The nurse is preparing to perform an evaluation of the older adult client's level of cognitive reasoning. The student nurse is observing. Which of the following statements by the student nurse indicates the need for further education?

Question

1. "The Mini–Mental State Examination seems like a quick way to determine how well the client is able to reason.".
2. "It's best to go ahead and give the Mini–Mental State Examination at the beginning of the focused interview because the client's mind will be fresh.".
3. "It sounds like some older people get really nervous about these cognitive reasoning examinations because they worry they may be developing problems.".
4. "The Mini–Mental State Examination is really easy to perform so it's important to remember that the client may have just gone through these types of questions the day before with another healthcare provider.".

Answer 1

2
Rationale 1: The Mini–Mental State Examination is one screening instrument of cognitive reasoning that has been used extensively for 30 years. It is familiar to most practitioners and rates well as a reliable and valid tool for detecting dementia and delirium relating to organic disease.The Mini–Mental State Examination is easy to use. It takes less than 10 minutes to administer and requires no special testing materials other than paper and pencil.
Rationale 2: The nurse should wait to develop rapport with the older adult client prior to performing a cognitive reasoning examination. The nurse should not perform this assessment at the beginning of the focused interview. The screening should be done toward the end of the verbal part of the interview, when the client has learned to feel comfortable with the interviewer and a rapport has developed.
Rationale 3: Older clients who take the test on a periodic basis begin to learn the scoring system and keep track of their scores. They may become fearful of this progression of numbers and resist giving an opportunity for comparison if they feel it will show decline.
Rationale 4: One problem with the Mini–Mental State Examination is that it is so widely used that clients may become irritated when they find themselves taking the test over and over. It also becomes easy for anyone, young or old, with dementia or not, to become confused between the answers on one test and the next when they are given too close together.