Cranial Nerves

Question 1

Cranial Nerve I (1)

Answer 1

Olfactory: Sense of smell

Ask client to identify familiar odors e.g., peppermint, coffee

Question 2

Cranial Nerve II (2)

Answer 2

Optic: Visual Acuity, Visual field

Assess visual acuity using a snellen chart.

Normal: 20/20 vision

Question 3

Cranial Nerve III (3)

Answer 3

Oculomotor: Pupillary reaction, muscles that move the eye, pupillary constriction

Assess pupils for equality and reactivity to light

Reaction to light: Shine light on pupil, observe response to light and the other eye’s response

Reaction to accommodation: Ask client to look at a near object and then a distant object. Next, move an object towards the client’s nose.

Normal: PERRLA

Question 4

Cranial IV (4)

Answer 4

Trochlear: Eye movement, muscles that move the eyes

Have patient follow penlight or finger. Move penlight upward, downward, sideward and diagonally

Question 5

Cranial nerve V (5)

Answer 5

Trigeminal: Facial sensation, muscle of mastication, corneal reflex

Lightly touch lateral sclera to elicit corneal reflex. Wisp of cotton over client’s forehead to test light sensation.

Palpate temporomandibular joint

Question 6

Cranial VI (6)

Answer 6

Abducens: Abduction of the eye, muscles that move the eye

Have patient follow your finger or penlight in all six cardinal fields of vision without moving their head.

Normal: Both eyes move in coordination

Question 7

Cranial nerve VII (7)

Answer 7

Facial: Facial expression, sense of taste

Ask patient to smile, raise the eyebrows, frown and puff out cheeks, close eyes tightly.

Ask patient to identify various tastes placed on top and sides of tongue

Question 8

Cranial Nerve VII (8)

Answer 8

Vestibulocochlear/Acoustic: Hearing, balance

Have the client occlude one ear and whisper in the other ear. Repeat for other side.

Ask client to walk across the room and back, assessing their gait.

• Rhine test, weber’s test, wisper test

Question 9

Cranial nerve IX (9)

Answer 9

Glossopharyngeal: swallowing & voice

Ask the client to say “ah”, assess uvula

Elicit gag response

Note ability to swallow

Question 10

Cranial X (10)

Answer 10

Vagus: Speaking and swallowing

Ask the client to say “ah”. Assess uvula

Ask patient to swallow and speak (note hoarseness)

Question 11

Cranial nerve XI (11)

Answer 11

Accessory: neck motion

Ask client to shrug shoulders against resistance from your hands and turn head to side against resistance. Repeat on other side

Question 12

Cranial nerve (12)

Answer 12

Hypoglossal: tongue movement and strength

Ask client to protrude tongue at midline and then move it side to side