Name this tool
otoscope
the nurse is assessing the movement trapezius and sternomastoid muscles. which cranial nerve is the nurse assessing?
Spinal Accessory
This nerve tests the sense of smell. For example the nurse uses the smell of soap and vanilla to test this nerve.
Cranial Nerve I
Olfactory
Tool utilized to test visual acuity, and the normal range
Snellen Chart
20/20
this nerve is used when the nurse assesses the patient using the snellen test
optic
the nurse assesses this cranial nerve by assessing the patients sensation in the mouth, mucus membranes, and ability for the patient to chew their food
Cranial nerve V
trigeminal
the nurse is assessing a patient by using a tongue depressor to assess the pts uvula and soft palate. In addition, assessing the gag reflex and the ability to talk without straining. Which two nerves is the nurse assessing?
Cranial Nerves X & IX
vagus & glossopharyngeal
Ataxia or unsteady gait
a patient was brought into the ER and opens their eyes only to pain, is able to follow directions by performing RAM, has +5 full active ROM of the BLE and BUE. Is alert and oriented to person, place, and situation, but not time. what is this pts Glasgow Coma Scale Rating?
12
this cranial nerve is assessed when the nurse is assessing the movement of the patients tongue
cranial nerve XII
hypoglossal
The nurse utilizes PERRLA and the six cardinal positions of gaze to assess these cranial nerves.
Cranial Nerves III, IV, VI
oculomotor, trochlear, and abducens
the nurse is caring for a 2yo pt. who has an earache. The nurse wants to inspect the ear canal. what is the proper way to pull the pinna in order to assess the eardrum?
down & forward
In the acronym PERRLA what does the "A" represent?
Accommodation
the nurse is assessing the patients ability to hear normal conversation and the whispered voice test. which nerve is being assessed
Cranial nerve VIII
Acoustic/ vestibulocochlear
The nurse is assessing an infant's plantar reflex and notes there was dorsiflexion of the big toe and fanning of all toes. which sign is described above?
+ Babinski sign
what is used to illuminate the internal eye structures?
opthalmoscope
The nurse asks the pt to stand up with their feet together and arms at the sides. Once in a stable position, the nurse asks the patient to close their eyes and to hold the position. What is the name of this test?
Rohnberg
the nurse is assessing the patient's facial symmetry, by using smiling, frowning, and having the patient close their eyes. which cranial nerve is being tested?
Cranial nerve VII
Facial
a pt comes into the doctor's office wearing sunglasses. the pt states "the sun hurts my eyes. What condition is the patient displaying?
Photophobia
the sensation of ringing, roaring, or buzzing in your ears
Tinnitus