NURS 5220 – Advanced Health Assessment
Exam 2 Questions and Answers
University of Texas at Arlington (UTA)
1. During a cranial nerve exam, the nurse practitioner asks the patient to identify the
smell of coffee with eyes closed. Which cranial nerve is being tested?
A. CN I – Olfactory
B. CN II – Optic
C. CN V – Trigeminal
D. CN VII – Facial
Answer: A. CN I – Olfactory
Rationale: CN I (olfactory) is tested by having the patient identify familiar, non-irritating
odors (coffee, vanilla, soap) with eyes closed and one nostril occluded at a time. CN V
can sense irritants like ammonia but not discriminate true smell.
2. A patient reads 20/40 on the Snellen chart with the right eye. Which cranial nerve
function is primarily being assessed?
A. CN II – visual acuity
B. CN III – pupillary constriction
C. CN IV – extraocular movement
D. CN VI – lateral gaze
Answer: A. CN II – visual acuity
Rationale: The Snellen chart tests central visual acuity, a function of CN II (optic nerve). A
result of 20/40 means the patient sees at 20 feet what a person with normal vision sees
at 40 feet, indicating reduced acuity.
3. The examiner tests peripheral vision by having the patient look straight ahead while
a finger is moved in from the periphery in each quadrant. This assesses:
A. CN II visual fields by confrontation
B. CN III accommodation
C. CN VI abduction
D. CN VII visual reflex
Answer: A. CN II visual fields by confrontation
Rationale: Confrontation visual field testing evaluates CN II by comparing the patient's
peripheral field to the examiner's own (presumed normal) field in each of the four
quadrants.
,4. A patient is asked to follow the examiner's finger through the six cardinal fields of
gaze in an 'H' pattern. This maneuver simultaneously tests which cranial nerves?
A. CN III, IV, and VI
B. CN II and III only
C. CN V and VII
D. CN VIII and XI
Answer: A. CN III, IV, and VI
Rationale: The cardinal fields of gaze test the oculomotor (III), trochlear (IV), and
abducens (VI) nerves, which together control the six extraocular muscles responsible for
coordinated eye movement.
5. On penlight exam, both pupils constrict when light is shone into the right eye alone.
This is documented as a normal:
A. Direct and consensual pupillary response
B. Accommodation reflex
C. Corneal reflex
D. Oculocephalic reflex
Answer: A. Direct and consensual pupillary response
Rationale: Shining light in one eye should cause direct constriction of that pupil and
consensual (simultaneous) constriction of the opposite pupil via CN II afferent and CN III
efferent pathways, confirming intact pupillary reflex arcs.
6. To test both motor and sensory components of CN V, the nurse practitioner should:
A. Palpate the masseter and temporalis while the patient clenches the teeth, then
test light touch over the forehead, cheek, and jaw
B. Ask the patient to smile and puff out the cheeks
C. Test the gag reflex bilaterally
D. Have the patient shrug the shoulders against resistance
Answer: A. Palpate the masseter and temporalis while the patient clenches the teeth,
then test light touch over the forehead, cheek, and jaw
Rationale: CN V (trigeminal) has a motor branch (muscles of mastication, tested by
palpating the masseter/temporalis during clenching) and three sensory divisions
(ophthalmic, maxillary, mandibular) tested with light touch across the forehead, cheek,
and jaw.
7. Touching the cornea lightly with a wisp of cotton produces a blink response. This
tests the afferent limb of which cranial nerve and efferent limb of which cranial nerve?
, A. Afferent CN V, efferent CN VII
B. Afferent CN VII, efferent CN V
C. Afferent CN II, efferent CN III
D. Afferent CN IX, efferent CN X
Answer: A. Afferent CN V, efferent CN VII
Rationale: The corneal reflex has sensory input via CN V (ophthalmic division) and motor
output (eyelid closure) via CN VII (facial nerve). Loss of this reflex may indicate CN V or
CN VII dysfunction.
8. A patient cannot wrinkle the forehead on the left side but can still close both eyes
tightly and smile symmetrically otherwise. This pattern is most consistent with:
A. A central (upper motor neuron) facial lesion, sparing the forehead
B. Peripheral Bell's palsy affecting the entire left face
C. CN V motor lesion
D. CN VIII lesion
Answer: A. A central (upper motor neuron) facial lesion, sparing the forehead
Rationale: The forehead receives bilateral cortical innervation, so a central (UMN) lesion,
such as a stroke, spares forehead wrinkling while causing lower facial weakness. A
peripheral CN VII lesion (Bell's palsy) affects the entire face including the forehead.
9. During otoscopic and balance assessment, the nurse practitioner is evaluating
hearing and equilibrium, functions carried by which cranial nerve?
A. CN VIII – Vestibulocochlear
B. CN VII – Facial
C. CN IX – Glossopharyngeal
D. CN XI – Accessory
Answer: A. CN VIII – Vestibulocochlear
Rationale: CN VIII has two divisions: the cochlear branch for hearing and the vestibular
branch for balance/equilibrium. Weber and Rinne tuning fork tests evaluate the cochlear
branch.
10. When the posterior pharynx is stimulated with a tongue blade, the soft palate
rises symmetrically and the patient gags. Which cranial nerves mediate this reflex?
A. CN IX (afferent) and CN X (efferent)
B. CN VII and CN XII
C. CN V and CN XI
D. CN III and CN VI
, Answer: A. CN IX (afferent) and CN X (efferent)
Rationale: The gag reflex depends on CN IX (glossopharyngeal) for sensory input from
the pharynx and CN X (vagus) for motor output causing symmetric elevation of the soft
palate and uvula.
11. Asked to shrug the shoulders against resistance and turn the head against
resistance, the patient demonstrates weakness on the right. This tests:
A. CN XI – Spinal accessory
B. CN X – Vagus
C. CN XII – Hypoglossal
D. CN IX – Glossopharyngeal
Answer: A. CN XI – Spinal accessory
Rationale: CN XI innervates the trapezius (shoulder shrug) and sternocleidomastoid
(head rotation). Weakness with these maneuvers suggests spinal accessory nerve
dysfunction.
12. On protrusion, the patient's tongue deviates to the left with visible atrophy and
fasciculations on that side. This indicates a lesion of:
A. The left CN XII (hypoglossal nerve)
B. The right CN XII (hypoglossal nerve)
C. CN X bilaterally
D. CN VII peripheral branch
Answer: A. The left CN XII (hypoglossal nerve)
Rationale: The tongue deviates toward the side of a peripheral (LMN) hypoglossal nerve
lesion because the unopposed genioglossus muscle on the healthy side pushes it that
direction. Atrophy and fasciculations confirm a peripheral nerve process.
13. Striking the biceps tendon with a reflex hammer while the examiner's thumb is
placed over the tendon elicits forearm flexion. This reflex corresponds to which spinal
nerve roots?
A. C5–C6
B. C7–C8
C. L2–L4
D. S1–S2
Answer: A. C5–C6
Rationale: The biceps reflex tests the musculocutaneous nerve and spinal levels C5–C6. It
is commonly remembered with the mnemonic 'ankle S1-2, knee L3-4, biceps C5-6, triceps
C7-8.'
Exam 2 Questions and Answers
University of Texas at Arlington (UTA)
1. During a cranial nerve exam, the nurse practitioner asks the patient to identify the
smell of coffee with eyes closed. Which cranial nerve is being tested?
A. CN I – Olfactory
B. CN II – Optic
C. CN V – Trigeminal
D. CN VII – Facial
Answer: A. CN I – Olfactory
Rationale: CN I (olfactory) is tested by having the patient identify familiar, non-irritating
odors (coffee, vanilla, soap) with eyes closed and one nostril occluded at a time. CN V
can sense irritants like ammonia but not discriminate true smell.
2. A patient reads 20/40 on the Snellen chart with the right eye. Which cranial nerve
function is primarily being assessed?
A. CN II – visual acuity
B. CN III – pupillary constriction
C. CN IV – extraocular movement
D. CN VI – lateral gaze
Answer: A. CN II – visual acuity
Rationale: The Snellen chart tests central visual acuity, a function of CN II (optic nerve). A
result of 20/40 means the patient sees at 20 feet what a person with normal vision sees
at 40 feet, indicating reduced acuity.
3. The examiner tests peripheral vision by having the patient look straight ahead while
a finger is moved in from the periphery in each quadrant. This assesses:
A. CN II visual fields by confrontation
B. CN III accommodation
C. CN VI abduction
D. CN VII visual reflex
Answer: A. CN II visual fields by confrontation
Rationale: Confrontation visual field testing evaluates CN II by comparing the patient's
peripheral field to the examiner's own (presumed normal) field in each of the four
quadrants.
,4. A patient is asked to follow the examiner's finger through the six cardinal fields of
gaze in an 'H' pattern. This maneuver simultaneously tests which cranial nerves?
A. CN III, IV, and VI
B. CN II and III only
C. CN V and VII
D. CN VIII and XI
Answer: A. CN III, IV, and VI
Rationale: The cardinal fields of gaze test the oculomotor (III), trochlear (IV), and
abducens (VI) nerves, which together control the six extraocular muscles responsible for
coordinated eye movement.
5. On penlight exam, both pupils constrict when light is shone into the right eye alone.
This is documented as a normal:
A. Direct and consensual pupillary response
B. Accommodation reflex
C. Corneal reflex
D. Oculocephalic reflex
Answer: A. Direct and consensual pupillary response
Rationale: Shining light in one eye should cause direct constriction of that pupil and
consensual (simultaneous) constriction of the opposite pupil via CN II afferent and CN III
efferent pathways, confirming intact pupillary reflex arcs.
6. To test both motor and sensory components of CN V, the nurse practitioner should:
A. Palpate the masseter and temporalis while the patient clenches the teeth, then
test light touch over the forehead, cheek, and jaw
B. Ask the patient to smile and puff out the cheeks
C. Test the gag reflex bilaterally
D. Have the patient shrug the shoulders against resistance
Answer: A. Palpate the masseter and temporalis while the patient clenches the teeth,
then test light touch over the forehead, cheek, and jaw
Rationale: CN V (trigeminal) has a motor branch (muscles of mastication, tested by
palpating the masseter/temporalis during clenching) and three sensory divisions
(ophthalmic, maxillary, mandibular) tested with light touch across the forehead, cheek,
and jaw.
7. Touching the cornea lightly with a wisp of cotton produces a blink response. This
tests the afferent limb of which cranial nerve and efferent limb of which cranial nerve?
, A. Afferent CN V, efferent CN VII
B. Afferent CN VII, efferent CN V
C. Afferent CN II, efferent CN III
D. Afferent CN IX, efferent CN X
Answer: A. Afferent CN V, efferent CN VII
Rationale: The corneal reflex has sensory input via CN V (ophthalmic division) and motor
output (eyelid closure) via CN VII (facial nerve). Loss of this reflex may indicate CN V or
CN VII dysfunction.
8. A patient cannot wrinkle the forehead on the left side but can still close both eyes
tightly and smile symmetrically otherwise. This pattern is most consistent with:
A. A central (upper motor neuron) facial lesion, sparing the forehead
B. Peripheral Bell's palsy affecting the entire left face
C. CN V motor lesion
D. CN VIII lesion
Answer: A. A central (upper motor neuron) facial lesion, sparing the forehead
Rationale: The forehead receives bilateral cortical innervation, so a central (UMN) lesion,
such as a stroke, spares forehead wrinkling while causing lower facial weakness. A
peripheral CN VII lesion (Bell's palsy) affects the entire face including the forehead.
9. During otoscopic and balance assessment, the nurse practitioner is evaluating
hearing and equilibrium, functions carried by which cranial nerve?
A. CN VIII – Vestibulocochlear
B. CN VII – Facial
C. CN IX – Glossopharyngeal
D. CN XI – Accessory
Answer: A. CN VIII – Vestibulocochlear
Rationale: CN VIII has two divisions: the cochlear branch for hearing and the vestibular
branch for balance/equilibrium. Weber and Rinne tuning fork tests evaluate the cochlear
branch.
10. When the posterior pharynx is stimulated with a tongue blade, the soft palate
rises symmetrically and the patient gags. Which cranial nerves mediate this reflex?
A. CN IX (afferent) and CN X (efferent)
B. CN VII and CN XII
C. CN V and CN XI
D. CN III and CN VI
, Answer: A. CN IX (afferent) and CN X (efferent)
Rationale: The gag reflex depends on CN IX (glossopharyngeal) for sensory input from
the pharynx and CN X (vagus) for motor output causing symmetric elevation of the soft
palate and uvula.
11. Asked to shrug the shoulders against resistance and turn the head against
resistance, the patient demonstrates weakness on the right. This tests:
A. CN XI – Spinal accessory
B. CN X – Vagus
C. CN XII – Hypoglossal
D. CN IX – Glossopharyngeal
Answer: A. CN XI – Spinal accessory
Rationale: CN XI innervates the trapezius (shoulder shrug) and sternocleidomastoid
(head rotation). Weakness with these maneuvers suggests spinal accessory nerve
dysfunction.
12. On protrusion, the patient's tongue deviates to the left with visible atrophy and
fasciculations on that side. This indicates a lesion of:
A. The left CN XII (hypoglossal nerve)
B. The right CN XII (hypoglossal nerve)
C. CN X bilaterally
D. CN VII peripheral branch
Answer: A. The left CN XII (hypoglossal nerve)
Rationale: The tongue deviates toward the side of a peripheral (LMN) hypoglossal nerve
lesion because the unopposed genioglossus muscle on the healthy side pushes it that
direction. Atrophy and fasciculations confirm a peripheral nerve process.
13. Striking the biceps tendon with a reflex hammer while the examiner's thumb is
placed over the tendon elicits forearm flexion. This reflex corresponds to which spinal
nerve roots?
A. C5–C6
B. C7–C8
C. L2–L4
D. S1–S2
Answer: A. C5–C6
Rationale: The biceps reflex tests the musculocutaneous nerve and spinal levels C5–C6. It
is commonly remembered with the mnemonic 'ankle S1-2, knee L3-4, biceps C5-6, triceps
C7-8.'
