NURS 550 FINAL QUESTIONS & ANSWERS
Attention definitions: Alert, lethargic, obtunded, Stuporous, coma - Answers - Alert - pt
is awake and aware
Lethargic - you have to speak to pt in a loud and forceful manner to get a response
Obtunded - you must shake pt to get a response
Stuporous - arousable except by painful stimuli (sternal rub)
Coma - pt is completely unarousabe
Memory - Answers - Short term memory - covers events or memories that occurred
minutes to days before
Long term memory - covers event or memories that occurred months to years before
Orientation - Answers - Aware of person, place, and time
Perceptions - Answers - Awareness of the objects in the environment to the five
senses and their interrelationships
Thought processes - Answers - The logic, coherence, and relevance of the patient's
thoughts and goals; how ppl think
Insight - Answers - Awareness that thought, symptoms, or behaviors are normal or
abnormal; e.g. distinguishing that a daydream or hallucination is not real
Judgment - Answers - process of comparing and evaluating different possible courses
of action
Affect - Answers - The observable mood of a person expressed through facial
expression, body movements, and voice
Mood - Answers - The sustained emotion of the patient (euthymic, dysthymic, manic)
Language - Answers - The complex symbolic system for expressing written and verbal
thoughts, emotion, attention, and memory
Higher cognitive functions - Answers - level of intelligence assessed by vocabulary,
knowledge base, calculations, and abstract thinking
Speech and Language: Quantity, Rate, Loud, Articulation of words - Answers -
Quantity: is patient talkative or silent
Rate: is the speech fast or slow
Loud: Is speech loud or soft
Articulation of words: does the patient speak clearly and distinctly
Fluency: involves the rate, flow, melody of speech
Define: hesitancies in speech
,Monotone infections
Circumlocutions
Paraphasias - Answers - Hesitancies in speech - as seen in patients with aphasia from
strokes
Monotone inflections - schizophrenia or severe depression
Circumlocutions - words or phrases are substituted for the word a person cannot
remember; e.g. "the thing you block out your writing with" for an eraser
Paraphasias: words are malformed ("I write with a den"), wrong ("I write write with a
branch"), or invented ("I write with a dar")
Abnormal thought processes:
Circumstantiality
Derailment
Flight of Ideas
Neologisms
Incoherence
Blocking
Confabulation
Perseveration
Echolalia
Clanging - Answers - Circumstantiality - speech characterized by indirection and delay
due to the patients excessive use of details that have no connection to the point
Derailment - speech in which a person shifts topics with no apparent relations between
the tropics
Flight of ideas - accelerated change of topics in a very fast but generally coherent
manner
Neologisms - invented or distorted words
Incoherence - speech that is incomprehensible because it is illogical
Blocking - Sudden interruption of speech, before the completion of an idea, occurs in
normal ppl
Confabulation - fabrication of facts to hide memory impairment
Perseveration - persistent repetition of words or ideas
Echolalia - repetition of the words or phrases of others
Clanging - choosing a word on the basis of sound rather than meaning
Abnormal Thought content
Compulsions
Obsessions
Phobias
Anxiety - Answers - Compulsions - repetitive behaviors that a person feels driven to
perform to prevent or produce some future state of affairs
Obsessions - recurrent, uncontrollable thoughts, images, or impulses that a patient
considers unacceptable
Phobias - persistent fear of a stimuli the patient feels is irrational
Anxiety - apprehension or fear that may be focused (phobia) or free floating (general
sense of dread)
, Abnormal Thought Content: delusions - Answers - False, fixed beliefs that are not
shared by other members of the person's culture
Somatic delusions: believing that one has a disease or defect that he does not
Systematized delusion: a single delusion with many elaborations around a single theme
all systematized into a complex network
Delusions of persecution, grandeur, jealousy, controlled by outside forces
Delusion of reference: a person believes. An outside event or object has an unusual
personal reference to them; i.e. a comment passing earth means the patient should buy
a car
abnormalities of perception:
Illusions
Hallucinations - Answers - Illusions - internal stimuli, misinterpretations of real stimuli;
e.g., the postman leaves mail, therefore there is a plot to poison the patient
Hallucinations - a subjective external stimuli the patient hears or sees that others do not
hear or see and that the patient may not recognize as false; these can be auditory,
visual, olfactory, gustatory, or tactile
How to assess insight and judgment on a clinic or hospital visit? - Answers - Patient
with psychological disorders often lack insight into their disease
Assess judgment by nothing the patients responses to stressors on their relationships,
jobs, finances
3 ways to assess attention - Answers - Digital span: give the patient a string of
numbers to recite back to you
Serial 7s: ask the patient to subtract serial 7s from 100
Spelling backward: ask the patient to spell W-O-R-L-D backwards
Higher cognitive functions:
Calculating ability
Constructional ability - Answers - Calculating ability: ask the patient to perform more
difficult calculations such as making change (e.g., if you had a dollar's worth of nickels
and someone needed 65 cents how many nickels would you have left)
major depressive disorder statistics - Answers - 5-11% lifetime risk of depression
- 50% recurrence after one episode
- 70% recurrence after two episodes
- 90% recurrence after three episodes
1 out of 7 will commit suicide (70% see their PCP within 6 weeks of committing suicide)
Major depressive disorder Subjective Findings - Answers - Historical risk factors that
may mimic MDD
- Other medical diagnoses
- Medications/Drugs
Attention definitions: Alert, lethargic, obtunded, Stuporous, coma - Answers - Alert - pt
is awake and aware
Lethargic - you have to speak to pt in a loud and forceful manner to get a response
Obtunded - you must shake pt to get a response
Stuporous - arousable except by painful stimuli (sternal rub)
Coma - pt is completely unarousabe
Memory - Answers - Short term memory - covers events or memories that occurred
minutes to days before
Long term memory - covers event or memories that occurred months to years before
Orientation - Answers - Aware of person, place, and time
Perceptions - Answers - Awareness of the objects in the environment to the five
senses and their interrelationships
Thought processes - Answers - The logic, coherence, and relevance of the patient's
thoughts and goals; how ppl think
Insight - Answers - Awareness that thought, symptoms, or behaviors are normal or
abnormal; e.g. distinguishing that a daydream or hallucination is not real
Judgment - Answers - process of comparing and evaluating different possible courses
of action
Affect - Answers - The observable mood of a person expressed through facial
expression, body movements, and voice
Mood - Answers - The sustained emotion of the patient (euthymic, dysthymic, manic)
Language - Answers - The complex symbolic system for expressing written and verbal
thoughts, emotion, attention, and memory
Higher cognitive functions - Answers - level of intelligence assessed by vocabulary,
knowledge base, calculations, and abstract thinking
Speech and Language: Quantity, Rate, Loud, Articulation of words - Answers -
Quantity: is patient talkative or silent
Rate: is the speech fast or slow
Loud: Is speech loud or soft
Articulation of words: does the patient speak clearly and distinctly
Fluency: involves the rate, flow, melody of speech
Define: hesitancies in speech
,Monotone infections
Circumlocutions
Paraphasias - Answers - Hesitancies in speech - as seen in patients with aphasia from
strokes
Monotone inflections - schizophrenia or severe depression
Circumlocutions - words or phrases are substituted for the word a person cannot
remember; e.g. "the thing you block out your writing with" for an eraser
Paraphasias: words are malformed ("I write with a den"), wrong ("I write write with a
branch"), or invented ("I write with a dar")
Abnormal thought processes:
Circumstantiality
Derailment
Flight of Ideas
Neologisms
Incoherence
Blocking
Confabulation
Perseveration
Echolalia
Clanging - Answers - Circumstantiality - speech characterized by indirection and delay
due to the patients excessive use of details that have no connection to the point
Derailment - speech in which a person shifts topics with no apparent relations between
the tropics
Flight of ideas - accelerated change of topics in a very fast but generally coherent
manner
Neologisms - invented or distorted words
Incoherence - speech that is incomprehensible because it is illogical
Blocking - Sudden interruption of speech, before the completion of an idea, occurs in
normal ppl
Confabulation - fabrication of facts to hide memory impairment
Perseveration - persistent repetition of words or ideas
Echolalia - repetition of the words or phrases of others
Clanging - choosing a word on the basis of sound rather than meaning
Abnormal Thought content
Compulsions
Obsessions
Phobias
Anxiety - Answers - Compulsions - repetitive behaviors that a person feels driven to
perform to prevent or produce some future state of affairs
Obsessions - recurrent, uncontrollable thoughts, images, or impulses that a patient
considers unacceptable
Phobias - persistent fear of a stimuli the patient feels is irrational
Anxiety - apprehension or fear that may be focused (phobia) or free floating (general
sense of dread)
, Abnormal Thought Content: delusions - Answers - False, fixed beliefs that are not
shared by other members of the person's culture
Somatic delusions: believing that one has a disease or defect that he does not
Systematized delusion: a single delusion with many elaborations around a single theme
all systematized into a complex network
Delusions of persecution, grandeur, jealousy, controlled by outside forces
Delusion of reference: a person believes. An outside event or object has an unusual
personal reference to them; i.e. a comment passing earth means the patient should buy
a car
abnormalities of perception:
Illusions
Hallucinations - Answers - Illusions - internal stimuli, misinterpretations of real stimuli;
e.g., the postman leaves mail, therefore there is a plot to poison the patient
Hallucinations - a subjective external stimuli the patient hears or sees that others do not
hear or see and that the patient may not recognize as false; these can be auditory,
visual, olfactory, gustatory, or tactile
How to assess insight and judgment on a clinic or hospital visit? - Answers - Patient
with psychological disorders often lack insight into their disease
Assess judgment by nothing the patients responses to stressors on their relationships,
jobs, finances
3 ways to assess attention - Answers - Digital span: give the patient a string of
numbers to recite back to you
Serial 7s: ask the patient to subtract serial 7s from 100
Spelling backward: ask the patient to spell W-O-R-L-D backwards
Higher cognitive functions:
Calculating ability
Constructional ability - Answers - Calculating ability: ask the patient to perform more
difficult calculations such as making change (e.g., if you had a dollar's worth of nickels
and someone needed 65 cents how many nickels would you have left)
major depressive disorder statistics - Answers - 5-11% lifetime risk of depression
- 50% recurrence after one episode
- 70% recurrence after two episodes
- 90% recurrence after three episodes
1 out of 7 will commit suicide (70% see their PCP within 6 weeks of committing suicide)
Major depressive disorder Subjective Findings - Answers - Historical risk factors that
may mimic MDD
- Other medical diagnoses
- Medications/Drugs
