NSG 500 Exam 4 Actual Exam V2 | NSG 500 Advanced Health
Assessment (NSG500 Exam 4) [PDF] | Wilkes University
1. A 72-year-old female presents to the clinic complaining of a sudden, severe headache
described as a ‘thunderclap’ that reached maximum intensity within seconds. She also
reports nausea and neck stiffness. Which of the following is the most appropriate next step in
management?
A. Prescribe a sumatriptan injection for acute migraine management.
B. Perform a lumbar puncture in the office to rule out meningitis.
C. Order a non-contrast CT scan of the head and emergency transport.
D. Recommend a follow-up appointment in one week if symptoms persist.
Answer: C
Rationale: The presentation of a ‘thunderclap’ headache is a classic red flag for a
subarachnoid hemorrhage, which is a neurologic emergency. Nausea and neck stiffness
(meningismus) further support the need for immediate imaging to detect intracranial
bleeding. A non-contrast head CT is the gold standard for initial evaluation in the
emergency setting.
2. During a musculoskeletal assessment, a patient demonstrates a positive Phalen’s test. The
clinician understands that this finding is indicative of which condition?
A. Ulnar nerve entrapment at the elbow.
B. De Quervain’s tenosynovitis.
C. Carpal tunnel syndrome.
D. Radial nerve palsy.
Answer: C
Rationale: Phalen’s test involves flexing the wrists for 60 seconds to see if numbness or
tingling occurs in the median nerve distribution. A positive result suggests compression of
the median nerve within the carpal tunnel. This test is a standard physical examination
maneuver for diagnosing carpal tunnel syndrome.
3. When assessing a patient’s skin for potential melanoma, the clinician notes a lesion that is
7mm in diameter, has irregular borders, and shows shades of brown and black. According to
the ABCDE criteria, which finding specifically addresses the ‘D’?
A. The diameter being greater than 6mm.
B. The presence of multiple colors.
,C. The irregular borders of the lesion.
D. The asymmetry of the lesion shape.
Answer: A
Rationale: In the ABCDE mnemonic for melanoma, ‘D’ stands for diameter, typically
referring to lesions larger than 6mm. While the other characteristics are also concerning
for malignancy, diameter specifically refers to size. Any lesion larger than a pencil eraser
warrants further investigation and possible biopsy.
4. A patient presents with a fixed, hard, and non-tender lymph node in the left
supraclavicular region. This finding, known as Virchow’s node, is most strongly associated
with which of the following?
A. Acute viral pharyngitis.
B. Localized cellulitis of the neck.
C. Chronic bacterial sinusitis.
D. Metastatic abdominal malignancy.
Answer: D
Rationale: Virchow’s node is an enlarged left supraclavicular lymph node that often signals
the presence of an occult malignancy, particularly from the abdomen or thorax. Unlike
inflammatory nodes, malignant nodes are typically fixed, hard, and painless. This finding
necessitates a comprehensive workup for systemic cancer.
5. During a neurologic screening, the clinician asks the patient to stand with feet together and
eyes closed. The patient begins to sway significantly and loses balance. This is recorded as a
positive Romberg test, indicating an issue with which system?
A. Lower motor neuron strength.
B. Proprioception or cerebellar function.
C. Cranial nerve III function.
D. Basal ganglia coordination.
Answer: B
Rationale: The Romberg test assesses the sensory system’s ability to maintain equilibrium
without visual input. A positive test occurs when the patient can maintain balance with
eyes open but loses it when eyes are closed, suggesting a loss of proprioception or
vestibular function. It is a vital component of the neurological examination for ataxia.
, 6. A 45-year-old male reports ‘pins and needles’ sensations in his feet that have gradually
progressed to his mid-calves over several months. He has a history of poorly controlled type 2
diabetes. What is the most likely sensory deficit pattern?
A. Dermatomal distribution.
B. Stocking-glove distribution.
C. Hemisensory loss.
D. Crossed sensory deficit.
Answer: B
Rationale: Peripheral neuropathy, common in diabetes, typically presents in a ‘stocking-
glove’ pattern where the longest nerves are affected first. The sensory loss or paresthesia
begins in the distal lower extremities and moves proximally as the disease progresses. This
symmetrical pattern is characteristic of metabolic or toxic neuropathies.
7. A clinician is performing a musculoskeletal exam on a high school athlete who felt a ‘pop’
in their knee during a football game. The clinician performs the Lachman test, which is used
to evaluate the integrity of the:
A. Medial collateral ligament (MCL).
B. Posterior cruciate ligament (PCL).
C. Lateral meniscus.
D. Anterior cruciate ligament (ACL).
Answer: D
Rationale: The Lachman test is considered the most sensitive physical exam maneuver for
detecting an ACL tear. The clinician stabilizes the femur and pulls the tibia forward to check
for excessive translation and a soft end-feel. A positive result indicates significant laxity or
rupture of the anterior cruciate ligament.
8. While assessing cranial nerves, the clinician notes that the patient is unable to close their
right eye tightly, wrinkle their forehead, or smile on the right side of the face. The left side
remains normal. This indicates a lesion of which cranial nerve?
A. CN V (Trigeminal).
B. CN XII (Hypoglossal).
C. CN III (Oculomotor).
D. CN VII (Facial).
Answer: D
Assessment (NSG500 Exam 4) [PDF] | Wilkes University
1. A 72-year-old female presents to the clinic complaining of a sudden, severe headache
described as a ‘thunderclap’ that reached maximum intensity within seconds. She also
reports nausea and neck stiffness. Which of the following is the most appropriate next step in
management?
A. Prescribe a sumatriptan injection for acute migraine management.
B. Perform a lumbar puncture in the office to rule out meningitis.
C. Order a non-contrast CT scan of the head and emergency transport.
D. Recommend a follow-up appointment in one week if symptoms persist.
Answer: C
Rationale: The presentation of a ‘thunderclap’ headache is a classic red flag for a
subarachnoid hemorrhage, which is a neurologic emergency. Nausea and neck stiffness
(meningismus) further support the need for immediate imaging to detect intracranial
bleeding. A non-contrast head CT is the gold standard for initial evaluation in the
emergency setting.
2. During a musculoskeletal assessment, a patient demonstrates a positive Phalen’s test. The
clinician understands that this finding is indicative of which condition?
A. Ulnar nerve entrapment at the elbow.
B. De Quervain’s tenosynovitis.
C. Carpal tunnel syndrome.
D. Radial nerve palsy.
Answer: C
Rationale: Phalen’s test involves flexing the wrists for 60 seconds to see if numbness or
tingling occurs in the median nerve distribution. A positive result suggests compression of
the median nerve within the carpal tunnel. This test is a standard physical examination
maneuver for diagnosing carpal tunnel syndrome.
3. When assessing a patient’s skin for potential melanoma, the clinician notes a lesion that is
7mm in diameter, has irregular borders, and shows shades of brown and black. According to
the ABCDE criteria, which finding specifically addresses the ‘D’?
A. The diameter being greater than 6mm.
B. The presence of multiple colors.
,C. The irregular borders of the lesion.
D. The asymmetry of the lesion shape.
Answer: A
Rationale: In the ABCDE mnemonic for melanoma, ‘D’ stands for diameter, typically
referring to lesions larger than 6mm. While the other characteristics are also concerning
for malignancy, diameter specifically refers to size. Any lesion larger than a pencil eraser
warrants further investigation and possible biopsy.
4. A patient presents with a fixed, hard, and non-tender lymph node in the left
supraclavicular region. This finding, known as Virchow’s node, is most strongly associated
with which of the following?
A. Acute viral pharyngitis.
B. Localized cellulitis of the neck.
C. Chronic bacterial sinusitis.
D. Metastatic abdominal malignancy.
Answer: D
Rationale: Virchow’s node is an enlarged left supraclavicular lymph node that often signals
the presence of an occult malignancy, particularly from the abdomen or thorax. Unlike
inflammatory nodes, malignant nodes are typically fixed, hard, and painless. This finding
necessitates a comprehensive workup for systemic cancer.
5. During a neurologic screening, the clinician asks the patient to stand with feet together and
eyes closed. The patient begins to sway significantly and loses balance. This is recorded as a
positive Romberg test, indicating an issue with which system?
A. Lower motor neuron strength.
B. Proprioception or cerebellar function.
C. Cranial nerve III function.
D. Basal ganglia coordination.
Answer: B
Rationale: The Romberg test assesses the sensory system’s ability to maintain equilibrium
without visual input. A positive test occurs when the patient can maintain balance with
eyes open but loses it when eyes are closed, suggesting a loss of proprioception or
vestibular function. It is a vital component of the neurological examination for ataxia.
, 6. A 45-year-old male reports ‘pins and needles’ sensations in his feet that have gradually
progressed to his mid-calves over several months. He has a history of poorly controlled type 2
diabetes. What is the most likely sensory deficit pattern?
A. Dermatomal distribution.
B. Stocking-glove distribution.
C. Hemisensory loss.
D. Crossed sensory deficit.
Answer: B
Rationale: Peripheral neuropathy, common in diabetes, typically presents in a ‘stocking-
glove’ pattern where the longest nerves are affected first. The sensory loss or paresthesia
begins in the distal lower extremities and moves proximally as the disease progresses. This
symmetrical pattern is characteristic of metabolic or toxic neuropathies.
7. A clinician is performing a musculoskeletal exam on a high school athlete who felt a ‘pop’
in their knee during a football game. The clinician performs the Lachman test, which is used
to evaluate the integrity of the:
A. Medial collateral ligament (MCL).
B. Posterior cruciate ligament (PCL).
C. Lateral meniscus.
D. Anterior cruciate ligament (ACL).
Answer: D
Rationale: The Lachman test is considered the most sensitive physical exam maneuver for
detecting an ACL tear. The clinician stabilizes the femur and pulls the tibia forward to check
for excessive translation and a soft end-feel. A positive result indicates significant laxity or
rupture of the anterior cruciate ligament.
8. While assessing cranial nerves, the clinician notes that the patient is unable to close their
right eye tightly, wrinkle their forehead, or smile on the right side of the face. The left side
remains normal. This indicates a lesion of which cranial nerve?
A. CN V (Trigeminal).
B. CN XII (Hypoglossal).
C. CN III (Oculomotor).
D. CN VII (Facial).
Answer: D
