Q&A | Rasmussen College
1. Which assessment is performed first when evaluating a patient's neurological status?
A) Cranial nerve testing
B) Deep tendon reflexes
C) Level of consciousness
D) Sensory discrimination
Correct Answer: Level of consciousness
Rationale: Level of consciousness is the most critical and first component of the
neurological examination because changes often signal early neurological deterioration.
Cranial nerve testing, reflexes, and sensory discrimination are important but are assessed
after consciousness and orientation are established.
2. A patient opens eyes spontaneously, is confused in conversation, and localizes pain. What
Glasgow Coma Scale score should the nurse document?
A) 11
B) 12
C) 14
D) 15
Correct Answer: 14
Rationale: Spontaneous eye opening is 4, confused conversation is 4, and localizing pain
is 5, totaling 14. A score of 11 would indicate lower responses, 12 would undercount, and
15 would require oriented conversation.
,3. Which term describes a patient who requires painful stimulation to arouse and cannot
communicate meaningfully when awakened?
A) Lethargic
B) Obtunded
C) Stuporous
D) Comatose
Correct Answer: Stuporous
Rationale: Stupor is a state in which the patient responds only to painful or vigorous
stimulation and cannot communicate meaningfully when aroused. Lethargy involves
drowsiness with minimal stimulation, obtundation involves reduced alertness with
vigorous stimulation but some interaction, and coma involves unresponsiveness even to
pain.
4. A patient correctly states their name and location but cannot identify the current year.
How should the nurse document orientation?
A) Oriented to person and place; disoriented to time
B) Oriented to person, place, and time
C) Disoriented to person and place
D) Fully oriented to all spheres
Correct Answer: Oriented to person and place; disoriented to time
Rationale: Orientation is assessed across person, place, time, and situation. Correctly
identifying name and location but not the year indicates orientation to person and place
with disorientation to time. Documenting full orientation or disorientation to person and
place would be inaccurate.
, 5. Which question best assesses a patient's recent memory during the interview?
A) "What is your date of birth?"
B) "What did you eat for breakfast today?"
C) "Who was the first president?"
D) "What is your mother's maiden name?"
Correct Answer: "What did you eat for breakfast today?"
Rationale: Recent memory involves information acquired within hours to days, such as
meals or recent events. Date of birth, a historical president, and a mother's maiden name
assess remote memory rather than recent memory.
6. Which task primarily evaluates attention and concentration?
A) Naming a familiar object
B) Repeating a series of digits backward
C) Identifying a smell
D) Testing the gag reflex
Correct Answer: Repeating a series of digits backward
Rationale: Repeating digits backward requires sustained attention, working memory, and
concentration. Naming objects assesses language, smell identification assesses cranial
nerve I, and the gag reflex assesses cranial nerves IX and X.
7. A patient cannot follow a three-step command despite adequate hearing and strength.
Which finding should the nurse consider?
A) Possible cognitive impairment