Chapter 7 Mental Status

Question 1

When is the mental status portion of the neurologic system examination performed?
a. During the history-taking process
b. During assessment of cranial nerves and deep tendon reflexes
c. During the time when questions related to memory are asked
d. Continually, throughout the entire interaction with a patient

Answer 1

ANS: D
A mental status evaluation should be continually performed throughout the patient encounter.
Assessing and validating clues to determine the individual’s ability to interact within the
environment is a priority of the mental status evaluation.

Question 2

A 69-year-old truck driver presents with a sudden loss of the ability to understand spoken
language. This indicates a lesion in the
a. temporal lobe.
b. Broca area.
c. frontal cortex.
d. cerebellum.

Answer 2

ANS: A
The temporal lobe, specifically in the Wernicke speech area, is responsible for the comprehension of spoken and written language.

Question 3

The ability for abstract thinking normally develops during
a. infancy.
b. early childhood.
c. adolescence.
d. adulthood.

Answer 3

ANS: C
Abstract thinking is an intellectual maturation that develops during adolescence.

Question 4

The Mini-Mental State Examination (MMSE) may be used to
a. estimate cognitive changes quantitatively.
b. estimate personality disorders qualitatively.
c. diagnose neurologic disorders.
d. determine the cause of memory loss.

Answer 4

ANS: A
The MMSE is a standard tool that functions to estimate cognitive function quantitatively or to
document cognitive changes serially.

Question 5

Assessing orientation to person, place, and time helps determine
a. ability to understand analogies.
b. abstract reasoning.
c. attention span.
d. state of consciousness.

Answer 5

ANS: D
Orientation to person, place, and time are measures of states of consciousness and awareness.

Question 6

When you ask the patient to tell you the meaning of a proverb or metaphor, you are assessing
which of the following?
a. Level of consciousness
b. Abstract reasoning
c. Emotional stability
d. Memory

Answer 6

ANS: B
Asking the patient to tell you the meaning of a proverb, metaphor, or fable assesses the
patient’s ability to reason abstractly. Asking the patient to tell you the meaning of a proverb or
metaphor does not assess level of consciousness, emotional stability, or memory. The
Mini-Mental State Examination tests memory.

Question 7

Impairment of arithmetic skills is often the result of
a. impaired execution of motor skills.
b. impaired judgment.
c. perceptual distortions.
d. depression

Answer 7

ANS: D
The patient with depression can display difficulty with simple arithmetic calculations.

Question 8

Peripheral neuropathy is most likely to be manifested by
a. impaired memory.
b. impaired abstract reasoning.
c. impaired writing ability.
d. hallucinations.

Answer 8

ANS: C
Uncoordinated writing or drawing may indicate peripheral neuropathy, dementia, parietal lobe
damage, or a cerebellar lesion.

Question 9

Recent memory may be tested by
a. asking the patient to name the past four presidents.
b. asking the patient to listen to and repeat a series of numbers.
c. showing the patient four items and asking him or her to list the items about 10
minutes later.
d. asking the patient about verifiable information, such as his or her mother’s maiden
name.

Answer 9

ANS: C
Showing the patient four or five objects, saying you will ask about them in a few minutes, and
then 10 minutes later asking the patient to list the objects is a technique to measure recent
memory

Question 10

Loss of immediate and recent memory with retention of remote memory suggests
a. attention-deficit/hyperactivity disorder (ADHD).
b. impaired judgment.
c. stupor.
d. dementia.

Answer 10

ANS: D
Dementia is the loss of both immediate and recent memory while retaining remote memories.
ADHD is associated with recent and remote memory impairment. Impaired judgment is a
thought process dysfunction. Stupor is impaired consciousness.

Question 11

You ask the patient to follow a series of short commands to assess
a. judgment.
b. attention span.
c. arithmetic calculations.
d. abstract reasoning.

Answer 11

ANS: B
Asking the patient to follow a series of short commands will test attention span.

Question 12

Which observation would be most significant when assessing the condition of a patient who
has judgment impairment?
a. Repeated failure to fulfill family obligations
b. Forgetting family members’ birth dates
c. Going to church three times a week
d. Planning for retirement in 20 years

Answer 12

ANS: A
Inadequately dealing with family and social affairs indicates impaired judgment, whereas the
other choices do not.

Question 13

Appropriateness of logic, sequence, cohesion, and relevance to topics are markers for the
assessment of
a. mood and feelings.
b. attention span.
c. thought process and content.
d. abstract reasoning.

Answer 13

ANS: C
Thought process and content are examined while observing the patient’s patterns of thinking,
especially appropriateness of sequence, logic, coherence, and relevance to the topics
discussed.

Question 14

Which type of hallucination is most commonly associated with alcohol withdrawal?
a. Olfactory
b. Visual
c. Auditory
d. Tactile

Answer 14

ANS: D
Tactile hallucinations are most commonly associated with alcohol withdrawal.

Question 15

Flight of ideas or loosening of associations is associated with
a. aphasia.
b. dysphonia.
c. multiple sclerosis.
d. psychiatric disorders.

Answer 15

ANS: D
Flight of ideas, loosening of associations, word salads, neologisms, clang associations,
echolalia, and utterances of unusual sounds are all associated with psychiatric disorders.

Question 16

The Glasgow Coma Scale is used to
a. determine the cause of decreased consciousness.
b. diagnose disorders that alter level of consciousness.
c. quantify consciousness.
d. predict response to stimulant medications.

Answer 16

ANS: C
The Glasgow Coma Scale is used when a patient has an altered level of consciousness and is
used to quantify consciousness.

Question 17

Which condition is considered progressive rather than reversible?
a. Delirium
b. Dementia
c. Depression
d. Anxiety

Answer 17

ANS: B
Dementia is considered progressive and irreversible. Delirium has the potential for reversal.
Depression and anxiety are reversible.

Question 18

A clinical syndrome of failing memory and impairment of other intellectual functions, usually
related to obvious structural diseases of the brain, describes
a. delirium.
b. dementia.
c. depression.
d. anxiety.

Answer 18

ANS: B
Dementia results from a chronic progressive deterioration of the brain that results in failing
memory and impairment of other intellectual functioning.

Question 19

Mrs. Griffiths, a 28-year-old patient, presents to your office to discuss her
attention-deficit/hyperactivity disorder (ADHD). Which statement is true in regard to ADHD?
a. It occurs before 7 years of age.
b. It is usually related to mental retardation.
c. It is usually related to dementia.
d. It is manifested by prolonged periods of catatonic behavior.

Answer 19

ANS: A
ADHD occurs before 7 years of age. ADHD is not related to mental retardation, dementia, or
prolonged periods of catatonic behavior

Question 20

An aversion to touch or being held, along with delayed or absent language development, is
characteristic of
a. attention-deficit/hyperactivity disorder.
b. autism.
c. dementia.
d. mental retardation

Answer 20

ANS: B
Autistic disorder involves a combination of behavioral traits (lack of awareness of others,
aversion to touch or being held, odd or repetitive behaviors, or preoccupation with parts of
objects) and communication deficits (usually echolalia [parrot speech]).

Question 21

You are interviewing a 20-year-old patient with a new-onset psychotic disorder. The patient is
apathetic and has disturbed thoughts and language patterns. The nurse recognizes this
behavior pattern as consistent with a diagnosis of
a. depression.
b. autistic disorder.
c. mania.
d. schizophrenia.

Answer 21

ANS: D
Schizophrenia manifests as a psychotic disorder of early adult onset, with disturbances in
language and speech, emotions and social withdrawal, and apathy. Depression and mania do
not have the language or speech component. Autistic disorders are not psychotic disorders,
and they usually begin before 3 years of age.

Question 22

While interviewing a patient, you ask him to explain the ―Lion and the Mouse‖ to assess
a. reading comprehension.
b. attention span.
c. mood and feeling.
d. reasoning skills.

Answer 22

ANS: D
Having the patient explain fables or metaphors determines abstract reasoning skills.

Question 23

The Mini-Mental State Examination (MMSE) should be administered for the patient who
a. gets lost in her neighborhood.
b. sleeps an excessive amount of time.
c. has repetitive ritualistic behaviors.
d. uses illegal hallucinogenic drugs.

Answer 23

ANS: A
The MMSE is a tool used to quantitatively estimate cognitive function or to serially document
cognitive changes. Getting lost in a familiar territory is a sign of possible cognitive
impairment.

Question 24

Which clinical assessments test attention span? (Select all that apply.)
a. Spell WORLD backward.
b. Draw a clock.
c. Say the days of the week.
d. Do arithmetic calculations.
e. Explain ―a stitch in time saves nine

Answer 24

ANS: A, C, D
Clinical assessments to test attention span include spell WORLD backward, say the days of
the week, and do arithmetic calculations. Drawing a clock tests writing ability, and explaining
a ―stitch in time saves nine‖ tests abstract reasoning.

Question 25

Which are signs and symptoms of dementia? (Select all that apply.)
a. Aphasia
b. Apathy
c. Odd behaviors
d. Disintegration of personality
e. Lack of awareness of others

Answer 25

ANS: A, B, D
Aphasia, apathy, and disintegration of personality are all characteristics of dementia. Odd
behaviors and lack of awareness of others are characteristics of autism.