Difficulty: Medium
Average Score: 87%
Simulated
A nurse is caring for a client who has right sided acoustic neuroma resulting in impairment of cranial nerves IX and X. Which of the following actions should the nurse take?
Correct answer
A
Rationale
The correct answer is A: Place suction equipment at the client's bedside. This is important due to the impairment of cranial nerves IX (glossopharyngeal) and X (vagus), which can lead to difficulty swallowing and potential aspiration. Having suction equipment readily available can help manage any secretions or saliva that may accumulate, reducing the risk of aspiration pneumonia.
Choice B is incorrect because warm water can be used to wash the client's face as it does not directly relate to the client's condition.
Choice C is incorrect as range of motion exercises for the neck and shoulders may not be appropriate or safe considering the cranial nerve impairment.
Choice D is incorrect as applying an eye patch to the right eye does not address the issues related to the cranial nerve impairment.
Choice B is incorrect because warm water can be used to wash the client's face as it does not directly relate to the client's condition.
Choice C is incorrect as range of motion exercises for the neck and shoulders may not be appropriate or safe considering the cranial nerve impairment.
Choice D is incorrect as applying an eye patch to the right eye does not address the issues related to the cranial nerve impairment.