NURS 5220 Exam 4 V1 | NURS 5220
Advanced Health Assessment and
Diagnostic Reasoning Review | Actual
Q&A with Rationale (NURS5220 Exam 4) |
The University of Texas at Arlington
1. A 72-year-old patient presents with a sudden onset of right-sided facial drooping. The
nurse practitioner notes that the patient is unable to wrinkle their forehead or close their eye
on the affected side. Based on these findings, which condition is most likely?
A. Ischemic Stroke
B. Bell’s Palsy
C. Trigeminal Neuralgia
D. Transient Ischemic Attack
Answer: B
Rationale: Bell’s Palsy is a peripheral nervous system lesion of Cranial Nerve VII that
causes paralysis of the entire half of the face, including the forehead. In contrast, a central
nervous system lesion like a stroke typically spares the forehead due to bilateral
innervation. This clinical distinction is a hallmark of diagnostic reasoning in neurological
assessments for older adults.
,2. When assessing a 4-month-old infant, the nurse practitioner suddenly lowers the infant’s
head and trunk. The infant responds by symmetrical abduction and extension of the arms
with the fingers fanned. Which reflex is being demonstrated?
A. Palmar Grasp
B. Rooting Reflex
C. Moro Reflex
D. Tonic Neck Reflex
Answer: C
Rationale: The Moro reflex, often called the startle reflex, is a primitive reflex present at
birth that normally disappears by 4 to 6 months of age. An asymmetric Moro reflex may
indicate a fractured clavicle or brachial plexus injury sustained during birth. Persistent
primitive reflexes beyond the expected age are significant indicators of potential
neurological developmental delays.
3. During a neurological exam, the patient is asked to stand with feet together and arms at
the sides. The nurse practitioner notices that the patient maintains balance with eyes open
but begins to sway significantly when the eyes are closed. This is a positive:
A. Phalen’s Test
B. Babinski Sign
C. Allen’s Test
D. Romberg Test
,Answer: D
Rationale: A positive Romberg sign occurs when a patient loses balance only after closing
their eyes, suggesting a loss of proprioception. This test helps differentiate between
cerebellar ataxia and sensory ataxia caused by posterior column disease. Safety is
paramount during this assessment, and the examiner should stand close to the patient to
prevent a fall.
4. A 68-year-old male reports difficulty initiating urination and a weak urinary stream. Digital
rectal examination reveals a smooth, firm, and non-tender enlarged prostate. Which
condition does this most likely represent?
A. Prostate Cancer
B. Acute Prostatitis
C. Orchitis
D. Benign Prostatic Hyperplasia (BPH)
Answer: D
Rationale: Benign Prostatic Hyperplasia is a common condition in aging males
characterized by a smooth, symmetrical enlargement of the prostate gland. Unlike prostate
cancer, which often presents as hard nodules, BPH feels rubbery or firm but consistent.
Evaluation of the International Prostate Symptom Score (IPSS) is often used to quantify the
severity of the patient’s symptoms.
, 5. The nurse practitioner asks a patient to identify a common object, such as a key or a coin,
placed in their hand while their eyes are closed. This specific sensory test is known as:
A. Graphesthesia
B. Extinction
C. Two-point discrimination
D. Stereognosis
Answer: D
Rationale: Stereognosis is the ability to perceive and recognize the form of an object using
cues from texture, size, and spatial properties. This test assesses the integrative function of
the parietal lobe and sensory cortex. Astereognosis, or the inability to recognize objects,
can indicate a lesion in the sensory cortex or posterior columns.
6. In the pediatric clinical setting, which tool is most appropriate for assessing the
developmental milestones of children from birth to age 6?
A. Mini-Cog
B. Geriatric Depression Scale
C. PHQ-9
D. Denver II Screening
Answer: D
Advanced Health Assessment and
Diagnostic Reasoning Review | Actual
Q&A with Rationale (NURS5220 Exam 4) |
The University of Texas at Arlington
1. A 72-year-old patient presents with a sudden onset of right-sided facial drooping. The
nurse practitioner notes that the patient is unable to wrinkle their forehead or close their eye
on the affected side. Based on these findings, which condition is most likely?
A. Ischemic Stroke
B. Bell’s Palsy
C. Trigeminal Neuralgia
D. Transient Ischemic Attack
Answer: B
Rationale: Bell’s Palsy is a peripheral nervous system lesion of Cranial Nerve VII that
causes paralysis of the entire half of the face, including the forehead. In contrast, a central
nervous system lesion like a stroke typically spares the forehead due to bilateral
innervation. This clinical distinction is a hallmark of diagnostic reasoning in neurological
assessments for older adults.
,2. When assessing a 4-month-old infant, the nurse practitioner suddenly lowers the infant’s
head and trunk. The infant responds by symmetrical abduction and extension of the arms
with the fingers fanned. Which reflex is being demonstrated?
A. Palmar Grasp
B. Rooting Reflex
C. Moro Reflex
D. Tonic Neck Reflex
Answer: C
Rationale: The Moro reflex, often called the startle reflex, is a primitive reflex present at
birth that normally disappears by 4 to 6 months of age. An asymmetric Moro reflex may
indicate a fractured clavicle or brachial plexus injury sustained during birth. Persistent
primitive reflexes beyond the expected age are significant indicators of potential
neurological developmental delays.
3. During a neurological exam, the patient is asked to stand with feet together and arms at
the sides. The nurse practitioner notices that the patient maintains balance with eyes open
but begins to sway significantly when the eyes are closed. This is a positive:
A. Phalen’s Test
B. Babinski Sign
C. Allen’s Test
D. Romberg Test
,Answer: D
Rationale: A positive Romberg sign occurs when a patient loses balance only after closing
their eyes, suggesting a loss of proprioception. This test helps differentiate between
cerebellar ataxia and sensory ataxia caused by posterior column disease. Safety is
paramount during this assessment, and the examiner should stand close to the patient to
prevent a fall.
4. A 68-year-old male reports difficulty initiating urination and a weak urinary stream. Digital
rectal examination reveals a smooth, firm, and non-tender enlarged prostate. Which
condition does this most likely represent?
A. Prostate Cancer
B. Acute Prostatitis
C. Orchitis
D. Benign Prostatic Hyperplasia (BPH)
Answer: D
Rationale: Benign Prostatic Hyperplasia is a common condition in aging males
characterized by a smooth, symmetrical enlargement of the prostate gland. Unlike prostate
cancer, which often presents as hard nodules, BPH feels rubbery or firm but consistent.
Evaluation of the International Prostate Symptom Score (IPSS) is often used to quantify the
severity of the patient’s symptoms.
, 5. The nurse practitioner asks a patient to identify a common object, such as a key or a coin,
placed in their hand while their eyes are closed. This specific sensory test is known as:
A. Graphesthesia
B. Extinction
C. Two-point discrimination
D. Stereognosis
Answer: D
Rationale: Stereognosis is the ability to perceive and recognize the form of an object using
cues from texture, size, and spatial properties. This test assesses the integrative function of
the parietal lobe and sensory cortex. Astereognosis, or the inability to recognize objects,
can indicate a lesion in the sensory cortex or posterior columns.
6. In the pediatric clinical setting, which tool is most appropriate for assessing the
developmental milestones of children from birth to age 6?
A. Mini-Cog
B. Geriatric Depression Scale
C. PHQ-9
D. Denver II Screening
Answer: D
