When performing a head-to-toe assessment, during which part would the nurse evaluate cranial nerve (CN) IX, X, and XII?

Ears

Mouth and throat

Head and face

Mental status examination

Answer and Explanation

The Correct Answer is B

A. Ears: Evaluation of the ears is primarily concerned with hearing and balance, which involve cranial nerves such as VIII (Vestibulocochlear), not IX, X, and XII.

B. Mouth and throat: Cranial nerves IX (Glossopharyngeal), X (Vagus), and XII (Hypoglossal) are assessed through the examination of the mouth and throat. CN IX and X are evaluated by checking the gag reflex and the ability to swallow, while CN XII is assessed by examining tongue movements.

C. Head and face: The assessment of the head and face generally involves cranial nerves V (Trigeminal) and VII (Facial), which control facial sensation and movement, rather than IX, X, and XII.

D. Mental status examination: While mental status is crucial for overall health assessment, it does not specifically target cranial nerves IX, X, and XII.

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Correct Answer is C

Explanation

A. Technician: Technicians generally perform specific tasks or tests rather than collecting comprehensive subjective data.

B. Secretary: A secretary's role is administrative and does not involve direct patient assessment or data collection.

C. Nurse: Nurses are typically responsible for collecting subjective data from clients during the initial comprehensive assessment, including patient history and current health concerns.

D. Physician: While physicians review and interpret data, they often rely on nurses to collect detailed subjective information during initial assessments.

A. Identify ways to ensure client privacy. B. Turn on relaxing music of the client's choice. C. Wash hands D. Obtain and check needed equipment. E. Dim the lighting to promote comfort.

Correct Answer is ["A","C","D","E"]

Explanation

A. Identify ways to ensure client privacy: Ensuring privacy is essential for a respectful and confidential examination.

B. Turn on relaxing music of the client's choice: While this might improve the client's comfort, it is not a standard or necessary step before conducting a physical examination.

C. Wash hands: Hand hygiene is crucial before any physical examination to prevent infection.

D. Obtain and check needed equipment: Having and checking equipment ensures that all necessary tools are available and in working order for the examination.

E. Dim the lighting to promote comfort: Proper lighting can help in conducting a thorough examination and make the client feel more comfortable.

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When performing a head-to-toe assessment, during which part would the nurse evaluate cranial nerve (CN) IX, X, and XII?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which individual typically would be responsible for collecting the subjective data on a client during the initial comprehensive assessment?

Correct Answer is C

Explanation

Which of the following should the nurse do before conducting a physical examination of a client? (Select all that apply.)

Correct Answer is ["A","C","D","E"]

Explanation

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