Name 4 common cognitive assessment tools.
What will be an ideal response?
Answer:
1) Mini-Mental State Examination (MMSE): 30-point questionnaire that is commonly used to measure cognitive impairment. Usually takes 8 minutes to complete.
2) Abbreviated Mental Test (AMT): brief 10-item scale used to screen for cognitive impairment. Usually takes 3 minutes to complete.
3) Mini-Cog + Clock Drawing Test (CDT): mini-cog consists of two components, a 3-item recall test for memory and a scored clock drawing test. Usually takes 3 minutes to complete.
4) Six-Item Cognitive Impairment Test (6CIT): short 6-item questionnaire used for assessing cognitive status. Takes about 3 minutes to complete.
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An older woman who has COPD wants to perform self-care activities. Which instruction should the nurse include in patient teaching to help her achieve this goal?
a. Bathe and eat slowly with periodic rest. b. Walk short distances without oxygen. c. Perform all activities of daily living (ADLs) and then rest. d. Bathe right after eating, and then rest.
When performing an assessment of the integumentary system on a client, the nurse should:
1. palpate for edema over the knee. 2. inspect the inside of the mouth for skin tags. 3. check color, quantity, and distribution of hair. 4. check for skin turgor on the forearm.
The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has been moved to an air bed. What would be the nurse's best response?
A) "Air beds allow the care team to reposition her more easily while she's on bed rest." B) "Air beds are far more comfortable than regular beds and she'll likely have to be on bed rest a long time." C) "The bed automatically moves, so she's less likely to develop pressure sores while she's in bed." D) "The bed automatically moves, so she is likely to have less pain."
An adolescent in a residential program threatens to throw a pool ball at another adolescent. Which comment by the nurse would set limits?
a. "You will be taken to seclusion if you throw that ball." b. "Do not throw the ball. Put it back on the pool table." c. "Attention everyone: We're all going to the gym." d. "Please do not lose control of your behavior."