Comprehensive NCLEX RN ACTUAL EXAM
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Acculturation. - ansIs a process of learning a different culture to adapt to a new or changing
environment.
Ethnic identity - ansIt is a subjective perspective of the person's heritage and a sense of
belonging to a group
Low-risk therapies: - ansInclude meditation, relaxation techniques, imagery, music therapy,
massage, touch, laughter, humor, & spiritual measures (prayer).
High risk of obesity & diabetes mellitus - ansBecause of their health & dietary practices,
Native Americans, Latino Americans, Hispanic Americans, & African Americans.
Jehovah's Witnesses - ansSurgery is not prohibited, but the administration of blood and blood
products is forbidden. This religious group believes the soul cannot live after death.
Administration of medication is an acceptable practice except if the medication is derived
from blood products.
Orthodox Judaism - ansBelievers adhere to dietary kosher laws. In this religion, the dairy-
meat combination is unacceptable. Only fish that have scales and fins are allowed; meats that
are allowed include animals that are vegetable eaters, cloven-hoofed, and ritually slaughtered.
Five categories of complementary and alternative medicine (CAM): - ansinclude whole
medical systems, mind-body medicine, biologically based practices, manipulative & body-
based practices, & energy medicine.
Autocratic leader - ansFocused, maintains strong control, makes decisions, & addresses all
problems. Dominates group & commands, rather than seeks suggestions or input. Manager
addresses problem (quality improvement) with taff, designs a plan without input, & wants all
problems reported directly back to her
Democratic leader - ansParticipative & would likely meet with each staff person individually
to determine staff member's perception of problem. Would also speak with the staff about any
issues & ask the staff for input with developing a plan.
Laissez-faire leader - ansPassive and nondirective. Would state what the problem was &
inform staff that the staff needed to come up with a plan to "fix it."
Overhydration or fluid overload & occurs when fluid intake or fluid retention -
ansAssessment findings include cough, dyspnea, crackles, tachypnea, tachycardia, elevated
blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck & hand vein
distention, altered LOC, & decreased hematocrit.
Common food sources of potassium: - ansAvocado, bananas, cantaloupe, carrots, fish,
mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, & tomatoes
Hyponatremia - ansMuscle weakness, increased urinary output, & decreased specific gravity
of the urine would be noted
Hypophosphatemia - ansCausative factors relate to malnutrition or starvation & the use of
aluminum hydroxide-based or magnesium-based antacids. Malnutrition is associated with
alcoholism.
Hyperphosphatemia - ansRenal insufficiency, hypoparathyroidism, & tumor lysis syndrome;
causative factors. Should avoid foods high in phosphates; fish, eggs, milk products,
vegetables, whole grains, & carbonated beverages.
,Comprehensive NCLEX RN ACTUAL EXAM
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Causes of a fluid volume deficit - ansVomiting, diarrhea, conditions that increased
respiration's or increased urinary output, insufficient intravenous fluid replacement, draining
fistulas, presence of ileostomy or colostomy. Diuretics, & gastrointestinal suctioning.
Causes of overhydration or fluid overload: - ansDecreased kidney function, heart failure,
hypotonic fluids to replace isotonic fluid losses, excessive irrigation of wounds & body
cavities, & excessive ingestion of sodium.
Hyperkalemia causes: - ansTrauma, burns, sepsis, or metabolic or respiratory acidosis.
Hypokalemia causes: - ansCushing's syndrome or colitis & over use of laxatives.
Metabolic acidotic - ansDecreased pH & decreased HCO3. Occurs in kidney disease; diabetic
ketoacidosis; high fat diet; insufficient metabolism of carbohydrates; malnutrition; ingestion
of toxins, such as acetylsalicylic acid (aspirin); malnutrition; severe diarrhea. Intestinal
secretion high in bicarbonate & may be lost through enteric drainage tubes, an ileostomy, or
diarrhea.
Metabolic alkalosis - ansNausea & vomiting. Loss of gastric acid, cause pH & HCO3 to
increase. Symptoms experienced would include hypoventilation & tachycardia.
Respiratory acidotic - ansDecreased pH and an increased CO2. Hypoventalation & COPD
Respiratory alkalotic - ansIncreased pH & decreased CO2. Hyperventalation, Lethargy,
lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea,
vomiting, epigastric pain, numbness & tingling of extremities. Hyperventilation (tachypnea)
occurs.
Warfarin (Coumadin) - ansSample for PT & INR level to determine anticoagulation status &
risk for bleeding
Heparin - ansaPTT monitors the effects. Anticoagulant used most often during hemodialysis.
Monitors extent of anticoagulation checking PTT, which is appropriate measure heparin
effect. Protamine sulfate is antidote.
Iron deficiency anemia foods in diet: - ansDark green leafy vegetables good source iron,
oranges are a good source of vitamin C, which enhances iron absorption.
Vegans - ansMay lack B12 in diet.
Low sodium foods: - ansInclude fruits & vegetables
High Sodium foods: - ansHighly processed or refined foods (tomato soup, instant oatmeal),
Saltwater fish & shellfish. Smoked foods,
Clear liquid diet: - ansWater, bouillon, clear broth, carbonated beverages, gelatin, hard candy,
lemonade, ice pops, and regular or decaffeinated coffee or tea.
Full liquid diet: - ansPulling, Vegetable juice, Pureed vegetables, plain ice cream, sherbet,
breakfast drinks, milk, pudding & custard, soups that are strained, refined cooked cereals, &
strained vegetable juices.
High Thiamine foods - ansPork products rich in this vitamin. Other good food sources
include nuts, whole grain cereals, & legumes.
Suspects air embolism. Should immediately place client in which position? - ansOn the left
side, with the head lower than the feet. This position used to minimize effect of air traveling
as a bolus to lungs by trapping it in right side of heart.
Fat emulsion (lipids) - ansAssess for known allergies to eggs to prevent anaphylaxis.
,Comprehensive NCLEX RN ACTUAL EXAM
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Hyperglycemia: - ansSigns include excessive thirst, fatigue, restlessness, confusion,
weakness, Kussmaul's respirations, diuresis, & coma when severe. If has these symptoms,
blood glucose level should be checked immediately.
Parenteral nutrition; PN monitor - ansTemperature and weight: Temperature monitored to
detect infection, potential complication of therapy. Infection also could result in sepsis
because catheter in blood vessel. Weight monitored for effectiveness nutritional therapy &
detect hypervolemia.
Parenteral nutrition; Patients needing - ansBurns, exacerbation Crohn's disease, persistent
nausea & vomiting due to chemotherapy. Had extensive surgery, multiple fractures, are
septic, have advanced cancer or AIDS. (Electronic infusion pump used to administer)
Parenteral nutrition; If PN bag empty hang - ans10% dextrose in water until new PN solution
becomes available.
Infiltrated IV - ansIV dislodged from vein & is lying in subcutaneous tissue. Pallor, coolness,
& swelling are results of IV fluid being deposited in tissue. Corrective action is remove
catheter & start new IV line at another site.
Phlebitis at IV site: - ansDiscomfort at site, redness, warmth, & swelling proximal to catheter.
If phlebitis occurs, discontinue IV line & insert new IV line at different site. Apply warm
moist compresses to area speed resolution of inflammation. Notify (HCP). Document
occurrence, actions taken, & client response.
An allergic reaction at IV site: - ansProduces a rash, redness, & itching.
Hematoma - ansCharacterized by ecchymosis, swelling, & leakage at IV insertion site, as
well as hard & painful lumps at site.
Hypersensitivity reaction: - ansDyspnea, a swollen tongue, & cyanosis.
PICC line - ansTaught minor activity restrictions apply with this type of catheter. Protect site
during bathing & should carry or wear Medic-Alert ID. Have repair kit in home for use as
needed because catheter is for long-term use.
Central venous catheter insertion: - ansBefore beginning administration IV solution, assess
whether chest radiograph reveals central catheter is in proper place. Portable chest X-ray.
Systemic infection - ansCharacterized by chills, fever, malaise, headache, nausea, vomiting,
backache, & tachycardia.
Air embolism - ansCharacterized by tachycardia, dyspnea, hypotension, cyanosis, decreased
LOC, anxiety, feelings of impending doom, chest pain, & hypotension. Place left side in
Trendelenburg's position. Lying left side may prevent air from flowing into pulmonary veins.
Trendelenburg's position increases intrathoracic pressure, which decreases amount of blood
pulled into vena cava during inspiration.
Septicemia - ansOccurs with transfusion of blood contaminated with microorganisms. Signs
include chills, fever, vomiting, diarrhea, hypotension, & development of shock
Platelets - ansNecessary for proper blood clotting. Insufficient platelets may exhibit frank
bleeding or oozing of blood from puncture sites, wounds, & mucous membranes.
Fire event - ansOrder of priority is to rescue patient in immediate danger. Next activate fire
alarm. Close all doors & fire extinguished.
Meningococcal pneumonia - ansTransmitted by droplet infection. Precautions include private
room or cohort client & use of standard precaution mask.
, Comprehensive NCLEX RN ACTUAL EXAM
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Incentive spirometer - ansBest results sitting head of bed elevated 45 to 90 degrees. Semi-
Fowler's or high Fowler's position. Mouthpiece should be covered completely & tightly while
inhales slowly, with constant flow through unit. Breath should be held for 5 seconds before
exhaling slowly.
Cleansing enema - ansPlaced in left Sims position so enema solution can flow by gravity in
natural direction of colon.
Kohlberg's theory of moral development - ansPreconventional stage, morals are thought to be
motivated by punishment & reward.
Erikson's psychosocial development theory - ansShould not try anticipate newborn infant
needs but allow newborn infant to signal needs. If newborn infant is not allowed to signal a
need, newborn will not learn how to control environment. Delayed or prolonged response to
newborn infant's signal would inhibit development trust & lead to mistrust of others
Formal operations stage of Piaget's cognitive developmental theory - ansChild has the ability
to think abstractly and logically.
Paiget's sensorimotor stage - ansChild begins to understand the environment.
Paiget's concrete operational stage - ansChild is able to classify, order, and sort facts.
Paiget's preoperational stage - ansChild learns to think in terms of past, present, & future.
Normal respiratory rate in a 12-month-old - ans20 to 40 breaths/minute
Normal apical heart rate in a 12-month-old - ans90 to 130 beats/minute
Average blood pressure in a 12-month-old - ans90/56 mm Hg
Anterior fontane - ansDiamond-shaped & located on top of head. Soft & flat in normal infant,
& it normally closes by 12- 18 months of age
older client is at risk for medication toxicity because - ansDecreased lean body mass & age-
associated decreased glomerular filtration rate.
Romberg's test - ansStand feet together & arms at sides, close eyes & hold position; normally
client can maintain posture & balance. Positive Romberg's sign is a vestibular neurological
sign found when client exhibits loss balance when closing eyes.
Cheyne-Stokes respirations - ansRhythmic respirations with periods of apnea. Periods apnea
followed by deep rapid breathing
Conductive hearing loss - ansPhysical obstruction to transmission of sound waves
Sensorineural hearing loss - ansoccurs as result pathological process in inner ear, defect in
8th cranial nerve, or defect of sensory fibers that lead to cerebral cortex.
Heart murmur - ansAbnormal heart sound & described as gentle, blowing, swooshing sound.
Pericardial friction rub - ansDescribed as a scratchy, leathery heart sound.
Assess for muscle weakness in eyes - ansTests the six cardinal positions of gaze
Snellen eye chart - ansVisual acuity & cranial nerve II (optic).
Testing sensory function - ansClose eyes & then lightly touching areas of face & testing
corneal reflexes assess cranial nerve V (trigeminal).
Positive Brudzinski's sign - anstested insupine position. Flexes head (gently moves head to
chest) & there should be no reports of pain or resistance to the neck flexion. A positive
Brudzinski's sign is observed if passively flexes hip & knee in response to neck flexion &
reports pain in vertebral column.
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Acculturation. - ansIs a process of learning a different culture to adapt to a new or changing
environment.
Ethnic identity - ansIt is a subjective perspective of the person's heritage and a sense of
belonging to a group
Low-risk therapies: - ansInclude meditation, relaxation techniques, imagery, music therapy,
massage, touch, laughter, humor, & spiritual measures (prayer).
High risk of obesity & diabetes mellitus - ansBecause of their health & dietary practices,
Native Americans, Latino Americans, Hispanic Americans, & African Americans.
Jehovah's Witnesses - ansSurgery is not prohibited, but the administration of blood and blood
products is forbidden. This religious group believes the soul cannot live after death.
Administration of medication is an acceptable practice except if the medication is derived
from blood products.
Orthodox Judaism - ansBelievers adhere to dietary kosher laws. In this religion, the dairy-
meat combination is unacceptable. Only fish that have scales and fins are allowed; meats that
are allowed include animals that are vegetable eaters, cloven-hoofed, and ritually slaughtered.
Five categories of complementary and alternative medicine (CAM): - ansinclude whole
medical systems, mind-body medicine, biologically based practices, manipulative & body-
based practices, & energy medicine.
Autocratic leader - ansFocused, maintains strong control, makes decisions, & addresses all
problems. Dominates group & commands, rather than seeks suggestions or input. Manager
addresses problem (quality improvement) with taff, designs a plan without input, & wants all
problems reported directly back to her
Democratic leader - ansParticipative & would likely meet with each staff person individually
to determine staff member's perception of problem. Would also speak with the staff about any
issues & ask the staff for input with developing a plan.
Laissez-faire leader - ansPassive and nondirective. Would state what the problem was &
inform staff that the staff needed to come up with a plan to "fix it."
Overhydration or fluid overload & occurs when fluid intake or fluid retention -
ansAssessment findings include cough, dyspnea, crackles, tachypnea, tachycardia, elevated
blood pressure, bounding pulse, elevated CVP, weight gain, edema, neck & hand vein
distention, altered LOC, & decreased hematocrit.
Common food sources of potassium: - ansAvocado, bananas, cantaloupe, carrots, fish,
mushrooms, oranges, potatoes, pork, beef, veal, raisins, spinach, strawberries, & tomatoes
Hyponatremia - ansMuscle weakness, increased urinary output, & decreased specific gravity
of the urine would be noted
Hypophosphatemia - ansCausative factors relate to malnutrition or starvation & the use of
aluminum hydroxide-based or magnesium-based antacids. Malnutrition is associated with
alcoholism.
Hyperphosphatemia - ansRenal insufficiency, hypoparathyroidism, & tumor lysis syndrome;
causative factors. Should avoid foods high in phosphates; fish, eggs, milk products,
vegetables, whole grains, & carbonated beverages.
,Comprehensive NCLEX RN ACTUAL EXAM
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Causes of a fluid volume deficit - ansVomiting, diarrhea, conditions that increased
respiration's or increased urinary output, insufficient intravenous fluid replacement, draining
fistulas, presence of ileostomy or colostomy. Diuretics, & gastrointestinal suctioning.
Causes of overhydration or fluid overload: - ansDecreased kidney function, heart failure,
hypotonic fluids to replace isotonic fluid losses, excessive irrigation of wounds & body
cavities, & excessive ingestion of sodium.
Hyperkalemia causes: - ansTrauma, burns, sepsis, or metabolic or respiratory acidosis.
Hypokalemia causes: - ansCushing's syndrome or colitis & over use of laxatives.
Metabolic acidotic - ansDecreased pH & decreased HCO3. Occurs in kidney disease; diabetic
ketoacidosis; high fat diet; insufficient metabolism of carbohydrates; malnutrition; ingestion
of toxins, such as acetylsalicylic acid (aspirin); malnutrition; severe diarrhea. Intestinal
secretion high in bicarbonate & may be lost through enteric drainage tubes, an ileostomy, or
diarrhea.
Metabolic alkalosis - ansNausea & vomiting. Loss of gastric acid, cause pH & HCO3 to
increase. Symptoms experienced would include hypoventilation & tachycardia.
Respiratory acidotic - ansDecreased pH and an increased CO2. Hypoventalation & COPD
Respiratory alkalotic - ansIncreased pH & decreased CO2. Hyperventalation, Lethargy,
lightheadedness, confusion, tachycardia, dysrhythmias related to hypokalemia, nausea,
vomiting, epigastric pain, numbness & tingling of extremities. Hyperventilation (tachypnea)
occurs.
Warfarin (Coumadin) - ansSample for PT & INR level to determine anticoagulation status &
risk for bleeding
Heparin - ansaPTT monitors the effects. Anticoagulant used most often during hemodialysis.
Monitors extent of anticoagulation checking PTT, which is appropriate measure heparin
effect. Protamine sulfate is antidote.
Iron deficiency anemia foods in diet: - ansDark green leafy vegetables good source iron,
oranges are a good source of vitamin C, which enhances iron absorption.
Vegans - ansMay lack B12 in diet.
Low sodium foods: - ansInclude fruits & vegetables
High Sodium foods: - ansHighly processed or refined foods (tomato soup, instant oatmeal),
Saltwater fish & shellfish. Smoked foods,
Clear liquid diet: - ansWater, bouillon, clear broth, carbonated beverages, gelatin, hard candy,
lemonade, ice pops, and regular or decaffeinated coffee or tea.
Full liquid diet: - ansPulling, Vegetable juice, Pureed vegetables, plain ice cream, sherbet,
breakfast drinks, milk, pudding & custard, soups that are strained, refined cooked cereals, &
strained vegetable juices.
High Thiamine foods - ansPork products rich in this vitamin. Other good food sources
include nuts, whole grain cereals, & legumes.
Suspects air embolism. Should immediately place client in which position? - ansOn the left
side, with the head lower than the feet. This position used to minimize effect of air traveling
as a bolus to lungs by trapping it in right side of heart.
Fat emulsion (lipids) - ansAssess for known allergies to eggs to prevent anaphylaxis.
,Comprehensive NCLEX RN ACTUAL EXAM
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Hyperglycemia: - ansSigns include excessive thirst, fatigue, restlessness, confusion,
weakness, Kussmaul's respirations, diuresis, & coma when severe. If has these symptoms,
blood glucose level should be checked immediately.
Parenteral nutrition; PN monitor - ansTemperature and weight: Temperature monitored to
detect infection, potential complication of therapy. Infection also could result in sepsis
because catheter in blood vessel. Weight monitored for effectiveness nutritional therapy &
detect hypervolemia.
Parenteral nutrition; Patients needing - ansBurns, exacerbation Crohn's disease, persistent
nausea & vomiting due to chemotherapy. Had extensive surgery, multiple fractures, are
septic, have advanced cancer or AIDS. (Electronic infusion pump used to administer)
Parenteral nutrition; If PN bag empty hang - ans10% dextrose in water until new PN solution
becomes available.
Infiltrated IV - ansIV dislodged from vein & is lying in subcutaneous tissue. Pallor, coolness,
& swelling are results of IV fluid being deposited in tissue. Corrective action is remove
catheter & start new IV line at another site.
Phlebitis at IV site: - ansDiscomfort at site, redness, warmth, & swelling proximal to catheter.
If phlebitis occurs, discontinue IV line & insert new IV line at different site. Apply warm
moist compresses to area speed resolution of inflammation. Notify (HCP). Document
occurrence, actions taken, & client response.
An allergic reaction at IV site: - ansProduces a rash, redness, & itching.
Hematoma - ansCharacterized by ecchymosis, swelling, & leakage at IV insertion site, as
well as hard & painful lumps at site.
Hypersensitivity reaction: - ansDyspnea, a swollen tongue, & cyanosis.
PICC line - ansTaught minor activity restrictions apply with this type of catheter. Protect site
during bathing & should carry or wear Medic-Alert ID. Have repair kit in home for use as
needed because catheter is for long-term use.
Central venous catheter insertion: - ansBefore beginning administration IV solution, assess
whether chest radiograph reveals central catheter is in proper place. Portable chest X-ray.
Systemic infection - ansCharacterized by chills, fever, malaise, headache, nausea, vomiting,
backache, & tachycardia.
Air embolism - ansCharacterized by tachycardia, dyspnea, hypotension, cyanosis, decreased
LOC, anxiety, feelings of impending doom, chest pain, & hypotension. Place left side in
Trendelenburg's position. Lying left side may prevent air from flowing into pulmonary veins.
Trendelenburg's position increases intrathoracic pressure, which decreases amount of blood
pulled into vena cava during inspiration.
Septicemia - ansOccurs with transfusion of blood contaminated with microorganisms. Signs
include chills, fever, vomiting, diarrhea, hypotension, & development of shock
Platelets - ansNecessary for proper blood clotting. Insufficient platelets may exhibit frank
bleeding or oozing of blood from puncture sites, wounds, & mucous membranes.
Fire event - ansOrder of priority is to rescue patient in immediate danger. Next activate fire
alarm. Close all doors & fire extinguished.
Meningococcal pneumonia - ansTransmitted by droplet infection. Precautions include private
room or cohort client & use of standard precaution mask.
, Comprehensive NCLEX RN ACTUAL EXAM
Latest Updated 2026/2027 TEST BANK
QUESTIONS AND CORRECT DETAILED
WITH RATIONALES ANSWERS
Incentive spirometer - ansBest results sitting head of bed elevated 45 to 90 degrees. Semi-
Fowler's or high Fowler's position. Mouthpiece should be covered completely & tightly while
inhales slowly, with constant flow through unit. Breath should be held for 5 seconds before
exhaling slowly.
Cleansing enema - ansPlaced in left Sims position so enema solution can flow by gravity in
natural direction of colon.
Kohlberg's theory of moral development - ansPreconventional stage, morals are thought to be
motivated by punishment & reward.
Erikson's psychosocial development theory - ansShould not try anticipate newborn infant
needs but allow newborn infant to signal needs. If newborn infant is not allowed to signal a
need, newborn will not learn how to control environment. Delayed or prolonged response to
newborn infant's signal would inhibit development trust & lead to mistrust of others
Formal operations stage of Piaget's cognitive developmental theory - ansChild has the ability
to think abstractly and logically.
Paiget's sensorimotor stage - ansChild begins to understand the environment.
Paiget's concrete operational stage - ansChild is able to classify, order, and sort facts.
Paiget's preoperational stage - ansChild learns to think in terms of past, present, & future.
Normal respiratory rate in a 12-month-old - ans20 to 40 breaths/minute
Normal apical heart rate in a 12-month-old - ans90 to 130 beats/minute
Average blood pressure in a 12-month-old - ans90/56 mm Hg
Anterior fontane - ansDiamond-shaped & located on top of head. Soft & flat in normal infant,
& it normally closes by 12- 18 months of age
older client is at risk for medication toxicity because - ansDecreased lean body mass & age-
associated decreased glomerular filtration rate.
Romberg's test - ansStand feet together & arms at sides, close eyes & hold position; normally
client can maintain posture & balance. Positive Romberg's sign is a vestibular neurological
sign found when client exhibits loss balance when closing eyes.
Cheyne-Stokes respirations - ansRhythmic respirations with periods of apnea. Periods apnea
followed by deep rapid breathing
Conductive hearing loss - ansPhysical obstruction to transmission of sound waves
Sensorineural hearing loss - ansoccurs as result pathological process in inner ear, defect in
8th cranial nerve, or defect of sensory fibers that lead to cerebral cortex.
Heart murmur - ansAbnormal heart sound & described as gentle, blowing, swooshing sound.
Pericardial friction rub - ansDescribed as a scratchy, leathery heart sound.
Assess for muscle weakness in eyes - ansTests the six cardinal positions of gaze
Snellen eye chart - ansVisual acuity & cranial nerve II (optic).
Testing sensory function - ansClose eyes & then lightly touching areas of face & testing
corneal reflexes assess cranial nerve V (trigeminal).
Positive Brudzinski's sign - anstested insupine position. Flexes head (gently moves head to
chest) & there should be no reports of pain or resistance to the neck flexion. A positive
Brudzinski's sign is observed if passively flexes hip & knee in response to neck flexion &
reports pain in vertebral column.
