NSG 500 Exam 4 Actual Exam V1 | NSG 500 Advanced Health
Assessment (NSG500 Exam 4) [PDF] | Wilkes University
1. A 65-year-old patient presents with sudden onset of ptosis and a dilated pupil that does
not react to light. Which cranial nerve is most likely affected?
A. Cranial Nerve III
B. Cranial Nerve II
C. Cranial Nerve IV
D. Cranial Nerve VI
Answer: A
Rationale: Cranial Nerve III (Oculomotor) is responsible for most extraocular movements,
eyelid elevation, and pupillary constriction. Ptosis combined with a fixed, dilated pupil
suggests a palsy of this nerve, often requiring urgent imaging to rule out a compressive
aneurysm. Cranial nerves IV and VI are involved in eye movement but do not control
pupillary reaction or eyelid elevation.
2. During a skin assessment, you note a lesion on a patient’s back that is 7mm in diameter,
has irregular borders, and displays multiple shades of brown and black. What is the most
appropriate next step?
A. Monitor the lesion for changes in 6 months
B. Apply a topical corticosteroid
C. Document the finding as a benign nevus
D. Refer the patient for a skin biopsy
Answer: D
Rationale: The lesion exhibits several ‘ABCDE’ warning signs of melanoma, including
asymmetry, border irregularity, and a diameter greater than 6mm. Color variation is
another significant risk factor for malignancy in pigmented lesions. Immediate referral for
biopsy is necessary to rule out melanoma and ensure early intervention.
3. When performing the Rinne test, the patient reports that bone conduction is heard longer
than air conduction in the right ear. What does this finding indicate?
A. Conductive hearing loss in the right ear
B. Sensorineural hearing loss in the right ear
C. Normal hearing in the right ear
D. Tympanic membrane perforation in the left ear
,Answer: A
Rationale: In a normal ear, air conduction should be twice as long as bone conduction.
When bone conduction is greater than air conduction (BC > AC), it indicates a conductive
hearing loss in that ear. This can be caused by obstructions like cerumen impaction or fluid
in the middle ear.
4. An adult patient exhibits a positive Babinski sign during a neurologic exam. How is this
finding documented, and what does it suggest?
A. Toes curl downward; normal finding
B. Ankle clonus occurs; indicates lower motor neuron lesion
C. Toes fan out and the big toe dorsiflexes; abnormal in adults
D. The foot jerks away; indicates peripheral neuropathy
Answer: C
Rationale: A positive Babinski sign involves the dorsiflexion of the big toe and fanning of
the other toes when the sole of the foot is stimulated. While normal in infants, this reflex is
abnormal in adults and typically indicates an upper motor neuron lesion. It is often
associated with conditions like stroke, multiple sclerosis, or spinal cord injury.
5. A patient complains of knee pain after a sports injury. The examiner flexes the knee and
hip, then rotates the lower leg medially and laterally while extending the knee. Which test is
being performed?
A. Lachman test
B. McMurray test
C. Bulge sign
D. Anterior drawer test
Answer: B
Rationale: The McMurray test is used to assess for meniscal tears in the knee. By rotating
the leg while extending the knee, the examiner can elicit a ‘click’ or pain if a tear is present.
This maneuver helps differentiate meniscal injuries from ligamentous injuries like ACL
tears.
6. Upon palpation of the neck, you find a hard, non-tender, fixed lymph node in the left
supraclavicular fossa. What is the clinical significance of this finding?
A. It is likely Virchow’s node, suggesting occult malignancy
B. It suggests a localized infection of the scalp
C. It is a normal response to a recent viral infection
, D. It indicates chronic lymphadenitis from childhood
Answer: A
Rationale: A palpable supraclavicular node, especially on the left side (Virchow’s node), is
highly suspicious for metastatic cancer from the thorax or abdomen. Unlike nodes
associated with infection, malignant nodes are typically hard, fixed, and non-tender. Any
such finding requires an immediate and thorough diagnostic workup.
7. During a fundoscopic exam, the examiner notes that the margins of the optic disc are
blurred and the physiological cup is not visible. What is this condition called?
A. Glaucomatous cupping
B. Papilledema
C. Arteriovenous nicking
D. Macular degeneration
Answer: B
Rationale: Papilledema refers to swelling of the optic disc caused by increased intracranial
pressure. The blurring of the disc margins and loss of the physiological cup are classic
ophthalmoscopic signs. This is a medical emergency that requires investigation into the
cause of the pressure increase.
8. You are palpating the thyroid gland and note the presence of a localized, firm nodule.
Auscultation over the area reveals a soft, rushing sound. What is the sound called, and what
does it suggest?
A. Bruit; hypervascularity
B. Stridor; airway obstruction
C. Murmur; valvular disease
D. Friction rub; inflammation
Answer: A
Rationale: A bruit is a vascular sound heard over an enlarged thyroid or a nodule,
indicating increased blood flow. This is commonly found in conditions like Graves’ disease
or hyperthyroidism. The presence of a bruit suggests hypervascularity and warrants
further metabolic testing of thyroid function.
9. A patient is asked to stand with feet together and eyes closed. After closing their eyes, they
lose their balance and must step to the side. What is this test, and what does it assess?
A. Romberg test; proprioception and cerebellar function
B. Pronator drift; upper motor neuron function
Assessment (NSG500 Exam 4) [PDF] | Wilkes University
1. A 65-year-old patient presents with sudden onset of ptosis and a dilated pupil that does
not react to light. Which cranial nerve is most likely affected?
A. Cranial Nerve III
B. Cranial Nerve II
C. Cranial Nerve IV
D. Cranial Nerve VI
Answer: A
Rationale: Cranial Nerve III (Oculomotor) is responsible for most extraocular movements,
eyelid elevation, and pupillary constriction. Ptosis combined with a fixed, dilated pupil
suggests a palsy of this nerve, often requiring urgent imaging to rule out a compressive
aneurysm. Cranial nerves IV and VI are involved in eye movement but do not control
pupillary reaction or eyelid elevation.
2. During a skin assessment, you note a lesion on a patient’s back that is 7mm in diameter,
has irregular borders, and displays multiple shades of brown and black. What is the most
appropriate next step?
A. Monitor the lesion for changes in 6 months
B. Apply a topical corticosteroid
C. Document the finding as a benign nevus
D. Refer the patient for a skin biopsy
Answer: D
Rationale: The lesion exhibits several ‘ABCDE’ warning signs of melanoma, including
asymmetry, border irregularity, and a diameter greater than 6mm. Color variation is
another significant risk factor for malignancy in pigmented lesions. Immediate referral for
biopsy is necessary to rule out melanoma and ensure early intervention.
3. When performing the Rinne test, the patient reports that bone conduction is heard longer
than air conduction in the right ear. What does this finding indicate?
A. Conductive hearing loss in the right ear
B. Sensorineural hearing loss in the right ear
C. Normal hearing in the right ear
D. Tympanic membrane perforation in the left ear
,Answer: A
Rationale: In a normal ear, air conduction should be twice as long as bone conduction.
When bone conduction is greater than air conduction (BC > AC), it indicates a conductive
hearing loss in that ear. This can be caused by obstructions like cerumen impaction or fluid
in the middle ear.
4. An adult patient exhibits a positive Babinski sign during a neurologic exam. How is this
finding documented, and what does it suggest?
A. Toes curl downward; normal finding
B. Ankle clonus occurs; indicates lower motor neuron lesion
C. Toes fan out and the big toe dorsiflexes; abnormal in adults
D. The foot jerks away; indicates peripheral neuropathy
Answer: C
Rationale: A positive Babinski sign involves the dorsiflexion of the big toe and fanning of
the other toes when the sole of the foot is stimulated. While normal in infants, this reflex is
abnormal in adults and typically indicates an upper motor neuron lesion. It is often
associated with conditions like stroke, multiple sclerosis, or spinal cord injury.
5. A patient complains of knee pain after a sports injury. The examiner flexes the knee and
hip, then rotates the lower leg medially and laterally while extending the knee. Which test is
being performed?
A. Lachman test
B. McMurray test
C. Bulge sign
D. Anterior drawer test
Answer: B
Rationale: The McMurray test is used to assess for meniscal tears in the knee. By rotating
the leg while extending the knee, the examiner can elicit a ‘click’ or pain if a tear is present.
This maneuver helps differentiate meniscal injuries from ligamentous injuries like ACL
tears.
6. Upon palpation of the neck, you find a hard, non-tender, fixed lymph node in the left
supraclavicular fossa. What is the clinical significance of this finding?
A. It is likely Virchow’s node, suggesting occult malignancy
B. It suggests a localized infection of the scalp
C. It is a normal response to a recent viral infection
, D. It indicates chronic lymphadenitis from childhood
Answer: A
Rationale: A palpable supraclavicular node, especially on the left side (Virchow’s node), is
highly suspicious for metastatic cancer from the thorax or abdomen. Unlike nodes
associated with infection, malignant nodes are typically hard, fixed, and non-tender. Any
such finding requires an immediate and thorough diagnostic workup.
7. During a fundoscopic exam, the examiner notes that the margins of the optic disc are
blurred and the physiological cup is not visible. What is this condition called?
A. Glaucomatous cupping
B. Papilledema
C. Arteriovenous nicking
D. Macular degeneration
Answer: B
Rationale: Papilledema refers to swelling of the optic disc caused by increased intracranial
pressure. The blurring of the disc margins and loss of the physiological cup are classic
ophthalmoscopic signs. This is a medical emergency that requires investigation into the
cause of the pressure increase.
8. You are palpating the thyroid gland and note the presence of a localized, firm nodule.
Auscultation over the area reveals a soft, rushing sound. What is the sound called, and what
does it suggest?
A. Bruit; hypervascularity
B. Stridor; airway obstruction
C. Murmur; valvular disease
D. Friction rub; inflammation
Answer: A
Rationale: A bruit is a vascular sound heard over an enlarged thyroid or a nodule,
indicating increased blood flow. This is commonly found in conditions like Graves’ disease
or hyperthyroidism. The presence of a bruit suggests hypervascularity and warrants
further metabolic testing of thyroid function.
9. A patient is asked to stand with feet together and eyes closed. After closing their eyes, they
lose their balance and must step to the side. What is this test, and what does it assess?
A. Romberg test; proprioception and cerebellar function
B. Pronator drift; upper motor neuron function
