Serial 7s Assessment

Voiceover: Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Expert Fitzgerald faculty clinicians share their knowledge and experience to help you dissect the anatomy of a test question so you can better understand how to arrive at the correct test answer. So, if you're ready, let's jump right in.

Sally Miller: The psychiatric mental health nurse practitioner is performing a new patient assessment on a 41-year-old patient referred from primary care for depressive disorder refractory to SSRIs. During the mental status examination, the patient is unable to successfully perform a serial 7's backward count. The NP documents an abnormal finding in the area of:

A. Speech

B. Thought process

C. Judgment

D. Cognition

And clearly this is an assessment question. This is about the physical examination component of a mental health evaluation. Right? This is the mental status exam and serial sevens. In other words, you know, starting from 100, count backward by sevens, and you hope that the patient will say 93, 86, 79, 72, 65.

Notice how I crossed my fingers for a moment before I did that to make sure I could do it correctly, and I did not have a prompt, but that is your serial 7's backward count, and it's part of the physical examination. And so, this question really is about making sure that you understand the elements of the mental status examination. And I know it sounds very basic and very prosaic, but the fact is, you know, nowadays it's almost always a click and pick on an EMR menu and you just go through and click, click, click. And sometimes we find that clinicians, you know, especially newer clinicians, but anybody for that matter, doesn't exactly know what it is that they're examining or documenting when they click off all those click clicks.

I promise you, I'm am certain from my own experience and from my feedback from your peers that precede you on your exam, there will be a couple of questions that specifically evaluate your understanding of what a mental status examination is and what you are doing. So, this is an excellent question and just a good point of review in general are not only the elements of the mental status examination, but how you evaluate each one.

So when you're doing serial 7s, would this be an evaluation of speech, thought process, judgment, or cognition? And D is the correct answer. This is an evaluation of cognition. The mental status exam includes several distinct domains of assessment. Like I said, just like a a physical examination in primary care, you've got your cardiovascular, your pulmonary, your GI, dermatologic, etc. Same thing with the mental status examination. You have several domains. Cognition is one of them and it's evaluated in a few different ways. It's evaluated by examining attention and concentration which is what we're evaluating with serial 7s. We also as part of the cognitive assessment evaluate recent and long-term memory. Um we evaluate the ability to calculate uh the patients fund of knowledge, abstract reasoning. These are all elements of cognition and specifically serial sevens is about attention and concentration.

Conversely, A is not correct. Speech evaluates the character of speech. Is there word finding difficulty? You know, we all have the occasional word finding difficulty. I think I just did as a matter of fact. But is the patient consistently having difficulty retrieving words to express what they want to say? To the extent that it's that it's overt, that it's clearly a problem. Speech also evaluates rate. Is it too slow? Is it too fast? The tone, the volume, is it pressured? Is it almost inaudible? You know, the character of the speech.

B is not correct. Thought process refers to how thoughts are formed. And there are several evaluations of thought process also that you should probably be familiar with before you sit down and take your boards. Flight of ideas is that thought process where the patient just appears to go from thing to thing to thing. Circumstantial is the patient who will include detail that may not be directly relevant to the question, but then they just, you know, go off from one thing to the next linked thing to the next link thing. If you wait long enough, they will usually come back to address the subject of your question, but it could take a while.

Conversely, tangential thought process is a little bit different. I mean, it's similar to circumstantial and that the patient takes a basic concept and goes off literally on a tangent, but generally they keep going off on tangents and don't come back to the original line of reasoning. There's looseness of associations where maybe you can't see the connection that the patient does. Perseveration where they can't get off of an idea. They keep talking about the same thing repeatedly. I mean there's several examples of thought processes and you should know what they are and that they are indeed assessments of thought processes.

And then finally we have C judgment. This is not correct. Judgment speaks to the patients ability to make good decisions. Are they making good decisions um about their money? Are they potentially putting themselves in dangerous or harmful situations? um you know, engaging in like sex or um going off with strangers, things that could be dangerous if they were thinking clearly. Extreme risk-taking like, you know, driving way way way way too fast in an area where it's clearly like an immediate danger, an immediate threat. That's an example of judgment.

And so I've just, you know, popped out a few examples of each one here. A few elements of the mental status examination, but it does, it encompasses several things. There's thought content, which is different from thought processes. Of course, mood, affect, insight, perception. These are all elements of the physical examination and mental health, the mental status examination, and you should be familiar with them and how you evaluate each thing before you go in to take your boards.

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