NSG 500 Exam 3: Advanced Health Assessment - Wilkes
University Updated and Latest Questions and Correct
Answers with Rationale
1. During a neurological examination, you ask the patient to puff out their cheeks and show their teeth.
Which cranial nerve are you assessing?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer: A
Rationale: Assessment of facial symmetry and muscle strength involves the motor branch of the Facial
nerve. Asking the patient to smile, frown, and puff cheeks tests the muscles of facial expression.
Weakness or asymmetry in these movements can indicate Bell’s palsy or central nervous system lesions.
The Trigeminal nerve, while also on the face, primarily handles sensation and mastication muscles.
Therefore, checking for symmetric puffing of the cheeks directly evaluates Cranial Nerve VII function.
2. A patient presents with knee pain after a sports injury. You perform the Lachman test and find significant
forward displacement of the tibia. This finding is highly suggestive of an injury to which structure?
A. Medial collateral ligament (MCL)
B. Posterior cruciate ligament (PCL)
C. Anterior cruciate ligament (ACL)
D. Medial meniscus
Correct Answer: C
,Rationale: The Lachman test is considered the most sensitive clinical test for detecting an ACL tear. It is
performed by stabilizing the femur and pulling the tibia forward with the knee flexed at 20 to 30 degrees.
Significant laxity or the absence of a firm end point indicates a positive result. This maneuver specifically
assesses the stability provided by the anterior cruciate ligament. Accurate performance of this test is
crucial for differentiating ACL injuries from other ligamentous knee trauma.
3. Which physical finding is most characteristic of Graves’ disease in an endocrine assessment?
A. Delayed relaxation of deep tendon reflexes
B. Periorbital edema
C. Brittle hair
D. Exophthalmos
Correct Answer: D
Rationale: Graves’ disease is an autoimmune form of hyperthyroidism often characterized by specific
ocular changes. Exophthalmos, or bulging of the eyes, results from inflammation and tissue buildup
behind the eyeballs. While other thyroid conditions may cause puffiness, true proptosis is highly specific
to Graves’ ophthalmopathy. Clinical assessment should also include monitoring for lid lag and thyroid
enlargement. Identifying exophthalmos helps differentiate Graves’ disease from other causes of
thyrotoxicosis like toxic multinodular goiter.
4. During a musculoskeletal exam, a positive Phalen’s test is indicated by which of the following sensations?
A. Pain in the elbow when extending the wrist
B. Numbness and tingling in the median nerve distribution
C. Weakness of the deltoid muscle
D. Crepitus in the wrist joint
, Correct Answer: B
Rationale: Phalen’s test is a diagnostic maneuver used specifically to identify carpal tunnel syndrome.
The patient holds their wrists in maximum flexion for 60 seconds to compress the median nerve. A
positive result occurs if the patient experiences numbness, tingling, or paresthesia in the thumb and first
three fingers. This test helps the clinician differentiate nerve entrapment at the wrist from other types of
hand pain. Consistent positive findings warrant further diagnostic studies like electromyography to
confirm the diagnosis.
5. When assessing deep tendon reflexes, a patient’s response is described as ‘very brisk, hyperactive, with
clonus.’ What numerical grade should be assigned?
A. 1+
B. 4+
C. 3+
D. 2+
Correct Answer: B
Rationale: Reflexes are graded on a standard scale from 0 to 4 to ensure clinical consistency. A grade of
4+ is reserved for hyperactive responses that include rhythmic oscillations known as clonus. This level of
activity usually indicates an upper motor neuron lesion rather than a normal physiological variation. In
contrast, 2+ is considered the standard average or normal reflex response. Documentation of clonus is a
critical diagnostic indicator in neurological assessments of spinal cord health.
6. A patient presents with ‘moon face,’ ‘buffalo hump,’ and purple striae on the abdomen. Which endocrine
condition is most likely?
A. Addison’s Disease
University Updated and Latest Questions and Correct
Answers with Rationale
1. During a neurological examination, you ask the patient to puff out their cheeks and show their teeth.
Which cranial nerve are you assessing?
A. Cranial Nerve VII (Facial)
B. Cranial Nerve V (Trigeminal)
C. Cranial Nerve IX (Glossopharyngeal)
D. Cranial Nerve XII (Hypoglossal)
Correct Answer: A
Rationale: Assessment of facial symmetry and muscle strength involves the motor branch of the Facial
nerve. Asking the patient to smile, frown, and puff cheeks tests the muscles of facial expression.
Weakness or asymmetry in these movements can indicate Bell’s palsy or central nervous system lesions.
The Trigeminal nerve, while also on the face, primarily handles sensation and mastication muscles.
Therefore, checking for symmetric puffing of the cheeks directly evaluates Cranial Nerve VII function.
2. A patient presents with knee pain after a sports injury. You perform the Lachman test and find significant
forward displacement of the tibia. This finding is highly suggestive of an injury to which structure?
A. Medial collateral ligament (MCL)
B. Posterior cruciate ligament (PCL)
C. Anterior cruciate ligament (ACL)
D. Medial meniscus
Correct Answer: C
,Rationale: The Lachman test is considered the most sensitive clinical test for detecting an ACL tear. It is
performed by stabilizing the femur and pulling the tibia forward with the knee flexed at 20 to 30 degrees.
Significant laxity or the absence of a firm end point indicates a positive result. This maneuver specifically
assesses the stability provided by the anterior cruciate ligament. Accurate performance of this test is
crucial for differentiating ACL injuries from other ligamentous knee trauma.
3. Which physical finding is most characteristic of Graves’ disease in an endocrine assessment?
A. Delayed relaxation of deep tendon reflexes
B. Periorbital edema
C. Brittle hair
D. Exophthalmos
Correct Answer: D
Rationale: Graves’ disease is an autoimmune form of hyperthyroidism often characterized by specific
ocular changes. Exophthalmos, or bulging of the eyes, results from inflammation and tissue buildup
behind the eyeballs. While other thyroid conditions may cause puffiness, true proptosis is highly specific
to Graves’ ophthalmopathy. Clinical assessment should also include monitoring for lid lag and thyroid
enlargement. Identifying exophthalmos helps differentiate Graves’ disease from other causes of
thyrotoxicosis like toxic multinodular goiter.
4. During a musculoskeletal exam, a positive Phalen’s test is indicated by which of the following sensations?
A. Pain in the elbow when extending the wrist
B. Numbness and tingling in the median nerve distribution
C. Weakness of the deltoid muscle
D. Crepitus in the wrist joint
, Correct Answer: B
Rationale: Phalen’s test is a diagnostic maneuver used specifically to identify carpal tunnel syndrome.
The patient holds their wrists in maximum flexion for 60 seconds to compress the median nerve. A
positive result occurs if the patient experiences numbness, tingling, or paresthesia in the thumb and first
three fingers. This test helps the clinician differentiate nerve entrapment at the wrist from other types of
hand pain. Consistent positive findings warrant further diagnostic studies like electromyography to
confirm the diagnosis.
5. When assessing deep tendon reflexes, a patient’s response is described as ‘very brisk, hyperactive, with
clonus.’ What numerical grade should be assigned?
A. 1+
B. 4+
C. 3+
D. 2+
Correct Answer: B
Rationale: Reflexes are graded on a standard scale from 0 to 4 to ensure clinical consistency. A grade of
4+ is reserved for hyperactive responses that include rhythmic oscillations known as clonus. This level of
activity usually indicates an upper motor neuron lesion rather than a normal physiological variation. In
contrast, 2+ is considered the standard average or normal reflex response. Documentation of clonus is a
critical diagnostic indicator in neurological assessments of spinal cord health.
6. A patient presents with ‘moon face,’ ‘buffalo hump,’ and purple striae on the abdomen. Which endocrine
condition is most likely?
A. Addison’s Disease
