A nurse is preparing to assess a client. Which action should the nurse take to check cranial nerve VI?
Open the client’s visual acuity using a Snellen chart.
Whisper none of the client’s ears while blocking the other.
Ask the client to inspect up.
Ask the client to smile.
The Correct Answer is C
Choice A Reason:
Open the client’s visual acuity using a Snellen chart is incorrect. This action assesses cranial nerve II (optic nerve), which is responsible for vision. The Snellen chart is used to measure visual acuity, not the function of cranial nerve VI
Choice B Reason:
Whisper none of the client’s ears while blocking the other is incorrect. This action assesses cranial nerve VIII (vestibulocochlear nerve), which is responsible for hearing and balance. Whispering tests the auditory function of this nerve.
Choice C Reason:
Ask the client to inspect up is correct. Cranial nerve VI (abducens nerve) controls the lateral rectus muscle, which is responsible for moving the eye outward. Asking the client to look up and outward helps assess the function of this nerve.
Choice D Reason:
Ask the client to smile is incorrect. This action assesses cranial nerve VII (facial nerve), which controls the muscles of facial expression. Smiling tests the motor function of this nerve.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
When calculating the fluid balance for a client undergoing continuous bladder irrigation (CBI), the irrigation solution must be deducted from the total urine output. This is because the irrigation fluid is not part of the client’s actual urine production but is an additional fluid introduced into the bladder to prevent or remove blood clots and ensure catheter patency. By deducting the irrigation solution from the total urine output, the nurse can accurately determine the client’s true urine output and fluid balance.
Choice B Reason:
Subtracting the irrigation solution from the intravenous flow sheet as output is incorrect. The intravenous flow sheet is used to document fluids administered intravenously, not those introduced into the bladder. Therefore, this choice does not apply to the management of continuous bladder irrigation.
Choice C Reason:
Documenting the intake hourly in the urine output column is also incorrect. The urine output column should reflect the actual urine produced by the client, not the irrigation solution. Including the irrigation solution in this column would lead to an inaccurate representation of the client’s urine output and fluid balance.
Choice D Reason:
Adding the irrigation solution to the oral intake column is incorrect as well. The oral intake column is designated for fluids consumed orally by the client. The irrigation solution is introduced directly into the bladder and should not be recorded as oral intake.
Correct Answer is ["2"]
Explanation
To determine the number of tablets per dose, follow these steps:
- Calculate the total daily dose in milligrams (mg):
- 2 grams (g) = 2000 milligrams (mg)
- Divide the total daily dose by the number of doses per day:
- 2000 mg/day ÷ 2 doses/day = 1000 mg/dose
- Determine the number of tablets per dose:
- Each tablet is 500 mg.
- 1000 mg/dose ÷ 500 mg/tablet = 2 tablets/dose
Therefore, the nurse should administer 2 tablets of 500 mg amoxicillin with each dose.
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