NRNP 6540 MIDTERM 2026 PRACTICE TEST
SHEET FULL SOLUTIONS CORRECT ANSWERS
PREPARATION SET
◉ Specific findings for back pain.
Answer: - numbness
- saddle anesthesia (CA, mass)
- bowel, bladder dysfunction (emergency surgery)
- pain worse at rest (CA, tumor, infection)
- Discitis, epidural abcess (IV drug use)
- Decreased rom
- Radiculopathy (pain down leg), not with OA
- Crossover straight leg test: herniated disk
- back, buttock, leg pain when ambulating (neurogenic claudication
with spinal stenosis). Also positive straight leg raise test with spinal
stenosis
xr anteroposterior, to rule out scoliosis, bone spur
MRI for soft tissue structure, bulging disk
,CT for bony imaging
◉ Cauda Equina Syndrome.
Answer: Spinal cord compression from metastatic lesion to spine.
Causes: gradual to sudden weakness and inability to move/ lift legs,
bowel/ bladder incontinence, diminished sensation in legs: saddle.
Surgical emergency!
◉ Low back pain management.
Answer: Nonsurgical:
- rest
- ice/ heat (alternate)
- NSAIDS
- antispasmodics (diazepam, flexeril)
- opioid short-term, to promote mobility
- anticonvulsants and antidepressants for neuropathic pain
- PT
- weight loss
- epidural steroid injection
Surgical:
- Foraminotomy or diskectomy
,- spinal fusion
◉ Herniated disk: what, who.
Answer: Bulging or protrusion of nucleus through a defect in the
annulus of spine, may cause nerve entrapment
- Trauma
- Obesity/ sedentary lifestyle
- Age 35 - 45
- Often located at L4- L5, L5 - S1
◉ Herniated disk findings and diagnostics.
Answer: - Decreased/ absent reflexes
- Atrophy of muscles
- limp
- possible straight leg raise test/ radiculopathy
- limited rom spine
- xr anteroposterior and lateral of spine
- CT with and without dye: detects bony defects
- MRI: detects soft tissue defects
- myelogram
, - EMG (tests nerve innervation)
◉ Herniated disk L4 root finding (disk between L3 and L4).
Answer: - quadriceps weak, difficulty extending quadriceps (have pt
squat and rise)
- pain and numbness radiating into medial malleous
- diminished/ absent knee jerk
◉ Herniated disk L5 root finding (disk between L4 and L5).
Answer: - dorsiflexion of great toe and foot weak (have pt walk on
heels of feet)
- pain and numbness into lateral calf and between first toe web
space
◉ Herniated disk S1 root finding (disk between L5 and S1).
Answer: - weakness of plantar flexion of great toe and foot (have pt
walk on toes)
- pain along buttock, lateral leg and lateral aspect of foot and
posterior calf
- diminished achilles calf
◉ Herniated disk management.
Answer: Non surgical:
SHEET FULL SOLUTIONS CORRECT ANSWERS
PREPARATION SET
◉ Specific findings for back pain.
Answer: - numbness
- saddle anesthesia (CA, mass)
- bowel, bladder dysfunction (emergency surgery)
- pain worse at rest (CA, tumor, infection)
- Discitis, epidural abcess (IV drug use)
- Decreased rom
- Radiculopathy (pain down leg), not with OA
- Crossover straight leg test: herniated disk
- back, buttock, leg pain when ambulating (neurogenic claudication
with spinal stenosis). Also positive straight leg raise test with spinal
stenosis
xr anteroposterior, to rule out scoliosis, bone spur
MRI for soft tissue structure, bulging disk
,CT for bony imaging
◉ Cauda Equina Syndrome.
Answer: Spinal cord compression from metastatic lesion to spine.
Causes: gradual to sudden weakness and inability to move/ lift legs,
bowel/ bladder incontinence, diminished sensation in legs: saddle.
Surgical emergency!
◉ Low back pain management.
Answer: Nonsurgical:
- rest
- ice/ heat (alternate)
- NSAIDS
- antispasmodics (diazepam, flexeril)
- opioid short-term, to promote mobility
- anticonvulsants and antidepressants for neuropathic pain
- PT
- weight loss
- epidural steroid injection
Surgical:
- Foraminotomy or diskectomy
,- spinal fusion
◉ Herniated disk: what, who.
Answer: Bulging or protrusion of nucleus through a defect in the
annulus of spine, may cause nerve entrapment
- Trauma
- Obesity/ sedentary lifestyle
- Age 35 - 45
- Often located at L4- L5, L5 - S1
◉ Herniated disk findings and diagnostics.
Answer: - Decreased/ absent reflexes
- Atrophy of muscles
- limp
- possible straight leg raise test/ radiculopathy
- limited rom spine
- xr anteroposterior and lateral of spine
- CT with and without dye: detects bony defects
- MRI: detects soft tissue defects
- myelogram
, - EMG (tests nerve innervation)
◉ Herniated disk L4 root finding (disk between L3 and L4).
Answer: - quadriceps weak, difficulty extending quadriceps (have pt
squat and rise)
- pain and numbness radiating into medial malleous
- diminished/ absent knee jerk
◉ Herniated disk L5 root finding (disk between L4 and L5).
Answer: - dorsiflexion of great toe and foot weak (have pt walk on
heels of feet)
- pain and numbness into lateral calf and between first toe web
space
◉ Herniated disk S1 root finding (disk between L5 and S1).
Answer: - weakness of plantar flexion of great toe and foot (have pt
walk on toes)
- pain along buttock, lateral leg and lateral aspect of foot and
posterior calf
- diminished achilles calf
◉ Herniated disk management.
Answer: Non surgical:
