SOUTHEASTERN LOUISIANA UNIVERSITY
School of Nursing
NURSING 382
MENTAL STATUS EXAM
How many checkmarks does your patient have in each category?
___________
_______
___________
_________ ________
Appearance
Behavior
Affect & Mood
Perception
Cognition
(Count the checkmarks in the “slight” or “marked” columns.)
STUDENT’S NAME______________________________
DATE________________
Place a checkmark or an X in the column that corresponds to your patient.
HX (History) = Described or charted but not demonstrated currently
ND (No Data ) = means you cannot assess at this time
Not present Slight or Marked or Repeated
occas.
Appearance
Descriptions:
1. physically unkempt,
unclean
2. clothing
disheveled, dirty
3. clothing atypical,
unusual, bizarre
4. unusual physical
characteristics
np
Posture
Behavior
5. slumped
6. rigid, tense
7. atypical, inappropriate
Facial
Expression
Suggests
8. anxiety, fear,
apprehension
9. depression, sadness
10.anger, hostility
11. decreased variability
of expression
12. bizarreness,
inappropriateness
General
Body
Movements
13. accelerated,
increased speed
14. decreased, slowed
15. atypical, peculiar,
inappropriate
16. restlessness, fidgety
Amplitude
and Quality
of Speech
17. increased, loud
18. decreased, slowed
19. atypical quality,
slurring, stammer
Student
20. domineering
Nurse21. submissive, overly
Patient
compliant
Relationship 22. provocative
23. suspicious
24. uncooperative
slight
marked
Descriptions:
np
Feeling (Affect
and Mood)
25. inappropriate to
thought content
26. increased
lability of affect
27. blunted, absent,
unvarying
28. euphoria, elation
29. anger, hostility
30. fear, anxiety,
apprehension
31. depression,
sadness
Descriptions:
slight
marked
np
Perception
slight
marked
32. illusions
33. auditory
hallucination
34. visual
hallucinations
35. other type of
hallucinations
Descriptions:
np
Intellectual 36. impaired level of consciousness
Functioning
37. impaired attention span
Thinking
38. impaired abstract thinking
39. impaired calculation ability
40. impaired intelligence
Orientation
41. disoriented to person
42. disoriented to place
43. disoriented to time
Insight
44. difficulty in acknowledging the
presence of psychological problems
slight marked
45. most blames others or
circumstances for problems
Judgment
Memory
46. impaired ability to manage daily
living activities
47. impaired ability to make
reasonable life decisions
48. impaired immediate recall
49. impaired recent memory
50. impaired remote memory
Thought
Content
51. obsessions
52. compulsions
53. phobias
54.derealization/depersonalization
55. suicidal ideation
56. homicidal ideation
57. delusions
58. ideas of reference
59. ideas of influence
Stream of
60. associational disturbance
Thought (as
manifested 61. thought flow decreased, slowed
by speech)
62. thought flow increased
Descriptions: