Maryville NURS 623 Exam 4 with
complete solution 2026 exam
graded A+
Course
NURS 623
1. Which finding most strongly suggests an articular source of musculoskeletal pain?
A. Pain only with active movement
B. Pain with both active and passive movement
C. Pain limited to a tendon
D. Pain only after exercise
Answer: B. Pain with both active and passive movement
Rationale: Articular disorders commonly produce pain and restricted ROM with both active and
passive movement. Crepitus, swelling, and joint-line abnormalities may also be present.
2. Which finding is most characteristic of an inflammatory musculoskeletal disorder?
A. Morning stiffness
B. Increased energy
C. Absence of swelling
D. Pain exclusively after strenuous exercise
Answer: A. Morning stiffness
Rationale: Prolonged morning stiffness is a classic feature of inflammatory joint disease and
helps distinguish inflammatory from many mechanical conditions.
3. A patient reports low-back pain radiating down the posterior leg. Which assessment
is particularly useful when lumbar radiculopathy is suspected?
A. Romberg test
B. Straight-leg raise
C. Weber test
D. Allen test
Answer: B. Straight-leg raise
Rationale: The straight-leg-raise maneuver is useful when evaluating lumbosacral nerve-root
irritation, particularly involving the lower lumbar/sacral roots.
4. Bell's palsy primarily affects which cranial nerve?
,A. CN V
B. CN VII
C. CN VIII
D. CN XII
Answer: B. CN VII
Rationale: Bell's palsy involves the facial nerve (cranial nerve VII), producing acute unilateral
facial weakness or paralysis.
5. Which presentation is most consistent with Bell's palsy?
A. Bilateral lower-extremity weakness
B. Acute unilateral facial weakness
C. Loss of sensation over the entire body
D. Bilateral hearing loss without facial changes
Answer: B. Acute unilateral facial weakness
Rationale: Bell's palsy typically presents with acute unilateral peripheral facial nerve
dysfunction. Patients may also report altered taste, postauricular discomfort, or sound sensitivity.
6. Which headache description requires the most urgent evaluation?
A. Mild headache occurring after inadequate sleep
B. Recurrent tension headache with the same pattern
C. Sudden, severe headache described as the worst headache of the patient's life
D. Mild headache relieved by hydration
Answer: C. Sudden, severe headache described as the worst headache of the patient's life
Rationale: A sudden, severe “worst headache” presentation is a red flag for potentially serious
intracranial pathology and requires urgent assessment.
7. Which patient presentation is most characteristic of a cluster headache?
A. A 45-year-old man repeatedly awakened at night by severe unilateral headaches
B. A patient with bilateral mild pressure after studying
C. A patient with headache only after missing breakfast
D. A patient with chronic shoulder pain
Answer: A. A 45-year-old man repeatedly awakened at night by severe unilateral headaches
Rationale: Cluster headaches classically occur in recurrent attacks, often at predictable times,
and are more common in men.
8. Which symptom is particularly concerning for temporal arteritis?
,A. Jaw claudication
B. Increased appetite
C. Bilateral ankle edema
D. Nasal congestion
Answer: A. Jaw claudication
Rationale: Temporal arteritis can cause new headache, scalp tenderness, jaw claudication, and
visual symptoms. Visual involvement represents an urgent concern because permanent vision
loss can occur.
9. Temporal arteritis occurs primarily in which population?
A. Children younger than 10
B. Adults younger than 20
C. Adults age 50 and older
D. Newborns
Answer: C. Adults age 50 and older
Rationale: Giant cell arteritis is predominantly a disorder of adults aged 50 years and older.
10. Which finding best distinguishes delirium from dementia?
A. Gradual progression over several years
B. Abrupt onset with fluctuating attention
C. Persistent memory impairment only
D. Progressive decline without an identifiable acute trigger
Answer: B. Abrupt onset with fluctuating attention
Rationale: Delirium typically develops rapidly, often over hours to days, and is characterized by
impaired attention and fluctuating cognition. Dementia generally develops gradually over
months to years.
11. An older adult suddenly becomes confused, restless, and inattentive after developing
a urinary infection. Which condition is most likely?
A. Alzheimer disease
B. Delirium
C. Parkinson disease
D. Chronic depression
Answer: B. Delirium
Rationale: Acute cognitive change associated with an underlying medical illness strongly
suggests delirium. Agitation and restlessness may occur in older adults with delirium.
, 12. Which feature is most consistent with dementia rather than delirium?
A. Sudden onset over several hours
B. Fluctuating attention throughout the day
C. Progressive cognitive decline over months to years
D. Acute hallucinations associated with infection
Answer: C. Progressive cognitive decline over months to years
Rationale: Dementia generally develops gradually and progressively, whereas delirium has an
acute onset and fluctuating course.
13. Which medication class is commonly initiated early in Alzheimer disease to support
cognitive function?
A. Cholinesterase inhibitors
B. Loop diuretics
C. Beta blockers
D. Bisphosphonates
Answer: A. Cholinesterase inhibitors
Rationale: Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine may be
used in appropriate patients with Alzheimer disease to provide symptomatic cognitive benefit.
14. Which finding is commonly associated with early Alzheimer disease?
A. Progressive difficulty learning and retaining new information
B. Sudden unilateral paralysis
C. Acute fever and fluctuating consciousness
D. Isolated knee pain
Answer: A. Progressive difficulty learning and retaining new information
Rationale: Early Alzheimer disease commonly affects recent memory and the ability to acquire
new information, followed by progressive impairment in other cognitive domains.
15. Which combination represents the classic cardinal features of Parkinson disease?
A. Tremor, rigidity, bradykinesia, postural instability
B. Fever, rash, cough, diarrhea
C. Aphasia, blindness, deafness, syncope
D. Edema, hypertension, tachycardia, anemia
Answer: A. Tremor, rigidity, bradykinesia, postural instability
Rationale: The classic Parkinsonian features are commonly summarized as resting tremor,
rigidity, bradykinesia/akinesia, and postural instability.
complete solution 2026 exam
graded A+
Course
NURS 623
1. Which finding most strongly suggests an articular source of musculoskeletal pain?
A. Pain only with active movement
B. Pain with both active and passive movement
C. Pain limited to a tendon
D. Pain only after exercise
Answer: B. Pain with both active and passive movement
Rationale: Articular disorders commonly produce pain and restricted ROM with both active and
passive movement. Crepitus, swelling, and joint-line abnormalities may also be present.
2. Which finding is most characteristic of an inflammatory musculoskeletal disorder?
A. Morning stiffness
B. Increased energy
C. Absence of swelling
D. Pain exclusively after strenuous exercise
Answer: A. Morning stiffness
Rationale: Prolonged morning stiffness is a classic feature of inflammatory joint disease and
helps distinguish inflammatory from many mechanical conditions.
3. A patient reports low-back pain radiating down the posterior leg. Which assessment
is particularly useful when lumbar radiculopathy is suspected?
A. Romberg test
B. Straight-leg raise
C. Weber test
D. Allen test
Answer: B. Straight-leg raise
Rationale: The straight-leg-raise maneuver is useful when evaluating lumbosacral nerve-root
irritation, particularly involving the lower lumbar/sacral roots.
4. Bell's palsy primarily affects which cranial nerve?
,A. CN V
B. CN VII
C. CN VIII
D. CN XII
Answer: B. CN VII
Rationale: Bell's palsy involves the facial nerve (cranial nerve VII), producing acute unilateral
facial weakness or paralysis.
5. Which presentation is most consistent with Bell's palsy?
A. Bilateral lower-extremity weakness
B. Acute unilateral facial weakness
C. Loss of sensation over the entire body
D. Bilateral hearing loss without facial changes
Answer: B. Acute unilateral facial weakness
Rationale: Bell's palsy typically presents with acute unilateral peripheral facial nerve
dysfunction. Patients may also report altered taste, postauricular discomfort, or sound sensitivity.
6. Which headache description requires the most urgent evaluation?
A. Mild headache occurring after inadequate sleep
B. Recurrent tension headache with the same pattern
C. Sudden, severe headache described as the worst headache of the patient's life
D. Mild headache relieved by hydration
Answer: C. Sudden, severe headache described as the worst headache of the patient's life
Rationale: A sudden, severe “worst headache” presentation is a red flag for potentially serious
intracranial pathology and requires urgent assessment.
7. Which patient presentation is most characteristic of a cluster headache?
A. A 45-year-old man repeatedly awakened at night by severe unilateral headaches
B. A patient with bilateral mild pressure after studying
C. A patient with headache only after missing breakfast
D. A patient with chronic shoulder pain
Answer: A. A 45-year-old man repeatedly awakened at night by severe unilateral headaches
Rationale: Cluster headaches classically occur in recurrent attacks, often at predictable times,
and are more common in men.
8. Which symptom is particularly concerning for temporal arteritis?
,A. Jaw claudication
B. Increased appetite
C. Bilateral ankle edema
D. Nasal congestion
Answer: A. Jaw claudication
Rationale: Temporal arteritis can cause new headache, scalp tenderness, jaw claudication, and
visual symptoms. Visual involvement represents an urgent concern because permanent vision
loss can occur.
9. Temporal arteritis occurs primarily in which population?
A. Children younger than 10
B. Adults younger than 20
C. Adults age 50 and older
D. Newborns
Answer: C. Adults age 50 and older
Rationale: Giant cell arteritis is predominantly a disorder of adults aged 50 years and older.
10. Which finding best distinguishes delirium from dementia?
A. Gradual progression over several years
B. Abrupt onset with fluctuating attention
C. Persistent memory impairment only
D. Progressive decline without an identifiable acute trigger
Answer: B. Abrupt onset with fluctuating attention
Rationale: Delirium typically develops rapidly, often over hours to days, and is characterized by
impaired attention and fluctuating cognition. Dementia generally develops gradually over
months to years.
11. An older adult suddenly becomes confused, restless, and inattentive after developing
a urinary infection. Which condition is most likely?
A. Alzheimer disease
B. Delirium
C. Parkinson disease
D. Chronic depression
Answer: B. Delirium
Rationale: Acute cognitive change associated with an underlying medical illness strongly
suggests delirium. Agitation and restlessness may occur in older adults with delirium.
, 12. Which feature is most consistent with dementia rather than delirium?
A. Sudden onset over several hours
B. Fluctuating attention throughout the day
C. Progressive cognitive decline over months to years
D. Acute hallucinations associated with infection
Answer: C. Progressive cognitive decline over months to years
Rationale: Dementia generally develops gradually and progressively, whereas delirium has an
acute onset and fluctuating course.
13. Which medication class is commonly initiated early in Alzheimer disease to support
cognitive function?
A. Cholinesterase inhibitors
B. Loop diuretics
C. Beta blockers
D. Bisphosphonates
Answer: A. Cholinesterase inhibitors
Rationale: Cholinesterase inhibitors such as donepezil, rivastigmine, and galantamine may be
used in appropriate patients with Alzheimer disease to provide symptomatic cognitive benefit.
14. Which finding is commonly associated with early Alzheimer disease?
A. Progressive difficulty learning and retaining new information
B. Sudden unilateral paralysis
C. Acute fever and fluctuating consciousness
D. Isolated knee pain
Answer: A. Progressive difficulty learning and retaining new information
Rationale: Early Alzheimer disease commonly affects recent memory and the ability to acquire
new information, followed by progressive impairment in other cognitive domains.
15. Which combination represents the classic cardinal features of Parkinson disease?
A. Tremor, rigidity, bradykinesia, postural instability
B. Fever, rash, cough, diarrhea
C. Aphasia, blindness, deafness, syncope
D. Edema, hypertension, tachycardia, anemia
Answer: A. Tremor, rigidity, bradykinesia, postural instability
Rationale: The classic Parkinsonian features are commonly summarized as resting tremor,
rigidity, bradykinesia/akinesia, and postural instability.
