Quiz Questions

Neurology

Question #1

You are assisting with the well-child exam of an 8-month old infant when the doctor assesses their neurologic status and reflexes. When the doctor scrapes the handle of a reflex hammer on the baby’s foot and their toes splay apart, the parent asks you what the doctor is assessing for. She also says, “My toes don’t do that! Is everything okay?”

What would you explain to the parent about this test and why she may have a different assessment than her child?

Question #2

The client is a 19-month-old baby, born prematurely with active substance use histories. He is tracheostomy and ventilator dependent and requires a G/J tube for nutrition. His medical history includes tracheomalacia spells. Client had recently visited the Emergency Department for a skin rash, where multiple providers recommended a visit to rehabilitation services. At his rehab appointment, his provider is looking at his developmental milestone.

Developmentally, the child can transfer objects from one hand to another, grasp and hold objects, and he is able to kick his legs. He prefers his left side more than his right. He can roll over in bed and push himself up with his hands. However, he is unable to sit or stand independently and requires support to maintain a seated position. He also demonstrates occasional delayed responses to his name. Provider notices client has low tone in his lower extremities.

Given client’s development delays and complex medical history, could this be indicative of cerebral palsy? Why or why not?
What are the key signs and symptoms of cerebral palsy in infants and toddlers, and which of these does this client exhibit?
What additional assessments (e.g., imaging, developmental evaluations) would help confirm or rule out a diagnosis of cerebral palsy?

Question #3

Jane, a 27-year-old female, has been receiving involuntary, inpatient psychiatric treatment for the past 6 weeks. Throughout her treatment, Jane’s provider has spoken with her multiple times about wanting to change her to a different antipsychotic medication due to her extrapyramidal symptoms (EPS). Each time the provider speaks to Jane about this Jane has become notably escalated. During the latest conversation with her provider about switching her antipsychotic, Jane threatened harm to the doctor and herself, stating, “I’ve been on Haldol for years, and I like it. It makes the voices say nice things to me. It’s not like it’ll cause me any real problems if you just keep giving me the other med with it. I swear, if you switch it on me, I’m going to either kill myself or break your neck.”

While giving Jane her morning medications, her nurse notices that Jane is frequently smacking her lips together, grimacing, and protruding/twisting her tongue, in addition to repetitively twisting her hands while spreading her fingers and moving them as though she’s playing a piano. When asked, Jane denies being in pain and doesn’t seem to generally notice her repetitive movements, but does state, “It has been a bit harder to talk and eat lately.” Since the nurse hasn’t been at work in a couple of days and hasn’t seen Jane exhibit these movements before, they ask a coworker if these are new symptoms for Jane. The coworker responds, “No, she’s been doing that for a few days now. She keeps acting like she doesn’t know it’s going on, but you know how far some of these borderline patients will go to get attention.”

What is the most likely cause of Janes new symptoms? (Please give your rationale for why you chose the option you did)

A.) Lithium toxicity
B.) Tardive dyskinesia
C.) Voluntary behavior
D.) Drug-induced parkinsonism

What treatment/medication changes should the nurse expect and why? (you don’t have to go too in depth, 1-2 sentences is good)

When a coworker hears the nurse and provider discussing the planned treatment/medication changes, they say, “I’m worried that what you’re suggesting is going to cause Jane to hurt herself or someone else. Can’t we just wait and see if it gets worse?” What could the potential long-term effects of not addressing Jane’s new symptoms be?

Question #4

Toby, a 38-year-old male with no prior medical history, presents to the emergency department after falling at home due to progressive weakness and numbness in both legs. He reports that approximately 10 days ago, he noticed his "feet feeling heavy" following his usual daily run. He attributed this to deconditioning, as he had recently taken a two-week break from exercise due to a COVID-19 infection. However, over the next several days, the weakness ascended from his feet to his thighs. He now reports complete inability to move his legs and minimal sensation from the hips down. He denies recent trauma, back pain, or changes in bowel or bladder habits.

His focused neurological exam revealed the following:

Motor: 0/5 strength in bilateral lower extremities; 5/5 strength in upper extremities
Sensory: Decreased sensation from the mid-abdomen down
Reflexes: Absent deep tendon reflexes in lower extremities
Cranial nerves: Intact

1. What is the most likely diagnosis? How would you explain the diagnosis and prognosis to the patient?

2. What is the standard first line treatment? Why is early treatment important?

3. What is one complication of this disease? Include signs and symptoms or specific monitoring interventions.

Question #5

A 40-year-old female butcher named Shaynenalyn presented to your clinic for acute visit with her primary care physician (PCP) with chief complaint of mild pain and intermittent numbness and tingling in her both hands for about a month now, which was previously resolved with an over-the-counter (OTC) pain medicine. However, for the past few days, the pain progressively got worst and became constant described as burning and a 10/10 pain scale which also made it hard for her to sleep at night. The pain sometimes radiates from the wrist up to the arm and elbow which makes it difficult for her to hold her knives and cut meats at work. You asked her to show you her hands, and saw Figure 1.

On your initial impression, Shaynenalyn is suffering from what musculoskeletal condition?

Although the exact etiology of this condition remains uncertain, what are some of its associated risk factors and give at least one clinical exam or physical assessment that the PCP or you would do to evaluate Shaynenalyn’s condition?

Question #6

Rufino a 58-year-old male presents to the emergency department with complaints of facial weakness, difficulty swallowing, and slurred speech that began 24 hours ago. He now reports weakness in his right arm. He denies trauma or recent head injury. He had a mild stomach flu one week ago. He also just arrived from Mexico after doing a 14 day long walking pilgrimage that spanned from Morelia Michoacán to Mexico City.

On assessment:

Bilateral facial droop
Weak gag reflex
Decreased strength in both upper limbs
Respiratory rate 22/min with mild shortness of breath
SpO₂ 95% on room air
Deep tendon reflexes in the upper extremities are diminished
Lower extremity strength is currently normal but as time progresses strength is diminished.

Case Study Question:

As the nurse caring for this patient, what diagnosis do you suspect Rufino to have? What are your immediate concerns based on this descending pattern of symptoms? What priority assessments and interventions should be implemented to prevent complications and ensure patient safety?

Image of disease progression. From The Lancet (British Edition)

Question #7

Part 1 (4 pts)

A 60-year-old patient comes to your clinic complaining of a sharp, shooting pain that starts in their lower back and radiates down their left leg to his ankle. He stated that the pain started a few days ago after lifting a heavy box. He also reports some tingling and numbness in their toes. Which of the following is the MOST likely cause of this patient's complaint?

a) Hip osteoarthritis
b) Peripheral neuropathy
c) Lumbar disc herniation with sciatic nerve involvement
d) Meralgia paresthetica (lateral femoral cutaneous nerve entrapment)

Part 2 (6pts)

What specific symptom, if present in this case, would raise immediate concern for a medical emergency requiring immediate evaluation and potential surgical intervention and why?

Question #8

James is a 62-year-old woman with progressive multiple sclerosis (MS) who has been living in a skilled nursing facility for the past two years. She is wheelchair-bound, has limited use of her arms, and experiences chronic neuropathic pain. Mrs. James is alert and cognitively intact but is often described by staff as “difficult to please” due to her frequent complaints, emotional outbursts, and refusal of care when she feels misunderstood or rushed. Mrs. James has a documented history of past trauma, including prior neglect in a long-term care setting, which contributes to her guarded behavior. She prefers consistent caregivers, values autonomy in her care decisions, and expresses frustration when her preferences are not followed.

How can the nurse incorporate trauma-informed care principles while managing the physical and emotional needs of a cognitively intact patient with progressive multiple sclerosis who exhibits resistance to care and values autonomy?

Question #9

Background:

You are at your family’s Thanksgiving dinner get-together and notice that your uncle, a 70 year old male with no known major medical history, is walking more slowly than usual. You also note that his face is showing less expression, he has a slightly stooped posture, his voice is softer than usual, and he appears to be stiff overall. You also note that his left arm is in a slightly bent posture at rest with a reduced arm swing noted. As your uncle is going to pick up his water glass, you notice a very slight tremor that subsides when he has the glass in his hand. Although he is A&Ox4 and is not showing signs of confusion, your uncle is known to be an active and animated person, so these changes are concerning. Your uncle shares with you that he has noticed these changes and has an appointment with a neurologist coming up soon.

Questions:

1) Based on these symptoms and observations, what diagnosis do you expect the neurologist to make? How is this diagnosis usually made?
2) What pharmacological treatment would you expect to be initially prescribed to manage this condition? What other therapies can be helpful in treating the symptoms of this condition? Name one.

Please use in-text citations when answering these questions.

Question #10

You are the nurse in an operating room circulating a revision total knee arthroplasty surgical case. Your patient is a 70-year-old woman and weighs 61.2 kg. Prior to the procedure start, your patient received a regional block in preop. During the surgery it becomes apparent the revision will take longer and be more complex than anticipated. The surgeon says to you, “I’m worried about pain control after this. Can you please get 20 mL of 0.50% marcaine and give it to the back table?”

1) Before retrieving the requested dose, which other provider in the OR should you consult to determine the safety of administering more local anesthetic? (2 points)
2) What is the name of the toxicity you are concerned about? (1 point)
3) Consider your environment; identify 2 potential symptoms of this toxicity that you could observe in the OR. (2 points)
4) Identify two patient factors that could contribute to a higher risk for this toxicity. (2 points)
5) What is the rescue medication for this toxicity? (1 point)

Reference and citations (1 point)

BONUS: What role does epinephrine play when added to local anesthetics? You don’t need to explain the biochemical mechanism of action; simply state the physiological effect of epinephrine in the context of local anesthetics and therefore what it means in regard to dosing. (1 point)

Question #11

You are charge nurse at a comprehensive stroke center and receive an incoming ambulance from the field. They state, “Medic 33 incoming with a 72 year old female, last known well 1 hr ago, with left facial droop, left arm and hand grip weakness, and aphasia. FAST positive, LAMS score of 4, BP 200/100 and blood sugar 115.”

You pre-activate the code team.

1. Explain to the primary nurse what the medics mean by FAST and LAMS.
2. Based on the patient’s symptoms, describe the potential findings on CTA, localized to which artery?
3. What sort of treatment options (list two) might be considered for this patient?

OpenAI. (2025). ChatGPT (May 12 version) [Large language model]. https://chat.openai.com

Musculoskeletal

Question #12

Jason is a 13-year-old boy who comes to the clinic for a routine sports physical. During the exam, you notice that his right scapula appears more prominent than the left when he bends forward. His mother mentions that Jason has been complaining of occasional back fatigue during long walks. He has not yet started puberty and denies any pain, numbness, or weakness. During further inspection, you also observe uneven waist creases and a slight tilt of the pelvis.

Question:

Based on Jason’s physical assessment findings and developmental stage, explain your clinical impression and describe the next appropriate step in evaluation or management. Include the underlying pathophysiology of the suspected condition and any relevant factors that influence treatment decisions.

Question #13

You are caring for a 14-year-old boy named Tony who recently had a cast applied to his right arm for a distal radial head fracture. Tony is complaining that their cast is too tight. What nursing assessments can you perform to rule out compartment syndrome? (8 points)

Tony’s assessment is positive for compartment syndrome – you notify the provider and their cast is removed, but symptoms persist. What is the definitive treatment for compartment syndrome and why? (2 points)

Question #14

Samantha is a 27-year-old female presented to the ED with a headache (9/10 on numeric pain scale), photophobia, and lethargy. Her girlfriend, Charlotte, reports that she has been sick since they got back from a music festival but has looked worse over the last few hours.

Her vital signs are:

HR = 124
RR = 22
BP = 91/42 (58)
SpO2 = 95%
T = 39.8 C

On assessment, Samantha has altered mental status (A/O X 1, GCS = 13), nuchal rigidity, and a positive Kernig and Brudzinski signs. You call Dr. Emergency and ask them to come examine the patient and say that you are going to call a sepsis huddle. Briefly describe how to assess Kernig and Brudzinski signs and what a positive result looks like.

After you hang up the phone Samantha begins to seize at 12:03. You note that she has whole-body contractions, and she has lost consciousness which you recognize as a tonic-clonic seizure. What are your three immediate priorities for Samantha? Provide a very brief rationale for your answers.

Dr. Emergency comes into the room and asks you what happened. Provide a short (1-2 sentences) SBAR in your own words.

It is now 12:09, and Samantha is still seizing despite multiple doses of IV Lorazepam. Dr. Emergency gives the following orders. In what order would you do these interventions?

1. Administer 1500 mg of Levetiracetam
2. Insert 2 large-bore IVs, or an IO if unable to obtain venous access
3. Obtain a BMP, CBC, LFTs, and 2 sets of blood cultures
4. Prepare to assist with endotracheal intubation
5. Administer 1L of Lactated Ringer’s
6. Start a propofol drip at 50 mcg/kg/min
7. Call the EEG tech for a STAT EEG

Samantha has now stabilized, and you call the ICU charge nurse to arrange transfer. You see Charlotte crying the corner and she asks you “What’s wrong with her? Is she going to be okay?”. In 2-4 sentences, how would you explain Samantha’s diagnosis to Charlotte?

Question #15

You are a nurse in an urgent care clinic. A 41-year-old Asian American male presents with a chief complaint of severe pain and swelling in his right big toe. The pain awakened him early in the morning and he had to call for help from his brother whom he lives with to stand up and move to come to the clinic to seek care. Patient reports attending a party the night before with friends, consuming beer and a traditional pork and liver dish. Upon physical examination of his extremities, you find that the skin of the proximal phalanx of the great toe noted to be shiny and red.

Lab tests were ordered which showed the following: neutrophilic leukocytosis on CBC and normal serum urate levels.

What is the most likely diagnosis and what most likely contributed to this acute event, as mentioned in the patient’s history?

Identify at least one medication considered as first-line therapy for the patient’s condition and would likely be included in their treatment plan. Also include the rationale for giving this medication.

Name at least one nonpharmacologic strategy to treat this condition that you can include when educating the patient.

Question #16

A 63-year-old man comes into the clinic with a history of HTN, DM2, and he reports that he drinks 3-5 beers a sitting at least 2-3 days a week. He complains of sudden, increasing pain in his right foot that has limited his ability to walk for the past few days and reports that this is not the first time it has happened. On assessment, you notice that the foot is hot, swollen, and he has a limited range of motion due to extreme pain. Additionally, most of his symptoms seem to be isolated to his joints, especially the metatarsophalangeal joint of his big toe.

1. Based on your assessment, what do you suspect his diagnosis to be?
2. Briefly describe the pathophysiology of this diagnosis.
3. What medication do you suspect will be prescribed to treat his diagnosis long term and how can alterations in diet impact the occurrence of this diagnosis?

Question #17

Gary is a 32-year-old man who presents to the emergency department after speeding on an e-scooter and hitting a parked car. He reports severe pain, swelling, inability to bear weight, bruising/redness, and distal paresthesia in his right leg. The doctor orders imaging and labs. The image below is from an X-ray obtained and allows the provider to confirm Gary’s diagnosis. What injury did Gary sustain (name the injury pattern/classification for bonus!)? Name at least two nonpharmacological ways you may help ease Gary’s pain (there are two specific nonpharmacological methods that are shown to be beneficial for this injury that I would ideally like you to put, but pain is a subjective experience, and some patients may prefer different approaches to reducing their pain, so feel free to be creative!). To fixate Gary’s injury, the provider obtained Gary’s consent to perform an IMN. What is an IMN? (Just looking for the expanded/non-abbreviated name of the procedure, but feel free to talk about it more if you’d like)

BONUS: If not already mentioned in the above answer, what is the specific pattern/classification of Gary’s injury?

(Sabiston, D. C., 2022).

Question #18

A baseball player sustained an injury during a recent game and was unable to move due to sever left ankle pain. He was taken to the nearest hospital for further evaluation. Upon arrival in the ER, He presented with significant swelling on left lower leg and foot, warm to touch compared to his right leg.

His Vital Signs were concerning:

BP 186/90
HR : 80
RR: 30
Temp: 38.0 degree C
SpO2: 87% on room air

Patient has no significant medical history. His Xray showed a dislocated talus and a spiral fracture of the proximal fibula, consistent with a Maisonneuve fracture. Surgical treatment included ankle arthroscopy, drilling for a talar injury, and syndesmosis screw fixation.

Based on the information and current surgical intervention, Answer the following questions.

1) What is this patient at risk of developing? Name at least three complications that might occur after surgery.
2) What are the interventions for these complications? Provide a brief overview of each.
3) When might he be able to return to playing baseball?

Maisonneuve Fracture

Question #19

John is a 65 year old male presents to an urgent care for complaints of right foot pain in the setting of a poorly healing wound. He has history of Type 2 Diabetes and peripheral vascular disease, and is a pack a day smoker. You are the nurse taking him back to an exam room and gathering assessment data for the provider.

Vitals:

Temp: 100.4 degrees F4
BP: 145/80
HR: 95
RR: 18
SpO2: 98% on room air

Upon assessment of John’s right foot, you note an open sore that is red around the edges on the side of his pinky toe. It is hard to tell but the wound is deep enough you are concerned you can see bone. He has pedal edema 2+ on the right foot, and no edema on the left foot. His right foot is erythematous and warm to the touch. The patient reports that his foot is painful with palpation.

1. Based on the assessments, what do you suspect John has with his right foot? (2 pts)
2. What is the pathophysiology of this condition? (4 pts)
3. What medications would you suspect would be administered for this patient? (2 pts)
4. List 2 pieces of patient education that you would discuss with John surrounding this condition and management (1 pt per education piece).

Question #20

John, a 70-year-old male, was just admitted to the Med/Surg unit after undergoing a right total hip arthroplasty (also known as a total hip replacement). According to the PACU handoff report, the patient received Tramadol 50 mg x 1, had a bladder scan showing 350 mL, a glucose level of 90, and a soft blood pressure around 100/70 in the PACU. He is currently receiving Lactated Ringer's at 75 mL/hr. The patient is alert and oriented ×4, calm, with a temperature of 96.5°F, heart rate of 72, blood pressure of 95/60, respiratory rate of 16, and is complaining of spasms and tightness at the right hip incision site.

1. What assessments would you perform for this post-op patient who was just admitted to the floor? List at least three.
2. What are the appropriate nursing management interventions? List at least three.
3. What discharge education should be provided to the patient? List at least three.

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