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A nurse is assessing a client's cranial nerves. Which method should the nurse use to assess cranial nerve I?

A.

Ask the client to identify scented aromas.

B.

Ask the click to read a Snellen chart.

C.

Listen to the client's speech.

D.

Ask the client to clench his teeth.

Answer and Explanation

The Correct Answer is A

A. Asking the client to identify scented aromas assesses cranial nerve I (olfactory nerve), which is responsible for the sense of smell.


B. Reading a Snellen chart assesses cranial nerve II (optic nerve), which is related to vision.


C. Listening to the client's speech evaluates the function of cranial nerves V (trigeminal) and XII (hypoglossal), which are related to mastication and tongue movement, respectively.


D. Asking the client to clench his teeth tests cranial nerve V, which innervates the muscles of mastication.


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View Related questions

Correct Answer is ["B","C","E"]

Explanation

A. The diaphragm of the stethoscope is used for high-pitched sounds, such as lung and normal heart sounds, not low-pitched sounds.

B. The binaural (earpieces) should fit snugly in the ears to ensure proper sound transmission and clarity.

C. Short tubing provides more accurate sounds by minimizing sound distortion, making it ideal for clinical use.

D. The bell of the stethoscope is used for low-pitched sounds, such as heart murmurs, not high-pitched sounds.

E. The stethoscope works by blocking out environmental sounds to help the user focus on internal body sounds.

Correct Answer is A

Explanation

A. Respiratory acidosis: The pH is low (indicating acidosis), and the Paco₂ is elevated, which signifies that carbon dioxide retention is causing the acidosis. This pattern indicates respiratory acidosis, as the elevated HCO₃ suggests a compensatory response.

B. Respiratory alkalosis: Respiratory alkalosis would show a high pH with a low Paco₂. This is not consistent with the client’s lab results.

C. Metabolic acidosis: Metabolic acidosis would show a low pH with a low HCO₃. In this case, the HCO₃ is slightly elevated, ruling out metabolic acidosis.

D. Metabolic alkalosis: Metabolic alkalosis would show a high pH with an elevated HCO₃, which does not match the client’s results.

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