NUR 631 ADVANCED HEALTH ASSESSMENT EXAM 4
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SECTION 1: Neurological System Assessment (Q1-Q20)
Q1. A 62-year-old patient presents with sudden onset of right-sided facial droop, inability
to close the right eye, and flattened nasolabial fold. The forehead wrinkles are
symmetrically preserved on both sides. Which cranial nerve is affected, and what does
the preserved forehead movement indicate?
A. Cranial nerve VII (facial) upper motor neuron lesion [CORRECT]
B. Cranial nerve VII (facial) lower motor neuron lesion
C. Cranial nerve V (trigeminal) motor branch lesion
D. Cranial nerve XII (hypoglossal) ipsilateral lesion
Correct Answer: A
Rationale: In an upper motor neuron (UMN) facial lesion, the forehead is spared
because the upper facial muscles receive bilateral cortical innervation. A lower motor
neuron lesion would affect the entire ipsilateral face including the forehead. The
trigeminal nerve (CN V) is primarily sensory to the face and motor to the muscles of
mastication, not facial expression. CN XII controls tongue movement.
Q2. During a neurological examination, the nurse practitioner asks the patient to stand
with feet together and arms at the sides, first with eyes open and then with eyes closed.
,The patient sways significantly and loses balance when the eyes are closed but remains
stable with eyes open. This finding is consistent with:
A. Cerebellar ataxia
B. Positive Romberg sign indicating proprioceptive or dorsal column dysfunction
[CORRECT]
C. Vestibular dysfunction
D. Corticospinal tract lesion
Correct Answer: B
Rationale: A positive Romberg test (increased sway with eyes closed) indicates
impaired proprioception or dorsal column function because the patient relies on visual
input to compensate for lost position sense. Cerebellar ataxia causes sway regardless
of eye position. Vestibular dysfunction typically causes vertigo and nystagmus.
Corticospinal tract lesions cause weakness and spasticity, not Romberg positivity.
Q3. A patient is unable to identify the smell of coffee or vanilla during cranial nerve
testing. Which cranial nerve should the nurse practitioner document as abnormal?
A. Cranial nerve II (optic)
B. Cranial nerve I (olfactory) [CORRECT]
C. Cranial nerve VII (facial)
D. Cranial nerve VIII (vestibulocochlear)
Correct Answer: B
Rationale: Cranial nerve I (olfactory) is tested using non-irritating aromatic substances
such as coffee, vanilla, or cloves. CN II is tested with visual acuity and fields. CN VII is
tested with facial movement and taste (anterior two-thirds of tongue). CN VIII is tested
with hearing and balance.
,Q4. During deep tendon reflex testing, the nurse practitioner grades the patient's biceps
reflex as "2+". What does this grade indicate?
A. Diminished reflex
B. Normal active reflex [CORRECT]
C. Brisk reflex indicating hyperreflexia
D. Absent reflex
Correct Answer: B
Rationale: The standard reflex grading scale is: 0 = absent, 1+ = diminished or barely
detectable, 2+ = normal active reflex, 3+ = brisker than normal (may indicate pathology),
4+ = very brisk with clonus (definitely pathological). A 2+ reflex is the expected normal
response in a healthy adult.
Q5. A 45-year-old patient presents with complaints of progressive weakness in the right
hand, muscle fasciculations in the forearm, and no sensory deficits. The nurse
practitioner notes muscle atrophy in the thenar eminence. Which condition is highest on
the differential diagnosis list?
A. Multiple sclerosis
B. Amyotrophic lateral sclerosis (ALS) [CORRECT]
C. Myasthenia gravis
D. Guillain-Barré syndrome
Correct Answer: B
Rationale: ALS presents with combined upper and lower motor neuron signs including
progressive weakness, muscle atrophy, and fasciculations without sensory deficits.
Multiple sclerosis typically involves sensory changes and optic neuritis. Myasthenia
gravis causes fatigable weakness without atrophy or fasciculations. Guillain-Barré
syndrome presents with ascending weakness and sensory involvement.
, Q6. The nurse practitioner performs the Babinski reflex test by stroking the lateral sole
of the foot from heel to toe. The patient's great toe extends upward and the other toes
fan outward. What is the clinical significance of this finding in an adult?
A. Normal physiological response
B. Upper motor neuron lesion [CORRECT]
C. Peripheral neuropathy
D. Cerebellar dysfunction
Correct Answer: B
Rationale: A positive Babinski sign (upgoing great toe and fanning of other toes) in an
adult indicates an upper motor neuron lesion. This is a normal finding in infants under 2
years due to incomplete myelination. Peripheral neuropathy causes diminished or
absent reflexes. Cerebellar dysfunction presents with ataxia and intention tremor, not
Babinski sign.
Q7. During a mental status examination, the nurse practitioner asks the patient to spell
"WORLD" backwards, subtract serial 7s from 100, and recall three objects after 5
minutes. Which cognitive domain is being assessed?
A. Abstract thinking
B. Attention and concentration [CORRECT]
C. Remote memory
D. Judgment and insight
Correct Answer: B
Rationale: Serial 7s, spelling backwards, and immediate/recall memory tasks assess
attention, concentration, and working memory. Abstract thinking is tested with proverb
interpretation or similarities/differences. Remote memory is tested with historical facts.
Judgment is assessed with hypothetical scenarios.
2026/2027 | 100 Prep Questions & Verified Answers | BRAND
NEW | Pass Guaranteed - A+ Graded
SECTION 1: Neurological System Assessment (Q1-Q20)
Q1. A 62-year-old patient presents with sudden onset of right-sided facial droop, inability
to close the right eye, and flattened nasolabial fold. The forehead wrinkles are
symmetrically preserved on both sides. Which cranial nerve is affected, and what does
the preserved forehead movement indicate?
A. Cranial nerve VII (facial) upper motor neuron lesion [CORRECT]
B. Cranial nerve VII (facial) lower motor neuron lesion
C. Cranial nerve V (trigeminal) motor branch lesion
D. Cranial nerve XII (hypoglossal) ipsilateral lesion
Correct Answer: A
Rationale: In an upper motor neuron (UMN) facial lesion, the forehead is spared
because the upper facial muscles receive bilateral cortical innervation. A lower motor
neuron lesion would affect the entire ipsilateral face including the forehead. The
trigeminal nerve (CN V) is primarily sensory to the face and motor to the muscles of
mastication, not facial expression. CN XII controls tongue movement.
Q2. During a neurological examination, the nurse practitioner asks the patient to stand
with feet together and arms at the sides, first with eyes open and then with eyes closed.
,The patient sways significantly and loses balance when the eyes are closed but remains
stable with eyes open. This finding is consistent with:
A. Cerebellar ataxia
B. Positive Romberg sign indicating proprioceptive or dorsal column dysfunction
[CORRECT]
C. Vestibular dysfunction
D. Corticospinal tract lesion
Correct Answer: B
Rationale: A positive Romberg test (increased sway with eyes closed) indicates
impaired proprioception or dorsal column function because the patient relies on visual
input to compensate for lost position sense. Cerebellar ataxia causes sway regardless
of eye position. Vestibular dysfunction typically causes vertigo and nystagmus.
Corticospinal tract lesions cause weakness and spasticity, not Romberg positivity.
Q3. A patient is unable to identify the smell of coffee or vanilla during cranial nerve
testing. Which cranial nerve should the nurse practitioner document as abnormal?
A. Cranial nerve II (optic)
B. Cranial nerve I (olfactory) [CORRECT]
C. Cranial nerve VII (facial)
D. Cranial nerve VIII (vestibulocochlear)
Correct Answer: B
Rationale: Cranial nerve I (olfactory) is tested using non-irritating aromatic substances
such as coffee, vanilla, or cloves. CN II is tested with visual acuity and fields. CN VII is
tested with facial movement and taste (anterior two-thirds of tongue). CN VIII is tested
with hearing and balance.
,Q4. During deep tendon reflex testing, the nurse practitioner grades the patient's biceps
reflex as "2+". What does this grade indicate?
A. Diminished reflex
B. Normal active reflex [CORRECT]
C. Brisk reflex indicating hyperreflexia
D. Absent reflex
Correct Answer: B
Rationale: The standard reflex grading scale is: 0 = absent, 1+ = diminished or barely
detectable, 2+ = normal active reflex, 3+ = brisker than normal (may indicate pathology),
4+ = very brisk with clonus (definitely pathological). A 2+ reflex is the expected normal
response in a healthy adult.
Q5. A 45-year-old patient presents with complaints of progressive weakness in the right
hand, muscle fasciculations in the forearm, and no sensory deficits. The nurse
practitioner notes muscle atrophy in the thenar eminence. Which condition is highest on
the differential diagnosis list?
A. Multiple sclerosis
B. Amyotrophic lateral sclerosis (ALS) [CORRECT]
C. Myasthenia gravis
D. Guillain-Barré syndrome
Correct Answer: B
Rationale: ALS presents with combined upper and lower motor neuron signs including
progressive weakness, muscle atrophy, and fasciculations without sensory deficits.
Multiple sclerosis typically involves sensory changes and optic neuritis. Myasthenia
gravis causes fatigable weakness without atrophy or fasciculations. Guillain-Barré
syndrome presents with ascending weakness and sensory involvement.
, Q6. The nurse practitioner performs the Babinski reflex test by stroking the lateral sole
of the foot from heel to toe. The patient's great toe extends upward and the other toes
fan outward. What is the clinical significance of this finding in an adult?
A. Normal physiological response
B. Upper motor neuron lesion [CORRECT]
C. Peripheral neuropathy
D. Cerebellar dysfunction
Correct Answer: B
Rationale: A positive Babinski sign (upgoing great toe and fanning of other toes) in an
adult indicates an upper motor neuron lesion. This is a normal finding in infants under 2
years due to incomplete myelination. Peripheral neuropathy causes diminished or
absent reflexes. Cerebellar dysfunction presents with ataxia and intention tremor, not
Babinski sign.
Q7. During a mental status examination, the nurse practitioner asks the patient to spell
"WORLD" backwards, subtract serial 7s from 100, and recall three objects after 5
minutes. Which cognitive domain is being assessed?
A. Abstract thinking
B. Attention and concentration [CORRECT]
C. Remote memory
D. Judgment and insight
Correct Answer: B
Rationale: Serial 7s, spelling backwards, and immediate/recall memory tasks assess
attention, concentration, and working memory. Abstract thinking is tested with proverb
interpretation or similarities/differences. Remote memory is tested with historical facts.
Judgment is assessed with hypothetical scenarios.
