A nurse is performing a focused assessment for vision on a client suspected of having vision loss. Which cranial nerve is the nurse assessing when determining if there are visual field or visual acuity deficits?
Cranial Nerve VIII
Cranial Nerve II
Cranial Nerve I
Cranial Nerve VII
The Correct Answer is B
Choice A Reason: This choice is incorrect. Cranial Nerve VIII is the vestibulocochlear nerve, which is responsible for hearing and balance. It does not affect vision or eye movements.
Choice B Reason: This is the correct choice. Cranial Nerve II is the optic nerve, which is responsible for transmitting visual information from the retina to the brain. It affects visual field and visual acuity, which are measures of peripheral and central vision, respectively.
Choice C Reason: This choice is incorrect. Cranial Nerve I is the olfactory nerve, which is responsible for smell. It does not affect vision or eye movements.
Choice D Reason: This choice is incorrect. Cranial Nerve VII is the facial nerve, which is responsible for facial expressions and taste. It does not affect vision or eye movements.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A Reason: This is incorrect because a blister-like pustule on the face that oozes clear fluid may indicate impetigo, which is a bacterial skin infection, not basal cell carcinoma. Basal cell carcinoma is a type of skin cancer that arises from the basal layer of the epidermis, which is the outermost layer of the skin. Basal cell carcinoma lesions are usually not blistered or pustular, but rather smooth, shiny, or waxy.
Choice B Reason: This is incorrect because a dark brown lesion that is flat may indicate a mole, which is a benign growth of melanocytes, which are cells that produce pigment, not basal cell carcinoma. Basal cell carcinoma lesions are usually not dark brown or flat, but rather flesh-colored, pink, or red, and may have a raised or indented center.
Choice C Reason: This is correct because a small scaly, dry lesion on the elbow may indicate basal cell carcinoma. Basal cell carcinoma lesions are often small, scaly, and dry, and may bleed or crust over. They can occur anywhere on the body, but are more common on areas that are exposed to the sun, such as the face, neck, arms, or legs.
Choice D Reason: This is incorrect because location on the top of the head where exposed frequently to sunlight may indicate squamous cell carcinoma, which is another type of skin cancer that arises from the squamous layer of the epidermis, not basal cell carcinoma. Squamous cell carcinoma lesions are usually rough, scaly, or crusted, and may have a firm or hard texture. They can also occur anywhere on the body, but are more common on areas that are exposed to the sun.
Correct Answer is C
Explanation
Choice A Reason: This choice is incorrect. Instilling eye drops in both eyes every hour around the clock is not an information that the nurse will provide, as it is not a recommended treatment for chronic bilateral inflammation of the eyelid margins. This condition is also known as blepharitis, which is a common and chronic disorder that causes redness, itching, burning, and crusting of the eyelids. Eye drops may be used to relieve symptoms, but not every hour or without a prescription.
Choice B Reason: This choice is incorrect. Using sterile gloves when assisting with activities of daily living is not an information that the nurse will provide, as it is not a necessary precaution for chronic bilateral inflammation of the eyelid margins. Blepharitis is not contagious or infectious, but rather caused by an overgrowth of bacteria or mites on the eyelids, or by an underlying skin condition such as seborrheic dermatitis or rosacea.
Choice C Reason: This is the correct choice. Using baby shampoo on the eyelid margins is an information that the nurse will provide, as it is a simple and effective way to clean and soothe the eyelids. Baby shampoo is gentle and non-irritating, and can help remove excess oil, debris, and scales from the eyelids. The nurse will instruct the caregiver to dilute a few drops of baby shampoo with warm water, apply it to a cotton ball or washcloth, and gently rub it along the eyelid margins. The nurse will also advise to rinse well with water and pat dry with a clean towel.
Choice D Reason: This choice is incorrect. Using a salt scrub inside the eyelid is not an information that the nurse will provide, as it is a harmful and painful method that can damage and irritate the eye. Salt scrub is abrasive and drying, and can cause corneal abrasion, infection, or inflammation. The nurse will warn the caregiver to avoid using any harsh or unapproved products on or near the eye.
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