Chapter 6 Part 2

Front 1

t or f

Back 1

when assessing the mental status of an older client, be sure to check vision and hearing before assuming that the have a mental problem

Front 2

when assessing level of consciousness always begin with the least noxious stimulus:____, ______, to _______

Back 2

verbal, tactile to painful

Front 3

What do clients with lesions of the corticospinal tract do when stiumulated

Back 3

they draw hands up to the chest (decorticate or abnormal flexor posture)

Front 4

what do clients with lesions of the diencephalon, midbrain, or pons do when stimulated

Back 4

they extend arms and legs, arch neck, and rotate hands and arms internally (decerebrate or abnormal extensor posture)

Front 5

the Glasgow Coma Scale (GCS) are used for clients who are

Back 5

at risk for rapid deterioration of the nervous system or ICU pts.

Front 6

GCS score of _____ indicates an optimal level of consciousness

Back 6

14

Front 7

A GCS score of 3, the lowest possible, indicates a

Back 7

deep coma

Front 8

the GCS cannot be used to assess a

Back 8

verbal score in intubated or aphasic pts

Front 9

Slumperd posture may reflect feelings of powerlessness or hopelessness characteristic of

Back 9

depression or organic brain disease

Front 10

Bizarre body movements and behavior may be noted in

Back 10

schizophrenia or may be a side effect of drug therapy or other activity

Front 11

Clients may elevate their shoulders toward their ears and hold the entire body stiffly when they are

Back 11

tense or anxious

Front 12

Uncooperative, bizarre behavior may be seen in

Back 12

the angry, mentally ill, or violent client

Front 13

anxious clients are often

Back 13

fidgety and restless

Front 14

Incongruent behavior may be seen in clients who are

Back 14

in denial of problems or illness

Front 15

prolonged, euphoric laughing is typical of

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mania

Front 16

Unusually meticulous grooming and finicky mannerisms may be seen in

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OCD

Front 17

poor hygiene and inap­propriate dress may be seen with

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organic brain syndrome

Front 18

Bizarre dress may be seen in

Back 18

schizophrenia or manic disorders

Front 19

extreme unilateral neglect may result from a _____ due to a _____

Back 19

lesion; cerebral vascular accident (CVA)

Front 20

Uncoordinated clothing, extremely light clothing, or extremely warm clothing for the weather conditions may be seen on

Back 20

mentally ill, grieving, depressed, or poor cliens; or in clients w/ heat or cold intolerances.

Front 21

soiled clothing may indicate

Back 21

homelessness, vision deficits in older adults or mental illness

Front 22

Clients wearing long sleeves in warm weather may be

Back 22

protecting themselves from the sun or covering up needle marks secondary to drug abuse

Front 23

extremely loose clothing held up by pins or a belt may suggest

Back 23

recent weight loss

Front 24

t or f

Back 24

Asians and Native Americans have fewer sweat glands and, there- fore, less obvious body odor than most Caucasians and black Africans, who have more sweat glands

Front 25

Clients with mask-like expressionless face may have

Back 25

parkinson’s disease

Front 26

Staring watchfulness appears in

Back 26

metabolic disorders and anxiety.

Front 27

Drooping or gross asymmetry occurs with

Back 27

neurologic disorder or injury (e.g., Bell’s palsy or stroke)

Front 28

Slow, repetitive speech is characteristic of

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depression or parkinson’s disease

Front 29

Loud, rapid speech may occur in manic phases of

Back 29

bipolar disorder

Front 30

Disorganized speech, consistent (nonstop) speech, or long peri­ ods of silence may indicate

Back 30

mental illness or a neurologic disorder (e.g., dysarthria, dysphasia, speech defect, garbled speech)

Front 31

what tests should be done if client has difficulty with speech

Back 31

1. ask client to name objects in the room

2. ask client to read from printed material appropriate to their educational level

3. ask client to write a sentence

Front 32

Flat affect, euphoria, anxiety, fear, ambivalence, irritability, depression, and/or rage are all examples of

Back 32

altered mood expressions

Front 33

Eccentric moods not appropriate to the situation are seen in

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schizophrenia

Front 34

Expression of elation and grandiosity, high energy level, and engagement in high-risk but pleasurable activities is seen in

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manic phases

Front 35

Quick Inventory of Depressive Symptomatology (Self-Report) is used to determine if the client

Back 35

is at risk for depression and needs to be referred to a doctor

(0-5 score = no risk)

Front 36

questions such as“Tell me more about what you just said” or “Tell me what your understanding is of the current situation or your health.” are used to

Back 36

observe thought process and perception

Front 37

Confabulation (making up of answers to cover for not knowing) is seen in

Back 37

Korsakoff’s syndrome.

Front 38

Clients undergoing hemodialysis often have

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depression and suicidal ideation

Front 39

the SAD PERSONS Suicide Risk Assessment is used to determine

Back 39

the risk factors the client may have that might put him at risk for suicide

Front 40

10th leading cause of death in the US

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suicide

Front 41

suicide is 4 times more prevalent in

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men

Front 42

Orientation to time is usually lost ____- and orientation to person is usually lost ____-

Back 42

first; last

Front 43

reduced degree of orientation may be seen with

Back 43

organic brain disordersor psychiatric illness such as withdrawal from chronic alco­hol use or schizophrenia.

Front 44

Inability to recall recent events is seen in

Back 44

delirium, dementia, depression, and anxiety.

Front 45

Inability to recall past events is seen in

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cerebral cortex disorderes

Front 46

Inability to recall words after a delayed period is seen in

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anxiety, depression, or Alzheimer's disease

Front 47

older adults considerations

Back 47

Clients older than 80 should recall two to four words after 5 minutes and pos- sibly after 10 and30 minutes with hints that prompt recal

Front 48

when assessing abstract reasoning, if client has limited education, what other alternatives can be used

Back 48

note their ability to joke or use puns

Front 49

Inability to compare and contrast objects correctly or interpret proverbs correctly is seen in

Back 49

schizophrenia, mental retardation, delirium, and dementia.

Front 50

Use the SLUMS Dementia/Alzheimer’s test Exam if

Back 50

time is limited and a quick measure is needed to evaluate cognitive function.

Front 51

t or f

Back 51

the SLUMS and CAM test level of orientation, memory, speech, and cognitive functions but not mood, feelings, expres- sions, thought processes, or perception