NSG 3160 HEALTH ASSESSMENT -
EXAM 4 COMPREHENSIVE QUESTIONS
AND ANSWERS AND EXPLANATIONS
1. A patient presents with ‘the worst headache of my life.’ The nurse observes neck stiffness
and a positive Brudzinski sign. Which condition is most likely?
A. Tension-type headache
B. Trigeminal neuralgia
C. Subarachnoid hemorrhage
D. Cerebral palsy
Answer: C
Conceptual Explanation: A sudden, severe ‘thunderclap’ headache associated with nuchal
rigidity and meningeal signs like Brudzinski’s is a classic presentation of a subarachnoid
hemorrhage.
2. During a neurological exam, the nurse asks the patient to identify a familiar object, like a
key, placed in their hand with eyes closed. What is being tested?
A. Graphesthesia
,B. Stereognosis
C. Extinction
D. Two-point discrimination
Answer: B
Conceptual Explanation: Stereognosis is the ability to recognize an object by touch and
manipulation; it tests the sensory cortex and posterior column tract.
3. A nurse is assessing Cranial Nerve VII. Which action by the patient indicates this nerve is
intact?
A. Protruding the tongue and moving it side to side
B. Shrugging the shoulders against resistance
C. Smiling, frowning, and puffing out the cheeks
D. Clenching the teeth while the nurse palpates the masseter
Answer: C
Conceptual Explanation: Cranial Nerve VII (Facial) controls muscles of facial expression.
Tongue movement is CN XII, shrugging is CN XI, and clenching is CN V.
4. When evaluating the deep tendon reflexes of a patient, the nurse notes a very brisk
response with rhythmic oscillations (clonus). How should this be graded?
A. 1+
B. 4+
, C. 3+
D. 2+
Answer: B
Conceptual Explanation: A 4+ reflex is characterized as very brisk, hyperactive with
clonus, and is usually indicative of upper motor neuron disease.
5. The nurse performs a Romberg test. Which finding indicates a positive Romberg sign?
A. The patient demonstrates an asymmetric gait
B. The patient is unable to stand still even with eyes open
C. The patient experiences dizziness when turning the head
D. The patient maintains balance with eyes open but loses it with eyes closed
Answer: D
Conceptual Explanation: A positive Romberg sign is loss of balance when eyes are closed,
suggesting ataxia from posterior column vicariousness (loss of proprioception).
6. An elderly patient shows difficulty with rapid alternating movements, such as patting
knees with palms and backs of hands. This is known as:
A. Dysmetria
B. Ataxia
C. Aphasia
EXAM 4 COMPREHENSIVE QUESTIONS
AND ANSWERS AND EXPLANATIONS
1. A patient presents with ‘the worst headache of my life.’ The nurse observes neck stiffness
and a positive Brudzinski sign. Which condition is most likely?
A. Tension-type headache
B. Trigeminal neuralgia
C. Subarachnoid hemorrhage
D. Cerebral palsy
Answer: C
Conceptual Explanation: A sudden, severe ‘thunderclap’ headache associated with nuchal
rigidity and meningeal signs like Brudzinski’s is a classic presentation of a subarachnoid
hemorrhage.
2. During a neurological exam, the nurse asks the patient to identify a familiar object, like a
key, placed in their hand with eyes closed. What is being tested?
A. Graphesthesia
,B. Stereognosis
C. Extinction
D. Two-point discrimination
Answer: B
Conceptual Explanation: Stereognosis is the ability to recognize an object by touch and
manipulation; it tests the sensory cortex and posterior column tract.
3. A nurse is assessing Cranial Nerve VII. Which action by the patient indicates this nerve is
intact?
A. Protruding the tongue and moving it side to side
B. Shrugging the shoulders against resistance
C. Smiling, frowning, and puffing out the cheeks
D. Clenching the teeth while the nurse palpates the masseter
Answer: C
Conceptual Explanation: Cranial Nerve VII (Facial) controls muscles of facial expression.
Tongue movement is CN XII, shrugging is CN XI, and clenching is CN V.
4. When evaluating the deep tendon reflexes of a patient, the nurse notes a very brisk
response with rhythmic oscillations (clonus). How should this be graded?
A. 1+
B. 4+
, C. 3+
D. 2+
Answer: B
Conceptual Explanation: A 4+ reflex is characterized as very brisk, hyperactive with
clonus, and is usually indicative of upper motor neuron disease.
5. The nurse performs a Romberg test. Which finding indicates a positive Romberg sign?
A. The patient demonstrates an asymmetric gait
B. The patient is unable to stand still even with eyes open
C. The patient experiences dizziness when turning the head
D. The patient maintains balance with eyes open but loses it with eyes closed
Answer: D
Conceptual Explanation: A positive Romberg sign is loss of balance when eyes are closed,
suggesting ataxia from posterior column vicariousness (loss of proprioception).
6. An elderly patient shows difficulty with rapid alternating movements, such as patting
knees with palms and backs of hands. This is known as:
A. Dysmetria
B. Ataxia
C. Aphasia
