Grand Canyon University
2 MAXE · 613-GSN
★ ★
GCU College of Nursing & Health Care Professions
EST. 1949
F I N D YO U R P U R P O S E
NSG-316 Exam 2
N E U R O LO G I C A L & S E N S O RY A SS E SS M E N T
INSTITUTION Grand Canyon University COURSE CODE NSG-316
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
EXAM TITLE NSG-316 Exam 2 TOTAL QUESTIONS 93 Questions
COURSE TITLE Health Assessment FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Cranial nerves, neurological assessment, sensory testing, and reflexes are all testable content.
▸ Key terms and definitions from the course are emphasized throughout.
▸ Correct answers and detailed rationales appear below each question for board review purposes.
▸ All content reflects current nursing education standards.
, SECTION I — NEUROLOGICAL & SENSORY ASSESSMENT Questions 1 – 93
1. What is Cranial Nerve II?
A. Optic
B. Olfactory
C. Oculomotor
D. Trochlear
CORRECT ANSWER A — Optic
RATIONALE Cranial Nerve II is the Optic nerve, which is responsible for vision. It is a sensory
nerve that carries visual information from the retina to the brain. Assessment
includes testing visual acuity and visual fields by confrontation.
2. What is the best method to assess lymph nodes?
A. Gentle, circular motion, use finger pads to palpate and use both hands at the same time
to compare both sides
B. Firm pressure with fingertips
C. Palpate one side at a time
D. Use the palm of the hand
CORRECT ANSWER A — Gentle, circular motion, use finger pads to palpate and use both hands
at the same time to compare both sides
RATIONALE The best method to assess lymph nodes is to use gentle, circular motion with the
finger pads, using both hands simultaneously to compare both sides. Normal
lymph nodes are movable, discrete, non-tender, and soft.
,3. How are reflexes documented?
A. 4 = very brisk, hyperactive with clonus; 3 = brisker than average; 2 = average, normal; 1 =
diminished; 0 = no response
B. 5 = hyperactive; 3 = normal; 1 = absent
C. 3 = brisk; 2 = normal; 1 = weak; 0 = absent
D. 4 = normal; 3 = diminished; 2 = absent
CORRECT ANSWER A — 4 = very brisk, hyperactive with clonus; 3 = brisker than average; 2 =
average, normal; 1 = diminished; 0 = no response
RATIONALE Reflexes are documented on a scale of 0 to 4: 4 = very brisk, hyperactive with
clonus (indicative of disease); 3 = brisker than average (may indicate disease); 2 =
average, normal; 1 = diminished, low normal; 0 = no response. This standardized
scale allows for consistent documentation and comparison.
4. What is the Romberg test?
A. Assesses ability of vestibular apparatus in inner ear to maintain standing balance; person
stands with feet together and arms at sides, closes eyes for 20 seconds
B. Tests hearing by whispering words from a distance
C. Tests the ability to recognize objects by touch
D. Tests coordination by touching finger to nose
CORRECT ANSWER A — Assesses ability of vestibular apparatus in inner ear to maintain
standing balance; person stands with feet together and arms at sides,
closes eyes for 20 seconds
RATIONALE The Romberg test assesses the ability of the vestibular apparatus in the inner ear
to help maintain standing balance. The person stands with feet together and arms
at sides; when in stable position, ask person to close eyes and hold position for
about 20 seconds. A positive test is significant swaying or loss of balance.
, 5. What does a + Romberg test indicate?
A. Patient sways and is unable to hold posture and balance
B. Patient maintains balance without difficulty
C. Patient has normal vestibular function
D. Patient has intact cerebellar function
CORRECT ANSWER A — Patient sways and is unable to hold posture and balance
RATIONALE A positive Romberg test indicates that the patient sways and is unable to hold
posture and balance when the eyes are closed. This suggests a problem with the
vestibular apparatus, proprioception, or cerebellar function.
6. What is CN III?
A. Oculomotor, eye movement, motor
B. Optic, vision, sensory
C. Olfactory, smell, sensory
D. Trochlear, eye movement, motor
CORRECT ANSWER A — Oculomotor, eye movement, motor
RATIONALE CN III is the Oculomotor nerve, which controls most eye movements, including
pupil constriction and accommodation. It is a motor nerve that innervates four of
the six extraocular muscles.
7. What is the sequence of doing a neurological assessment?
A. Mental status, Cranial nerves, Motor system, Sensory system, Reflexes
B. Cranial nerves, Mental status, Motor system, Reflexes, Sensory system
C. Motor system, Sensory system, Reflexes, Cranial nerves, Mental status
D. Reflexes, Motor system, Sensory system, Cranial nerves, Mental status
CORRECT ANSWER A — Mental status, Cranial nerves, Motor system, Sensory system, Reflexes
RATIONALE The correct sequence for a neurological assessment is: Mental status, Cranial
nerves, Motor system, Sensory system, and Reflexes. This systematic approach
ensures a comprehensive evaluation of the nervous system.
2 MAXE · 613-GSN
★ ★
GCU College of Nursing & Health Care Professions
EST. 1949
F I N D YO U R P U R P O S E
NSG-316 Exam 2
N E U R O LO G I C A L & S E N S O RY A SS E SS M E N T
INSTITUTION Grand Canyon University COURSE CODE NSG-316
PROGRAM Bachelor of Science in Nursing ACADEMIC YEAR
EXAM TITLE NSG-316 Exam 2 TOTAL QUESTIONS 93 Questions
COURSE TITLE Health Assessment FORMAT Multiple Choice — Select the
Single Best Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question unless otherwise instructed.
▸ Cranial nerves, neurological assessment, sensory testing, and reflexes are all testable content.
▸ Key terms and definitions from the course are emphasized throughout.
▸ Correct answers and detailed rationales appear below each question for board review purposes.
▸ All content reflects current nursing education standards.
, SECTION I — NEUROLOGICAL & SENSORY ASSESSMENT Questions 1 – 93
1. What is Cranial Nerve II?
A. Optic
B. Olfactory
C. Oculomotor
D. Trochlear
CORRECT ANSWER A — Optic
RATIONALE Cranial Nerve II is the Optic nerve, which is responsible for vision. It is a sensory
nerve that carries visual information from the retina to the brain. Assessment
includes testing visual acuity and visual fields by confrontation.
2. What is the best method to assess lymph nodes?
A. Gentle, circular motion, use finger pads to palpate and use both hands at the same time
to compare both sides
B. Firm pressure with fingertips
C. Palpate one side at a time
D. Use the palm of the hand
CORRECT ANSWER A — Gentle, circular motion, use finger pads to palpate and use both hands
at the same time to compare both sides
RATIONALE The best method to assess lymph nodes is to use gentle, circular motion with the
finger pads, using both hands simultaneously to compare both sides. Normal
lymph nodes are movable, discrete, non-tender, and soft.
,3. How are reflexes documented?
A. 4 = very brisk, hyperactive with clonus; 3 = brisker than average; 2 = average, normal; 1 =
diminished; 0 = no response
B. 5 = hyperactive; 3 = normal; 1 = absent
C. 3 = brisk; 2 = normal; 1 = weak; 0 = absent
D. 4 = normal; 3 = diminished; 2 = absent
CORRECT ANSWER A — 4 = very brisk, hyperactive with clonus; 3 = brisker than average; 2 =
average, normal; 1 = diminished; 0 = no response
RATIONALE Reflexes are documented on a scale of 0 to 4: 4 = very brisk, hyperactive with
clonus (indicative of disease); 3 = brisker than average (may indicate disease); 2 =
average, normal; 1 = diminished, low normal; 0 = no response. This standardized
scale allows for consistent documentation and comparison.
4. What is the Romberg test?
A. Assesses ability of vestibular apparatus in inner ear to maintain standing balance; person
stands with feet together and arms at sides, closes eyes for 20 seconds
B. Tests hearing by whispering words from a distance
C. Tests the ability to recognize objects by touch
D. Tests coordination by touching finger to nose
CORRECT ANSWER A — Assesses ability of vestibular apparatus in inner ear to maintain
standing balance; person stands with feet together and arms at sides,
closes eyes for 20 seconds
RATIONALE The Romberg test assesses the ability of the vestibular apparatus in the inner ear
to help maintain standing balance. The person stands with feet together and arms
at sides; when in stable position, ask person to close eyes and hold position for
about 20 seconds. A positive test is significant swaying or loss of balance.
, 5. What does a + Romberg test indicate?
A. Patient sways and is unable to hold posture and balance
B. Patient maintains balance without difficulty
C. Patient has normal vestibular function
D. Patient has intact cerebellar function
CORRECT ANSWER A — Patient sways and is unable to hold posture and balance
RATIONALE A positive Romberg test indicates that the patient sways and is unable to hold
posture and balance when the eyes are closed. This suggests a problem with the
vestibular apparatus, proprioception, or cerebellar function.
6. What is CN III?
A. Oculomotor, eye movement, motor
B. Optic, vision, sensory
C. Olfactory, smell, sensory
D. Trochlear, eye movement, motor
CORRECT ANSWER A — Oculomotor, eye movement, motor
RATIONALE CN III is the Oculomotor nerve, which controls most eye movements, including
pupil constriction and accommodation. It is a motor nerve that innervates four of
the six extraocular muscles.
7. What is the sequence of doing a neurological assessment?
A. Mental status, Cranial nerves, Motor system, Sensory system, Reflexes
B. Cranial nerves, Mental status, Motor system, Reflexes, Sensory system
C. Motor system, Sensory system, Reflexes, Cranial nerves, Mental status
D. Reflexes, Motor system, Sensory system, Cranial nerves, Mental status
CORRECT ANSWER A — Mental status, Cranial nerves, Motor system, Sensory system, Reflexes
RATIONALE The correct sequence for a neurological assessment is: Mental status, Cranial
nerves, Motor system, Sensory system, and Reflexes. This systematic approach
ensures a comprehensive evaluation of the nervous system.
