ATI RN
CNS Vital Signs Assessment Questions
Question 1 of 5
The nurse is assessing a patient's gait. Which finding indicates a normal gait?
Correct Answer: D
Rationale: The correct answer is D because a symmetrical stride length indicates a normal gait. When both legs move in a coordinated manner and cover equal distances, it suggests proper balance and coordination. Absent arm swing (A) can indicate a gait abnormality. A narrow base of support (B) can lead to instability. Unequal step lengths (C) can also point to an abnormal gait pattern. In summary, a symmetrical stride length is crucial for an individual to maintain balance and walk efficiently.
Question 2 of 5
What is the primary reason for performing a Romberg test during a neurological assessment?
Correct Answer: A
Rationale: The Romberg test is primarily performed to evaluate balance and coordination by assessing the proprioceptive function of the lower extremities. This test helps identify sensory ataxia, a condition where there is a loss of proprioception leading to impaired balance. Testing cranial nerve function (Choice B) involves different assessments, such as cranial nerve examination. Muscle strength (Choice C) is evaluated through manual muscle testing, not the Romberg test. Reflexes (Choice D) are typically assessed using tests like deep tendon reflexes, not the Romberg test. Thus, the correct answer is A as it aligns with the purpose and methodology of the Romberg test.
Question 3 of 5
Which of the following findings is most concerning during a neurological assessment?
Correct Answer: D
Rationale: The correct answer is D because a positive Babinski sign in an adult indicates an abnormal response suggesting potential neurological dysfunction, specifically upper motor neuron pathology. This finding is concerning as it can indicate underlying issues such as spinal cord injury, brain tumor, or multiple sclerosis. In contrast, choices A and B are normal findings, indicating proper pupil response and equal strength, respectively. Choice C also indicates normal mental status. So, a positive Babinski sign is the most concerning because it suggests potential serious neurological issues, while the other choices are within normal parameters.
Question 4 of 5
A physical therapist evaluates a patient with adhesive capsulitis of the shoulder. Which intervention is MOST appropriate to improve range of motion?
Correct Answer: A
Rationale: The correct answer is A: Joint mobilization. Joint mobilization involves skilled passive movement techniques applied to a joint to restore motion. In adhesive capsulitis, there is restricted motion due to adhesions within the joint capsule. Joint mobilization helps break down these adhesions, improving range of motion. Electrical stimulation (B) and ultrasound therapy (C) may help with pain management but do not directly address the joint restriction. Postural training (D) may be beneficial for overall shoulder function but is not the most direct intervention for improving range of motion in adhesive capsulitis.
Question 5 of 5
Which assessment finding is most consistent with a diagnosis of arterial insufficiency?
Correct Answer: B
Rationale: The correct answer is B - Dependent rubor and cool skin. Arterial insufficiency is characterized by poor blood flow to the extremities, resulting in decreased oxygen supply and tissue damage. Dependent rubor (redness when legs are in a dependent position) and cool skin are indicative of decreased arterial blood flow. Brown discoloration (choice A) typically indicates chronic venous insufficiency. Pitting edema (choice C) is associated with venous insufficiency and heart failure. Warm, erythematous skin (choice D) is more indicative of inflammation or infection, rather than arterial insufficiency.