Before We Start
Why a focused screen exists alongside the full 12-nerve exam
A complete, formal cranial nerve exam testing all 12 nerves individually takes real time — time that isn't always available during a busy shift, or clinically necessary for every patient. GLOVES bundles the highest-yield cranial nerve checks into a single, fast sequence that a nurse can genuinely complete in under two minutes, covering the nerves most relevant to common acute concerns: stroke, head trauma, and post-op neuro changes.
💡 A Screen, Not a Replacement
GLOVES is a rapid screening tool, not a substitute for a complete neurological exam when one is clinically indicated. Any abnormal finding on the GLOVES screen should prompt a more thorough, targeted follow-up assessment of the specific nerve involved — not just documentation and moving on.
Mnemonic
GLOVES — six checks, seven nerves
G — Gag reflex
CN IX and X
A present, symmetric gag reflex confirms intact brainstem function at the medullary level and supports safe swallowing — see the dedicated Gag Reflex lesson for the full mechanism.
L — Light reflex
CN II (afferent) and CN III (efferent)
The pupillary light reflex — pupils should constrict briskly and symmetrically to light. See the dedicated PERRL lesson for the full breakdown of this two-nerve circuit.
O — Oculomotor
CN III
Confirm the eye moves normally with no ptosis (drooping eyelid) and no dilated, fixed pupil — the classic signs of CN III palsy covered in its own dedicated lesson.
V — Vision
CN II
Basic visual acuity (can the patient see fingers held up in each visual quadrant?) and gross visual field screening by confrontation.
E — Extraocular movements
CN III, IV, and VI
Ask the patient to follow a finger through an "H" pattern — checking for smooth tracking in all directions, and screening for diplopia (double vision) or nystagmus. See the LR6SO4 lesson for how to localize a specific deficit within this movement.
💊 The "H" pattern is deliberately chosen because it isolates each extraocular muscle at some point along the path — a smooth, symmetric "H" essentially screens CN III, IV, and VI together in one motion.
S — Sensation
CN V
Light touch and pain sensation tested on the forehead, cheek, and jaw on both sides, screening all three trigeminal branches (V1, V2, V3) for gross sensory symmetry.
🏥 Clinical Scenario — Using GLOVES for a Rapid Post-Op Check
A patient is two hours post-craniotomy. The nurse performs an hourly neuro check, which includes a rapid cranial nerve screen.
Run the Screen
The nurse works through GLOVES in under two minutes: gag intact, pupils equal and reactive, no ptosis, vision grossly intact, extraocular movements smooth in all directions, facial sensation symmetric. All six checks are normal — this provides a fast, structured baseline that can be efficiently repeated at each hourly check, making any new deviation easy to catch quickly.
Next Check, One Hour Later
On the following check, the right pupil is now sluggish to react, though still equal in size. Because the baseline GLOVES screen was clearly documented an hour earlier, this new sluggish reactivity is immediately recognizable as a CHANGE — not just an isolated abnormal finding — which is exactly the kind of trend that prompts urgent provider notification after a craniotomy.
📌 NCLEX Application
GLOVES-related questions test efficient prioritization and trend recognition:
Which nerves are covered: "The GLOVES screen assesses which cranial nerves?" → II, III, IV, V, VI, IX, X.
Value of serial screening: "Why is repeating the same structured cranial nerve screen at each neuro check more useful than performing a different assessment each time?" → It allows new changes to be recognized against a consistent baseline, which is often more clinically significant than any single abnormal finding in isolation.
⚠️ The Trap — Treating GLOVES as a Complete Substitute for a Full Neuro Exam
GLOVES deliberately leaves out several cranial nerves (I, VII, VIII, XI, XII) because they're lower-yield for the acute situations GLOVES is designed for. Using GLOVES as if it were a complete, exhaustive cranial nerve exam — and documenting "cranial nerves intact" based on GLOVES alone — overstates what was actually assessed.
The safeguard: Document specifically which nerves were assessed via GLOVES, and complete additional targeted testing (facial symmetry, hearing, tongue, shoulder shrug) whenever the clinical picture calls for a more complete picture.
✓ Quick Self-Test
Answer before checking:
1. What does each letter in GLOVES stand for?
2. Which cranial nerves are NOT covered by the GLOVES screen?
3. Why is the "H" pattern used to test extraocular movements?
4. Why is serial, repeated use of the same screen valuable in a post-op neuro patient?
Answers:
1. Gag reflex, Light reflex, Oculomotor, Vision, Extraocular movements, Sensation.
2. CN I, VII, VIII, XI, and XII.
3. Because the "H" pattern's path isolates each extraocular muscle at some point, effectively screening CN III, IV, and VI together in one smooth motion.
4. A consistent baseline makes any new change easy to recognize quickly — a shift from a prior normal finding is often more clinically urgent than a single abnormal finding evaluated in isolation.
Next Lesson
Down and Out — CN III Damage Pattern
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