NSG 6020 Orthopedics Exam Questions with Answers
and Rationales | Complete Nursing Review
Question 1
A sixty-five-year-old female presents to the outpatient clinic complaining of
chronic, deep, aching pain in both knees that worsens with prolonged weight-
bearing activity and stair climbing, and improves with rest. Physical examination
reveals crepitus and bony enlargement of the distal interphalangeal joints of her
hands. This clinical presentation is most characteristic of:
Option A. Rheumatoid arthritis
Option B. Primary osteoarthritis
Option C. Gouty arthritis
Option D. Septic bacterial arthritis
Answer: Option B
Rationale: Osteoarthritis is the most common degenerative joint disease,
characterized by cartilage breakdown, subchondral bone remodeling, joint
pain exacerbated by use, and Heberden nodes at distal interphalangeal
joints.
Question 2
An advanced practice registered nurse is evaluating a thirty-year-old male who
sustained a sports-related knee injury while pivoting during soccer. He reports an
audible popping sound followed by immediate joint swelling and instability.
Physical examination demonstrates a positive anterior drawer test and a positive
Lachman test. These findings strongly indicate an injury to the:
Option A. Anterior cruciate ligament
Option B. Posterior cruciate ligament
Option C. Medial collateral ligament
Option D. Lateral meniscus
, Answer: Option A
Rationale: The Lachman test and anterior drawer test assess the integrity of
the anterior cruciate ligament, which is commonly injured during sudden
deceleration, hyperextension, or rotational pivoting movements.
Question 3
A seventy-year-old postmenopausal female presents with sudden onset of severe
lower back pain after lifting a heavy grocery bag. Radiographic evaluation of the
lumbar spine reveals a compression fracture of the first lumbar vertebra. Dual-
energy x-ray absorptiometry scan demonstrates a T-score of minus two point
eight. This diagnosis is:
Option A. Osteoporosis
Option B. Osteomalacia
Option C. Paget disease of bone
Option D. Spinal stenosis
Answer: Option A
Rationale: Osteoporosis is a systemic skeletal disease characterized by low
bone mass and microarchitectural deterioration, defined clinically by a
dual-energy x-ray absorptiometry T-score of minus two point five or lower,
predisposing patients to fragility fractures.
Question 4
A nurse practitioner is assessing a patient with acute right-sided shoulder pain
following a fall. Which of the following physical examination maneuvers involves
passive forward elevation of the shoulder with internal rotation to compress the
greater tuberosity against the coracoacromial arch, evaluating for subacromial
impingement?
Option A. Neer test
Option B. Hawkins-Kennedy test
Option C. Drop arm test
, Option D. Apprehension test
Answer: Option A
Rationale: The Neer impingement test reproduces subacromial pain when
the examiner passively forward-flexes the internally rotated arm, forcing
the greater tuberosity against the anterior acromion.
Question 5
A forty-five-year-old female presents with widespread musculoskeletal pain,
fatigue, unrefreshing sleep, and multiple tender points persisting for over three
months. Comprehensive laboratory workup including complete blood count,
erythrocyte sedimentation rate, and thyroid-stimulating hormone are entirely
normal. This clinical syndrome is:
Option A. Fibromyalgia
Option B. Polymyalgia rheumatica
Option C. Systemic lupus erythematosus
Option D. Rheumatoid arthritis
Answer: Option A
Rationale: Fibromyalgia is a chronic central pain sensitization syndrome
characterized by widespread chronic pain, fatigue, sleep disturbances, and
tender points in the absence of systemic inflammatory markers.
Question 6
A sixty-year-old male presents with deep, boring pain in his right hip that radiates
to the groin and buttocks, worsening with weight-bearing and relieved by rest.
Range of motion is restricted, particularly internal rotation. Plain radiography
demonstrates joint space narrowing, subchondral sclerosis, and osteophyte
formation. This condition is:
Option A. Hip osteoarthritis
Option B. Avascular necrosis of the femoral head
Option C. Trochanteric bursitis
, Option D. Septic hip arthritis
Answer: Option A
Rationale: Hip osteoarthritis manifests with groin and hip pain exacerbated
by weight-bearing, limited internal rotation, and hallmark radiographic
features of joint space loss and osteophytes.
Question 7
A nurse practitioner evaluates a patient with severe pain and swelling in the right
great toe. Arthrocentesis of the first metatarsophalangeal joint yields synovial
fluid containing needle-shaped, negatively birefringent crystals under polarized
light microscopy. This finding confirms:
Option A. Acute gouty arthritis
Option B. Calcium pyrophosphate deposition disease
Option C. Septic arthritis
Option D. Rheumatoid arthritis
Answer: Option A
Rationale: Gout is diagnosed definitively by identifying needle-shaped
monosodium urate crystals that exhibit negative birefringence under
polarized light microscopy in synovial fluid aspirates.
Question 8
A twenty-five-year-old female presents with bilateral symmetric joint pain,
prolonged morning stiffness exceeding one hour, and swelling involving the
metacarpophalangeal and proximal interphalangeal joints of both hands.
Laboratory studies reveal a positive rheumatoid factor and elevated anti-cyclic
citrullinated peptide antibodies. This diagnosis is:
Option A. Rheumatoid arthritis
Option B. Osteoarthritis
Option C. Psoriatic arthritis
Option D. Systemic lupus erythematosus
and Rationales | Complete Nursing Review
Question 1
A sixty-five-year-old female presents to the outpatient clinic complaining of
chronic, deep, aching pain in both knees that worsens with prolonged weight-
bearing activity and stair climbing, and improves with rest. Physical examination
reveals crepitus and bony enlargement of the distal interphalangeal joints of her
hands. This clinical presentation is most characteristic of:
Option A. Rheumatoid arthritis
Option B. Primary osteoarthritis
Option C. Gouty arthritis
Option D. Septic bacterial arthritis
Answer: Option B
Rationale: Osteoarthritis is the most common degenerative joint disease,
characterized by cartilage breakdown, subchondral bone remodeling, joint
pain exacerbated by use, and Heberden nodes at distal interphalangeal
joints.
Question 2
An advanced practice registered nurse is evaluating a thirty-year-old male who
sustained a sports-related knee injury while pivoting during soccer. He reports an
audible popping sound followed by immediate joint swelling and instability.
Physical examination demonstrates a positive anterior drawer test and a positive
Lachman test. These findings strongly indicate an injury to the:
Option A. Anterior cruciate ligament
Option B. Posterior cruciate ligament
Option C. Medial collateral ligament
Option D. Lateral meniscus
, Answer: Option A
Rationale: The Lachman test and anterior drawer test assess the integrity of
the anterior cruciate ligament, which is commonly injured during sudden
deceleration, hyperextension, or rotational pivoting movements.
Question 3
A seventy-year-old postmenopausal female presents with sudden onset of severe
lower back pain after lifting a heavy grocery bag. Radiographic evaluation of the
lumbar spine reveals a compression fracture of the first lumbar vertebra. Dual-
energy x-ray absorptiometry scan demonstrates a T-score of minus two point
eight. This diagnosis is:
Option A. Osteoporosis
Option B. Osteomalacia
Option C. Paget disease of bone
Option D. Spinal stenosis
Answer: Option A
Rationale: Osteoporosis is a systemic skeletal disease characterized by low
bone mass and microarchitectural deterioration, defined clinically by a
dual-energy x-ray absorptiometry T-score of minus two point five or lower,
predisposing patients to fragility fractures.
Question 4
A nurse practitioner is assessing a patient with acute right-sided shoulder pain
following a fall. Which of the following physical examination maneuvers involves
passive forward elevation of the shoulder with internal rotation to compress the
greater tuberosity against the coracoacromial arch, evaluating for subacromial
impingement?
Option A. Neer test
Option B. Hawkins-Kennedy test
Option C. Drop arm test
, Option D. Apprehension test
Answer: Option A
Rationale: The Neer impingement test reproduces subacromial pain when
the examiner passively forward-flexes the internally rotated arm, forcing
the greater tuberosity against the anterior acromion.
Question 5
A forty-five-year-old female presents with widespread musculoskeletal pain,
fatigue, unrefreshing sleep, and multiple tender points persisting for over three
months. Comprehensive laboratory workup including complete blood count,
erythrocyte sedimentation rate, and thyroid-stimulating hormone are entirely
normal. This clinical syndrome is:
Option A. Fibromyalgia
Option B. Polymyalgia rheumatica
Option C. Systemic lupus erythematosus
Option D. Rheumatoid arthritis
Answer: Option A
Rationale: Fibromyalgia is a chronic central pain sensitization syndrome
characterized by widespread chronic pain, fatigue, sleep disturbances, and
tender points in the absence of systemic inflammatory markers.
Question 6
A sixty-year-old male presents with deep, boring pain in his right hip that radiates
to the groin and buttocks, worsening with weight-bearing and relieved by rest.
Range of motion is restricted, particularly internal rotation. Plain radiography
demonstrates joint space narrowing, subchondral sclerosis, and osteophyte
formation. This condition is:
Option A. Hip osteoarthritis
Option B. Avascular necrosis of the femoral head
Option C. Trochanteric bursitis
, Option D. Septic hip arthritis
Answer: Option A
Rationale: Hip osteoarthritis manifests with groin and hip pain exacerbated
by weight-bearing, limited internal rotation, and hallmark radiographic
features of joint space loss and osteophytes.
Question 7
A nurse practitioner evaluates a patient with severe pain and swelling in the right
great toe. Arthrocentesis of the first metatarsophalangeal joint yields synovial
fluid containing needle-shaped, negatively birefringent crystals under polarized
light microscopy. This finding confirms:
Option A. Acute gouty arthritis
Option B. Calcium pyrophosphate deposition disease
Option C. Septic arthritis
Option D. Rheumatoid arthritis
Answer: Option A
Rationale: Gout is diagnosed definitively by identifying needle-shaped
monosodium urate crystals that exhibit negative birefringence under
polarized light microscopy in synovial fluid aspirates.
Question 8
A twenty-five-year-old female presents with bilateral symmetric joint pain,
prolonged morning stiffness exceeding one hour, and swelling involving the
metacarpophalangeal and proximal interphalangeal joints of both hands.
Laboratory studies reveal a positive rheumatoid factor and elevated anti-cyclic
citrullinated peptide antibodies. This diagnosis is:
Option A. Rheumatoid arthritis
Option B. Osteoarthritis
Option C. Psoriatic arthritis
Option D. Systemic lupus erythematosus
