A nurse is evaluating a client who has a suspected stroke.

The nurse asks the client to stick out his tongue and observes that it deviates to the left side.

Which of the following cranial nerves is most likely affected?

A nurse is performing a neurological assessment on a 4-month-old infant.

The nurse gently drops the infant’s head backward while supporting the body.

The nurse expects to see which of the following responses as part of a normal reflex?

A nurse is performing a routine assessment on a newborn.

The nurse gently drops the head of the newborn while supporting the body and observes symmetric abduction and extension of the arms followed by flexion and adduction of the arms.

This finding indicates a positive response for which of the following reflexes?

A nurse is evaluating a 3-month-old baby for developmental milestones.

Which of the following findings should the nurse report to the provider as a possible concern?

A nurse is assessing a newborn’s reflexes as part of a neurologic examination.

The nurse strokes the outer edge of the sole of the newborn’s foot from heel to toe and observes that the newborn’s toes fan upward and out.

The nurse documents this as a positive response for which of the following reflexes?

A nurse is performing a routine check-up on a 2-month-old infant.

The nurse gently drops the infant from one hand to the other and observes that the infant’s arms and legs symmetrically extend, then abduct while fingers spread to form a C-shape.

The nurse identifies this as:

A nurse is performing a neurological examination on a client who has a history of multiple sclerosis.

The nurse notices that the client has difficulty walking and maintaining balance.

Which of the following tests should the nurse use to assess the client’s coordination?

A nurse is evaluating an infant’s neuromuscular development by testing different reflexes.

The nurse strokes the outer edge of the sole of the infant’s foot up toward the toes and observes that the infant’s toes fan upward and out.

The nurse documents this as:

A nurse is performing a neurological assessment on a newborn.

Which of the following reflexes should disappear by 8 months of age? (Select all that apply.)

A nurse is evaluating a client who has a suspected stroke.

The nurse asks the client to stick out his tongue and observes that it deviates to the left side.

Which of the following cranial nerves is most likely affected?

A nurse is caring for a 2-month-old infant who has a positive Moro reflex.

Which of the following actions should the nurse take to elicit this reflex? (Select all that apply.)