A nurse is admitting an older adult client to the unit who has a suspected cognitive disorder. Which of the following inventories should be included as part of the admission assessment?
Brief Patient Health Questionnaire (Brief PHQ).
Scale for Assessment of Negative Symptoms (SANS).
Mental status examination (MSE).
Abnormal Involuntary Movements Scale (AIMS).
The Correct Answer is C
Choice A rationale:
The Brief Patient Health naire (Brief PHQ) is primarily used for assessing the presence and severity of depressive symptoms and not specifically for cognitive disorders. It consists of nine items that assess the frequency of specific symptoms over the past two weeks.
Choice B rationale:
The Scale for Assessment of Negative Symptoms (SANS) is a tool used to assess negative symptoms in schizophrenia and other related psychotic disorders. It includes items related to affective blunting, alogia, anhedonia, and avolition, which are not directly relevant to the assessment of cognitive disorders.
Choice C rationale:
The Mental Status Examination (MSE) is a comprehensive assessment of cognitive function, including orientation, memory, attention, language, and executive function. It provides valuable information about the client's cognitive abilities and can aid in diagnosing cognitive disorders such as dementia or delirium.
Choice D rationale:
The Abnormal Involuntary Movements Scale (AIMS) is used to assess the presence and severity of tardive dyskinesia, a movement disorder commonly associated with the use of antipsychotic medications. It is not relevant to the assessment of cognitive disorders.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Identifying the client's coping skills is an important assessment, but in the context of acute anxiety requiring crisis intervention, immediate safety takes precedence over assessment. Coping skills assessment can follow once the client is stable.
Choice B rationale:
Protecting the client from injury to himself is the highest priority in this scenario. Acute anxiety can lead to behaviors that pose a risk to the client's safety, such as self-harm or suicide. Ensuring the client's physical safety is paramount.
Choice C rationale:
Determining the cause of the client's anxiety is relevant for long-term care but not the immediate priority during crisis intervention. Immediate safety concerns must be addressed first.
Choice D rationale:
Ensuring that the client feels safe is important, but physical safety takes precedence. The client's subjective feeling of safety may not necessarily prevent them from engaging in harmful behaviors.
Correct Answer is B
Explanation
Choice A rationale:
Bizarre behavior is not a negative symptom of schizophrenia but rather a positive symptom. Positive symptoms involve an excess or distortion of normal functioning and include hallucinations, delusions, and disorganized speech or behavior. Bizarre behavior falls under the category of disorganized behavior, which is a positive symptom.
Choice B rationale:
Waxy flexibility is a characteristic of negative symptoms in schizophrenia. Negative symptoms involve a reduction or loss of normal functioning and include behaviors like social withdrawal, reduced emotional expression, and decreased motivation. Waxy flexibility refers to the phenomenon where a person with schizophrenia can be molded into different positions and maintain those positions for an extended period. This rigidity is a manifestation of reduced spontaneous movement, which is a negative symptom.
Choice C rationale:
Somatic delusions are a type of positive symptom seen in schizophrenia. These delusions involve false beliefs about one's body, health, or bodily functions. They are not negative symptoms, which are characterized by deficits in normal functioning.
Choice D rationale:
Illogicality is related to disorganized thinking, which is a positive symptom of schizophrenia. Individuals experiencing disorganized thinking may have difficulty organizing their thoughts coherently and logically, leading to speech that is difficult to follow. Negative symptoms, on the other hand, involve a decrease in normal functioning and do not pertain to logical coherence.
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