University of Florida
Course Number: NUR 3066C
Course Title: Clinical Reasoning-Health
Assessment
Exam: Final Exam
Date:2026
During a physical assessment of a patient taking Lithium, the PMHNP observes a
fine intentional tremor. The patient now reports new onset of ataxia, slurred
speech, and blurred vision. Which clinical reasoning step is most appropriate?
A. Increase the Lithium dose to stabilize the mood symptoms.
B. Order a stat serum Lithium level to assess for toxicity.
C. Screen the patient for a stroke using the NIH Stroke Scale.
D. Advise the patient to increase caffeine intake to counteract the lethargy.
Answer: B.
Rationale: Ataxia, slurred speech, and coarse tremors are hallmark signs of Lithium
toxicity. Because Lithium has a narrow therapeutic index, any neurological
change must be treated as potential toxicity until proven otherwise by a serum
level check.
True or False: The Myerson’s Sign, elicited by repetitive tapping on the glabella, is a
normal finding in healthy adults that indicates intact cranial nerve function.
Answer: False.
Rationale: In healthy adults, the blinking response to tapping the glabella should
extinguish after a few taps. Persistence of the blinking reflex (Myerson's Sign) is
, a frontal release sign often associated with Parkinson’s disease or extrapyramidal
damage.
Fill in the blank: The physical assessment finding of a rhythmic, "flapping" tremor
of the hands when the wrists are extended, often seen in hepatic
encephalopathy, is known as ________.
Answer: Asterixis.
Rationale: Asterixis is a metabolic tremor reflecting a failure in the body's ability to
detoxify ammonia, frequently seen in chronic alcoholics with cirrhosis, which
may mimic or complicate psychiatric presentations.
A 28 year old female patient presents with primary complaints of anxiety,
palpitations, and weight loss. On physical exam, the PMHNP notes exophthalmos
and a diffuse, non tender enlargement of the thyroid gland. What should be the
first line of diagnostic reasoning?
A. Initiate a trial of an SSRI for Generalized Anxiety Disorder.
B. Order a TSH and free T4 level to rule out hyperthyroidism.
C. Refer the patient for an emergency psychiatric hold for mania.
D. Conduct an EKG to check for a prolonged QTc interval.
Answer: B.
Rationale: Hyperthyroidism is a well known medical mimic of anxiety and manic
symptoms. Exophthalmos (bulging eyes) and goiter are physical markers of
Graves’ disease, necessitating endocrine screening before a psychiatric diagnosis
is finalized.
During the Mental Status Examination of a patient with suspected mania, the
PMHNP observes the patient shifting rapidly from one topic to another based on
sounds or rhymes. How is this thought process correctly documented?
A. Circumstantiality.
B. Tangentiality.
,C. Clang associations.
D. Perseveration.
Answer: C.
Rationale: Clang associations involve choosing words based on sound rather than
meaning. This is a common finding in manic episodes within the context of
disorganized thought processes.
True or False: A positive Babinski reflex, where the great toe dorsiflexes and other
toes fan out, is a normal finding in an adult patient with no history of
neurological disease.
Answer: False.
Rationale: In adults, the normal response is the plantar reflex (toes curl downward).
A positive Babinski in an adult indicates an upper motor neuron lesion, such as a
stroke, tumor, or multiple sclerosis.
Fill in the blank: The standardized tool used specifically to detect and monitor the
severity of involuntary movements in patients taking antipsychotic medications is
the ________.
Answer: Abnormal Involuntary Movement Scale (or AIMS).
Rationale: The AIMS is the gold standard assessment for identifying Tardive
Dyskinesia, which is a common and potentially irreversible side effect of long
term dopamine blockade.
A PMHNP is evaluating a patient for Clozapine initiation. The patient’s Absolute
Neutrophil Count (ANC) is 1,200/uL. According to clinical reasoning based on
the Clozapine REMS program, what is the correct action?
A. Start the Clozapine at a low dose and recheck the labs in one week.
B. Do not start the Clozapine because the ANC must be at least 1,500/uL.
C. Start the Clozapine but only if the patient is of Asian descent.
, D. Proceed with the medication because 1,200/uL is within the normal reference
range.
Answer: B.
Rationale: For the general population, the ANC must be at least 1,500/uL to initiate
Clozapine. Starting below this threshold increases the risk of life threatening
agranulocytosis.
During a neurological assessment, the patient is asked to stand with feet together
and eyes closed. The patient remains stable with eyes open but immediately
loses balance when the eyes are closed. This is documented as:
A. Negative Romberg sign.
B. Positive Romberg sign.
C. Cerebellar ataxia.
D. Nystagmus.
Answer: B.
Rationale: A positive Romberg sign indicates a loss of sensory input from the
posterior columns of the spinal cord (proprioception). If the instability occurred
with eyes open, it would more likely point to a cerebellar issue.
True or False: Wernicke’s encephalopathy is characterized by the clinical triad of
ophthalmoplegia, ataxia, and confusion, resulting from a severe deficiency in
Vitamin B12.
Answer: False.
Rationale: Wernicke’s encephalopathy is caused by a deficiency in Vitamin B1
(Thiamine), not B12. It is a medical emergency frequently encountered in patients
with chronic alcohol use disorder.
Fill in the blank: The inability of a patient to recognize or name their own body
parts or the inability to distinguish left from right is an assessment finding
known as ________.
Course Number: NUR 3066C
Course Title: Clinical Reasoning-Health
Assessment
Exam: Final Exam
Date:2026
During a physical assessment of a patient taking Lithium, the PMHNP observes a
fine intentional tremor. The patient now reports new onset of ataxia, slurred
speech, and blurred vision. Which clinical reasoning step is most appropriate?
A. Increase the Lithium dose to stabilize the mood symptoms.
B. Order a stat serum Lithium level to assess for toxicity.
C. Screen the patient for a stroke using the NIH Stroke Scale.
D. Advise the patient to increase caffeine intake to counteract the lethargy.
Answer: B.
Rationale: Ataxia, slurred speech, and coarse tremors are hallmark signs of Lithium
toxicity. Because Lithium has a narrow therapeutic index, any neurological
change must be treated as potential toxicity until proven otherwise by a serum
level check.
True or False: The Myerson’s Sign, elicited by repetitive tapping on the glabella, is a
normal finding in healthy adults that indicates intact cranial nerve function.
Answer: False.
Rationale: In healthy adults, the blinking response to tapping the glabella should
extinguish after a few taps. Persistence of the blinking reflex (Myerson's Sign) is
, a frontal release sign often associated with Parkinson’s disease or extrapyramidal
damage.
Fill in the blank: The physical assessment finding of a rhythmic, "flapping" tremor
of the hands when the wrists are extended, often seen in hepatic
encephalopathy, is known as ________.
Answer: Asterixis.
Rationale: Asterixis is a metabolic tremor reflecting a failure in the body's ability to
detoxify ammonia, frequently seen in chronic alcoholics with cirrhosis, which
may mimic or complicate psychiatric presentations.
A 28 year old female patient presents with primary complaints of anxiety,
palpitations, and weight loss. On physical exam, the PMHNP notes exophthalmos
and a diffuse, non tender enlargement of the thyroid gland. What should be the
first line of diagnostic reasoning?
A. Initiate a trial of an SSRI for Generalized Anxiety Disorder.
B. Order a TSH and free T4 level to rule out hyperthyroidism.
C. Refer the patient for an emergency psychiatric hold for mania.
D. Conduct an EKG to check for a prolonged QTc interval.
Answer: B.
Rationale: Hyperthyroidism is a well known medical mimic of anxiety and manic
symptoms. Exophthalmos (bulging eyes) and goiter are physical markers of
Graves’ disease, necessitating endocrine screening before a psychiatric diagnosis
is finalized.
During the Mental Status Examination of a patient with suspected mania, the
PMHNP observes the patient shifting rapidly from one topic to another based on
sounds or rhymes. How is this thought process correctly documented?
A. Circumstantiality.
B. Tangentiality.
,C. Clang associations.
D. Perseveration.
Answer: C.
Rationale: Clang associations involve choosing words based on sound rather than
meaning. This is a common finding in manic episodes within the context of
disorganized thought processes.
True or False: A positive Babinski reflex, where the great toe dorsiflexes and other
toes fan out, is a normal finding in an adult patient with no history of
neurological disease.
Answer: False.
Rationale: In adults, the normal response is the plantar reflex (toes curl downward).
A positive Babinski in an adult indicates an upper motor neuron lesion, such as a
stroke, tumor, or multiple sclerosis.
Fill in the blank: The standardized tool used specifically to detect and monitor the
severity of involuntary movements in patients taking antipsychotic medications is
the ________.
Answer: Abnormal Involuntary Movement Scale (or AIMS).
Rationale: The AIMS is the gold standard assessment for identifying Tardive
Dyskinesia, which is a common and potentially irreversible side effect of long
term dopamine blockade.
A PMHNP is evaluating a patient for Clozapine initiation. The patient’s Absolute
Neutrophil Count (ANC) is 1,200/uL. According to clinical reasoning based on
the Clozapine REMS program, what is the correct action?
A. Start the Clozapine at a low dose and recheck the labs in one week.
B. Do not start the Clozapine because the ANC must be at least 1,500/uL.
C. Start the Clozapine but only if the patient is of Asian descent.
, D. Proceed with the medication because 1,200/uL is within the normal reference
range.
Answer: B.
Rationale: For the general population, the ANC must be at least 1,500/uL to initiate
Clozapine. Starting below this threshold increases the risk of life threatening
agranulocytosis.
During a neurological assessment, the patient is asked to stand with feet together
and eyes closed. The patient remains stable with eyes open but immediately
loses balance when the eyes are closed. This is documented as:
A. Negative Romberg sign.
B. Positive Romberg sign.
C. Cerebellar ataxia.
D. Nystagmus.
Answer: B.
Rationale: A positive Romberg sign indicates a loss of sensory input from the
posterior columns of the spinal cord (proprioception). If the instability occurred
with eyes open, it would more likely point to a cerebellar issue.
True or False: Wernicke’s encephalopathy is characterized by the clinical triad of
ophthalmoplegia, ataxia, and confusion, resulting from a severe deficiency in
Vitamin B12.
Answer: False.
Rationale: Wernicke’s encephalopathy is caused by a deficiency in Vitamin B1
(Thiamine), not B12. It is a medical emergency frequently encountered in patients
with chronic alcohol use disorder.
Fill in the blank: The inability of a patient to recognize or name their own body
parts or the inability to distinguish left from right is an assessment finding
known as ________.
