NSG 464 – Final Exam Review
NSG 464 – FINAL EXAM REVIEW NEWEST 2025/2026
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |BRAND NEW VERSION!!
A 21-year-old engineering student comes to your office complaining of leg and
back pain and of tripping when he walks. He states this started 3 months ago with
back and buttock pain but has since progressed to feeling weak in his left leg. He
denies any bowel or bladder symptoms. He can think of no specific traumatic
incidences but he was a defensive lineman in high-school and junior college. He
past medical history is unremarkable. He denies tobacco use or alcohol use or
drug abuse. His parents are both healthy. On examination he is tender over the
lumbar spine and has a positive straight-leg raise on the left. His Achilles tendon
deep reflex is decreased on the left. While watching his gait you notice he has to
pick his left foot up high in order not to trip. What abnormality of gait does he
most likely have?
A. Sensory ataxia
B. Parkinsonian gait
C. Steppage gait
D. Spastic hemiparesis
C. Steppage gait
Rationale: This gait is associated with foot drop, usually secondary to a lower
motor neuron disease. This is often seen with a herniated disc, such as in this
patient
A 17-year-old high school student is brought to your ER in a comatose state. His
friends have accompanied him and tell you that they have been shooting up
heroin tonight and they think their friend might have had too much. The patient is
unconscious and cannot protect his airway, so he is intubated. His HR is 60 and he
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, NSG 464 – Final Exam Review
is breathing through the ventilator. He is not posturing and he does not respond to
sternal rub. Preparing to finish the neurologic examination, you get a penlight.
What size pupil do you expect to see in this comatose patient?
A. Pinpoint pupils
B. Large pupils
C. Asymmetric pupils
D. Irregularity shaped pupils
A. Pinpoint pupils
Rationale: Narcotics and cholinergics cause very small (1mm) pupils. Reactions to
light can be appreciated with a magnifying glass
A 37 year-old woman is brought into your emergency room comatose. The
paramedics say her husband found her unconscious in her home. Her past medical
history consists of T1DM and she is on insulin. In the ambulance the paramedics
obtained a glucose check and her sugar was 15 (normal is 70-105). They began a
dextrose saline infusion and intubated her to protect her airway. Despite their
efforts, she is posturing in the emergency room with her arms straight at her side
and her jaw clenched. her legs are also straight and her feet are plantar flexed.
What type of posturing is she showing?
A. Decorticate posturing
B. Decerebrate posturing
C. Hemiplegia
D. Chorea
B. Decerebrate posturing
A patient presents with left-sided facial droop. On further testing, you not that he
is unable to wrinkle his forehead on the left side and has decreased taste. Which
of the following is true?
A. This represents a central lesion
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, NSG 464 – Final Exam Review
B. This represents a CN IV lesion
C. This may be related to travel
D. This most likely represents a stroke
C. This may be related to travel
Rationale: Because the forehead is also involved, this represents a peripheral
nerve lesion of CN VII and does not represent a classic middle cerebral artery
stroke. The latter would spare the upper face but include speech difficulties as
well as upper extremity weakness on the ipsilateral side. One cause of this type of
lesion is Lyme disease and related to travel to endemic areas, so a careful travel
history should be sought
Which is true of examination of the olfactory nerve?
A. It is not tested for laterality
B. The smell must be identified to declare a normal response
C. Abnormal response may be seen in otherwise normal elderly
D. Allergies are unrelated to testing of this nerve
C. Abnormal response may be seen in otherwise normal elderly
Rationale: Abnormal olfactory nerve examination findings may be seen in
otherwise normal elderly but may also be associated with other conditions such
as Parkinson's disease. You should try to determine if only one side is abnormal by
occluding the contralateral nostril. The smell must only be detected, not identified
by name, to indicate a normal examination. If nasal occlusion occurs for other
reasons, such as allergic rhinitis or anatomic abnormalities, the nerve cannot be
tested and may seem to be abnormal for unrelated reasons
Steve has had a stroke and comes to you for follow-up today. On examination you
find that he has increased muscle tone, some involuntary movements, and
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, NSG 464 – Final Exam Review
abnormal gait, and a slowness of response in movements. He most likely has
involvement of which of the following?
A. The corticospinal tract
B. The cerebellum
C. The cerebrum
D. The basal ganglia
D. The basal ganglia
Rationale: These findings are typical of disease in the basal ganglia
You are conducting a mental status examination and note impairment of speech
and judgment, but the rest of your examination is intact. Where is the most likely
location of the problem?
A. Cerebrum
B. Cerebellum
C. Brainstem
D. Basal ganglia
A. Cerebrum
Rationale: The cerebrum is responsible for higher cognitive functions such as
speech and judgment
A patient presents with a daily headache which has worsened over the past
several months. On funduscopic examination, you notice that the disk edge is
indistinct and the veins do not pulsate. Which is most likely?
A. Migraine
B. Glaucoma
C. Visual acuity problem
D. Increased intracranial pressure
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NSG 464 – FINAL EXAM REVIEW NEWEST 2025/2026
COMPLETE QUESTIONS AND CORRECT DETAILED ANSWERS
(VERIFIED ANSWERS) |BRAND NEW VERSION!!
A 21-year-old engineering student comes to your office complaining of leg and
back pain and of tripping when he walks. He states this started 3 months ago with
back and buttock pain but has since progressed to feeling weak in his left leg. He
denies any bowel or bladder symptoms. He can think of no specific traumatic
incidences but he was a defensive lineman in high-school and junior college. He
past medical history is unremarkable. He denies tobacco use or alcohol use or
drug abuse. His parents are both healthy. On examination he is tender over the
lumbar spine and has a positive straight-leg raise on the left. His Achilles tendon
deep reflex is decreased on the left. While watching his gait you notice he has to
pick his left foot up high in order not to trip. What abnormality of gait does he
most likely have?
A. Sensory ataxia
B. Parkinsonian gait
C. Steppage gait
D. Spastic hemiparesis
C. Steppage gait
Rationale: This gait is associated with foot drop, usually secondary to a lower
motor neuron disease. This is often seen with a herniated disc, such as in this
patient
A 17-year-old high school student is brought to your ER in a comatose state. His
friends have accompanied him and tell you that they have been shooting up
heroin tonight and they think their friend might have had too much. The patient is
unconscious and cannot protect his airway, so he is intubated. His HR is 60 and he
1|Page
, NSG 464 – Final Exam Review
is breathing through the ventilator. He is not posturing and he does not respond to
sternal rub. Preparing to finish the neurologic examination, you get a penlight.
What size pupil do you expect to see in this comatose patient?
A. Pinpoint pupils
B. Large pupils
C. Asymmetric pupils
D. Irregularity shaped pupils
A. Pinpoint pupils
Rationale: Narcotics and cholinergics cause very small (1mm) pupils. Reactions to
light can be appreciated with a magnifying glass
A 37 year-old woman is brought into your emergency room comatose. The
paramedics say her husband found her unconscious in her home. Her past medical
history consists of T1DM and she is on insulin. In the ambulance the paramedics
obtained a glucose check and her sugar was 15 (normal is 70-105). They began a
dextrose saline infusion and intubated her to protect her airway. Despite their
efforts, she is posturing in the emergency room with her arms straight at her side
and her jaw clenched. her legs are also straight and her feet are plantar flexed.
What type of posturing is she showing?
A. Decorticate posturing
B. Decerebrate posturing
C. Hemiplegia
D. Chorea
B. Decerebrate posturing
A patient presents with left-sided facial droop. On further testing, you not that he
is unable to wrinkle his forehead on the left side and has decreased taste. Which
of the following is true?
A. This represents a central lesion
2|Page
, NSG 464 – Final Exam Review
B. This represents a CN IV lesion
C. This may be related to travel
D. This most likely represents a stroke
C. This may be related to travel
Rationale: Because the forehead is also involved, this represents a peripheral
nerve lesion of CN VII and does not represent a classic middle cerebral artery
stroke. The latter would spare the upper face but include speech difficulties as
well as upper extremity weakness on the ipsilateral side. One cause of this type of
lesion is Lyme disease and related to travel to endemic areas, so a careful travel
history should be sought
Which is true of examination of the olfactory nerve?
A. It is not tested for laterality
B. The smell must be identified to declare a normal response
C. Abnormal response may be seen in otherwise normal elderly
D. Allergies are unrelated to testing of this nerve
C. Abnormal response may be seen in otherwise normal elderly
Rationale: Abnormal olfactory nerve examination findings may be seen in
otherwise normal elderly but may also be associated with other conditions such
as Parkinson's disease. You should try to determine if only one side is abnormal by
occluding the contralateral nostril. The smell must only be detected, not identified
by name, to indicate a normal examination. If nasal occlusion occurs for other
reasons, such as allergic rhinitis or anatomic abnormalities, the nerve cannot be
tested and may seem to be abnormal for unrelated reasons
Steve has had a stroke and comes to you for follow-up today. On examination you
find that he has increased muscle tone, some involuntary movements, and
3|Page
, NSG 464 – Final Exam Review
abnormal gait, and a slowness of response in movements. He most likely has
involvement of which of the following?
A. The corticospinal tract
B. The cerebellum
C. The cerebrum
D. The basal ganglia
D. The basal ganglia
Rationale: These findings are typical of disease in the basal ganglia
You are conducting a mental status examination and note impairment of speech
and judgment, but the rest of your examination is intact. Where is the most likely
location of the problem?
A. Cerebrum
B. Cerebellum
C. Brainstem
D. Basal ganglia
A. Cerebrum
Rationale: The cerebrum is responsible for higher cognitive functions such as
speech and judgment
A patient presents with a daily headache which has worsened over the past
several months. On funduscopic examination, you notice that the disk edge is
indistinct and the veins do not pulsate. Which is most likely?
A. Migraine
B. Glaucoma
C. Visual acuity problem
D. Increased intracranial pressure
4|Page
