When performing a mental status examination on an older adult ...

[sc00by25]

When performing a mental status examination on an older adult client, the nurse discovers that the client is illiterate and only has a third-grade education. How should the nurse assess the client's cognition?
 
  a. Have the client spell the word world backwards.
  b. Have the client spell the word world forwards.
  c. Ask the client to perform serial 7s.
  d. Instruct the client to state the days of the week backwards.

Question 2

The nurse is caring for an older adult client who has been diagnosed with dementia. The nurse recognizes which of the following as true in relation to the use of touch with this client?
 
  a. Clients with dementia can ask for touch.
  b. Clients with dementia can create touch for themselves.
  c. Clients with dementia can become more anchored in the present time, space, and humanity when touched.
  d. Clients with dementia can tell the nurse about the meaning of touch.

[tsternbergh47]

Answer to Question 1

ANS: D
The nurse should determine the client's level of formal education. If the client never learned to spell, it will be impossible to spell world backwards. Saying the days of the week backwards is a good alternative. Spelling and use of serial 7s would not be an appropriate alternative with this client's level of formal education.

Answer to Question 2

ANS: C
Touch is something clients with dementia can no longer ask for, create for themselves, or tell another of its meaning. Touch is a form of communication, used to reinforce simple verbal instructions with cognitively impaired adults and as a primary form of communication. It is experienced not only physically as sensation, but also affectively as emotion and behavior. As dementia progresses, gentle touch can anchor an anxious or disoriented person in present time, space, and humanity. When used to gain a client's attention or to guide a person toward an activity, touch can acknowledge a client's stress, calm an agitated client, or provide a sense of security. In general, clients with dementia appreciate the use of touch.