NURS 5433 NP MOCK EXAM: MUSCULOSKELETAL (HARD LEVEL)
QUESTIONS AND ANSWERS WITH COMPLETE SOLUTION
Instructions:
• Multiple choice (A–D)
• Choose BEST answer
• Answers + detailed rationales at the end
QUESTIONS 1.
A 52-year-old male presents with low back pain for 3 weeks after lifting boxes. Pain
is localized to the lower back and worse with sitting. No fever, weight loss, or
neurologic symptoms.
What is the BEST next step?
A. Order lumbar MRI
B. Prescribe oral corticosteroids
C. Recommend NSAIDs and activity modification
D. Refer to spine surgery
2.
A 67-year-old female presents with low back pain, night pain, and 10-lb
unintentional weight loss. Pain has persisted for 2 months.
What is the MOST appropriate next step?
A. Start physical therapy
B. Order MRI of the lumbar spine
C. Prescribe NSAIDs
D. Reassure and follow up
3.
A 45-year-old presents with low back pain radiating down the posterior leg.
Straight leg raise reproduces sharp, electric pain.
What is the MOST likely diagnosis?
A. Spinal stenosis
B. Disc herniation
C. Facet joint arthritis
D. Sacroiliac dysfunction
4.
A patient with low back pain reports urinary retention and saddle anesthesia.
What is the BEST next step?
A. NSAIDs and outpatient follow-up
B. MRI STAT and surgical consult
,C. Physical therapy referral
D. Epidural steroid injection
5.
A 72-year-old reports back pain that worsens when walking and improves when
leaning forward on a shopping cart.
What is the MOST likely diagnosis?
A. Disc herniation
B. Spinal stenosis
C. Muscle strain
D. Vertebral fracture
6.
A 40-year-old presents with shoulder pain when reaching overhead and difficulty
sleeping on that side. Passive ROM is normal, active ROM is limited.
What is the MOST likely diagnosis?
A. Rotator cuff tear
B. Shoulder impingement
C. Adhesive capsulitis
D. Shoulder dislocation
7.
A patient with suspected shoulder impingement asks for treatment.
What is FIRST-LINE therapy?
A. Immediate surgery
B. Corticosteroid injection
C. Physical therapy and activity modification
D. Opioid therapy
8.
A 55-year-old presents with shoulder pain and weakness lifting the arm. He cannot
resist downward pressure during testing.
What is the MOST likely diagnosis?
A. Shoulder impingement
B. Rotator cuff tear
C. Biceps tendinitis
D. Cervical radiculopathy
9.
,A 30-year-old presents after falling on an outstretched arm. He holds his arm
abducted and externally rotated and has severe shoulder pain.
What is the NEXT step?
A. Order MRI
B. Reduce the shoulder
C. Prescribe NSAIDs
D. Immobilize and discharge
10.
A 60-year-old with chronic low back pain asks for medication.
Which medication has the BEST evidence for benefit?
A. Acetaminophen
B. Oral corticosteroids
C. NSAIDs
D. Benzodiazepines
11.
A patient with chronic low back pain asks about long-term management.
Which intervention provides the MOST sustained benefit?
A. Opioids
B. Exercise therapy
C. Steroid injections
D. Bed rest
12.
A 65-year-old presents with acute low back pain after minor trauma. She has a
history of long-term corticosteroid use.
What should you do?
A. Reassure and discharge
B. Start PT only
C. Order lumbar radiographs
D. Prescribe muscle relaxants
13.
A patient presents with shoulder pain radiating below the elbow with numbness.
What is the MOST likely source?
A. Rotator cuff tear
B. Shoulder impingement
, C. Cervical spine pathology
D. Bursitis
14.
A patient with partial rotator cuff tear is being managed.
What is FIRST-LINE treatment?
A. Surgery
B. Physical therapy
C. Immobilization
D. Opioids
15.
A 48-year-old with low back pain has no red flags. Pain started 1 week ago.
What is the BEST management?
A. MRI now
B. Bed rest for 2 weeks
C. Encourage activity + NSAIDs
D. Refer to orthopedics
✅ ANSWER KEY + DETAILED RATIONALES
1. → C
Rationale:
No red flags → NO imaging. First-line = NSAIDs + activity. Steroids not effective.
2. → B
QUESTIONS AND ANSWERS WITH COMPLETE SOLUTION
Instructions:
• Multiple choice (A–D)
• Choose BEST answer
• Answers + detailed rationales at the end
QUESTIONS 1.
A 52-year-old male presents with low back pain for 3 weeks after lifting boxes. Pain
is localized to the lower back and worse with sitting. No fever, weight loss, or
neurologic symptoms.
What is the BEST next step?
A. Order lumbar MRI
B. Prescribe oral corticosteroids
C. Recommend NSAIDs and activity modification
D. Refer to spine surgery
2.
A 67-year-old female presents with low back pain, night pain, and 10-lb
unintentional weight loss. Pain has persisted for 2 months.
What is the MOST appropriate next step?
A. Start physical therapy
B. Order MRI of the lumbar spine
C. Prescribe NSAIDs
D. Reassure and follow up
3.
A 45-year-old presents with low back pain radiating down the posterior leg.
Straight leg raise reproduces sharp, electric pain.
What is the MOST likely diagnosis?
A. Spinal stenosis
B. Disc herniation
C. Facet joint arthritis
D. Sacroiliac dysfunction
4.
A patient with low back pain reports urinary retention and saddle anesthesia.
What is the BEST next step?
A. NSAIDs and outpatient follow-up
B. MRI STAT and surgical consult
,C. Physical therapy referral
D. Epidural steroid injection
5.
A 72-year-old reports back pain that worsens when walking and improves when
leaning forward on a shopping cart.
What is the MOST likely diagnosis?
A. Disc herniation
B. Spinal stenosis
C. Muscle strain
D. Vertebral fracture
6.
A 40-year-old presents with shoulder pain when reaching overhead and difficulty
sleeping on that side. Passive ROM is normal, active ROM is limited.
What is the MOST likely diagnosis?
A. Rotator cuff tear
B. Shoulder impingement
C. Adhesive capsulitis
D. Shoulder dislocation
7.
A patient with suspected shoulder impingement asks for treatment.
What is FIRST-LINE therapy?
A. Immediate surgery
B. Corticosteroid injection
C. Physical therapy and activity modification
D. Opioid therapy
8.
A 55-year-old presents with shoulder pain and weakness lifting the arm. He cannot
resist downward pressure during testing.
What is the MOST likely diagnosis?
A. Shoulder impingement
B. Rotator cuff tear
C. Biceps tendinitis
D. Cervical radiculopathy
9.
,A 30-year-old presents after falling on an outstretched arm. He holds his arm
abducted and externally rotated and has severe shoulder pain.
What is the NEXT step?
A. Order MRI
B. Reduce the shoulder
C. Prescribe NSAIDs
D. Immobilize and discharge
10.
A 60-year-old with chronic low back pain asks for medication.
Which medication has the BEST evidence for benefit?
A. Acetaminophen
B. Oral corticosteroids
C. NSAIDs
D. Benzodiazepines
11.
A patient with chronic low back pain asks about long-term management.
Which intervention provides the MOST sustained benefit?
A. Opioids
B. Exercise therapy
C. Steroid injections
D. Bed rest
12.
A 65-year-old presents with acute low back pain after minor trauma. She has a
history of long-term corticosteroid use.
What should you do?
A. Reassure and discharge
B. Start PT only
C. Order lumbar radiographs
D. Prescribe muscle relaxants
13.
A patient presents with shoulder pain radiating below the elbow with numbness.
What is the MOST likely source?
A. Rotator cuff tear
B. Shoulder impingement
, C. Cervical spine pathology
D. Bursitis
14.
A patient with partial rotator cuff tear is being managed.
What is FIRST-LINE treatment?
A. Surgery
B. Physical therapy
C. Immobilization
D. Opioids
15.
A 48-year-old with low back pain has no red flags. Pain started 1 week ago.
What is the BEST management?
A. MRI now
B. Bed rest for 2 weeks
C. Encourage activity + NSAIDs
D. Refer to orthopedics
✅ ANSWER KEY + DETAILED RATIONALES
1. → C
Rationale:
No red flags → NO imaging. First-line = NSAIDs + activity. Steroids not effective.
2. → B
