Seidel's ch 7 Flashcards
When is the mental status portion of the neurologic system examination performed?
a. During the history-taking process
b. Immediately after the vital signs are taken
c. During the time when questions related to memory are asked
d. Constantly, throughout the entire interaction with a pt
e. During assessment of cranial nerves and deep tendon reflexes
D.
A mental status evaluation should be continually evaluated throughout the pt encounter. Assessing and validating clues to determine the individual’s ability to interact with the environment is a priority of the mental status evaluation.
Which statement is true regarding mental status changes in older adults?
a. There is usually a decline in general intelligence in older adults
b. Vocabulary and inventories of information show a marked decrease in older adults
c. Remote memory decline frequently causes problems in processing information
d. Recent memory is usually more efficient than remote memory
e. There is an increased risk of delirium with acute illness or metabolic derangement
E.
Acute illness of metabolic derangement of older adults places such a stress on the declining metabolism and synthesis of neurotransmitters that adaptation is inadequate, and delirium results. None of the other statements are true.
A 69 yr 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. precentral gyrus
e. occipital lobe
A.
The temporal lobe, specifically in the Wernicke’s area, is responsible for the comprehension of spoken and written language.
Slumped posture and a lack of facial expression may indicate depression or
a. anxiety
b. Parkinson disease
c. loss of abstract reasoning
d. attention-deficit/hyperactivity disorder
e. hyperthyroidism
B.
A slumped posture and lack of facial expression may be clues to more than depression; they also are a defining characteristic of the neurologic disorder know as Parkinson disease.
The ability for abstract thinking normally develops
a. in utero
b. during infancy
c. during early childhood
d. during adolescence
e. during adulthood
D.
Abstract thinking is an intellectual maturation that develops during adolescence.
The Mini-Mental State Examintation (MMSE)
a. may be used to estimate cognitive changes quantitatively
b. may be used to estimate personality disorders qualitatively
c. scores do not vary with regard to age or education
d. will determine the cause of memory loss
e. is a good tool to diagnose neurologic disorders
A.
The MMSE is a standard tool that functions to estimate cognitive function quantitatively or to document cognitive changes serially. None of the other statements are correct.
While interviewing a 70 yr old female clinic pt, she tells you that she takes ginkgo biloba and St. John’s wort. You make short note to check for results of the
a. Denver II
b. Mini-Mental State Examination
c. Glasgow Coma Scale
d. Goodenough-Harris Drawing Test
e. CAGE questionnaire
B.
Ginkgo biloba and St. John’s wort are herbal remedies used to improve mental alertness and elevate mood. As side effects, they can also result in disorientation and confusion that can be monitored with the MMSE. The Denver and Goodeneough-Harris tests are used for childhood development, and the Glasgow Coma Scale is used to rate coma depth. TheCAGE Questionnaire is a useful tool for approaching a discussion of the use of alcohol.
Assessing orientation to person, place, and time helps determine
a. the ability to understand analogies
b. abstract reasoning
c. attention span
d. state of consciousness
e. emotional status
D.
Orientation to person, place, and time are measures of states of consciousness and awareness, not degrees of attention span. Analogies and abstract reasoning are higher functions than orientation. Emotional status can be better evaluated by observing behaviors.
A state of impaired cognition, consciousness, mood and behavioral dysfunction of acute onset refers to
a. lethargy
b. delirium
c. stupor
d. coma
e. confusion
B.
Delirium is a state of impaired cognition, consciousness, mood and behavioral dysfunction of acute onset. Stupor describes arousals for short periods of time after a stimulus for arousal (e.g., visual, verbal, or painful). Lethargy relates to sleepiness with ease of arousal; coma is nonarousal and nonawareness. Confusion relates to inappropriate responses to questions with decreased attention span and memory.
Under most conditions, adult patients should be able to repeat a series of _____ numbers
a. 2-3
b. 5-8
c. 10-15
d. 15-20
e. >20
B.
Most adults should be able to recall immediately a series of 5-8 numbers forward and 4-6 numbers backward
When you ask the pt 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
e. Impaired judgment
B.
Asking the pt to tell you the meaning of a proverb, metaphor, or fable assesses the pt’s ability to reason abstractly. This intelligence test does not assess level of consciousness, emotional health, judgment, or memory.
Impairment of arithmetic skills is often caused by
a. impaired execution of motor skills
b. impaired judgment
c. peripheral neuropathies
d. depression
e. perceptual distortions
D.
The pt with depression or diffuse brain disease can display difficulty with simple arithmetic calculations. This is not commonly seen with motor skill impairments, judgment impairments, or perceptual distortions and hallucinations. Peripheral neuropathies are best assessed by evaluating motor skills.
Peripheral neuropathy is most likely to be manifested by
a. impaired memory
b. impaired abstract reasoning
c. impaired writing ability
d. hallucinations
e. difficulties with analogies
C.
Uncoordinated writing or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or peripheral neuropathy.
Recent memory may be tested by
a. asking the pt to do simple arithmetic
b. asking the pt to listen to and repeat a series of numbers
c. showingi the pt four items and asking him or her to list the items about 10 minutes later
d. asking the pt about verifiable past events, such as his or her mother’s maiden name.
e. asking the pt to name the past 4 presidents
C.
Showing the pt 4 or 5 objects, saying you will ask about them in a few minutes, and then 10 minutes later asking the pt to list the objects is a technique to measure recent memory. The other choices are not tests of recent memory. Asking the pt to listen and then repeat tests immediate recall.
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
e. delirium
D.
Dementia is the loss of immediate and recent memory while retaining remote memories. ADHD is associated with the recent and remote memory impairment, impaired judgments are thought process dysfunctions, and stupor is impaired consciousness. Delirium manifests with confusion with disordered perceptions as well as motor and sensory excitement, with inappropriate reactions to stimuli.
