A nurse is caring for a client who had a stroke involving the right cerebral hemisphere. The nurse should monitor for which of the following findings?

Choice A reason: Encourage the use of wide grip utensils. This action is not related to homonymous hemianopsia, but to the motor weakness or paralysis that may occur on the opposite side of the body after a stroke. Wide grip utensils can help the client hold and use them more easily.

Choice B reason: Remind the client to look for food on the left side of the tray. This action is appropriate because homonymous hemianopsia is a visual field loss on the same side of both eyes. A client who had a right sided stroke will have difficulty seeing the left side of their visual field. Reminding the client to look for food on the left side of the tray will help them eat more completely and prevent malnutrition.

Choice C reason: Provide a nonskid mat to alleviate plate movement. This action is not related to homonymous hemianopsia, but to the safety and stability of the client's eating environment. A nonskid mat can prevent the plate from sliding or falling off the tray.

Choice D reason: Encourage the client to use his right hand when feeding himself. This action is not related to homonymous hemianopsia, but to the motor weakness or paralysis that may occur on the opposite side of the body after a stroke. Encouraging the client to use his right hand can help him maintain his independence and function.

Choice A reason: Placing suction equipment at the client’s bedside is a necessary action for the nurse to take for a client who has right sided acoustic neuroma resulting in impairment of cranial nerves IX and X. Acoustic neuroma is a noncancerous tumor that develops on the vestibulocochlear nerve, which is responsible for hearing and balance. It can also affect the adjacent cranial nerves, such as the glossopharyngeal (CN IX) and the vagus (CN X) nerves, which are involved in swallowing and gagging. A client with acoustic neuroma may have difficulty swallowing and clearing secretions, which can increase the risk of aspiration and respiratory infections. The nurse should have suction equipment ready to remove any excess saliva or mucus from the client’s mouth or throat.

Choice B reason: Avoiding the use of warm water to wash the client’s face is not a relevant action for the nurse to take for a client who has right sided acoustic neuroma resulting in impairment of cranial nerves IX and X. The temperature of the water does not affect the function of these nerves or the tumor. The nurse should use gentle and appropriate hygiene measures to clean the client’s face and prevent skin breakdown.

Choice C reason: Providing range of motion exercises to the client’s neck and shoulders is not a priority action for the nurse to take for a client who has right sided acoustic neuroma resulting in impairment of cranial nerves IX and X. Range of motion exercises can help to maintain joint mobility and prevent stiffness, but they are not directly related to the cranial nerve impairment or the tumor. The nurse should consult with a physical therapist to determine the best exercise regimen for the client.

Choice D reason: Applying an eye patch to the client’s right eye is not a helpful action for the nurse to take for a client who has right sided acoustic neuroma resulting in impairment of cranial nerves IX and X. An eye patch is used to protect the eye from injury or infection, or to treat conditions such as strabismus or amblyopia. An eye patch does not affect the function of the cranial nerves IX and X or the tumor. The nurse should monitor the client’s eye movements and vision, as acoustic neuroma can also affect the facial (CN VII) and oculomotor (CN III) nerves, which are involved in blinking and eye movement.