A nurse is admitting an older adult client 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)

Abnormal Involuntary Movements Scale (AIMS)

Mental status examination (MSE)

Scale for Assessment of Negative Symptoms (SANS)

Answer and Explanation

The Correct Answer is C

A. Brief Patient Health Questionnaire (Brief PHQ):

The Brief PHQ is a screening tool used to assess symptoms of depression. While it may be relevant to assess mood and emotional well-being, it is not specific to evaluating cognitive functioning or cognitive disorders.

B. Abnormal Involuntary Movements Scale (AIMS):

The AIMS is used to assess involuntary movements, particularly in individuals taking antipsychotic medications. It is not directly related to assessing cognitive disorders.

C,. Mental status examination (MSE)

Explanation:

When admitting an older adult client with a suspected cognitive disorder, including a mental status examination (MSE) as part of the assessment is crucial. The MSE is a structured assessment of a client's current cognitive functioning, emotional state, and thought processes. It helps to evaluate memory, attention, language, perception, orientation, mood, and other cognitive and emotional domains.

D. Scale for Assessment of Negative Symptoms (SANS):

The SANS is used to assess negative symptoms in individuals with schizophrenia. It focuses on features such as affective blunting, alogia, anhedonia, and other negative symptoms. While it may provide important information about a client's mental state, it is not primarily used to assess cognitive disorders.

Assessing cognitive function is a key component when evaluating older adult clients for cognitive disorders such as dementia or other cognitive impairments. The MSE provides valuable information to guide diagnosis and treatment planning for these conditions.

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Correct Answer is A

Explanation

A. Determining if the client has psychotic thinking.

Explanation: The highest priority assessment in this situation is to determine if the client has psychotic thinking. Psychotic thinking can indicate a severe mental health condition that requires immediate attention and intervention. If the client is experiencing psychotic symptoms, they might be at risk of harming themselves or others. Identifying and addressing psychotic thinking is crucial to ensure the safety and well-being of the client and those around them.

B. Asking the client to identify the cause of the crisis.

While understanding the cause of the crisis is important for providing appropriate care, it is not the highest priority. Psychotic thinking or risk of harm takes precedence over understanding the cause.

C. Identifying the client's coping skills.

Coping skills are important for managing the crisis and promoting the client's well-being, but assessing for psychotic thinking and immediate safety concerns comes before evaluating coping skills.

D. Identifying the client's support systems.

Support systems are valuable for the client's overall recovery, but they are not as time-sensitive as assessing for psychotic thinking or imminent safety risks. Identifying support systems can come after addressing the immediate concerns.

A. Low self-esteem B. Irritability C. Chronic pain D. Insomnia E. Euphoria

Correct Answer is ["A","B","C","D"]

Explanation

A. Low self-esteem is a risk factor for depression because negative self-perception and feelings of worthlessness can contribute to the development of depressive symptoms.

B. Irritability is associated with depression, especially in adolescents. It can manifest as a mood symptom and is often seen alongside other depressive features.

C. Chronic pain can be both a symptom and a risk factor for depression. Persistent pain can lead to changes in mood, behavior, and physical function, contributing to the development of depressive symptoms.

D. Insomnia, or difficulty sleeping, is a common symptom of depression and can also be a risk factor. Sleep disturbances are often seen in individuals with depression, and they can contribute to the severity of the condition.

E. Euphoria is not a risk factor for depression. In fact, it is more commonly associated with conditions like bipolar disorder, where individuals experience periods of elevated mood (mania or hypomania) alternating with periods of depression.

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A nurse is admitting an older adult client who has a suspected cognitive disorder. Which of the following inventories should be included as part of the admission assessment?

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