Final Exam
NR511 Final Exam Study Guide
1. Signs and symptoms and management of musculoskeletal sprains/strains/dislocations
16-15 When Maxwell, age 12, slid into home plate while playing baseball, he injured his
ankle. The nurse practitioner is trying to differentiate between a sprain and a strain. A
sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the
tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears
of the muscles. D. is an injury th
16-98 Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to
whether to apply heat or cold. What should the nurse practitioner tell him? A. “Use
continuous heat for the fi rst 12 hours and then use heat or cold to your own
preference.” B. “Use continuous cold for the fi rst 12 hours and then use heat or cold to
your own preference.” C. “Apply cold for 20 minutes, then take it off for 30 to 45
minutes; repeat this for the f i rst 24 to 48 hours while awake.” D. “Alternate between
cold and heat for 20 minutes each for the fi rst 24 to 48 hours.”
16-69 Ankylosis is defi ned as A. muscle shortening. B. joint stiffness. C. malposition of a
joint. D. dislocation of a joint.
16-108 Jill, age 49, has recently begun a rigorous weight- lifting regimen. She presents
to the primary care offi ce with a shoulder dislocation. Which of the following clinical
manifestations lead the nurse practitioner to suspect an anterior shoulder dislocation
over a posterior dislocation? A. Inability to shrug the shoulder B. Absence of pain C.
Inability to rotate the shoulder externally D. Shortening of the arm
16-123 In assessing an infant for developmental dysplasia of the hip (DDH), the
practitioner places the infant supine, fl exes the knees by holding the thumbs on the
inner mid- thighs, with fi ngers outside on the hips touching the greater trochanters,
stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this
external rotation feels smooth with no sound present, there is no hip dislocation. This
is
A. the Allis test. B. Lasègue’s sign. C. the McMurray test. D. the Ortolani maneuver.
16-124 Emily, age 12, presents to the clinic with another muscle strain from one of her
many sports activities. The nurse practitioner thinks that the patient was probably
never taught about health promotion and maintenance regarding physical activity.
What information should be included in patient teaching? A. “After an activity, if any
part hurts, apply ice for 20 minutes.” B. “You must fi rst get in shape with a rigorous
schedule of weight training, and then you can participate in any activity once you are
physically fi t.” C. “After any strenuous activity, you must completely rest your muscles
before beginning your next activity.” D. “Stretching and warm- up exercises are an
important part of any exercise routine.”
16-27 Upon assessment, the nurse practitioner notes unilateral back pain that had an
acute onset and increases when standing and bending. A straight- leg test is negative.
The most likely differential diagnosis is A. herniated nucleus pulposus. B. muscle
strain.
C. osteoarthritis. D. spondylolisthesis.
16-67 June, age 67, presents with back pain with no precipitating event. The pain is
located over her lower back and muscles without sciatica, and it is aggravated by sitting,
standing, and certain movements. It is alleviated with rest. Palpation localizes the pain,
and muscle spasms are felt. There was an insidious onset with progressive
, Final Exam
improvement.
, Final Exam
What is the most likely differential diagnosis? A. Ankylosing spondylitis B.
Musculoskeletal strain C. Spondylolisthesis D. Herniated disk
2. Signs and symptoms and management of spinal disorders (spondylosis, stenosis, etc.)
6-79 Sam, age 73, has lumbar spinal stenosis and asks which exercises he should do
to
help his condition. You advise him to A. do any exercise that results in hyperextension of
the lumbar spine. B. do exercises that encourage lumbar f l exion and f l attening of the
lumbar lordotic curve. C. refrain from exercising. D. see a surgeon because surgery is the
best treatment option.
7-57 Clients with spinal cord injuries often have bowel incontinence and need to have a
bowel program instituted. What is the most effective way to stimulate the rectum to
evacuate in the quadriplegic client? A. Administer stool softeners every night. B. Insert a
rectal suppository and then eventually perform digital stimulation. C. Administer
laxatives every other night. D. Administer enemas on a regular basis.
13-12 Decreased bladder capacity; bladder irritation from a urinary tract infection,
tumor, stones, or irritants such as caffeine and alcohol; and central nervous system
disorders or spinal cord lesions are all contributing factors to A. stress urinary
incontinence. B. urge urinary incontinence. C. overfl ow urinary incontinence. D. refl ex
urinary incontinence.
16-50 Beth, age 49, comes in with low back pain. An x- ray of the lumbar/sacral spine is
within normal limits. Which of the following diagnoses do you explore further? A.
Scoliosis B. Osteoarthritis C. Spinal stenosis D. Herniated nucleus pulposus
16-72 Hilda, age 73, presents with a complaint of low back pain. Red fl ags in her history
of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus
suggest the possibility of which of the following serious underlying conditions as the
cause of her low back pain? A. Cancer B. Cauda equina syndrome D spinal fracture
16-14 Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-
related change? A. Lordosis B. Dorsal kyphosis C. Scoliosis D. Kyphoscoliosis
16-90 What disorder affects older individuals, particularly women, and is characterized
by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs
of systemic infection such as malaise, weight loss, sweats, and low- grade fever? A.
Fibromyalgia syndrome B. Myofascial somatic dysfunction C. Polymyalgia rheumatica
D. Reiter’s syndrome
3. Recognition and immediate management of cauda equina syndrome
16-11 The most common cause of cauda equina syndrome is A. fracture. B. hematoma.
C. lumbar intervertebral disk herniation. D. space- occupying lesion.
16-60 Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition,
incontinence, and progressive loss of strength in the legs. You suspect cauda equina
syndrome. What is your next action? A. Order physical therapy B. Order a
lumbar/sacral x- ray C. Order extensive lab work D. Refer to a neurosurgeon
16-72 Hilda, age 73, presents with a complaint of low back pain. Red fl ags in her history
of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus
suggest the possibility of which of the following serious underlying conditions as the
cause of her low back pain? A. Cancer B. Cauda equina syndrome C. Neurological
compromise D. Spinal fracture
NR511 Final Exam Study Guide
1. Signs and symptoms and management of musculoskeletal sprains/strains/dislocations
16-15 When Maxwell, age 12, slid into home plate while playing baseball, he injured his
ankle. The nurse practitioner is trying to differentiate between a sprain and a strain. A
sprain A. is an injury to the ligaments that attach to bones in a joint. B. is an injury to the
tendons that attach to the muscles in a joint. C. is an injury resulting in extensive tears
of the muscles. D. is an injury th
16-98 Alexander, age 12, sprained his ankle playing ice hockey. He is confused as to
whether to apply heat or cold. What should the nurse practitioner tell him? A. “Use
continuous heat for the fi rst 12 hours and then use heat or cold to your own
preference.” B. “Use continuous cold for the fi rst 12 hours and then use heat or cold to
your own preference.” C. “Apply cold for 20 minutes, then take it off for 30 to 45
minutes; repeat this for the f i rst 24 to 48 hours while awake.” D. “Alternate between
cold and heat for 20 minutes each for the fi rst 24 to 48 hours.”
16-69 Ankylosis is defi ned as A. muscle shortening. B. joint stiffness. C. malposition of a
joint. D. dislocation of a joint.
16-108 Jill, age 49, has recently begun a rigorous weight- lifting regimen. She presents
to the primary care offi ce with a shoulder dislocation. Which of the following clinical
manifestations lead the nurse practitioner to suspect an anterior shoulder dislocation
over a posterior dislocation? A. Inability to shrug the shoulder B. Absence of pain C.
Inability to rotate the shoulder externally D. Shortening of the arm
16-123 In assessing an infant for developmental dysplasia of the hip (DDH), the
practitioner places the infant supine, fl exes the knees by holding the thumbs on the
inner mid- thighs, with fi ngers outside on the hips touching the greater trochanters,
stabilizes one hip, and abducts and gently pulls anteriorly on the other thigh. If this
external rotation feels smooth with no sound present, there is no hip dislocation. This
is
A. the Allis test. B. Lasègue’s sign. C. the McMurray test. D. the Ortolani maneuver.
16-124 Emily, age 12, presents to the clinic with another muscle strain from one of her
many sports activities. The nurse practitioner thinks that the patient was probably
never taught about health promotion and maintenance regarding physical activity.
What information should be included in patient teaching? A. “After an activity, if any
part hurts, apply ice for 20 minutes.” B. “You must fi rst get in shape with a rigorous
schedule of weight training, and then you can participate in any activity once you are
physically fi t.” C. “After any strenuous activity, you must completely rest your muscles
before beginning your next activity.” D. “Stretching and warm- up exercises are an
important part of any exercise routine.”
16-27 Upon assessment, the nurse practitioner notes unilateral back pain that had an
acute onset and increases when standing and bending. A straight- leg test is negative.
The most likely differential diagnosis is A. herniated nucleus pulposus. B. muscle
strain.
C. osteoarthritis. D. spondylolisthesis.
16-67 June, age 67, presents with back pain with no precipitating event. The pain is
located over her lower back and muscles without sciatica, and it is aggravated by sitting,
standing, and certain movements. It is alleviated with rest. Palpation localizes the pain,
and muscle spasms are felt. There was an insidious onset with progressive
, Final Exam
improvement.
, Final Exam
What is the most likely differential diagnosis? A. Ankylosing spondylitis B.
Musculoskeletal strain C. Spondylolisthesis D. Herniated disk
2. Signs and symptoms and management of spinal disorders (spondylosis, stenosis, etc.)
6-79 Sam, age 73, has lumbar spinal stenosis and asks which exercises he should do
to
help his condition. You advise him to A. do any exercise that results in hyperextension of
the lumbar spine. B. do exercises that encourage lumbar f l exion and f l attening of the
lumbar lordotic curve. C. refrain from exercising. D. see a surgeon because surgery is the
best treatment option.
7-57 Clients with spinal cord injuries often have bowel incontinence and need to have a
bowel program instituted. What is the most effective way to stimulate the rectum to
evacuate in the quadriplegic client? A. Administer stool softeners every night. B. Insert a
rectal suppository and then eventually perform digital stimulation. C. Administer
laxatives every other night. D. Administer enemas on a regular basis.
13-12 Decreased bladder capacity; bladder irritation from a urinary tract infection,
tumor, stones, or irritants such as caffeine and alcohol; and central nervous system
disorders or spinal cord lesions are all contributing factors to A. stress urinary
incontinence. B. urge urinary incontinence. C. overfl ow urinary incontinence. D. refl ex
urinary incontinence.
16-50 Beth, age 49, comes in with low back pain. An x- ray of the lumbar/sacral spine is
within normal limits. Which of the following diagnoses do you explore further? A.
Scoliosis B. Osteoarthritis C. Spinal stenosis D. Herniated nucleus pulposus
16-72 Hilda, age 73, presents with a complaint of low back pain. Red fl ags in her history
of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus
suggest the possibility of which of the following serious underlying conditions as the
cause of her low back pain? A. Cancer B. Cauda equina syndrome D spinal fracture
16-14 Mrs. Kelly, age 80, has a curvature of the spine. This is likely to indicate which age-
related change? A. Lordosis B. Dorsal kyphosis C. Scoliosis D. Kyphoscoliosis
16-90 What disorder affects older individuals, particularly women, and is characterized
by pain and stiffness in the cervical spine and shoulder and hip girdles, along with signs
of systemic infection such as malaise, weight loss, sweats, and low- grade fever? A.
Fibromyalgia syndrome B. Myofascial somatic dysfunction C. Polymyalgia rheumatica
D. Reiter’s syndrome
3. Recognition and immediate management of cauda equina syndrome
16-11 The most common cause of cauda equina syndrome is A. fracture. B. hematoma.
C. lumbar intervertebral disk herniation. D. space- occupying lesion.
16-60 Sandy, age 49, presents with loss of anal sphincter tone, impaired micturition,
incontinence, and progressive loss of strength in the legs. You suspect cauda equina
syndrome. What is your next action? A. Order physical therapy B. Order a
lumbar/sacral x- ray C. Order extensive lab work D. Refer to a neurosurgeon
16-72 Hilda, age 73, presents with a complaint of low back pain. Red fl ags in her history
of a minor fall, osteopenia, and prolonged steroid use for systemic lupus erythematosus
suggest the possibility of which of the following serious underlying conditions as the
cause of her low back pain? A. Cancer B. Cauda equina syndrome C. Neurological
compromise D. Spinal fracture
