A nurse is assessing a client's cranial nerves. Which method should the nurse use to assess cranial nerve I?

Ask the client to identify scented aromas.

Ask the click to read a Snellen chart.

Listen to the client's speech.

Ask the client to clench his teeth.

Answer and Explanation

The Correct Answer is A

A. Asking the client to identify scented aromas assesses cranial nerve I (olfactory nerve), which is responsible for the sense of smell.
B. Reading a Snellen chart assesses cranial nerve II (optic nerve), which is related to vision.
C. Listening to the client's speech evaluates the function of cranial nerves V (trigeminal) and XII (hypoglossal), which are related to mastication and tongue movement, respectively.
D. Asking the client to clench his teeth tests cranial nerve V, which innervates the muscles of mastication.

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Correct Answer is C

Explanation

A. This description relates more to a sensory discrimination test, not graphesthesia.

B. This option does not accurately describe the graphesthesia test, which involves identifying shapes or numbers rather than just touch location.

C. In the graphesthesia test, the client closes their eyes while the nurse uses a blunt object to write a number or shape in the client's palm, and the client must identify what was written. This assesses the ability to recognize letters or numbers drawn on the skin.

D. This option describes a two-point discrimination test rather than graphesthesia, which focuses on identifying drawn shapes or numbers.

A. Assess the pedal pulses for a full minute. B. Assess the apical pulse for a full minute. C. Assess the popliteal pulses with a Doppler device for a minimum of five minutes. D. Assess the apical pulse with a pulse oximeter.

Correct Answer is B

Explanation

A. Assessing the pedal pulses does not provide relevant information about the irregularity of the radial pulse.

B. Assessing the apical pulse for a full minute is appropriate in this situation, as it provides a more accurate measurement of the heart rate and rhythm, especially when the radial pulse is irregular.

C. Assessing the popliteal pulses with a Doppler device is not necessary and does not directly address the irregular radial pulse.

D. While a pulse oximeter can provide information about oxygen saturation, it does not assess heart rate or rhythm.

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A nurse is assessing a client's cranial nerves. Which method should the nurse use to assess cranial nerve I?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is precepting a nursing student. The nurse explains to the nursing student how you would perform the graphesthesia test on a client. What is the correct way to perform this test?

Correct Answer is C

Explanation

A nurse is assessing a client's radial pulse and determines that the pulse is irregular. Which action should the nurse take?

Correct Answer is B

Explanation

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