Exam 5: Mental Status Assessment

The nurse is assessing orientation in a 79-year-old patient.Which of these responses would lead the nurse to conclude that this patient is oriented?

A 20-year-old construction worker has been brought into the emergency department with heat stroke.He has delirium as a result of a fluid and electrolyte imbalance.For the mental status examination,the nurse should first assess the patient's:

The nurse is preparing to conduct a mental status examination.Which statement is true regarding the mental status examination?

A patient states,"I feel so sad all of the time.I can't feel happy even doing things I used to like to do." He also states that he is tired,sleeps poorly,and has no energy.To differentiate between a dysthymic disorder and a major depressive disorder,the nurse should ask which question?

When assessing aging adults,the nurse knows that one of the first things that should be assessed before making judgments about their mental status is:

During an examination,the nurse can assess mental status by which activity?

The nurse is performing the Denver II screening test on a 12-month-old infant during a routine well-child visit.The nurse should tell the infant's parents that the Denver II:

During morning rounds,the nurse asks a patient,"How are you today?" The patient responds,"You today,you today,you today!" and mumbles the words.This speech pattern is an example of:

The nurse is administering a Mini-Cog test to an older adult woman.When asked to draw a clock showing the time of 10:45,the patient drew a clock with the numbers out of order and with an incorrect time.This result indicates which finding?

During an examination,the nurse notes that a patient is exhibiting flight of ideas.Which statement by the patient is an example of flight of ideas?

A patient has had a cerebrovascular accident (stroke).He is trying very hard to communicate.He seems driven to speak and says,"I buy obie get spirding and take my train." What is the best description of this patient's problem?

The nurse is performing a mental status assessment on a 5-year-old girl.Her parents are undergoing a bitter divorce and are worried about the effect it is having on their daughter.Which action or statement might lead the nurse to be concerned about the girl's mental status?

During a mental status examination,the nurse wants to assess a patient's affect.The nurse should ask the patient which question?

A 19-year-old woman comes to the clinic at the insistence of her brother.She is wearing black combat boots and a black lace nightgown over the top of her other clothes.Her hair is dyed pink with black streaks throughout.She has several pierced holes in her nares and ears and is wearing an earring through her eyebrow and heavy black makeup.The nurse concludes that:

A patient drifts off to sleep when she is not being stimulated.The nurse can easily arouse her by calling her name,but the patient remains drowsy during the conversation.The best description of this patient's level of consciousness would be:

A patient has been in the intensive care unit for 10 days.He has just been moved to the medical-surgical unit,and the admitting nurse is planning to perform a mental status examination.During the tests of cognitive function,the nurse would expect that he:

During an interview,the nurse notes that the patient gets up several times to wash her hands even though they are not dirty.This behavior is an example of:

The nurse is providing instructions to newly hired graduates for the mini-mental state examination (MMSE).Which statement best describes this examination?

The nurse is planning to assess new memory with a patient.The best way for the nurse to do this would be to:

A 45-year-old woman is at the clinic for a mental status assessment.In giving her the Four Unrelated Words Test,the nurse would be concerned if she could not ____ four unrelated words ____.