Which statement made by the new nurse regarding carpal tunnel syndrome indicates the need for further teaching?

Choice A reason: Having the client touch their nose with eyes closed tests cerebellar function and proprioception, not the oculomotor nerve (cranial nerve III). This assesses coordination and sensory integration, unrelated to the nerve controlling eye movement and pupil response, making it an incorrect choice.

Choice B reason: Instructing the client to look up and down without moving their head tests the oculomotor nerve (cranial nerve III), which innervates most extraocular muscles and controls pupil constriction. This movement relies on nerve function for vertical eye motion, making it the correct assessment for oculomotor nerve integrity.

Choice C reason: Shrugging shoulders against resistance tests the spinal accessory nerve (cranial nerve XI), which innervates the trapezius muscle. This is unrelated to the oculomotor nerve, which governs eye movement and pupil response, so this action does not assess cranial nerve III function.

Choice D reason: Observing smiling and frowning tests the facial nerve (cranial nerve VII), which controls facial muscles. This is distinct from the oculomotor nerve, which manages eye movements and pupil constriction, making it an inappropriate method for assessing cranial nerve III function.

Choice A reason: Propranolol, a beta-blocker, reduces physical anxiety symptoms (e.g., tachycardia) by blocking adrenaline’s effects on beta receptors. It is not first-line for generalized anxiety disorder, as it addresses somatic symptoms rather than the underlying neurochemical imbalance, such as serotonin dysregulation, targeted by more effective long-term treatments.

Choice B reason: Hydroxyzine, an antihistamine, has sedative properties and is used for acute anxiety by modulating histamine and serotonin receptors. It is not first-line for generalized anxiety disorder, as it lacks long-term efficacy and primarily addresses short-term symptoms, unlike treatments targeting chronic serotonin imbalances.

Choice C reason: Fluoxetine, a selective serotonin reuptake inhibitor (SSRI), is the first-choice medication for generalized anxiety disorder. It increases serotonin levels in the brain, stabilizing mood and reducing excessive worry by enhancing neurotransmission in the prefrontal cortex and amygdala, offering long-term efficacy with fewer dependency risks compared to benzodiazepines.

Choice D reason: Alprazolam, a benzodiazepine, enhances GABA activity for rapid anxiety relief but is not first-line due to high dependence risk and short-term effects. Generalized anxiety disorder requires long-term management, and SSRIs like fluoxetine are preferred for their efficacy in addressing chronic serotonin dysregulation without addiction potential.