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 D

Explanation

A) Carotid bruits: Carotid bruits are associated with turbulent blood flow in the carotid arteries, often due to stenosis or atherosclerosis. While they are important to assess in cardiovascular evaluations, they are not specific indicators of congestive heart failure (CHF).
B) 4th heart sound (S4): An S4 heart sound is associated with decreased ventricular compliance and is often seen in conditions like hypertension and left ventricular hypertrophy. It is not specific to CHF but can be present in patients with heart failure.
C) Harsh holosystolic murmur at the apex: A harsh holosystolic murmur is characteristic of mitral regurgitation, which can contribute to heart failure. However, this type of murmur is not specifically used to diagnose CHF but rather to identify the underlying cardiac pathology that could lead to CHF.
D) 3rd heart sound (S3): The S3 heart sound, often described as a "gallop," is commonly associated with congestive heart failure. It occurs due to increased fluid volume and rapid ventricular filling, reflecting the heart's struggle to manage increased blood volume and pressure, making it a key sign of CHF.

A. Lordosis B. Kyphosis C. Keratosis D. Scoliosis

Correct Answer is A

Explanation

A) Lordosis: Lordosis refers to an increased inward curvature of the lumbar spine. During pregnancy, this curvature often increases to help compensate for the growing uterus and shift the center of gravity. This adjustment helps maintain balance and alignment but can lead to noticeable changes in posture.
B) Kyphosis: Kyphosis is characterized by an exaggerated outward curvature of the thoracic spine, resulting in a hunchback appearance. It is not related to the increased lumbar curvature seen during pregnancy.
C) Keratosis: Keratosis refers to a condition involving thickening or hardening of the skin, such as actinic keratosis. It is unrelated to spinal curvature or changes associated with pregnancy.
D) Scoliosis: Scoliosis is a condition marked by an abnormal lateral curvature of the spine. It does not specifically relate to the increased lumbar curvature that occurs during pregnancy due to the enlarging uterus.

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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?

Nursing Test Bank

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