MSN 621 final exam
MSN 621 FINAL EXAM 2025, ADVANCED HEALTH ASSESSMENT
QUESTIONS, MSN CLINICAL DECISION MAKING EXAM, NURSING STUDY
GUIDE, GRADED A+ MSN 621, NURSE PRACTITIONER FINAL EXAM
A 52-year-old woman with a past medical history of hypertension and hyperlipidemia presents
to her primary care provider after feeling a hard lump in her right breast while showering. She
has a sister with breast cancer diagnosed at 60 years of age. Her blood pressure is 134/76
mmHg, heart rate 87/min, respiratory rate of 17/min, and temperature of 98.6 F (37 C).
Examination is significant for a palpable, nontender 1.5 cm mass noted in the right breast at 3'o
clock position 5 cm from the nipple, with no associated nipple discharge or axillary adenopathy.
A diagnostic mammogram with ultrasound of the right breast is ordered. Which of the following
is included in the "triple assessment" for this patient's evaluation?
1. Positron emission tomography scan
2. Computed tomography scan
3. Ultrasound-guided core needle biopsy
4. Nuclear medicine bone scan - ANSWER-3
A 33-year-old woman presents with a painful and erythematous right breast. Her history is
significant for a normal spontaneous vaginal delivery 4 weeks ago and she is exclusively
breastfeeding her infant. Vital signs are temperature 99.7 F (37.6 C), blood pressure 130/70
mmHg, and heart rate 89 bpm. Physical examination reveals an erythematous area on the right
breast covering approximately 2 cm by 3 cm at 7 o'clock. The area is tender to palpation,
fluctuant, and slightly indurated. The nipple of the right breast is cracked, but milk can be
expressed without any difficulty. No visible pus is observed in breast milk. A breast ultrasound
confirms a collection of pus in the erythematous part of the right breast. The clinician prescribes
antibiotics and recommends fine-needle aspiration of the affected area of the breast. Which is
the next best step if the patient does not improve with the recommended therapy?
1. Incis - ANSWER-1
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, MSN 621 final exam
A 24-year-old woman presents to the clinic with breast tenderness, which increases before
menses. Ultrasound reveals a round, well-circumscribed, anechoic structure, with an
imperceptible wall. What is the most likely diagnosis?
1. Simple cyst
2. Complicated cyst
3. Complex cyst
4. Fibroadenoma - ANSWER-1
A 37-year-old female presents to the clinic with a painless breast lump. Examination reveals a
mobile, solitary, painless breast mass, felt in the lower outer quadrant of the right breast. A
mammogram reveals a well-circumscribed discrete oval hypodense breast glandular mass. What
is the most likely diagnosis?
1. Lipoma
2. Ductal carcinoma in situ
3. Breast fibrocystic disease
4. Fibroadenoma - ANSWER-4
A 25-year-old G0P0 female presents with intermittent abdominal pain. She states that the pain
starts before her period, is "crampy" in nature, and lasts for a few days after, and has been
occurring intermittently since menarche. Her periods have been regular, with no spotting or
pain in between periods. Her last period was a week ago. She has no other health issues and
takes no medications. She has had no previous surgeries in the past. She is currently sexually
active with her husband and is interested in starting a family shortly. What is the first line of
treatment for this patient?
1. Morphine
2. Selective serotonin reuptake inhibitor
3. Oral contraceptives
4. NSAIDs - ANSWER-4
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, MSN 621 final exam
A 22-year-old woman presents to the clinic with a history of lower abdominal pain for the past
six months. There is no history of dysuria and dyspareunia. There is no relevant family history of
cancer. The patient noticed that the pain increases during the first two days of her period. The
periods are regular and slightly heavier than usual. She has to change 6 to 7 pads per day. The
patient's blood pressure is 120/80 mmHg, pulse 63/minute, and the temperature is 36.1 C. She
denies any loss of weight. The pelvic examination shows a globularly enlarged and retroverted
uterus. The pregnancy test is negative. She has a recent pelvic ultrasound, which showed some
evidence of endometriosis. What is the most likely diagnosis for this patient?
1. Primary dysmenorrhea
2. Secondary dysmenorrhoea
3. Cervical stenosis
4. Endometrial polyp - ANSWER-2
A 31-year-old female attends the clinics with a complaint of being unable to conceive. She has
been having regular unprotected intercourse for the last 18 months but still unable to conceive.
Her periods are regular every 28 days which last for 4-5 days. She has a history of lower
abdominal pain starting a day before her menstruation. She has been taking paracetamol and
mefenamic acid with minimal relief. She has no other relevant history, and she is a teetotaler
and denies smoking. On examination, her blood pressure is 123/76 mmHg, and her pulse is 81
bpm, her body mass index is 29 kg/m2. On bimanual pelvic examination, there is tenderness on
the left side for her abdomen. What the most appropriate next step in management?
1. Pelvic MRI
2. Hysterosalpingogram
3. Pelvic ultrasound
4. Laparoscopy - ANSWER-3
A 13-year-old girl presents with her mother to the office complaining of lower abdominal pain
that has been increasing for the past three days. The patient describes the pain as crampy, that
improved with ibuprofen. However, now she has pain during defecation and has a sense of
incomplete evacuation. She has not reached menarche. Her blood pressure is 115/82 mm Hg,
her pulse is 79/min, and her temperature is 37.3 C. Pelvic examination shows a bluish bulge
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, MSN 621 final exam
between the labia, but otherwise normal external genitalia, pubic hair, and breast Tanner stage
3 development. Which of the following is the most likely diagnosis?
1. Endometriosis
2. Imperforate hymen
3. Uterine prolapse
4. Adenomyosis - ANSWER-2
A 43-year-old woman comes to the clinic with a 3-day history of vaginal itch and foul-smelling
discharge. The patient has a history of diabetes mellitus. She lives with her boyfriend near a
lake. The physical examination reveals vulvar erythema, thick yellow discharge, and punctate
appearing cervix. The patient undergoes vaginal fluid microscopy, which reveals motile
trichomonads. Which of the following is the best treatment for her sex partner?
1. Clotrimazole
2. Doxycycline
3. Fluconazole
4. Metronidazole - ANSWER-4
A 44-year-old woman reports a 2-day history of itching in the vagina, increased vaginal
discharge, and pain with urination. She denies fever, nausea, constipation, anorexia, and sleep
disturbances. Her past medical history is significant for diabetes mellitus type 2. She irregularly
uses intravaginal estriol cream for relief of vaginal dryness. On examination, she has vaginal
erythema, foamy thick vaginal discharge, and a strawberry-appearing cervix. She reports an
increase in the amount of drainage and a change in the character of the discharge since her last
sexual encounter one month ago. Which of the following is the most appropriate step in the
management of this patient's condition?
1. Measure the pH of the vaginal fluid
2. Perform bacterial culture on the vaginal fluid
3. Recommend a diagnostic trial of not using vaginal estriol cream
4. Observe the vaginal fluid under a microscope - ANSWER-4
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MSN 621 FINAL EXAM 2025, ADVANCED HEALTH ASSESSMENT
QUESTIONS, MSN CLINICAL DECISION MAKING EXAM, NURSING STUDY
GUIDE, GRADED A+ MSN 621, NURSE PRACTITIONER FINAL EXAM
A 52-year-old woman with a past medical history of hypertension and hyperlipidemia presents
to her primary care provider after feeling a hard lump in her right breast while showering. She
has a sister with breast cancer diagnosed at 60 years of age. Her blood pressure is 134/76
mmHg, heart rate 87/min, respiratory rate of 17/min, and temperature of 98.6 F (37 C).
Examination is significant for a palpable, nontender 1.5 cm mass noted in the right breast at 3'o
clock position 5 cm from the nipple, with no associated nipple discharge or axillary adenopathy.
A diagnostic mammogram with ultrasound of the right breast is ordered. Which of the following
is included in the "triple assessment" for this patient's evaluation?
1. Positron emission tomography scan
2. Computed tomography scan
3. Ultrasound-guided core needle biopsy
4. Nuclear medicine bone scan - ANSWER-3
A 33-year-old woman presents with a painful and erythematous right breast. Her history is
significant for a normal spontaneous vaginal delivery 4 weeks ago and she is exclusively
breastfeeding her infant. Vital signs are temperature 99.7 F (37.6 C), blood pressure 130/70
mmHg, and heart rate 89 bpm. Physical examination reveals an erythematous area on the right
breast covering approximately 2 cm by 3 cm at 7 o'clock. The area is tender to palpation,
fluctuant, and slightly indurated. The nipple of the right breast is cracked, but milk can be
expressed without any difficulty. No visible pus is observed in breast milk. A breast ultrasound
confirms a collection of pus in the erythematous part of the right breast. The clinician prescribes
antibiotics and recommends fine-needle aspiration of the affected area of the breast. Which is
the next best step if the patient does not improve with the recommended therapy?
1. Incis - ANSWER-1
1|Page
, MSN 621 final exam
A 24-year-old woman presents to the clinic with breast tenderness, which increases before
menses. Ultrasound reveals a round, well-circumscribed, anechoic structure, with an
imperceptible wall. What is the most likely diagnosis?
1. Simple cyst
2. Complicated cyst
3. Complex cyst
4. Fibroadenoma - ANSWER-1
A 37-year-old female presents to the clinic with a painless breast lump. Examination reveals a
mobile, solitary, painless breast mass, felt in the lower outer quadrant of the right breast. A
mammogram reveals a well-circumscribed discrete oval hypodense breast glandular mass. What
is the most likely diagnosis?
1. Lipoma
2. Ductal carcinoma in situ
3. Breast fibrocystic disease
4. Fibroadenoma - ANSWER-4
A 25-year-old G0P0 female presents with intermittent abdominal pain. She states that the pain
starts before her period, is "crampy" in nature, and lasts for a few days after, and has been
occurring intermittently since menarche. Her periods have been regular, with no spotting or
pain in between periods. Her last period was a week ago. She has no other health issues and
takes no medications. She has had no previous surgeries in the past. She is currently sexually
active with her husband and is interested in starting a family shortly. What is the first line of
treatment for this patient?
1. Morphine
2. Selective serotonin reuptake inhibitor
3. Oral contraceptives
4. NSAIDs - ANSWER-4
2|Page
, MSN 621 final exam
A 22-year-old woman presents to the clinic with a history of lower abdominal pain for the past
six months. There is no history of dysuria and dyspareunia. There is no relevant family history of
cancer. The patient noticed that the pain increases during the first two days of her period. The
periods are regular and slightly heavier than usual. She has to change 6 to 7 pads per day. The
patient's blood pressure is 120/80 mmHg, pulse 63/minute, and the temperature is 36.1 C. She
denies any loss of weight. The pelvic examination shows a globularly enlarged and retroverted
uterus. The pregnancy test is negative. She has a recent pelvic ultrasound, which showed some
evidence of endometriosis. What is the most likely diagnosis for this patient?
1. Primary dysmenorrhea
2. Secondary dysmenorrhoea
3. Cervical stenosis
4. Endometrial polyp - ANSWER-2
A 31-year-old female attends the clinics with a complaint of being unable to conceive. She has
been having regular unprotected intercourse for the last 18 months but still unable to conceive.
Her periods are regular every 28 days which last for 4-5 days. She has a history of lower
abdominal pain starting a day before her menstruation. She has been taking paracetamol and
mefenamic acid with minimal relief. She has no other relevant history, and she is a teetotaler
and denies smoking. On examination, her blood pressure is 123/76 mmHg, and her pulse is 81
bpm, her body mass index is 29 kg/m2. On bimanual pelvic examination, there is tenderness on
the left side for her abdomen. What the most appropriate next step in management?
1. Pelvic MRI
2. Hysterosalpingogram
3. Pelvic ultrasound
4. Laparoscopy - ANSWER-3
A 13-year-old girl presents with her mother to the office complaining of lower abdominal pain
that has been increasing for the past three days. The patient describes the pain as crampy, that
improved with ibuprofen. However, now she has pain during defecation and has a sense of
incomplete evacuation. She has not reached menarche. Her blood pressure is 115/82 mm Hg,
her pulse is 79/min, and her temperature is 37.3 C. Pelvic examination shows a bluish bulge
3|Page
, MSN 621 final exam
between the labia, but otherwise normal external genitalia, pubic hair, and breast Tanner stage
3 development. Which of the following is the most likely diagnosis?
1. Endometriosis
2. Imperforate hymen
3. Uterine prolapse
4. Adenomyosis - ANSWER-2
A 43-year-old woman comes to the clinic with a 3-day history of vaginal itch and foul-smelling
discharge. The patient has a history of diabetes mellitus. She lives with her boyfriend near a
lake. The physical examination reveals vulvar erythema, thick yellow discharge, and punctate
appearing cervix. The patient undergoes vaginal fluid microscopy, which reveals motile
trichomonads. Which of the following is the best treatment for her sex partner?
1. Clotrimazole
2. Doxycycline
3. Fluconazole
4. Metronidazole - ANSWER-4
A 44-year-old woman reports a 2-day history of itching in the vagina, increased vaginal
discharge, and pain with urination. She denies fever, nausea, constipation, anorexia, and sleep
disturbances. Her past medical history is significant for diabetes mellitus type 2. She irregularly
uses intravaginal estriol cream for relief of vaginal dryness. On examination, she has vaginal
erythema, foamy thick vaginal discharge, and a strawberry-appearing cervix. She reports an
increase in the amount of drainage and a change in the character of the discharge since her last
sexual encounter one month ago. Which of the following is the most appropriate step in the
management of this patient's condition?
1. Measure the pH of the vaginal fluid
2. Perform bacterial culture on the vaginal fluid
3. Recommend a diagnostic trial of not using vaginal estriol cream
4. Observe the vaginal fluid under a microscope - ANSWER-4
4|Page
