The nurse continues a neurologic assessment of the cranial nerve XI (spinal accessory) for a client as seen in the picture. Which instruction should the nurse give the client to complete this assessment?

Choice A rationale Turning the head from side to side against resistance assesses the sternocleidomastoid muscle, which is innervated by the cranial nerve XI (spinal accessory nerve). While this movement is part of the assessment, the question specifically asks for an instruction to *complete* the assessment of CN XI. This is one component, but not the only one. Choice B rationale The spinal accessory nerve (CN XI) innervates the sternocleidomastoid and trapezius muscles. Assessment of the trapezius muscle involves evaluating the client's ability to shrug their shoulders against resistance. This action directly tests the motor function of the trapezius, providing a comprehensive assessment of the strength and integrity of cranial nerve XI. Choice C rationale Standing up slowly with eyes closed assesses balance and proprioception, which are primarily functions of the vestibular system (cranial nerve VIII) and cerebellar pathways, not directly cranial nerve XI. This instruction is part of a broader neurological assessment but is not specific to the spinal accessory nerve. Choice D rationale Raising both arms overhead primarily tests the deltoid and other shoulder girdle muscles, which are innervated by nerves originating from the brachial plexus (e.g., axillary nerve, musculocutaneous nerve). This action does not specifically target the sternocleidomastoid or trapezius muscles, which are the primary muscles innervated by cranial nerve XI.