,West Coast University NURS 190 Module Exam 4 | Physical Assessment
(2026) Q&A
1. A patient exhibits a positive Romberg sign. Which systems are primarily responsible for
maintaining balance during this test?
A) Extrapyramidal system and motor cortex
B) Cerebellar system, vestibular system, and vision
C) Spinothalamic tract and medulla
D) Reticular activating system and midbrain
Correct Answer: Cerebellar system, vestibular system, and vision
Rationale: The Romberg test assesses the ability of the vestibular apparatus in the inner
ear to help maintain standing balance, along with proprioception and vision. A positive
Romberg sign indicates a loss of balance when the eyes are closed, suggesting ataxia or
sensory issues, which significantly increases fall risk. The other options do not accurately
represent the systems responsible for maintaining balance during this test.
2. During a neurological assessment, the nurse asks the patient to identify a common object,
such as a key, placed in their hand while their eyes are closed. This test is evaluating which of
the following?
A) Graphesthesia
B) Extinction phenomena
C) Stereognosis
D) Two-point discrimination
Correct Answer: Stereognosis
Rationale: Stereognosis is the ability to recognize objects by feeling their form, size, and
weight while the eyes are closed. Graphesthesia is the ability to read a number or letter
traced on the skin. Two-point discrimination assesses the ability to distinguish two points.
Extinction phenomena is a neurological finding related to neglect.
,3. Which cranial nerve is being assessed when the nurse asks the patient to shrug their
shoulders against resistance?
A) Cranial Nerve IX
B) Cranial Nerve X
C) Cranial Nerve XII
D) Cranial Nerve XI
Correct Answer: Cranial Nerve XI
Rationale: The Spinal Accessory nerve (CN XI) innervates the trapezius and sternomastoid
muscles used for shoulder shrugging and head turning. CN IX is the glossopharyngeal nerve,
CN X is the vagus nerve, and CN XII is the hypoglossal nerve. Testing shoulder shrug against
resistance specifically assesses CN XI.
4. A patient presents with a shuffling gait and a pill-rolling tremor. Which area of the brain is
most likely affected?
A) Cerebral cortex
B) Occipital lobe
C) Parietal lobe
D) Basal ganglia
Correct Answer: Basal ganglia
Rationale: Parkinsonian symptoms like shuffling gait and pill-rolling tremors are associated
with dysfunction in the basal ganglia and a deficiency of dopamine. The cerebral cortex,
occipital lobe, and parietal lobe are not primarily associated with these specific motor
findings. Recognizing these symptoms helps identify basal ganglia dysfunction.
5. When testing deep tendon reflexes, the nurse notes a very brisk response with clonus.
How should this be documented?
A) 1+
B) 2+
, C) 3+
D) 4+
Correct Answer: 4+
Rationale: A 4+ reflex is very brisk, hyperactive, and often indicative of upper motor
neuron disease; it is frequently associated with clonus. A 2+ reflex is considered normal. A
1+ reflex is diminished, and a 3+ reflex is brisker than average but not necessarily abnormal.
Clonus is the key finding that indicates a 4+ reflex.
6. To evaluate the function of Cranial Nerve V (Trigeminal), what action should the nurse
take?
A) Ask the patient to puff out their cheeks
B) Palpate the temporal and masseter muscles as the patient clenches their teeth
C) Check for the presence of a gag reflex
D) Assess for lateral gaze using the six cardinal fields
Correct Answer: Palpate the temporal and masseter muscles as the patient clenches their
teeth
Rationale: CN V has motor functions involving the muscles of mastication; clenching the
teeth allows the nurse to feel these muscles. Puffing out cheeks assesses CN VII. Checking
the gag reflex assesses CN IX and X. Lateral gaze assesses CN VI. Palpating the temporal and
masseter muscles is the specific technique for CN V.
7. An elderly patient has difficulty with rapid alternating movements during a neuro exam.
This finding suggests a problem with which area?
A) Frontal lobe integration
B) Cerebellar function
C) Temporal lobe processing
D) Sensory perception
Correct Answer: Cerebellar function
(2026) Q&A
1. A patient exhibits a positive Romberg sign. Which systems are primarily responsible for
maintaining balance during this test?
A) Extrapyramidal system and motor cortex
B) Cerebellar system, vestibular system, and vision
C) Spinothalamic tract and medulla
D) Reticular activating system and midbrain
Correct Answer: Cerebellar system, vestibular system, and vision
Rationale: The Romberg test assesses the ability of the vestibular apparatus in the inner
ear to help maintain standing balance, along with proprioception and vision. A positive
Romberg sign indicates a loss of balance when the eyes are closed, suggesting ataxia or
sensory issues, which significantly increases fall risk. The other options do not accurately
represent the systems responsible for maintaining balance during this test.
2. During a neurological assessment, the nurse asks the patient to identify a common object,
such as a key, placed in their hand while their eyes are closed. This test is evaluating which of
the following?
A) Graphesthesia
B) Extinction phenomena
C) Stereognosis
D) Two-point discrimination
Correct Answer: Stereognosis
Rationale: Stereognosis is the ability to recognize objects by feeling their form, size, and
weight while the eyes are closed. Graphesthesia is the ability to read a number or letter
traced on the skin. Two-point discrimination assesses the ability to distinguish two points.
Extinction phenomena is a neurological finding related to neglect.
,3. Which cranial nerve is being assessed when the nurse asks the patient to shrug their
shoulders against resistance?
A) Cranial Nerve IX
B) Cranial Nerve X
C) Cranial Nerve XII
D) Cranial Nerve XI
Correct Answer: Cranial Nerve XI
Rationale: The Spinal Accessory nerve (CN XI) innervates the trapezius and sternomastoid
muscles used for shoulder shrugging and head turning. CN IX is the glossopharyngeal nerve,
CN X is the vagus nerve, and CN XII is the hypoglossal nerve. Testing shoulder shrug against
resistance specifically assesses CN XI.
4. A patient presents with a shuffling gait and a pill-rolling tremor. Which area of the brain is
most likely affected?
A) Cerebral cortex
B) Occipital lobe
C) Parietal lobe
D) Basal ganglia
Correct Answer: Basal ganglia
Rationale: Parkinsonian symptoms like shuffling gait and pill-rolling tremors are associated
with dysfunction in the basal ganglia and a deficiency of dopamine. The cerebral cortex,
occipital lobe, and parietal lobe are not primarily associated with these specific motor
findings. Recognizing these symptoms helps identify basal ganglia dysfunction.
5. When testing deep tendon reflexes, the nurse notes a very brisk response with clonus.
How should this be documented?
A) 1+
B) 2+
, C) 3+
D) 4+
Correct Answer: 4+
Rationale: A 4+ reflex is very brisk, hyperactive, and often indicative of upper motor
neuron disease; it is frequently associated with clonus. A 2+ reflex is considered normal. A
1+ reflex is diminished, and a 3+ reflex is brisker than average but not necessarily abnormal.
Clonus is the key finding that indicates a 4+ reflex.
6. To evaluate the function of Cranial Nerve V (Trigeminal), what action should the nurse
take?
A) Ask the patient to puff out their cheeks
B) Palpate the temporal and masseter muscles as the patient clenches their teeth
C) Check for the presence of a gag reflex
D) Assess for lateral gaze using the six cardinal fields
Correct Answer: Palpate the temporal and masseter muscles as the patient clenches their
teeth
Rationale: CN V has motor functions involving the muscles of mastication; clenching the
teeth allows the nurse to feel these muscles. Puffing out cheeks assesses CN VII. Checking
the gag reflex assesses CN IX and X. Lateral gaze assesses CN VI. Palpating the temporal and
masseter muscles is the specific technique for CN V.
7. An elderly patient has difficulty with rapid alternating movements during a neuro exam.
This finding suggests a problem with which area?
A) Frontal lobe integration
B) Cerebellar function
C) Temporal lobe processing
D) Sensory perception
Correct Answer: Cerebellar function
