While taking a history, the nurse observes that the patient's facial cranial nerves (CN VII) are intact based on which behaviors of the patient?

The sides of the mouth are symmetric when the patient smiles.

The patient's eyes move to the left, right, up, down, and obliquely during conversation.

The patient's eyelids blink periodically.

The patient moistens the lips with the tongue.

Answer and Explanation

The Correct Answer is A

Choice A rationale

The sides of the mouth being symmetric when the patient smiles indicate intact function of the facial cranial nerve (CN VII). This nerve controls the muscles responsible for facial expressions, including smiling, frowning, and closing the eyes. Symmetry in these actions suggests that the facial nerve is functioning properly and that there is no nerve damage or weakness.

Choice B rationale

The patient's eyes moving to the left, right, up, down, and obliquely during conversation are functions of the oculomotor nerve (CN III), trochlear nerve (CN IV), and abducens nerve (CN VI), not the facial cranial nerve (CN VII). These nerves work together to control the movements of the eye muscles, enabling the eyes to move in different directions and maintain proper alignment.

Choice C rationale

Periodic blinking of the eyelids involves the oculomotor nerve (CN III) and the facial nerve (CN VII). The oculomotor nerve controls the muscles that lift the eyelid, while the facial nerve controls the muscles that close the eyelid. Blinking is a coordinated action involving both nerves, but the observation alone is not sufficient to determine the integrity of CN VII.

Choice D rationale

The patient moistening the lips with the tongue involves the function of the hypoglossal nerve (CN XII), which controls the movements of the tongue. The hypoglossal nerve is responsible for the motor control of most of the tongue muscles, allowing for actions like licking the lips, speaking, and swallowing. It is not related to the facial cranial nerve (CN VII).

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Correct Answer is B

Explanation

Choice A rationale

5th ICS Left MCL is the location for the apical impulse (point of maximal impulse), not Erb's Point.

Choice B rationale

Erb's Point is located at the 3rd ICS Left SB and is significant for auscultation of heart sounds, particularly the S1 and S2 sounds.

Choice C rationale

2nd ICS Left SB is the location for auscultating the pulmonic valve area.

Choice D rationale

4th ICS Left SB is where the tricuspid valve is auscultated.

A. DVT. B. Venous insufficiency. C. Varicosities. D. Arterial insufficiency.

Correct Answer is D

Explanation

Choice A rationale

Deep vein thrombosis (DVT) involves a blood clot in a deep vein, usually in the legs. Symptoms include swelling, pain, and redness, but not typically cold legs or hair loss, making it unlikely in this scenario.

Choice B rationale

Venous insufficiency occurs when veins struggle to send blood back to the heart, leading to varicose veins, swelling, and skin changes. While it can cause leg discomfort, it does not typically result in cold legs or hair loss.

Choice C rationale

Varicosities are enlarged, twisted veins caused by increased pressure. They can cause pain and swelling but not cold legs or hair loss, making them an unlikely cause of the described symptoms.

Choice D rationale

Arterial insufficiency, caused by poor blood flow due to narrowed arteries, results in symptoms such as cold legs, hair loss, pain, and weakened pulses. The description of cold legs and hair loss fits arterial insufficiency, making it the most likely diagnosis.

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While taking a history, the nurse observes that the patient's facial cranial nerves (CN VII) are intact based on which behaviors of the patient?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The instructor asks the student nurse to auscultate the client's Erb's Point. Where is the cardiac landmark referred to as the Erb's Point located?

Correct Answer is B

Explanation

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Correct Answer is D

Explanation

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