MARYVILLE NURS 623 EXAM 4,EXAM 4 NURS 623 ACTUAL
EXAM .. NEWEST VERSION 2026-2027 EXPECTED 115
QUESTION AND CORRECT ANSWER FROM VERIFIED
SOURCES.
QUESTION
What are the common bacterial organisms associated with bacterial meningitis?
CORRECT ANS: Neisseria meningitidis (high mortality), Haemophilus influenzae type B,
Streptococcus pneumoniae (most common).
EXPERT RATIONALE
Bacterial meningitis is a medical emergency with significant morbidity and mortality. The
most common causative organisms vary by age group. Streptococcus pneumoniae is the
most common cause in adults and the elderly. Neisseria meningitidis is highly
contagious and associated with high mortality, especially in adolescents and young
adults. Haemophilus influenzae type B was historically a common cause in children but
has declined significantly with the introduction of the Hib vaccine.
QUESTION
What are the signs and symptoms of Alzheimer's disease?
CORRECT ANS: Presence of dementia by clinical exam and MMSE (mini-mental state
exam) deficit in 2 or more areas of cognition, progressive worsening of memory and
cognitive function without disturbed consciousness and absence of systemic
illness/other brain disease. Impaired ability to learn new information along with
disturbance in language, function, or perception.
EXPERT RATIONALE
Alzheimer's disease is the most common cause of dementia. It is characterized by a
gradual, progressive decline in cognitive function. The diagnosis is clinical, based on the
presence of dementia (impairment in two or more cognitive domains) that is
progressive and not explained by other causes. Key features include impaired memory
(especially learning new information) and disturbances in language, executive function,
or perception. Consciousness is typically preserved until late stages.
,QUESTION
What are the signs and symptoms of Parkinson's disease?
CORRECT ANS: Age >60, tremor at rest (pill rolling), rigidity, bradykinesia, masked face,
stooped posture, shuffling gait, arching (limbs, neck, back), decrease facial dexterity,
dysphagia, orthostatic hypotension, anosmia, depression, cognitive impairment, freezing
phenomenon, cogwheeling, postural instability (advanced disease).
EXPERT RATIONALE
Parkinson's disease is a progressive neurodegenerative disorder characterized by the
classic motor triad of resting tremor, rigidity, and bradykinesia. Non-motor symptoms,
including anosmia, depression, and cognitive impairment, are also common and can
precede motor symptoms. Postural instability is a late feature. The "pill-rolling" tremor is
a classic sign, and "cogwheeling" rigidity is a specific finding on physical exam.
QUESTION
What are the signs and symptoms of Guillain-Barré syndrome (GBS)?
CORRECT ANS: Prickling, pins and needles sensations in your fingers, toes, ankles or
wrists. Weakness in your legs that spreads to your upper body. Unsteady walking or
inability to walk or climb stairs. Difficulty with eye or facial movements, including
speaking, chewing or swallowing. Severe pain that may feel achy or cramplike and may
be worse at night. Difficulty with bladder control or bowel function. Rapid heart rate.
Low or high blood pressure. Difficulty breathing.
EXPERT RATIONALE
Guillain-Barré syndrome is an acute, immune-mediated polyneuropathy. It typically
presents with progressive, ascending weakness, often starting in the lower extremities
and moving upward. Sensory symptoms such as paresthesias are common. Autonomic
dysfunction (heart rate, blood pressure) and respiratory muscle weakness are serious
complications that can be life-threatening. The classic presentation is a rapidly
progressive, symmetric weakness with areflexia.
,QUESTION
What are the signs and symptoms of temporal arteritis (giant cell arteritis)?
CORRECT ANS: Jaw claudication (pain with chewing that is relieved when stops
chewing), unilateral pain, temporal area with scalp tenderness; skin over artery is
indurated, tender, warm, and reddened. Amaurosis fugax (temporary blindness), may
occur. Low-grade fever and fatigue, occurs sometimes. ESR/sed rate (often reaches 100
mm/hr or more). CRP elevated >50. Medical Urgency: polymyalgia rheumatica common
in these patients, older adults and elder are more common.
EXPERT RATIONALE
Temporal arteritis is a systemic vasculitis affecting medium and large arteries,
particularly the temporal arteries. It is a medical urgency due to the risk of blindness.
Jaw claudication and scalp tenderness are classic symptoms. The sedimentation rate
(ESR) is almost always markedly elevated. Polymyalgia rheumatica is a common
associated condition. It predominantly affects individuals over 50 years of age.
QUESTION
What are articular bone structures?
CORRECT ANS: Includes structures like the synovium, synovial fluid, articular cartilage,
joint capsules, and juxta-articular bone. Articular disorders may be characterized by
deep or diffuse pain, pain or limited ROM on active and passive movement, swelling,
crepitus.
EXPERT RATIONALE
Articular structures are those directly involved in the joint itself. Disorders of these
structures cause pain that is typically deep and diffuse, and is present with both active
and passive range of motion. Crepitus and swelling are common findings. The pain is
localized to the joint.
QUESTION
What are non-articular bone structures?
, CORRECT ANS: Supportive structures such as tendons, bursae, muscles, fascia, bone,
nerve, overlying skin. Tend to be painful on active but not passive (assisted) ROM.
Seldom demonstrate swelling, crepitus, instability, or deformity by itself.
EXPERT RATIONALE
Non-articular structures are the supportive tissues around the joint, including tendons,
bursae, and muscles. Pain from these structures is typically worse with active movement
(muscle contraction) and is often relieved with passive movement. Swelling and crepitus
are not typical features. This distinction is important for differentiating between articular
and periarticular pain.
QUESTION
What diagnostic test is most useful in a patient who presents with lumbar
radiculopathy?
CORRECT ANS: The straight leg raise (assesses L5-S1). This is the best initial diagnostic
because the most common disc herniation is at L5-S1. Straight leg raise will cause
sciatica and radicular pain.
EXPERT RATIONALE
The straight leg raise (SLR) test is a key physical exam maneuver for lumbar
radiculopathy. It is performed by passively raising the patient's leg while they are supine.
A positive test reproduces radicular pain (sciatica) in the affected leg. This is the most
common disc herniation at L5-S1, and the SLR is the most sensitive test for this
condition.
QUESTION
In older adults, how can you increase physical activity—things you can encourage or are
there certain underlying factors that would enable a patient to be more successful?
CORRECT ANS: Ensure the patient is motivated.
EXPERT RATIONALE
The most important factor in increasing physical activity in older adults is patient
motivation. While addressing barriers like pain, fear of falling, and comorbidities is
EXAM .. NEWEST VERSION 2026-2027 EXPECTED 115
QUESTION AND CORRECT ANSWER FROM VERIFIED
SOURCES.
QUESTION
What are the common bacterial organisms associated with bacterial meningitis?
CORRECT ANS: Neisseria meningitidis (high mortality), Haemophilus influenzae type B,
Streptococcus pneumoniae (most common).
EXPERT RATIONALE
Bacterial meningitis is a medical emergency with significant morbidity and mortality. The
most common causative organisms vary by age group. Streptococcus pneumoniae is the
most common cause in adults and the elderly. Neisseria meningitidis is highly
contagious and associated with high mortality, especially in adolescents and young
adults. Haemophilus influenzae type B was historically a common cause in children but
has declined significantly with the introduction of the Hib vaccine.
QUESTION
What are the signs and symptoms of Alzheimer's disease?
CORRECT ANS: Presence of dementia by clinical exam and MMSE (mini-mental state
exam) deficit in 2 or more areas of cognition, progressive worsening of memory and
cognitive function without disturbed consciousness and absence of systemic
illness/other brain disease. Impaired ability to learn new information along with
disturbance in language, function, or perception.
EXPERT RATIONALE
Alzheimer's disease is the most common cause of dementia. It is characterized by a
gradual, progressive decline in cognitive function. The diagnosis is clinical, based on the
presence of dementia (impairment in two or more cognitive domains) that is
progressive and not explained by other causes. Key features include impaired memory
(especially learning new information) and disturbances in language, executive function,
or perception. Consciousness is typically preserved until late stages.
,QUESTION
What are the signs and symptoms of Parkinson's disease?
CORRECT ANS: Age >60, tremor at rest (pill rolling), rigidity, bradykinesia, masked face,
stooped posture, shuffling gait, arching (limbs, neck, back), decrease facial dexterity,
dysphagia, orthostatic hypotension, anosmia, depression, cognitive impairment, freezing
phenomenon, cogwheeling, postural instability (advanced disease).
EXPERT RATIONALE
Parkinson's disease is a progressive neurodegenerative disorder characterized by the
classic motor triad of resting tremor, rigidity, and bradykinesia. Non-motor symptoms,
including anosmia, depression, and cognitive impairment, are also common and can
precede motor symptoms. Postural instability is a late feature. The "pill-rolling" tremor is
a classic sign, and "cogwheeling" rigidity is a specific finding on physical exam.
QUESTION
What are the signs and symptoms of Guillain-Barré syndrome (GBS)?
CORRECT ANS: Prickling, pins and needles sensations in your fingers, toes, ankles or
wrists. Weakness in your legs that spreads to your upper body. Unsteady walking or
inability to walk or climb stairs. Difficulty with eye or facial movements, including
speaking, chewing or swallowing. Severe pain that may feel achy or cramplike and may
be worse at night. Difficulty with bladder control or bowel function. Rapid heart rate.
Low or high blood pressure. Difficulty breathing.
EXPERT RATIONALE
Guillain-Barré syndrome is an acute, immune-mediated polyneuropathy. It typically
presents with progressive, ascending weakness, often starting in the lower extremities
and moving upward. Sensory symptoms such as paresthesias are common. Autonomic
dysfunction (heart rate, blood pressure) and respiratory muscle weakness are serious
complications that can be life-threatening. The classic presentation is a rapidly
progressive, symmetric weakness with areflexia.
,QUESTION
What are the signs and symptoms of temporal arteritis (giant cell arteritis)?
CORRECT ANS: Jaw claudication (pain with chewing that is relieved when stops
chewing), unilateral pain, temporal area with scalp tenderness; skin over artery is
indurated, tender, warm, and reddened. Amaurosis fugax (temporary blindness), may
occur. Low-grade fever and fatigue, occurs sometimes. ESR/sed rate (often reaches 100
mm/hr or more). CRP elevated >50. Medical Urgency: polymyalgia rheumatica common
in these patients, older adults and elder are more common.
EXPERT RATIONALE
Temporal arteritis is a systemic vasculitis affecting medium and large arteries,
particularly the temporal arteries. It is a medical urgency due to the risk of blindness.
Jaw claudication and scalp tenderness are classic symptoms. The sedimentation rate
(ESR) is almost always markedly elevated. Polymyalgia rheumatica is a common
associated condition. It predominantly affects individuals over 50 years of age.
QUESTION
What are articular bone structures?
CORRECT ANS: Includes structures like the synovium, synovial fluid, articular cartilage,
joint capsules, and juxta-articular bone. Articular disorders may be characterized by
deep or diffuse pain, pain or limited ROM on active and passive movement, swelling,
crepitus.
EXPERT RATIONALE
Articular structures are those directly involved in the joint itself. Disorders of these
structures cause pain that is typically deep and diffuse, and is present with both active
and passive range of motion. Crepitus and swelling are common findings. The pain is
localized to the joint.
QUESTION
What are non-articular bone structures?
, CORRECT ANS: Supportive structures such as tendons, bursae, muscles, fascia, bone,
nerve, overlying skin. Tend to be painful on active but not passive (assisted) ROM.
Seldom demonstrate swelling, crepitus, instability, or deformity by itself.
EXPERT RATIONALE
Non-articular structures are the supportive tissues around the joint, including tendons,
bursae, and muscles. Pain from these structures is typically worse with active movement
(muscle contraction) and is often relieved with passive movement. Swelling and crepitus
are not typical features. This distinction is important for differentiating between articular
and periarticular pain.
QUESTION
What diagnostic test is most useful in a patient who presents with lumbar
radiculopathy?
CORRECT ANS: The straight leg raise (assesses L5-S1). This is the best initial diagnostic
because the most common disc herniation is at L5-S1. Straight leg raise will cause
sciatica and radicular pain.
EXPERT RATIONALE
The straight leg raise (SLR) test is a key physical exam maneuver for lumbar
radiculopathy. It is performed by passively raising the patient's leg while they are supine.
A positive test reproduces radicular pain (sciatica) in the affected leg. This is the most
common disc herniation at L5-S1, and the SLR is the most sensitive test for this
condition.
QUESTION
In older adults, how can you increase physical activity—things you can encourage or are
there certain underlying factors that would enable a patient to be more successful?
CORRECT ANS: Ensure the patient is motivated.
EXPERT RATIONALE
The most important factor in increasing physical activity in older adults is patient
motivation. While addressing barriers like pain, fear of falling, and comorbidities is
