NSG 3160 Exam 4 (2026) Health Assessment Questions Nursing Exam PDF
Section 1: Neurological System (Questions 1-40)
1. A nurse is assessing a patient's level of consciousness using the Glasgow Coma
Scale (GCS). The patient opens eyes to pain, makes incomprehensible sounds, and
withdraws from pain. What is the patient's GCS score?
A) 7
B) 8
C) 9
D) 10
Answer: B) 8
Rationale: The GCS assesses eye opening (1-4), verbal response (1-5), and motor
response (1-6). Opening eyes to pain = 2, incomprehensible sounds = 2,
withdrawal to pain = 4. The total is 8, indicating a severe brain injury and coma .
2. During a neurological examination, the nurse asks the patient to stand with feet
together and eyes closed, observing for swaying. What is the nurse assessing?
,A) Weber test
B) Rinne test
C) Romberg test
D) Babinski test
Answer: C) Romberg test
Rationale: The Romberg test assesses proprioception and cerebellar function
(balance). A positive sign is significant swaying or loss of balance with eyes closed,
indicating a sensory ataxia .
3. A patient reports a sudden, severe "thunderclap" headache. This is a classic
symptom of which condition?
A) Tension headache
B) Migraine with aura
C) Cluster headache
D) Subarachnoid hemorrhage
Answer: D) Subarachnoid hemorrhage
,Rationale: A “thunderclap” headache is the hallmark of a subarachnoid
hemorrhage, often described as the “worst headache of my life.” It requires
immediate neurological evaluation .
4. To test cranial nerve XII (hypoglossal), the nurse should ask the patient to:
A) Smile and show teeth
B) Shrug shoulders against resistance
C) Say “ah” and observe uvula movement
D) Protrude the tongue and move it side to side
Answer: D) Protrude the tongue and move it side to side
Rationale: Cranial nerve XII (hypoglossal) is a motor nerve that controls tongue
movement. Asking the patient to protrude the tongue and move it side to side
assesses its function. Asymmetry or deviation indicates a lesion .
5. The nurse documents that a patient's pupils are equal, round, and reactive to
light and accommodation (PERRLA). Which cranial nerves are being assessed with
this finding?
A) CN II and CN VII
B) CN II and CN III
C) CN III and CN VI
, D) CN II and CN V
Answer: B) CN II and CN III
Rationale: PERRLA assesses CN II (optic) for afferent sensory input (light
perception) and CN III (oculomotor) for efferent motor response (pupillary
constriction) .
6. A patient with a stroke has difficulty understanding language and cannot follow
a simple command, though they can speak fluently but with nonsensical words.
This is most consistent with:
A) Expressive aphasia (Broca’s)
B) Receptive aphasia (Wernicke’s)
C) Global aphasia
D) Dysarthria
Answer: B) Receptive aphasia (Wernicke’s)
Rationale: Wernicke’s aphasia is characterized by fluent, often nonsensical speech
with poor comprehension. The patient cannot understand spoken or written
language but can produce words, albeit incorrectly .
Section 1: Neurological System (Questions 1-40)
1. A nurse is assessing a patient's level of consciousness using the Glasgow Coma
Scale (GCS). The patient opens eyes to pain, makes incomprehensible sounds, and
withdraws from pain. What is the patient's GCS score?
A) 7
B) 8
C) 9
D) 10
Answer: B) 8
Rationale: The GCS assesses eye opening (1-4), verbal response (1-5), and motor
response (1-6). Opening eyes to pain = 2, incomprehensible sounds = 2,
withdrawal to pain = 4. The total is 8, indicating a severe brain injury and coma .
2. During a neurological examination, the nurse asks the patient to stand with feet
together and eyes closed, observing for swaying. What is the nurse assessing?
,A) Weber test
B) Rinne test
C) Romberg test
D) Babinski test
Answer: C) Romberg test
Rationale: The Romberg test assesses proprioception and cerebellar function
(balance). A positive sign is significant swaying or loss of balance with eyes closed,
indicating a sensory ataxia .
3. A patient reports a sudden, severe "thunderclap" headache. This is a classic
symptom of which condition?
A) Tension headache
B) Migraine with aura
C) Cluster headache
D) Subarachnoid hemorrhage
Answer: D) Subarachnoid hemorrhage
,Rationale: A “thunderclap” headache is the hallmark of a subarachnoid
hemorrhage, often described as the “worst headache of my life.” It requires
immediate neurological evaluation .
4. To test cranial nerve XII (hypoglossal), the nurse should ask the patient to:
A) Smile and show teeth
B) Shrug shoulders against resistance
C) Say “ah” and observe uvula movement
D) Protrude the tongue and move it side to side
Answer: D) Protrude the tongue and move it side to side
Rationale: Cranial nerve XII (hypoglossal) is a motor nerve that controls tongue
movement. Asking the patient to protrude the tongue and move it side to side
assesses its function. Asymmetry or deviation indicates a lesion .
5. The nurse documents that a patient's pupils are equal, round, and reactive to
light and accommodation (PERRLA). Which cranial nerves are being assessed with
this finding?
A) CN II and CN VII
B) CN II and CN III
C) CN III and CN VI
, D) CN II and CN V
Answer: B) CN II and CN III
Rationale: PERRLA assesses CN II (optic) for afferent sensory input (light
perception) and CN III (oculomotor) for efferent motor response (pupillary
constriction) .
6. A patient with a stroke has difficulty understanding language and cannot follow
a simple command, though they can speak fluently but with nonsensical words.
This is most consistent with:
A) Expressive aphasia (Broca’s)
B) Receptive aphasia (Wernicke’s)
C) Global aphasia
D) Dysarthria
Answer: B) Receptive aphasia (Wernicke’s)
Rationale: Wernicke’s aphasia is characterized by fluent, often nonsensical speech
with poor comprehension. The patient cannot understand spoken or written
language but can produce words, albeit incorrectly .
