MSN 610 FINAL EXAM ACTUAL QUESTIONS AND ANSWERS
RATED A+
✔✔State of Consciousness - ✔✔The patient should be oriented to person, place, and
time and make appropriate responses to questions, as well as physical and
environmental stimuli. Person disorientation results from cerebral trauma, seizures, or
amnesia. Place disorientation occurs with psychiatric disorders, delirium, and cognitive
impairment. Time disorientation is associated with anxiety, delirium, depression, and
cognitive impairment. The Glasgow Coma Scale is used to quantify the level of
consciousness after an acute brain injury or medical condition
✔✔Analogies (Cognitive Abilities) - ✔✔Ask the patient to describe simple analogies first
and then more complex analogies: • What is similar about these objects: Peaches and
lemons?
Ocean and lake? Trumpet and flute? • Complete this comparison: An engine is to an
airplane
as an oar is to a ____. • What is different about these two objects: A magazine
✔✔Cognitive Abilities - ✔✔Evaluate cognitive functions as the patient responds to
questions during the history-taking process. Specific questions and tasks can provide a
detailed assessment of cognition, the execution of complex mental processes (e.g.,
learning, perceiving, decision making, and memory).
Signs of possible cognitive impairment include the following: significant memory loss,
confusion (impaired cognitive function with disorientation, attention and memory deficits,
and difficulty answering questions or following multiple-step directions), impaired
communication, inappropriate affect, personal care difficulties, hazardous behavior,
agitation, and suspiciousness.
✔✔Abstract Reasoning (Cognitive Abilities) - ✔✔Ask the patient to tell you the meaning
of a fable, proverb, or metaphor, such as the following: •A stitch in time saves nine. •A
bird in the hand is worth two in the bush.
•A rolling stone gathers no moss. When the patient has average intelligence, an
adequate interpretation should be given. Inability to explain a phrase may indicate poor
cognition, dementia, brain damage, or schizophrenia.
✔✔Arithmetic Calculation (Cognitive Abilities) - ✔✔Ask the patient to do simple
arithmetic, without paper and pencil, such as the following: •Subtract 7 from 50, subtract
7 from that answer, and so
on, until the answer is 8. •Add 8 to 50, add 8 to that total, and so on, until the
answer is 98.
The calculations should be completed with few errors and within 1 minute when the
patient has average intelligence. Impairment of arithmetic skills may be associated with
depression, cognitive impairment, and diffuse brain disease.
, ✔✔Writing ability (Cognitive Abilities) - ✔✔For a comprehensive mental status
examination, ask the patient to write his or her name and address or a dictated phrase.
Omission or addition of letters, syllables, words, or mirror writing may indicate aphasia
(impairment in language function). Alternatively, if poor literacy is a concern, ask the
patient to draw simple geometric figures (e.g., a triangle, circle, or square) and then
more complex figures such as a clock face, a house, or a flower. Uncoordinated writing
or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or
peripheral neuropathy.
✔✔Execution of Motor Skills (Cognitive Abilities) - ✔✔Ask the patient to unbutton a shirt
button or to comb his or her hair. Apraxia (the inability to translate an intention into
action that is unrelated to paralysis or lack of compre- hension) may indicate a cerebral
disorder.
✔✔Immediate recall or new learning: (Cognitive Abilities) - ✔✔Ask the patient to listen
and then repeat a sentence or a series of numbers. Five to eight numbers forward or
four to six numbers back- ward can usually be repeated
✔✔Recent memory: (Cognitive Abilities) - ✔✔Give the patient a short time to view four
or five test objects, telling him or her that you will ask about them in a few minutes. Ten
minutes later, ask the patient to list the objects. All objects should be remembered.
✔✔Remote memory: (Cognitive Abilities) - ✔✔Ask the patient about verifiable past
events or information such as sibling's name, high school attended, or a subject of
common knowledge.
✔✔Memory loss causes - ✔✔Memory loss may result from disease, infection, or
temporal lobe trauma. Impaired memory occurs with various neurologic or psychiatric
disorders, such as anxiety and depression. Loss of immediate and recent memory with
retention of remote memory suggests dementia.
✔✔Attention Span (Cognitive Abilities) - ✔✔Ask the patient to follow a short set of
commands. Alter- natively, ask the patient to say either the days of the week or to spell
the word "world" forward or backward. The ability to perform arithmetic calculations is
another test of attention span. Appropriate response to directions is expected. Easy
distraction, confusion, negativism, and impairment of recent and remote memory may
all indicate a decreased attention span. This may be related to fatigue, depression,
delirium, or toxic or metabolic causes that result in confusion.
✔✔Judgment (Cognitive Abilities) - ✔✔Determine the patient's judgment and reasoning
skills by exploring the following topics: • How is the patient meeting social and family
obligations? • What are the patient's plans for the future? Do they
seem appropriate? •Ask the patient to provide solutions to hypothetical situations, such
as: "What would you do if you found a stamped envelope?" "What would you do if a
RATED A+
✔✔State of Consciousness - ✔✔The patient should be oriented to person, place, and
time and make appropriate responses to questions, as well as physical and
environmental stimuli. Person disorientation results from cerebral trauma, seizures, or
amnesia. Place disorientation occurs with psychiatric disorders, delirium, and cognitive
impairment. Time disorientation is associated with anxiety, delirium, depression, and
cognitive impairment. The Glasgow Coma Scale is used to quantify the level of
consciousness after an acute brain injury or medical condition
✔✔Analogies (Cognitive Abilities) - ✔✔Ask the patient to describe simple analogies first
and then more complex analogies: • What is similar about these objects: Peaches and
lemons?
Ocean and lake? Trumpet and flute? • Complete this comparison: An engine is to an
airplane
as an oar is to a ____. • What is different about these two objects: A magazine
✔✔Cognitive Abilities - ✔✔Evaluate cognitive functions as the patient responds to
questions during the history-taking process. Specific questions and tasks can provide a
detailed assessment of cognition, the execution of complex mental processes (e.g.,
learning, perceiving, decision making, and memory).
Signs of possible cognitive impairment include the following: significant memory loss,
confusion (impaired cognitive function with disorientation, attention and memory deficits,
and difficulty answering questions or following multiple-step directions), impaired
communication, inappropriate affect, personal care difficulties, hazardous behavior,
agitation, and suspiciousness.
✔✔Abstract Reasoning (Cognitive Abilities) - ✔✔Ask the patient to tell you the meaning
of a fable, proverb, or metaphor, such as the following: •A stitch in time saves nine. •A
bird in the hand is worth two in the bush.
•A rolling stone gathers no moss. When the patient has average intelligence, an
adequate interpretation should be given. Inability to explain a phrase may indicate poor
cognition, dementia, brain damage, or schizophrenia.
✔✔Arithmetic Calculation (Cognitive Abilities) - ✔✔Ask the patient to do simple
arithmetic, without paper and pencil, such as the following: •Subtract 7 from 50, subtract
7 from that answer, and so
on, until the answer is 8. •Add 8 to 50, add 8 to that total, and so on, until the
answer is 98.
The calculations should be completed with few errors and within 1 minute when the
patient has average intelligence. Impairment of arithmetic skills may be associated with
depression, cognitive impairment, and diffuse brain disease.
, ✔✔Writing ability (Cognitive Abilities) - ✔✔For a comprehensive mental status
examination, ask the patient to write his or her name and address or a dictated phrase.
Omission or addition of letters, syllables, words, or mirror writing may indicate aphasia
(impairment in language function). Alternatively, if poor literacy is a concern, ask the
patient to draw simple geometric figures (e.g., a triangle, circle, or square) and then
more complex figures such as a clock face, a house, or a flower. Uncoordinated writing
or drawing may indicate dementia, parietal lobe damage, a cerebellar lesion, or
peripheral neuropathy.
✔✔Execution of Motor Skills (Cognitive Abilities) - ✔✔Ask the patient to unbutton a shirt
button or to comb his or her hair. Apraxia (the inability to translate an intention into
action that is unrelated to paralysis or lack of compre- hension) may indicate a cerebral
disorder.
✔✔Immediate recall or new learning: (Cognitive Abilities) - ✔✔Ask the patient to listen
and then repeat a sentence or a series of numbers. Five to eight numbers forward or
four to six numbers back- ward can usually be repeated
✔✔Recent memory: (Cognitive Abilities) - ✔✔Give the patient a short time to view four
or five test objects, telling him or her that you will ask about them in a few minutes. Ten
minutes later, ask the patient to list the objects. All objects should be remembered.
✔✔Remote memory: (Cognitive Abilities) - ✔✔Ask the patient about verifiable past
events or information such as sibling's name, high school attended, or a subject of
common knowledge.
✔✔Memory loss causes - ✔✔Memory loss may result from disease, infection, or
temporal lobe trauma. Impaired memory occurs with various neurologic or psychiatric
disorders, such as anxiety and depression. Loss of immediate and recent memory with
retention of remote memory suggests dementia.
✔✔Attention Span (Cognitive Abilities) - ✔✔Ask the patient to follow a short set of
commands. Alter- natively, ask the patient to say either the days of the week or to spell
the word "world" forward or backward. The ability to perform arithmetic calculations is
another test of attention span. Appropriate response to directions is expected. Easy
distraction, confusion, negativism, and impairment of recent and remote memory may
all indicate a decreased attention span. This may be related to fatigue, depression,
delirium, or toxic or metabolic causes that result in confusion.
✔✔Judgment (Cognitive Abilities) - ✔✔Determine the patient's judgment and reasoning
skills by exploring the following topics: • How is the patient meeting social and family
obligations? • What are the patient's plans for the future? Do they
seem appropriate? •Ask the patient to provide solutions to hypothetical situations, such
as: "What would you do if you found a stamped envelope?" "What would you do if a
