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How to do a neurological exam

Other platforms explain it with text and video. In Making Synapses you practice it on the patient.

MD / DOPANursing (NCLEX)
Practice it in VR with Blocky

The neuro exam has many parts, but it is always the same order and always left against right. A difference between sides is the finding that matters most.

Step by step

  1. Prepare

    Clean your hands, introduce yourself, get consent and explain each part before doing it. [1]

  2. Mental status

    Level of consciousness, orientation, attention and speech. [1]

  3. Cranial nerves

    Pupils, eye movements, face, hearing, palate and tongue (see the cranial nerve guide). [1]

  4. Motor

    Look for wasting and twitching, check tone, test strength 0 to 5 in each muscle group and look for pronator drift. [1]

  5. Reflexes

    Biceps, triceps, knee and ankle, graded 0 to 4+, and the plantar response. [1]

  6. Sensation

    Light touch, pinprick, vibration and position sense, from the hands and feet upward. [1]

  7. Coordination

    Finger to nose, heel to shin and rapid alternating movements. [1]

  8. Gait and Romberg

    Normal walk, heel-to-toe walk, then Romberg: feet together, eyes closed, stay close to catch the patient. [1]

  9. Record

    Write findings by part and compare sides. [1]

Common errors

Practice it in Making Synapses

In Making Synapses you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.

Making Synapses cases that train this skill

91 Making Synapses cases train this skill: open the case library

Sources

  1. Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
  2. NBOME COMLEX-USA clinical presentations

Steps adapted from Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. Facts and steps also follow NBOME COMLEX-USA clinical presentations. Making Synapses is not affiliated with these organizations. Updated: 2026-10-11.