ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
COMPONENTS OF MENTAL STATUS EXAM INCLUDE: - ANSWER A-B-C-T
APPEARANCE; posture, body movements, dress, grooming and hygiene
BEHAVIOR; LOC, Facial expression, speech, mood and affect
COGNITION; address, phone#, etc. date?, attention span, recent and remote memory, new learning
THOUGHT PROCESS; perceptions, should be logical and consistent this person make sense?
how do people treat you?, do you feel you are being watched, followed or controlled? have you heard
your name when alone?
___________________ screens for Anxiety - ANSWER GAD- 7
questions to ask for depression or suicidal ideations: - ANSWER Depression:
Over the past two weeks, have you fell down, depressed or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Suicidal:
Have you ever felt so blue you thought of hurting yourself?
Do you have a plan to hurt yourself?
How would you do it?
***Must not ignore any talk of suicide***
When is a full mental status exam necessary? - ANSWER * Patients whose initial screening suggests an
anxiety disorder or depression
* Behavioral changes: such as memory loss, inappropriate social interaction
,ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
* Brain lesions: trauma, tumor, cerebrovascular accident or stroke
* Aphasia: impairment of language ability secondary to brain damage
* Symptoms- of psychiatric mental illness especially with acute onset
________________ Screens for Alcoholism. - ANSWER CAGE: Score 2 or greater highly significant
* Have you ever felt you should CUT down on your drinking?
* Have people ANNOYED you by criticizing your drinking?
* Have you ever felt bad or GUILTY about your drinking?
* Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
(EYE OPENER)
Things to Consider When Assessing Older Adults mental status include: - ANSWER Ask about chronic
illness and how they are managing?
Sensory impairments?
Polypharmacy (med list again!)
Social isolation
Physiological issue
- Delirium vs. Dementia
- UTI
- Sundowners
Delirium VS Dementia VS Depression:
Onset
course
duration
consciousness
,ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
attention
psychomotor changes
reversibility - ANSWER Delirium ** Dementia ** Depression:
==========================================
O: Acute insidious Acute or insidious
C: Fluctuating Progressive May be chronic
D: Hrs to wks Mos to yrs Mos to yrs
C: Altered Usually clear clear
A: Impaired Normal unless May be decreased
severe dementia
P: increased often normal may be slowed in decreased severe cases
R: usually irreversible usually
Delirium Causes: - ANSWER D- Dementia
E- Electrolyte disorders
L - Lung, liver, heart, kidney, brain dysfunction
I- Infection
R- Rx Drugs
I- Injury, pain, stress
U- Unfamiliar environment
M- Metabolic
Adolescent: heeadsss psychosocial interview: - ANSWER - Home
- Education & Employment
- Eating
- Activities
, ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
- Drugs
- Sexuality
- Suicide & Depression
- Safety (injury/violence)
When assessing children for mental heath disorders, things to consider: - ANSWER Does the child seem
sad, tired, restless?
Does the child spend a lot of time alone?
Frequent outbursts of shouting, complaining, or crying?
Lost interest in hobbies like music/sports?
Talks about death or suicide?
Sleep too much or not enough?
Other questions...
____________________ is the test for Proprioception. - ANSWER Romberg's Test:
- Stand with feet together
- Arms out with palms up
- Shut eyes
- If pt sways or looses balance = Positive Romberg's
Risks Related to Undiagnosed Ear Disorders: - ANSWER - Poor language development
- Delayed learning
- Social isolation
- Hearing loss
- Risk for falls
- Missed diagnoses of respiratory and oral infections
Comprehensive Final Exam 191
Complete Solutions.
ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
COMPONENTS OF MENTAL STATUS EXAM INCLUDE: - ANSWER A-B-C-T
APPEARANCE; posture, body movements, dress, grooming and hygiene
BEHAVIOR; LOC, Facial expression, speech, mood and affect
COGNITION; address, phone#, etc. date?, attention span, recent and remote memory, new learning
THOUGHT PROCESS; perceptions, should be logical and consistent this person make sense?
how do people treat you?, do you feel you are being watched, followed or controlled? have you heard
your name when alone?
___________________ screens for Anxiety - ANSWER GAD- 7
questions to ask for depression or suicidal ideations: - ANSWER Depression:
Over the past two weeks, have you fell down, depressed or hopeless?
Over the past 2 weeks, have you felt little interest or pleasure in doing things?
Suicidal:
Have you ever felt so blue you thought of hurting yourself?
Do you have a plan to hurt yourself?
How would you do it?
***Must not ignore any talk of suicide***
When is a full mental status exam necessary? - ANSWER * Patients whose initial screening suggests an
anxiety disorder or depression
* Behavioral changes: such as memory loss, inappropriate social interaction
,ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
* Brain lesions: trauma, tumor, cerebrovascular accident or stroke
* Aphasia: impairment of language ability secondary to brain damage
* Symptoms- of psychiatric mental illness especially with acute onset
________________ Screens for Alcoholism. - ANSWER CAGE: Score 2 or greater highly significant
* Have you ever felt you should CUT down on your drinking?
* Have people ANNOYED you by criticizing your drinking?
* Have you ever felt bad or GUILTY about your drinking?
* Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?
(EYE OPENER)
Things to Consider When Assessing Older Adults mental status include: - ANSWER Ask about chronic
illness and how they are managing?
Sensory impairments?
Polypharmacy (med list again!)
Social isolation
Physiological issue
- Delirium vs. Dementia
- UTI
- Sundowners
Delirium VS Dementia VS Depression:
Onset
course
duration
consciousness
,ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
attention
psychomotor changes
reversibility - ANSWER Delirium ** Dementia ** Depression:
==========================================
O: Acute insidious Acute or insidious
C: Fluctuating Progressive May be chronic
D: Hrs to wks Mos to yrs Mos to yrs
C: Altered Usually clear clear
A: Impaired Normal unless May be decreased
severe dementia
P: increased often normal may be slowed in decreased severe cases
R: usually irreversible usually
Delirium Causes: - ANSWER D- Dementia
E- Electrolyte disorders
L - Lung, liver, heart, kidney, brain dysfunction
I- Infection
R- Rx Drugs
I- Injury, pain, stress
U- Unfamiliar environment
M- Metabolic
Adolescent: heeadsss psychosocial interview: - ANSWER - Home
- Education & Employment
- Eating
- Activities
, ADVANCED HEALTH ASSESSMENT -
Comprehensive Final Exam 191
Complete Solutions.
- Drugs
- Sexuality
- Suicide & Depression
- Safety (injury/violence)
When assessing children for mental heath disorders, things to consider: - ANSWER Does the child seem
sad, tired, restless?
Does the child spend a lot of time alone?
Frequent outbursts of shouting, complaining, or crying?
Lost interest in hobbies like music/sports?
Talks about death or suicide?
Sleep too much or not enough?
Other questions...
____________________ is the test for Proprioception. - ANSWER Romberg's Test:
- Stand with feet together
- Arms out with palms up
- Shut eyes
- If pt sways or looses balance = Positive Romberg's
Risks Related to Undiagnosed Ear Disorders: - ANSWER - Poor language development
- Delayed learning
- Social isolation
- Hearing loss
- Risk for falls
- Missed diagnoses of respiratory and oral infections
