The mental status examination takes place during which part of the nursing process?

Evaluation

Assessment

Planning

Implementation

Answer and Explanation

The Correct Answer is B

Choice A reason: Evaluation is the final step of the nursing process, where the nurse determines the effectiveness of the nursing care provided.

Choice B reason: Assessment is the correct part of the nursing process for the mental status examination, as it involves collecting data about the patient.

Choice C reason: Planning involves setting goals and choosing appropriate nursing actions based on the assessment data.

Choice D reason: Implementation is the step where the nurse carries out the planned interventions.

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Correct Answer is A

Explanation

Choice A reason: This response is calming and supportive. It addresses Mr. L's immediate distress by providing reassurance and a directive that can help him manage his panic, which is essential in a situation where a patient is experiencing extreme anxiety.

Choice B reason: While taking vital signs is an important step, it should not be the first response. The priority is to address the patient's acute distress and provide reassurance.

Choice C reason: This response minimizes the patient's feelings and does not address his immediate fear or offer any comfort or support.

Choice D reason: Asking why he thinks he's having a heart attack could increase his anxiety. It's important to first calm the patient before attempting to rationalize the situation.

A. Thinking/content of thought B. Mood and affect C. Judgment D. Perception

Correct Answer is D

Explanation

Choice A reason: Thinking/content of thought refers to the logical process of thought and coherence, not directly to the experience of reality.

Choice B reason: Mood and affect pertain to the emotional state and its expression, not the perception of reality.

Choice C reason: Judgment involves decision-making abilities and the evaluation of situations, not the perception of reality.

Choice D reason: Perception is the component that deals with how a person experiences reality, including any hallucinations or delusions they may have.

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The mental status examination takes place during which part of the nursing process?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Mr. L, who has a severe fear of needles, is hospitalized on your medical unit. The laboratory technician enters to draw blood for the routine CBC, and Mr. L begins to cry out, "Get away from me! I can't breathe! I'm having a heart attack!" What should be your first response to Mr. L?

Correct Answer is A

Explanation

Which component of the Mental Health Status Examination focuses on the way a person experiences reality?

Correct Answer is D

Explanation

A nurse is reinforcing teaching with a client who is preoperative following abdominal surgery about deep breathing and coughing exercises. Which of the following client statements should indicate to the nurse an understanding of the instructions?

The mental health status examination includes (select all that apply):

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Debridement is:

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