Chapter 05: Mental Status Assessment Physical Examination and Health Assessment, 8th Edition by Carolyn Jarvis

Chapter 05: Mental Status Assessment Physical Examination and Health Assessment, 8th Edition by Carolyn Jarvis MULTIPLE CHOICE 1. During an examination, the nurse can assess mental status by which activity? a. Examining the patients electroencephalogram b. Observing the patient as he or she performs an intelligence quotient (IQ) test c. Observing the patient and inferring health or dysfunction d. Examining the patients response to a specific set of questions ANS: C Mental status cannot be directly scrutinized like the characteristics of skin or heart sounds. Its functioning is inferred through an assessment of an individuals behaviors, such as consciousness, language, mood and affect, and other aspects. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) 2. The nurse is assessing the mental status of a child. Which statement about children and mental status istrue? a. All aspects of mental status in children are interdependent. b. Children are highly labile and unstable until the age of 2 years. c. Childrens mental status is largely a function of their parents level of functioning until the age of 7 years. d. A childs mental status is impossible to assess until the child develops the ability to concentrate. ANS: A Separating and tracing the development of only one aspect of mental status is difficult. All aspects are interdependent. For example, consciousness is rudimentary at birth because the cerebral cortex is not yet developed. The infant cannot distinguish the self from the mothers body. The other statements are not true. PTS: 1 DIF: Cognitive Level: Understanding (Comprehension) 3. The nurse is assessing a 75-year-old man. As the nurse begins the mental status portion of the assessment, the nurse expects that this patient: a. Will have no decrease in any of his abilities, including response time. b. Will have difficulty on tests of remote memory because this ability typically decreases with age. c. May take a little longer to respond, but his general knowledge and abilities should not have declined. d. Will exhibit had a decrease in his response time because of the loss of language and a decrease in general knowledge. ANS: C The aging process leaves the parameters of mental status mostly intact. General knowledge does not decrease, and little or no loss in vocabulary occurs. Response time is slower than in a youth. It takes a little longer for the brain to process information and to react to it. Recent memory, which requires some processing, is somewhat decreased with aging, but remote memory is not affected. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) 4. 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: a. Presence ofphobias b. General intelligence c. Presence of irrational thinking patterns d. Sensory-perceptive abilities ANS: D Age-related changes in sensory perception can affect mental status. For example, vision loss (as detailed in Chapter 15) may result in apathy, social isolation, and depression. Hearing changes are common in older adults, which produces frustration, suspicion, and social isolation and makes the person appear confused. PTS: 1 DIF: Cognitive Level: Analyzing (Analysis) 5. The nurse is preparing to conduct a mental status examination. Which statement is true regarding the mental status examination? a. A patients family is the best resource for information about the patients coping skills. b. Gathering mental status information during the health history interview is usually sufficient. c. Integrating the mental status examination into the health history interview takes an enormous amount of extra time. d. To get a good idea of the patients level of functioning, performing a complete mental status examination is usually necessary.