NURS 6531 FINAL EXAM PAPER 2026
COMPLETE QUESTIONS AND VERIFIED
CLINICAL SOLUTIONS
◉ An adolescent patient reports intermitted pain and swelling in
various joints on the right side including the knee, elbow, wrist, and
ankle. A physical examination reveals tenosynovitis and a
maculopapular rash. Which diagnostic tests will be most helpful in
determining a diagnosis in this patient?
a. Blood cultures and a complete blood count
b. Cultures of the urethra, pharynx, cervix, and rectum
c. Skin lesion scrapings and cultures
d. Urine cultures and renal
Answer: ANS: B
This patient has signs of gonococcal arthritis. Cultures of the
urethra, pharynx, cervix, and rectum will be positive in 80% of
patients with this infection. Blood cultures are likely to be negative.
Culturing skin lesions is not helpful. Renal involvement is not part of
this infection.
◉ A patient has marked swelling of a shoulder joint with erythema
and severe pain. The provider suspects a bacterial cause. Which
culture will be most helpful to determine the cause of these
symptoms?
,a. Blood culture
b. Synovial fluid culture
c. Urethral culture
d. Urine culture
Answer: ANS: B
Synovial fluid culture is the most important exam for diagnosis of
septic arthritis. Blood culture may be positive in only 10% of cases.
Urethral culture is performed if gonococcal arthritis is suspected.
Urine culture is not helpful.
◉ A patient reports severe back pain located in the lumbar spine. To
evaluate whether the patient has axial pain or radicular pain, which
assessment is necessary?
a. Asking the patient to perform the Valsalva maneuver
b. Assessing reflexes and asking about tingling or numbness
c. Determining whether the pain is present with prolonged sitting
d. Noting whether pain is mitigated with frequent position shifts
Answer: ANS: A
Associated neurological signs are present with radicular pain and
include numbness, tingling,
weakness, and reflex changes. The other symptoms occur with both
axial and radicular pain.
,◉ A patient has an acute onset of lower back pain associated with
lifting heavy objects at work. A physical examination reveals no loss
of lower extremity function or neurological symptoms. What is the
initial intervention for this patient?
a. Magnetic resonance imaging (MRI) to evaluate soft tissue
involvement
b. Plain radiographs to evaluate the extent of the injury
c. Traction therapy to minimize complications
d. Treatment with a nonsteroidal anti-inflammatory drug (NSAID)
Answer: ANS: D
NSAIDs are appropriate as first-line treatment in patients without
potential complications. Radiologic studies are performed if
improvement does not occur in 4 to 6 weeks. Traction may be used
for patients with radicular symptoms to help resolve neurological
deficits, although systematic review of research has not clearly
identified a benefit to this therapy.
◉ A patient has recurrent lumbar pain which is sometimes severe.
The patient reports that prescription of nonsteroidal anti-
inflammatory drugs (NSAIDs) is no longer effective for pain
relief. What will the provider recommend?
a. Adjunctive treatment with physical therapy
b. Beginning treatment with opioid analgesics
c. Complementary and alternative therapies
d. Referral to an interventional spine physician
, Answer: ANS: D
Patients with recurrent or chronic lower back pain may benefit from
lumbar epidural corticosteroid injection performed by an
interventional spine physician. Physical therapy is often used for
acute injury if no improvement in 4 to 6 weeks. Opioid analgesics are
not usually effective.
◉ An adult patient who has been taking high-dose corticosteroids
reports a dull, aching pain in the groin and presents with a limp.
What condition does the provider suspect, based on this history?
a. Avascular necrosis of the femoral head
b. Infectious arthritis of the hip
c. Osteoarthritis of the hip
d. Slipped capital femoral epiphysis (SCFE)
Answer: ANS: A
Avascular necrosis has the symptoms listed above and is common
among patients who have been taking corticosteroids. Infectious
arthritis will typically be accompanied by fever and intense pain.
Osteoarthritis causes progressively worsening pain with activity and
improvement with rest. SCFE is common in adolescents.
◉ A patient with chronic hip pain cannot take nonsteroidal anti-
inflammatory drugs (NSAIDs) and tells the provider that
acetaminophen is minimally helpful. What might the provider
recommend initially to improve pain relief?
COMPLETE QUESTIONS AND VERIFIED
CLINICAL SOLUTIONS
◉ An adolescent patient reports intermitted pain and swelling in
various joints on the right side including the knee, elbow, wrist, and
ankle. A physical examination reveals tenosynovitis and a
maculopapular rash. Which diagnostic tests will be most helpful in
determining a diagnosis in this patient?
a. Blood cultures and a complete blood count
b. Cultures of the urethra, pharynx, cervix, and rectum
c. Skin lesion scrapings and cultures
d. Urine cultures and renal
Answer: ANS: B
This patient has signs of gonococcal arthritis. Cultures of the
urethra, pharynx, cervix, and rectum will be positive in 80% of
patients with this infection. Blood cultures are likely to be negative.
Culturing skin lesions is not helpful. Renal involvement is not part of
this infection.
◉ A patient has marked swelling of a shoulder joint with erythema
and severe pain. The provider suspects a bacterial cause. Which
culture will be most helpful to determine the cause of these
symptoms?
,a. Blood culture
b. Synovial fluid culture
c. Urethral culture
d. Urine culture
Answer: ANS: B
Synovial fluid culture is the most important exam for diagnosis of
septic arthritis. Blood culture may be positive in only 10% of cases.
Urethral culture is performed if gonococcal arthritis is suspected.
Urine culture is not helpful.
◉ A patient reports severe back pain located in the lumbar spine. To
evaluate whether the patient has axial pain or radicular pain, which
assessment is necessary?
a. Asking the patient to perform the Valsalva maneuver
b. Assessing reflexes and asking about tingling or numbness
c. Determining whether the pain is present with prolonged sitting
d. Noting whether pain is mitigated with frequent position shifts
Answer: ANS: A
Associated neurological signs are present with radicular pain and
include numbness, tingling,
weakness, and reflex changes. The other symptoms occur with both
axial and radicular pain.
,◉ A patient has an acute onset of lower back pain associated with
lifting heavy objects at work. A physical examination reveals no loss
of lower extremity function or neurological symptoms. What is the
initial intervention for this patient?
a. Magnetic resonance imaging (MRI) to evaluate soft tissue
involvement
b. Plain radiographs to evaluate the extent of the injury
c. Traction therapy to minimize complications
d. Treatment with a nonsteroidal anti-inflammatory drug (NSAID)
Answer: ANS: D
NSAIDs are appropriate as first-line treatment in patients without
potential complications. Radiologic studies are performed if
improvement does not occur in 4 to 6 weeks. Traction may be used
for patients with radicular symptoms to help resolve neurological
deficits, although systematic review of research has not clearly
identified a benefit to this therapy.
◉ A patient has recurrent lumbar pain which is sometimes severe.
The patient reports that prescription of nonsteroidal anti-
inflammatory drugs (NSAIDs) is no longer effective for pain
relief. What will the provider recommend?
a. Adjunctive treatment with physical therapy
b. Beginning treatment with opioid analgesics
c. Complementary and alternative therapies
d. Referral to an interventional spine physician
, Answer: ANS: D
Patients with recurrent or chronic lower back pain may benefit from
lumbar epidural corticosteroid injection performed by an
interventional spine physician. Physical therapy is often used for
acute injury if no improvement in 4 to 6 weeks. Opioid analgesics are
not usually effective.
◉ An adult patient who has been taking high-dose corticosteroids
reports a dull, aching pain in the groin and presents with a limp.
What condition does the provider suspect, based on this history?
a. Avascular necrosis of the femoral head
b. Infectious arthritis of the hip
c. Osteoarthritis of the hip
d. Slipped capital femoral epiphysis (SCFE)
Answer: ANS: A
Avascular necrosis has the symptoms listed above and is common
among patients who have been taking corticosteroids. Infectious
arthritis will typically be accompanied by fever and intense pain.
Osteoarthritis causes progressively worsening pain with activity and
improvement with rest. SCFE is common in adolescents.
◉ A patient with chronic hip pain cannot take nonsteroidal anti-
inflammatory drugs (NSAIDs) and tells the provider that
acetaminophen is minimally helpful. What might the provider
recommend initially to improve pain relief?
