A client who is being assessed by the nurse is ill and confused. ...

[sarasara]

A client who is being assessed by the nurse is ill and confused. In order to check the client's normal level of consciousness (LOC), the nurse should:
 
  1. ask the client to repeat words.
  2. ask the client to speak her name.
  3. ask the family the information.
  4. have the client walk a straight line.

Question 2

The nurse explains to the client with an ear infection that the reason the client has symptoms is that the eighth cranial nerve might be impaired by the infection. The nurse further explains that the vestibulocochlear nerve is responsible for:
 
  1. movement of the facial muscles.
  2. the lateral movement of the eye.
  3. enhancing swallowing.
  4. equilibrium.

[steff9894]

Answer to Question 1

Answer: 3

1. If the client is ill and confused, the client might not be able to repeat words.
2. Confusion might prevent the client from speaking her own name.
3. To get a baseline normal LOC for the client, it might be necessary to ask the client's family or escort to describe what is usual for the client.
4. When confused, the client might not be able to follow directions.

Answer to Question 2

Answer: 4

1. Movement of the facial muscles is controlled by the facial nerve.
2. Lateral movement of the eye is the responsibility of the abducens nerve.
3. Enhancing swallowing is the job of the vagus nerve.
4. Equilibrium is controlled by the vestibulocochlear nerve.