,NU 518 Exam 2 | Advanced Nursing Assessment
(2026) Q&A | University of South Alabama
1. A client is unable to identify a number traced on the palm with eyes closed. This
finding suggests dysfunction in which cortical sensory area?
A) Graphesthesia
B) Stereognosis
C) Two-point discrimination
D) Proprioception
Correct Answer: Graphesthesia
Rationale: Graphesthesia is the ability to identify numbers or letters traced on
the skin. Impairment indicates a lesion in the sensory cortex. Stereognosis
involves identifying objects by touch, two-point discrimination assesses the ability
to distinguish two simultaneous points, and proprioception is position sense.
2. Which cranial nerve is assessed by asking the client to follow a finger through
the six cardinal fields of gaze?
A) Cranial nerve III (oculomotor)
B) Cranial nerve IV (trochlear)
C) Cranial nerve VI (abducens)
D) Cranial nerves III, IV, and VI
Correct Answer: Cranial nerves III, IV, and VI
,Rationale: The six cardinal fields of gaze assess the function of cranial nerves III
(oculomotor), IV (trochlear), and VI (abducens), which together control
extraocular eye movements. Testing each nerve in isolation is not possible with
this maneuver.
3. A client’s deep tendon reflexes are graded as 4+. How should the nurse interpret
this finding?
A) Absent reflexes
B) Normal reflexes
C) Hyperactive reflexes with clonus
D) Diminished reflexes
Correct Answer: Hyperactive reflexes with clonus
Rationale: Deep tendon reflexes are graded on a scale from 0 (absent) to 4+
(hyperactive with clonus). A grade of 2+ is normal. A 4+ response suggests upper
motor neuron dysfunction and warrants further evaluation.
4. Which finding during a head and neck assessment is most concerning for a
thyroid malignancy?
A) A soft, symmetrical goiter
B) A single, hard, fixed nodule
C) Mild tenderness on palpation
D) A smooth, non-tender gland
Correct Answer: A single, hard, fixed nodule
, Rationale: A hard, fixed, solitary thyroid nodule raises suspicion for malignancy.
Soft, symmetrical goiters and mild tenderness are more often associated with
benign conditions. Any suspicious nodule warrants further evaluation with
ultrasound or biopsy.
5. A client reports a severe, unilateral headache with tearing and nasal congestion.
Which type of headache should the nurse suspect?
A) Tension headache
B) Migraine headache
C) Cluster headache
D) Sinus headache
Correct Answer: Cluster headache
Rationale: Cluster headaches cause severe unilateral orbital or temporal pain
accompanied by autonomic symptoms such as tearing, conjunctival injection, and
nasal congestion. Tension headaches are bilateral and pressing, migraines are
often pulsating with photophobia, and sinus headaches are associated with sinus
tenderness.
6. Which test assesses the integrity of the spinal accessory nerve (CN XI)?
A) Asking the client to smile
B) Asking the client to shrug the shoulders against resistance
C) Asking the client to protrude the tongue
D) Testing the gag reflex
Correct Answer: Asking the client to shrug the shoulders against resistance
(2026) Q&A | University of South Alabama
1. A client is unable to identify a number traced on the palm with eyes closed. This
finding suggests dysfunction in which cortical sensory area?
A) Graphesthesia
B) Stereognosis
C) Two-point discrimination
D) Proprioception
Correct Answer: Graphesthesia
Rationale: Graphesthesia is the ability to identify numbers or letters traced on
the skin. Impairment indicates a lesion in the sensory cortex. Stereognosis
involves identifying objects by touch, two-point discrimination assesses the ability
to distinguish two simultaneous points, and proprioception is position sense.
2. Which cranial nerve is assessed by asking the client to follow a finger through
the six cardinal fields of gaze?
A) Cranial nerve III (oculomotor)
B) Cranial nerve IV (trochlear)
C) Cranial nerve VI (abducens)
D) Cranial nerves III, IV, and VI
Correct Answer: Cranial nerves III, IV, and VI
,Rationale: The six cardinal fields of gaze assess the function of cranial nerves III
(oculomotor), IV (trochlear), and VI (abducens), which together control
extraocular eye movements. Testing each nerve in isolation is not possible with
this maneuver.
3. A client’s deep tendon reflexes are graded as 4+. How should the nurse interpret
this finding?
A) Absent reflexes
B) Normal reflexes
C) Hyperactive reflexes with clonus
D) Diminished reflexes
Correct Answer: Hyperactive reflexes with clonus
Rationale: Deep tendon reflexes are graded on a scale from 0 (absent) to 4+
(hyperactive with clonus). A grade of 2+ is normal. A 4+ response suggests upper
motor neuron dysfunction and warrants further evaluation.
4. Which finding during a head and neck assessment is most concerning for a
thyroid malignancy?
A) A soft, symmetrical goiter
B) A single, hard, fixed nodule
C) Mild tenderness on palpation
D) A smooth, non-tender gland
Correct Answer: A single, hard, fixed nodule
, Rationale: A hard, fixed, solitary thyroid nodule raises suspicion for malignancy.
Soft, symmetrical goiters and mild tenderness are more often associated with
benign conditions. Any suspicious nodule warrants further evaluation with
ultrasound or biopsy.
5. A client reports a severe, unilateral headache with tearing and nasal congestion.
Which type of headache should the nurse suspect?
A) Tension headache
B) Migraine headache
C) Cluster headache
D) Sinus headache
Correct Answer: Cluster headache
Rationale: Cluster headaches cause severe unilateral orbital or temporal pain
accompanied by autonomic symptoms such as tearing, conjunctival injection, and
nasal congestion. Tension headaches are bilateral and pressing, migraines are
often pulsating with photophobia, and sinus headaches are associated with sinus
tenderness.
6. Which test assesses the integrity of the spinal accessory nerve (CN XI)?
A) Asking the client to smile
B) Asking the client to shrug the shoulders against resistance
C) Asking the client to protrude the tongue
D) Testing the gag reflex
Correct Answer: Asking the client to shrug the shoulders against resistance
