EXAM 3 GUIDE
1. A 30-year-old woman tells the NP that she had been very unsteady and has had
difficulties maintaining her balance. Which area of the brain would the NP be concerned
about with these findings?
a.Thalamus
b.Brainstem
c.Cerebellum
d.Extrapyramidal tract
Cerebellum -rationale- The cerebellum is responsible for coordinating voluntary muscle
movements, maintaining posture, and controlling balance and equilibrium. Damage or
dysfunction of the cerebellum commonly results in:
• Unsteady gait (ataxia)
• Poor balance
• Difficulty coordinating movements
• Dizziness or instability
• Problems with fine motor control
2. During an assessment of the cranial nerves, the NP finds the following: asymmetry
when the patient frowns or smiles, uneven lifting of the eyebrow, sagging of the lower
eyelid, and escape of the air when the NP presses against the right puffed checks. This
would indicate dysfunction of the which of these cranial nerves?
Motor component of cranial nerve VII
Motor component of cranial nerve IV
Motor and sensory component of cranial nerve XI
Motor component of cranial nerve X and sensory component of cranial nerve VII
✓ · Motor component of cranial nerve VII
RATIONALE: The facial nerve (Cranial Nerve VII) controls the muscles of facial expression.
During a cranial nerve assessment, findings such as:
• Asymmetry when smiling or frowning
• Uneven eyebrow elevation
• Sagging of the lower eyelid
• Inability to keep air in the cheeks when puffed out
https://www.stuvia.com/user/mboffin
, 3. During a neurological assessment of a “healthy” 35-year-old patient, the NP asks him
to relax his muscles completely. The NP then moves each extremity through full range
of motion. Which of these results would the NP expect to find?
Firm, rigid resistance to movement
Mild, even resistance to movement
Hypotonic muscles as a result of total relaxation
Pain with some direction of movement
✓ Mild even resistance to movement
RATIONALE: When assessing muscle tone in a healthy adult, the examiner asks the patient to
relax completely and then passively moves the extremities through their range of motion.
A normal finding is:
• Mild, even resistance to passive movement throughout the range of motion.
• This indicates normal muscle tone (normotonia) and intact neurological function.
https://www.stuvia.com/user/mboffin
, 4. The NP is conducting an assessment on a 29-year-old woman who visits the clinic
complaining of “always dropping things and falling down.” While testing rapid alternating
movements, the NP notices that the woman is unable to pat both her knees. Her
response is very slow, and she misses frequently. What should the NP suspects?
Dysfunction of the cerebellum
Vestibular disease
Lesion of cranial nerve IX
Inability to understand directions
✓ Dysfunction of the cerebellum
RATIONALE: The ability to perform rapid alternating movements (RAMs), such as patting
the knees alternately, is controlled by the cerebellum. Difficulty performing these movements is
called dysdiadochokinesia, a classic sign of cerebellar dysfunction.
In this question, the patient:
• Frequently drops things
• Falls down
• Performs rapid alternating movements slowly
• Misses frequently during testing
5. The NP is performing a neurological assessment of on a 41-year-old woman with a
history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the NP
notices that the patient is unable to feel vibration on the great toe or ankle bilaterally, but
she is able to feel vibrations on both patellae. Given this information, what would the NP
suspect?
Hyperalgesia
Hyperesthesia
Peripheral neuropathy
Lesion of sensory cortex
✓ Peripheral neuropathy
RATIONALE: Vibration sense is tested using a tuning fork and assesses the integrity of the
posterior (dorsal) columns of the spinal cord and peripheral sensory nerves. In patients with
diabetes mellitus, one of the most common neurological complications is peripheral
neuropathy, which typically affects the distal extremities first ("stocking-glove" distribution).
https://www.stuvia.com/user/mboffin
1. A 30-year-old woman tells the NP that she had been very unsteady and has had
difficulties maintaining her balance. Which area of the brain would the NP be concerned
about with these findings?
a.Thalamus
b.Brainstem
c.Cerebellum
d.Extrapyramidal tract
Cerebellum -rationale- The cerebellum is responsible for coordinating voluntary muscle
movements, maintaining posture, and controlling balance and equilibrium. Damage or
dysfunction of the cerebellum commonly results in:
• Unsteady gait (ataxia)
• Poor balance
• Difficulty coordinating movements
• Dizziness or instability
• Problems with fine motor control
2. During an assessment of the cranial nerves, the NP finds the following: asymmetry
when the patient frowns or smiles, uneven lifting of the eyebrow, sagging of the lower
eyelid, and escape of the air when the NP presses against the right puffed checks. This
would indicate dysfunction of the which of these cranial nerves?
Motor component of cranial nerve VII
Motor component of cranial nerve IV
Motor and sensory component of cranial nerve XI
Motor component of cranial nerve X and sensory component of cranial nerve VII
✓ · Motor component of cranial nerve VII
RATIONALE: The facial nerve (Cranial Nerve VII) controls the muscles of facial expression.
During a cranial nerve assessment, findings such as:
• Asymmetry when smiling or frowning
• Uneven eyebrow elevation
• Sagging of the lower eyelid
• Inability to keep air in the cheeks when puffed out
https://www.stuvia.com/user/mboffin
, 3. During a neurological assessment of a “healthy” 35-year-old patient, the NP asks him
to relax his muscles completely. The NP then moves each extremity through full range
of motion. Which of these results would the NP expect to find?
Firm, rigid resistance to movement
Mild, even resistance to movement
Hypotonic muscles as a result of total relaxation
Pain with some direction of movement
✓ Mild even resistance to movement
RATIONALE: When assessing muscle tone in a healthy adult, the examiner asks the patient to
relax completely and then passively moves the extremities through their range of motion.
A normal finding is:
• Mild, even resistance to passive movement throughout the range of motion.
• This indicates normal muscle tone (normotonia) and intact neurological function.
https://www.stuvia.com/user/mboffin
, 4. The NP is conducting an assessment on a 29-year-old woman who visits the clinic
complaining of “always dropping things and falling down.” While testing rapid alternating
movements, the NP notices that the woman is unable to pat both her knees. Her
response is very slow, and she misses frequently. What should the NP suspects?
Dysfunction of the cerebellum
Vestibular disease
Lesion of cranial nerve IX
Inability to understand directions
✓ Dysfunction of the cerebellum
RATIONALE: The ability to perform rapid alternating movements (RAMs), such as patting
the knees alternately, is controlled by the cerebellum. Difficulty performing these movements is
called dysdiadochokinesia, a classic sign of cerebellar dysfunction.
In this question, the patient:
• Frequently drops things
• Falls down
• Performs rapid alternating movements slowly
• Misses frequently during testing
5. The NP is performing a neurological assessment of on a 41-year-old woman with a
history of diabetes. When testing her ability to feel the vibrations of a tuning fork, the NP
notices that the patient is unable to feel vibration on the great toe or ankle bilaterally, but
she is able to feel vibrations on both patellae. Given this information, what would the NP
suspect?
Hyperalgesia
Hyperesthesia
Peripheral neuropathy
Lesion of sensory cortex
✓ Peripheral neuropathy
RATIONALE: Vibration sense is tested using a tuning fork and assesses the integrity of the
posterior (dorsal) columns of the spinal cord and peripheral sensory nerves. In patients with
diabetes mellitus, one of the most common neurological complications is peripheral
neuropathy, which typically affects the distal extremities first ("stocking-glove" distribution).
https://www.stuvia.com/user/mboffin
