Author Question: When a nurse assesses an older adult patient, answers seem vague or unrelated to the questions. The ... (Read 63 times)

HudsonKB16 · **on:** Jul 19, 2018

When a nurse assesses an older adult patient, answers seem vague or unrelated to the questions. The patient also leans forward and frowns, listening intently to the nurse. An appropriate question for the nurse to ask would be:

a. Are you having difficulty hearing when I speak?
b. How can I make this assessment interview easier for you?
c. I notice you are frowning. Are you feeling annoyed with me?
d. You're having trouble focusing on what I'm saying. What is distracting you?

Question 2

A nurse asks a patient, If you had fever and vomiting for 3 days, what would you do? Which aspect of the mental status examination is the nurse assessing?

a. Behavior
b. Cognition
c. Affect and mood
d. Perceptual disturbances

bdobbins · **Reply #1 on:** Jul 19, 2018

Answer to Question 1

ANS: A
The patient's behaviors may indicate difficulty hearing. Identifying any physical need the patient may have at the onset of the interview and making accommodations are important considerations. By asking if the patient is annoyed, the nurse is jumping to conclusions. Asking how to make the interview easier for the patient may not elicit a concrete answer. Asking about distractions is a way of asking about auditory hallucinations, which is not appropriate because the nurse has observed that the patient seems to be listening intently.

Answer to Question 2

ANS: B
Assessing cognition involves determining a patient's judgment and decision-making capabilities. In this case, the nurse expects a response of, Call my doctor if the patient's cognition and judgment are intact. If the patient responds, I would stop eating or I would just wait and see what happened, the nurse would conclude that judgment is impaired. The other options refer to other aspects of the examination.