hepatomegaly
appreciated on examination. Her complete blood count showed a
leukocyte count of 32,000/mm3, hemoglobin of 9.8 g/dL, platelet
count of 145,000/mm3, neutrophil count 1,900/mm3, lymphocyte
count 30,000/mm3, elevated LDH, and elevated reticulocyte count.
,Peripheral blood smear showed an increasing number of mature
lymphocytes, spherocytes, and pol
Answer: Autoimmune hemolytic anemia
◉ A 67-year-old female with a performance status of 0, is brought to
the clinic with symptomatic anemia and has required several
transfusions over the past 2 to 3 months. Currently, her hemoglobin
is 7.5 g/dL, absolute neutrophil count 1500/microL and platelet
count is 119,000/microL. She had a bone marrow biopsy performed
that reveals myelodysplastic syndrome (MDS) with 6% blasts and
cytogenetics positive for 5q deletion. She did not have any mutations
or other cytogenetic abnormalities. Which of the following is the
best initial course of treatment?
Answer: A thalidomide derivative
◉ A 36-year-old woman with a past medical history significant for
menorrhagia from uterine fibroids presents with exertional dyspnea
and fatigue. Examination shows conjunctival pallor. Laboratory tests
reveal a hemoglobin of 6.2 grams/dL, mean corpuscular volume
(MCV) 60 fl (normal: 80-100 fl), and normal liver function tests.
What is the most likely diagnosis?
Answer: Iron deficiency anemia
◉ A 59-year-old male patient with a history of non-Hodgkins
lymphoma treated with cyclophosphamide, adriamycin, vincristine,
and prednisone eight years ago presents with a new diagnosis of
, myelodysplastic syndrome. Bone marrow biopsy reveals 12% blasts
and greater than 10% dysplasia in the erythroid and granulocytic
lineages. Fluorescence in situ hybridization (FISH) revealed
monosomy 7. He asks you about the risk of transformation into
acute myeloid leukemia (AML). What is the risk of treatment-related
myelodysplastic syndrome transforming into AML
Answer: 50% of patients will transform into AML
◉ A 45-year-old asymptomatic man is found to have leukocytosis on
a preoperative complete blood count. His physical examination is
significant for the spleen tip being palpable 2 cm below the left
costal margin. Enlarged, rubbery, nontender lymph nodes up to 1.5
cm in size are present in the axillae and inguinal regions. Laboratory
workup reveals a hemoglobin of 13.3 g/dL, leukocytes
40,000/microliter, and platelets 238,000/microliter. His peripheral
blood smear shows mature lymphocytes with smudge cells. If he
fails first-line therapy, which of the following cytogenetic changes
would be an indication for stem cell transplant in this patient?
Answer: 17p deletion
◉ A 60-year-old asymptomatic man is found to have leukocytosis on
a preoperative CBC. Physical examination shows the spleen tip to be
palpable 2 cm below the left costal margin. Rubbery, nontender
lymph nodes up to 1.5 cm in size are present in the axillae and
inguinal regions. Laboratory data include the following: Hgb: 13.3
g/dL (normal 14 to 18) Leukocytes: 40,000/microL (normal 4300 to
10,800) Platelet count: 238,000 (normal 150,000 to 400,000) His
