K
C
LO
YC
NUR 3065 EXAM 4 QUESTIONS
D
AND CORRECT VERIFIED
U
ANSWERS 100% GUARANTEED
ST
PASS A+ GRADED
,Cranial Nerve I: Olfactory
o SENSORY
o Assess smell with eyes closed
o Normal = able to identify smells correctly
Cranial Nerve II: Optic
o SENSORY
K
o Inspect visual acuity
♣ Use Snellen chart
♣ Normal = 20/20 vision
C
o Inspect visual fields - peripheral vision tested by confrontation
♣ When looking straight ahead, wiggle fingers out to in, cover 1 eye, ask when the moving
object is spotted
LO
♣ Normal = visual fields intact by confrontation
Cranial Nerve III, IV, VI: Oculomotor, Trochlear, and Abducens
o MOTOR
YC
o Inspect extraocular muscles function using the diagnostic positions test
♣ EOM's test - follow in an H or Vs
• Normal =
-EOM's intact in 5 cardinal fields of gaze
-Gaze is conjugate; simultaneous movement of both eyes, without nystagmus
D
♣ CN III = EOM
♣ CN IV = up, down, and inward movements
U
♣ CN VI = lateral movements
o Inspect pupil size and constriction
ST
♣ Normal pupil size = equal, resting size is 3 to 5 mm
o Assess pupillary light reflex test
♣ Penlight from side to side, check same eye-direct and other eye-consensual/simultaneous
pupil constriction or reaction to light
o Accommodation test
♣ Focus far away to dilate pupils, then bring finger close to pt.'s nose 4 inches, check for pupils
to constrict and converge - axes move in
o PEERLA = pupils equal, round, react to light, and accommodation with consensual response
,o Abnormal - CN VI = nerve palsy
Cranial Nerve V: Trigeminal
o MOTOR AND SENSORY
o Palpate for TMJ
♣ Ask pt. to clench teeth or chew, check jaw muscle strength
♣ Normal = strength equal bilateral, TMJ without pain or crepitus
K
Cranial Nerve VII: Facial
o MOTOR AND SENSORY
C
o Motor - pt. can smile, frown, raise eyebrow, puff cheeks symmetrically
o Ask pt. if they can identify taste (sweet, salty, sour, bitter) on anterior 2/3 of tongue
o Abnormal - Bell's Palsy (nerve paralysis)
LO
♣ Facial paralysis
♣ Self-limiting; will resolve in approximately 6 weeks
♣ Usually follows trauma, infection (cannot wrinkle forehead)
YC
Cranial Nerve VIII: Acoustic
o SENSORY
o Assess hearing acuity
o Whisper word at 2 feet
♣ Normal = voices sounds were audible, and words correctly identified
D
o Rinne test (compares air and bone conduction); Weber test (tuning fork); Romberg test (pt.
close eyes and remain still)
U
Cranial Nerve IX and X: Glossopharyngeal and Vagus
o MOTOR AND SENSORY
ST
o Inspect and palpate and uvula rise midline on phonation
♣ Normal = soft palate intact, uvular midline
o Ask pt. to swallow, say 'ahh', use tongue blade, uvula rises
Cranial Nerve XI: Spinal
o MOTOR
o Palpate muscle strength with head/neck movement and shoulder shrug
♣ Normal = 5/5 bilaterally as client moves against resistance
, Cranial Nerve XII: Hypoglossal
o MOTOR
o Inspect tongue when extended
♣ Ask pt. to stick out their tongue, check position
♣ Normal = midline without deviation
o Abnormal - nerve palsy
Head
o Headaches
K
o Injury
o Dizziness/syncope
C
Neck
o Pain
LO
o Limited ROM
o Enlarged or tender nodes
o Goiter
YC
Mouth and Throat
o Mouth pain or toothache
o Bleeding gums
o Lesions in mouth or tongue
o Sore throat
o Dysphagia
D
Nose and Sinuses
U
o Discharge
o Severe/unusual/frequent colds
o Sinus pain
ST
o Nosebleeds
o Allergies
Ears
o Earaches
o Infections
o Discharge
o Vertigo
o Tinnitus
C
LO
YC
NUR 3065 EXAM 4 QUESTIONS
D
AND CORRECT VERIFIED
U
ANSWERS 100% GUARANTEED
ST
PASS A+ GRADED
,Cranial Nerve I: Olfactory
o SENSORY
o Assess smell with eyes closed
o Normal = able to identify smells correctly
Cranial Nerve II: Optic
o SENSORY
K
o Inspect visual acuity
♣ Use Snellen chart
♣ Normal = 20/20 vision
C
o Inspect visual fields - peripheral vision tested by confrontation
♣ When looking straight ahead, wiggle fingers out to in, cover 1 eye, ask when the moving
object is spotted
LO
♣ Normal = visual fields intact by confrontation
Cranial Nerve III, IV, VI: Oculomotor, Trochlear, and Abducens
o MOTOR
YC
o Inspect extraocular muscles function using the diagnostic positions test
♣ EOM's test - follow in an H or Vs
• Normal =
-EOM's intact in 5 cardinal fields of gaze
-Gaze is conjugate; simultaneous movement of both eyes, without nystagmus
D
♣ CN III = EOM
♣ CN IV = up, down, and inward movements
U
♣ CN VI = lateral movements
o Inspect pupil size and constriction
ST
♣ Normal pupil size = equal, resting size is 3 to 5 mm
o Assess pupillary light reflex test
♣ Penlight from side to side, check same eye-direct and other eye-consensual/simultaneous
pupil constriction or reaction to light
o Accommodation test
♣ Focus far away to dilate pupils, then bring finger close to pt.'s nose 4 inches, check for pupils
to constrict and converge - axes move in
o PEERLA = pupils equal, round, react to light, and accommodation with consensual response
,o Abnormal - CN VI = nerve palsy
Cranial Nerve V: Trigeminal
o MOTOR AND SENSORY
o Palpate for TMJ
♣ Ask pt. to clench teeth or chew, check jaw muscle strength
♣ Normal = strength equal bilateral, TMJ without pain or crepitus
K
Cranial Nerve VII: Facial
o MOTOR AND SENSORY
C
o Motor - pt. can smile, frown, raise eyebrow, puff cheeks symmetrically
o Ask pt. if they can identify taste (sweet, salty, sour, bitter) on anterior 2/3 of tongue
o Abnormal - Bell's Palsy (nerve paralysis)
LO
♣ Facial paralysis
♣ Self-limiting; will resolve in approximately 6 weeks
♣ Usually follows trauma, infection (cannot wrinkle forehead)
YC
Cranial Nerve VIII: Acoustic
o SENSORY
o Assess hearing acuity
o Whisper word at 2 feet
♣ Normal = voices sounds were audible, and words correctly identified
D
o Rinne test (compares air and bone conduction); Weber test (tuning fork); Romberg test (pt.
close eyes and remain still)
U
Cranial Nerve IX and X: Glossopharyngeal and Vagus
o MOTOR AND SENSORY
ST
o Inspect and palpate and uvula rise midline on phonation
♣ Normal = soft palate intact, uvular midline
o Ask pt. to swallow, say 'ahh', use tongue blade, uvula rises
Cranial Nerve XI: Spinal
o MOTOR
o Palpate muscle strength with head/neck movement and shoulder shrug
♣ Normal = 5/5 bilaterally as client moves against resistance
, Cranial Nerve XII: Hypoglossal
o MOTOR
o Inspect tongue when extended
♣ Ask pt. to stick out their tongue, check position
♣ Normal = midline without deviation
o Abnormal - nerve palsy
Head
o Headaches
K
o Injury
o Dizziness/syncope
C
Neck
o Pain
LO
o Limited ROM
o Enlarged or tender nodes
o Goiter
YC
Mouth and Throat
o Mouth pain or toothache
o Bleeding gums
o Lesions in mouth or tongue
o Sore throat
o Dysphagia
D
Nose and Sinuses
U
o Discharge
o Severe/unusual/frequent colds
o Sinus pain
ST
o Nosebleeds
o Allergies
Ears
o Earaches
o Infections
o Discharge
o Vertigo
o Tinnitus
