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NURS 8026 Differential Diagnosis Test 4 Study Guide | Comprehensive
Practice Questions, Verified Answers, Clinical Case Scenarios, Detailed
Rationales & Latest Exam Review (2025–2026)
NURS 8026 Differential Diagnosis Test 4 Study Guide
Comprehensive Practice Examination
1. A 45-year-old male presents with acute low back pain following heavy lifting. Which initial
management step is most appropriate?
• A) MRI of the lumbar spine
• B) Referral to orthopedic surgery
• C) Prescribing bed rest for two weeks
• D) Non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy
• Rationale: NSAIDs reduce inflammation and pain while physical therapy promotes
mobility; bed rest is discouraged as it delays recovery, and imaging is not indicated
without red flags.
2. A 50-year-old woman complains of low back pain radiating to her left leg. On examination,
you suspect a herniated disc. Which test would most likely confirm this diagnosis?
• A) Straight leg raise test
• B) Blood test for inflammatory markers
• C) Pelvic ultrasound
• D) Abdominal X-ray
• Rationale: The straight leg raise test produces radicular pain below the knee in patients
with nerve root irritation from disc herniation, with sensitivity of approximately 80-90%.
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3. A patient with a herniated lumbar disc is advised on body mechanics to prevent further injury.
Which of the following is the most important advice?
• A) Lift heavy objects with the back bent and knees straight
• B) Avoid any physical activity
• C) Maintain a healthy weight and strong core muscles
• D) Use a soft mattress for sleeping
• Rationale: Maintaining healthy weight reduces spinal stress while strong core muscles
provide stability and support to the lumbar spine, reducing injury risk.
4. A 35-year-old patient presents with low back pain after a minor fall. There are no neurological
deficits. Which management plan is most appropriate initially?
• A) Immediate surgical consultation
• B) Bed rest for one month
• C) Over-the-counter pain relief and gradual return to activity
• D) Complete immobilization with a back brace
• Rationale: Without neurological deficits or red flags, conservative management with
analgesics and gradual activity resumption is the standard of care.
5. An elderly patient with osteoporosis presents with sudden onset of severe low back pain
without a history of trauma. What is the most likely diagnosis?
• A) Lumbar strain
• B) Vertebral compression fracture
• C) Herniated disc
• D) Muscular spasm
• Rationale: Osteoporotic patients are at high risk for vertebral compression fractures
which can occur spontaneously or with minimal stress, causing sudden severe pain.
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6. A 40-year-old male presents with low back pain and sciatica. Which finding on physical
examination would necessitate urgent referral?
• A) Reduced knee reflex
• B) Positive straight leg raise test
• C) Loss of bladder control
• D) Tenderness over the lumbar spine
• Rationale: Loss of bladder control indicates cauda equina syndrome, a surgical
emergency requiring immediate neurosurgical consultation to prevent permanent
neurological damage.
7. A patient with low back pain is found to have herniation of the annulus fibrosis on MRI.
Which of the following is a characteristic feature of this condition?
• A) Inflammation of the vertebral body
• B) Protrusion of the nucleus pulposus
• C) Fusion of the lumbar vertebrae
• D) Narrowing of the spinal canal
• Rationale: Disc herniation involves the nucleus pulposus protruding through a tear in the
annulus fibrosis, potentially compressing adjacent nerve roots.
8. A patient with a history of recurrent low back pain presents with acute exacerbation. Which
diagnostic approach is most appropriate initially?
• A) MRI
• B) CT scan
• C) Plain X-rays
• D) Electromyography (EMG)
• Rationale: Plain X-rays are the initial imaging study to evaluate for fractures, alignment
abnormalities, or degenerative changes before considering advanced imaging.
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9. A young athlete presents with low back pain after a fall. Examination reveals tenderness over
the lumbar spine but no neurological deficits. What is the most likely diagnosis?
• A) Spinal stenosis
• B) Lumbar strain
• C) Cauda equina syndrome
• D) Osteoarthritis
• Rationale: Lumbar strain is common in athletes and presents with localized tenderness
without neurological findings, typically improving with conservative care.
10. A 70-year-old female with a history of osteoporosis presents with low back pain after
minimal trauma. Which imaging study is most appropriate to confirm your suspicion?
• A) MRI of the lumbar spine
• B) Dual-energy X-ray absorptiometry (DEXA) scan
• C) CT scan of the abdomen
• D) X-ray of the lumbar spine
• Rationale: X-rays readily demonstrate vertebral compression fractures which appear as
wedge-shaped deformities, making them the appropriate first imaging study.
11. A patient with chronic low back pain is found to have spinal stenosis on MRI. What is the
most common symptom associated with this condition?
• A) Acute leg weakness
• B) Pain relieved by sitting or leaning forward
• C) Night sweats and fever
• D) Loss of bowel and bladder function
• Rationale: Neurogenic claudication from spinal stenosis improves with flexion (sitting
forward) which increases spinal canal diameter and reduces nerve compression.
NURS 8026 Differential Diagnosis Test 4 Study Guide | Comprehensive
Practice Questions, Verified Answers, Clinical Case Scenarios, Detailed
Rationales & Latest Exam Review (2025–2026)
NURS 8026 Differential Diagnosis Test 4 Study Guide
Comprehensive Practice Examination
1. A 45-year-old male presents with acute low back pain following heavy lifting. Which initial
management step is most appropriate?
• A) MRI of the lumbar spine
• B) Referral to orthopedic surgery
• C) Prescribing bed rest for two weeks
• D) Non-steroidal anti-inflammatory drugs (NSAIDs) and physical therapy
• Rationale: NSAIDs reduce inflammation and pain while physical therapy promotes
mobility; bed rest is discouraged as it delays recovery, and imaging is not indicated
without red flags.
2. A 50-year-old woman complains of low back pain radiating to her left leg. On examination,
you suspect a herniated disc. Which test would most likely confirm this diagnosis?
• A) Straight leg raise test
• B) Blood test for inflammatory markers
• C) Pelvic ultrasound
• D) Abdominal X-ray
• Rationale: The straight leg raise test produces radicular pain below the knee in patients
with nerve root irritation from disc herniation, with sensitivity of approximately 80-90%.
, Page | 2
3. A patient with a herniated lumbar disc is advised on body mechanics to prevent further injury.
Which of the following is the most important advice?
• A) Lift heavy objects with the back bent and knees straight
• B) Avoid any physical activity
• C) Maintain a healthy weight and strong core muscles
• D) Use a soft mattress for sleeping
• Rationale: Maintaining healthy weight reduces spinal stress while strong core muscles
provide stability and support to the lumbar spine, reducing injury risk.
4. A 35-year-old patient presents with low back pain after a minor fall. There are no neurological
deficits. Which management plan is most appropriate initially?
• A) Immediate surgical consultation
• B) Bed rest for one month
• C) Over-the-counter pain relief and gradual return to activity
• D) Complete immobilization with a back brace
• Rationale: Without neurological deficits or red flags, conservative management with
analgesics and gradual activity resumption is the standard of care.
5. An elderly patient with osteoporosis presents with sudden onset of severe low back pain
without a history of trauma. What is the most likely diagnosis?
• A) Lumbar strain
• B) Vertebral compression fracture
• C) Herniated disc
• D) Muscular spasm
• Rationale: Osteoporotic patients are at high risk for vertebral compression fractures
which can occur spontaneously or with minimal stress, causing sudden severe pain.
, Page | 3
6. A 40-year-old male presents with low back pain and sciatica. Which finding on physical
examination would necessitate urgent referral?
• A) Reduced knee reflex
• B) Positive straight leg raise test
• C) Loss of bladder control
• D) Tenderness over the lumbar spine
• Rationale: Loss of bladder control indicates cauda equina syndrome, a surgical
emergency requiring immediate neurosurgical consultation to prevent permanent
neurological damage.
7. A patient with low back pain is found to have herniation of the annulus fibrosis on MRI.
Which of the following is a characteristic feature of this condition?
• A) Inflammation of the vertebral body
• B) Protrusion of the nucleus pulposus
• C) Fusion of the lumbar vertebrae
• D) Narrowing of the spinal canal
• Rationale: Disc herniation involves the nucleus pulposus protruding through a tear in the
annulus fibrosis, potentially compressing adjacent nerve roots.
8. A patient with a history of recurrent low back pain presents with acute exacerbation. Which
diagnostic approach is most appropriate initially?
• A) MRI
• B) CT scan
• C) Plain X-rays
• D) Electromyography (EMG)
• Rationale: Plain X-rays are the initial imaging study to evaluate for fractures, alignment
abnormalities, or degenerative changes before considering advanced imaging.
, Page | 4
9. A young athlete presents with low back pain after a fall. Examination reveals tenderness over
the lumbar spine but no neurological deficits. What is the most likely diagnosis?
• A) Spinal stenosis
• B) Lumbar strain
• C) Cauda equina syndrome
• D) Osteoarthritis
• Rationale: Lumbar strain is common in athletes and presents with localized tenderness
without neurological findings, typically improving with conservative care.
10. A 70-year-old female with a history of osteoporosis presents with low back pain after
minimal trauma. Which imaging study is most appropriate to confirm your suspicion?
• A) MRI of the lumbar spine
• B) Dual-energy X-ray absorptiometry (DEXA) scan
• C) CT scan of the abdomen
• D) X-ray of the lumbar spine
• Rationale: X-rays readily demonstrate vertebral compression fractures which appear as
wedge-shaped deformities, making them the appropriate first imaging study.
11. A patient with chronic low back pain is found to have spinal stenosis on MRI. What is the
most common symptom associated with this condition?
• A) Acute leg weakness
• B) Pain relieved by sitting or leaning forward
• C) Night sweats and fever
• D) Loss of bowel and bladder function
• Rationale: Neurogenic claudication from spinal stenosis improves with flexion (sitting
forward) which increases spinal canal diameter and reduces nerve compression.
