NSG-316 Exam 2 Questions with Correct Answers

What is cranial nerve II - Optic What is the best method to assess lymph nodes? - gentle, circular motion, use the finger pads to palpate and use both hands at the same time to compare both sides normal lymph nodes are - movable, discrete, contender, soft Anisocoria - unequal pupil size Presbyopia - loss of lens elasticity Seen a lot in elderly people Tinnitus - ringing in the ears The meaning of a vision score (20/20) - the first number is what the patient is able to see at, the second number is what a normal person is able to see at When someone is unable to read from the distance of 20 feet, what do you do - shorten the distance until they are able to read the sign and document where they can read it from Intentional tremors - when someone is trying to feed themselves and they are unable to because of tremors - - s/s of (seasonal) allergy rhinitis - sneezing runny nose stuffy nose itchy nose coughing sore or scratchy throat itchy eyes water eyes how reflexes are documented - 4 = very brisk, hyperactive with clonus, indicative of disease 3 = brisker than average, may indicate disease 2 = average, normal 1 = diminished, low normal, or occurs with reinforcement 0 = no response What is the Romberg test - assesses ability of vestibular apparatus in inner ear to help maintain standing balance. person stands with feet together and arms at sides; when in stable position, ask person to close eyes and hold position for about 20 seconds tests balance What is a +/- Romberg test - + Romberg test - pt. sways and is unable to hold posture and balance CN I - Olfactory, smell, sensory test by occluding one nostril at a time, eyes closed and trying to identify smells CN II - Optic, vision, sensory test visual acuity and visual fields by confrontation - observe pt. walking and if they can move around w/o bumping into anything CN III - Oculomotor, eye movement, motor What is CN IV - trochlear, eye movement, motor What is CN V - trigeminal Motor - mastication (palpate temporal and master muscles as person clenches teeth) Sensory - sensations in ophthalmic, maxillary and mandibular (close pt. eyes, test light touch sensation by touching cotton wisp to designated ares on persons face) What is CN VI - abducens, eye movement, motor What is CN VII - facial What is CN VIII - Acoustic (vestibulocochlear) What is CN IX - Glossopharyngeal What is CN X - vagus