NR-304 Health Assessment II - Set 4 - Part 3

Correct Answer: The fourth nerve alone supplies the superior oblique

Down and inward movement is the clinical action of the superior oblique, and the superior oblique is supplied by the trochlear nerve alone. The oculomotor nerve supplies elevation, depression, adduction, lid elevation and pupil constriction. Option b is incorrect because the oculomotor nerve supplies four eye muscles, the levator of the lid, the pupil and the lens, but never the superior oblique. That single muscle belongs to the trochlear. Option c is incorrect because no extraocular muscle receives motor fibers from two cranial nerves. Shared supply would make the matching exercise unanswerable, which is exactly the flaw the printed key introduced. Option d is incorrect because the lateral rectus abducts the eye and takes its supply from the sixth nerve. Pairing the trochlear with that muscle swaps the two single-muscle nerves for one another.

Correct Answer: Ask whether the inequality is long-standing

Physiologic anisocoria occurs in up to twenty percent of people, differs by a millimeter or less, and leaves both pupils reactive. Establishing that the inequality is old, and comparing prior records, distinguishes a variant from a new finding. Option a is incorrect because a rapid response is reserved for a sudden change such as a newly dilated, fixed pupil after head injury. This client is alert, comfortable, and reacting normally in both eyes. Option b is incorrect because nothing here establishes that the difference is new. Calling the provider before checking the baseline generates an alarm over what is most likely a lifelong variant carried by many healthy adults. Option c is incorrect because postponing assessment abandons the trend that gives pupil findings their meaning. Even a benign variant deserves documented serial checks so that any later change in size or reactivity is recognized promptly.

Correct Answer: Trace a number on the client's palm

Graphesthesia asks the client to read a number or letter traced on the palm, and it is the preferred cortical test when the hand cannot manipulate objects well enough for stereognosis. Option a is incorrect because stereognosis depends on the client actively exploring an object with the fingers. A contracted hand cannot do that, so a failed result would reflect the contracture rather than the cortex. Option c is incorrect because vibration is a primary posterior column modality, not a cortical discriminative test. It answers whether sensation reaches the brain at all, which is a different question from whether the cortex can interpret it. Option d is incorrect because moving the fingers tests kinesthesia, another primary modality carried in the posterior columns. Position sense must be intact before any cortical test can be interpreted, but it is not itself a cortical test.

Correct Answer: Cerebellar ataxia typically yields a negative Romberg

The Romberg is positive only when vision has been compensating for a proprioceptive or vestibular deficit. A cerebellar client is already unsteady with the eyes open, so closing them adds little and the sign stays negative. Option b is incorrect because vision does not repair cerebellar incoordination; the staggering and the failed tandem walk occur in full light. If vision were correcting the sway, removing it would make the client markedly worse. Option c is incorrect because chronic alcohol use damages peripheral sensory fibers as well, and many such clients do lose vibration and position sense. The absence of a Romberg sign here reflects the test's logic, not a guarantee. Option d is incorrect because the standard hold with the eyes closed is about twenty seconds, and the client's sway was unchanged throughout. Lengthening an already adequate observation would not convert a negative sign into a positive one.

Correct Answer: That maneuver tested light touch and superficial pain

Asking a client to report soft versus sharp tests light touch and superficial pain, the two spinothalamic screening modalities. Two-point discrimination applies two blunt points at closing distances and asks whether one point or two is felt. Option a is incorrect because position sense is tested by moving a finger or toe held at the sides, and vibration by placing a tuning fork on a bony prominence. Neither was performed with cotton and a sharp point. Option b is incorrect because stereognosis requires placing a familiar object such as a key or coin into the client's hand for identification with the eyes closed. Stroking the skin cannot demonstrate that cortical ability. Option d is incorrect because extinction requires touching both sides of the body at the same instant and asking how many sensations were felt. The student applied her stimuli one at a time down each limb.

Correct Answer: Report the finding as possible early hemiparesis

A unilateral downward drift with pronation is a positive pronator drift, a corticospinal sign of mild hemiparesis that is more sensitive than manual muscle testing. Early stroke must be reported promptly. Option a is incorrect because slight swaying applies to the Romberg test of standing balance, not to an arm that sinks and pronates. Calling an abnormal motor finding normal delays evaluation of a possible stroke. Option b is incorrect because pronator drift interrogates the corticospinal motor pathway rather than the cerebellum. Cerebellar coordination is screened with rapid alternating movements, finger-to-nose and heel-to-shin, and the result described here is abnormal. Option c is incorrect because the eyes are deliberately closed to remove visual correction of the arm position. Repeating the maneuver with vision restored would mask the very weakness the test was designed to expose.

Correct Answer: The cerebellum and its coordinating pathways

Overshooting the mark on finger-to-nose is dysmetria, a cerebellar sign, and acute alcohol intoxication is the classic cause of this picture. The deficit is coordination, not strength, sensation or cerebral interpretation. Option a is incorrect because parietal lesions blunt the interpretation of sensation and produce astereognosis, agraphesthesia or extinction. The client here is inaccurate in his reaching while sensation is never shown to be impaired. Option c is incorrect because posterior column loss shows itself through absent vibration and position sense and a positive Romberg, and reaching errors worsen sharply once the eyes close. This test was performed with the eyes open. Option d is incorrect because a corticospinal lesion causes weakness, spasticity and pronator drift rather than inaccurate targeting. A client with hemiparesis cannot lift the arm well, but the arm that does move still travels a straight course.

Correct Answer: The right trigeminal nerve is weak

The lateral pterygoid pushes the jaw toward the opposite side, so when one side is weak the intact muscle drives the jaw across to the weak side. Jaw deviation therefore points at the injured trigeminal nerve. Option b is incorrect because the jaw swings away from the strong side, not toward it. A left-sided lesion would send the jaw leftward, and the palpated masseter weakness is on the right. Option c is incorrect because the hypoglossal nerve governs the tongue, not the muscles of chewing. Its weakness shows up when the tongue is protruded, and the masseter would remain full and firm. Option d is incorrect because the facial nerve moves the surface muscles of expression and has no part in chewing. A facial lesion flattens the nasolabial fold and weakens eye closure instead.

Correct Answer: The spinal nerves and their branches

The peripheral nervous system is everything outside the skull and vertebral canal, including the twelve pairs of cranial nerves and the thirty one pairs of spinal nerves with their autonomic fibers. Option a is incorrect because the spinal cord lies inside the vertebral canal and is therefore part of the central nervous system along with the brain. The division between the two systems is anatomic. Option b is incorrect because the cortex is the outer grey matter of the cerebral hemispheres, sitting entirely within the skull. It serves thought, memory, sensation and voluntary movement as a central structure. Option d is incorrect because the thalamus is a deep grey matter mass at the top of the brainstem, well inside the cranium. Its relay work happens entirely within the central nervous system.

Correct Answer: Record the stimulus used and the response

Documenting the stimulus applied and the response obtained is what makes the record clinically useful, because it lets the next nurse detect change. The word unresponsive alone records nothing another examiner can compare against. Option a is incorrect because this client did respond, groaning and withdrawing to a trapezius pinch. Calling him unresponsive is factually wrong and hides the very information the next assessment depends upon. Option b is incorrect because painful stimulation is applied only as far up the ladder as needed to answer a question, never on a routine schedule. Repeated sternal rubs cause bruising without adding data. Option c is incorrect because level of consciousness is the earliest and most sensitive indicator of neurologic change, so serial assessment must continue. Waiting idly for a provider delays recognition of deterioration.