A nurse in a provider’s office is assessing a client. The nurse should identify that which of the following findings are manifestations of pulmonary tuberculosis? (Select all that apply)

Choice A reason: Eliciting the gag reflex is not a valid way to assess cranial nerve III. The gag reflex is a protective mechanism that prevents choking or aspiration by triggering a contraction of the pharyngeal muscles when the back of the throat is stimulated. The gag reflex is mediated by cranial nerves IX and X, not III.

Choice B reason: Checking the pupillary response to light is a reliable way to assess cranial nerve III. The pupillary response to light is a reflex that causes the pupil to constrict when exposed to bright light and dilate when exposed to dim light. This reflex helps to regulate the amount of light that enters the eye and protects the retina from damage. The pupillary response to light is controlled by cranial nerve III, which innervates the sphincter pupillae muscle that constricts the pupil.

Choice C reason: Observing for facial symmetry is not a relevant way to assess cranial nerve III. Facial symmetry is the degree of similarity between the two halves of the face. Facial symmetry can be affected by various factors, such as genetics, aging, or facial nerve palsy. Facial nerve palsy is a condition that causes weakness or paralysis of the muscles that control facial expression. Facial nerve palsy is caused by damage to cranial nerve VII, not III.

Choice D reason: Testing visual acuity is not a sufficient way to assess cranial nerve III. Visual acuity is the ability to see fine details and distinguish objects at a distance. Visual acuity depends on various factors, such as the clarity of the lens and cornea, the shape of the eyeball, and the function of the retina. Visual acuity is mainly affected by cranial nerve II, which carries visual information from the retina to the brain. Cranial nerve III does not directly influence visual acuity, but it does innervate some of the muscles that move the eye and enable binocular vision.

Choice A reason: Encourage brief exercise before meals to promote appetite. This answer is incorrect because exercise before meals can increase fatigue and decrease appetite in some clients with dysphagia. Exercise can also affect the blood flow to the brain and the muscles involved in swallowing .

Choice B reason: Encourage the client to take small bites. This answer is correct because taking small bites can help the client swallow more easily and reduce the risk of choking or aspiration.

Choice C reason: Place the client with the head reclined back to facilitate swallowing. This answer is incorrect because placing the client with the head reclined back can impair the swallowing mechanism and increase the risk of aspiration. The client should be placed with the head tilted slightly forward to help the food move down the throat.

Choice D reason: Place food in the affected side of the mouth. This answer is incorrect because placing food in the affected side of the mouth can cause the food to remain in the mouth and not be swallowed properly. The client should be encouraged to use both sides of the mouth to chew and swallow food.