When the nurse is assessing a client's mental status as part of the neurological examination, which question would be most appropriate to ask?

"Do you feel like crying often?"

"Do you have a history of psychotic disorder?"

"Can you tell me about your mood today?"

"Can you tell me where you are right now?"

Answer and Explanation

The Correct Answer is D

A) "Do you feel like crying often?": This question is more focused on assessing mood rather than cognitive function. While mood is an important aspect of mental health, it is not the primary focus in a neurological examination. The goal of a neurological assessment is to evaluate cognitive functions, orientation, and mental status.
B) "Do you have a history of psychotic disorder?": Asking about a history of psychotic disorders might be relevant in some contexts but does not directly assess the current mental status of the client. This question is more about past psychiatric history than current cognitive or neurological function.
C) "Can you tell me about your mood today?": While understanding a client’s mood can be valuable for overall mental health assessment, this question does not specifically assess cognitive functions or orientation. It is important to evaluate mood, but it is not the primary question for assessing neurological status.
D) "Can you tell me where you are right now?": This question is appropriate for assessing orientation, a key component of a neurological examination. Orientation questions assess a person's awareness of their current environment, which helps evaluate their cognitive function and mental status. This is directly relevant to a neurological assessment as it determines if the client is aware of their surroundings, which is crucial for understanding cognitive and neurological function.

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

Explanation

A) Decreased exercises: This is not a recommended measure for preventing peripheral arterial disease (PAD). Regular physical activity is important in managing PAD and preventing its progression. Exercise helps improve circulation and can alleviate symptoms.
B) Diabetes management: Effective management of diabetes is crucial for preventing PAD. High blood sugar levels can damage blood vessels over time, increasing the risk of PAD. Managing blood glucose levels helps reduce this risk.
C) Smoking cessation: Smoking is a major risk factor for PAD. It contributes to the narrowing and hardening of arteries. Quitting smoking is essential for preventing PAD and improving overall vascular health.
D) Hyperlipidemia control: Managing high cholesterol levels is important in preventing PAD. Elevated lipid levels contribute to the buildup of plaques in arteries, which can lead to PAD. Controlling hyperlipidemia through diet, exercise, and medication can reduce this risk.

A. Right knee +1; Left knee 0 B. Right knee +3; Left knee +2 C. Right knee +2; Left knee +1 D. Right knee +4; Left knee +3

Correct Answer is C

Explanation

A) Right knee +1; Left knee 0: The scale for grading reflexes typically ranges from 0 to 4. A score of 0 indicates no reflex, which does not align with the description of having a diminished but not absent reflex. A score of +1 suggests a reduced but present reflex, which would be appropriate for a diminished reflex on the left side.

B) Right knee +3; Left knee +2: A score of +3 indicates an exaggerated or brisk reflex, while +2 denotes a normal reflex. Since the right knee reflex is normal, it should be documented as +2. A diminished reflex on the left side is more accurately reflected by a score of +1, not +2.
C) Right knee +2; Left knee +1: This is the most accurate documentation. A score of +2 denotes a normal reflex, which applies to the right knee. A score of +1 reflects a diminished reflex, which is appropriate for the left knee where the reflex is present but reduced.
D) Right knee +4; Left knee +3: A score of +4 represents a very brisk or hyperactive reflex, which is not consistent with a normal finding. Similarly, a score of +3 would indicate an exaggerated reflex, which does not fit the description of the right knee being normal. The correct grading for a normal reflex is +2, and for a diminished reflex is +1.

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When the nurse is assessing a client's mental status as part of the neurological examination, which question would be most appropriate to ask?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A Community nurse is doing a class teaching measures to prevent peripheral arterial disease. Select all that apply teaching for this topic. (Select All that Apply.)

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

Explanation

A client's patellar reflex is normal for the right side but diminished on the left. Using the scale for grading reflexes, how should the nurse document this finding?

Correct Answer is C

Explanation

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