NSG 316 Exam 2 Health
Assessment Actual Questions &
Rationalized Answers – GCU
1. A nurse asks a client to say the words “light, tight, dynamite” and notices the speech is
slurred. Which cranial nerve is most likely affected?
A. Cranial Nerve V (Trigeminal)
B. Cranial Nerve VII (Facial)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer D
Rationale: CN XII controls tongue movement. Damage causes slurred speech and difficulty
articulating consonants.
2. During a neurological assessment, the nurse places a familiar object in the client’s hand
with eyes closed and asks them to identify it. What is this assessment called?
A. Graphesthesia
B. Proprioception
C. Stereognosis
D. Two-point discrimination
Correct Answer C
Rationale: Stereognosis assesses the ability to recognize objects by touch, reflecting cortical
sensory function.
3. The nurse asks a patient to smile, frown, close their eyes tightly, and puff out their cheeks.
Which cranial nerve is being assessed?
,A. Cranial Nerve V
B. Cranial Nerve VII
C. Cranial Nerve IX
D. Cranial Nerve XI
Correct Answer B
Rationale: CN VII (Facial) controls facial expression muscles.
4. A client sways and begins to fall during the Romberg test when standing with feet together
and eyes closed. How should this be interpreted?
A. Normal finding
B. Cerebellar lesion
C. Positive Romberg sign indicating balance dysfunction
D. Muscle weakness
Correct Answer C
Rationale: A positive Romberg indicates vestibular or proprioceptive impairment.
5. A very brisk deep tendon reflex with clonus is noted. How should the nurse document this?
A. 1+
B. 2+
C. 3+
D. 4+
Correct Answer D
Rationale: 4+ indicates hyperactive reflexes with clonus, often linked to upper motor neuron
lesions.
6. A client reports numbness and tingling in the hands and feet. Which part of the
neurological exam best evaluates this symptom?
A. Motor strength
B. Reflex testing
, C. Cerebellar testing
D. Sensory assessment
Correct Answer D
Rationale: Sensory testing evaluates pain, touch, vibration, and position sense.
7. The nurse observes posture, balance, and coordination while a client walks across the room
and returns. What assessment is being performed?
A. Motor strength test
B. Sensory exam
C. Cerebellar gait assessment
D. Cranial nerve exam
Correct Answer C
Rationale: Gait testing evaluates cerebellar function.
8. Which action best assesses Cranial Nerve II (Optic)?
A. Pupillary light reflex
B. Extraocular movements
C. Reading a Snellen chart
D. Confrontation testing
Correct Answer C
Rationale: CN II is responsible for visual acuity.
9. Sudden, involuntary, jerky limb movements are observed. How should this be
documented?
A. Ataxia
B. Tremor
C. Chorea
D. Fasciculations
Assessment Actual Questions &
Rationalized Answers – GCU
1. A nurse asks a client to say the words “light, tight, dynamite” and notices the speech is
slurred. Which cranial nerve is most likely affected?
A. Cranial Nerve V (Trigeminal)
B. Cranial Nerve VII (Facial)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer D
Rationale: CN XII controls tongue movement. Damage causes slurred speech and difficulty
articulating consonants.
2. During a neurological assessment, the nurse places a familiar object in the client’s hand
with eyes closed and asks them to identify it. What is this assessment called?
A. Graphesthesia
B. Proprioception
C. Stereognosis
D. Two-point discrimination
Correct Answer C
Rationale: Stereognosis assesses the ability to recognize objects by touch, reflecting cortical
sensory function.
3. The nurse asks a patient to smile, frown, close their eyes tightly, and puff out their cheeks.
Which cranial nerve is being assessed?
,A. Cranial Nerve V
B. Cranial Nerve VII
C. Cranial Nerve IX
D. Cranial Nerve XI
Correct Answer B
Rationale: CN VII (Facial) controls facial expression muscles.
4. A client sways and begins to fall during the Romberg test when standing with feet together
and eyes closed. How should this be interpreted?
A. Normal finding
B. Cerebellar lesion
C. Positive Romberg sign indicating balance dysfunction
D. Muscle weakness
Correct Answer C
Rationale: A positive Romberg indicates vestibular or proprioceptive impairment.
5. A very brisk deep tendon reflex with clonus is noted. How should the nurse document this?
A. 1+
B. 2+
C. 3+
D. 4+
Correct Answer D
Rationale: 4+ indicates hyperactive reflexes with clonus, often linked to upper motor neuron
lesions.
6. A client reports numbness and tingling in the hands and feet. Which part of the
neurological exam best evaluates this symptom?
A. Motor strength
B. Reflex testing
, C. Cerebellar testing
D. Sensory assessment
Correct Answer D
Rationale: Sensory testing evaluates pain, touch, vibration, and position sense.
7. The nurse observes posture, balance, and coordination while a client walks across the room
and returns. What assessment is being performed?
A. Motor strength test
B. Sensory exam
C. Cerebellar gait assessment
D. Cranial nerve exam
Correct Answer C
Rationale: Gait testing evaluates cerebellar function.
8. Which action best assesses Cranial Nerve II (Optic)?
A. Pupillary light reflex
B. Extraocular movements
C. Reading a Snellen chart
D. Confrontation testing
Correct Answer C
Rationale: CN II is responsible for visual acuity.
9. Sudden, involuntary, jerky limb movements are observed. How should this be
documented?
A. Ataxia
B. Tremor
C. Chorea
D. Fasciculations
