When preparing to test a client for meningeal irritation, what would the nurse do first?

Check for a Babinski reflex

Position the client prone

Ensure no injury to the cervical spine

Check for evidence of fever and chills

Answer and Explanation

The Correct Answer is C

A.   The Babinski reflex is a test used to assess the integrity of the corticospinal tract and is particularly useful in evaluating neurological function in infants and adults with neurological conditions. However, it is not specifically related to testing for meningeal irritation.
B.   Positioning the client prone (lying on their stomach) is not typically used when testing for meningeal irritation. The tests for meningeal irritation, such as the Brudzinski sign and Kernig sign, are performed with the client in a supine (lying on their back) position to accurately assess reactions to neck flexion and leg movements.
C.   Before performing tests for meningeal irritation, such as neck flexion, it is important to ensure that the client does not have an injury to the cervical spine. If there is a possibility of cervical spine injury, performing neck flexion could exacerbate the injury. Ensuring that there is no cervical spine injury helps to avoid causing harm and ensures a safe examination.
D.   While fever and chills can be associated with infections that may cause meningeal irritation (such as meningitis), checking for these symptoms is not the first step in assessing meningeal irritation itself.

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Correct Answer is C

Explanation

A. The trigeminal nerve (CN V) is primarily responsible for sensory information from the face and motor control of the muscles of mastication (chewing). It does not carry taste sensations. Instead, it is involved in sensation (e.g., touch, pain, temperature) of the face and mouth, but not taste.
B. The vagus nerve (CN X) has various functions, including parasympathetic control of the heart, lungs, and digestive tract, and sensory and motor functions in the throat and voice box. It does contribute to taste sensation in the region of the pharynx and the epiglottis, but it is not primarily responsible for the taste sensation on the posterior third of the tongue.
C. The glossopharyngeal nerve (CN IX) is responsible for taste sensation on the posterior one-third of the tongue. It also contributes to the sensory innervation of the pharynx and helps in the regulation of saliva production. This nerve is specifically involved in the taste perception in the back third of the tongue.
D. The facial nerve (CN VII) provides taste sensation to the anterior two-thirds of the tongue. It also controls the muscles of facial expression and contributes to the production of saliva and tears. The facial nerve does not provide taste sensation to the posterior third of the tongue.

A. Sternoclavicular B. Temporomandibular C. Subtalar D. Radioulnar

Correct Answer is B

Explanation

A. The sternoclavicular joint is where the sternum (breastbone) meets the clavicle (collarbone). It plays a role in the movement of the shoulder girdle but does not involve the jaw. Issues with this joint would typically present as shoulder or chest discomfort rather than problems with the jaw.
B. The temporomandibular joint is the joint where the mandible (lower jaw) meets the temporal bone of the skull, just in front of the ear. It is crucial for jaw movement, including opening, closing, and chewing. If a client feels that their jaws are "stuck," it is likely related to a problem with the TMJ. Common issues include TMJ disorders, which can cause pain, limited movement, or a sensation of the jaw being stuck.
C. The subtalar joint is located in the ankle, between the talus and calcaneus bones. It is involved in the movement of the foot, particularly in inversion and eversion. This joint is unrelated to jaw function, so problems here would affect the foot rather than the jaw.
D. The radioulnar joints are located in the forearm and involve the radius and ulna bones. These joints are responsible for the rotation of the forearm, such as turning the palm up or down. They do not relate to jaw movement or problems, so issues with these joints would affect the forearm or wrist rather than the jaw.

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When preparing to test a client for meningeal irritation, what would the nurse do first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Taste in the 1/3 posterior of your tongue is given by:

Correct Answer is C

Explanation

The client presents to the nurse stating that his jaws feel "stuck". What joint should the nurse assess?

Correct Answer is B

Explanation

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