AGNP BOARD EXAM QUESTIONS Neurology Assessment (Questions 194)
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.
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.
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.
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.
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.
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.
,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.
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.
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.
, 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.
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.
Explanation:
Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice.
Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its
nerve supply. Dysarthria refers to a defect in the muscular control of the speech
apparatus (lips, tongue, palate, or pharynx). Aphasia refers to a disorder in producing or
understanding language.
Question:
Symptoms of a migraine headache can include throbbing, nausea or vomiting, duration
of one day, and be unilateral and/or disabling. How many of these symptoms should be
present to classify the headache as a migraine?
One of the five
Two of the five
Three of the five Correct
Four of the five
Explanation:
A migraine headache is highly likely if three of the five “POUND” features are present:
Pulsatile or throbbing; One-day duration, or lasts 4 to 72 hours if untreated; Unilateral;
Nausea or vomiting; Disabling or intensity causing interruption of daily activity.
Question:
The cranial sutures are closed on the head of a 9 month old infant. This indicates:
hydrocephalus.
craniosynostosis. Correct
a normal finding.
opisthotonos.
Explanation:
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.
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.
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.
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.
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.
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.
,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.
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.
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.
, 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.
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.
Explanation:
Dysphonia refers to less severe impairment in the volume, quality, or pitch of the voice.
Aphonia refers to a loss of voice that accompanies disease affecting the larynx or its
nerve supply. Dysarthria refers to a defect in the muscular control of the speech
apparatus (lips, tongue, palate, or pharynx). Aphasia refers to a disorder in producing or
understanding language.
Question:
Symptoms of a migraine headache can include throbbing, nausea or vomiting, duration
of one day, and be unilateral and/or disabling. How many of these symptoms should be
present to classify the headache as a migraine?
One of the five
Two of the five
Three of the five Correct
Four of the five
Explanation:
A migraine headache is highly likely if three of the five “POUND” features are present:
Pulsatile or throbbing; One-day duration, or lasts 4 to 72 hours if untreated; Unilateral;
Nausea or vomiting; Disabling or intensity causing interruption of daily activity.
Question:
The cranial sutures are closed on the head of a 9 month old infant. This indicates:
hydrocephalus.
craniosynostosis. Correct
a normal finding.
opisthotonos.
Explanation:
