NSG 121 Health Assessment Exam 4 Study Blueprint 2026 | Herzing University | Latest Update |
Graded A+
Unit 11 – Assessment of the Neurologic System
Expected effect of neurological damage
a. Cerebral Cortex: motor and sensory function:
a. The frontal lobe is responsible for complex cognition (orientation, memory, insight,
judgment, arithmetic, and abstraction), language (verbal and written), and voluntary motor
function. It integrates this cognitive function with emotional responses, personality, impulse
control, and social behavior. The motor function area is located at the foot of the frontal
lobe.
b. The parietal lobe recognizes the size, shape, and texture of objects and interprets touch,
pressure, and pain. The sensory areas re located at the front of the parietal lobe.
i. Language is processed in the Wernicke area (located in the parietal lobe of the left
hemisphere) and the Broca area (located in the frontal lobe).
ii. The Wernicke area integrates understanding of spoken and written words, whereas
the Broca area regulates verbal expression and writing ability.
iii. Patients with a stroke in the brain’s left hemisphere are more likely to have language
deficits. Damage to the Wernicke area may lead to difficulty understanding verbal
communication, called receptive aphasia. Damage to the Broca area causes
problems with speaking or finding words, called expressive aphasia. Global aphasia
is both expressive and receptive.
c. The occipital lobe at the back of the brain is the primary visual area, with visual associative
areas that interpret and integrate stimuli.
d. The temporal lobe registers auditory input and is responsible for hearing, speech, behavior,
and memory.
e. Basal ganglia modulate automatic movement
f. Thalamus is major relay station and gatekeeper for motor and sensory stimuli
g. Hypothalamus controls vital functions of temp, HR, BP, sleep, pituitary, autonomic, and
emotions.
b. Brainstem
a. integral to intact neurological functioning.
b. The brainstem includes the medulla, midbrain, pons, and reticular formation. The cell
bodies of cranial nerves (CNs) III–XII are in the medulla, which also contains the vital
autonomic centers for respiratory, cardiac, and vasomotor function
c. The medulla works with the pons to regulate smooth breathing rhythm. The medulla also
controls involuntary functions, such as sneezing, swallowing, vomiting, hiccoughing, and
coughing.
c. Cerebellum
a. coordinates voluntary movement, posture, and muscle tone and maintains special
orientation and equilibrium. It ensures adjustments in movement to maintain overall balance
and coordination through connections to the motor cortex, brainstem, and neurological
pathways. It integrates information from the cerebral cortex, inner ear, muscles, and joints.
The cerebellum rests against the opening at the base of the skull known as the foramen
magnum. Alcohol intake can affect the cerebellum, causing the characteristic loss of balance
and coordination.
d. Spinal cord
a. ascending tracts generally carry specific sensory information from the periphery to higher
levels of the CNS. Input from sensory receptors in the skin, organs, and muscles travels
through the peripheral nerves to the dorsal root of the spinal nerve and into the spinal cord.
These dorsal columns (also called posterior columns) carry information about localized
touch (stereognosis), deep pressure, vibration, position sense (proprioception), and
movement (kinesthesia)
, b. When half of the spinal cord is severed (e.g., by a gunshot wound), the patient may
experience Brown-Séquard syndrome sensory loss. Manifestations include loss of pain and
temperature sensation on the opposite side of the injury because these fibers cross the spinal
cord. Localized touch, deep pressure, vibration, position sense, and movement remain on
the same side of the body because these fibers cross the medulla.
c. descending tracts carry information related to motor function and muscle movement. They
control voluntary movement, carrying impulses from the cortex to the cranial (corticobulbar
tract) and peripheral (corticospinal tract) nerves
d. extrapyramidal tract originates in the reticular formation and is modulated by the brainstem,
basal ganglia, and cerebellum. It travels down and synapses in the ventral root of the spinal
cord; however, it does not directly innervate the peripheral motor system. This tract controls
gross automatic movements, such as reflexes, walking, complex movements, and postural
control.
Neurological changes in aging
a. Normal: aging, even when free from dementia, is associated with structural brain changes. The
major changes have been noted in the frontal and temporal cortexes as well as in the putamen,
thalamus, and nucleus accumbens.
b. The reduction in brain volume that occurs in healthy aging is most likely related to the shrinkage
of neurons and reduction in the number of synaptic spines and synapses.
c. Changes in the CNS can reduce cognitive abilities, such as processing speed, executive function,
episodic memory, reduced response to stimuli, delayed reflexes, decreased ability to respond to
multiple stimuli, and the ability to manage multiple tasks at the same time.
d. Peripheral nerve function and impulse conduction decrease, causing decreased proprioception
and potential for a Parkinson-like gait. Thus, older adults are at risk for poor balance, postural
hypotension, falls, and injury. Light touch and pain sensation are reduced, with ischemic
paresthesia common in the extremities.
e. Overall cognitive function with aging varies greatly depending on overall lifestyle choices and
heredity. Additionally, the size of the ventricles holding the CSF expands in healthy aging. This
may cause hydrocephalus with symptoms of headaches, vision problems, irritability, fatigue,
personality change, loss of coordination, difficulty in waking up or staying awake, a return of
walking difficulties, mild dementia, or incontinence.
f. Abnormal
Stroke Risk Factors
a. Modifiable
a. high BP, smoking, diabetes mellitus, diet high in fat and cholesterol, physical inactivity,
obesity, high cholesterol, carotid artery disease, peripheral arterial disease, atrial
fibrillation, heart disease, and sickle cell disease
b. Nonmodifiable
a. age, sex, race-ethnicity and genetics
Neurological Symptoms
• Headache or other pain
• Weakness of single limb or one side of body
• Generalized weakness
• Involuntary movements or tremors
• Difficulty with balance, coordination, or gait
• Dizziness or vertigo
• Difficulty swallowing
• Change in intellectual abilities
• Difficulties with expression or comprehension of speech/language
• Alteration in touch, taste, or smell
• Loss or blurring of vision in one or both eyes, diplopia (double vision)
, • Hearing loss or tinnitus (ringing in the ears)
Communication and Brain Damage
a. Broca’s Area
a. The Broca area regulates verbal expression and writing ability. (frontal)
b. Damage to the Broca area causes problems with speaking or finding words, called
expressive aphasia.
b. Wenicke’s Area
a. The Wernicke area integrates understanding of spoken and written words (left parietal
lobe)
b. Damage to the Wernicke area may lead to difficulty understanding verbal
communication, called receptive aphasia
c. Patients with a stroke in the brain’s left hemisphere are more likely to have language deficits.
Global aphasia is both expressive and receptive.
Assessment of LOC
First arouse the patient by speech, then by touch, and finally by pressure to the nail beds
Order of Stimulation Example
Spontaneous Enter room and observe arousal.
Normal voice State patient’s name; ask him or her to open eyes.
Loud voice Use loud voice if no response to normal voice.
Tactile (touch) Touch patient’s shoulder or arm lightly.
Noxious stimulation Apply nail bed pressure to elicit pain response, telling patient that you
(pain) will be applying pressure.
Neurological Assessment: Basic and Advanced.
Cranial Nerve Assessment
Cranial Nerve Technique
I. Olfactory Tell the patient to close the eyes, place a familiar scent near the open nostril,
and ask the patient to inhale and identify the scent. Repeat on the opposite side.
II. Optic Monitor while working with the patient. Ask him or her to identify how many
fingers you are holding up. Use the Snellen chart to evaluate far vision and near
vision with small print. Test visual fields using confrontation.
III. Oculomotor, Assess pupils for size, shape, and equality. Assess the six cardinal positions of
V. trochlear gaze. Observe for nystagmus in one or both eyes
VI. abducens
V. Trigeminal Evaluate sensory function by touch and motor function with movement. To
evaluate the sensory component, ask the patient to close the eyes. Using a
cotton swab and broken tongue blade or swab, ask the patient to identify sharp
Graded A+
Unit 11 – Assessment of the Neurologic System
Expected effect of neurological damage
a. Cerebral Cortex: motor and sensory function:
a. The frontal lobe is responsible for complex cognition (orientation, memory, insight,
judgment, arithmetic, and abstraction), language (verbal and written), and voluntary motor
function. It integrates this cognitive function with emotional responses, personality, impulse
control, and social behavior. The motor function area is located at the foot of the frontal
lobe.
b. The parietal lobe recognizes the size, shape, and texture of objects and interprets touch,
pressure, and pain. The sensory areas re located at the front of the parietal lobe.
i. Language is processed in the Wernicke area (located in the parietal lobe of the left
hemisphere) and the Broca area (located in the frontal lobe).
ii. The Wernicke area integrates understanding of spoken and written words, whereas
the Broca area regulates verbal expression and writing ability.
iii. Patients with a stroke in the brain’s left hemisphere are more likely to have language
deficits. Damage to the Wernicke area may lead to difficulty understanding verbal
communication, called receptive aphasia. Damage to the Broca area causes
problems with speaking or finding words, called expressive aphasia. Global aphasia
is both expressive and receptive.
c. The occipital lobe at the back of the brain is the primary visual area, with visual associative
areas that interpret and integrate stimuli.
d. The temporal lobe registers auditory input and is responsible for hearing, speech, behavior,
and memory.
e. Basal ganglia modulate automatic movement
f. Thalamus is major relay station and gatekeeper for motor and sensory stimuli
g. Hypothalamus controls vital functions of temp, HR, BP, sleep, pituitary, autonomic, and
emotions.
b. Brainstem
a. integral to intact neurological functioning.
b. The brainstem includes the medulla, midbrain, pons, and reticular formation. The cell
bodies of cranial nerves (CNs) III–XII are in the medulla, which also contains the vital
autonomic centers for respiratory, cardiac, and vasomotor function
c. The medulla works with the pons to regulate smooth breathing rhythm. The medulla also
controls involuntary functions, such as sneezing, swallowing, vomiting, hiccoughing, and
coughing.
c. Cerebellum
a. coordinates voluntary movement, posture, and muscle tone and maintains special
orientation and equilibrium. It ensures adjustments in movement to maintain overall balance
and coordination through connections to the motor cortex, brainstem, and neurological
pathways. It integrates information from the cerebral cortex, inner ear, muscles, and joints.
The cerebellum rests against the opening at the base of the skull known as the foramen
magnum. Alcohol intake can affect the cerebellum, causing the characteristic loss of balance
and coordination.
d. Spinal cord
a. ascending tracts generally carry specific sensory information from the periphery to higher
levels of the CNS. Input from sensory receptors in the skin, organs, and muscles travels
through the peripheral nerves to the dorsal root of the spinal nerve and into the spinal cord.
These dorsal columns (also called posterior columns) carry information about localized
touch (stereognosis), deep pressure, vibration, position sense (proprioception), and
movement (kinesthesia)
, b. When half of the spinal cord is severed (e.g., by a gunshot wound), the patient may
experience Brown-Séquard syndrome sensory loss. Manifestations include loss of pain and
temperature sensation on the opposite side of the injury because these fibers cross the spinal
cord. Localized touch, deep pressure, vibration, position sense, and movement remain on
the same side of the body because these fibers cross the medulla.
c. descending tracts carry information related to motor function and muscle movement. They
control voluntary movement, carrying impulses from the cortex to the cranial (corticobulbar
tract) and peripheral (corticospinal tract) nerves
d. extrapyramidal tract originates in the reticular formation and is modulated by the brainstem,
basal ganglia, and cerebellum. It travels down and synapses in the ventral root of the spinal
cord; however, it does not directly innervate the peripheral motor system. This tract controls
gross automatic movements, such as reflexes, walking, complex movements, and postural
control.
Neurological changes in aging
a. Normal: aging, even when free from dementia, is associated with structural brain changes. The
major changes have been noted in the frontal and temporal cortexes as well as in the putamen,
thalamus, and nucleus accumbens.
b. The reduction in brain volume that occurs in healthy aging is most likely related to the shrinkage
of neurons and reduction in the number of synaptic spines and synapses.
c. Changes in the CNS can reduce cognitive abilities, such as processing speed, executive function,
episodic memory, reduced response to stimuli, delayed reflexes, decreased ability to respond to
multiple stimuli, and the ability to manage multiple tasks at the same time.
d. Peripheral nerve function and impulse conduction decrease, causing decreased proprioception
and potential for a Parkinson-like gait. Thus, older adults are at risk for poor balance, postural
hypotension, falls, and injury. Light touch and pain sensation are reduced, with ischemic
paresthesia common in the extremities.
e. Overall cognitive function with aging varies greatly depending on overall lifestyle choices and
heredity. Additionally, the size of the ventricles holding the CSF expands in healthy aging. This
may cause hydrocephalus with symptoms of headaches, vision problems, irritability, fatigue,
personality change, loss of coordination, difficulty in waking up or staying awake, a return of
walking difficulties, mild dementia, or incontinence.
f. Abnormal
Stroke Risk Factors
a. Modifiable
a. high BP, smoking, diabetes mellitus, diet high in fat and cholesterol, physical inactivity,
obesity, high cholesterol, carotid artery disease, peripheral arterial disease, atrial
fibrillation, heart disease, and sickle cell disease
b. Nonmodifiable
a. age, sex, race-ethnicity and genetics
Neurological Symptoms
• Headache or other pain
• Weakness of single limb or one side of body
• Generalized weakness
• Involuntary movements or tremors
• Difficulty with balance, coordination, or gait
• Dizziness or vertigo
• Difficulty swallowing
• Change in intellectual abilities
• Difficulties with expression or comprehension of speech/language
• Alteration in touch, taste, or smell
• Loss or blurring of vision in one or both eyes, diplopia (double vision)
, • Hearing loss or tinnitus (ringing in the ears)
Communication and Brain Damage
a. Broca’s Area
a. The Broca area regulates verbal expression and writing ability. (frontal)
b. Damage to the Broca area causes problems with speaking or finding words, called
expressive aphasia.
b. Wenicke’s Area
a. The Wernicke area integrates understanding of spoken and written words (left parietal
lobe)
b. Damage to the Wernicke area may lead to difficulty understanding verbal
communication, called receptive aphasia
c. Patients with a stroke in the brain’s left hemisphere are more likely to have language deficits.
Global aphasia is both expressive and receptive.
Assessment of LOC
First arouse the patient by speech, then by touch, and finally by pressure to the nail beds
Order of Stimulation Example
Spontaneous Enter room and observe arousal.
Normal voice State patient’s name; ask him or her to open eyes.
Loud voice Use loud voice if no response to normal voice.
Tactile (touch) Touch patient’s shoulder or arm lightly.
Noxious stimulation Apply nail bed pressure to elicit pain response, telling patient that you
(pain) will be applying pressure.
Neurological Assessment: Basic and Advanced.
Cranial Nerve Assessment
Cranial Nerve Technique
I. Olfactory Tell the patient to close the eyes, place a familiar scent near the open nostril,
and ask the patient to inhale and identify the scent. Repeat on the opposite side.
II. Optic Monitor while working with the patient. Ask him or her to identify how many
fingers you are holding up. Use the Snellen chart to evaluate far vision and near
vision with small print. Test visual fields using confrontation.
III. Oculomotor, Assess pupils for size, shape, and equality. Assess the six cardinal positions of
V. trochlear gaze. Observe for nystagmus in one or both eyes
VI. abducens
V. Trigeminal Evaluate sensory function by touch and motor function with movement. To
evaluate the sensory component, ask the patient to close the eyes. Using a
cotton swab and broken tongue blade or swab, ask the patient to identify sharp
