MJ J.

Arejola April 3, 2022

BSN 1B NCM 101 – 82624
MIDTERM EXAM
This activity serves as your Midterm Exam in Laboratory. Please answer the questions and submit
them on time.
1. Identify the Cranial Nerves with their Roman Numeral value and their complete names.
2. Explain briefly how you can assess each CRANIAL NERVE and mention (if there's any) the
equipment needed.
3. Identify at least one abnormal finding in each Cranial Nerve.
• For all assessments of the cranial nerves, have the client sit in a comfortable position at your
eye level.

Cranial Nerve Assessment Abnormal Findings

I. Olfactory Nerve
II. Optic Nerve
-Please ask that the client clear -a total absence of smell
his or her nose to remove any (neurogenic anosmia)
mucus. Keep a vial of a recognize the correct scent
nonirritating substance within 30
cm or less of the nose; vanilla,
lemon, and freshly ground coffee
are good examples, and tobacco
or scented soap will suffice if
necessary. When performing the
test, avoid touching the patient.
The movement of your body will
indicate when the test object will
be presented. Do not provide
auditory cues. Repeat the
procedure with the opposite
nostril. When a patient reports
smelling something, his or her
sense of smell is intact. Olfactory
memory, a higher cortical
function, is required for odor
recognition.
-Each eye is assessed - Difficulty reading Snellen
individually, with the other eye chart, missing letters, and
covered, using a Snellen chart squinting.
 for distance vision or a handheld - Loss of visual fields.
chart for near vision.
- Papilledema (Swelling of the
-Color perception is evaluated optic nerve).
using standard
pseudoisochromatic Ishihara or - Hemianopsia
Hardy-Rand-Ritter plates with
numbers or figures embedded in
a field of specific colored dots.

-Examine the retina and optic

disc of each eye with an
ophthalmoscope.
III. Oculomotor Nerve - Examine the margins of each - Ptosis (drooping of the eyelid.
eyelid.
IV. Trochlear Nerve - Nystagmus
- Examine extraocular
VI. Abducens Nerve - Diplopia
movements. Determine the
direction of the fast and slow
phases of movement if
nystagmus is present.

- Examine the pupillary response

to light (both direct and indirect)
and accommodation in both
eyes.

V. Trigeminal Nerve -Examine motor function. Ask - Reduced contraction in

for information about the client one from each side 5
to clench his or her teeth while the fifth cranial
you feel the temporal as well as nerve.
the masseter muscles - Clenching causes pain.
contraction. in terms of teeth

- Evaluate sensory function. Vary

the contrast between sharp and
dull stimuli in the facial regions,
and contrast the two sides Test
once more for a light touch with
a smidgeon of cotton.

- Evaluate the corneal reflex.

Request about the client to look
up and away while lightly
touching the
 fine wisp of corneal
cotton. Repeat on the other
side.
VII. Facial Nerve -Test motor function. Ask the -Inability to close eyes, wrinkle
patient to smile, show teeth, the forehead, or raise the
close both eyes, puff cheeks, forehead along with paralysis of
frown, and raise eyebrows. Look the lower part of the face on the
for symmetry and strength of affected side is seen with Bell’s
facial muscles. palsy (a peripheral injury to
cranial nerve VII [facial]).
-Test sensory function. Test the
sense of taste by moistening
- Inability to identify correct
three different cotton
flavor on the anterior two-thirds
applicators with salt, sugar, and
of the tongue suggests
lemon. Touch the patient’s
impairment of cranial nerve VII
anterior tongue with each swab
(facial).
separately, and ask the patient
to identify the taste.

VIII. Vestibulocochlear (acoustic)
Nerve
Test auditory function. Perform -Vibratory sound lateralizes to
the whispered voice test. The the good ear in the
whispered voice test is a simple sensorineural loss. Air
test for detecting hearing conduction is longer than bone
impairment if done accurately. conduction, but not twice as
long, in a sensorineural loss
 Stand at arm’s length
behind the seated
patient to prevent lip
reading.
 Each ear is tested
individually. The patient
should be instructed to
occlude the non-test ear
with their finger.
 Exhale before
whispering and use as
quiet a voice as possible.
 Whisper a combination
of numbers and letters
(for example, 4-K-2), and
then ask the patient to
repeat the sequence.
 If the patient responds
correctly, hearing is
considered normal; if
 the patient responds
incorrectly, the test is
repeated using a
different number/letter
combination.
 The patient is
considered to have
passed the screening
test if they repeat at
least three out of a
possible six numbers or
letters correctly.
 The other ear is
assessed similarly with a
different combination of
numbers and letters.
Test balance. The Romberg test
is used to test balance and is
also used as a test for driving
under the influence of an
intoxicant. Ask the patient to
stand with their feet together
and eyes closed. Stand nearby
and be prepared to assist if the
patient begins to fall. It is
expected that the patient will
maintain balance and stand
erect. A positive Romberg test
occurs if the patient sways or is
unable to maintain balance. The
Romberg test is also a test of the
body’s sense of positioning
(proprioception), which requires
healthy functioning of the spinal
cord.

IX. Glossopharyngeal Nerve -Ask the patient to open their - Dysphagia or hoarseness
mouth and say “Ah” and note may indicate a lesion of
X. Vagus Nerve
the symmetry of the upper cranial nerve IX, X, or
palate. The uvula and tongue another neurologic disorder
should be in a midline position
and the uvula should rise
symmetrically when the patient
says “Ah.”
 - Use a cotton swab or tongue
blade to touch the patient’s
posterior pharynx and observe
for a gag reflex followed by a
swallow. The glossopharyngeal
and vagus nerves work together
for the integration of gag and
swallowing.

XI. Spinal Accessory Nerve Test the right - Asymmetric muscle contraction
sternocleidomastoid muscle. or drooping of the shoulder.
Face the patient and place your
right palm laterally on the
patient’s left cheek. Ask the
patient to turn their head to the
left while resisting the pressure
you are exerting in the opposite
direction. At the same time,
observe and palpate the right
sternocleidomastoid with your
left hand. Then reverse the
procedure to test the left
sternocleidomastoid.

Continue to test the

sternocleidomastoid by placing
your hand on the patient’s
forehead and pushing backward
as the patient pushes forward.
Observe and palpate the
sternocleidomastoid muscles.

Test the trapezius muscle. Ask

the patient to face away from
you and observe the shoulder
contour for hollowing,
displacement, or winging of the
scapula and observe for
drooping of the shoulder. Place
your hands on the patient’s
shoulders and press down as the
patient elevates or shrugs the
shoulders and then retracts the
shoulders.
 XII. Hypoglossal Nerve Ask the patient to protrude the -Fasciculations and atrophy of
tongue. If there is unilateral the tongue.
weakness present, the tongue
will point to the affected side
due to the unopposed action of
the normal muscle. An
alternative technique is to ask
the patient to press their tongue
against their cheek while
providing resistance with a
finger placed on the outside of
the cheek.

Reference/s:

Assessing cranial nerves: 6.5 Assessing Cranial Nerves. Nursing skills. Retrieved

April 3, 2022, from https://wtcs.pressbooks.pub/nursingskills/chapter/6-5-assessing-cranial-nerves/

Weber, J. R., & Kelly, J. H. (2015). Health Assessment in Nursing (5th ed.) [E-book]. Wolters

Kluwer Health.

Cranial nerve assessment: A practical approach. American Nurse. (2022, March 17). Retrieved

April 2, 2022, from https://www.myamericannurse.com/cranial-nerve-assessment-a-practicalapproach