NUR 631 Advanced Health Assessment
Exam 4 ACTUAL EXAM 2026/2027 |
NUR631 | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Neurologic System (20 Questions)
Q1: During a neurologic examination, you ask a patient to close their eyes and then you
lightly touch a cotton wisp to the left cheek, then the right cheek, and then both cheeks
simultaneously. The patient reports feeling only the left and right touches but not the
simultaneous touch. What does this finding suggest?
A. Peripheral neuropathy of the trigeminal nerve
B. Normal sensory examination
C. Extinction phenomenon suggesting contralateral parietal lobe lesion [CORRECT]
D. Ipsilateral thalamic stroke
Rationale: The correct finding is extinction to double simultaneous stimulation, which
indicates a lesion in the contralateral parietal lobe (typically right parietal lobe causing
left-sided extinction). This is not a normal finding, as a normal patient would report both
touches. The phenomenon of extinction is a key cortical sensory sign that distinguishes
peripheral from central causes of sensory loss.
Q2: A 68-year-old male presents with sudden onset right-sided weakness and aphasia.
During cranial nerve examination, you notice his right nasolabial fold is flattened and he
cannot puff out his left cheek. Which cranial nerve is affected and what type of lesion is
this?
A. Right facial nerve (CN VII) peripheral lesion
B. Left facial nerve (CN VII) central lesion [CORRECT]
,C. Left trigeminal nerve (CN V) motor lesion
D. Right trigeminal nerve (CN V) sensory lesion
Rationale: The correct answer is a central lesion of the left facial nerve. Central lesions
(upper motor neuron) affect the lower face contralaterally because the upper face
receives bilateral cortical innervation. The patient has right lower facial weakness
(flattened nasolabial fold) but can still wrinkle forehead (bilateral innervation spared). A
peripheral lesion would affect the entire ipsilateral face including forehead. The
trigeminal nerve controls mastication, not facial expression.
Q3: When testing deep tendon reflexes, you note that the patellar reflex is brisk with
clonus (3-4 beats). The Achilles reflex is 2+. What is the grade of the patellar reflex?
A. 1+ (diminished)
B. 2+ (normal)
C. 3+ (brisk without clonus)
D. 4+ (clonus present, hyperreflexia) [CORRECT]
Rationale: The correct grading is 4+ because clonus is present. Deep tendon reflexes are
graded 0 (absent) to 4+ (clonus). Clonus indicates hyperreflexia due to loss of inhibitory
upper motor neuron influence. Three-plus is brisk but without clonus. One-plus is
diminished or requires reinforcement. Two-plus is normal.
Q4: A patient has loss of proprioception and vibration sense in the lower extremities but
intact pain and temperature sensation. Where is the lesion located?
A. Lateral spinothalamic tract
B. Dorsal columns [CORRECT]
C. Anterior horn cells
D. Corticospinal tract
Rationale: The correct localization is the dorsal columns, which carry proprioception,
vibration, and fine touch. The spinothalamic tract (carrying pain and temperature) is
,spared, creating a dissociated sensory loss pattern. This is seen in tabes dorsalis
(syphilis), vitamin B12 deficiency, and multiple sclerosis. Lateral spinothalamic tract
lesions cause contralateral pain/temperature loss. Anterior horn cell lesions cause lower
motor neuron signs. Corticospinal tract lesions cause weakness.
Q5: During a stroke assessment using the NIH Stroke Scale, you ask a patient to hold
both arms outstretched with palms up for 10 seconds. The left arm drifts down and
pronates. What does this indicate?
A. Left cerebellar lesion
B. Right corticospinal tract lesion [CORRECT]
C. Left peripheral nerve injury
D. Normal finding in elderly patients
Rationale: The correct interpretation is a right corticospinal tract lesion causing left arm
weakness and pronator drift. Upper motor neuron lesions cause pronation of the
forearm when arms are held supinated due to relative weakness of supinators.
Cerebellar lesions cause intention tremor or past-pointing, not pronator drift. Peripheral
nerve injuries cause specific patterns, not generalized drift. This is never normal.
Q6: You are testing extraocular movements and note that when the patient looks to the
right, the left eye does not adduct. Convergence is intact. Where is the lesion?
A. Left abducens nerve (CN VI)
B. Right abducens nerve (CN VI)
C. Left medial longitudinal fasciculus (MLF) [CORRECT]
D. Right oculomotor nerve (CN III)
Rationale: The correct localization is the left medial longitudinal fasciculus causing
internuclear ophthalmoplegia (INO). The MLF connects CN VI nucleus (ipsilateral) to CN
III nucleus (contralateral) for conjugate gaze. In left INO, the left eye cannot adduct on
right gaze but adducts with convergence (differentiating from CN III palsy). Right CN VI
, lesion would prevent right eye abduction. Left CN VI lesion would prevent left eye
abduction, not adduction.
Q7: A 55-year-old female reports numbness and tingling in her right thumb, index, and
middle fingers that wakes her at night. Which provocative test is most specific for carpal
tunnel syndrome?
A. Tinel sign at the elbow
B. Phalen maneuver [CORRECT]
C. Spurling test
D. Straight leg raise
Rationale: The correct test is the Phalen maneuver (wrist flexion for 60 seconds), which
reproduces median nerve symptoms in carpal tunnel syndrome. Tinel sign at the wrist
(not elbow) is also used but less specific. Spurling test is for cervical radiculopathy.
Straight leg raise is for lumbar radiculopathy. The distribution described is classic
median nerve territory.
Q8: During sensory examination, you map a sensory deficit to the lateral aspect of the
forearm and thumb. This corresponds to which dermatome?
A. C5
B. C6 [CORRECT]
C. C7
D. C8
Rationale: The correct dermatome is C6, which supplies the lateral forearm, thumb, and
index finger. C5 supplies the lateral arm. C7 supplies the middle finger and posterior
forearm. C8 supplies the medial forearm and little finger. Dermatomal mapping helps
differentiate peripheral nerve from nerve root lesions.
Exam 4 ACTUAL EXAM 2026/2027 |
NUR631 | Verified Q&A | Pass
Guaranteed - A+ Graded
Section 1: Neurologic System (20 Questions)
Q1: During a neurologic examination, you ask a patient to close their eyes and then you
lightly touch a cotton wisp to the left cheek, then the right cheek, and then both cheeks
simultaneously. The patient reports feeling only the left and right touches but not the
simultaneous touch. What does this finding suggest?
A. Peripheral neuropathy of the trigeminal nerve
B. Normal sensory examination
C. Extinction phenomenon suggesting contralateral parietal lobe lesion [CORRECT]
D. Ipsilateral thalamic stroke
Rationale: The correct finding is extinction to double simultaneous stimulation, which
indicates a lesion in the contralateral parietal lobe (typically right parietal lobe causing
left-sided extinction). This is not a normal finding, as a normal patient would report both
touches. The phenomenon of extinction is a key cortical sensory sign that distinguishes
peripheral from central causes of sensory loss.
Q2: A 68-year-old male presents with sudden onset right-sided weakness and aphasia.
During cranial nerve examination, you notice his right nasolabial fold is flattened and he
cannot puff out his left cheek. Which cranial nerve is affected and what type of lesion is
this?
A. Right facial nerve (CN VII) peripheral lesion
B. Left facial nerve (CN VII) central lesion [CORRECT]
,C. Left trigeminal nerve (CN V) motor lesion
D. Right trigeminal nerve (CN V) sensory lesion
Rationale: The correct answer is a central lesion of the left facial nerve. Central lesions
(upper motor neuron) affect the lower face contralaterally because the upper face
receives bilateral cortical innervation. The patient has right lower facial weakness
(flattened nasolabial fold) but can still wrinkle forehead (bilateral innervation spared). A
peripheral lesion would affect the entire ipsilateral face including forehead. The
trigeminal nerve controls mastication, not facial expression.
Q3: When testing deep tendon reflexes, you note that the patellar reflex is brisk with
clonus (3-4 beats). The Achilles reflex is 2+. What is the grade of the patellar reflex?
A. 1+ (diminished)
B. 2+ (normal)
C. 3+ (brisk without clonus)
D. 4+ (clonus present, hyperreflexia) [CORRECT]
Rationale: The correct grading is 4+ because clonus is present. Deep tendon reflexes are
graded 0 (absent) to 4+ (clonus). Clonus indicates hyperreflexia due to loss of inhibitory
upper motor neuron influence. Three-plus is brisk but without clonus. One-plus is
diminished or requires reinforcement. Two-plus is normal.
Q4: A patient has loss of proprioception and vibration sense in the lower extremities but
intact pain and temperature sensation. Where is the lesion located?
A. Lateral spinothalamic tract
B. Dorsal columns [CORRECT]
C. Anterior horn cells
D. Corticospinal tract
Rationale: The correct localization is the dorsal columns, which carry proprioception,
vibration, and fine touch. The spinothalamic tract (carrying pain and temperature) is
,spared, creating a dissociated sensory loss pattern. This is seen in tabes dorsalis
(syphilis), vitamin B12 deficiency, and multiple sclerosis. Lateral spinothalamic tract
lesions cause contralateral pain/temperature loss. Anterior horn cell lesions cause lower
motor neuron signs. Corticospinal tract lesions cause weakness.
Q5: During a stroke assessment using the NIH Stroke Scale, you ask a patient to hold
both arms outstretched with palms up for 10 seconds. The left arm drifts down and
pronates. What does this indicate?
A. Left cerebellar lesion
B. Right corticospinal tract lesion [CORRECT]
C. Left peripheral nerve injury
D. Normal finding in elderly patients
Rationale: The correct interpretation is a right corticospinal tract lesion causing left arm
weakness and pronator drift. Upper motor neuron lesions cause pronation of the
forearm when arms are held supinated due to relative weakness of supinators.
Cerebellar lesions cause intention tremor or past-pointing, not pronator drift. Peripheral
nerve injuries cause specific patterns, not generalized drift. This is never normal.
Q6: You are testing extraocular movements and note that when the patient looks to the
right, the left eye does not adduct. Convergence is intact. Where is the lesion?
A. Left abducens nerve (CN VI)
B. Right abducens nerve (CN VI)
C. Left medial longitudinal fasciculus (MLF) [CORRECT]
D. Right oculomotor nerve (CN III)
Rationale: The correct localization is the left medial longitudinal fasciculus causing
internuclear ophthalmoplegia (INO). The MLF connects CN VI nucleus (ipsilateral) to CN
III nucleus (contralateral) for conjugate gaze. In left INO, the left eye cannot adduct on
right gaze but adducts with convergence (differentiating from CN III palsy). Right CN VI
, lesion would prevent right eye abduction. Left CN VI lesion would prevent left eye
abduction, not adduction.
Q7: A 55-year-old female reports numbness and tingling in her right thumb, index, and
middle fingers that wakes her at night. Which provocative test is most specific for carpal
tunnel syndrome?
A. Tinel sign at the elbow
B. Phalen maneuver [CORRECT]
C. Spurling test
D. Straight leg raise
Rationale: The correct test is the Phalen maneuver (wrist flexion for 60 seconds), which
reproduces median nerve symptoms in carpal tunnel syndrome. Tinel sign at the wrist
(not elbow) is also used but less specific. Spurling test is for cervical radiculopathy.
Straight leg raise is for lumbar radiculopathy. The distribution described is classic
median nerve territory.
Q8: During sensory examination, you map a sensory deficit to the lateral aspect of the
forearm and thumb. This corresponds to which dermatome?
A. C5
B. C6 [CORRECT]
C. C7
D. C8
Rationale: The correct dermatome is C6, which supplies the lateral forearm, thumb, and
index finger. C5 supplies the lateral arm. C7 supplies the middle finger and posterior
forearm. C8 supplies the medial forearm and little finger. Dermatomal mapping helps
differentiate peripheral nerve from nerve root lesions.
