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When do you need a complete mental status exam (MSE)? [Ch 5; +2] Select all that apply.
A) If the family thinks you are a little strange.
B) If nursing school is giving you brain lesions, CVA, trauma, or tumors.
C) If the family is sure you have recently become more than a little strange.
D) Aphasia go through is impairing your speech, or if you see acute onset lover giving you symptoms of psychiatric mental illness.
E) You spend large amounts of money to see theatre productions of little consequence. |
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| Yes, I had a little fun with this one. With a little bit of humor added, the correct answers are B), C), D). Hopefully B) has nothing to do with nursing school. C) refers to an abnormal change in affect or behavior; innappropriate social interaction, or memory loss. Note for D): "aphasia" is the impairment of lanquage (2° to brain damage); and symptoms of psychiatric mental illness, particularly w/ acute onset; each justifies an MSE. A) & E) are purely for humor. |
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What subjective data do we need for an MSE? 'All that apply. [Slide 7]
A) Vital signs
B) Any joint pain patient can relate
C) History of medication & psychiatric illness
D) Chief complaint & history of present illness (HPI)
E) Demographic & Socioeconomic data |
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| C), D) & E) are correct; not shown but also included is cultural & religious beliefs. A) is not subjective data, and B) is musculoskeletal; not a part of mental status. |
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When do you do a minimental status exam (MMSE)? [Ch 5; +6] 'All that apply.
A) As a detector of organic disease
B) Memory loss, inappropriate social actions, and other behavioral changes have caused family concern.
C) As a simpler way to score initial and serial cognitive function.
D) When there is brain damage: lesions, tumor, trauma, CVA.
E) To differentiate delerium / dementia from psychiatric mental illness, and demonstrate worsening or improvement of cognition. |
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| A), C), and E) are correct. B), and D) are criteria for a complete MSE, not an MMSE. |
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What objective data is part of a minimental status exam (MMSE)? 'All that apply.
A) Mood and affect
B) Orientation and Registration
C) Attention and calculation
D) Recall and language.
E) Delerium and dementia
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B), C) & D) are correct: Orientation for time & place; registration of 3 words repeated back until they can (1 second hesitation between words). Attention & calculation is by starting at 100 and subtracting 7's several times. Recall is repeating the registration words. Language is having them read, write, respond to direction.
Normal mental status average 27; scores between 24 and 30 indicate no cognitive impairment. [Ch 5; +7]
NOTE: MMSE is a good screening tool to differentiate between delerium/dementia and psychiatric mental illness, but delerium and dementia are not objective data of the MMSE exam. Mood and Affect are a part of (complete) MSE, not MMSE data. |
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- Considerations when performing a MSE on the older adult (study guide bullet)
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Pick all MSE considerations that apply to the older adult:
A) There is no loss of status or prestige.
B) Loss of energy, income, and family is the same as for younger patients.
C) Confusion is common and easily misdiagnosed, particularly if hearing or vision is impaired; may cause false lower test scores.
D) Older adults can have a slower response time without a loss of intelligence so that timed test scores appear lower.
E) Ambiguity in level of consciousness can be avoided by using the Glasgow Coma Scale |
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| A) & B) are false: C), D) & E) are correct. |
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- Review health history for the MSE (study guide bullet)
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What are the components of the Mental Status Examination? [Ch 5, +2] 'All that apply.
A) Memory, Language, Mood & Affect & Consciousness
B) Appearance & Behavior
C) Cognition & Thought Processes
D) Orientation & Attention
E) Abstract reasoning, Perceptions & Thought (process & content) |
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| Only B) & C) are correct. The others are all mental status inferred through behaviors (1st p. of Ch 5). Components of an MSE are ABCT: appearance, behavior, cognition & thought process. |
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- Assessing behavior in the MSE (LOC, facial expression, speech and mood & affect) (study guide bullet)
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Tell yourself about behavior for the MSE; all that apply. [Ch 5; +2]
A) Behavior includes dress & grooming & hygiene.
B) Body movements and posture are a part of behavior.
C) Attention span, orientation, memory (recent & remote).
D) The person is awake & alert, aware of & appropriately responds to stimuli.
E) Affect, mood, speech, facial expression & level of consciousness are part of behavior. |
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| D) & E) are correct. A) & B) are part of appearance, not behavior. C) is cognitive functions, not behavior |
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Which of the following list are part of the MSE behavior section?
A) Person provides appropriate responses when asked how they feel today / usually; plus body language, facial expression, and cooperation.
B) Comfortable eye contact, subject to culture. Also includes an appropriate look & adjustment to topic.
C) Effortless laryngeal sounds & appropriate conversation
D) Can relate verifiable past events, such as the first job, birthdays and anniversaries, and personally relevant historical events.
E) Awake, alert, aware & appropriately responds to self- and environmental stimuli.
Name each one before turning the card over. |
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Only D) is incorrect. A) is mood & affect. B) is facial expression. C) refers to speech. E) is level of consciousness (LOC).
D) is remote memory; part of conitive functions on the MSE, NOT behavior. |
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What are the categories of behavior in the MSE; all that apply?
A) Level of Consciousness; mood & affect
B) Thought Processes; Thought Content
C) Facial Expression; Speech
D) Perceptions; Suicide screening
E) Judgement
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What are the categories of behavior in the MSE; all that apply?
A) & C) are correct: Level of Consciousness; mood & affect; Facial Expression; Speech
B) & D) are from the Thought Processes & Perceptions category of the MSE: Thought Processes; Thought Content; Perceptions; Suicide screening
E) Judgement is from the Cognitive category of the MSE
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Assessing cognitive functioning in the MSE (orientation, attentions span, recent & remote memory, and new learning) (study guide bullet)
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Congregate the cognitive: pick all the MSE parts that are. [Ch 5; +2]
A) The person remembers a series of 4 diverse words for 5; 10; 30 minutes.
B) Person can recite 24-hr diet and verifiable personal histories.
C) Person conveys consistent, goal directed, coherent, relevant and logical thoughts; no suicidal tendencies.
D) Person responds accurately and easily to who, where, and when they are.
E) Person is not anxious, fatigued nor intoxicated: can complete a thought or series of directions withour wandering.
Name each one before turning the card over. |
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A), B), D) & E) are correct. A) is New Learning - The 4 Unrelated Words Test. B) is Recent Memory & Remote Memory, respectively. D) is Orientation. E) is Attention Span.
C) Thought Processes & Perceptions; not Cognitive.
Cognitive category includes Orientation, Attention Span, Recent Memory, Remote Memory, and New Learning |
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What do cognitive functions include for the MSE? [Ch 5, +4] 'All that apply:
A) Orientation as to time, place, & person.
B) Thought content that is consistent and logical in what the patient says.
C) Ability to complete a thought without wandering as a measure of attention span.
D) 24-hr diet recall to show recent memory; cognitive.
E) New learning, as in remembering 4 unrelated words. |
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| A), C), D) & E) are correct. B) Thought content is a part of the Thought Processes & Perceptions in MSE rather than part of cognitive. |
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What other cognitive functions are in the MSE? [Ch 5, +4] 'All that apply:
A) Asking the patient to name items from pockets or the room or the body as word comprehension for aphasia.
B) The patient has realistic job and future plans relative to their current health as a reflection of judgement.
C) Screen for suicidal thoughts by asking if they have a plan to hurt themselves.
D) Judge the quality of speech by whether laryngeal sounds are effortless and conversation is appropriate.
E) Problem solving and reasoning tests for higher intellectual function.
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| A), B) & E) are correct, though E) is rarely used. C) Suicidal screening is for thought process / perception of the MSE, but not cognitive functions. D) Quality of speech is part of behavior, not cognitive functions. Word comprehension, reading and writing are part of testing for aphasia in cognitive functions. |
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Pick all that apply to MSE Thought Processes and Perceptions. [Ch 5; +5]
A) 27 is an average score; any score between 24 and 30 indicate no impairment.
B) Ask how other people treat, talk to, or watch them. Is their imagination active? Have they heard their name when they are alone.
C) Ask if they have a plan to hurt themselves as suicide screening.
D) Ask them to describe verifiable past events, such as past health, the 1st job, birthday, anniversary, or historical events that are relevant.
E) What they say should be consistent and logical. The way they think should be logical, goal directed, coherent, and relevant; they should complete a thought. |
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| B), C) & E) are correct. B) is perceptions. E) is Thought Content (the first sentence in the answer) and Thought Processes (the 2nd sentence in the answer). A) is the MMSE cognitive test, not the one for a complete MSE. D) is the remote memory test for cognitive function, not thought process/content. |
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Tell me about Denver; all that apply:
A) Categories include word comprehension, reading and writing.
B) It is designed to detect developmental delays in children, aged 3 months to 5 years.
C) Grooming and hygiene competence should be complete by age 6.
D) The full name is the Denver Development Screening Test II (DDST II).
E) Categories include Gross Motor, Fine Motor, Language, and Social Skills |
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| Correct answers are B), D) & E). A) refers to the atdditional testing for persons with aphasia under the Cognitive portion of the MSE; it is not part of DDST II. C) is supposed to be a fabricated absurdity. |
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