NSG 464 FINAL EXAM AND STUDY GUIDE NEWEST
2026 TEST BANK| NSG464 PHYSICAL ASSESSMENT
FOR ADVANCED PRACTICE FINAL EXAM REVIEW
WITH 450 REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS WITH RATIONALES/ ALREADY
GRADED A+ (MOST RECENT!!)
A 17-year-old high school student is brought to your ER in a comatose
state. His friends have accompanied him and tell you that they have been
shooting up heroin tonight and they think their friend might have had too
much. The patient is unconscious and cannot protect his airway, so he is
intubated. His HR is 60 and he is breathing through the ventilator. He is
not posturing and he does not respond to sternal rub. Preparing to finish
the neurologic examination, you get a penlight. What size pupil do you
expect to see in this comatose patient?
A. Pinpoint pupils
B. Large pupils
C. Asymmetric pupils
D. Irregularity shaped pupils - Correct Answer - A. Pinpoint pupils
Narcotics and cholinergics cause very small (1mm) pupils. Reactions to
light can be appreciated with a magnifying glass
A 37 year-old woman is brought into your emergency room comatose.
The paramedics say her husband found her unconscious in her home.
Her past medical history consists of T1DM and she is on insulin. In the
ambulance the paramedics obtained a glucose check and her sugar was
15 (normal is 70-105). They began a dextrose saline infusion and
intubated her to protect her airway. Despite their efforts, she is posturing
in the emergency room with her arms straight at her side and her jaw
pg. 1
,clenched. her legs are also straight and her feet are plantar flexed. What
type of posturing is she showing?
A. Decorticate posturing
B. Decerebrate posturing
C. Hemiplegia
D. Chorea - Correct Answer - B. Decerebrate posturing
A patient presents with left-sided facial droop. On further testing, you
not that he is unable to wrinkle his forehead on the left side and has
decreased taste. Which of the following is true?
A. This represents a central lesion
B. This represents a CN IV lesion
C. This may be related to travel
D. This most likely represents a stroke - Correct Answer - C. This may
be related to travel
Because the forehead is also involved, this represents a peripheral nerve
lesion of CN VII and does not represent a classic middle cerebral artery
stroke. The latter would spare the upper face but include speech
difficulties as well as upper extremity weakness on the ipsilateral side.
One cause of this type of lesion is Lyme disease and related to travel to
endemic areas, so a careful travel history should be sought
Steve has had a stroke and comes to you for follow-up today. On
examination you find that he has increased muscle tone, some
involuntary movements, and abnormal gait, and a slowness of response
in movements. He most likely has involvement of which of the
following?
A. The corticospinal tract
pg. 2
,B. The cerebellum
C. The cerebrum
D. The basal ganglia - Correct Answer - D. The basal ganglia
These findings are typical of disease in the basal ganglia
You are conducting a mental status examination and note impairment of
speech and judgment, but the rest of your examination is intact. Where is
the most likely location of the problem?
A. Cerebrum
B. Cerebellum
C. Brainstem
D. Basal ganglia - Correct Answer - A. Cerebrum
The cerebrum is responsible for higher cognitive functions such as
speech and judgment
A patient presents with a daily headache which has worsened over the
past several months. On funduscopic examination, you notice that the
disk edge is indistinct and the veins do not pulsate. Which is most
likely?
A. Migraine
B. Glaucoma
C. Visual acuity problem
D. Increased intracranial pressure - Correct Answer - D.
This is a description of papilledema, which should make you think of
increased intracranial pressure. This can be a critical finding. This
patient may have a brain tumor or benign intracranial hypertension.
These findings cannot be ignored and should be acted upon quickly.
pg. 3
, A young woman comes in today complaining of fatigue, irregular
menses, and polyuria which have gradually increased over the past few
months. Which eye findings would be consistent with her condition?
A. An upper quadrantanopsia
B. A lower quadrantanopsia
C. A bitemporal hemianopsia
D. An increased cup-to-disc ratio - Correct Answer - C. A bitemporal
hemianopsia
The symptoms are consistent with a pituitary lesion. Enlargement of a
tumor in this area would compress the fibers responsible for the lateral
visual fields. A quadrantanopsia would usually be caused by a lesion in
the optic radiations in the parietal lobe of the cerebrum. Glaucoma
would cause a narrowing of the entire visual field, not just the lateral
aspect.
You are testing the biceps strength in a young man following a spinal
trauma from a motor vehicle accident. He cannot lift his hand upward,
but if the arm is abducted to 90 degrees, he can then move his forearm
side-to-side. This would represent which muscle strength grading?
A. I
B. II
C. III
D. IV - Correct Answer - B. II
The ability to move an extremity, but not against gravity, represents a
strength of 2 out of 5. Zero represents no muscular contraction detected
(not even a "flicker"); one represents a contraction but no movement of
the extremity; three means that the extremity can move against gravity
but not resistance; four means perceived weakness but the patient can
oppose some resistance; and five is normal
pg. 4
2026 TEST BANK| NSG464 PHYSICAL ASSESSMENT
FOR ADVANCED PRACTICE FINAL EXAM REVIEW
WITH 450 REAL EXAM QUESTIONS AND CORRECT
VERIFIED ANSWERS WITH RATIONALES/ ALREADY
GRADED A+ (MOST RECENT!!)
A 17-year-old high school student is brought to your ER in a comatose
state. His friends have accompanied him and tell you that they have been
shooting up heroin tonight and they think their friend might have had too
much. The patient is unconscious and cannot protect his airway, so he is
intubated. His HR is 60 and he is breathing through the ventilator. He is
not posturing and he does not respond to sternal rub. Preparing to finish
the neurologic examination, you get a penlight. What size pupil do you
expect to see in this comatose patient?
A. Pinpoint pupils
B. Large pupils
C. Asymmetric pupils
D. Irregularity shaped pupils - Correct Answer - A. Pinpoint pupils
Narcotics and cholinergics cause very small (1mm) pupils. Reactions to
light can be appreciated with a magnifying glass
A 37 year-old woman is brought into your emergency room comatose.
The paramedics say her husband found her unconscious in her home.
Her past medical history consists of T1DM and she is on insulin. In the
ambulance the paramedics obtained a glucose check and her sugar was
15 (normal is 70-105). They began a dextrose saline infusion and
intubated her to protect her airway. Despite their efforts, she is posturing
in the emergency room with her arms straight at her side and her jaw
pg. 1
,clenched. her legs are also straight and her feet are plantar flexed. What
type of posturing is she showing?
A. Decorticate posturing
B. Decerebrate posturing
C. Hemiplegia
D. Chorea - Correct Answer - B. Decerebrate posturing
A patient presents with left-sided facial droop. On further testing, you
not that he is unable to wrinkle his forehead on the left side and has
decreased taste. Which of the following is true?
A. This represents a central lesion
B. This represents a CN IV lesion
C. This may be related to travel
D. This most likely represents a stroke - Correct Answer - C. This may
be related to travel
Because the forehead is also involved, this represents a peripheral nerve
lesion of CN VII and does not represent a classic middle cerebral artery
stroke. The latter would spare the upper face but include speech
difficulties as well as upper extremity weakness on the ipsilateral side.
One cause of this type of lesion is Lyme disease and related to travel to
endemic areas, so a careful travel history should be sought
Steve has had a stroke and comes to you for follow-up today. On
examination you find that he has increased muscle tone, some
involuntary movements, and abnormal gait, and a slowness of response
in movements. He most likely has involvement of which of the
following?
A. The corticospinal tract
pg. 2
,B. The cerebellum
C. The cerebrum
D. The basal ganglia - Correct Answer - D. The basal ganglia
These findings are typical of disease in the basal ganglia
You are conducting a mental status examination and note impairment of
speech and judgment, but the rest of your examination is intact. Where is
the most likely location of the problem?
A. Cerebrum
B. Cerebellum
C. Brainstem
D. Basal ganglia - Correct Answer - A. Cerebrum
The cerebrum is responsible for higher cognitive functions such as
speech and judgment
A patient presents with a daily headache which has worsened over the
past several months. On funduscopic examination, you notice that the
disk edge is indistinct and the veins do not pulsate. Which is most
likely?
A. Migraine
B. Glaucoma
C. Visual acuity problem
D. Increased intracranial pressure - Correct Answer - D.
This is a description of papilledema, which should make you think of
increased intracranial pressure. This can be a critical finding. This
patient may have a brain tumor or benign intracranial hypertension.
These findings cannot be ignored and should be acted upon quickly.
pg. 3
, A young woman comes in today complaining of fatigue, irregular
menses, and polyuria which have gradually increased over the past few
months. Which eye findings would be consistent with her condition?
A. An upper quadrantanopsia
B. A lower quadrantanopsia
C. A bitemporal hemianopsia
D. An increased cup-to-disc ratio - Correct Answer - C. A bitemporal
hemianopsia
The symptoms are consistent with a pituitary lesion. Enlargement of a
tumor in this area would compress the fibers responsible for the lateral
visual fields. A quadrantanopsia would usually be caused by a lesion in
the optic radiations in the parietal lobe of the cerebrum. Glaucoma
would cause a narrowing of the entire visual field, not just the lateral
aspect.
You are testing the biceps strength in a young man following a spinal
trauma from a motor vehicle accident. He cannot lift his hand upward,
but if the arm is abducted to 90 degrees, he can then move his forearm
side-to-side. This would represent which muscle strength grading?
A. I
B. II
C. III
D. IV - Correct Answer - B. II
The ability to move an extremity, but not against gravity, represents a
strength of 2 out of 5. Zero represents no muscular contraction detected
(not even a "flicker"); one represents a contraction but no movement of
the extremity; three means that the extremity can move against gravity
but not resistance; four means perceived weakness but the patient can
oppose some resistance; and five is normal
pg. 4
