When the nurse assesses the Cranial Nerve VII, which would the nurse ask the patient to perform? (Select all that apply)
Smile
Close eyes tightly
Shrug shoulders
Frown
Smell a flower
Correct Answer : A,B,D
Choice A reason: Cranial Nerve VII (facial nerve) controls facial expression muscles. Asking the patient to smile tests the nerve’s motor function, specifically the zygomaticus muscles, which elevate the mouth corners, making this a correct assessment task for this nerve.
Choice B reason: Closing eyes tightly assesses Cranial Nerve VII’s motor function, specifically the orbicularis oculi muscle, which closes the eyelids. Weakness or asymmetry indicates potential facial nerve dysfunction, making this a correct task for evaluating this nerve.
Choice C reason: Shrugging shoulders tests Cranial Nerve XI (spinal accessory nerve), which innervates the trapezius and sternocleidomastoid muscles. This action is unrelated to Cranial Nerve VII’s facial motor functions, making it an incorrect choice for this assessment.
Choice D reason: Frowning assesses Cranial Nerve VII’s control over the corrugator supercilii and procerus muscles, which wrinkle the brow and depress the mouth. This task evaluates facial nerve function, making it a correct choice for the assessment.
Choice E reason: Smelling a flower tests Cranial Nerve I (olfactory nerve), responsible for smell sensation. This is unrelated to Cranial Nerve VII’s motor functions for facial expressions, making it an incorrect task for assessing this nerve.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: Inspection visually assesses abdominal shape and distention but cannot differentiate gas from constipation, as both may cause distention. It lacks the specificity to identify the cause, making it less effective for this purpose.
Choice B reason: Auscultation assesses bowel sounds but cannot directly distinguish gas from constipation. Hyperactive sounds may suggest gas, but this is indirect, and constipation can also alter sounds, making this less specific than percussion.
Choice C reason: Percussion produces a tympanic sound over gas-filled areas, indicating air in the bowel, versus a dull sound over solid masses like feces in constipation. This directly differentiates the cause of distention, making it the correct technique.
Choice D reason: Palpation assesses tenderness or masses but cannot reliably distinguish gas from constipation, as both may feel firm or distended. It lacks the specificity of percussion’s auditory cues, making it less effective for this purpose.
Correct Answer is C
Explanation
Choice A reason: A nodule is a solid, elevated lesion, typically greater than 1 cm in diameter, often extending deeper into the dermis or subcutaneous tissue. The lesion described is less than 1 cm, making nodule an incorrect term for this superficial, smaller skin finding.
Choice B reason: A wheal is a transient, elevated lesion caused by dermal edema, often associated with allergic reactions or urticaria. It is not solid and typically lacks the circumscribed nature of the described lesion, making wheal an inappropriate documentation term.
Choice C reason: A papule is a solid, elevated, circumscribed lesion less than 1 cm in diameter, often due to localized skin changes like inflammation or benign growths. This matches the described lesion’s characteristics, making papule the correct term for documentation.
Choice D reason: A pustule is an elevated lesion containing pus, often associated with infections like acne. The described lesion is solid, not fluid-filled, so pustule does not fit the clinical presentation, making it an incorrect choice.
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