Mental Status Prep U Questions and answers

Mental Status Prep U Questions A nurse performs an admission assessment and notices that the client's speech is slow and the client has difficulty answering some of the questions. How can the nurse differentiate the cause of the client's slow speech? ans: Have the client read a few sentences out loud A 29-year-old woman comes to the office. During history taking, the nurse notices that the client is speaking very quickly and jumping from topic to topic so rapidly that it is difficult to follow her. The nurse can find some connections between ideas, but it is difficult. Which word best describes this thought process? ans: Flight of ideas Which factor would alert the nurse to the risk of suicide in the patient? Select all that apply. ans: -depression -alcohol abuse -lack of social support When assessing the client's ability to make sound judgments, what question should the nurse ask? ans: "How do you plan to pay rent if you lose your job?" The nurse has made a nursing diagnosis of self-esteem disturbance. Which assessment data supports the nursing diagnosis? ans: Guilt and negative comments about themself A new nurse asks the charge nurse what the Mini-Mental Status Examination tests. What is the appropriate response by the charge nurse? ans: " A quick tool used to examine the orientation, memory, speech and cognitive function While conducting an interview with a psychiatric-mental health client, the nurse is observing the client's facial expressions and nonverbal cues. What are these physical manifestations known as? ans: Affect When observing a patient diagnosed with mania, the nurse observes his mood to be elated. Another term for this type of mood includes which of the following? ans: Euphoric During the initial assessment of a client with a mental health disorder, what would be the priority information for the nurse to obtain? (Select all that apply.) ans: -preexisting mental health disorders -current mental health disorders As part of the mental status examination, the nurse assesses the cognitive abilities of the client. Which questions should the nurse ask to assess the judgment ability in the client? ans: "What do you do if you have pain?" The nurse notes that an older adult client is wearing layers of clothing on a warm, fall day. Which of the following would be the priority assessment at this time? ans: Ask whether the client often feels cold The nurse assesses an older adult using the Mini-Mental Status Exam. The total score obtained is 24. Which interpretation by the nurse is correct? ans: The pt is cognitively intact Which question asked by the nurse assesses judgment of the patient? ans: "What will you do if you feel the need to use cocaine again?" The patient states, "I don't know why God as abandoned me; I am a good person." The nurse suspects the patient is at risk for ans: Suicide The nurse observes a client's entire body posture to be stiff, with his shoulders elevated upward toward the ears. The nurse would most likely interpret this to indicate that the client is ans: Anxious A 75-year-old homemaker brings her 76-year-old husband to the clinic. She states that 4 months ago he had a stroke; ever since she has been frustrated with his problems with communication. They were at a restaurant after church one Sunday when he suddenly became quiet. When she realized something was wrong, he was taken to the hospital by ambulance. He spent 2 weeks in the hospital with right-sided weakness and difficulty speaking. After hospitalization he was in a rehab center where he regained the ability to walk and most of the use of his right hand. He also began to speak more, but she says that much of the time "he doesn't make any sense." She gives an example that when she reminded him the car needed to be serviced he told her "I will change the Kool-Aid out of the sink myself with the ludrip." She says that these sayings are becoming frustrating. She wants the nurse to tell her what is wrong and what can be done about it. What type of aphasia does the client have? ans: Wernicke's aphasia Adam is a very successful 15-year-old student and athlete. His mother brings him in today because he no longer studies, works out, or sees his friends. This has gone on for a month and a half. When the nurse speaks with Adam alone, the client states it "would be better if he were not here." What should the nurse do next? ans: Assess Adam's suicide risk