NSG 500 Exam 4 Actual Exam V3 | NSG 500 Advanced Health
Assessment (NSG500 Exam 4) [PDF] | Wilkes University
1. A 68-year-old patient presents with a ‘shuffling’ gait and difficulty initiating movement.
During the neurologic exam, the nurse practitioner notes a ‘pill-rolling’ tremor at rest. Which
area of the brain is most likely affected by this pathological finding?
A. Cerebellum
B. Brainstem
C. Cerebral cortex
D. Basal ganglia
Answer: D
Rationale: The symptoms described are classic hallmarks of Parkinson’s disease, which
involves the degeneration of dopamine-producing neurons in the substantia nigra within
the basal ganglia. The basal ganglia are responsible for the regulation of voluntary motor
movements and procedural learning. Dysfunction in this area leads to the characteristic
resting tremor and bradykinesia seen in this patient.
2. When assessing a patient for carpal tunnel syndrome, the nurse practitioner asks the
patient to hold both wrists in a fully flexed position with the dorsal surfaces pressed together
for 60 seconds. What is the name of this diagnostic maneuver?
A. Phalen test
B. Lachman test
C. Tinel sign
D. Allen test
Answer: A
Rationale: The Phalen test involves acute flexion of the wrists to increase pressure on the
median nerve. A positive result is indicated by numbness or tingling in the distribution of
the median nerve within 60 seconds. This test is a standard part of a comprehensive
musculoskeletal assessment for repetitive strain injuries.
3. During a neck examination, the nurse practitioner notes a midline mass that moves upward
when the patient swallows. Which structure is most likely being palpated?
A. Thyroid gland
B. Cervical lymph node
C. Parotid gland
,D. Submandibular gland
Answer: A
Rationale: The thyroid gland is located anterior to the trachea and moves upward during
swallowing due to its attachment to the pretracheal fascia. This upward movement is a
critical finding to differentiate a thyroid mass from other neck masses like lymph nodes or
cysts. Proper assessment requires the patient to sip water while the practitioner palpates
the gland from a posterior or anterior approach.
4. An 80-year-old patient is being evaluated for a fall. The nurse practitioner observes that
the patient has a wider base of support and shorter steps during ambulation. How should the
practitioner document this finding?
A. Ataxic gait due to cerebellar dysfunction
B. Steppage gait
C. Spastic hemiparesis
D. Normal age-related changes in gait
Answer: D
Rationale: In older adults, it is common to see a decrease in step height and an increase in
the width of the base to maintain stability. These changes are often compensatory for
decreased proprioception or balance and are considered normal variations of aging rather
than acute pathology. Documentation should reflect these findings as consistent with the
patient’s developmental stage.
5. A patient complains of a ‘popping’ sensation in the knee followed by immediate swelling
after a pivoting injury during a soccer match. The nurse practitioner performs the Lachman
test, which shows increased laxity compared to the unaffected side. This finding is most
suggestive of an injury to which structure?
A. Anterior cruciate ligament (ACL)
B. Meniscus
C. Medial collateral ligament (MCL)
D. Patellar tendon
Answer: A
Rationale: The Lachman test is the most sensitive physical examination maneuver for
detecting an ACL tear. It involves pulling the tibia anteriorly while the knee is flexed at 20-
30 degrees. Increased forward translation of the tibia indicates a lack of restraint from the
ACL.
, 6. When assessing the cranial nerves, the nurse practitioner asks the patient to say ‘ah’ and
observes the movement of the soft palate and uvula. Which cranial nerves are being
evaluated?
A. CN V and CN VII
B. CN IX and CN X
C. CN XI and CN XII
D. CN III and CN IV
Answer: B
Rationale: The movement of the soft palate and the symmetry of the uvula rise are
controlled by the glossopharyngeal (CN IX) and vagus (CN X) nerves. Failure of the palate
to rise symmetrically or a deviation of the uvula can indicate a lesion in these nerves. This
assessment is vital for ensuring the patient has a functional gag reflex and protected
airway.
7. A patient presents with a suspicious skin lesion on the back. The nurse practitioner notes a
lesion that is 7mm in diameter, has irregular borders, and displays varying shades of brown
and black. Which of the following is the most appropriate next step?
A. Monitor the lesion for changes in 6 months
B. Apply a topical corticosteroid
C. Advise the patient to use more sunscreen
D. Refer for an urgent skin biopsy
Answer: D
Rationale: The lesion meets several of the ABCDE criteria for melanoma: Border
irregularity, Color variation, and Diameter greater than 6mm. Given these suspicious
characteristics, an immediate referral for biopsy is necessary to rule out malignancy.
Delaying assessment by monitoring could lead to advanced disease if the lesion is indeed
melanoma.
8. During a musculoskeletal exam of the shoulder, the nurse practitioner performs the
Hawkins-Kennedy test. A positive result (pain with internal rotation) suggests which
condition?
A. Bicipital tendonitis
B. Subacromial impingement syndrome
C. Acromioclavicular joint arthritis
D. Adhesive capsulitis
Answer: B
Assessment (NSG500 Exam 4) [PDF] | Wilkes University
1. A 68-year-old patient presents with a ‘shuffling’ gait and difficulty initiating movement.
During the neurologic exam, the nurse practitioner notes a ‘pill-rolling’ tremor at rest. Which
area of the brain is most likely affected by this pathological finding?
A. Cerebellum
B. Brainstem
C. Cerebral cortex
D. Basal ganglia
Answer: D
Rationale: The symptoms described are classic hallmarks of Parkinson’s disease, which
involves the degeneration of dopamine-producing neurons in the substantia nigra within
the basal ganglia. The basal ganglia are responsible for the regulation of voluntary motor
movements and procedural learning. Dysfunction in this area leads to the characteristic
resting tremor and bradykinesia seen in this patient.
2. When assessing a patient for carpal tunnel syndrome, the nurse practitioner asks the
patient to hold both wrists in a fully flexed position with the dorsal surfaces pressed together
for 60 seconds. What is the name of this diagnostic maneuver?
A. Phalen test
B. Lachman test
C. Tinel sign
D. Allen test
Answer: A
Rationale: The Phalen test involves acute flexion of the wrists to increase pressure on the
median nerve. A positive result is indicated by numbness or tingling in the distribution of
the median nerve within 60 seconds. This test is a standard part of a comprehensive
musculoskeletal assessment for repetitive strain injuries.
3. During a neck examination, the nurse practitioner notes a midline mass that moves upward
when the patient swallows. Which structure is most likely being palpated?
A. Thyroid gland
B. Cervical lymph node
C. Parotid gland
,D. Submandibular gland
Answer: A
Rationale: The thyroid gland is located anterior to the trachea and moves upward during
swallowing due to its attachment to the pretracheal fascia. This upward movement is a
critical finding to differentiate a thyroid mass from other neck masses like lymph nodes or
cysts. Proper assessment requires the patient to sip water while the practitioner palpates
the gland from a posterior or anterior approach.
4. An 80-year-old patient is being evaluated for a fall. The nurse practitioner observes that
the patient has a wider base of support and shorter steps during ambulation. How should the
practitioner document this finding?
A. Ataxic gait due to cerebellar dysfunction
B. Steppage gait
C. Spastic hemiparesis
D. Normal age-related changes in gait
Answer: D
Rationale: In older adults, it is common to see a decrease in step height and an increase in
the width of the base to maintain stability. These changes are often compensatory for
decreased proprioception or balance and are considered normal variations of aging rather
than acute pathology. Documentation should reflect these findings as consistent with the
patient’s developmental stage.
5. A patient complains of a ‘popping’ sensation in the knee followed by immediate swelling
after a pivoting injury during a soccer match. The nurse practitioner performs the Lachman
test, which shows increased laxity compared to the unaffected side. This finding is most
suggestive of an injury to which structure?
A. Anterior cruciate ligament (ACL)
B. Meniscus
C. Medial collateral ligament (MCL)
D. Patellar tendon
Answer: A
Rationale: The Lachman test is the most sensitive physical examination maneuver for
detecting an ACL tear. It involves pulling the tibia anteriorly while the knee is flexed at 20-
30 degrees. Increased forward translation of the tibia indicates a lack of restraint from the
ACL.
, 6. When assessing the cranial nerves, the nurse practitioner asks the patient to say ‘ah’ and
observes the movement of the soft palate and uvula. Which cranial nerves are being
evaluated?
A. CN V and CN VII
B. CN IX and CN X
C. CN XI and CN XII
D. CN III and CN IV
Answer: B
Rationale: The movement of the soft palate and the symmetry of the uvula rise are
controlled by the glossopharyngeal (CN IX) and vagus (CN X) nerves. Failure of the palate
to rise symmetrically or a deviation of the uvula can indicate a lesion in these nerves. This
assessment is vital for ensuring the patient has a functional gag reflex and protected
airway.
7. A patient presents with a suspicious skin lesion on the back. The nurse practitioner notes a
lesion that is 7mm in diameter, has irregular borders, and displays varying shades of brown
and black. Which of the following is the most appropriate next step?
A. Monitor the lesion for changes in 6 months
B. Apply a topical corticosteroid
C. Advise the patient to use more sunscreen
D. Refer for an urgent skin biopsy
Answer: D
Rationale: The lesion meets several of the ABCDE criteria for melanoma: Border
irregularity, Color variation, and Diameter greater than 6mm. Given these suspicious
characteristics, an immediate referral for biopsy is necessary to rule out malignancy.
Delaying assessment by monitoring could lead to advanced disease if the lesion is indeed
melanoma.
8. During a musculoskeletal exam of the shoulder, the nurse practitioner performs the
Hawkins-Kennedy test. A positive result (pain with internal rotation) suggests which
condition?
A. Bicipital tendonitis
B. Subacromial impingement syndrome
C. Acromioclavicular joint arthritis
D. Adhesive capsulitis
Answer: B
