NUR 604 FINAL EXAM 2025/2026 QUESTIONS AND
CORRECT ANSWERS GRADED A+ SUMMER-FALL
CHAMBERLAIN
A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden
onset of pain after lifting a set of boxes that were heavier than usual. He also states that he has
numbness and tingling in the left leg. He wants to know if he needs to be off of work. What test
should you perform to assess for a herniated disc?
leg length test
straight leg raise test
Tinel's test
Phelan's test
Straight leg raise test
The straight leg raise test involves having the patient lie supine with the examiner raising the leg.
If the patient experiences a sharp pain radiating from the back down the leg in an L5 or S1
distribution, that suggests the presence of a herniated disc.
A 37-year-old woman is brought into your emergency room comatose. The paramedics say her
husband found her unconscious in her home. Her past medical history consists of type 1 diabetes
and she is on insulin shots. In the ambulance the paramedics obtained a glucose check and her
sugar was 15 (normal is 70 to 105). They began a dextrose saline infusion and intubated her to
protect her airway. Despite their efforts she is posturing in the emergency room with her arms
straight at her side and her jaw clenched. Her legs are also straight and her feet are plantar
flexed.What type of posturing is she showing?
,decorticate rigidity
decerebrate rigidity
Decerebrate rigidity
In this type of rigidity the jaws are clenched and the neck is extended. The arms are adducted and
stiffly extended at the elbows with forearms pronated and wrists and fingers flexed. The legs are
stiffly extended at the knees with the feet plantar flexed. This posture occurs with lesions in the
diencephalon, midbrain, or pons. It can also be seen with severe metabolic disorder such as
hypoxia or hypoglycemia, such as in this case.
A 48-year-old grocery store manager comes to your clinic complaining of her head being "stuck"
to one side. She says that today she was doing her normal routine when it suddenly felt like her
head was being moved to her left and then it just stuck that way. She says it is somewhat painful
because she cannot get it moved back to normal. She denies any recent neck trauma. Her past
medical history consists of type 2 diabetes and gastroparesis (slow-moving peristalsis in the
digestive tract, seen in diabetes). She is on oral medication for each. She is married with three
children. She denies tobacco, alcohol, or drug use. Her father has diabetes and her mother passed
away from breast cancer. Her children are healthy. On exam you see a slightly overweight
Hispanic woman appearing her stated age. Her head is twisted grotesquely to her left but
otherwise her exam is normal. What form of involuntary movement does she hav
Dystonia
Dystonia involves large movements of the body, such as with the head or trunk, leading to
grotesque twisted postures. Some medications (such as one often used for gastroparesis) often
cause dystonia.
,A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims
for 30 minutes daily, early in the morning. He notes a sharp, catching pain and a sensation of
something grating when he tries overhead movements of his arm. On physical examination, you
note tenderness just below the tip of the acromion in the area of the tendon insertions. The drop
arm test is negative, and there is no limitation with shoulder shrug. The patient is not holding his
arm close to his side, and there is no tenderness to palpation in the bicipital groove when the arm
is at the patient's side, flexed to 90 degrees, and then supinated against resistance. Based on this
description, what is the most likely cause of his shoulder pain?
rotator cuff tendonitis
rotator cuff tear
calcific tendonitis
bicipital tendonitis
Rotator cuff tendonitis
Rotator cuff tendinitis is typically precipitated by repetitive motions, such as occurs with
throwing or swimming. Crepitus/grating is noted in the shoulder with range of motion.
A 37-year-old insurance agent comes to your office complaining of trembling hands. She says
that for the past 3 months when she tries to use her hands to fix her hair or cook they shake
badly. She says she doesn't feel particularly nervous when this occurs but she worries that other
people will think she has an anxiety disorder or that she's a drinker. She admits to having some
recent fatigue, trouble with vision, and difficulty maintaining bladder control. Her past medical
history is remarkable for hypothyroidism. Her mother has lupus and her father is healthy. She
has an older brother with type1 diabetes. She is married with three children. She denies tobacco,
, alcohol, or drug use. On exam, when she tries to reach for a pencil to fill out the health form she
has obvious tremors in her dominant hand.What type of tremor is she most likely to have?
Intention tremor
This is seen in cerebellar disease (stroke or alcohol use) or in multiple sclerosis. This patient's
tremor, fatigue, bladder problems, and visual problems are suggestive of multiple sclerosis.
A 77-year-old retired school superintendent comes to your office complaining of unsteady hands.
He says that for the past 6 months when his hands are resting in his lap they shake
uncontrollably. He says when he holds them out in front of his body the shaking improves and
when he uses his hands the shaking is also better. He also complains of some difficulty getting
up out of his chair and walking around. His past medical history is significant for high blood
pressure and coronary artery disease, requiring a stent in the past. He has been married for over
50 years and has five children and twelve grandchildren. He denies any tobacco, alcohol, or drug
use. On exam you see a fine pill-rolling tremor of his left hand. His right shows less movement.
His cranial nerve exam is normal. He has some difficulty rising from his chair, his gait is slow,
and it takes him time to turn around to walk back towards you. What type of
Resting tremor
Resting tremors occur when the hands are literally at rest, such as sitting in the lap. These are
slow, fine tremors, such as the pill rolling seen in Parkinson's disease, which this patient most
likely has.
A 41-year-old real estate agent comes to your office complaining that he feels like his face is
paralyzed on the left. He states that last week he felt his left eyelid was drowsy and as the day
progressed he was unable to close his eyelid all the way. Later he felt like his smile became
affected also. He denies any recent injuries but had an upper respiratory viral infection last
month. His past medical history is unremarkable. He is divorced with one child. He smokes one
pack of cigarettes a day, occasionally drinks alcohol, and denies any illegal drug use. His mother
has high blood pressure and his father has sarcoidosis. On exam you see ask him to close his
eyes. He is unable to close his left eye. You ask him to open his eyes and raise his eyebrows. His
CORRECT ANSWERS GRADED A+ SUMMER-FALL
CHAMBERLAIN
A 32-year-old warehouse worker presents for evaluation of low back pain. He notes a sudden
onset of pain after lifting a set of boxes that were heavier than usual. He also states that he has
numbness and tingling in the left leg. He wants to know if he needs to be off of work. What test
should you perform to assess for a herniated disc?
leg length test
straight leg raise test
Tinel's test
Phelan's test
Straight leg raise test
The straight leg raise test involves having the patient lie supine with the examiner raising the leg.
If the patient experiences a sharp pain radiating from the back down the leg in an L5 or S1
distribution, that suggests the presence of a herniated disc.
A 37-year-old woman is brought into your emergency room comatose. The paramedics say her
husband found her unconscious in her home. Her past medical history consists of type 1 diabetes
and she is on insulin shots. In the ambulance the paramedics obtained a glucose check and her
sugar was 15 (normal is 70 to 105). They began a dextrose saline infusion and intubated her to
protect her airway. Despite their efforts she is posturing in the emergency room with her arms
straight at her side and her jaw clenched. Her legs are also straight and her feet are plantar
flexed.What type of posturing is she showing?
,decorticate rigidity
decerebrate rigidity
Decerebrate rigidity
In this type of rigidity the jaws are clenched and the neck is extended. The arms are adducted and
stiffly extended at the elbows with forearms pronated and wrists and fingers flexed. The legs are
stiffly extended at the knees with the feet plantar flexed. This posture occurs with lesions in the
diencephalon, midbrain, or pons. It can also be seen with severe metabolic disorder such as
hypoxia or hypoglycemia, such as in this case.
A 48-year-old grocery store manager comes to your clinic complaining of her head being "stuck"
to one side. She says that today she was doing her normal routine when it suddenly felt like her
head was being moved to her left and then it just stuck that way. She says it is somewhat painful
because she cannot get it moved back to normal. She denies any recent neck trauma. Her past
medical history consists of type 2 diabetes and gastroparesis (slow-moving peristalsis in the
digestive tract, seen in diabetes). She is on oral medication for each. She is married with three
children. She denies tobacco, alcohol, or drug use. Her father has diabetes and her mother passed
away from breast cancer. Her children are healthy. On exam you see a slightly overweight
Hispanic woman appearing her stated age. Her head is twisted grotesquely to her left but
otherwise her exam is normal. What form of involuntary movement does she hav
Dystonia
Dystonia involves large movements of the body, such as with the head or trunk, leading to
grotesque twisted postures. Some medications (such as one often used for gastroparesis) often
cause dystonia.
,A 68-year-old retired banker comes to your clinic for evaluation of left shoulder pain. He swims
for 30 minutes daily, early in the morning. He notes a sharp, catching pain and a sensation of
something grating when he tries overhead movements of his arm. On physical examination, you
note tenderness just below the tip of the acromion in the area of the tendon insertions. The drop
arm test is negative, and there is no limitation with shoulder shrug. The patient is not holding his
arm close to his side, and there is no tenderness to palpation in the bicipital groove when the arm
is at the patient's side, flexed to 90 degrees, and then supinated against resistance. Based on this
description, what is the most likely cause of his shoulder pain?
rotator cuff tendonitis
rotator cuff tear
calcific tendonitis
bicipital tendonitis
Rotator cuff tendonitis
Rotator cuff tendinitis is typically precipitated by repetitive motions, such as occurs with
throwing or swimming. Crepitus/grating is noted in the shoulder with range of motion.
A 37-year-old insurance agent comes to your office complaining of trembling hands. She says
that for the past 3 months when she tries to use her hands to fix her hair or cook they shake
badly. She says she doesn't feel particularly nervous when this occurs but she worries that other
people will think she has an anxiety disorder or that she's a drinker. She admits to having some
recent fatigue, trouble with vision, and difficulty maintaining bladder control. Her past medical
history is remarkable for hypothyroidism. Her mother has lupus and her father is healthy. She
has an older brother with type1 diabetes. She is married with three children. She denies tobacco,
, alcohol, or drug use. On exam, when she tries to reach for a pencil to fill out the health form she
has obvious tremors in her dominant hand.What type of tremor is she most likely to have?
Intention tremor
This is seen in cerebellar disease (stroke or alcohol use) or in multiple sclerosis. This patient's
tremor, fatigue, bladder problems, and visual problems are suggestive of multiple sclerosis.
A 77-year-old retired school superintendent comes to your office complaining of unsteady hands.
He says that for the past 6 months when his hands are resting in his lap they shake
uncontrollably. He says when he holds them out in front of his body the shaking improves and
when he uses his hands the shaking is also better. He also complains of some difficulty getting
up out of his chair and walking around. His past medical history is significant for high blood
pressure and coronary artery disease, requiring a stent in the past. He has been married for over
50 years and has five children and twelve grandchildren. He denies any tobacco, alcohol, or drug
use. On exam you see a fine pill-rolling tremor of his left hand. His right shows less movement.
His cranial nerve exam is normal. He has some difficulty rising from his chair, his gait is slow,
and it takes him time to turn around to walk back towards you. What type of
Resting tremor
Resting tremors occur when the hands are literally at rest, such as sitting in the lap. These are
slow, fine tremors, such as the pill rolling seen in Parkinson's disease, which this patient most
likely has.
A 41-year-old real estate agent comes to your office complaining that he feels like his face is
paralyzed on the left. He states that last week he felt his left eyelid was drowsy and as the day
progressed he was unable to close his eyelid all the way. Later he felt like his smile became
affected also. He denies any recent injuries but had an upper respiratory viral infection last
month. His past medical history is unremarkable. He is divorced with one child. He smokes one
pack of cigarettes a day, occasionally drinks alcohol, and denies any illegal drug use. His mother
has high blood pressure and his father has sarcoidosis. On exam you see ask him to close his
eyes. He is unable to close his left eye. You ask him to open his eyes and raise his eyebrows. His
