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    Quiz - Neurological

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    Rebekah H
    The nurse is assessing cranial nerves 3, 4, and 6 by having the patient focus on an object while the nurse moves it diagonally and from left to right. This assesses extraocular movements to test all three cranial nerves at once. The vagus nerve (CN 10) is responsible for the gag reflex triggered when the nurse accidentally inserts the tongue blade too far during a tonsil assessment. Of the clients described, the 68-year-old African American male with hypertension has the highest risk for a cerebrovascular accident due to factors like his age, race, and hypertension status. Sudden weakness to the face or extremities would be a priority assessment finding for a client admitted with

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    Quiz - Neurological

    Uploaded by

    Rebekah H
    113 views3 pages
    The nurse is assessing cranial nerves 3, 4, and 6 by having the patient focus on an object while the nurse moves it diagonally and from left to right. This assesses extraocular movements to test all three cranial nerves at once. The vagus nerve (CN 10) is responsible for the gag reflex triggered when the nurse accidentally inserts the tongue blade too far during a tonsil assessment. Of the clients described, the 68-year-old African American male with hypertension has the highest risk for a cerebrovascular accident due to factors like his age, race, and hypertension status. Sudden weakness to the face or extremities would be a priority assessment finding for a client admitted with

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    Quiz- Neurological

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    The nurse is assessing cranial nerves 3, 4, and 6 by having the patient focus on an object while the nurse moves it diagonally and from left to right. This assesses extraocular movements to test all three cranial nerves at once. The vagus nerve (CN 10) is responsible for the gag reflex triggered when the nurse accidentally inserts the tongue blade too far during a tonsil assessment. Of the clients described, the 68-year-old African American male with hypertension has the highest risk for a cerebrovascular accident due to factors like his age, race, and hypertension status. Sudden weakness to the face or extremities would be a priority assessment finding for a client admitted with

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    113 views3 pages

    Quiz - Neurological

    Uploaded by

    Rebekah H
    The nurse is assessing cranial nerves 3, 4, and 6 by having the patient focus on an object while the nurse moves it diagonally and from left to right. This assesses extraocular movements to test all three cranial nerves at once. The vagus nerve (CN 10) is responsible for the gag reflex triggered when the nurse accidentally inserts the tongue blade too far during a tonsil assessment. Of the clients described, the 68-year-old African American male with hypertension has the highest risk for a cerebrovascular accident due to factors like his age, race, and hypertension status. Sudden weakness to the face or extremities would be a priority assessment finding for a client admitted with

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 3

    Question 1

    1 / 1 pts
    The nurse is assessing cranial nerves 3, 4, and 6 (oculomotor, trochlear, and
    abducens). Which technique might the nurse use to assess all three in one technique?
     

      
    Use a tuning fork to see if the client can sense vibration on the closed eyelids bilaterally.
     
      
    Use an ophthalmoscope to view the optic disc and retina.
     
      
    Have the client move his eyes in the 6 cardinal fields of gaze.
     
      
    Have the client turn his head to track the nurse's hand movement as it makes a 360
    curve around the client's head.
     
    The nurses assesses extraocular movements by having patient to focus on an object
    while the nurse moves the object diagnally and from left to right. The other assessments
    do not assess these cranial nerves.
     
    The nurses assesses extraocular movements by having patient to focus on an object
    while the nurse moves the object diagnally and from left to right. The other assessments
    do not assess these cranial nerves.
     
     
    Question 2
    1 / 1 pts
    As the nurse is using a tongue blade to assess the tonsils, the nurse accidentally inserts
    the tongue blade too far causing the client to cough and gag. Which cranial nerve (CN)
    is responsible for this reflex?
     

      
    CN 10, the vagus nerve
     
      
    CN 11, the spinal accessory nerve
     
      
    CN 7, the facial nerve
     
      
    CN 12, the hypoglossal nerve
     
    The vagus nerve is assess by testing the gag reflex. The facial nerve is assessing facial
    nerve by asking patient to smile and raise eyebrows. Cranial nerve 11 is assessed by
    asking client to shrug shoulders. Cranial nerve 12 is assessed by having clients
    protrude tongue and move side to side with resistance.
    The vagus nerve is assess by testing the gag reflex. The facial nerve is assessing facial
    nerve by asking patient to smile and raise eyebrows. Cranial nerve 11 is assessed by
    asking client to shrug shoulders. Cranial nerve 12 is assessed by having clients
    protrude tongue and move side to side with resistance.
     
    Question 3
    1 / 1 pts
    When evaluating a client's risk for cerebrovascular accident, which client should the
    nurse identify as being at highest risk?

      
    A 70-year-old Caucasian male who has one to two beers a day
     
      
    A 42-year-old Caucasian female who smokes
     
      
    A 35-year-old African American male who has sleep apnea
     
      
    A 68-year-old African American male with hypertension
     
    Risk factors include older adulthood (risk doubling each decade after age 55), male sex,
    African American race, hypertension, smoking, chronic alcohol intake (more than three
    drinks per day), and sleep apnea. In the clients listed, the 68-year-old African American
    male with hypertension has the greatest risk due to his age, race, and hypertension.
    The other clients would be at risk, but the risk would be less.
    Risk factors include older adulthood (risk doubling each decade after age 55), male sex,
    African American race, hypertension, smoking, chronic alcohol intake (more than three
    drinks per day), and sleep apnea. In the clients listed, the 68-year-old African American
    male with hypertension has the greatest risk due to his age, race, and hypertension.
    The other clients would be at risk, but the risk would be less.
     
    Question 4
    1 / 1 pts
    Client is admitted to hospital with signs and symptoms of cerebrovascular stroke. The
    understands the priority assessment findings for this patient are expected to be

      
    presbyopia
     
      
    confusion or memory loss
     
      
    sudden weakness to face or extremity
     
      
    headaches that improve later in the day
     
    A symptom of stroke is the sudden weakness to face or extremities. Confusion or
    memory loss may be related to dementia, headaches that improve later in the day may
    be tumor related, presbyopia can be an age related finding.
    A symptom of stroke is the sudden weakness to face or extremities. Confusion or
    memory loss may be related to dementia, headaches that improve later in the day may
    be tumor related, presbyopia can be an age related finding.

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