NSG 500 Exam 4 V1 | NSG 500 Advanced
Health Assessment | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG500
Exam 4 2026)
1. A 55-year-old male patient presents with difficulty maintaining balance and a staggering
gait. Which area of the brain is most likely affected based on these clinical manifestations?
A. Parietal lobe
B. Temporal lobe
C. Cerebellum
D. Prefrontal cortex
Answer: C
Rationale: The cerebellum is the primary center for coordination, equilibrium, and
maintenance of posture. Impairment in this area typically results in ataxia, which is
characterized by a staggering or uncoordinated gait. The nurse practitioner must
differentiate these motor coordination issues from sensory deficits located in the parietal
lobe.
2. During a musculoskeletal assessment, the nurse practitioner performs the Phalen test. The
patient reports numbness and burning in the thumb and index finger within 60 seconds.
What condition does this suggest?
A. Ulnar nerve entrapment
,B. Rheumatoid arthritis
C. Carpal tunnel syndrome
D. Radial nerve palsy
Answer: C
Rationale: The Phalen test involves holding the wrists in acute flexion for 60 seconds to
compress the median nerve. A positive result, characterized by numbness or tingling, is
highly indicative of carpal tunnel syndrome. This diagnostic maneuver is a standard
component of the advanced assessment of the upper extremities.
3. Which cranial nerve is being assessed when the nurse practitioner asks the patient to shrug
their shoulders against resistance?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve XI (Spinal Accessory)
C. Cranial Nerve XII (Hypoglossal)
D. Cranial Nerve IX (Glossopharyngeal)
Answer: B
Rationale: Cranial Nerve XI, the Spinal Accessory nerve, innervates the trapezius and
sternocleidomastoid muscles. Assessing shoulder shrug and head rotation against
resistance evaluates the motor integrity of this nerve. Weakness or asymmetry during this
maneuver may indicate nerve damage or muscle pathology.
, 4. A patient exhibits a positive Romberg sign. Which of the following best describes this
finding?
A. Decreased sensation to vibration in the lower extremities
B. Inability to perform rapid alternating movements
C. A tremor that worsens with intentional movement
D. Loss of balance when the eyes are closed
Answer: D
Rationale: A positive Romberg sign occurs when a patient can maintain balance with eyes
open but loses balance when eyes are closed. This indicates a problem with proprioception
or vestibular function rather than cerebellar ataxia. The practitioner uses this test to screen
for sensory ataxia and dorsal column disease.
5. When assessing the Deep Tendon Reflexes (DTRs) of a patient, the nurse practitioner notes
a brisk, hyperactive response with intermittent clonus. How should this be graded?
A. 1+
B. 2+
C. 4+
D. 3+
Answer: C
Health Assessment | Wilkes University |
2026 Q&A with Rationale (Wilkes NSG500
Exam 4 2026)
1. A 55-year-old male patient presents with difficulty maintaining balance and a staggering
gait. Which area of the brain is most likely affected based on these clinical manifestations?
A. Parietal lobe
B. Temporal lobe
C. Cerebellum
D. Prefrontal cortex
Answer: C
Rationale: The cerebellum is the primary center for coordination, equilibrium, and
maintenance of posture. Impairment in this area typically results in ataxia, which is
characterized by a staggering or uncoordinated gait. The nurse practitioner must
differentiate these motor coordination issues from sensory deficits located in the parietal
lobe.
2. During a musculoskeletal assessment, the nurse practitioner performs the Phalen test. The
patient reports numbness and burning in the thumb and index finger within 60 seconds.
What condition does this suggest?
A. Ulnar nerve entrapment
,B. Rheumatoid arthritis
C. Carpal tunnel syndrome
D. Radial nerve palsy
Answer: C
Rationale: The Phalen test involves holding the wrists in acute flexion for 60 seconds to
compress the median nerve. A positive result, characterized by numbness or tingling, is
highly indicative of carpal tunnel syndrome. This diagnostic maneuver is a standard
component of the advanced assessment of the upper extremities.
3. Which cranial nerve is being assessed when the nurse practitioner asks the patient to shrug
their shoulders against resistance?
A. Cranial Nerve X (Vagus)
B. Cranial Nerve XI (Spinal Accessory)
C. Cranial Nerve XII (Hypoglossal)
D. Cranial Nerve IX (Glossopharyngeal)
Answer: B
Rationale: Cranial Nerve XI, the Spinal Accessory nerve, innervates the trapezius and
sternocleidomastoid muscles. Assessing shoulder shrug and head rotation against
resistance evaluates the motor integrity of this nerve. Weakness or asymmetry during this
maneuver may indicate nerve damage or muscle pathology.
, 4. A patient exhibits a positive Romberg sign. Which of the following best describes this
finding?
A. Decreased sensation to vibration in the lower extremities
B. Inability to perform rapid alternating movements
C. A tremor that worsens with intentional movement
D. Loss of balance when the eyes are closed
Answer: D
Rationale: A positive Romberg sign occurs when a patient can maintain balance with eyes
open but loses balance when eyes are closed. This indicates a problem with proprioception
or vestibular function rather than cerebellar ataxia. The practitioner uses this test to screen
for sensory ataxia and dorsal column disease.
5. When assessing the Deep Tendon Reflexes (DTRs) of a patient, the nurse practitioner notes
a brisk, hyperactive response with intermittent clonus. How should this be graded?
A. 1+
B. 2+
C. 4+
D. 3+
Answer: C
