Correct Answers (A Pass) 2025
Update
mental status - Answer- ✔✔a person's emotional and cognitive functioning
strikes a balance between good and bad days, allowing person to function socially and
occupationally
mental disorder - Answer- ✔✔an illness that affects a person's thoughts, emotions, and
behaviors
organic disorders - Answer- ✔✔Due to brain disease of known specific organic cause
(e.g., delirium, dementia, alcohol and drug intoxication and withdrawal)
psychiatric mental illness - Answer- ✔✔organic etiology has not yet been established
(e.g., anxiety disorder or schizophrenia)
when do you perform a full mental status examination - Answer- ✔✔when any
abnormality in affect or behavior is discovered and in certain situations
mental status: aging adult - Answer- ✔✔o Older adulthood contains more potential for
losses
o Grief and despair surrounding theses losses can affect mental status and can result in
disability, disorientation, or depression
o Chronic diseases such as heart failure, cancer, diabetes, and osteoporosis include
fear of loss of life
the four main headings of mental status assessment: - Answer- ✔✔A-B-C-T
-Appearance
-Behavior
-Cognition
-Thought processes
aphasia - Answer- ✔✔impairment of language ability secondary to brain damage
brain lesions - Answer- ✔✔trauma, tumor, cerebrovascular accident or stroke
when is a full mental status examination necessary - Answer- ✔✔-Patients whose initial
screening suggests an anxiety disorder or depression
-Behavioral changes, such as memory loss, inappropriate social interaction
-Brain lesions
, -Aphasia
-Symptoms of psychiatric mental illness, especially with acute onset
what things does the nurse ask about when determining the orientation of a client? -
Answer- ✔✔-time(day of the week, date, year, season)
-place(where person lives, address, phone number, present location, type of building,
name of city and state)
-person(own name, age, who examiner is, type of worker)
attention span - Answer- ✔✔ability to concentrate-noting completes a thought without
wandering
assessing recent memory - Answer- ✔✔Assess in context of interview by 24-hour diet
recall or by asking time person arrived at agency
confabulates - Answer- ✔✔makes up plausible explanation for his actions without
intention to deceive, to fill in gaps of memory loss
assessing remote memory - Answer- ✔✔In the context of the interview, ask verifiable
past events;
describe past health, the first job, birthday and anniversary dates, and historical events
that are relevant for that person
Remote memory is lost when - Answer- ✔✔cortical storage area for that memory is
damaged, such as in Alzheimer disease, dementia, or any disease that damages
cerebral cortex
the four unrelated words test - Answer- ✔✔Pick four words with semantic and phonetic
diversity; ask person to remember the four words
have him or her repeat the words
Ask for the recall of four words at 5, 10, and 30 minutes
what is a normal response of the four unrelated words test for a person younger than 60
- Answer- ✔✔an accurate 3- or 4-word recall after 5, 10, and 30 minutes
assessing word comprehension - Answer- ✔✔ask person to name object in room
assessing reading - Answer- ✔✔ask person to read available print; be aware that
reading is related to educational level
assessing writing - Answer- ✔✔ask person to make up and write a sentence; note
coherence, spelling, and parts of speech
thought processes - Answer- ✔✔Way person thinks should be logical, goal directed,
coherent, and relevant; should complete thoughts