CRANIAL NERVES NURSING EXAM 2026 TEST BANK (
CORRECTLY ANSWERED QUESTIONS)
1. Question
A nurse in the emergency department assesses a 29-year-old client after a minor
motor vehicle crash. The client reports new vertical diplopia that worsens when
walking downstairs and says, “I have to tilt my head to see better.”
Which assessment finding most strongly supports Cranial Nerve IV (Trochlear)
dysfunction?
A. Inability to look down and inward with the affected eye
Correct Answer
B. Inability to move the affected eye laterally
Incorrect
C. Fixed, dilated pupil with ptosis
D. Loss of corneal sensation
Incorrect
Correct Answer: A. Inability to look down and inward with the affected eye
,CN IV innervates the superior oblique muscle, which helps depress the eye when
it is adducted. Trochlear palsy often causes vertical diplopia that worsens on stairs
or reading and may lead to compensatory head tilt.
Option B: Inability to move the eye laterally suggests CN VI (abducens)
dysfunction, not CN IV. CN VI palsy causes impaired abduction and horizontal
diplopia, which is a different pattern. Normal downward-inward movement would
still be expected with isolated CN VI issues.
Option C: A fixed dilated pupil and ptosis point to CN III compression rather than
CN IV. CN IV does not control pupil size or eyelid elevation. Those findings raise
concern for increased ICP or aneurysm rather than a trochlear palsy.
Option D: Corneal sensation is mediated by CN V, and blinking is CN VII. CN IV
does not contribute to corneal reflex pathways. Loss of corneal sensation would
suggest trigeminal involvement and a corneal injury risk.
2. Question
A nurse in the ICU assesses a client with a newly diagnosed brainstem lesion. The
client reports numbness over the right cheek and jaw and has difficulty chewing
solid food. Which findings support Cranial Nerve V (Trigeminal) dysfunction?
(Select all that apply.)
A. Decreased facial sensation over the maxillary area
Correct Answer
, B. Weak jaw clench when palpating the masseter muscles
Correct Answer
C. Loss of taste on the posterior third of the tongue
D. Absent corneal sensation on the affected side
Correct Answer
E. Inability to raise the eyebrows symmetrically
Incorrect
Incorrect
Correct Answer: A, B, D
CN V provides facial sensation (including the cornea) and motor control for
chewing. Loss of facial sensation, reduced jaw strength, and diminished corneal
sensation all fit trigeminal impairment and increase risk for corneal injury and
poor nutrition.
Option A: Sensory loss over the maxillary region is consistent with CN V2
involvement. This finding supports trigeminal dysfunction because CN V carries
facial sensory input. It also helps localize which branch is affected.
Option B: Weak jaw clench indicates impaired motor function of CN V to the
muscles of mastication. This can cause difficulty chewing and fatigue with eating.
It is a direct functional assessment of trigeminal motor integrity.
CORRECTLY ANSWERED QUESTIONS)
1. Question
A nurse in the emergency department assesses a 29-year-old client after a minor
motor vehicle crash. The client reports new vertical diplopia that worsens when
walking downstairs and says, “I have to tilt my head to see better.”
Which assessment finding most strongly supports Cranial Nerve IV (Trochlear)
dysfunction?
A. Inability to look down and inward with the affected eye
Correct Answer
B. Inability to move the affected eye laterally
Incorrect
C. Fixed, dilated pupil with ptosis
D. Loss of corneal sensation
Incorrect
Correct Answer: A. Inability to look down and inward with the affected eye
,CN IV innervates the superior oblique muscle, which helps depress the eye when
it is adducted. Trochlear palsy often causes vertical diplopia that worsens on stairs
or reading and may lead to compensatory head tilt.
Option B: Inability to move the eye laterally suggests CN VI (abducens)
dysfunction, not CN IV. CN VI palsy causes impaired abduction and horizontal
diplopia, which is a different pattern. Normal downward-inward movement would
still be expected with isolated CN VI issues.
Option C: A fixed dilated pupil and ptosis point to CN III compression rather than
CN IV. CN IV does not control pupil size or eyelid elevation. Those findings raise
concern for increased ICP or aneurysm rather than a trochlear palsy.
Option D: Corneal sensation is mediated by CN V, and blinking is CN VII. CN IV
does not contribute to corneal reflex pathways. Loss of corneal sensation would
suggest trigeminal involvement and a corneal injury risk.
2. Question
A nurse in the ICU assesses a client with a newly diagnosed brainstem lesion. The
client reports numbness over the right cheek and jaw and has difficulty chewing
solid food. Which findings support Cranial Nerve V (Trigeminal) dysfunction?
(Select all that apply.)
A. Decreased facial sensation over the maxillary area
Correct Answer
, B. Weak jaw clench when palpating the masseter muscles
Correct Answer
C. Loss of taste on the posterior third of the tongue
D. Absent corneal sensation on the affected side
Correct Answer
E. Inability to raise the eyebrows symmetrically
Incorrect
Incorrect
Correct Answer: A, B, D
CN V provides facial sensation (including the cornea) and motor control for
chewing. Loss of facial sensation, reduced jaw strength, and diminished corneal
sensation all fit trigeminal impairment and increase risk for corneal injury and
poor nutrition.
Option A: Sensory loss over the maxillary region is consistent with CN V2
involvement. This finding supports trigeminal dysfunction because CN V carries
facial sensory input. It also helps localize which branch is affected.
Option B: Weak jaw clench indicates impaired motor function of CN V to the
muscles of mastication. This can cause difficulty chewing and fatigue with eating.
It is a direct functional assessment of trigeminal motor integrity.
