CRANIAL NERVE TESTING

VIDEO REQUIREMENT STUDENT GUIDE

Introduction:

Cranial nerves originate and/or terminate in the brain. They serve the
various parts of the head and the neck. The first two pairs of cranial nerves
synapse with the anterior brain, while the rest synapse with the brainstem.
The composition of each cranial nerve varies. There are cranial nerves that
are made up of sensory fibers, motor fibers, or both (D’Amico & Barbarito,
2016). Testing of cranial nerves forms part of neurologic assessment.

Instructions:

The complete list of cranial nerve testing materials and techniques is on the
succeeding pages. Prepare the materials and perform only those
techniques NOT highlighted. This activity is considered a group
requirement for the midterm period.

1. Divide the testing of the cranial nerves among your group members.
You will need to ask or request somebody in your household or your
classmate to be your “patient or client.”

2. Your group is expected to accomplish the following:

a. Demonstrate the testing of the indicated cranial nerves through

a video recording (collated video per group).

b. Record the results of your test and answers to the questions on

the provided Cranial Nerve Testing Worksheet_2024.

3. For the collated video output, ensure that each patient is not
identifiable unless consent has been obtained and captured in the
video. You may opt to blur certain parts of the patient’s face,
depending on the test that you are doing. (For example, if you are
testing the cardinal fields of gaze, blur the face except the eyes.)

4. Entries in the CN Testing Worksheet should be handwritten by a

member of your group.

5. Both outputs – video and accomplished worksheet – should be

submitted on or before the date announced by your Anatomy teachers.
Said outputs should be submitted by one or two members of your
group.
a. Upload the group video to your Google Drive.
b. In the submission bin in our LMS under the section, Nervous
System, share the Google Drive link of your group video. (Please
do not delete the video unless you have already informed your
teacher)
c. Submit the accomplished worksheet as a PDF file with the file
name format: Section - Group No._- CN Testing.
 Cranial Nerve Testing Materials and Techniques
Materials:
 Clean examination gloves
 Wisp of cotton
 Cotton balls
 Penlight
 Tongue blade or tongue depressor, popsicle stick applicator, or cotton
buds
 Objects to touch (coins, paper clips, or safety pins)
 Substances to smell (e.g. vanilla, mint, coffee)
 Substances to taste (e.g. sugar, salt, lemon, grape)
 Percussion hammer
 Tuning fork
 Ophthalmoscope
 Stethoscope
 Hot and cold water in test tubes
 Snellen chart
 Newspaper

Techniques:

1. Instruct the patient.

 Tell the patient that you will be testing special nerves and the senses
of smell, vision, taste, and hearing. Explain that several of the tests
may require the patient to close both eyes or make facial expressions.
Lastly, different types of equipment may be used during each test.

2. Test the olfactory nerve (CN I)

 If you suspect that the patient’s nares are obstructed with mucus, ask
the patient to blow his or her nose.
 Ask the patient to close both eyes and then apply gentle pressure to
the external surface of one naris with his or her index finger. If
necessary, you could occlude the patient’s naris. Place a familiar odor
under the open naris.
 Ask the patient to sniff and identify the odor. Use coffee, peppermint,
or other scents that are familiar to the patient. Repeat with the other
naris.

3. Test the optic nerve (CN II)

 Test near vision by asking the patient to read from a magazine,

newspaper, or prepared card. Observe the closeness or distance of the
page to the face. Note the position of the head as well.
 Use the Snellen chart to test distant vision. Color vision may be tested
using Ishihara cards, which feature colored dot patterns that contain
embedded symbols or numbers.
 Use the ophthalmoscope to inspect the fundus of the eye. Locate the
optic disc and describe the color and shape.
4. Test the oculomotor, trochlear, and abducens nerves (CN III, IV,
and VI)

Test the six cardinal fields of gaze.

 Position the patient. The patient should sit in a comfortable
position. You are at eye level with the patient.
 Explain that you will be testing eye movements and the muscles of
the eye. Explain that the patient must keep the head still while
following a pen or penlight that you will move in several directions
in front of the patient’s eyes.
 Position yourself about 2 feet in front of the patient, at eye level.
 Using the letter “H” method:
o Starting at midline, move the penlight to the left, then straight
up, then straight down.
o Drop your hand. Position the penlight against the midline.
o Move the penlight to the right, then straight up, then straight
down.
 Assess the patient’s ability to follow your movements with the eyes.

Test direct and consensual pupillary reaction to light.

 Shine a penlight from the side across the cornea.
 Observe the constriction in the illuminated pupil.
 Observe the simultaneous reaction of the other pupil (not
illuminated).

Test convergence and accommodation of the eyes.

 Ask the patient to stare straight ahead at a distant point.
 Hold a penlight/pen about 4-5 inches from the patient’s nose, then
ask the patient to shift the gaze from the distant point to the
penlight/pen.
 Observe what happens to the position of the eyes while looking at
the penlight/pen.
 Observe what happens to the size of the pupil as a result of the
shift in focus from the distant point to the penlight/pen.

5. Explain the procedure for testing the trigeminal nerve (CN V)

 Show the patient the cotton wisp. Touch the patient’s arm with the
wisp and explain that the wisp will feel like that when a body part is
touched. Ask the patient to close both eyes.
 Touch the arm with the wisp. Ask the patient to say “now” when
the wisp is felt. Explain that further tests with the wisp will be
carried out with the eyes closed, and “now” is to be stated when
the wisp is felt.
 Show the patient a broken tongue blade/popsicle stick. Explain that
while you touch the arm with the rounded end, the sensation is
“dull,” and with the broken end, the sensation is “sharp.”
 Tell the patient that both eyes must be closed during several tests
with the tongue blade/tongue depressor/popsicle stick.
 The patient is expected to identify each touch or sensation as sharp
or dull.
 Discard the tongue blade after the examination.
6. Test the trigeminal nerve (CN V)

Test the sensory function of the nerve:

 Ask the patient to close both eyes.
 Touch the patient’s face, forehead, and chin with a wisp of cotton.
 Direct the patient to say “now” every time the cotton is felt. Repeat
the test using sharp and dull stimuli.
 Be random with the stimulation. Do not establish a pattern when
testing.

Test the motor function of the nerve:

 Ask the patient to clench the teeth tightly. Bilaterally palpate the
masseter and temporalis muscles, noting muscle strength.
 Ask the patient to open and close the mouth several times.
Observe for symmetry of movement of the mandible without
deviation from midline.

7. Test the facial nerve (CN VII)

Test the motor activity of the nerve.

 Ask the patient to perform several functions, such as the following:
smile, show your teeth, close both eyes, puff your cheeks, frown,
and raise your eyebrows.
 Look for symmetry of facial movements.

Test the muscle strength of the upper face.

 Ask the patient to close both eyes tightly and keep them closed.
 Try to open the eyes by retracting the upper and lower lids
simultaneously and bilaterally.

Test the muscle strength of the lower face.

 Ask the patient to puff the cheeks.
 Apply pressure to the cheeks, attempting to force the air out of the
lips.

Test the sense of taste.

 Moisten three applicators/cotton buds and dab one in each of the
samples of sugar, salt, and lemon.
 Touch the patient’s tongue with one applicator/cotton bud at a time
and ask the patient to identify the taste.
 Water may be needed to rinse the mouth between tests.

8. Test the vestibulocochlear nerve (CN VIII)

Test the auditory branch of the nerve

 Perform the Weber test. This test uses the tuning fork and provides
lateralization of the sound.
 Perform the Rinne test. This compares bone conduction of sound
with air conduction
 Test the vestibular portion of the nerve
 Perform the Caloric test. This is also known as the “ice water” test
and is usually conducted only when the patient is experiencing
dizziness or vertigo.

Test equilibrium by doing the Romberg test.

 Ask the patient to stand with feet together and arms at sides, first
with eyes open and then with eyes closed.
 Wait about 20 seconds. The person should be able to maintain this
position, although some mild swaying may occur. Mild swaying is a
negative Romberg. It is important to stand nearby and prepare to
support the patient if there is a loss of balance.

9. Test the glossopharyngeal and vagus nerves (CN IX and X)

Test motor activity

 Ask the patient to open the mouth.
 Depress the patient’s tongue with the tongue blade/popsicle stick.
 Ask the patient to say “ah.”
 Observe the movement of the soft palate and uvula.

Test the gag reflex

 Inform the patient that you are going to place an applicator in the
mouth and lightly touch the throat.
 Touch the posterior wall of the pharynx with the applicator.
 Observe pharyngeal movement.

Test the motor activity of the pharynx

 Ask the patient to drink a small amount of water and note the ease
or difficulty of swallowing.
 Note the quality of the voice or hoarseness when speaking.

10.Test the accessory nerve (CN XI)

Test the trapezius muscle

 Ask the patient to shrug his/her shoulders.
 Observe the equality of the shoulders, symmetry of action, and lack
of fasciculations.

Test the sternocleidomastoid muscle

 Ask the patient to turn the head to the right and then to the left.
 Ask the patient to try to touch the right ear to the right shoulder
without raising the shoulder.
 Repeat with the left shoulder.
 Observe ease of movement and degree of range of motion.

Test trapezius muscle strength

 Have the patient shrug the shoulders while you resist with your
hands.

Test sternocleidomastoid strength

 Ask the patient to turn the head to the left to meet your hand.
 Attempt to return the patient’s head to midline position.
  Repeat the preceding steps with the patient turning the head to the
right.

11.Test the hypoglossal nerve (CN XII)

Test the movement of the tongue

 Ask the patient to:
o protrude the tongue.
o retract the tongue.
o protrude the tongue and move it to the right and then to the
left.
 Note ease and equality of movement.

Test the strength of the tongue

 Ask the patient to push against the inside of the cheek with the tip
of the tongue.
 Provide resistance by pressing one or two fingers against the
patient’s outer cheek.
 Repeat on the other side.

Reference:

D’Amico, D. & Barbarito, C. (2016). Health and physical assessment in

nursing. USA: Pearson Education, Inc., pp. 308, 311-312, 353, 762, 766-774,
except “popsicle stick”, “cotton buds”
 Cranial Nerve Testing Evaluation Tool

GRADING - CRANIAL NERVE TESTING TECHNIQUES (SELECTED ONLY)

Scoring: 2 - all steps correctly done

1 - needs improvement in doing some steps
0 - not done
1. Instruction to the patient at the start.
2. Testing of olfactory nerve.
a. instruction to patient
b. occluding nostril and placing substance close to nose.
3. Testing of optic nerve.
a. testing near vision
4. Testing of oculomotor, trochlear and abducens nerves.
a. testing the cardinal flelds of gaze.
1) positioning
2) instruction to patient
3) moving the penlight/pen
b. testing direct and consensual pupillary reaction to light.
1) shining a light on right eye while observing pupillary reaction
2) shining a light on left eye while observing pupillary reaction
c. testing convergence and accommodation
1) instruction to patient while observing convergence and accommodation.
2) holding a penlight about 4-5 inches from nose
5. Testing of trigeminal nerve
a. instruction to patient.
b. testing sensory function.
c. testing motor function.
6. Testing of facial nerve.
a. testing motor activity.
b. testing muscle strength of the upper face
c. testing muscle strength of the lower face
d. testing the sense of taste
7. Testing of vestibulocochlear nerve.
a. testing equilibrium
8. testing of glossopharyngeal and vagus nerves
a. testing motor activity
b. testing the gag reflex
c. testing the motor activity of the pharynx
9. Testing of accessory nerve
a. testing the trapezius muscle.
b. testing the sternocleidomastoid muscle.
10. Testing of hypoglossal nerve.
a. testing the movement of the tongue
b. testing the strength of the tongue