Penn State University
3 MAXE • 152 SRUN
PSU
★
College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Examination 3 (Added Chapters & Misc Topics)
CO G N I T I O N , S E N S O R Y, R E S P I R ATO R Y, PAT I E N T E D U C AT I O N & PA I N
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 3 — Added Chapters & Misc TOTAL QUESTIONS 60 Questions
Topics
ACCREDITATION MSCHE — Middle States Commission on FORMAT Multiple Choice — Select the Single Best
Higher Education Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover cognition (aphasia types, MMSE, CAM, dementia vs delirium), sensory function (hearing, vision,
overload/deprivation), respiratory assessment (lung sounds, oxygen therapy, coughing techniques), patient education (domains
of learning, Johari Window), pain (types, assessment), and sleep.
▸ Correct answers and clinical rationales appear below each question for examination review.
▸ All content aligns with Penn State University BSN curriculum and MSCHE accreditation standards.
SECTION I — COGNITION, SENSORY, RESPIRATORY, EDUCATION, PAIN & Questions 1 –
SLEEP 60
1. What is cognition?
A. The ability to hear and process sounds
B. The systematic way in which a person thinks, reasons, and uses language
C. The emotional response to environmental stimuli
D. The physical ability to perform motor tasks
CORRECT ANSWER B — The systematic way in which a person thinks, reasons, and uses language
RATIONALE Cognition encompasses the higher-level brain functions that define human intellectual capacity: thinking
(processing information, problem-solving), reasoning (logical analysis, drawing conclusions), and language
(communication, comprehension, expression). These functions are interdependent and are assessed through
mental status examination. Cognitive function can be affected by numerous conditions including dementia,
delirium, stroke, traumatic brain injury, psychiatric illness, and metabolic disturbances.
,2. What is orientation in the context of cognitive assessment?
A. The ability to follow multi-step commands
B. Knowing one's location in time and place and understanding one's identity
C. The speed at which one processes information
D. The capacity to learn new information
CORRECT ANSWER B — Knowing one's location in time and place and understanding one's identity
RATIONALE Orientation is assessed across four spheres: person (self-identity — name, age), place (current location —
hospital, city), time (date, day, month, year, season), and situation (awareness of current circumstances).
Orientation is typically lost in a predictable order with cognitive decline: time is lost first, then place, then
person (person is most deeply encoded). Disorientation to person is a late and serious finding. Orientation is a
key component of the MMSE and CAM assessments.
3. What is judgment (insight) in cognitive assessment?
A. The ability to remember recent events
B. The process of reasoning — the ability to evaluate alternatives and make appropriate decisions
C. The capacity to speak fluently
D. The speed of motor responses
CORRECT ANSWER B — The process of reasoning — the ability to evaluate alternatives and make appropriate decisions
RATIONALE Judgment (often paired with insight) is the cognitive capacity to weigh options, consider consequences, and
make sound decisions. Insight is the patient's awareness of their own condition — do they recognize they
have a problem? Judgment is assessed by asking scenario-based questions ("What would you do if you
smelled smoke in a movie theater?") and by observing the patient's real-world decision-making. Impaired
judgment has significant implications for patient safety, treatment adherence, and the need for supervision
or guardianship.
4. Which conditions are included under impaired thought processes?
A. Hypertension, diabetes, and obesity
B. Delirium, dementia, and depression
C. Asthma, COPD, and pneumonia
D. Arthritis, osteoporosis, and gout
CORRECT ANSWER B — Delirium, dementia, and depression
RATIONALE The "3 D's" of impaired thought processes in older adults are Delirium (acute, fluctuating confusion from
medical causes — reversible), Dementia (chronic, progressive cognitive decline — usually irreversible), and
Depression (mood disorder causing cognitive slowing, poor concentration, and memory complaints —
treatable). These conditions can coexist and must be distinguished because treatments differ. Delirium is a
medical emergency; depression in the elderly often presents with cognitive complaints ("pseudodementia")
rather than overt sadness. All three cause impaired thought processes affecting safety and function.
, 5. What is aphasia?
A. A speech disorder from muscle weakness
B. Complete or partial loss of language abilities including understanding and expression
C. A hearing disorder affecting speech perception
D. A memory disorder affecting word recall
CORRECT ANSWER B — Complete or partial loss of language abilities including understanding and expression
RATIONALE Aphasia is a LANGUAGE disorder (not a speech or hearing disorder) caused by damage to the language centers
of the brain, most commonly from stroke affecting the dominant hemisphere (left hemisphere in ~95% of
right-handed individuals). Aphasia affects both comprehension (understanding language) and expression
(producing language). It is distinct from dysarthria (motor speech disorder from muscle weakness) and
dysphonia (voice disorder). Aphasia classification is based on fluency, comprehension, and repetition ability.
The nurse must differentiate aphasia from confusion, hearing impairment, and psychiatric conditions.
6. What characterizes expressive (Broca's) aphasia?
A. Fluent but meaningless speech with poor comprehension
B. Limited speech that is slow and halting — the patient understands but cannot produce fluent speech
C. Complete loss of all language abilities
D. Problems only with word retrieval
CORRECT ANSWER B — Limited speech that is slow and halting — the patient understands but cannot produce fluent
speech
RATIONALE Broca's (expressive/non-fluent) aphasia results from damage to Broca's area in the inferior frontal gyrus. The
patient KNOWS what they want to say but cannot produce the words fluently. Speech is effortful, slow,
halting, agrammatic (missing connecting words), but comprehension is relatively PRESERVED. The patient is
often acutely aware of their deficit, which causes significant frustration. This contrasts with Wernicke's
aphasia where the patient speaks fluently but nonsensically and cannot comprehend. Nursing implications:
use simple questions, allow extra time for responses, use yes/no questions or communication boards, and
acknowledge the patient's frustration.
7. What characterizes receptive (Wernicke's) aphasia?
A. Difficulty understanding written or spoken words — fluent but nonsensical speech
B. Slow, effortful speech with good comprehension
C. Problems only with naming objects
D. Complete mutism
CORRECT ANSWER A — Difficulty understanding written or spoken words — fluent but nonsensical speech
RATIONALE Wernicke's (receptive/fluent) aphasia results from damage to Wernicke's area in the superior temporal gyrus.
The patient produces FLUENT speech with normal rate, rhythm, and intonation, but the content is
nonsensical — word substitutions (paraphasias), neologisms (made-up words), and "word salad." Crucially,
the patient CANNOT comprehend spoken or written language, including their own speech — they are often
unaware of their deficit (anosognosia). This makes communication extremely challenging. Nursing
implications: use gestures, pictures, and contextual cues; do NOT assume the patient understands you just
because they speak fluently; protect patient safety as impaired comprehension prevents understanding of
instructions.
3 MAXE • 152 SRUN
PSU
★
College of Nursing
MAKING LIFE BETTER
EST. 1855
NURS 251 — Examination 3 (Added Chapters & Misc Topics)
CO G N I T I O N , S E N S O R Y, R E S P I R ATO R Y, PAT I E N T E D U C AT I O N & PA I N
INSTITUTION Penn State University — College of COURSE CODE NURS 251
Nursing
PROGRAM Bachelor of Science in Nursing (BSN) ACADEMIC YEAR
EXAM TITLE Examination 3 — Added Chapters & Misc TOTAL QUESTIONS 60 Questions
Topics
ACCREDITATION MSCHE — Middle States Commission on FORMAT Multiple Choice — Select the Single Best
Higher Education Answer
EXAMINATION INSTRUCTIONS
▸ Select the single best answer for each question based on NURS 251 course content.
▸ Questions cover cognition (aphasia types, MMSE, CAM, dementia vs delirium), sensory function (hearing, vision,
overload/deprivation), respiratory assessment (lung sounds, oxygen therapy, coughing techniques), patient education (domains
of learning, Johari Window), pain (types, assessment), and sleep.
▸ Correct answers and clinical rationales appear below each question for examination review.
▸ All content aligns with Penn State University BSN curriculum and MSCHE accreditation standards.
SECTION I — COGNITION, SENSORY, RESPIRATORY, EDUCATION, PAIN & Questions 1 –
SLEEP 60
1. What is cognition?
A. The ability to hear and process sounds
B. The systematic way in which a person thinks, reasons, and uses language
C. The emotional response to environmental stimuli
D. The physical ability to perform motor tasks
CORRECT ANSWER B — The systematic way in which a person thinks, reasons, and uses language
RATIONALE Cognition encompasses the higher-level brain functions that define human intellectual capacity: thinking
(processing information, problem-solving), reasoning (logical analysis, drawing conclusions), and language
(communication, comprehension, expression). These functions are interdependent and are assessed through
mental status examination. Cognitive function can be affected by numerous conditions including dementia,
delirium, stroke, traumatic brain injury, psychiatric illness, and metabolic disturbances.
,2. What is orientation in the context of cognitive assessment?
A. The ability to follow multi-step commands
B. Knowing one's location in time and place and understanding one's identity
C. The speed at which one processes information
D. The capacity to learn new information
CORRECT ANSWER B — Knowing one's location in time and place and understanding one's identity
RATIONALE Orientation is assessed across four spheres: person (self-identity — name, age), place (current location —
hospital, city), time (date, day, month, year, season), and situation (awareness of current circumstances).
Orientation is typically lost in a predictable order with cognitive decline: time is lost first, then place, then
person (person is most deeply encoded). Disorientation to person is a late and serious finding. Orientation is a
key component of the MMSE and CAM assessments.
3. What is judgment (insight) in cognitive assessment?
A. The ability to remember recent events
B. The process of reasoning — the ability to evaluate alternatives and make appropriate decisions
C. The capacity to speak fluently
D. The speed of motor responses
CORRECT ANSWER B — The process of reasoning — the ability to evaluate alternatives and make appropriate decisions
RATIONALE Judgment (often paired with insight) is the cognitive capacity to weigh options, consider consequences, and
make sound decisions. Insight is the patient's awareness of their own condition — do they recognize they
have a problem? Judgment is assessed by asking scenario-based questions ("What would you do if you
smelled smoke in a movie theater?") and by observing the patient's real-world decision-making. Impaired
judgment has significant implications for patient safety, treatment adherence, and the need for supervision
or guardianship.
4. Which conditions are included under impaired thought processes?
A. Hypertension, diabetes, and obesity
B. Delirium, dementia, and depression
C. Asthma, COPD, and pneumonia
D. Arthritis, osteoporosis, and gout
CORRECT ANSWER B — Delirium, dementia, and depression
RATIONALE The "3 D's" of impaired thought processes in older adults are Delirium (acute, fluctuating confusion from
medical causes — reversible), Dementia (chronic, progressive cognitive decline — usually irreversible), and
Depression (mood disorder causing cognitive slowing, poor concentration, and memory complaints —
treatable). These conditions can coexist and must be distinguished because treatments differ. Delirium is a
medical emergency; depression in the elderly often presents with cognitive complaints ("pseudodementia")
rather than overt sadness. All three cause impaired thought processes affecting safety and function.
, 5. What is aphasia?
A. A speech disorder from muscle weakness
B. Complete or partial loss of language abilities including understanding and expression
C. A hearing disorder affecting speech perception
D. A memory disorder affecting word recall
CORRECT ANSWER B — Complete or partial loss of language abilities including understanding and expression
RATIONALE Aphasia is a LANGUAGE disorder (not a speech or hearing disorder) caused by damage to the language centers
of the brain, most commonly from stroke affecting the dominant hemisphere (left hemisphere in ~95% of
right-handed individuals). Aphasia affects both comprehension (understanding language) and expression
(producing language). It is distinct from dysarthria (motor speech disorder from muscle weakness) and
dysphonia (voice disorder). Aphasia classification is based on fluency, comprehension, and repetition ability.
The nurse must differentiate aphasia from confusion, hearing impairment, and psychiatric conditions.
6. What characterizes expressive (Broca's) aphasia?
A. Fluent but meaningless speech with poor comprehension
B. Limited speech that is slow and halting — the patient understands but cannot produce fluent speech
C. Complete loss of all language abilities
D. Problems only with word retrieval
CORRECT ANSWER B — Limited speech that is slow and halting — the patient understands but cannot produce fluent
speech
RATIONALE Broca's (expressive/non-fluent) aphasia results from damage to Broca's area in the inferior frontal gyrus. The
patient KNOWS what they want to say but cannot produce the words fluently. Speech is effortful, slow,
halting, agrammatic (missing connecting words), but comprehension is relatively PRESERVED. The patient is
often acutely aware of their deficit, which causes significant frustration. This contrasts with Wernicke's
aphasia where the patient speaks fluently but nonsensically and cannot comprehend. Nursing implications:
use simple questions, allow extra time for responses, use yes/no questions or communication boards, and
acknowledge the patient's frustration.
7. What characterizes receptive (Wernicke's) aphasia?
A. Difficulty understanding written or spoken words — fluent but nonsensical speech
B. Slow, effortful speech with good comprehension
C. Problems only with naming objects
D. Complete mutism
CORRECT ANSWER A — Difficulty understanding written or spoken words — fluent but nonsensical speech
RATIONALE Wernicke's (receptive/fluent) aphasia results from damage to Wernicke's area in the superior temporal gyrus.
The patient produces FLUENT speech with normal rate, rhythm, and intonation, but the content is
nonsensical — word substitutions (paraphasias), neologisms (made-up words), and "word salad." Crucially,
the patient CANNOT comprehend spoken or written language, including their own speech — they are often
unaware of their deficit (anosognosia). This makes communication extremely challenging. Nursing
implications: use gestures, pictures, and contextual cues; do NOT assume the patient understands you just
because they speak fluently; protect patient safety as impaired comprehension prevents understanding of
instructions.
