A patient is admitted to the unit after an automobile accident. The nurse begins the mental status examination and finds that the patient has dysarthric speech and is lethargic. How should the nurse proceed?

A) Defer the rest of the mental status examination.
B) Skip the language portion of the examination and proceed onto assessing mood and affect.
C) Conduct an in-depth speech evaluation and defer the mental status examination to another time.
D) Proceed with the examination and assess the patient for suicidal thoughts because dysarthria is often accompanied by severe depression.

In the mental status examination, the sequence of steps forms a hierarchy in which the most basic functions (consciousness, language) are assessed first. The first steps must be accurately assessed to ensure validity of the steps that follow. For example, if consciousness is clouded, then the person cannot be expected to have full attention and to cooperate with new learning. If language is impaired, then a subsequent assessment of new learning or abstract reasoning (anything that requires language functioning) can give erroneous conclusions. Dysarthric speech and lethargy are signs of altered consciousness and answers to questions on the mental status examination may be invalid. The nurse should not proceed with any further part of the mental status examination at this time.