,NSG500/NSG 500 Exam 3 Advanced Health
Assessment | Wilkes | Latest 2026/2027 Update
1. During a neurological assessment, the nurse practitioner asks the patient to identify a familiar
object placed in their hand with their eyes closed. The patient is unable to name the object but can
describe its texture and shape. Which specific cortical function is most likely impaired?
A) Graphesthesia
B) Stereognosis
C) Two-point discrimination
D) Extinction
Correct Answer: Stereognosis
Rationale: Stereognosis is the ability to identify objects by touch with eyes closed, relying on intact
parietal lobe function. The patient can feel texture and shape but cannot integrate this into
recognition. Graphesthesia is identifying numbers traced on the skin. Two-point discrimination
assesses the ability to distinguish two simultaneous points. Extinction tests bilateral simultaneous
stimulation.
2. A 68-year-old patient presents with sudden onset of severe, unilateral, periorbital headache
accompanied by ipsilateral ptosis, miosis, and lacrimation. The nurse practitioner should recognize
this constellation of findings as most consistent with which type of headache?
A) Tension headache
B) Migraine with aura
C) Cluster headache
D) Temporal arteritis
Correct Answer: Cluster headache
Rationale: Cluster headaches present with severe unilateral periorbital pain and ipsilateral autonomic
symptoms including ptosis, miosis, lacrimation, and nasal congestion. Tension headaches are bilateral
and band-like. Migraines are typically pulsating and may have aura. Temporal arteritis presents with
jaw claudication and elevated ESR.
,3. The nurse practitioner is performing a cranial nerve assessment and asks the patient to protrude
the tongue. The tongue deviates to the left. Which cranial nerve is most likely affected, and on which
side?
A) Cranial nerve XII, left side
B) Cranial nerve XII, right side
C) Cranial nerve X, left side
D) Cranial nerve X, right side
Correct Answer: Cranial nerve XII, left side
Rationale: Cranial nerve XII (hypoglossal) innervates the tongue. When there is unilateral weakness,
the tongue deviates toward the side of the lesion due to unopposed action of the intact genioglossus
muscle. Cranial nerve X (vagus) affects the soft palate and uvula, not tongue protrusion.
4. A 72-year-old patient presents with a resting tremor, rigidity, bradykinesia, and postural instability.
The nurse practitioner documents a "cogwheel" type of rigidity during passive range of motion. This
finding is most characteristic of which condition?
A) Essential tremor
B) Parkinson's disease
C) Cerebellar ataxia
D) Multiple sclerosis
Correct Answer: Parkinson's disease
Rationale: Parkinson's disease classically presents with the triad of resting tremor, rigidity (often
cogwheel), and bradykinesia, along with postural instability. Essential tremor is action-based and lacks
rigidity. Cerebellar ataxia presents with intention tremor and dysmetria. Multiple sclerosis presents
with varied neurological deficits.
5. The nurse practitioner is assessing a patient with suspected meningitis. Which maneuver involves
flexing the patient's neck and observing for involuntary flexion of the hips and knees?
, A) Kernig sign
B) Brudzinski sign
C) Romberg test
D) Babinski sign
Correct Answer: Brudzinski sign
Rationale: Brudzinski sign is positive when flexion of the neck causes involuntary flexion of the hips
and knees, indicating meningeal irritation. Kernig sign is resistance to knee extension when the hip is
flexed. Romberg test assesses proprioception and cerebellar function. Babinski sign assesses
corticospinal tract integrity.
6. A 55-year-old patient reports a "band-like" pressure sensation around the entire head that is
bilateral and non-throbbing. The nurse practitioner recognizes this as most consistent with which type
of headache?
A) Tension headache
B) Migraine headache
C) Cluster headache
D) Sinus headache
Correct Answer: Tension headache
Rationale: A tension headache is typically described as a bilateral, band-like pressure or tightness
around the head without throbbing. Migraines are usually unilateral and throbbing. Cluster headaches
are severe, unilateral, and periorbital. Sinus headaches are associated with facial pain and nasal
congestion.
7. The nurse practitioner is assessing a patient's visual acuity using a Snellen chart. The patient is able
to read the line designated as 20/40. What does this indicate?
A) The patient can read at 20 feet what a person with normal vision can read at 40 feet
B) The patient can read at 40 feet what a person with normal vision can read at 20 feet
C) The patient has normal vision
Assessment | Wilkes | Latest 2026/2027 Update
1. During a neurological assessment, the nurse practitioner asks the patient to identify a familiar
object placed in their hand with their eyes closed. The patient is unable to name the object but can
describe its texture and shape. Which specific cortical function is most likely impaired?
A) Graphesthesia
B) Stereognosis
C) Two-point discrimination
D) Extinction
Correct Answer: Stereognosis
Rationale: Stereognosis is the ability to identify objects by touch with eyes closed, relying on intact
parietal lobe function. The patient can feel texture and shape but cannot integrate this into
recognition. Graphesthesia is identifying numbers traced on the skin. Two-point discrimination
assesses the ability to distinguish two simultaneous points. Extinction tests bilateral simultaneous
stimulation.
2. A 68-year-old patient presents with sudden onset of severe, unilateral, periorbital headache
accompanied by ipsilateral ptosis, miosis, and lacrimation. The nurse practitioner should recognize
this constellation of findings as most consistent with which type of headache?
A) Tension headache
B) Migraine with aura
C) Cluster headache
D) Temporal arteritis
Correct Answer: Cluster headache
Rationale: Cluster headaches present with severe unilateral periorbital pain and ipsilateral autonomic
symptoms including ptosis, miosis, lacrimation, and nasal congestion. Tension headaches are bilateral
and band-like. Migraines are typically pulsating and may have aura. Temporal arteritis presents with
jaw claudication and elevated ESR.
,3. The nurse practitioner is performing a cranial nerve assessment and asks the patient to protrude
the tongue. The tongue deviates to the left. Which cranial nerve is most likely affected, and on which
side?
A) Cranial nerve XII, left side
B) Cranial nerve XII, right side
C) Cranial nerve X, left side
D) Cranial nerve X, right side
Correct Answer: Cranial nerve XII, left side
Rationale: Cranial nerve XII (hypoglossal) innervates the tongue. When there is unilateral weakness,
the tongue deviates toward the side of the lesion due to unopposed action of the intact genioglossus
muscle. Cranial nerve X (vagus) affects the soft palate and uvula, not tongue protrusion.
4. A 72-year-old patient presents with a resting tremor, rigidity, bradykinesia, and postural instability.
The nurse practitioner documents a "cogwheel" type of rigidity during passive range of motion. This
finding is most characteristic of which condition?
A) Essential tremor
B) Parkinson's disease
C) Cerebellar ataxia
D) Multiple sclerosis
Correct Answer: Parkinson's disease
Rationale: Parkinson's disease classically presents with the triad of resting tremor, rigidity (often
cogwheel), and bradykinesia, along with postural instability. Essential tremor is action-based and lacks
rigidity. Cerebellar ataxia presents with intention tremor and dysmetria. Multiple sclerosis presents
with varied neurological deficits.
5. The nurse practitioner is assessing a patient with suspected meningitis. Which maneuver involves
flexing the patient's neck and observing for involuntary flexion of the hips and knees?
, A) Kernig sign
B) Brudzinski sign
C) Romberg test
D) Babinski sign
Correct Answer: Brudzinski sign
Rationale: Brudzinski sign is positive when flexion of the neck causes involuntary flexion of the hips
and knees, indicating meningeal irritation. Kernig sign is resistance to knee extension when the hip is
flexed. Romberg test assesses proprioception and cerebellar function. Babinski sign assesses
corticospinal tract integrity.
6. A 55-year-old patient reports a "band-like" pressure sensation around the entire head that is
bilateral and non-throbbing. The nurse practitioner recognizes this as most consistent with which type
of headache?
A) Tension headache
B) Migraine headache
C) Cluster headache
D) Sinus headache
Correct Answer: Tension headache
Rationale: A tension headache is typically described as a bilateral, band-like pressure or tightness
around the head without throbbing. Migraines are usually unilateral and throbbing. Cluster headaches
are severe, unilateral, and periorbital. Sinus headaches are associated with facial pain and nasal
congestion.
7. The nurse practitioner is assessing a patient's visual acuity using a Snellen chart. The patient is able
to read the line designated as 20/40. What does this indicate?
A) The patient can read at 20 feet what a person with normal vision can read at 40 feet
B) The patient can read at 40 feet what a person with normal vision can read at 20 feet
C) The patient has normal vision
