Laboratory work up included Complete Blood Count (CBC), Comprehensive Metabolic Panel (CMP), C-Reactive Protein (CRP) and Erythrocyte Sedimentation Rate (ESR). Results revealed CBC and CMP are WNL except aspartate aminotransferase (AST) and alanine transaminase (ALT) are elevated. CRP and ESR are also elevated. Imaging ordered which included computed tomography (CT) angiogram of the head and neck which revealed no aneurysms and a magnetic resonance imaging (MRI) of the brain (figure 1) which showed abnormal enhancement along the labyrinthine segment of the left facial nerve compatible with Bell’s palsy, and no enhancement demonstrated elsewhere. The patient was diagnosed with Bell’s Palsy and prednisone and valacyclovir were ordered. 

Your preceptor asked you the following questions:

1. Which cranial nerve is commonly linked to Bell’s palsy and how would you assess this cranial nerve?

2. Though definitive etiology is undetermined, based on patient’s history, what could have possibly triggered her current medical condition?

3. Why were prednisone and valacyclovir prescribed for this patient? 

Question #3

A 62-year-old female with a history of hypertension and type 2 diabetes, presents to the emergency department (ED) because of uncontrol glucose, and admitted to hospital for hyperglycemia. Next day, after morning shift report, nurse was going to give morning medication. Found patient’s left eye feels like it is “drooping,” and she has difficulty raising her left eyebrow. The patient reports that sudden-onset weakness and numbness on the left side of her body and her symptoms began approximately an hours ago while she was using her cellphone. Nurse also noticed her speech has become slurred.

The nurse activated the code “Stroke “, and provider ordered the CT scan, result came back with right middle cerebral artery infraction.

If you were her nurse, what assessment would you perform, and what management care can be?  

DynaMedex. Acute ischemic stroke. EBSCO Information Services. Accessed April 3, 2025. https://www-dynamedex-com.offcampus.lib.washington.edu/condition/acute-ischemic-stroke 

Question #4

A three year old presented to the emergency room due to persistent emesis and a recent history of ataxia. A subsequent CT scan was positive for large cerebellar tumor in the posterior fossa, so the patient was sent to the OR and had a tumor resection.  The patient is now post-op day #1 in the PICU, showing signs of posterior fossa syndrome and with post-op swelling expected to peak in the next 12-24 hours. 

What assessment findings would indicate that there was cranial nerve dysfunction as a result of the surgery and/or post-op swelling? What are other symptoms of posterior-fossa syndrome (also called post-operative cerebellar mutism syndrome (pCMS)?

Question #6

A 13 year old boy presents to the preoperative area to be checked in and prepped for a tonsillectomy and adenoidectomy. The patient appears pale and fidgets nervously while the preoperative history is conducted and visibly flinches when approached with a blood pressure cuff and O2 pulse oximeter for vitals. The patient’s mother expresses worry about his stress response to being in a surgical center. She also reports he recently visited a vaccine clinic and “briefly slumped or something” when vaccinated. Additionally she reports he has “passed out” before and she isn’t sure why but that he wakes up within a few seconds. 

The patient appears to tolerate the vital sign measurements; however, when the preop nurse attempts to insert a peripheral IV, he becomes very pale, his eyes roll back and he slumps over. 

What just happened to the patient, which cranial nerve is involved, and what might the preop nurse do in immediate response? What might the recovery nurse educate the mother and the patient about post-surgically?

Question #9

A 53-year-old female presents to a clinic with complaints of sharp, shooting, stabbing pain that comes in small bursts like electricity across her face.

In reviewing the patient’s history, you see that she has multiple sclerosis. You are concerned with trigeminal neuralgia.

How would you assess the patient for trigeminal neuralgia? Which cranial nerve does this impact?

Question #10

In the Post anesthesia Care Unit (PACU), you, the nurse, receive a 58-year-old female post-operative patient who had just undergone a right total parotidectomy. As she wakes up from anesthesia, you notice that she has difficulty keeping her right eye closed. Later, the patient also complains that the right side of her face feels itchy, and she also feels a “zapping” sensation. You report this to the surgeon who reports that this is expected post-operatively, but to closely monitor her symptoms. 

Which cranial nerve is at risk of damage during parotid gland surgery and how do you assess for injury to this cranial nerve? What should be included in the post-operative care of the patient?

Question #12

Cranial Nerves: Jake was previously a healthy child. Recently, he began experiencing recurring illness with symptoms such as chills, fever, and decreased appetite. These issues caused him to miss significant time from school. Eventually, he was admitted to the hospital, where imaging revealed a tumor. The tumor was surgically removed, but after multiple procedures, Jake became tracheostomy- and ventilator-dependent. He also sustained a brainstem injury, though he retains some voluntary movements.

How would you assess cranial nerves 3-12 with this child?

Mental Health: Henry is an 8-year-old child who was born healthy into a family of five. He has a younger brother, Jake, who was also born healthy. However, Jake was later diagnosed with a brain tumor and spent over a year in the hospital. Although the tumor was successfully removed and Jake initially began to recover, he later became seriously ill. As a result, Jake is now tracheostomy- and ventilator-dependent and remains sedated for most of the day.

Henry and Jake were extremely close and spent a lot of time playing together. Since Jake’s hospitalization and change in condition, Henry has begun showing signs of emotional distress. His parents have noticed that he has become more agitated, sometimes isolates himself, and his mood changes, some days are good, while others are not. His parents are becoming increasingly concerned about his behavior and emotional well-being.

What questions are necessary to ask the child about how he feels with his brother’s diagnosis? What steps would we take to ensure that the child is doing okay? 

Question #13

How does trigeminal neuralgia correlates to an individual’s cardiovascular health and mental health? 

Question #14

You are a triage nurse in an emergency department, and you are preparing to go see your next patient. In the electronic health record, you note see that your patient is a 24-year-old female with a past medical history of generalized anxiety disorder with depressive features. It is also noted that the patient came in due to concerns about mood swings, difficulty sleeping, inability to concentrate, restlessness, and decreased appetite. When you enter the room and begin talking to the patient, they report that about a month ago they started taking citalopram (Celexa).

As their nurse, what do you think could be causing their symptoms and why? What additional assessment information would you want to get from the patient to help determine the cause of the symptoms?

Question #16

Anna, a 38-year-old nurse, worked in the COVID-19 unit of her hospital for several months during the pandemic’s peak. Since returning to her regular duties, Anna has been experiencing increased emotional exhaustion, difficulty sleeping, and heightened anxiety. She also struggles with feelings of emotional detachment from her work and is having difficulty connecting with her peers and patients. Anna has nightmares and frequently experiences flashbacks to traumatic events she witnessed while caring for COVID-19 patients. During a physical examination, she exhibits symptoms such as an elevated heart rate, muscle tension in her shoulders, and shallow breathing. Anna’s symptoms are significantly affecting her daily functioning, causing her to avoid conversations about her experiences and avoid certain aspects of her nursing role.

What are the key physical, psychological, and PTSD-related signs of stress and burnout that Anna is exhibiting, and how should these be assessed and documented in her care plan?

Question #18

You receive report from the off-going nurse about your 82 y/o male patient. He has been diagnosed with acute psychosis r/t active COVID infection. He has a PMHx of HTN and late-onset dementia. He currently has a sitter because he is A&Ox1, impulsive and not able to follow instructions. The nurse tells you that he has needed several IM haloperidol over the past few days due to agitation and aggressive behavior. Upon introducing yourself to the patient during bedside report, you notice your patient has a tremor in his R forearm, his tongue is slightly protruded, and he is consistently drooling. What do you suspect is going on and what should the nurse do next?

• A. Patient is having a partial seizure. The nurse should notify the doctors and except to administer anti-epileptic medications.

• B. Patient is experiencing a medication side effect. The nurse should notify the doctor and expect to switch to a different medication.

• C. Patient has undiagnosed Parkinson’s. The nurse should notify the doctor and assess for additional Parkinson’s symptoms.

• D. Patient is over sedated. The nurse should notify the doctor and consider asking the doctor for lower doses.

• E. There is nothing wrong with the patient. The nurse should continue care as ordered.

Question #19 (submitted at 9:59 am on 04/05/2025)

You are caring for a 4-year-old boy named Ben with medulloblastoma, 24 hours post-surgical resection of the tumor. Ben is presenting with dysphagia, mutism and nystagmus. Which cranial nerves do you suspect were affected by the surgery? What physical assessments would you perform to evaluate their function? 

Question #20 (submitted at 1:20 pm on 04/06/2025)

A 72-year-old veteran is undergoing radiation therapy for oropharyngeal cancer at the VA medical center. During a follow-up appointment, he mentions experiencing changes in taste, difficulty swallowing, and occasional weakness on one side of his face. 

Which cranial nerve should the healthcare team evaluate to further investigate his facial weakness, and how might the assessment relate to his mental health during cancer treatment?

• A) Cranial Nerve III (Oculomotor)

• B) Cranial Nerve V (Trigeminal)

• C) Cranial Nerve VII (Facial)

• D) Cranial Nerve IX (Glossopharyngeal)