Test your skills with our perception and coordination quiz: Can You Identify the Right Client? In this free neurologic assessment quiz, discover which client should the nurse assess for degenerative neurologic symptoms while you sharpen critical thinking through patient assessment trivia. Plus, boost your clinical judgement! Tackle our nursing coordination test and explore practical assessment of the neurological system tips before pushing your limits with extra balance and coordination tests . Ready for hands-on neuro practice? Start now and prove your clinical prowess!
What clinical test assesses proprioception by asking a client to stand with feet together, eyes closed, and arms at the sides?
Romberg test
Tandem gait test
Kernig's sign
Babinski sign
The Romberg test evaluates proprioceptive function by assessing a client's ability to maintain balance without visual input. It specifically tests the dorsal columns of the spinal cord. A positive Romberg sign indicates a sensory ataxia rather than a cerebellar cause. See more here. Neuro Exam.
Which term describes a lack of muscle coordination during voluntary movements?
Ataxia
Apraxia
Hypotonia
Dysarthria
Ataxia refers to impaired coordination of voluntary movements, often due to cerebellar dysfunction. It is distinct from apraxia, which is a motor planning disorder. Dysarthria affects speech articulation, and hypotonia refers to reduced muscle tone. Neuro Exam.
The finger-to-nose test primarily evaluates which neurological function?
Cerebellar coordination
Deep tendon reflexes
Spinal cord conduction
Cranial nerve integrity
The finger-to-nose test assesses cerebellar coordination and proprioception by having the client rapidly touch their nose then the examiner's finger. It identifies dysmetria and intention tremor. It is a standard cerebellar function test. Neuro Exam.
Which assessment technique examines the client's ability to perceive a letter drawn on the palm?
Stereognosis
Two-point discrimination
Kinesthesia
Graphesthesia
Graphesthesia tests cortical sensory function by having the client identify a number or letter traced on the palm. It depends on intact dorsal column pathways and parietal lobe processing. Two-point discrimination tests tactile acuity, not specific to symbolic recognition. Neuro Exam.
The heel-to-shin test is used to assess:
Light touch sensitivity
Lower extremity coordination
Muscle strength
Pain perception
The heel-to-shin test evaluates lower extremity coordination by asking the client to run one heel down the opposite shin. Poor performance with intact strength suggests cerebellar ataxia. It is part of the cerebellar examination. Neuro Exam.
A positive Romberg sign indicates dysfunction in the:
Basal ganglia
Spinothalamic tract
Dorsal columns of the spinal cord
Corticospinal tract
A positive Romberg sign, marked by increased sway or falling with eyes closed, indicates impaired proprioceptive input via the dorsal columns. Disturbances of the corticospinal tract cause weakness, and basal ganglia issues cause movement disorders rather than pure sensory ataxia. Neuro Exam.
Stereognosis testing evaluates the:
Vibration sense
Tactile object recognition
Pain threshold
Temperature discrimination
Stereognosis tests the ability to identify a familiar object by touch in the absence of vision. It assesses the tactile association areas in the parietal lobe. Intact primary sensation with impaired recognition suggests cortical processing dysfunction. Neuro Exam.
Dysmetria is best described as:
Impaired speech articulation
Loss of voluntary movement
Inability to judge distance or scale of movement
Muscle rigidity
Dysmetria is a form of ataxia characterized by the inability to judge scale or range of voluntary movements, often due to cerebellar hemisphere lesions. It differs from dysdiadochokinesia, which is the impaired ability to perform rapid alternating movements. Neuro Exam.
A 65-year-old client presents with a resting tremor in one hand, bradykinesia, and a mask-like face. Which disorder is most likely?
Multiple sclerosis
Parkinson's disease
Huntington's disease
Amyotrophic lateral sclerosis
Parkinson's disease commonly presents with resting tremor, bradykinesia, rigidity, and reduced facial expression due to dopaminergic neuron loss in the substantia nigra. Multiple sclerosis involves sensory or motor deficits with remissions and exacerbations. ALS features both upper and lower motor neuron signs, and Huntington's includes chorea. Parkinson's Disease.
A client complains of numbness and tingling in the feet and difficulty walking. The Romberg test is positive. Which area is most likely affected?
Cerebellum
Motor cortex
Dorsal columns
Spinothalamic tract
Paresthesias and a positive Romberg sign indicate involvement of the dorsal columns, which carry proprioception. The spinothalamic tract transmits pain and temperature, the cerebellum is responsible for coordination but not primary sensation, and the motor cortex controls voluntary movement. Neuro Exam.
A client with multiple sclerosis demonstrates difficulty coordinating movements, diplopia, and spasticity. Which tissue is primarily demyelinated?
Neuromuscular junction
Basal ganglia
Peripheral nerves
Central nervous system white matter
Multiple sclerosis is characterized by autoimmune demyelination of central nervous system white matter, affecting myelinated axons in the brain and spinal cord. Peripheral nerves are spared, and the neuromuscular junction is not the primary site of pathology. MS Pathology.
A nurse performs the Romberg test and the client sways slightly but does not fall. This result is classified as:
Positive Romberg
Indicative of cerebellar lesion
Inconclusive
Negative Romberg
A negative Romberg test, characterized by slight sway without loss of balance, indicates intact proprioceptive pathways. A positive test would show significant sway or falling when the eyes are closed. Cerebellar lesions often cause ataxia even with eyes open. Neuro Exam.
A client demonstrates an intention tremor during the finger-to-nose test. This suggests a lesion in the:
Thalamus
Motor cortex
Basal ganglia
Cerebellar hemisphere
An intention tremor occurs during purposeful movement and is typically caused by lesions in the cerebellar hemispheres. Basal ganglia lesions produce resting tremors, and thalamic or cortical lesions have different presentations. Neuro Exam.
A patient exhibits increased muscle tone, hyperreflexia, and a positive Babinski sign. These findings most likely indicate:
Peripheral neuropathy
Lower motor neuron lesion
Upper motor neuron lesion
Neuromuscular junction disorder
Upper motor neuron lesions produce spasticity, hyperreflexia, and an extensor plantar response (positive Babinski). Lower motor neuron lesions cause flaccidity and hyporeflexia, peripheral neuropathy affects sensory and motor fibers, and neuromuscular junction disorders present with fatigable weakness. Neuro Exam.
A 30-year-old woman with suspected dorsal column dysfunction reports difficulty sensing vibration in her lower limbs. Which test is most appropriate?
Graphesthesia on palm
Light touch on face
Two-point discrimination on hand
Tuning fork on tibial bone
Testing vibration sense with a tuning fork placed on a bony prominence like the tibial bone evaluates dorsal column integrity in the lower limbs. Two-point discrimination assesses cortical function, not primary vibration sense. Neuro Exam.
A client with a suspected cerebellar stroke shows dysdiadochokinesia. What assessment would confirm this finding?
Rapid alternating movements
Knee-jerk reflex
Romberg test
Two-point discrimination test
Dysdiadochokinesia is the inability to perform rapid alternating movements smoothly, indicative of cerebellar hemisphere dysfunction. The Romberg test assesses proprioception, not alternating movements. Reflex testing and two-point discrimination evaluate different pathways. Neuro Exam.
In amyotrophic lateral sclerosis (ALS), which of the following signs would you expect initially?
Muscle weakness with fasciculations
Intention tremor
Ataxic gait
Loss of pain sensation
ALS begins with degeneration of upper and lower motor neurons, causing muscle weakness and fasciculations. Sensory modalities like pain are typically preserved. Intention tremor and ataxic gait are features of cerebellar disorders. ALS Overview.
During sensory assessment, a client cannot identify a coin placed in their hand although primary touch sensation is intact. Which cortical function is impaired?
Two-point discrimination
Vibration sense
Stereognosis
Graphesthesia
Stereognosis is the ability to recognize objects by touch. When primary sensation is intact but object recognition fails, it indicates a cortical sensory association area deficit. Graphesthesia tests symbolic interpretation, and two-point discrimination and vibration sense assess other sensory modalities. Neuro Exam.
A client with Parkinson's disease exhibits a festinating gait. Which description best fits this gait pattern?
Exaggerated arm swings
High-stepping gait to clear feet
Wide-based gait and veering
Short, rapid steps and forward leaning
Festination describes a gait with short, rapid steps and a stooped, forward-leaning posture, commonly seen in Parkinson's disease. A wide-based gait suggests cerebellar ataxia, and a high-stepping gait occurs in foot drop. Exaggerated arm swings are normal. Neuro Exam.
A client demonstrates impairment on the heel-to-shin test but normal muscle strength. This finding most likely suggests a lesion in the:
Cerebellum
Basal ganglia
Myelin sheath of motor neurons
Peripheral nerves
Poor performance on the heel-to-shin test with intact strength suggests cerebellar dysfunction affecting coordination. Peripheral nerve lesions often cause weakness or sensory loss. Basal ganglia disorders affect movement initiation, not coordination testing. Neuro Exam.
A rapid pronation-supination test is abnormal in a client, indicating difficulty with:
Dysdiadochokinesia
Hyperreflexia
Hypotonia
Bradykinesia
An abnormal rapid pronation-supination test indicates dysdiadochokinesia, a type of cerebellar coordination impairment. Hyperreflexia is a reflex change, hypotonia refers to decreased muscle tone, and bradykinesia is slow movement typical of basal ganglia disorders. Neuro Exam.
A positive pronator drift test indicates a lesion in the:
Cerebellum
Dorsal columns
Basal ganglia
Corticospinal tract
Pronator drift occurs when one arm involuntarily pronates and drifts downward, indicating an upper motor neuron lesion in the corticospinal tract. Dorsal column lesions affect sensation, cerebellar lesions cause ataxia, and basal ganglia lesions cause movement initiation problems. Neuro Exam.
A 50-year-old client presents with progressive choreiform movements, psychiatric disturbances, and cognitive decline. Which structure is primarily affected?
Cerebellar vermis
Caudate nucleus
Spinal anterior horn
Substantia nigra
Huntington's disease is characterized by neuronal degeneration in the caudate nucleus and putamen, leading to chorea, psychiatric symptoms, and dementia. The substantia nigra is affected in Parkinson's disease. The cerebellar vermis and spinal anterior horn are involved in other disorders. Huntington's Disease.
A client has difficulty with topographical orientation and cannot judge distances but visual recognition is intact. Which lobe lesion is most likely?
Parietal lobe
Frontal lobe
Temporal lobe
Occipital lobe
Lesions of the parietal lobe can impair spatial orientation and the ability to judge distances (optic ataxia), while visual recognition remains intact. Occipital lobe lesions impair primary vision, temporal lobe lesions affect object recognition, and frontal lobe lesions affect executive function. Parietal Lobe Function.
An older client shows progressive loss of proprioception, vibration sense, and ataxia along with a positive Lhermitte's sign. Which condition is most consistent?
Subacute combined degeneration due to vitamin B12 deficiency leads to degeneration of the dorsal columns and lateral corticospinal tracts, causing proprioceptive loss, vibration sense impairment, ataxia, and Lhermitte's sign. Tabes dorsalis involves only dorsal columns without corticospinal involvement. Subacute Combined Degeneration.
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AI Study Notes
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Study Outcomes
Identify Degenerative Neurologic Indicators -
Recognize early signs of degenerative neurologic symptoms such as muscle weakness, tremors, and coordination loss in simulated client scenarios.
Analyze Reflex and Motor Responses -
Evaluate deep tendon reflexes and motor function to distinguish which client should the nurse assess for degenerative neurologic symptoms.
Interpret Sensory Assessment Findings -
Assess touch, pain, vibration, and proprioception responses to pinpoint subtle neurologic changes during the perception and coordination quiz.
Prioritize High-Risk Patients -
Apply clinical judgment to rank clients based on severity of neurologic deficits and urgency for intervention in a realistic nursing coordination test.
Apply Critical Thinking in Patient Assessment -
Use evidence-based strategies to decide which client scenario requires immediate attention in the neurologic assessment quiz.
Enhance Confidence in Clinical Skills -
Build proficiency and self-assurance by consistently identifying the right client and refining techniques through interactive patient assessment trivia.
Cheat Sheet
Muscle Strength Grading -
Assess muscle strength on the standardized 0 - 5 scale (0 = no contraction, 5 = normal strength) to detect early degenerative changes in motor function. A handy mnemonic is "Zero packs, One crack, Two in line, Three's a tree, Four's a door, Five's alive" to remember each grade level. Regular practice of bilateral testing ensures you spot asymmetries quickly (NCSBN, 2021).
Deep Tendon Reflexes (DTRs) -
Evaluate reflexes such as the biceps, triceps, patellar, and Achilles using a reflex hammer to identify hypo- or hyperreflexia, which may signal upper or lower motor neuron degeneration. Record findings on a 0 - 4+ scale and look for pathological signs like a Babinski response in adults. Consistency in reflex testing is key to tracking subtle changes over time (American Academy of Neurology, 2020).
Coordination Tests -
Perform finger-to-nose, heel-to-shin, and rapid alternating movements to assess cerebellar function and coordination. Include the Romberg test - standing with feet together and eyes closed - to uncover proprioception deficits; a positive sway suggests dorsal column involvement. Remember the acronym "FINISH" (Finger, INstep, Swing, Heel) to cover all major coordination assessments in your quiz prep (UpToDate, 2022).
Sensory Modality Evaluation -
Test light touch, pain (pinprick), temperature, vibration (128 Hz tuning fork), and proprioception to pinpoint sensory pathway degeneration. Document any dermatomal patterns or stocking-glove distribution that may indicate peripheral neuropathy versus CNS involvement. Consistent thresholds help differentiate normal age-related changes from pathological loss (NIH NeuroToolkit, 2019).
Higher Cortical Sensory Functions -
Assess stereognosis (identifying objects by touch), graphesthesia (recognizing traced numbers), and two-point discrimination to evaluate parietal lobe integrity. A quick mnemonic "S-G Two" (Stereognosis, Graphesthesia, 2-point) ensures you never miss these tests in your neurologic assessment quiz. Deficits here often precede gross motor signs of degeneration and guide which client should the nurse assess for degenerative neurologic symptoms (BRS Physiology, 2021).
