← Study guidesNUR 120 · Quiz 2 Study Guide · updated Oct 8, 2026

NUR 120 · Health Assessment

The Twelve Cranial Nerves

Quiz 2 · number, name, and how each one is tested

Coverage: the twelve cranial nerves — their numbers, their names, whether each is sensory, motor or both, how you test it at the bedside, and what normal and abnormal look like. That is the whole quiz, and it is also the eight cranial-nerve questions on the exam that follows.
What the instructor asked for, in her words: “Understand the CN #, name, and application of the nerve testing.” The exam blueprint then names six of the twelve by name, plus PERRLA, as hints — and adds “You can write the acronym/cranial nerves on your test.” That single permission shapes how to revise: the order is the one thing you can carry in, so everything else has to be attached to it.
Format: the quiz is 10 questions — 9 multiple choice and 1 fill-in-the-blank — in 20 minutes, and the preparation sheet heads it “MEMORIZE”. It says to study from the cranial nerve assessment form and the lecture deck, and to be able to give, for every nerve, its name, its number in Roman numerals, its function, how to test it, and whether it is sensory or motor. The exam that follows it carries eight cranial-nerve questions, described as “just like the quiz” — so the same material is being examined twice, and nothing learned here is spent.
Reading: Taylor Ch 45 Sensory and Ch 34 Activity, with ATI Engage Fundamentals Sensory Perception. The course documents come first; the chapters fill gaps and are marked where they do.

About the blue stars. The neurological lab deck carries five drawn emphasis marks — two five-point stars and three arrows. Two of the five are on cranial-nerve slides and one is on the acronym slide itself; the other two mark neurology and musculoskeletal content that belongs to the exam rather than this quiz, and they are collected in the appendix. As in the Exam 2 guide, these marks sit beside the content rather than carrying text of their own, so what is marked is the slide content they point at. A blue box in this guide means one of two things, and it always says which: the deck drew a mark there, or the blueprint names it by name.

Memorize this first — you are allowed to write it down

The Two Acronyms

Start here, and start today. The blueprint gives you permission to write the acronym on the test, which means the twelve words below are the only thing on this topic you are guaranteed to have in front of you. Everything else you need has to hang off them. Learn them as two parallel lists of twelve: the first gives you the names in order, the second gives you sensory, motor or both in the same order. Write both down the moment the paper is in front of you, before you read a single question, and the recall half of the quiz is already answered.

The acronym slide — the deck draws a star on it Deck slide 8 · drawn star

Two mnemonics, one order. Read the table down, not across.
#	Acronym word	Nerve	S/M/B word	Which
I	On	Olfactory	Some	Sensory
II	Old	Optic	Say	Sensory
III	Olympus'	Oculomotor	Money	Motor
IV	Towering	Trochlear	Matters	Motor
V	Top	Trigeminal	But	Both
VI	A	Abducens	My	Motor
VII	Finn	Facial	Brother	Both
VIII	And	Vestibulocochlear (deck: Auditory)	Says	Sensory
IX	German	Glossopharyngeal	Big	Both
X	Viewed	Vagus	Brains	Both
XI	Some	Accessory (deck: Spinal accessory)	Matter	Motor
XII	Hops	Hypoglossal	Most	Motor

Say both sentences out loud, as sentences

“On Old Olympus’ Towering Top, A Finn And German Viewed Some Hops.”
“Some Say Money Matters, But My Brother Says Big Brains Matter Most.”

The second one is the one students skip, and it is the cheaper of the two: it answers a whole category of question on its own. Any item that asks whether a nerve is sensory, motor or both is answered by counting words, and you are permitted to have the words with you.

The acronym forces two names on you — use them The first mnemonic only works if you call VIII “Auditory” (for And) and XI “Spinal accessory” (for Some). That is not a coincidence — it is why the deck's own slides use those two names. The formal names are vestibulocochlear and accessory, and a question may use either. Learn both labels for both nerves and the mnemonic costs you nothing; learn one and a stem using the other can strand you.

Where the second acronym goes wrong Read the pattern out: S S M M B M B S B B M M. It doubles up at each end and then, from IV right through to IX, it never repeats itself once — M B M B S B, six nerves of pure alternation. That stretch is where essentially every mistake with this mnemonic happens, and the worst of it is the run “But My Brother” — V both, VI motor, VII both. Recite those three cold and the rest of the sentence looks after itself.

One question is fill-in-the-blank — so spell the names, not just recognise them Nine of the ten questions give you options to choose from. One gives you a blank, and a blank rewards recall, not recognition: you have to produce the word yourself. The acronym gives you the first letter of each name and nothing more, so practise writing out the long ones in full — Glossopharyngeal, Vestibulocochlear, Hypoglossal, Trigeminal, Trochlear, Abducens — and the Roman numerals beside them, since the sheet asks for the number in that form. The drill in Part 5 is built for exactly this.

The whole topic on one page

The Master Table

This is the table to photograph and keep on your phone. Every row holds the four things the instructor asked for — number, name, sensory or motor, and the test — and nothing else, so it stays readable. The sections after it take the same twelve rows and open each one out into what normal and abnormal look like, so if a row here feels thin, its full treatment is further down.

All twelve. The last column is the version to have on recall.
#	Name	Type	What it does	How you test it
I 1	Olfactory	Sensory	Smell.	Eyes closed, one nostril at a time.
II 2	Optic	Sensory	Visual acuity and visual fields.	Acuity AND fields. Each eye, then both.
III 3	Oculomotor	Motor	Pupil constriction, most eye movement, upper eyelid elevation.	PERRLA. Light in from the SIDE. Direct, then consensual.
IV 4	Trochlear	Motor	Eye movement downward and inward.	Down and in. Tested with III and VI.
V 5	Trigeminal	Both	Sensation to the face; the muscles of chewing.	Three branches: forehead, cheek, jaw. Clench the teeth, palpate the muscles.
VI 6	Abducens	Motor	Lateral eye movement.	Lateral. Abducens = abduct = away.
VII 7	Facial	Both	Facial movement; taste on the anterior two-thirds of the tongue.	Make faces. Salt and sweet, front of the tongue.
VIII 8	Vestibulocochlear also “Auditory”	Sensory	Hearing and balance.	Hearing AND balance. Romberg. Occlude one ear, stay out of sight.
IX 9	Glossopharyngeal	Both	Taste on the posterior third of the tongue; swallowing, gag, speech sounds.	“Ah.” Gag. Swallow. Sour and bitter, back of the tongue.
X 10	Vagus	Both	Swallowing, speech sounds; sensory limb of the gag.	Tested WITH IX. Listen for hoarseness.
XI 11	Accessory also “Spinal Accessory”	Motor	Turning the head; shrugging the shoulders.	Shrug and turn the head — AGAINST RESISTANCE, both sides.
XII 12	Hypoglossal	Motor	Tongue movement.	Protrude at midline, then side to side. CVA → deviates to the paralysed side.

The “type” column is the deck's own classification, and it agrees exactly with the second acronym — sensory, sensory, motor, motor, both, motor, both, sensory, both, both, motor, motor. If your memory of the sentence ever disagrees with this column, the column is right.

Why the order is the order

Where They Leave the Brain

The numbering is not arbitrary, and knowing why turns a list of twelve into four small groups. The nerves are numbered front to back, top to bottom, in the order they leave the brain — so the number tells you roughly where the nerve comes from, and the region tells you which nerves keep company with each other. That is worth more than it sounds: the nerves that leave together get tested together, which is exactly how the deck teaches III, IV and VI, and IX and X.

Start with the real thing. Below is the underside of a brain — the view you get looking at it from beneath, which is the view in which all twelve are visible at once. Follow it from the front of the head backwards and the numbering simply happens in front of you.

Ventral view of the human brain, all twelve nerves labelled. Patrick J. Lynch, medical illustrator; labelled derivative by Beao. Wikimedia Commons, CC BY 2.5. Reproduced under that licence; it is not from the course material. Note the real spacing — the nerves come off in clusters, not at even intervals, which is the next figure’s point. One label to read carefully: this figure says “Cranial Accessory” for XI. That is the cranial root, which joins the vagus and serves the palate and larynx. The nerve you test — trapezius and sternocleidomastoid, shrug and head turn — is the spinal root, which comes up from the cervical cord and is not drawn here.

That is what it looks like. What it means is the table and the figure below: the twelve fall into four groups, and the group tells you what a nerve is likely to be for.

Four groups, and the boundaries are where the brainstem changes.
Region	Nerves	What they have in common
Forebrain	I, II	The two special senses at the front of the head \— smell and sight. Both purely sensory, and neither is a peripheral nerve in the ordinary sense. Strictly: I attaches at the olfactory bulb, an outgrowth of the cerebrum; II attaches at the diencephalon, by way of the optic chiasm. \“Forebrain\” is the label that covers both.
Midbrain	III, IV	Start of the eye movers. Both motor.
Pons	V, VI, VII, VIII	The face and the ear \— feeling the face, moving the face, the last eye mover, and hearing and balance.
Medulla	IX, X, XI, XII	The throat, neck and tongue \— swallowing, speaking and holding the head up. IX, X and XII are the nerves that protect the airway, which is why they outrank the rest when a client is deteriorating. XI is the exception in this group. The accessory nerve you test \— trapezius and sternocleidomastoid \— arises from the upper cervical cord, C1\–C5, and travels up into the skull before leaving it again. It is grouped with the medulla by convention and by its exit, not by its origin.

Press Start and the figure will ask you to find a nerve.

Drag sideways to see the whole figure →

The same twelve, simplified. The dots are roughly where each nerve really leaves — bunched into four clusters, as in the illustration above — and the lines fan out to evenly spaced labels so they can be read. Watch where the lines converge: four onto the pons, four onto the medulla. Each label also carries sensory, motor or both, in grey — the colour in this figure means region and nothing else. Every one of these nerves is a pair, one for each side. Press Start to test yourself: the numerals and names hide while you find the nerve.

The count, as a sanity check 2 from the forebrain, 2 from the midbrain, 4 from the pons, 4 from the medulla. Two, two, four, four. If you are reciting the twelve and lose your place, that pattern tells you which group you are in.

The classification question

Sensory, Motor, or Both

This is a classification question, and classification questions are one of the shapes this course leans on. The trap is always the same: the categories are defined by what the nerve carries, while the distractors are sorted by what the test feels like. Asking a client to smile feels like a sensation question because you are looking at a face; it is motor, because the client is moving a muscle. Ask yourself who is doing the work. If the client is reporting something — what they smell, see, hear, taste or feel — that is sensory. If the client is moving something, that is motor. If the test asks for both in one breath, the nerve is both.

The same twelve, sorted by type rather than by number.
Type	Count	Which	The thing they share
Sensory only	3	I, II, VIII	The three nerves that carry nothing but sensation — smell, sight, hearing-and-balance. You ask; the client reports. Nothing is moved. Taste is a special sense too, and it rides on VII and IX — which is why “the special senses” is not the dividing line here; carrying only sensation is.
Motor only	5	III, IV, VI, XI, XII	Three move the eye, one moves the head and shoulders, one moves the tongue. You ask; the client moves.
Both	4	V, VII, IX, X	All four are about the face and throat, where feeling and moving are inseparable. Each has a taste or sensation job and a muscle job.

Three, five, four — and the one that surprises people VIII is sensory only. Students classify it as both, because balance feels like something you do. You do not: the vestibular apparatus reports head position, and the muscles that then correct your balance belong to other nerves entirely. Romberg looks like a motor test and is a sensory one — which is exactly why closing the eyes changes the result.

The four “both” nerves all have a taste or sensation job If you cannot remember whether a face-or-throat nerve is both, ask what it feels: V feels the face, VII tastes the front of the tongue, IX tastes the back of the tongue, X carries the gag. Every one of the four has an answer. III, IV, VI, XI and XII have none — they are pure movement.

I and II

Smell and Sight

The first two are the odd ones out. Both are purely sensory, both carry a single special sense, and both are really tracts of the brain rather than peripheral nerves. They are also the two most likely to be skipped at the bedside — and the deck makes a point of that, because knowing what was not assessed is itself a finding. Take them together, learn that I is smell and II is sight, and the first two words of the acronym are secure.

I — Olfactory

Blueprint names olfactory testing Deck slide 29


Carries	Sensory Smell — and nothing else. The only cranial nerve that is purely about odour.
How you test it	Eyes closed. Occlude one nostril and test each nostril separately. Offer a familiar, non-irritating odour — the deck uses coffee, soap or fruit; the assessment form uses cologne. Non-irritating matters: an irritant such as ammonia stimulates V instead, so a client with no sense of smell still reacts and the test proves nothing.
Normal	Perceives, and can usually identify, the odour with each nostril separately.
Abnormal	Anosmia — loss of smell: the client cannot detect or identify the odour through one nostril or both. The assessment form adds the exception: a cold can blunt smell without anything being wrong with the nerve. Also expect it to be absent from the chart entirely: the deck points out that an H&P reading “CN 2–12 intact” means smell was never assessed, which is normal practice and not an omission to correct.

II — Optic

Blueprint names optic nerve testing, and the deck draws an arrow on it Deck slide 30 · drawn arrow


Carries	Sensory Visual acuity (how sharp) and visual fields (how wide). Two separate tests, and a question can ask for either.
How you test it	Acuity: Snellen chart, or have the client read print held at 36 cm (14 in.) in good light — the deck's bedside versions are read the clock or how many fingers. Test each eye and both. Fields: confrontation — sit facing the client, use your own vision as the baseline, and bring fingers in through four fields for each eye.
Normal	Reads with each eye and with both eyes; sees your fingers in all four fields at the same time you do.
Abnormal	Acuity: the client cannot read the print, or count your fingers, with one eye or with both. Fields: a visual field deficit — they miss your fingers in a field where you can see them. The deck teaches the field deficit as something you notice before you test it: the client does not eat the food on half the tray, or does not see the telephone on one side. Test acuity with the client's glasses on if they wear them; blurring that the glasses correct is a focusing problem, not a nerve one. Fields are a different question: reading glasses do not change how far out a finger can be seen, so they can stay on for confrontation.

Optic is two tests, and a question can ask for either Acuity is how sharp the vision is — a chart, or print at a set distance. Fields are how wide it is — confrontation, four fields per eye, with your own vision as the baseline. Students revise acuity and forget fields, and fields are the half with the memorable bedside sign: a client who eats only half the tray has a field deficit, not a poor appetite. The nursing response follows from it: put the call bell, the tray and anything else the client needs in the field they can see, and teach them to turn the head and scan toward the side they have lost. Safety comes first; a call bell in the blind field cannot be used.

“CN 2–12 intact” is not a typo The deck flags this because you will see it in real charts. It means the examiner assessed eleven nerves and did not test smell — which is ordinary practice, since routine screening rarely includes an odour. It is not an error to correct and not an abnormal finding. If a stem shows you that phrasing, the question is almost certainly testing whether you know which nerve is missing from it.

III, IV and VI

The Three That Move the Eye

These three are inseparable in practice: you test them with one penlight, in one movement, and the deck teaches them on a single slide for that reason. All three are motor only. The division of labour is worth having cold, because it is the most compressible fact in the whole topic — IV takes down and in, VI takes out to the side, and III takes everything else, plus the pupil and the eyelid. Learn the two small ones and III is defined by subtraction.

III — Oculomotor

Blueprint names PERRLA — testing, application, consensual reaction Deck slides 32–34


Carries	Motor Pupillary constriction — this is the PERRLA nerve — plus most of the eye movement and elevation of the upper eyelid.
How you test it	Reaction to light: bring a bright penlight in from the side, not from the front. Watch the pupil you lit (direct), then watch the other one (consensual). Accommodation: have the client focus on something distant, then on the penlight held near. Pupil size is measured in mm, and the speed is charted as brisk or sluggish. Eye movement is tested with IV and VI as the six cardinal fields of gaze.
Normal	PERRLA — pupils equal, round, reactive to light and accommodation. Brisk.
Abnormal	Anisocoria — unequal pupils. Also sluggish reaction, and ptosis (the upper eyelid droops, because III is what holds it up). When III is lost completely, all three show at once: the lid droops, the pupil is large and does not react, and the eye rests turned down and out — because only IV and VI are left pulling on it.

IV — Trochlear


Carries	Motor One muscle, one direction: the superior oblique, which turns the eye downward and inward.
How you test it	Not tested on its own. It is one of the three nerves you assess together as the six cardinal fields of gaze — hold a penlight about a foot away, ask the client to follow it with the eyes only, and move it through the six positions.
Normal	Both eyes move together, in parallel alignment, into every field.
Abnormal	The eye will not track down and in. Watch also for nystagmus — rapid involuntary eye movement — and for diplopia (double vision) reported by the client. The double vision is worst looking down — reading, or going down stairs.

Deck slides 34–35.

VI — Abducens


Carries	Motor One muscle, one direction: the lateral rectus, which turns the eye outward. Abducens — abduct — away from the midline.
How you test it	With III and IV, through the six cardinal fields of gaze. Check for nystagmus while you do it.
Normal	Both eyes coordinated, moving in unison with parallel alignment.
Abnormal	The eye will not move laterally; the client may report diplopia. With nothing pulling it outward, the eye may sit turned in toward the nose, and the double vision is worst looking toward the weak side.

Deck slides 34–35.

Two words, and III is whatever is left Trochlear — down and in. Abducens — abduct — out. Both names carry their own answer: abduct already means away from the midline. Everything else the eye does, together with constricting the pupil and holding the eyelid up, is III.

One movement tests three nerves — so “which nerve” needs the direction The six cardinal fields of gaze is a single manoeuvre that assesses III, IV and VI at once, and a stem that says only “the client follows the penlight through the six fields” has not narrowed anything down. Look for the direction. Down and in is IV. Out to the side is VI. Anything else, or the pupil, or the lid, is III. If no direction is given, the answer is all three.

V and VII

Feeling the Face, and Moving It

Here is the pairing students most often collapse, and the distinction is clean once you have said it once: V feels the face, VII moves it. Both are sensory and motor, both are tested on the face, and a stem can put them side by side precisely because the tests look alike to anyone who has not sorted them out. The sorting question is the one from Part 1 — who is doing the work? If you are touching the client and they report what they feel, you are testing V. If you are asking them to make a face, you are testing VII.

V — Trigeminal

Blueprint names trigeminal testing Deck slides 36–37


Carries	Both Sensory: light touch, pain and temperature to the face, in three branches — forehead, cheek, jaw. Motor: the muscles of mastication — opening, clenching and chewing.
How you test it	Motor: palpate the temporal and masseter muscles while the client clenches their teeth, and note the strength. Sensory: eyes closed — the deck's words are “no peeking” — then light touch with a wisp of cotton, sharp versus dull with something like a paperclip, and hot versus cold. Test all three branches on both sides.
Normal	Equal sensation to all three branches bilaterally; distinguishes sharp from dull and warm from cold; strong, symmetrical jaw.
Abnormal	Sensory loss over one branch or one side: the client does not feel the cotton, or cannot tell sharp from dull or hot from cold. A weak or deviating jaw: the muscle under your fingers stays soft on one side when they clench. If the corneal reflex is tested, no blink.

Worth separating out The corneal reflex belongs to V — but read the deck's qualifier carefully: it is only assessed in a comatose client, or if a sensory or motor deficit has already been noted. You do not touch a wisp of cotton to the eye of an alert client as routine screening. The assessment form still lists it first among the V techniques — while the client looks upward, lightly touch the lateral sclera to bring on a blink, with a positive corneal reflex as the normal response — so an option describing it is a V test. The deck's qualifier is about when you do it, not which nerve it belongs to.

VII — Facial

The deck draws an arrow on this slide Deck slide 38 · drawn arrow


Carries	Both Motor: the muscles of facial expression. Sensory: taste — salt and sweet — on the anterior 2/3 of the tongue.
How you test it	Observe the face at rest first, noting any asymmetry. Then ask the client to raise and lower the eyebrows, wrinkle the forehead, frown, smile to show the teeth, puff out the cheeks, and close the eyes tightly — then test strength by trying to open them. Taste is tested with salt and sweet on the front of the tongue.
Normal	Symmetrical movement through all of it; eyes close with strength; distinguishes the tastes.
Abnormal	Facial asymmetry or droop, most often on one side; the client cannot keep one eye closed against resistance. Whole side weak, forehead included = the nerve itself (peripheral VII, e.g. Bell’s palsy). Forehead spared, lower face only = a central lesion, such as a stroke, in the opposite hemisphere.

Where standard anatomy differs. The territory is real; the flavours are not. VII really does carry taste from the anterior two-thirds. But salt-and-sweet-at-the-front, sour-and-bitter-at-the-back is the old “tongue map”, and it is wrong — every taste is detected across the whole tongue. It is still printed in nursing texts and it is in the deck, so answer with the deck’s labels; just do not carry the map into physiology.

V against VII — the split to have cold Deck slides 36–38 · VII carries a drawn arrow

If the stem says…	The nerve is…
A wisp of cotton to the forehead, cheek and jaw	V — sensory
Clench the teeth while you palpate the jaw muscles	V — motor
Sharp versus dull, or hot versus cold, on the face	V — sensory
Smile, frown, raise the eyebrows, puff the cheeks	VII — motor
Squeeze the eyes shut while you try to open them	VII — motor
Taste, front of the tongue — salt and sweet	VII — sensory
Taste, back of the tongue — sour and bitter	IX — not VII
The corneal reflex	V — but read the next box

Closing the eyes belongs to VII, not V Both nerves have business at the eye and it catches people out. V carries sensation from the eye's surface — which is why touching the cornea provokes a blink. VII closes the lid — it is the muscle. So the corneal reflex needs both: V to feel it, VII to perform it. If a stem asks you to squeeze the eyes shut against resistance, that is strength, and strength is VII.

VIII

Hearing and Balance

One nerve, two jobs, and the name tells you both: vestibulo- is balance, -cochlear is hearing. It is sensory only, which surprises people, and its balance half is the cranial-nerve finding that turns most directly into a fall risk rather than a neurological curiosity — which is why it sits inside a lab block about falls. The blueprint names its testing by name, with a question mark beside it, and it also names positive Romberg separately under neurology. That is the same test counted twice; learn it once, properly.

VIII — Vestibulocochlear (the deck also calls it Auditory)

Blueprint names vestibulocochlear testing Deck slide 39


Carries	Sensory Two jobs in one nerve, and the name says so: the cochlear half is hearing, the vestibular half is balance.
How you test it	Hearing: have the client occlude one ear; standing out of their sight, so they cannot lip-read, present a quiet sound a few centimetres away — the form uses a ticking watch — and ask what they hear. Repeat on the other ear. Balance: the Romberg test — feet together, arms at the sides, eyes closed, and they should stand with minimal sway for 5 seconds. Always assess gait. Note any nystagmus or reports of spinning or dizziness.
Normal	Hears equally in both ears; stands steady on Romberg. Gait is recorded in the same breath because you watch it in the same moment, but gait is cerebellar, not VIII. The assessment form does list gait under VIII, so if a cranial-nerve item offers gait as a VIII test, that is the form’s answer.
Abnormal	Hearing loss on one side; a positive Romberg — which means they sway or lose balance once the eyes close, and is a falls problem, not just a neurological finding; nystagmus; vertigo — reports of spinning or dizziness.

Worth separating out Positive Romberg is the one to have cold. The blueprint names it under Neurology as well, and “positive” is counter-intuitive — a positive result is the abnormal one. The eyes closing is the whole point of the test: vision has been covering for two systems at once — the vestibular one and proprioception, the sense of where your joints are — and closing the eyes takes the cover away from both. The course files Romberg twice — under VIII and under cerebellar function — so if a question lists it as a cerebellar test, that is the course’s own answer. Standard neurology treats Romberg mainly as a test of proprioception, and teaches that the sign is classically absent in cerebellar disease, because a cerebellar client is already unsteady with the eyes open. Many cerebellar clients do sway more with the eyes shut, so treat that as a tendency, not a rule.

What makes a Romberg “positive” Feet together, arms at the sides, eyes closed, standing with minimal sway for 5 seconds. Positive means abnormal — they sway, step, or need to be steadied. The word is counter-intuitive and the exam knows it. The reason the eyes must close is the whole mechanism: vision has been compensating for the vestibular system and proprioception all along, and shutting it off is what exposes the deficit. Stand close enough to catch them. A test that risks a fall is still your responsibility while you run it.

IX and X

The Throat, Tested as One

The deck assesses these two together, on one slide, because their jobs overlap almost completely — both are sensory and motor, both are about swallowing, gagging and speaking. For most purposes “IX and X” is a single answer, and a stem that describes saying “ah” or checking a gag is pointing at the pair. There are, however, exactly two findings that separate them, and those two are what a question has to use if it wants one nerve rather than both.

IX — Glossopharyngeal


Carries	Both Sensory: taste — sour and bitter — on the posterior 1/3 of the tongue. Motor: swallowing, the gag reflex, and speech sounds.
How you test it	Tested together with X. Ask the client to say “ah” and watch the soft palate and uvula rise symmetrically; have them yawn to see the same movement. Elicit the gag by stroking both sides of the soft palate. Note the ability to swallow.
Normal	Soft palate and uvula rise symmetrically; gag present; swallows without difficulty.
Abnormal	Asymmetrical palate rise; absent gag; dysphagia — and the first sign of that is often coughing after a sip of water.

Deck slide 40.

Where standard anatomy differs. Standard anatomy splits the gag the other way. It makes IX the sensory (afferent) limb — the side that feels the touch — and X the motor (efferent) limb that performs the lift, and it gives swallowing and voice to X, leaving IX just one small muscle. The deck assigns swallowing, gag and speech to IX as motor; answer the deck’s way on this paper. Nothing in the sensory/motor/both column changes either way — both nerves are Both on either account.

X — Vagus


Carries	Both Motor: swallowing and speech sounds. Sensory: the gag reflex. Overlaps IX so completely that the deck assesses the two as one nerve.
How you test it	Tested together with IX. On top of “ah”, gag and swallow, listen to the quality of the voice — is there hoarseness?
Normal	Swallows without difficulty and speaks audibly, without hoarseness.
Abnormal	Hoarseness — the finding that belongs to X specifically — plus dysphagia, and a uvula that pulls to one side.

Deck slide 40.

Where standard anatomy differs. See the note on IX: standard anatomy gives the motor half of the gag, the swallow and the voice to X, and the sensory half to IX. The deck has it the other way round and the deck is the exam answer.

Worth separating out IX and X are the pair most likely to be asked as a pair. If a stem gives you one finding and asks which nerve, use this split: taste at the back of the tongue is IX; hoarseness is X; gag and swallow are both, which is why the deck tests them together.

The two findings that tell IX from X Taste at the back of the tongue — sour and bitter — is IX. Hoarseness is X. Everything else on this pair — the palate rising to “ah”, the gag, the swallow — involves both, and the honest answer to “which nerve?” is both. Memorise the two exceptions and you can answer every version of this item.

Coughing after a sip of water is not a cough It is the earliest sign of dysphagia, and it is a priority finding, not a note for later. The course's own neuro case study turns on exactly this detail. If a stem offers you a new cough after fluids alongside a list of other findings, the expected action is to stop oral intake and keep the client NPO until swallowing has been evaluated — not to thicken the fluids yourself, not to offer a straw, and not to document and carry on. A nerve finding that threatens the airway outranks every other nerve finding on the page. A wet, gurgling voice after swallowing is the same warning. So is food pocketed in one cheek, which brings in two more nerves: VII holds the cheek against the teeth, and XII’s tongue sweeps the food clear.

XI and XII

Shoulders, Head and Tongue

The last two are motor only and are the easiest marks on the paper, provided you attach the right qualifier to each. Both are named in the blueprint. For XI the qualifier is “against resistance”; for XII it is “at the midline”. Drop either word and a correct-sounding option becomes the wrong one, which is precisely how these two get examined.

XI — Accessory (the deck also calls it Spinal Accessory)

Blueprint names spinal accessory testing Deck slide 41


Carries	Motor Pure motor, and only two movements: turning the head and shrugging the shoulders. It innervates the trapezius and sternocleidomastoid.
How you test it	Both movements against resistance. Ask the client to shrug the shoulders against resistance from your hands, and to turn the head to the side against resistance from your hand — then repeat on the other side. Compare strength and symmetry.
Normal	Shrugs and turns the head against resistance, with equal strength on both sides.
Abnormal	Weakness or asymmetry on one side: the client cannot shrug, or cannot hold the head turn, against your resistance as strongly as on the other side. The shoulder on the weak side may also sit lower at rest.

Worth separating out “Against resistance” is the examinable half. The blueprint names spinal accessory testing by name, and an option that has the client shrug with nothing opposing them is testing range of motion, not the nerve. No resistance, no strength grade.

And the two halves of XI report on opposite sides. The shrug is ipsilateral — the right shoulder grades the right XI. The head turn is contralateral: the right sternocleidomastoid turns the head to the left, so resisting a turn to the left is grading the right side. One nerve, two movements, opposite sides — and neither the deck nor the assessment form says so.

XII — Hypoglossal

Blueprint names hypoglossal testing Deck slide 42


Carries	Motor Pure motor, and the clue is in the name: hypo-glossal — under the tongue. It innervates the muscles of the tongue.
How you test it	Ask the client to protrude the tongue at the midline, then move it from side to side. For strength, have them push the tongue against the inside of the cheek while you resist from the outside.
Normal	Tongue protrudes at the midline and moves freely in every direction, with strength.
Abnormal	After a CVA the tongue deviates to the side of the paralysis. Also dysarthria — slurred, poorly formed speech, because the tongue shapes the sounds.

Worth separating out The direction rule points at the muscle, not at the brain. The tongue always deviates toward the weak side — that part is true of a nerve lesion and of a stroke alike. But in a cortical stroke the weak side is the opposite side from the brain lesion, so a tongue deviating right means a left-hemisphere infarct. If a stem asks which side is weak, follow the tongue; if it asks which hemisphere, cross over. A lower-motor-neuron XII lesion also wastes and twitches the tongue on that side; a stroke does not.

Which way does the tongue go? The deck states it plainly: after a CVA the tongue deviates to the side of the paralysis. The mechanism is worth a sentence, because it makes the direction impossible to reverse — the healthy side still pushes, the weak side does not, so the strong half shoves the tongue across towards the weak half. Pair it with the other two findings from the same case: slurred speech and a weaker grip on one side. Three unilateral findings together are a stroke presentation, not three separate nerve problems.

Six letters, and the blueprint wants all three of its parts

What the Letters Stand For

Every other hint in the blueprint names a nerve. This one names an acronym, and then asks for three different things from it — “PERRLA: testing, application, consensual reaction.” That is a strong signal: it is the most likely single source of a cranial-nerve question, and the consensual reaction is called out separately because it is the part students cannot explain. Start with the letters, because two of the six are the same letter doing different work.

PERRLA — the blueprint names it, and names three things it wants from it Deck slides 32–33


P	Pupils	Both of them. Size is recorded in millimetres, and the two are compared.
E	Equal	The same size as each other. Unequal pupils are anisocoria.
R	Round	Regular in outline, not oval or irregular.
R	Reactive	They respond. The speed is charted as brisk or sluggish — those are the two words to use.
L	to Light	They constrict when light hits them — and both constrict, which is the consensual half below.
A	and Accommodation	They constrict and converge as the gaze shifts from far to near. Accommodation is the eye’s ability to re-focus as an object’s distance changes.

The deck spells the word “consenual” on slide 33 and also offers indirect as an alternative term. The spelling to use is consensual; both consensual and indirect are correct names for the same thing, and a question may use either.

Three responses, one penlight

Direct, Consensual and Accommodation

Three separate observations come out of one manoeuvre, and the blueprint asks for them. The sequence that makes them easy to keep apart is: light one pupil and watch that pupil, light one pupil and watch the other one, then put the light down and change the distance. The first two differ only in which eye you are looking at — which is why the second one has its own name and its own line in the blueprint.

Three responses. The middle one is the one the blueprint calls out.
Response	What you do	What you watch for
Direct	Bring the penlight in from the side and shine it on one pupil.	That pupil constricts. Charted brisk or sluggish.
Consensual also “indirect”	Shine the light on one pupil again — but watch the other eye.	The unlit pupil constricts too, and by the same amount. This is the finding the blueprint names.
Accommodation	Have the client focus on something distant, then on a near object; move an object in towards the nose.	Pupils constrict for near and dilate for far, and converge as the object comes in.

Why the unlit pupil moves at all — and the nerve this hands you This is the point of the consensual reaction, and it is the one explanation worth having in your own words. Light arrives on one nerve and leaves on another. The signal goes in along II, the optic nerve, crosses to both sides inside the brain, and comes back out along III, the oculomotor nerve, to both pupils. One eye is lit; two eyes respond. The deck files PERRLA under III, and III is the answer to “which nerve?” — it does the constricting. The role of II here is what explains the consensual reaction, and it is worth knowing for exactly that reason.

Bring the light in from the side Approaching from the front makes the client look straight at the penlight, which triggers accommodation at the same moment you are trying to read the light reflex — so both pupils constrict and you cannot tell which response you just saw. From the side keeps the two tests separate. An option that shines a light directly into a client's line of sight is describing poor technique, however familiar it sounds.

“Equal and reactive” does not mean “normal size” PERRLA records whether the pupils match and whether they work. It does not record whether they are a normal size — that is why the size goes in millimetres as a separate number. Two pupils can be equal, round and briskly reactive and still both be abnormally large or abnormally small. Document the number as well as the acronym.

The application half

What You Physically Do

The instructor's phrasing was “the application of the nerve testing”, and that word is doing work. A question will rarely ask “what is cranial nerve XI?”. It will describe a nurse asking a client to shrug their shoulders against resistance and ask which nerve is being assessed — or give you the nerve and ask which action tests it. So the direction that matters most is from the action back to the number. The figure below runs that way round.

Press Start and the figure will describe a test; click the nerve it belongs to.

Drag sideways to see the whole figure →

The bedside test for each nerve, drawn schematically. Press Start to test yourself — the game asks in the direction the exam asks: here is the action, name the nerve. The test labels hide while you choose.

Reading the result

How to Tell a Nerve Is Damaged

Knowing how to run a test is only half of “the application of the nerve testing”. The other half is knowing what a failed test looks like while you are running it — because that is what a stem describes. It will rarely say “the client has a damaged trochlear nerve”; it will say the eye did not follow the penlight down and in, and ask which nerve. The table below puts the sign of damage next to the test, for all twelve, in one place.

Damage shows up in one of three ways The client cannot do it at all — no smell, no gag, the eye will not go there. One side does not match the other — a bigger pupil, a drooping half of the face, a weaker shoulder, a tongue off the midline. It works, but slowly or weakly — a sluggish pupil, a shrug you can push down. Every one of the three is judged against something: the client's other side, and the client's own earlier assessment.

The test, and what damage looks like while you run it.
Nerve	During the test you…	Damage looks like
I — Olfactory	Offer an odour to each nostril, eyes closed.	Cannot smell or name it through one nostril or both — anosmia.
II — Optic	Have them read print, each eye then both; bring fingers in through four fields.	Cannot read it with one eye; misses your fingers in a field where you can see them. On the ward: leaves half the tray.
III — Oculomotor	Shine the penlight in from the side; watch both pupils; check accommodation.	Unequal pupils (anisocoria), a sluggish or absent constriction, a drooping lid (ptosis).
IV — Trochlear	Move the penlight through the six fields of gaze.	The eye will not follow down and in; double vision.
V — Trigeminal	Cotton, sharp and dull, hot and cold on forehead, cheek and jaw; palpate the jaw as they clench.	Does not feel it, or cannot tell sharp from dull, over one branch or one side; a weak clench on one side.
VI — Abducens	Move the penlight through the six fields of gaze.	The eye will not move out to the side; double vision.
VII — Facial	Watch the face at rest, then ask for faces; try to open the closed eyes.	One side droops or lags — a lopsided smile, a cheek that will not puff — and the eye will not stay shut against your fingers.
VIII — Vestibulocochlear	A quiet sound at one ear at a time; Romberg with the eyes closed.	Hears it on one side only; sways or steps once the eyes close (positive Romberg); nystagmus, or reports of spinning.
IX — Glossopharyngeal	“Ah”, the gag, a swallow; sour or bitter at the back of the tongue.	The palate rises unevenly; no gag; coughs after a sip of water; cannot taste at the back.
X — Vagus	The same “ah”, gag and swallow — and listen to the voice.	Hoarseness; the uvula pulls to one side; difficulty swallowing.
XI — Accessory	Shrug and turn the head, both against your resistance, both sides.	You can push the shrug down or overcome the head turn on one side.
XII — Hypoglossal	Tongue out at the midline, side to side, then against the cheek.	The tongue deviates to one side — toward the weak side; a weak push; slurred speech.

A failed test is not always a damaged nerve Before you name a nerve, rule out the ordinary explanation. A cold blunts smell, and the assessment form says so. Trouble finding or understanding words is aphasia, which is the brain, not a cranial nerve; slurred words from a client who knows exactly what they mean is the nerves. And a finding that was already there at the client’s earlier assessment is their baseline, not new damage. Wax in the ear canal muffles hearing before any nerve is involved, so look in the ear before blaming VIII. A small, stable difference in pupil size that is on every earlier record is common and harmless; the same difference appearing since the last check is not. Blurred print that clears with the client’s own glasses is a focusing problem, not an optic nerve one. Unsteadiness with the eyes open as well as closed points at the cerebellum rather than VIII — a tendency rather than a rule. And a whole side of the face weak with the forehead spared is a stroke above the nerve, not the facial nerve itself.

A new sign of damage is reported, not just charted The week's neuro case turns on this. A client who was clear at the earlier check now has slurred speech, a weaker grip on one side and coughs after a sip of water. Each is a cranial-nerve or motor finding on its own; together, and new, they are an acute change in neurological status. Keep the client NPO because the cough threatens the airway, and notify the provider or rapid response team immediately — not rest and reassess later. What makes a finding urgent is that it is new, so the comparison with the client's own baseline is part of the test. One more pattern belongs here: both pupils turning sluggish together points at the brain rather than at one nerve, and is a sign of rising pressure inside the skull. Report it at once — though a falling level of consciousness is the earlier and more sensitive sign, and usually comes first.

Doing all twelve without a list in your hand

The Order You Actually Work In

Nobody assesses cranial nerves in numerical order, because it would mean picking up and putting down the same penlight four times. In practice you work by equipment and by region, and several nerves come out of one action. This matters for the quiz in a specific way: it is why a single stem can legitimately be testing more than one nerve, and why “all of the above” style answers about III, IV and VI are often right.

Grouped the way the assessment actually runs.
You pick up…	And you assess…	In one action
Nothing	VII, XI, XII	Observation and plain instructions — make a face, shrug, stick out your tongue. The quickest three, and the ones most often done without the client realising they are being tested.
A penlight	III, IV, VI	PERRLA, then the six cardinal fields of gaze. One light, two tests, three nerves.
Something to read	II	Acuity, then fields by confrontation — no equipment needed for the second half.
A wisp of cotton	V	Light touch to forehead, cheek and jaw, eyes closed. Then clench the teeth, for the motor half.
Your voice	VIII	A whisper or a quiet sound at one ear at a time, from out of sight.
A tongue blade	IX, X	“Ah” for the palate, then the gag, then watch a swallow and listen to the voice.
An odour	I	Usually skipped entirely — see “CN 2–12 intact” in Part 2.
Floor space	VIII, then the cerebellum	Romberg is the balance half of VIII, and the part that belongs to fall risk. Gait is cerebellar, not VIII — you watch it in the same moment, which is why the assessment form groups them, but a stem asking which system owns an unsteady gait wants the cerebellum. If it asks which cranial-nerve test the form pairs gait with, that is VIII.

Compare sides, always, and let the client be their own control Every cranial nerve is paired, and nearly every abnormal finding in this guide is described as asymmetry rather than as an absolute — one pupil bigger, one side of the face weaker, one shoulder lower, the tongue off the midline. There is no normal range to look up. The reference value is the client's other side, which is why the assessment form says to repeat each test on both sides and compare. “Compared with the other side” belongs in the answer and in the chart.

Turning a finding into a sentence

Saying It in Chart Language

Documentation is not a topic of its own on the exam blueprint, but the words below are how the cranial-nerve items will be phrased, so reading them is revision all the same. The pattern throughout is the one this course keeps returning to: write what you observed, not what you concluded. “Facial asymmetry noted, left side” is an observation. “Client had a stroke” is a diagnosis, and it is not yours to record.

The vocabulary a question will use, and what it describes.
Term	What it means
PERRLA	Pupils equal, round, reactive to light and accommodation — with the size in mm alongside it.
Brisk / sluggish	How fast a pupil reacts. These are the two charting words.
Anisocoria	Unequal pupils.
Ptosis	Drooping of the upper eyelid — a III finding, since III holds the lid up.
Diplopia	Double vision — reported by the client, so subjective, and pointing at the eye movers.
Nystagmus	Rapid involuntary eye movement, looked for during the six fields of gaze.
Anosmia	Loss of smell — nerve I.
Dysphagia	Difficulty swallowing — IX and X. First sign is often coughing after fluids.
Dysarthria	Slurred or poorly formed speech — a problem with the muscles of speech, so XII, X and VII. The client knows what they want to say.
Aphasia	A language problem, not a muscle one — expressive (cannot produce the words) or receptive (cannot understand them). Not a cranial nerve finding; it is cortical. Appears in the appendix.

Dysarthria and aphasia are not the same finding Both come out as “trouble talking” and the distinction is a classic two-way item. Dysarthria is mechanical — the tongue, palate and lips are not forming the sounds, so the speech is slurred but the thought behind it is intact. Aphasia is linguistic — the words themselves are not available, or not understood. Dysarthria is a cranial nerve problem; aphasia is a brain problem. A stem describing slurred speech in a client who clearly knows what they mean is pointing at the nerves.

Say these out loud before you move on

Which nerve, and is it sensory, motor or both: shrug against resistance? XI, spinal accessory. Motor only. And the resistance is the point.

You shine a light in the right eye and the left pupil constricts. What is that called, and which two nerves made it happen? The consensual (indirect) reaction. In along II, out along III.

A client cannot taste the sour solution placed at the back of the tongue. Which nerve? IX, glossopharyngeal. Front of the tongue, salt and sweet, would be VII.

Which three nerves are sensory only? I, II, VIII — smell, sight, hearing and balance. The three that carry nothing but sensation.

The tongue deviates to the left. Which nerve, and which side is weak? XII. The left — it deviates towards the paralysed side.

What does a positive Romberg mean, and why must the eyes be closed? Abnormal — they sway or lose balance. The eyes are closed because vision has been compensating for the vestibular system and proprioception.

Which nerve moves the eye down and in? Out to the side? IV trochlear; VI abducens. Everything else is III.

A chart reads “CN 2–12 intact”. What was not tested? Smell — nerve I. Routine, not an error.

Following the penlight, the left eye will not move out toward the left ear. Which nerve is damaged? VI, abducens, on the left. Out to the side is VI.

The client shrugs against your hands and the right shoulder gives way. Which nerve, and how do you chart it? XI, spinal accessory, right side. Shrug weaker on the right against resistance, compared with the left.

Recall, not recognition

Twelve Cards, as Deep as You Choose

Reading this guide is recognition; the quiz asks for recall, and the gap between the two is where marks go missing. The deck below closes it. Start with only “The name” ticked and go through the twelve in both directions until the order is automatic — that alone covers the acronym you are allowed to write down. Then tick one more column and run it again. The card gets harder, the deck does not get longer, and you will find out quickly that naming a nerve and knowing how to test it are two different pieces of knowledge. Cards you miss come back; cards you have go away. Nothing is saved, so the deck is new every time you open the page.

What should the card ask you for?

Show me the and I will recall the rest.

Self-graded on purpose — only you can tell whether you actually recalled it or merely recognised it once the answer was showing. Be strict with yourself in here and the paper will feel easy. The drill does not print; the tables above it do.

Not on this quiz — on the one after it

Appendix — The Neurological Terms the Exam Adds

This appendix is here so the guide does not mislead you about its own edges. The quiz is cranial nerves only. The exam that follows carries those eight cranial-nerve questions plus eight on general neurology, and the two sets share a vocabulary — so the terms below will make the cranial-nerve items easier to read even though none of them is a cranial nerve. They come from the week's preparation worksheet, which lists them as terms to define. Three of them are findings that look like cranial-nerve problems and are not, and those are the ones worth your attention here.

From the preparation worksheet’s key-terms list. Definitions are standard nursing usage.
Term	What it means
Expressive aphasia	Cannot produce language — knows the word, cannot say it. Cortical, not a cranial nerve.
Receptive aphasia	Cannot understand language. Speech may be fluent and make no sense. Also cortical.
Ataxia	Uncoordinated movement or gait — a cerebellar sign, not a nerve lesion. Easily confused with the balance half of VIII.
Hemiparesis	Weakness down one side of the body.
Paresthesia	Abnormal sensation — numbness, tingling, “pins and needles”.
Nuchal rigidity	Stiff neck, resistant to flexion — a meningeal sign.
Decorticate posturing	Arms flexed in to the core. Think “cor” for core. The less grave of the two.
Decerebrate posturing	Arms extended and rigid. The worse sign, and the blueprint names the pair.
Level of consciousness	The deck’s own scale: alert, lethargic, obtunded, stuporous, comatose.
CNS / PNS / ANS	Central — brain and spinal cord. Peripheral — everything else, cranial nerves included. Autonomic — the involuntary half of the peripheral system.

Where the cranial nerves sit, since the exam asks about the divisions The twelve cranial nerves are part of the peripheral nervous system, not the central one — even though they leave the brain directly and two of them are really brain tracts. CNS is brain and spinal cord only. It is a one-mark question and it is easy to get backwards.

The deck's other two emphasis marks — exam material, not quiz material Deck slides 15, 45

Marked	What it sits beside
Arrow, slide 15	The mental status slide — level of consciousness, recent and remote memory, calculation, abstract thinking, insight, judgment, thought processes and speech. The blueprint names short-term memory and judgment testing under neurology, so this mark and that hint agree.
Star, slide 45	The muscle strength scale, 0–5. Musculoskeletal, and the blueprint names strength ratings there. Recorded as a fraction: the denominator is always 5, the numerator is what you found.

Both are recorded here rather than developed, because they belong to other sections of the exam blueprint. They are noted so that the count of the deck's five emphasis marks is complete and you can see that nothing cranial-nerve-related was left out of this guide.

Sources. The course's own material, which always takes precedence: the neurological assessment lab deck and its five drawn emphasis marks, the cranial nerves assessment form (which supplies the assessment technique and normal response for all twelve), the week's preparation worksheet and its neuro case study, the following week's preparation sheet, which sets out the quiz's format and the four things to know for every nerve, and the exam blueprint, which supplies the six nerves named by name and the PERRLA breakdown. Chapter references are to Taylor, Fundamentals of Nursing — Ch 45 Sensory and Ch 34 Activity.

Where the course documents disagree with each other. Twice, and neither is consequential, but both are flagged in place rather than smoothed over. The deck calls VIII Vestibulocochlear on slides 1 and 39 but Auditory on slide 28; and it calls XI plain Accessory on slide 1 but Spinal accessory on slides 28 and 41 — so the deck uses both names for both nerves, and the assessment form’s Accessory is not a disagreement with it. Both names are given for both nerves everywhere they appear, because the acronym needs one form and a question may use the other. The deck also writes “consenual” for consensual on the PERRLA slide, and offers indirect as an alternative term; both correct names are given.

Where the textbook was used. Sparingly, and only to explain rather than to add. The afferent-and-efferent explanation of the consensual reaction and the dysarthria-versus-aphasia distinction are standard nursing content, included because the blueprint asks for the consensual reaction specifically and because the terms sit next to each other on the worksheet. The deck's own attribution of PERRLA to nerve III is what this guide answers with.

The illustrations. Three figures. The ventral view of the brain in Part 1 is by Patrick J. Lynch, medical illustrator, with the labelled derivative by Beao, from Wikimedia Commons under the Creative Commons Attribution 2.5 Generic licence, which requires exactly this credit. It was reduced to its English labels before use and is otherwise unaltered. The other two — the region schematic in Part 1 and the testing map in Part 4 — are original drawings made for this guide. The decks' own images are instructor material and are not reproduced anywhere here.

What is deliberately not here. No brainstem nuclei, no skull foramina, no nerve branches. None of it is on this quiz. The region schematic is exactly that — a schematic, drawn to make the ordering and the four groups legible — and the anatomical illustration above it is there so you can see what the simplification is a simplification of.

Expect application. The blueprint asks for the “application of the nerve testing”, and the exam that follows describes its cranial-nerve questions as being just like the quiz. Reading the master table is not enough on its own — the drill in Part 5 and the companion practice quiz are where the recall actually gets built.

Notes set in this smaller grey type are standard nursing content added for completeness. They are labelled so you always know what came from your instructor and what did not. Where the two ever conflict, what you were told in class wins.

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