AGNP Board Exam – Neurology Assessment Exam 2
1. Question:
When eliciting deep tendon reflexes in the knee, the nurse practitioner notes
an abnormal reflex in the right knee. This abnormality is probably consistent
with a pathological lesion in which segmented level of the spine?
Cervical 5 and 6
Cervical 6 and 7
Lumbar 2, 3, and 4 Correct
Sacral 1
Explanation:
The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee:
lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6
& 7.
2. Question:
A 80 year old male visits the nurse practitioner for an annual well exam.
History reveals two falls in the prior 12 months and difficulty with balance.
The next step the nurse practitioner should take is:
reassess the patient in 6 months.
obtain cognitive and functional assessment. Correct
assess respiratory assessment.
assess cardiac function.
Explanation:
High-risk older adults, namely those with a single fall in the past 12 months
with abnormal gait and balance and those with two or more falls in the prior
12 months, an acute fall, and/or difficulties with gait and balance, require
further assessment to determine the reasons for the falls. Obtaining relevant
medical history, physical exam, cognitive and functional assessment and
,determining multifactorial fall risks are essential to the preventing future
falls.
3. Question:
When evaluating the sensory system, testing the spinothalamic tracts would
include assessing sensations of:
position and vibration.
pain and temperature. Correct
deep touch.
discriminative sensations.
Explanation:
When evaluating the sensory system, testing the spinothalamic tracts would
include assessing sensations of pain and temperature. Assessing position
and vibration evaluate the posterior columns. Light touch assesses both the
spinothalamic and posterior column tracts. To assess discriminative
sensation, both the spinothalamic and posterior columns tracts as well as the
cortex would be assessed.
4. Question:
When testing for corneal reflex, an absent blink reflex is noted. This finding
may be suggestive of a lesion in which cranial nerve?
Cranial Nerve II (CN II)
Cranial Nerve IV (CN IV)
Cranial Nerve VI (CN V)
Cranial Nerve VII (CN VII) Correct
Explanation:
When testing for corneal reflex, an absent blink reflex would be suggestive of
a lesion in cranial nerves V or VII (CN V or CN VII)-Trigeminal or facial nerves.
5. Question:
An example of symmetric weakness is:
the right shoulder.
the right hand.
both arms. Correct
one the right side of the face.
Explanation:
There are 4 different patterns of weakness: Proximal, distal, symmetric, and
asymmetric. An example of proximal weakness is weakness in the shoulder
or hip girdle. Distal weakness occurs in the hands or feet. Symmetric
weakness occurs in the same areas on both sides of the body. An
,asymmetric weakness occurs in a portion of the face or extremity - a form of
focal weakness.
6. Question:
One maneuver used to assess coordination is to observe the patient:
dorsiflexing the ankle.
walking heel-to-toe in a straight line. Correct
squeezing the examiner's fingers.
counting to 10 backwards.
Explanation:
To assess coordination, observe the patient’s performance in rapid
alternating movements, point-to-point movements, gait and other related
body movements, standing in specified ways. Walking heel-to-toe would be
an example of observing the patient's gait. Dorsiflexion would be assessing
the patient's joint function. Squeezing the examiner's fingers would be one
way to assess hand grasp. Counting has nothing to do with coordination.
7. Question:
Assessment of a 70-year-old's ability to maintain personal safety would be
most adversely affected by declining function in the:
cardiovascular system.
respiratory system.
sensory perception system. Correct
gastrointestinal system.
Explanation:
The sensory system or sensory perception involves vision, touch, taste,
smell, and hearing. With the aging process these perceptions are altered and
these alterations put the elderly at risk for falls, burns, inability to smell
smoke, and the inability to move fast enough to get out of harm's way.
These impact personal safety. Changes in the cardiovascular,
gastrointestinal, and respiratory systems do not usually lead to safety issues.
8. Question:
A patient complains of experiencing symptoms of nausea, diaphoresis, and
pallor triggered by a fearful or unpleasant event. These symptoms are most
likely associated with:
subarachnoid hemorrhage.
stroke.
neurocardiogenic syncope.
vasovagal syncope. Correct
Explanation:
, In vasovagal syncope, a common cause of syncope, a prodrome of nausea,
diaphoresis, and pallor are triggered by a fearful or unpleasant event, then
vagally mediated hypotension, often with slow onset and offset. In syncope
from arrhythmias, onset and offset are often sudden, reflecting loss and
recovery of cerebral perfusion. Stroke or subarachnoid hemorrhage are
unlikely to cause syncope unless there are focal findings and damage to both
hemispheres.
9. Question:
An infant presents with an inappropriately increasing head circumference
and hydrocephalus confirmed by CT scan. In addition to these findings, which
one of the following would also be consistent with hydrocephalus?
A soft, low-pitched cry
Ability to be comforted easily
Tense, bulging fontanels Correct
Appropriately increasing weight
Explanation:
An infant with newly diagnosed hydrocephalus presents with a shrill and
high-pitched cry. They are very irritable and do not comfort easily.
Additionally, the infant's fontanels are tense and bulging due to the
increased amount of cerebral spinal fluid (CSF) being produced or not being
absorbed. These infants are very difficult feeders, so they often do not gain
weight appropriately.
10. Question:
Postural tremors appear when the affected part is:
at rest.
moving voluntarily.
is actively maintaining a posture. Correct
getting closer to its target.
Explanation:
Tremors are rhythmic oscillatory movements. Postural tremors appear when
the affected part is actively maintaining a posture. Examples include the fine
rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and
benign essential tremor. The other choices are not consistent with postural
tremors.
11. Question:
Dysphonia refers to:
the inability to produce or understand language.
the loss of voice.
an impairment in volume of the voice. Correct
a defect in the muscular control of the speech apparatus.
1. Question:
When eliciting deep tendon reflexes in the knee, the nurse practitioner notes
an abnormal reflex in the right knee. This abnormality is probably consistent
with a pathological lesion in which segmented level of the spine?
Cervical 5 and 6
Cervical 6 and 7
Lumbar 2, 3, and 4 Correct
Sacral 1
Explanation:
The segmented levels of the deep tendon reflexes are: Ankle: sacral 1; knee:
lumbar 2,3, & 4; Supinator and biceps: cervical 5 & 6; and triceps: cervical 6
& 7.
2. Question:
A 80 year old male visits the nurse practitioner for an annual well exam.
History reveals two falls in the prior 12 months and difficulty with balance.
The next step the nurse practitioner should take is:
reassess the patient in 6 months.
obtain cognitive and functional assessment. Correct
assess respiratory assessment.
assess cardiac function.
Explanation:
High-risk older adults, namely those with a single fall in the past 12 months
with abnormal gait and balance and those with two or more falls in the prior
12 months, an acute fall, and/or difficulties with gait and balance, require
further assessment to determine the reasons for the falls. Obtaining relevant
medical history, physical exam, cognitive and functional assessment and
,determining multifactorial fall risks are essential to the preventing future
falls.
3. Question:
When evaluating the sensory system, testing the spinothalamic tracts would
include assessing sensations of:
position and vibration.
pain and temperature. Correct
deep touch.
discriminative sensations.
Explanation:
When evaluating the sensory system, testing the spinothalamic tracts would
include assessing sensations of pain and temperature. Assessing position
and vibration evaluate the posterior columns. Light touch assesses both the
spinothalamic and posterior column tracts. To assess discriminative
sensation, both the spinothalamic and posterior columns tracts as well as the
cortex would be assessed.
4. Question:
When testing for corneal reflex, an absent blink reflex is noted. This finding
may be suggestive of a lesion in which cranial nerve?
Cranial Nerve II (CN II)
Cranial Nerve IV (CN IV)
Cranial Nerve VI (CN V)
Cranial Nerve VII (CN VII) Correct
Explanation:
When testing for corneal reflex, an absent blink reflex would be suggestive of
a lesion in cranial nerves V or VII (CN V or CN VII)-Trigeminal or facial nerves.
5. Question:
An example of symmetric weakness is:
the right shoulder.
the right hand.
both arms. Correct
one the right side of the face.
Explanation:
There are 4 different patterns of weakness: Proximal, distal, symmetric, and
asymmetric. An example of proximal weakness is weakness in the shoulder
or hip girdle. Distal weakness occurs in the hands or feet. Symmetric
weakness occurs in the same areas on both sides of the body. An
,asymmetric weakness occurs in a portion of the face or extremity - a form of
focal weakness.
6. Question:
One maneuver used to assess coordination is to observe the patient:
dorsiflexing the ankle.
walking heel-to-toe in a straight line. Correct
squeezing the examiner's fingers.
counting to 10 backwards.
Explanation:
To assess coordination, observe the patient’s performance in rapid
alternating movements, point-to-point movements, gait and other related
body movements, standing in specified ways. Walking heel-to-toe would be
an example of observing the patient's gait. Dorsiflexion would be assessing
the patient's joint function. Squeezing the examiner's fingers would be one
way to assess hand grasp. Counting has nothing to do with coordination.
7. Question:
Assessment of a 70-year-old's ability to maintain personal safety would be
most adversely affected by declining function in the:
cardiovascular system.
respiratory system.
sensory perception system. Correct
gastrointestinal system.
Explanation:
The sensory system or sensory perception involves vision, touch, taste,
smell, and hearing. With the aging process these perceptions are altered and
these alterations put the elderly at risk for falls, burns, inability to smell
smoke, and the inability to move fast enough to get out of harm's way.
These impact personal safety. Changes in the cardiovascular,
gastrointestinal, and respiratory systems do not usually lead to safety issues.
8. Question:
A patient complains of experiencing symptoms of nausea, diaphoresis, and
pallor triggered by a fearful or unpleasant event. These symptoms are most
likely associated with:
subarachnoid hemorrhage.
stroke.
neurocardiogenic syncope.
vasovagal syncope. Correct
Explanation:
, In vasovagal syncope, a common cause of syncope, a prodrome of nausea,
diaphoresis, and pallor are triggered by a fearful or unpleasant event, then
vagally mediated hypotension, often with slow onset and offset. In syncope
from arrhythmias, onset and offset are often sudden, reflecting loss and
recovery of cerebral perfusion. Stroke or subarachnoid hemorrhage are
unlikely to cause syncope unless there are focal findings and damage to both
hemispheres.
9. Question:
An infant presents with an inappropriately increasing head circumference
and hydrocephalus confirmed by CT scan. In addition to these findings, which
one of the following would also be consistent with hydrocephalus?
A soft, low-pitched cry
Ability to be comforted easily
Tense, bulging fontanels Correct
Appropriately increasing weight
Explanation:
An infant with newly diagnosed hydrocephalus presents with a shrill and
high-pitched cry. They are very irritable and do not comfort easily.
Additionally, the infant's fontanels are tense and bulging due to the
increased amount of cerebral spinal fluid (CSF) being produced or not being
absorbed. These infants are very difficult feeders, so they often do not gain
weight appropriately.
10. Question:
Postural tremors appear when the affected part is:
at rest.
moving voluntarily.
is actively maintaining a posture. Correct
getting closer to its target.
Explanation:
Tremors are rhythmic oscillatory movements. Postural tremors appear when
the affected part is actively maintaining a posture. Examples include the fine
rapid tremor of hyperthyroidism, the tremors of anxiety and fatigue, and
benign essential tremor. The other choices are not consistent with postural
tremors.
11. Question:
Dysphonia refers to:
the inability to produce or understand language.
the loss of voice.
an impairment in volume of the voice. Correct
a defect in the muscular control of the speech apparatus.
