Chamberlain University
2 MAXE • 403 RN
★ ★
C College of Nursing
J O U R N E Y T O E X T R A O R D I N A R Y CO M PA S S I O N AT E C A R E
EST. 1889
NR 304 — Examination 2
HEALTH ASSESSMENT: MUSCULOSKELETAL, GENITOURINARY, NEUROLOGIC & GERIATRICS
INSTITUTION Chamberlain University COURSE CODE NR 304
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 2 — Health Assessment TOTAL QUESTIONS 132 Questions
COURSE TITLE Health Assessment II FORMAT Multiple Choice — Comprehensive Q&A Review
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Musculoskeletal assessment — muscle strength grading, joint ROM, special tests (Tinel, Phalen, McMurray), and OA vs. RA differentiation are core
competencies.
▸ Genitourinary assessment — UTI, BPH, STIs, renal calculi, prostate cancer screening, and GU anatomy are emphasized throughout.
▸ Neurological assessment — cranial nerves, cerebellar testing, stroke recognition (BE FAST), and posturing are testable content.
▸ Geriatric considerations — atypical presentation, failure to rescue, normal aging changes, and polypharmacy risks are critical knowledge areas.
▸ Correct answers and clinical rationales appear below each question for NCLEX board review purposes.
▸ All content reflects current evidence-based health assessment and clinical practice standards.
SECTION I — MUSCULOSKELETAL ASSESSMENT & Questions 1 – 9, 33–34, 48, 60, 62, 66, 73–74, 99, 102–103, 111, 113–114,
SPECIAL TESTS 116–117, 119, 126–127
1. Which performance grade best matches a client who can only lift their leg when gravity's force is removed?
A. Grade 5 — Normal (full ROM against gravity with full resistance)
B. Grade 3 — Fair (full ROM against gravity only, no added resistance)
C. Moves fully through arc only in a gravity-eliminated plane (Grade 2 — Poor)
D. Grade 1 — Trace (palpable muscle contraction, no joint movement)
CORRECT ANSWER C — Grade 2 (Poor): full ROM with gravity eliminated; cannot move against gravity alone
RATIONALE The Medical Research Council (MRC) muscle strength scale: Grade 5 (Normal) — full ROM against gravity with full resistance.
Grade 4 (Good) — full ROM against gravity with some resistance. Grade 3 (Fair) — full ROM against gravity only, no added
resistance. Grade 2 (Poor) — full ROM only when gravity is eliminated (the limb is supported). Grade 1 (Trace) — palpable
muscle contraction without joint movement. Grade 0 — no contraction. Grade 2 is the key transition point — the patient CAN
move through the full range but CANNOT overcome gravity. This distinction guides functional assessment and rehabilitation
planning.
5. Which motion should be evaluated to assess whether the knee can straighten fully after injury?
A. Flexion of the knee joint
B. Extension of the knee joint
C. Internal rotation of the tibia
D. Valgus stress testing
CORRECT ANSWER B — Extension of the knee joint (full extension = 0 degrees)
RATIONALE Knee extension is the straightening motion that returns the knee to anatomical position (0 degrees). Inability to fully extend
the knee (extension lag or locked knee) after injury strongly suggests a mechanical blockage — most commonly a torn
meniscus (bucket-handle tear) where the torn fragment becomes wedged between the femoral condyle and tibial plateau,
physically preventing full extension. It can also indicate an ACL tear with associated hemarthrosis, loose body, or
osteochondral fragment. The McMurray test is the specific provocative test for meniscal tears. Full flexion is also assessed
(normal 130-150 degrees). Internal rotation and valgus stress test ligament integrity, not extension ability.
,9. Which sequence ensures a structured and reliable assessment during a full musculoskeletal exam?
A. Begin proximally and progress distally
B. Begin distally and progress proximally
C. Random order based on patient complaints
D. Head-to-toe only, ignoring extremities
CORRECT ANSWER B — Begin distally and progress proximally; compare bilaterally throughout
RATIONALE A systematic musculoskeletal examination begins distally (hands, feet) and progresses proximally (wrists/ankles →
elbows/knees → shoulders/hips → spine). This distal-to-proximal sequence ensures thoroughness and prevents omission. At
each level, the examiner compares bilaterally — symmetry is the expected normal finding; asymmetry suggests pathology.
The exam includes inspection (deformity, swelling, muscle atrophy), palpation (tenderness, warmth, crepitus), range of
motion (active then passive), and muscle strength testing. A head-to-toe approach (D) is too general. A random approach (C)
risks missing findings. The systematic sequence becomes automatic with practice and ensures a complete examination.
10. Which disorder is consistent with severe joint pain and laboratory confirmation of monosodium urate crystals?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Acute gout
D. Pseudogout (CPPD)
CORRECT ANSWER C — Acute gout; negatively birefringent monosodium urate crystals under polarized light microscopy
RATIONALE Gout is definitively diagnosed by joint aspiration (arthrocentesis) demonstrating negatively birefringent needle-shaped
monosodium urate crystals under polarized light microscopy. Clinical presentation: acute onset of severe pain, erythema,
swelling, and warmth — classically in the first metatarsophalangeal joint (podagra) but can affect any joint. Pseudogout (D —
calcium pyrophosphate deposition/CPPD) shows positively birefringent rhomboid crystals. RA (A) is diagnosed by clinical
criteria and serology (RF, anti-CCP). OA (B) is diagnosed clinically and radiographically. Gout is caused by hyperuricemia; risk
factors include purine-rich diet, alcohol, diuretics, and renal insufficiency. Acute treatment: NSAIDs, colchicine,
corticosteroids. Chronic management: urate-lowering therapy (allopurinol, febuxostat).
15. Which specific ankle motion should be tested for a client reporting difficulty pressing gas and brake pedals while driving?
A. Dorsiflexion ability
B. Plantar flexion ability
C. Ankle inversion
D. Ankle eversion
CORRECT ANSWER B — Plantar flexion ability (pressing pedals requires toes pointing down)
RATIONALE Pressing gas and brake pedals requires active ankle plantarflexion — movement of the foot downward (toes pointing away
from the shin). The gastrocnemius and soleus muscles (innervated by the tibial nerve, S1-S2) power this motion. Assessment:
have the patient press down against resistance as if pressing a pedal; assess strength (0-5 scale) and range of motion.
Dorsiflexion (A) is foot upward toward the shin (needed for releasing pedals). Inversion (C) and eversion (D) are side-to-side
ankle motions. Functional assessment — testing motions needed for daily activities — identifies deficits that affect safety
(driving, walking). If plantarflexion is weak, the patient may be unable to brake effectively and should be counseled about
driving safety.
33. How should a nurse address a client's fear of cancer due to chronic knee pain?
A. Dismiss the concern and focus on the knee examination
B. Acknowledge the client's fears and validate their concern
C. Immediately order a bone scan to rule out malignancy
D. Refer to psychiatry for health anxiety
CORRECT ANSWER B — Acknowledge the client's fears and validate their concern, then provide education and assess actual risk factors
RATIONALE Therapeutic communication begins with validation — acknowledging the patient's emotions without judgment: "I
understand why you would be worried about that. Tell me more about what concerns you." This builds trust and opens
dialogue. After validating, the nurse can provide education (chronic knee pain is most commonly OA, not malignancy) and
assess for actual red flags (night pain, unintentional weight loss, history of cancer). Dismissing the concern (A) damages the
nurse-patient relationship. Ordering tests (C) is not a nursing action — the nurse would communicate concerns to the
provider. Referring to psychiatry (D) is premature and invalidating. This question tests therapeutic communication and the
nurse's role in addressing patient anxiety.
, 34. Why should nurses avoid testing joint movement beyond the expected functional range?
A. It is not necessary for documentation
B. To prevent damaging or overstressing the joint structures
C. To save time during the examination
D. The patient will refuse further assessment
CORRECT ANSWER B — To prevent damaging or overstressing the joint structures; stop at the point of resistance or pain
RATIONALE Joint ROM assessment must stop when the patient reports pain or when the examiner feels resistance. Forcing a joint beyond
its physiological limit can cause: ligament sprains, muscle strains, cartilage damage, fracture in osteoporotic bone, or
exacerbation of existing injury. The nurse assesses active ROM (patient moves the joint independently) first, then passive
ROM (examiner moves the joint) only if active ROM is limited and no contraindications exist. Passive ROM should not be
performed on acutely inflamed joints (RA flare, gout) or immediately after trauma. The principle is: first, do no harm.
Document the angle at which pain or resistance occurs (e.g., "shoulder abduction limited to 90 degrees by pain").
48. What is the correct sequence of nursing actions for a client with wrist pain after trauma?
A. Palpate for warmth, assess ROM, acknowledge fear, inspect the wrist
B. Acknowledge the client's fear, inspect the wrist, palpate for warmth, assess range of motion
C. Assess ROM immediately, then inspect, then palpate
D. Order an x-ray before touching the patient
CORRECT ANSWER B — Acknowledge fear, inspect, palpate for warmth/tenderness, then assess ROM last
RATIONALE The correct assessment sequence for a painful joint after trauma: (1) Acknowledge fear — establish rapport and trust before
touching; the patient is anxious and in pain. (2) Inspection — observe for deformity, swelling, ecchymosis, and asymmetry
without causing pain. (3) Palpation — assess for warmth (inflammation), point tenderness (fracture), and crepitus. (4) Range
of motion — perform LAST because it may cause pain and the patient may resist further examination. If fracture is suspected,
ROM should be deferred until after imaging. This sequence minimizes patient discomfort and maximizes cooperation. The
principle: gather all possible information through observation before causing discomfort through palpation and movement.
61. What disorder is characterized by episodic attacks of intense joint pain with confirmed urate crystals?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Gout
D. Ankylosing spondylitis
CORRECT ANSWER C — Gout; acute flares are self-limiting but recurrent; chronic gout causes tophi and joint destruction
RATIONALE Gout is characterized by episodic attacks of intense inflammatory arthritis caused by monosodium urate crystal deposition.
Attacks reach peak intensity within 12-24 hours and are self-limiting (resolve over days to weeks even without treatment).
The first metatarsophalangeal joint (podagra) is affected in 50% of initial attacks. Without treatment, attacks become more
frequent, prolonged, and involve more joints. Chronic tophaceous gout develops after years of untreated hyperuricemia —
tophi (chalky urate deposits) form in joints, bursae, and soft tissues, causing erosive arthritis and joint destruction. Renal
complications include urate nephropathy and uric acid stones. OA (A) is degenerative, not episodic. RA (B) is symmetric and
inflammatory. Ankylosing spondylitis (D) primarily affects the spine.
62. What instruction reflects proper Tinel test technique?
A. "I will tap on your elbow to check for nerve function."
B. "Keep your palm up — I will tap over your wrist nerve to check for tingling."
C. "I will bend your wrist and hold it to see if you feel tingling."
D. "I will ask you to rotate your wrist against resistance."
CORRECT ANSWER B — "Keep your palm up — I will tap over your wrist nerve to check for tingling" (Tinel sign for carpal tunnel syndrome)
RATIONALE The Tinel test assesses for median nerve compression in carpal tunnel syndrome. Technique: the patient's palm faces up; the
examiner taps (percusses) lightly over the median nerve at the volar wrist (carpal tunnel). A positive test produces tingling,
numbness, or "pins and needles" radiating into the thumb, index, and middle fingers (median nerve distribution). The Phalen
test (C — wrist flexion held for 60 seconds) is the complementary provocative test. Tinel sign can also be tested at other sites:
ulnar nerve at the elbow (cubital tunnel) and tibial nerve at the ankle (tarsal tunnel). The test is named for Jules Tinel, a
French neurologist.
2 MAXE • 403 RN
★ ★
C College of Nursing
J O U R N E Y T O E X T R A O R D I N A R Y CO M PA S S I O N AT E C A R E
EST. 1889
NR 304 — Examination 2
HEALTH ASSESSMENT: MUSCULOSKELETAL, GENITOURINARY, NEUROLOGIC & GERIATRICS
INSTITUTION Chamberlain University COURSE CODE NR 304
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 2 — Health Assessment TOTAL QUESTIONS 132 Questions
COURSE TITLE Health Assessment II FORMAT Multiple Choice — Comprehensive Q&A Review
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless "Select all that apply" is specified.
▸ Musculoskeletal assessment — muscle strength grading, joint ROM, special tests (Tinel, Phalen, McMurray), and OA vs. RA differentiation are core
competencies.
▸ Genitourinary assessment — UTI, BPH, STIs, renal calculi, prostate cancer screening, and GU anatomy are emphasized throughout.
▸ Neurological assessment — cranial nerves, cerebellar testing, stroke recognition (BE FAST), and posturing are testable content.
▸ Geriatric considerations — atypical presentation, failure to rescue, normal aging changes, and polypharmacy risks are critical knowledge areas.
▸ Correct answers and clinical rationales appear below each question for NCLEX board review purposes.
▸ All content reflects current evidence-based health assessment and clinical practice standards.
SECTION I — MUSCULOSKELETAL ASSESSMENT & Questions 1 – 9, 33–34, 48, 60, 62, 66, 73–74, 99, 102–103, 111, 113–114,
SPECIAL TESTS 116–117, 119, 126–127
1. Which performance grade best matches a client who can only lift their leg when gravity's force is removed?
A. Grade 5 — Normal (full ROM against gravity with full resistance)
B. Grade 3 — Fair (full ROM against gravity only, no added resistance)
C. Moves fully through arc only in a gravity-eliminated plane (Grade 2 — Poor)
D. Grade 1 — Trace (palpable muscle contraction, no joint movement)
CORRECT ANSWER C — Grade 2 (Poor): full ROM with gravity eliminated; cannot move against gravity alone
RATIONALE The Medical Research Council (MRC) muscle strength scale: Grade 5 (Normal) — full ROM against gravity with full resistance.
Grade 4 (Good) — full ROM against gravity with some resistance. Grade 3 (Fair) — full ROM against gravity only, no added
resistance. Grade 2 (Poor) — full ROM only when gravity is eliminated (the limb is supported). Grade 1 (Trace) — palpable
muscle contraction without joint movement. Grade 0 — no contraction. Grade 2 is the key transition point — the patient CAN
move through the full range but CANNOT overcome gravity. This distinction guides functional assessment and rehabilitation
planning.
5. Which motion should be evaluated to assess whether the knee can straighten fully after injury?
A. Flexion of the knee joint
B. Extension of the knee joint
C. Internal rotation of the tibia
D. Valgus stress testing
CORRECT ANSWER B — Extension of the knee joint (full extension = 0 degrees)
RATIONALE Knee extension is the straightening motion that returns the knee to anatomical position (0 degrees). Inability to fully extend
the knee (extension lag or locked knee) after injury strongly suggests a mechanical blockage — most commonly a torn
meniscus (bucket-handle tear) where the torn fragment becomes wedged between the femoral condyle and tibial plateau,
physically preventing full extension. It can also indicate an ACL tear with associated hemarthrosis, loose body, or
osteochondral fragment. The McMurray test is the specific provocative test for meniscal tears. Full flexion is also assessed
(normal 130-150 degrees). Internal rotation and valgus stress test ligament integrity, not extension ability.
,9. Which sequence ensures a structured and reliable assessment during a full musculoskeletal exam?
A. Begin proximally and progress distally
B. Begin distally and progress proximally
C. Random order based on patient complaints
D. Head-to-toe only, ignoring extremities
CORRECT ANSWER B — Begin distally and progress proximally; compare bilaterally throughout
RATIONALE A systematic musculoskeletal examination begins distally (hands, feet) and progresses proximally (wrists/ankles →
elbows/knees → shoulders/hips → spine). This distal-to-proximal sequence ensures thoroughness and prevents omission. At
each level, the examiner compares bilaterally — symmetry is the expected normal finding; asymmetry suggests pathology.
The exam includes inspection (deformity, swelling, muscle atrophy), palpation (tenderness, warmth, crepitus), range of
motion (active then passive), and muscle strength testing. A head-to-toe approach (D) is too general. A random approach (C)
risks missing findings. The systematic sequence becomes automatic with practice and ensures a complete examination.
10. Which disorder is consistent with severe joint pain and laboratory confirmation of monosodium urate crystals?
A. Rheumatoid arthritis
B. Osteoarthritis
C. Acute gout
D. Pseudogout (CPPD)
CORRECT ANSWER C — Acute gout; negatively birefringent monosodium urate crystals under polarized light microscopy
RATIONALE Gout is definitively diagnosed by joint aspiration (arthrocentesis) demonstrating negatively birefringent needle-shaped
monosodium urate crystals under polarized light microscopy. Clinical presentation: acute onset of severe pain, erythema,
swelling, and warmth — classically in the first metatarsophalangeal joint (podagra) but can affect any joint. Pseudogout (D —
calcium pyrophosphate deposition/CPPD) shows positively birefringent rhomboid crystals. RA (A) is diagnosed by clinical
criteria and serology (RF, anti-CCP). OA (B) is diagnosed clinically and radiographically. Gout is caused by hyperuricemia; risk
factors include purine-rich diet, alcohol, diuretics, and renal insufficiency. Acute treatment: NSAIDs, colchicine,
corticosteroids. Chronic management: urate-lowering therapy (allopurinol, febuxostat).
15. Which specific ankle motion should be tested for a client reporting difficulty pressing gas and brake pedals while driving?
A. Dorsiflexion ability
B. Plantar flexion ability
C. Ankle inversion
D. Ankle eversion
CORRECT ANSWER B — Plantar flexion ability (pressing pedals requires toes pointing down)
RATIONALE Pressing gas and brake pedals requires active ankle plantarflexion — movement of the foot downward (toes pointing away
from the shin). The gastrocnemius and soleus muscles (innervated by the tibial nerve, S1-S2) power this motion. Assessment:
have the patient press down against resistance as if pressing a pedal; assess strength (0-5 scale) and range of motion.
Dorsiflexion (A) is foot upward toward the shin (needed for releasing pedals). Inversion (C) and eversion (D) are side-to-side
ankle motions. Functional assessment — testing motions needed for daily activities — identifies deficits that affect safety
(driving, walking). If plantarflexion is weak, the patient may be unable to brake effectively and should be counseled about
driving safety.
33. How should a nurse address a client's fear of cancer due to chronic knee pain?
A. Dismiss the concern and focus on the knee examination
B. Acknowledge the client's fears and validate their concern
C. Immediately order a bone scan to rule out malignancy
D. Refer to psychiatry for health anxiety
CORRECT ANSWER B — Acknowledge the client's fears and validate their concern, then provide education and assess actual risk factors
RATIONALE Therapeutic communication begins with validation — acknowledging the patient's emotions without judgment: "I
understand why you would be worried about that. Tell me more about what concerns you." This builds trust and opens
dialogue. After validating, the nurse can provide education (chronic knee pain is most commonly OA, not malignancy) and
assess for actual red flags (night pain, unintentional weight loss, history of cancer). Dismissing the concern (A) damages the
nurse-patient relationship. Ordering tests (C) is not a nursing action — the nurse would communicate concerns to the
provider. Referring to psychiatry (D) is premature and invalidating. This question tests therapeutic communication and the
nurse's role in addressing patient anxiety.
, 34. Why should nurses avoid testing joint movement beyond the expected functional range?
A. It is not necessary for documentation
B. To prevent damaging or overstressing the joint structures
C. To save time during the examination
D. The patient will refuse further assessment
CORRECT ANSWER B — To prevent damaging or overstressing the joint structures; stop at the point of resistance or pain
RATIONALE Joint ROM assessment must stop when the patient reports pain or when the examiner feels resistance. Forcing a joint beyond
its physiological limit can cause: ligament sprains, muscle strains, cartilage damage, fracture in osteoporotic bone, or
exacerbation of existing injury. The nurse assesses active ROM (patient moves the joint independently) first, then passive
ROM (examiner moves the joint) only if active ROM is limited and no contraindications exist. Passive ROM should not be
performed on acutely inflamed joints (RA flare, gout) or immediately after trauma. The principle is: first, do no harm.
Document the angle at which pain or resistance occurs (e.g., "shoulder abduction limited to 90 degrees by pain").
48. What is the correct sequence of nursing actions for a client with wrist pain after trauma?
A. Palpate for warmth, assess ROM, acknowledge fear, inspect the wrist
B. Acknowledge the client's fear, inspect the wrist, palpate for warmth, assess range of motion
C. Assess ROM immediately, then inspect, then palpate
D. Order an x-ray before touching the patient
CORRECT ANSWER B — Acknowledge fear, inspect, palpate for warmth/tenderness, then assess ROM last
RATIONALE The correct assessment sequence for a painful joint after trauma: (1) Acknowledge fear — establish rapport and trust before
touching; the patient is anxious and in pain. (2) Inspection — observe for deformity, swelling, ecchymosis, and asymmetry
without causing pain. (3) Palpation — assess for warmth (inflammation), point tenderness (fracture), and crepitus. (4) Range
of motion — perform LAST because it may cause pain and the patient may resist further examination. If fracture is suspected,
ROM should be deferred until after imaging. This sequence minimizes patient discomfort and maximizes cooperation. The
principle: gather all possible information through observation before causing discomfort through palpation and movement.
61. What disorder is characterized by episodic attacks of intense joint pain with confirmed urate crystals?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Gout
D. Ankylosing spondylitis
CORRECT ANSWER C — Gout; acute flares are self-limiting but recurrent; chronic gout causes tophi and joint destruction
RATIONALE Gout is characterized by episodic attacks of intense inflammatory arthritis caused by monosodium urate crystal deposition.
Attacks reach peak intensity within 12-24 hours and are self-limiting (resolve over days to weeks even without treatment).
The first metatarsophalangeal joint (podagra) is affected in 50% of initial attacks. Without treatment, attacks become more
frequent, prolonged, and involve more joints. Chronic tophaceous gout develops after years of untreated hyperuricemia —
tophi (chalky urate deposits) form in joints, bursae, and soft tissues, causing erosive arthritis and joint destruction. Renal
complications include urate nephropathy and uric acid stones. OA (A) is degenerative, not episodic. RA (B) is symmetric and
inflammatory. Ankylosing spondylitis (D) primarily affects the spine.
62. What instruction reflects proper Tinel test technique?
A. "I will tap on your elbow to check for nerve function."
B. "Keep your palm up — I will tap over your wrist nerve to check for tingling."
C. "I will bend your wrist and hold it to see if you feel tingling."
D. "I will ask you to rotate your wrist against resistance."
CORRECT ANSWER B — "Keep your palm up — I will tap over your wrist nerve to check for tingling" (Tinel sign for carpal tunnel syndrome)
RATIONALE The Tinel test assesses for median nerve compression in carpal tunnel syndrome. Technique: the patient's palm faces up; the
examiner taps (percusses) lightly over the median nerve at the volar wrist (carpal tunnel). A positive test produces tingling,
numbness, or "pins and needles" radiating into the thumb, index, and middle fingers (median nerve distribution). The Phalen
test (C — wrist flexion held for 60 seconds) is the complementary provocative test. Tinel sign can also be tested at other sites:
ulnar nerve at the elbow (cubital tunnel) and tibial nerve at the ankle (tarsal tunnel). The test is named for Jules Tinel, a
French neurologist.
