NUR 634 FINAL EXAM NEWEST ACTUAL EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
|ALREADY GRADED A+(REAL DEAL)
1. A patient with a known T4 spinal cord injury suddenly becomes flushed, diaphoretic above
the nipple line, and complains of a pounding headache. The nurse practitioner recognizes
these symptoms as indicative of:
A) Spinal shock
B) A migraine headache
C) Malignant hyperthermia
D) Autonomic dysreflexia
E) A seizure
Correct Answer: D) Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a medical emergency common in patients with spinal cord
injuries at or above the T6 level. It is a massive, uncoordinated autonomic response to a
noxious stimulus below the level of the injury (such as a full bladder or bowel), leading to
severe hypertension, flushing, and sweating above the injury level.
2. To assess for cerebellar function and coordination, which of the following tests would be
most appropriate?
A) Testing the patellar deep tendon reflex
B) Asking the patient to perform the finger-to-nose test
C) Performing the Romberg test
D) Assessing for a positive Kernig's sign
E) Checking the pupillary light reflex
Correct Answer: B) Asking the patient to perform the finger-to-nose test
Rationale: The cerebellum is responsible for coordinating movement, precision, and timing.
The finger-to-nose, heel-to-shin, and rapid alternating movement tests are specific maneuvers
to assess for dysmetria (inability to judge distance) and dysdiadochokinesia (inability to
perform rapid alternating movements), which are classic signs of cerebellar dysfunction.
,3. A nurse practitioner asks a patient to stand with their feet together and eyes closed. The
patient begins to sway and loses their balance. This finding is a positive Romberg test and
indicates a problem with:
A) Cerebellar function
B) Corticospinal tract integrity
C) Proprioception
D) Lower motor neuron function
E) Vestibular function
Correct Answer: C) Proprioception
Rationale: The Romberg test assesses the function of the dorsal columns of the spinal cord,
which are responsible for proprioception (the sense of one's body position in space). With
eyes open, a person can use vision to compensate for a proprioceptive deficit. When the eyes
are closed, this compensation is removed, revealing the instability.
4. Which of the following is NOT a common symptom associated with Parkinson's disease?
A) Resting tremor
B) Bradykinesia
C) Cogwheel rigidity
D) Intention tremor
E) Postural instability
Correct Answer: D) Intention tremor
Rationale: Parkinson's disease is characterized by a "pill-rolling" resting tremor that decreases
with voluntary movement. An intention tremor, which worsens as a person gets closer to a
target, is a hallmark sign of cerebellar disease, not Parkinson's.
5. A nurse practitioner is assessing for meningeal irritation. The provider flexes the supine
patient's hip and knee and then attempts to straighten the leg. The patient experiences pain
in the lower back and resistance to extension. This is a positive:
A) Brudzinski's sign
B) Romberg test
C) Straight leg raise test
,D) Kernig's sign
E) Homan's sign
Correct Answer: D) Kernig's sign
Rationale: Kernig's sign is a test for meningitis. The inflammation of the meninges causes
irritation of the spinal nerve roots. Stretching these nerve roots by attempting to extend the
flexed leg elicits pain and hamstring muscle spasm, resulting in a positive sign.
6. To assess the function of Cranial Nerve XI (Spinal Accessory Nerve), the nurse practitioner
should ask the patient to:
A) Stick out their tongue and move it side to side.
B) Swallow a sip of water.
C) Shrug their shoulders against resistance.
D) Smile, frown, and puff out their cheeks.
E) Follow the provider's finger with their eyes.
Correct Answer: C) Shrug their shoulders against resistance.
Rationale: Cranial Nerve XI innervates the trapezius and sternocleidomastoid muscles. Testing
the strength of these muscles by having the patient shrug their shoulders (trapezius) and turn
their head against resistance (sternocleidomastoid) is the standard method for assessing this
nerve.
7. A patient who has had a stroke is able to follow written commands and understand what is
said to them, but they struggle to find the right words to speak. This condition is known as:
A) Dysarthria
B) Receptive aphasia
C) Anomia
D) Expressive aphasia
E) Agnosia
Correct Answer: D) Expressive aphasia
Rationale: Expressive aphasia, also known as Broca's aphasia, is characterized by intact
comprehension but impaired speech production. Patients know what they want to say but
, have difficulty forming fluent sentences. This is distinct from receptive (Wernicke's) aphasia,
where comprehension is impaired.
8. The Glasgow Coma Scale (GCS) is used to assess a patient's level of consciousness by
evaluating which three components?
A) Pupillary response, motor response, verbal response
B) Eye opening, motor response, verbal response
C) Orientation, memory, motor response
D) Eye opening, pupillary response, orientation
E) Verbal response, memory, attention
Correct Answer: B) Eye opening, motor response, verbal response
Rationale: The GCS provides a standardized, objective score of a patient's level of
consciousness. It is based on a 15-point scale that sums the scores from three categories: eye
opening (4 points), best verbal response (5 points), and best motor response (6 points).
9. A patient is unable to identify a pen placed in their hand with their eyes closed. What is the
correct term for this finding?
A) Ataxia
B) Agnosia
C) Aphasia
D) Apraxia
E) Anisocoria
Correct Answer: B) Agnosia
Rationale: Agnosia is the inability to recognize objects, people, or other sensory inputs despite
intact sensory function. Specifically, the inability to identify an object by touch is called
astereognosis, which is a form of tactile agnosia.
10. When a provider asks a patient to explain the meaning of the proverb "People who live in
glass houses shouldn't throw stones," they are assessing:
A) Judgment
B) Insight
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES
|ALREADY GRADED A+(REAL DEAL)
1. A patient with a known T4 spinal cord injury suddenly becomes flushed, diaphoretic above
the nipple line, and complains of a pounding headache. The nurse practitioner recognizes
these symptoms as indicative of:
A) Spinal shock
B) A migraine headache
C) Malignant hyperthermia
D) Autonomic dysreflexia
E) A seizure
Correct Answer: D) Autonomic dysreflexia
Rationale: Autonomic dysreflexia is a medical emergency common in patients with spinal cord
injuries at or above the T6 level. It is a massive, uncoordinated autonomic response to a
noxious stimulus below the level of the injury (such as a full bladder or bowel), leading to
severe hypertension, flushing, and sweating above the injury level.
2. To assess for cerebellar function and coordination, which of the following tests would be
most appropriate?
A) Testing the patellar deep tendon reflex
B) Asking the patient to perform the finger-to-nose test
C) Performing the Romberg test
D) Assessing for a positive Kernig's sign
E) Checking the pupillary light reflex
Correct Answer: B) Asking the patient to perform the finger-to-nose test
Rationale: The cerebellum is responsible for coordinating movement, precision, and timing.
The finger-to-nose, heel-to-shin, and rapid alternating movement tests are specific maneuvers
to assess for dysmetria (inability to judge distance) and dysdiadochokinesia (inability to
perform rapid alternating movements), which are classic signs of cerebellar dysfunction.
,3. A nurse practitioner asks a patient to stand with their feet together and eyes closed. The
patient begins to sway and loses their balance. This finding is a positive Romberg test and
indicates a problem with:
A) Cerebellar function
B) Corticospinal tract integrity
C) Proprioception
D) Lower motor neuron function
E) Vestibular function
Correct Answer: C) Proprioception
Rationale: The Romberg test assesses the function of the dorsal columns of the spinal cord,
which are responsible for proprioception (the sense of one's body position in space). With
eyes open, a person can use vision to compensate for a proprioceptive deficit. When the eyes
are closed, this compensation is removed, revealing the instability.
4. Which of the following is NOT a common symptom associated with Parkinson's disease?
A) Resting tremor
B) Bradykinesia
C) Cogwheel rigidity
D) Intention tremor
E) Postural instability
Correct Answer: D) Intention tremor
Rationale: Parkinson's disease is characterized by a "pill-rolling" resting tremor that decreases
with voluntary movement. An intention tremor, which worsens as a person gets closer to a
target, is a hallmark sign of cerebellar disease, not Parkinson's.
5. A nurse practitioner is assessing for meningeal irritation. The provider flexes the supine
patient's hip and knee and then attempts to straighten the leg. The patient experiences pain
in the lower back and resistance to extension. This is a positive:
A) Brudzinski's sign
B) Romberg test
C) Straight leg raise test
,D) Kernig's sign
E) Homan's sign
Correct Answer: D) Kernig's sign
Rationale: Kernig's sign is a test for meningitis. The inflammation of the meninges causes
irritation of the spinal nerve roots. Stretching these nerve roots by attempting to extend the
flexed leg elicits pain and hamstring muscle spasm, resulting in a positive sign.
6. To assess the function of Cranial Nerve XI (Spinal Accessory Nerve), the nurse practitioner
should ask the patient to:
A) Stick out their tongue and move it side to side.
B) Swallow a sip of water.
C) Shrug their shoulders against resistance.
D) Smile, frown, and puff out their cheeks.
E) Follow the provider's finger with their eyes.
Correct Answer: C) Shrug their shoulders against resistance.
Rationale: Cranial Nerve XI innervates the trapezius and sternocleidomastoid muscles. Testing
the strength of these muscles by having the patient shrug their shoulders (trapezius) and turn
their head against resistance (sternocleidomastoid) is the standard method for assessing this
nerve.
7. A patient who has had a stroke is able to follow written commands and understand what is
said to them, but they struggle to find the right words to speak. This condition is known as:
A) Dysarthria
B) Receptive aphasia
C) Anomia
D) Expressive aphasia
E) Agnosia
Correct Answer: D) Expressive aphasia
Rationale: Expressive aphasia, also known as Broca's aphasia, is characterized by intact
comprehension but impaired speech production. Patients know what they want to say but
, have difficulty forming fluent sentences. This is distinct from receptive (Wernicke's) aphasia,
where comprehension is impaired.
8. The Glasgow Coma Scale (GCS) is used to assess a patient's level of consciousness by
evaluating which three components?
A) Pupillary response, motor response, verbal response
B) Eye opening, motor response, verbal response
C) Orientation, memory, motor response
D) Eye opening, pupillary response, orientation
E) Verbal response, memory, attention
Correct Answer: B) Eye opening, motor response, verbal response
Rationale: The GCS provides a standardized, objective score of a patient's level of
consciousness. It is based on a 15-point scale that sums the scores from three categories: eye
opening (4 points), best verbal response (5 points), and best motor response (6 points).
9. A patient is unable to identify a pen placed in their hand with their eyes closed. What is the
correct term for this finding?
A) Ataxia
B) Agnosia
C) Aphasia
D) Apraxia
E) Anisocoria
Correct Answer: B) Agnosia
Rationale: Agnosia is the inability to recognize objects, people, or other sensory inputs despite
intact sensory function. Specifically, the inability to identify an object by touch is called
astereognosis, which is a form of tactile agnosia.
10. When a provider asks a patient to explain the meaning of the proverb "People who live in
glass houses shouldn't throw stones," they are assessing:
A) Judgment
B) Insight
