NSG 3130 — Fundamentals II
Chapter 31: Cognitive and Sensory Alterations
Clinical Judgment Practice Test — 28 Questions
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
CHAPTER 31: COGNITIVE AND SENSORY ALTERATIONS — Questions 1–28
Q1. A nurse is assessing a patient with a lesion in the occipital lobe versus a patient with a lesion in the temporal lobe. Which
difference in findings would the nurse expect between these two patients?
Cerebral lobe functions
A. The occipital lobe patient would have visual processing problems, while the temporal lobe patient would have problems
with auditory stimuli and long-term memory
B. The occipital lobe patient would have problems with voluntary motor function, while the temporal lobe patient would have
visual processing problems
C. Both patients would be expected to have identical deficits, since the two lobes serve the same function
D. The occipital lobe patient would have somatic sensory deficits, while the temporal lobe patient would have short-term
memory problems
Q2. A patient has a spinal cord lesion on the left side at a level where general sensory fibers for pain and temperature have already
crossed to the opposite side. On which side of the body would the nurse expect the patient to notice loss of pain and temperature
sensation below the lesion?
Sensory pathway decussation
A. The left side of the body, since sensory impulses remain on the same side throughout the pathway
B. The right side of the body, since sensory impulses decussate (cross) to the opposite side before ascending to the brain
C. Both sides of the body equally, since sensory pathways do not follow a lateralized pattern
D. Neither side of the body, since pain and temperature sensation are not carried through the spinal cord
Q3. A patient reports that they can see reasonably well in bright light and can distinguish colors clearly but has significant trouble
seeing in dim lighting or in their peripheral vision. Which retinal photoreceptor is most likely primarily affected?
Rods vs. cones
A. Cones, since they are responsible for peripheral vision and vision in dim light
B. Both rods and cones equally, since they serve identical functions in the retina
C. Rods, since they are responsible for peripheral vision and vision in dim light
D. Neither rods nor cones, since photoreceptors are not involved in this type of vision
Q4. A nurse is comparing three older adult patients with altered mental status. Patient A developed sudden confusion and fluctuating
awareness over the past 2 days during hospitalization for a urinary tract infection. Patient B has had a gradual, permanent decline in
memory, language, and judgment over several years. Patient C has had a rapid onset of hopelessness, sadness, and loss of interest
following the recent death of a spouse. Which conditions are most consistent with these three patients, respectively?
Delirium vs. dementia vs. depression
A. Dementia for Patient A, depression for Patient B, and delirium for Patient C
B. Depression for Patient A, delirium for Patient B, and dementia for Patient C
C. All three patients have the same underlying condition at different stages
D. Delirium for Patient A, dementia for Patient B, and depression for Patient C
, Q5. A nurse explains to a family member the brain changes associated with Alzheimer's disease. Which changes are characteristic of
this condition?
Alzheimer's disease pathophysiology
A. Amyloid plaques, neurofibrillary tangles, and cerebral atrophy that disrupt nerve cell communication
B. A single, sudden ischemic event blocking blood flow to one specific area of the brain
C. Excess fluid accumulation within the labyrinth of the inner ear structure
D. Increased intraocular pressure that gradually damages the optic nerve
Q6. A nurse caring for a patient with Alzheimer's disease notices the patient becomes significantly more agitated and confused each
evening. What is this phenomenon called, and which strategy is most appropriate to help manage it?
Sundowning
A. Sundowning, managed by allowing an inconsistent schedule so the patient can rest whenever needed
B. Sundowning, managed by keeping the environment well lit during awake hours and maintaining a consistent schedule
C. Delirium, managed exclusively with sedating medication regardless of environmental factors
D. A normal, expected daily variation that requires no specific management strategy
Q7. A nurse compares two patients recovering from a stroke. Patient A has damage to the left side of the brain and demonstrates
speech problems along with right-sided sensory and motor deficits. Patient B has damage to the right side of the brain and
demonstrates visual-spatial problems along with left-sided sensory and motor deficits. How should the nurse interpret these
presentations?
CVA lateralization
A. Both presentations are inconsistent with expected findings, since brain damage should not produce lateralized deficits
B. Patient A's presentation fits, but Patient B's would not be expected after a right-sided CVA event
C. Both presentations match expected lateralization: left damage affects speech and right-body, right damage affects
visual-spatial and left-body
D. Patient B's presentation fits, but Patient A's would not be expected after a left-sided CVA event
Q8. A nurse compares two patients with speech problems after a stroke. Patient A can produce fluent speech but the words do not
make sense, and the patient cannot comprehend written or spoken language. Patient B understands language normally but is unable to
answer questions, name common objects, or express simple ideas. Which types of aphasia are these, respectively?
Receptive vs. expressive aphasia
A. Expressive (Broca) aphasia for Patient A and receptive (Wernicke) aphasia for Patient B
B. Both patients have the identical type of aphasia with the same underlying brain damage location
C. Neither presentation is consistent with a recognized type of aphasia
D. Receptive (Wernicke) aphasia for Patient A and expressive (Broca) aphasia for Patient B
Q9. [PRIORITY] A nurse notes that an older adult patient with no prior history of cognitive impairment has developed sudden,
rapid confusion overnight. What should the nurse prioritize?
Sudden confusion in older adults
A. Investigating for an acute cause such as a urinary tract infection or pneumonia, a common trigger in older adults
B. Documenting the finding as an expected part of the aging process requiring no further workup
C. Assuming the patient has developed dementia and initiating long-term care planning immediately
D. Waiting several days to see whether the confusion resolves on its own before taking any action
Q10. A nurse is caring for a patient with diabetes-related peripheral neuropathy affecting the feet. What is the primary safety
concern, and what should the nurse do?
Peripheral neuropathy safety
A. The patient has increased sensitivity to touch in the feet, so the nurse should avoid any physical contact with the lower
extremities
B. The patient may not feel sharp objects or extreme temperatures, so the nurse should carefully monitor the feet and
educate the patient on daily skin checks
C. The patient's sense of smell is affected, so the nurse should focus interventions on olfactory stimulation
D. The patient's hearing is affected, so the nurse should focus interventions on auditory communication strategies
Chapter 31: Cognitive and Sensory Alterations
Clinical Judgment Practice Test — 28 Questions
Directions: Every item on this test requires interpreting findings, comparing similar clinical presentations, prioritizing nursing actions,
or recognizing subtle differences between disorders — no question can be answered by recalling a single definition. Read each stem
carefully. For standard and EXCEPT items, select the single best answer. For SATA (Select All That Apply) items, select every option
that applies. The answer key with full rationales for every option begins after the questions.
Format legend: Standard best-answer | [SATA] Select All That Apply | [EXCEPT] Identify the exception | [PRIORITY] Triage /
prioritization
CHAPTER 31: COGNITIVE AND SENSORY ALTERATIONS — Questions 1–28
Q1. A nurse is assessing a patient with a lesion in the occipital lobe versus a patient with a lesion in the temporal lobe. Which
difference in findings would the nurse expect between these two patients?
Cerebral lobe functions
A. The occipital lobe patient would have visual processing problems, while the temporal lobe patient would have problems
with auditory stimuli and long-term memory
B. The occipital lobe patient would have problems with voluntary motor function, while the temporal lobe patient would have
visual processing problems
C. Both patients would be expected to have identical deficits, since the two lobes serve the same function
D. The occipital lobe patient would have somatic sensory deficits, while the temporal lobe patient would have short-term
memory problems
Q2. A patient has a spinal cord lesion on the left side at a level where general sensory fibers for pain and temperature have already
crossed to the opposite side. On which side of the body would the nurse expect the patient to notice loss of pain and temperature
sensation below the lesion?
Sensory pathway decussation
A. The left side of the body, since sensory impulses remain on the same side throughout the pathway
B. The right side of the body, since sensory impulses decussate (cross) to the opposite side before ascending to the brain
C. Both sides of the body equally, since sensory pathways do not follow a lateralized pattern
D. Neither side of the body, since pain and temperature sensation are not carried through the spinal cord
Q3. A patient reports that they can see reasonably well in bright light and can distinguish colors clearly but has significant trouble
seeing in dim lighting or in their peripheral vision. Which retinal photoreceptor is most likely primarily affected?
Rods vs. cones
A. Cones, since they are responsible for peripheral vision and vision in dim light
B. Both rods and cones equally, since they serve identical functions in the retina
C. Rods, since they are responsible for peripheral vision and vision in dim light
D. Neither rods nor cones, since photoreceptors are not involved in this type of vision
Q4. A nurse is comparing three older adult patients with altered mental status. Patient A developed sudden confusion and fluctuating
awareness over the past 2 days during hospitalization for a urinary tract infection. Patient B has had a gradual, permanent decline in
memory, language, and judgment over several years. Patient C has had a rapid onset of hopelessness, sadness, and loss of interest
following the recent death of a spouse. Which conditions are most consistent with these three patients, respectively?
Delirium vs. dementia vs. depression
A. Dementia for Patient A, depression for Patient B, and delirium for Patient C
B. Depression for Patient A, delirium for Patient B, and dementia for Patient C
C. All three patients have the same underlying condition at different stages
D. Delirium for Patient A, dementia for Patient B, and depression for Patient C
, Q5. A nurse explains to a family member the brain changes associated with Alzheimer's disease. Which changes are characteristic of
this condition?
Alzheimer's disease pathophysiology
A. Amyloid plaques, neurofibrillary tangles, and cerebral atrophy that disrupt nerve cell communication
B. A single, sudden ischemic event blocking blood flow to one specific area of the brain
C. Excess fluid accumulation within the labyrinth of the inner ear structure
D. Increased intraocular pressure that gradually damages the optic nerve
Q6. A nurse caring for a patient with Alzheimer's disease notices the patient becomes significantly more agitated and confused each
evening. What is this phenomenon called, and which strategy is most appropriate to help manage it?
Sundowning
A. Sundowning, managed by allowing an inconsistent schedule so the patient can rest whenever needed
B. Sundowning, managed by keeping the environment well lit during awake hours and maintaining a consistent schedule
C. Delirium, managed exclusively with sedating medication regardless of environmental factors
D. A normal, expected daily variation that requires no specific management strategy
Q7. A nurse compares two patients recovering from a stroke. Patient A has damage to the left side of the brain and demonstrates
speech problems along with right-sided sensory and motor deficits. Patient B has damage to the right side of the brain and
demonstrates visual-spatial problems along with left-sided sensory and motor deficits. How should the nurse interpret these
presentations?
CVA lateralization
A. Both presentations are inconsistent with expected findings, since brain damage should not produce lateralized deficits
B. Patient A's presentation fits, but Patient B's would not be expected after a right-sided CVA event
C. Both presentations match expected lateralization: left damage affects speech and right-body, right damage affects
visual-spatial and left-body
D. Patient B's presentation fits, but Patient A's would not be expected after a left-sided CVA event
Q8. A nurse compares two patients with speech problems after a stroke. Patient A can produce fluent speech but the words do not
make sense, and the patient cannot comprehend written or spoken language. Patient B understands language normally but is unable to
answer questions, name common objects, or express simple ideas. Which types of aphasia are these, respectively?
Receptive vs. expressive aphasia
A. Expressive (Broca) aphasia for Patient A and receptive (Wernicke) aphasia for Patient B
B. Both patients have the identical type of aphasia with the same underlying brain damage location
C. Neither presentation is consistent with a recognized type of aphasia
D. Receptive (Wernicke) aphasia for Patient A and expressive (Broca) aphasia for Patient B
Q9. [PRIORITY] A nurse notes that an older adult patient with no prior history of cognitive impairment has developed sudden,
rapid confusion overnight. What should the nurse prioritize?
Sudden confusion in older adults
A. Investigating for an acute cause such as a urinary tract infection or pneumonia, a common trigger in older adults
B. Documenting the finding as an expected part of the aging process requiring no further workup
C. Assuming the patient has developed dementia and initiating long-term care planning immediately
D. Waiting several days to see whether the confusion resolves on its own before taking any action
Q10. A nurse is caring for a patient with diabetes-related peripheral neuropathy affecting the feet. What is the primary safety
concern, and what should the nurse do?
Peripheral neuropathy safety
A. The patient has increased sensitivity to touch in the feet, so the nurse should avoid any physical contact with the lower
extremities
B. The patient may not feel sharp objects or extreme temperatures, so the nurse should carefully monitor the feet and
educate the patient on daily skin checks
C. The patient's sense of smell is affected, so the nurse should focus interventions on olfactory stimulation
D. The patient's hearing is affected, so the nurse should focus interventions on auditory communication strategies
