# A nurse is assessing a client who was diagnosed with Bell's palsy 2 days ago. Which assessment finding would the nurse expect to observe? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=541204 > language: ko > subject: Adult Health ## 문제 A nurse is assessing a client who was diagnosed with Bell's palsy 2 days ago. Which assessment finding would the nurse expect to observe? ## 보기 1. Bilateral facial muscle weakness affecting both sides of the face equally 2. Loss of sensation in the affected side of the face with intact motor function 3. Difficulty swallowing and speaking due to tongue paralysis 4. Unilateral facial drooping with inability to close the eye on the affected side **✔ 정답** **정답: 4** ## 해설 Bell's palsy typically presents with unilateral facial drooping and inability to close the eye on the affected side. Other options describe bilateral involvement, sensory loss without motor deficit, or tongue paralysis, which are not characteristic. ## 심화 해설 Understanding Bell's Palsy Bell's palsy is an acute, idiopathic peripheral paralysis of the seventh cranial nerve (facial nerve). The onset is typically rapid and, as highlighted in the pediatric study, characterized by a unilateral presentation [2]. The underlying pathophysiology involves inflammation and edema of the facial nerve as it travels through the bony fallopian canal, leading to compression and subsequent impairment of motor function. Expected Assessment Findings Because the facial nerve (CN VII) is a lower motor neuron, its paralysis results in the inability to move the muscles of facial expression on the entire half of the face. This manifests as: - Unilateral facial drooping with a smoothing of the nasolabial fold. - Inability to close the eye on the affected side due to paralysis of the orbicularis oculi muscle, which is a critical finding requiring eye protection to prevent corneal damage. - Drooping of the corner of the mouth and difficulty with facial expressions such as smiling or frowning. These findings are consistent with the lower motor neuron lesion described in the literature, where the entire ipsilateral side of the face is affected [1]. Why Other Options Are Incorrect - Option 1 (Bilateral facial muscle weakness): This is incorrect because Bell's palsy is overwhelmingly a unilateral condition. Bilateral facial nerve palsy is an exceptionally rare subset, representing a distinct clinical presentation often associated with other systemic etiologies such as Lyme disease or Guillain-Barre syndrome, rather than idiopathic Bell's palsy [3][4]. - Option 2 (Loss of sensation with intact motor function): This is incorrect. Bell's palsy is a motor paralysis. While the facial nerve carries some sensory fibers for taste (chorda tympani) from the anterior two-thirds of the tongue, the primary and most obvious deficit is motor, not a loss of general facial sensation. A loss of facial sensation would suggest trigeminal nerve (CN V) involvement, not a pure facial nerve palsy. - Option 3 (Difficulty swallowing and speaking due to tongue paralysis): This is incorrect. Tongue movement is controlled by the hypoglossal nerve (CN XII), not the facial nerve. While severe facial weakness can cause mild articulation difficulty due to lip weakness, the tongue itself is not paralyzed in Bell's palsy. Clinical Significance and Differential Diagnosis While Bell's palsy is the most common cause of unilateral facial paralysis, the nurse must recognize that it remains a diagnosis of exclusion. A key clinical pearl is that a pontine stroke can perfectly mimic the lower motor neuron facial weakness seen in Bell's palsy [1]. This underscores the importance of a thorough neurological assessment, looking for associated "red flag" symptoms such as dizziness, headache, or limb weakness that would point toward a central lesion. Furthermore, when a patient presents with progression from unilateral to bilateral facial palsy, infectious mimics such as Lyme neuroborreliosis must be investigated with cerebrospinal fluid analysis and Lyme serology, even if initial neuroimaging is normal [4]. References (research sources) - [1]Lacunar Pontine Infarct Presenting as Ipsilateral Lower Motor Neuron Facial Palsy: A Case Report.Case reportPopat N, Patel MD, J Vadodaria V. (2026) · DOI: 10.7759/cureus.104930 - [2]Demographic and Clinical Features of Pediatric Bell's Palsy: A 26-Year Experience at a Tertiary Care Hospital in Riyadh.Research articleAltwajiri W, Alshamrani A, Almughamis A, Alnufaei A, Alkharboosh A, Alotaibi S. (2025) · DOI: 10.7759/cureus.98360 - [3]Stressful Symmetry: Bilateral Bell's Palsy Potentially Induced by Extreme Stress.Research articleAhmed H, Mazahr M, Rehan J. (2025) · DOI: 10.7759/cureus.82704 - [4]Infectious Mimics of Bell's Palsy: Facial Nerve Palsy Due to Lyme Neuroborreliosis.Research articleMon T, Nyein A, Oo A. (2025) · DOI: 10.7759/cureus.93122 ## 임상 시나리오 Clinical Practice Guide: Bell's Palsy Assessment Key Assessment Findings - **Unilateral facial drooping** with smoothing of the nasolabial fold and drooping of the mouth corner. - **Inability to close the eye** on the affected side due to paralysis of the orbicularis oculi muscle, requiring immediate eye protection. - **Lower motor neuron pattern:** the entire ipsilateral side of the face is affected, including the forehead (unable to wrinkle brow). - Onset is typically rapid, progressing over hours to 1–2 days. Nursing Priorities & Interventions - **Eye care:** Apply artificial tears during the day and lubricating ointment at night; use an eye patch or moisture chamber to prevent corneal abrasion. - **Nutrition:** Instruct the client to chew on the unaffected side; provide soft, easy-to-swallow foods and monitor for aspiration risk. - **Pain management:** Administer analgesics as prescribed for postauricular pain, which may precede or accompany the palsy. - **Emotional support:** Address body image disturbance and anxiety related to sudden facial appearance changes. Red Flags: When to Escalate - Bilateral facial weakness (rule out Guillain-Barre syndrome, Lyme disease, or sarcoidosis). - Progression beyond 2–3 weeks without improvement or development of new neurological deficits. - Vesicular rash in the ear or mouth (suspect Ramsay Hunt syndrome from herpes zoster oticus). - Signs of corneal ulceration: eye pain, redness, foreign body sensation, or vision changes. Patient Education - Explain that most patients (70–85%) achieve complete recovery within 3–6 months, especially if treated early with corticosteroids. - Teach facial muscle exercises (e.g., gentle massage, mirror feedback) once acute inflammation subsides. - Instruct on strict eye protection measures and follow-up with an ophthalmologist if eye closure remains incomplete. - Advise to report any worsening symptoms or lack of improvement after 3 weeks. ## 핵심 개념 - **Bell's palsy** — An acute, idiopathic, unilateral peripheral facial nerve (CN VII) paralysis causing sudden weakness of facial muscles. - **Lower motor neuron lesion** — Damage to the motor neuron connecting the brainstem to the muscle, resulting in ipsilateral paralysis of the entire side of the face in CN VII injury. - **Orbicularis oculi muscle** — The muscle responsible for closing the eyelid; its paralysis in Bell's palsy leads to inability to close the eye, risking corneal damage. ## 같은 주제 문제 - [A nurse is assessing a client who was diagnosed with Bell's palsy 2 days ago. 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