A hospitalized patient does not require a full neurologic B
examination during every shift assessment. What Rationale:
method of assessing the neurologic status of a patient Offering the patient water is not only a courtesy but also an opportunity for the
without performing a full Neurological examination? nurse to note the following physical data: the pt's ability to hear, follow
A. Palpate the carotid pulse directions, cross the midline and swallow. Palpating the carotid pulse is a
B. Offer the patient a glass of water cardiovascular assessment. The nurse should make eye contact with the pt
C. Look at the significant other throughout examination during assessments. Assessment are not within the scope of practice of a
D. Assign the nursing assistant to ask the patient nursing assistant; the nurse cannot delegate assessment to nursing assistant
questions and report the findings
The examiner is assessing the extra ocular muscle. A
Which of the following tests would be inappropriate? Rationale:
A. confrontation test The confrontation test assesses cranial nerve II and visual fields, but not the
B. corneal light reflex extra ocular muscles. Extra ocular muscles can be tested by the cranial nerve
C. six cardinal positions of gaze III, IV and IV, corneal light reflex and the six cardinal positions of gaze
D. cranial nerve III, IV and VI testing
What should the examiner do during auscultation of B
breath sounds? Rationale:
A. Listen with the bell of the stethoscope The examiner should auscultate the lungs from side to side to compare the
B. Compare sounds on the left and right sides breath sounds. The diaphragm of the stethoscope is used to assess lung
C. Listen only to the posterior chest or adventitious sounds. The patient should be instructed to take deep breaths through the
sounds mouth during auscultation, Breath sounds should be auscultated on the
D. Instruct the patient to breathe in and out through the anterior, lateral and posterior chest
nose
In which situation should the examiner auscultate for A
carotid bruits? Rationale:
A. Middle aged or older patient The examiner should auscultate for carotid bruits if the patient is middle-aged
B. Pregnant patient with gestational diabetes or older or shows symptoms or signs of cardiovascular disease
C. Patient that reports abdominal pain
D. Patient with enlarged, tender cervical lymph nodes
examination during every shift assessment. What Rationale:
method of assessing the neurologic status of a patient Offering the patient water is not only a courtesy but also an opportunity for the
without performing a full Neurological examination? nurse to note the following physical data: the pt's ability to hear, follow
A. Palpate the carotid pulse directions, cross the midline and swallow. Palpating the carotid pulse is a
B. Offer the patient a glass of water cardiovascular assessment. The nurse should make eye contact with the pt
C. Look at the significant other throughout examination during assessments. Assessment are not within the scope of practice of a
D. Assign the nursing assistant to ask the patient nursing assistant; the nurse cannot delegate assessment to nursing assistant
questions and report the findings
The examiner is assessing the extra ocular muscle. A
Which of the following tests would be inappropriate? Rationale:
A. confrontation test The confrontation test assesses cranial nerve II and visual fields, but not the
B. corneal light reflex extra ocular muscles. Extra ocular muscles can be tested by the cranial nerve
C. six cardinal positions of gaze III, IV and IV, corneal light reflex and the six cardinal positions of gaze
D. cranial nerve III, IV and VI testing
What should the examiner do during auscultation of B
breath sounds? Rationale:
A. Listen with the bell of the stethoscope The examiner should auscultate the lungs from side to side to compare the
B. Compare sounds on the left and right sides breath sounds. The diaphragm of the stethoscope is used to assess lung
C. Listen only to the posterior chest or adventitious sounds. The patient should be instructed to take deep breaths through the
sounds mouth during auscultation, Breath sounds should be auscultated on the
D. Instruct the patient to breathe in and out through the anterior, lateral and posterior chest
nose
In which situation should the examiner auscultate for A
carotid bruits? Rationale:
A. Middle aged or older patient The examiner should auscultate for carotid bruits if the patient is middle-aged
B. Pregnant patient with gestational diabetes or older or shows symptoms or signs of cardiovascular disease
C. Patient that reports abdominal pain
D. Patient with enlarged, tender cervical lymph nodes
