NUR631 EXAM 3 QUESTIONS AND VERIFIED ANSWERS|
2026-2027 COMPLETE STUDY GUIDE
WITH CORRECT DETAILED RATIONALES|
LATEST UPDATED VERSION
PART 1: NEUROLOGICAL (Q1–100)
1. A 41-year-old man presents with left facial weakness, inability to
close the left eye, flattening of the left nasolabial fold, and drooling. He
had a viral URI last month. On exam, his forehead is flat on the left and
he cannot raise his left eyebrow. What is the most likely diagnosis?
A) Peripheral CN VII paralysis (Bell's palsy)
B) Central CN VII paralysis (stroke)
C) Myasthenia gravis
D) Guillain-Barré syndrome
Correct Answer: A) Peripheral CN VII paralysis (Bell's palsy)
Rationale: Bell's palsy is a peripheral lower motor neuron lesion of CN
VII affecting both upper and lower face (including forehead). Central
strokes spare the forehead due to bilateral cortical innervation. The
preceding viral URI is a classic trigger.
2. Which of the following is true of olfactory nerve (CN I) testing?
A) It is not tested for laterality
B) The smell must be identified to declare a normal response
C) Abnormal responses may be seen in otherwise normal elderly
D) Allergies are unrelated to testing
Correct Answer: C) Abnormal responses may be seen in otherwise
normal elderly
1
,Rationale: Olfactory function normally declines with age; many healthy
elderly have decreased smell identification. Laterality should always be
tested (each nostril separately), and correct identification is required
for a normal result.
3. Inability to close the left eye, flattening of the left nasolabial fold,
and drooling from the left side of the mouth indicate damage to which
cranial nerve?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN XII (Hypoglossal)
Correct Answer: B) CN VII (Facial)
Rationale: CN VII innervates all muscles of facial expression, including
orbicularis oculi (eye closure) and buccinator/orbicularis oris (mouth
control). Loss of these functions with forehead involvement points to
CN VII.
4. Which finding would indicate dysfunction of cranial nerve III
(Oculomotor)?
A) Inability to shrug shoulders
B) Ptosis and diplopia
C) Loss of taste on anterior tongue
D) Decreased hearing
Correct Answer: B) Ptosis and diplopia
Rationale: CN III innervates the levator palpebrae (eyelid) and most
extraocular muscles (medial rectus, superior rectus, inferior rectus,
inferior oblique). Dysfunction causes ptosis and diplopia due to
unopposed lateral pull by CN VI.
2
,5. A patient cannot identify a familiar scent with either nostril. This
suggests damage to which cranial nerve?
A) CN I (Olfactory)
B) CN II (Optic)
C) CN V (Trigeminal)
D) CN VIII (Vestibulocochlear)
Correct Answer: A) CN I (Olfactory)
Rationale: CN I is purely sensory for smell. Bilateral anosmia suggests
damage to the olfactory bulbs/tracts, which can occur from head
trauma, neurodegenerative disease, or viral infections.
6. Which cranial nerves mediate the gag reflex?
A) CN VII and CN VIII
B) CN IX and CN X
C) CN XI and CN XII
D) CN V and CN VII
Correct Answer: B) CN IX (Glossopharyngeal) and CN X (Vagus)
Rationale: CN IX provides the afferent (sensory) limb of the gag reflex
from the posterior pharynx, while CN X provides the efferent (motor)
limb causing pharyngeal constriction. Both are required for an intact
reflex.
7. A patient has difficulty swallowing, hoarseness, and deviation of the
uvula to the right. Which cranial nerve is most likely affected?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XI (Accessory)
D) CN XII (Hypoglossal)
3
, Correct Answer: B) CN X (Vagus)
Rationale: CN X innervates the pharyngeal muscles (swallowing),
laryngeal muscles (voice), and the levator veli palatini (uvula). With a
left CN X lesion, the uvula deviates toward the normal (right) side
because the intact side pulls harder.
8. You ask a patient to shrug their shoulders and turn their head against
resistance. Which cranial nerve are you testing?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XI (Accessory)
D) CN XII (Hypoglossal)
Correct Answer: C) CN XI (Accessory)
Rationale: CN XI (spinal accessory) innervates the sternocleidomastoid
(turns head to opposite side) and trapezius (shrugs shoulders).
Weakness indicates a lower motor neuron lesion of this nerve.
9. Tongue deviation to the left on protrusion indicates damage to which
cranial nerve?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XI (Accessory)
D) CN XII (Hypoglossal)
Correct Answer: D) CN XII (Hypoglossal)
Rationale: CN XII innervates the intrinsic and extrinsic tongue muscles.
With a left CN XII lesion, the left genioglossus is weak, and the tongue
4
2026-2027 COMPLETE STUDY GUIDE
WITH CORRECT DETAILED RATIONALES|
LATEST UPDATED VERSION
PART 1: NEUROLOGICAL (Q1–100)
1. A 41-year-old man presents with left facial weakness, inability to
close the left eye, flattening of the left nasolabial fold, and drooling. He
had a viral URI last month. On exam, his forehead is flat on the left and
he cannot raise his left eyebrow. What is the most likely diagnosis?
A) Peripheral CN VII paralysis (Bell's palsy)
B) Central CN VII paralysis (stroke)
C) Myasthenia gravis
D) Guillain-Barré syndrome
Correct Answer: A) Peripheral CN VII paralysis (Bell's palsy)
Rationale: Bell's palsy is a peripheral lower motor neuron lesion of CN
VII affecting both upper and lower face (including forehead). Central
strokes spare the forehead due to bilateral cortical innervation. The
preceding viral URI is a classic trigger.
2. Which of the following is true of olfactory nerve (CN I) testing?
A) It is not tested for laterality
B) The smell must be identified to declare a normal response
C) Abnormal responses may be seen in otherwise normal elderly
D) Allergies are unrelated to testing
Correct Answer: C) Abnormal responses may be seen in otherwise
normal elderly
1
,Rationale: Olfactory function normally declines with age; many healthy
elderly have decreased smell identification. Laterality should always be
tested (each nostril separately), and correct identification is required
for a normal result.
3. Inability to close the left eye, flattening of the left nasolabial fold,
and drooling from the left side of the mouth indicate damage to which
cranial nerve?
A) CN V (Trigeminal)
B) CN VII (Facial)
C) CN IX (Glossopharyngeal)
D) CN XII (Hypoglossal)
Correct Answer: B) CN VII (Facial)
Rationale: CN VII innervates all muscles of facial expression, including
orbicularis oculi (eye closure) and buccinator/orbicularis oris (mouth
control). Loss of these functions with forehead involvement points to
CN VII.
4. Which finding would indicate dysfunction of cranial nerve III
(Oculomotor)?
A) Inability to shrug shoulders
B) Ptosis and diplopia
C) Loss of taste on anterior tongue
D) Decreased hearing
Correct Answer: B) Ptosis and diplopia
Rationale: CN III innervates the levator palpebrae (eyelid) and most
extraocular muscles (medial rectus, superior rectus, inferior rectus,
inferior oblique). Dysfunction causes ptosis and diplopia due to
unopposed lateral pull by CN VI.
2
,5. A patient cannot identify a familiar scent with either nostril. This
suggests damage to which cranial nerve?
A) CN I (Olfactory)
B) CN II (Optic)
C) CN V (Trigeminal)
D) CN VIII (Vestibulocochlear)
Correct Answer: A) CN I (Olfactory)
Rationale: CN I is purely sensory for smell. Bilateral anosmia suggests
damage to the olfactory bulbs/tracts, which can occur from head
trauma, neurodegenerative disease, or viral infections.
6. Which cranial nerves mediate the gag reflex?
A) CN VII and CN VIII
B) CN IX and CN X
C) CN XI and CN XII
D) CN V and CN VII
Correct Answer: B) CN IX (Glossopharyngeal) and CN X (Vagus)
Rationale: CN IX provides the afferent (sensory) limb of the gag reflex
from the posterior pharynx, while CN X provides the efferent (motor)
limb causing pharyngeal constriction. Both are required for an intact
reflex.
7. A patient has difficulty swallowing, hoarseness, and deviation of the
uvula to the right. Which cranial nerve is most likely affected?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XI (Accessory)
D) CN XII (Hypoglossal)
3
, Correct Answer: B) CN X (Vagus)
Rationale: CN X innervates the pharyngeal muscles (swallowing),
laryngeal muscles (voice), and the levator veli palatini (uvula). With a
left CN X lesion, the uvula deviates toward the normal (right) side
because the intact side pulls harder.
8. You ask a patient to shrug their shoulders and turn their head against
resistance. Which cranial nerve are you testing?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XI (Accessory)
D) CN XII (Hypoglossal)
Correct Answer: C) CN XI (Accessory)
Rationale: CN XI (spinal accessory) innervates the sternocleidomastoid
(turns head to opposite side) and trapezius (shrugs shoulders).
Weakness indicates a lower motor neuron lesion of this nerve.
9. Tongue deviation to the left on protrusion indicates damage to which
cranial nerve?
A) CN IX (Glossopharyngeal)
B) CN X (Vagus)
C) CN XI (Accessory)
D) CN XII (Hypoglossal)
Correct Answer: D) CN XII (Hypoglossal)
Rationale: CN XII innervates the intrinsic and extrinsic tongue muscles.
With a left CN XII lesion, the left genioglossus is weak, and the tongue
4
