A 54 year-old client diagnosed with Bipolar disorder is clenching his jaw closed to avoid taking a prescribed oral medication. The nurse can use this observation to confirm the client is demonstrating motor function of which cranial nerve?

Vagus

Facial

Glossopharygeal

Trigeminal

Answer and Explanation

The Correct Answer is D

A. Vagus: The vagus nerve (cranial nerve X) is involved in regulating autonomic functions, such as heart rate and digestion. It does not play a significant role in controlling jaw movements or clenching.
B. Facial: The facial nerve (cranial nerve VII) controls facial expressions, such as smiling or frowning, and also contributes to taste sensation in the anterior two-thirds of the tongue. While it is related to facial motor function, it does not control the jaw muscles responsible for clenching.
C. Glossopharyngeal: The glossopharyngeal nerve (cranial nerve IX) is involved in taste sensation on the posterior one-third of the tongue, as well as in swallowing and salivation. It does not control the jaw muscles used for clenching.
D. Trigeminal: The trigeminal nerve (cranial nerve V) is responsible for sensation in the face and motor functions related to chewing. It innervates the muscles of mastication, including those involved in clenching the jaw. The client’s jaw clenching is a direct manifestation of motor function associated with the trigeminal nerve.

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Correct Answer is B

Explanation

A) Tension headache: Tension headaches are typically characterized by a dull, aching pain that feels like a tight band around the head. They are often associated with muscle tension and stress, and they generally do not involve nausea, vomiting, or sensitivity to light and sound, which are more indicative of migraines.
B) Migraine headache: The symptoms described—severe pain rated 10 out of 10, nausea, vomiting, and sensitivity to light (photophobia) and sound (phonophobia)—are classic signs of a migraine headache. Migraines are often intense and can be accompanied by these additional symptoms, making this the most likely diagnosis.
C) Cluster headache: Cluster headaches are extremely painful and typically occur in cyclical patterns or clusters. They are often unilateral (one-sided) and can cause severe pain, redness of the eye, and nasal congestion. While they can be very painful, they are less commonly associated with nausea, vomiting, and sensitivity to light and sound as described in the scenario.
D) Sinus headache: Sinus headaches are associated with sinusitis and typically involve pain and pressure in the forehead, cheeks, or nose area, often accompanied by nasal congestion. They usually do not present with the intensity of pain, nausea, vomiting, and sensitivity to light and sound seen in migraines.

A. Pelvic examination B. Transillumination C. Bladder percussion D. Digital rectal examination

Correct Answer is D

Explanation

A. Pelvic examination: A pelvic examination is generally used to assess the reproductive organs in females rather than the prostate. It does not provide a direct assessment of the prostate gland in males.
B. Transillumination: Transillumination is a technique used to detect fluid-filled cysts or masses in areas such as the scrotum or breast. It is not used to assess the prostate gland.
C. Bladder percussion: Bladder percussion is used to assess bladder size and fullness, typically to diagnose conditions related to bladder dysfunction. It does not provide information about the prostate.
D. Digital rectal examination: A digital rectal examination (DRE) is the standard method used to assess the size, shape, and consistency of the prostate gland. It allows the clinician to feel the prostate through the rectal wall and is essential for evaluating prostate health.

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A 54 year-old client diagnosed with Bipolar disorder is clenching his jaw closed to avoid taking a prescribed oral medication. The nurse can use this observation to confirm the client is demonstrating motor function of which cranial nerve?

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Correct Answer is B

Explanation

Which of the following would the nurse expect to be done to assess the size of the prostate?

Correct Answer is D

Explanation

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