SHADOW HEALTH | CHAMBERLAIN UNIVERSITY
NR 509 Musculoskeletal
Documentation Assessment
Official Practice Exam · 2026/2027 Edition
Questions: 50 Time: 90 Minutes Passing Score: 80% Recertification: Semester
Table of Contents
Musculoskeletal Assessment & Documentation (Questions 1-15)
Range of Motion & Functional Assessment (Questions 16-28)
Musculoskeletal Pathology & Clinical Findings (Questions 29-40)
Patient Education & Interprofessional Collaboration (Questions 41-50)
Instructions
This practice exam contains 50 multiple-choice questions divided into four sections. You have 90 minutes to
complete the exam. A score of 80% or higher (40 out of 50 correct) is required to pass. Each question has four
answer choices (A through D). Select the single best answer for each question. Read each scenario carefully
before selecting your response. Review the rationale provided after each answer to reinforce your understanding of
musculoskeletal assessment, documentation, and clinical decision-making.
Exam Content Areas:
Section 1: Musculoskeletal Assessment & Documentation - 15 questions (30%)
Section 2: Range of Motion & Functional Assessment - 13 questions (26%)
Section 3: Musculoskeletal Pathology & Clinical Findings - 12 questions (24%)
Section 4: Patient Education & Interprofessional Collaboration - 10 questions (20%)
NR 509 Musculoskeletal -- 2026/2027 | Passing Score: 80% | Page 1
,Section 1: Musculoskeletal Assessment & Documentation | 2026/2027
Q1. Question 1 of 50
Q1. A 42-year-old construction worker presents to the primary care clinic reporting persistent lower back pain that
radiates down his left leg for the past three weeks. The nurse practitioner is performing a comprehensive
musculoskeletal assessment. When documenting the initial observation of the patient's gait and posture, what is the
most appropriate documentation entry?
A. Patient walks with a noticeable antalgic gait favoring the left lower extremity and exhibits a forward-leaning
trunk posture upon standing
B. Patient has a weird walk and seems to be hurting on the left side when he moves around the room
C. Patient ambulates normally without any visible gait abnormalities or postural changes during the examination
D. Patient demonstrates a shuffling gait pattern with bilateral upper extremity resting tremors and masked facies
Correct Answer: A
Rationale:
An antalgic gait is the correct clinical term for a limping gait that minimizes pain on the affected side, and a forward-leaning posture is
consistent with radicular back pain. Option B uses non-clinical language inappropriate for documentation, and Option D describes a
parkinsonian gait rather than an antalgic gait.
Q2. Question 2 of 50
Q2. A 35-year-old female office worker reports bilateral hand numbness and tingling that worsens at night. The nurse
practitioner performs Tinel's sign and Phalen's test at the wrists. When documenting the results of these provocative
tests, what constitutes accurate documentation of a positive finding?
A. Positive Tinel's sign with tingling reproduced on percussion over the carpal tunnel and positive Phalen's test
with paresthesia within 30 seconds of wrist flexion
B. Negative Tinel's sign with no response to percussion and negative Phalen's test with no symptoms after holding wrists in
extension
C. Positive Tinel's sign with pain radiating to the shoulder and positive Phalen's test with swelling of the distal
interphalangeal joints
D. Positive Tinel's sign with weakness of grip strength and positive Phalen's test with decreased radial pulse upon wrist
flexion
Correct Answer: A
Rationale:
A positive Tinel's sign reproduces tingling (paresthesia) on percussion over the carpal tunnel, and a positive Phalen's test reproduces
paresthesia within 30-60 seconds of sustained wrist flexion, both indicating median nerve compression. Option C describes findings
inconsistent with carpal tunnel syndrome, and Option D confuses the test with vascular assessments.
NR 509 Musculoskeletal -- 2026/2027 | Passing Score: 80% | Page 2
, Q3. Question 3 of 50
Q3. A 67-year-old male presents with right knee swelling and stiffness that is worse in the morning but improves with
activity. The nurse practitioner examines the knee and notes a palpable effusion. When performing the bulge sign
test, what is the correct technique and expected positive finding?
A. Apply firm pressure to the medial aspect of the knee, then tap the lateral side; a positive sign shows a fluid
wave or bulge appearing on the medial side
B. Apply firm pressure to the lateral aspect of the knee, then tap the medial side; a positive sign shows a fluid wave or
bulge appearing on the lateral side
C. Compress the patella firmly against the femur and release quickly; a positive sign shows the patella bouncing back
sharply
D. Flex the knee to 90 degrees and apply valgus stress; a positive sign shows increased joint laxity on the lateral side
Correct Answer: A
Rationale:
The bulge sign is performed by milking fluid from the medial side upward, then tapping the lateral side to observe a fluid wave returning
to the medial compartment, indicating a mild knee effusion. Option C describes the ballottement test for larger effusions, and Option D
describes the valgus stress test for medial collateral ligament integrity.
Q4. Question 4 of 50
Q4. A 28-year-old competitive swimmer reports right shoulder pain with overhead movements and difficulty sleeping
on the affected side. The nurse practitioner performs the Neer impingement test. When documenting this finding,
what is the correct description of the test technique?
A. The examiner stabilizes the scapula and passively flexes the arm forward to assess for pain in the arc of motion
between 70 and 120 degrees
B. The examiner applies an anterior force to the humeral head while the arm is abducted 90 degrees and externally rotated
to assess for apprehension
C. The examiner resists supination of the forearm while the elbow is flexed 90 degrees to assess for pain at the lateral
epicondyle
D. The examiner passively internally rotates the arm while it is abducted 90 degrees and flexed 90 degrees at the elbow to
assess for labral pathology
Correct Answer: A
Rationale:
The Neer impingement test involves stabilizing the scapula and passively flexing the arm forward to provoke pain between 70-120
degrees, indicating supraspinatus tendon impingement under the acromion. Option B describes the apprehension test for shoulder
instability, and Option C describes the Cozen test for lateral epicondylitis.
NR 509 Musculoskeletal -- 2026/2027 | Passing Score: 80% | Page 3
NR 509 Musculoskeletal
Documentation Assessment
Official Practice Exam · 2026/2027 Edition
Questions: 50 Time: 90 Minutes Passing Score: 80% Recertification: Semester
Table of Contents
Musculoskeletal Assessment & Documentation (Questions 1-15)
Range of Motion & Functional Assessment (Questions 16-28)
Musculoskeletal Pathology & Clinical Findings (Questions 29-40)
Patient Education & Interprofessional Collaboration (Questions 41-50)
Instructions
This practice exam contains 50 multiple-choice questions divided into four sections. You have 90 minutes to
complete the exam. A score of 80% or higher (40 out of 50 correct) is required to pass. Each question has four
answer choices (A through D). Select the single best answer for each question. Read each scenario carefully
before selecting your response. Review the rationale provided after each answer to reinforce your understanding of
musculoskeletal assessment, documentation, and clinical decision-making.
Exam Content Areas:
Section 1: Musculoskeletal Assessment & Documentation - 15 questions (30%)
Section 2: Range of Motion & Functional Assessment - 13 questions (26%)
Section 3: Musculoskeletal Pathology & Clinical Findings - 12 questions (24%)
Section 4: Patient Education & Interprofessional Collaboration - 10 questions (20%)
NR 509 Musculoskeletal -- 2026/2027 | Passing Score: 80% | Page 1
,Section 1: Musculoskeletal Assessment & Documentation | 2026/2027
Q1. Question 1 of 50
Q1. A 42-year-old construction worker presents to the primary care clinic reporting persistent lower back pain that
radiates down his left leg for the past three weeks. The nurse practitioner is performing a comprehensive
musculoskeletal assessment. When documenting the initial observation of the patient's gait and posture, what is the
most appropriate documentation entry?
A. Patient walks with a noticeable antalgic gait favoring the left lower extremity and exhibits a forward-leaning
trunk posture upon standing
B. Patient has a weird walk and seems to be hurting on the left side when he moves around the room
C. Patient ambulates normally without any visible gait abnormalities or postural changes during the examination
D. Patient demonstrates a shuffling gait pattern with bilateral upper extremity resting tremors and masked facies
Correct Answer: A
Rationale:
An antalgic gait is the correct clinical term for a limping gait that minimizes pain on the affected side, and a forward-leaning posture is
consistent with radicular back pain. Option B uses non-clinical language inappropriate for documentation, and Option D describes a
parkinsonian gait rather than an antalgic gait.
Q2. Question 2 of 50
Q2. A 35-year-old female office worker reports bilateral hand numbness and tingling that worsens at night. The nurse
practitioner performs Tinel's sign and Phalen's test at the wrists. When documenting the results of these provocative
tests, what constitutes accurate documentation of a positive finding?
A. Positive Tinel's sign with tingling reproduced on percussion over the carpal tunnel and positive Phalen's test
with paresthesia within 30 seconds of wrist flexion
B. Negative Tinel's sign with no response to percussion and negative Phalen's test with no symptoms after holding wrists in
extension
C. Positive Tinel's sign with pain radiating to the shoulder and positive Phalen's test with swelling of the distal
interphalangeal joints
D. Positive Tinel's sign with weakness of grip strength and positive Phalen's test with decreased radial pulse upon wrist
flexion
Correct Answer: A
Rationale:
A positive Tinel's sign reproduces tingling (paresthesia) on percussion over the carpal tunnel, and a positive Phalen's test reproduces
paresthesia within 30-60 seconds of sustained wrist flexion, both indicating median nerve compression. Option C describes findings
inconsistent with carpal tunnel syndrome, and Option D confuses the test with vascular assessments.
NR 509 Musculoskeletal -- 2026/2027 | Passing Score: 80% | Page 2
, Q3. Question 3 of 50
Q3. A 67-year-old male presents with right knee swelling and stiffness that is worse in the morning but improves with
activity. The nurse practitioner examines the knee and notes a palpable effusion. When performing the bulge sign
test, what is the correct technique and expected positive finding?
A. Apply firm pressure to the medial aspect of the knee, then tap the lateral side; a positive sign shows a fluid
wave or bulge appearing on the medial side
B. Apply firm pressure to the lateral aspect of the knee, then tap the medial side; a positive sign shows a fluid wave or
bulge appearing on the lateral side
C. Compress the patella firmly against the femur and release quickly; a positive sign shows the patella bouncing back
sharply
D. Flex the knee to 90 degrees and apply valgus stress; a positive sign shows increased joint laxity on the lateral side
Correct Answer: A
Rationale:
The bulge sign is performed by milking fluid from the medial side upward, then tapping the lateral side to observe a fluid wave returning
to the medial compartment, indicating a mild knee effusion. Option C describes the ballottement test for larger effusions, and Option D
describes the valgus stress test for medial collateral ligament integrity.
Q4. Question 4 of 50
Q4. A 28-year-old competitive swimmer reports right shoulder pain with overhead movements and difficulty sleeping
on the affected side. The nurse practitioner performs the Neer impingement test. When documenting this finding,
what is the correct description of the test technique?
A. The examiner stabilizes the scapula and passively flexes the arm forward to assess for pain in the arc of motion
between 70 and 120 degrees
B. The examiner applies an anterior force to the humeral head while the arm is abducted 90 degrees and externally rotated
to assess for apprehension
C. The examiner resists supination of the forearm while the elbow is flexed 90 degrees to assess for pain at the lateral
epicondyle
D. The examiner passively internally rotates the arm while it is abducted 90 degrees and flexed 90 degrees at the elbow to
assess for labral pathology
Correct Answer: A
Rationale:
The Neer impingement test involves stabilizing the scapula and passively flexing the arm forward to provoke pain between 70-120
degrees, indicating supraspinatus tendon impingement under the acromion. Option B describes the apprehension test for shoulder
instability, and Option C describes the Cozen test for lateral epicondylitis.
NR 509 Musculoskeletal -- 2026/2027 | Passing Score: 80% | Page 3
