Master Cranial Nerves VIII, IX and X Assessments with Picmonic for Nurse Practitioner

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Cranial Nerves VIII, IX and X Assessments

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Cranial Nerves VIII, IX and X Assessments

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Picmonic

The twelve cranial nerves (CN) can be assessed through a series of different tests. This Picmonic covers the assessments of CNs VIII, IX, and X. CN VII is assessed by testing a patient’s hearing to normal conversation and a whisper test. CNs IX and X are both assessed by depressing the tongue and touching the posterior pharyngeal wall with a cotton-tipped applicator and noting the presence of sensation.

7 KEY FACTS

Also known as the vestibulocochlear nerve, cranial nerve VII is a sensory neuron responsible for hearing, balance, and visual fixation during movement.

The first test for assessing the acoustic nerve is by noting the person’s ability to hear normal conversation. Blockage in the ear from ear wax, known as cerumen, can affect the outcomes of this test.

Test the person’s ability to hear when standing 2 feet behind them. Test one ear at a time by having the person block sound from the other ear. Exhale fully and whisper slowly a set of three numbers and three letters at random. Have the person repeat the number/letter after you say each one. A passing score is 4 out of 6 numbers/letters. Assess the other ear.

Cranial nerve IX is also known as the glossopharyngeal nerve. It is a motor and sensory nerve that has various functions, including swallowing and taste sensation for the posterior 1/3 of the tongue.

Cranial nerve X is also known as the vagus nerve. It is a motor, sensory and visceral nerve with several functions, such as heart rate regulation, respiratory drive regulation, palate elevation, swallowing, and talking.

Depress the tongue with a tongue blade and have them say, "ah." Look at the pharyngeal movement. The uvula and soft palate should rise in the midline bilaterally.

Touch the posterior pharyngeal wall with a cotton-tipped applicator and note the presence of sensation. In some patients, this action may induce a “gag reflex,” which may cause discomfort. It is wise to ask the patient this prior to performing the test and defer (not perform) this test if concerned, document such findings. After a stroke, a patient may experience dysfunction in swallowing, which increases the risk of aspiration.

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