Psychiatric Mental Health Nursing ,4th Edition by Frisch, Noreen Cavan, Frisch, Lawrence E. – Test Bank

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CHAPTER 5 DIAGNOSTIC SYSTEMS FOR PSYCHIATRIC NURSING

TRUE/FALSE

1. Epidemiology is the study of factors that lead to the occurrence of disease in a population of people.

ANS: T PTS: 1

2. The International Classification of Diseases (ICD) has nothing to do with insurance coverage and

reimbursement for services.

ANS: F PTS: 1

3. An updated version of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,

(DSM-IV) came out in 2000 and is referred to as the DSM-IV-TR.

ANS: T PTS: 1

4. The NANDA taxonomy of nursing diagnoses was first published in 1990 and has been in use since that

time.

ANS: F PTS: 1

5. Over one-half of the approved or accepted nursing diagnoses address nursing concerns in the

psychosocial-spiritual realm of client care.

ANS: T PTS: 1

6. The nursing diagnosis represents the part of nursing practice that the nurse is licensed to address

independently.

ANS: T PTS: 1

COMPLETION

1. The major classification system for diagnosing mental disorders is contained in the publication called

the ____________________.

ANS:

DSM-IV

Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders, fourth edition

Diagnostic and Statistical Manual of Mental Disorders, 4th edition

PTS: 1

2. According to the DSM-IV classification system, the condition of mental retardation would be listed

under the axis known as ____________________.

ANS: Axis II

PTS: 13. 4. 5. 6. 7. 8. 9. According to the DSM-IV classification system, information about living in a group residence and the

interactions with other residents would be indicated on the axis known as ____________________.

ANS: Axis IV

PTS: 1

According to the DSM-IV classification system, information about general medical conditions would

appear on the axis known as ____________________.

ANS: Axis III

PTS: 1

You are working with a client who smears feces, has some trouble maintaining minimal personal

hygiene, and presents some danger of hurting self or others. Looking at the Global Assessment of

Functioning Scale, you would expect this client to have a rating ranging from ____________________

to ____________________.

ANS:

11, 20

eleven, twenty

PTS: 1

According to the DSM-IV classification system, the diagnosis of Obsessive-Compulsive Disorder is

listed on the axis known as ____________________.

ANS: Axis I

PTS: 1

According to the DSM-IV classification system, the diagnosis of Narcissistic Personality Disorder is

listed on the axis known as ____________________.

ANS: Axis II

PTS: 1

The minimal information necessary to meet information demands of nursing practice is known by the

acronym ____________________.

ANS: NMDS

PTS: 1

The comprehensive coding system that is more inclusive than ICD-9 in that it includes nursing

diagnoses and nursing interventions is known by the acronym ____________________.

ANS: SNOMED

PTS: 110. Through collaborative efforts of nurses all around the world under the auspices of the International

Council of Nursing (ICN), a universal reference terminology for nursing practice is being developed,

which is known as the ____________________.

ANS:

ICNP

International Classification for Nursing Practice

PTS: 1

MULTIPLE CHOICE

1. 2. 3. Which of the following statements regarding the International Classification of Diseases (ICD) system

codes is true? The ICD codes:

a. b. c. d. allow for a limited listing of the rarer clinical diagnoses

describe clinical symptoms specific to the client

can be evaluated by a computer for epidemiological analysis

are expressed by two whole numbers and three decimal places

ANS: B

The only true statement is that ICD codes describe clinical symptoms specific to a client. The other

three options are false.

PTS: 1 DIF: Comprehension REF: ICD-9

Compared to the ICD-9 diagnoses, the DSM-IV provides:

a. b. c. d. a clearer view of an individual client’s situation

less information relevant to diagnoses

less information describing the phenomena of mental disorders

an easier method for accounting and billing practices

ANS: A

Compared to the ICD-9 diagnoses, the DSM-IV provides a clearer view of an individual’s situation.

The DSM-IV uses a multiaxial system that allows development and other disorders to be considered

along with psychiatric diagnoses of more recent onset. The axial system facilitates comprehensive

evaluation and provides a format for organizing clinical information and for describing the unique

character of a client’s condition.

PTS: 1 DIF: Comprehension REF: DSM-IV-TR

In regard to cultural sensitivity, the DSM-IV-TR:

a. b. c. d. does not address cultural sensitivity in any way

has one axis designated for cultural data only

alerts the clinician to evaluate each client’s cultural frame of reference in the assessment

provides a decimal point designation for each specific culture from a list of different

cultures

ANS: C

The DSM-IV-TR alerts the clinician to gather information related to a culturally sensitive assessment.

The information gathered includes cultural identity of the individual, cultural explanations of the

individual’s illness, cultural factors related to psychosocial environment and levels of functioning,

cultural elements of the relationship between the individual and the child, and overall cultural

assessment for diagnosis and care.4. 5. 6. 7. PTS: 1 DIF: Comprehension REF: DSM-IV-TR

In comparison to other methods for diagnosing illness, the DSM-IV-TR has provided a:

a. complex language for mental health care

b. multitude of diagnostic criteria yet to be tested

c. standard for clinical diagnoses

d. substitute for clinical judgment

ANS: C

While not a substitute for clinical judgment and diagnosis, DSM-IV-TR serves as the current “gold

standard” for making mental health diagnoses. Few health care fields have such a gold standard, and

for the foreseeable future, DSM makes a landmark contribution to progress in mental health care.

PTS: 1 DIF: Comprehension REF: DSM-IV-TR

In July 2000, the American Psychiatric Association updated the DSM-IV to the DSM-IV-TR, with the

TR standing for “text revision.” When compared to the DSM-IV, the TR version has changed:

a. b. c. d. which psychiatric diagnoses are included in the DSM

some of the accompanying descriptions of diagnoses

the criteria for some of the psychiatric diagnoses contained in the DSM-IV

the code numbers for the psychiatric diagnoses

ANS: B

The TR version has not changed any of the diagnoses in the DSM-IV or any criteria for making them,

but it has changed some of the accompanying descriptions of diagnoses. The other options do not

address the changes that occurred with the text revision.

PTS: 1 DIF: Comprehension REF: DSM-IV-TR

One of the major contributions of the DSM was to:

a. officially recognize psychoanalytic theories as the primary etiology of all psychiatric

disorders

b. indicate which psychiatric disorders have a neurophysiological basis and which have a

psychoanalytic basis

c. officially recognize neurophysiological theories as the primary etiology of all psychiatric

disorders

d. describe the phenomena of mental disorder without taking sides in the controversies of

causation

ANS: D

A very important advantage of the DSM is the avoidance of controversies about what causes

psychiatric conditions. Much of the American and British psychiatry in the middle 20th century had

been dominated by psychoanalysis, and psychoanalytic theories of etiology were complex and rooted

in subjective interpretations of reported memories, experiences, and dreams. The neutrality of the

DSM opened the way both for the widespread acceptance of the DSM and for new, increasingly

“biological” approaches to the understanding of mental illness.

PTS: 1 DIF: Comprehension REF: DSM-IV-TR

The classification system that provides nurses with a common language to communicate and describe

the essence of nursing practice is the:

a. DSM-IV for nurses

b. ICD-10

c. NANDA nursing diagnoses

d. Unified Medical Language System (UMLS)8. 9. 10. ANS: C

The NANDA classification system provides nurses with a common language to communicate and

describe the essence of nursing practice. It is the most commonly used system of nursing diagnoses in

the United States.

PTS: 1 DIF: Knowledge REF: NANDA Taxonomy of Nursing Diagnoses

You are working with a group of nurses to clinically study and define the characteristics for a new

nursing diagnosis. This means that the nursing diagnosis has been:

a. accepted for clinical development

b. received for development

c. only provided with a diagnostic label

d. tested clinically

ANS: A

The process of accepting new diagnoses has been refined over the years. Currently, there are written

guidelines for the submission and review of diagnosis, and a new diagnosis is now accepted based on

information presented formally to the Diagnosis Review Committee. Diagnoses are staged on the basis

of how well developed they are, so that diagnoses reaching the third stage have research bases that

document the relevance and applicability of the diagnoses to nursing practice.

PTS: 1 DIF: Comprehension

REF: NANDA Taxonomy of Nursing Diagnoses

When nursing diagnoses were first proposed and a series of conferences were held with nurse

theorists, a means of organizing the diagnoses was adopted. The means of organizing the diagnoses is

the concept of:

a. simple to complex

b. young to old

c. human response patterns

d. human needs hierarchy

ANS: C

The concept of the human response patterns was adopted as a means of organizing or grouping a series

of diagnoses, though not included in taxonomy II. The notion of human response patterns was derived

from the American Nurses Association’s definition of nursing as “the response to actual or potential

health problems.”

PTS: 1 DIF: Comprehension

REF: NANDA Taxonomy of Nursing Diagnoses

Which statement is true about the diagnostic labels identified as the Psychiatric Nursing Diagnoses,

First Edition (PND-1)? The PND-1:

a. b. c. d. was developed because psychiatric nurses did not like NANDA diagnoses

was written by the American Psychiatric Association

met serious resistance in nursing arenas

was a list of 113 diagnostic labels that later was adopted by NANDA

ANS: D

Psychiatric Nursing Diagnoses evolved to become a list of 113 diagnostic labels, many of which

overlapped with the existing NANDA diagnoses. In 1994, the entire PND-1 list was presented to and

adopted by NANDA for incorporation into NANDA’s taxonomy.

PTS: 1 DIF: Comprehension11. 12. 13. 14. REF: NANDA Taxonomy of Nursing Diagnoses| Development of Psychiatric Nursing Diagnoses

In making a decision about which system of classification to use, the nurse must remember that each

system was developed with one purpose in mind, and that purpose was to:

a. streamline efforts

b. enhance communication

c. separate professional duties

d. provide a system for documentation

ANS: B

In making a decision about which classification system to use, the nurse must remember that each of

these systems was developed with the purpose of facilitating understanding and enhancing

communication about its content area. The NANDA-I enhances communication between nurses, DSM

enhances communication between psychiatric professionals (nurses, psychiatrist, psychologist, and

social workers), and the ICD-9 enhances communication between nurses and physicians regarding

physical illness.

PTS: 1 DIF: Application REF: Choosing a Diagnostic System

The Nursing Interventions Classification (NIC) first published in 1992 consists of:

a. b. c. d. a list of general nursing interventions

a listing of specific nursing interventions for specific diseases

four categories of nursing interventions

those interventions done only by nurses for specific diseases

ANS: A

The Nursing Interventions Classification (NIC) consists of a list of general nursing interventions.

Interventions are not directed at any specific diseases but are applicable to all patient conditions.

PTS: 1 DIF: Knowledge

REF: Nursing Interventions Nursing Outcomes Classifications

The purpose of the NIC is to:

a. assess validity of interventions

b. document nursing activities

c. identify when nursing is not needed

d. separate social workers’ and nurses’ interventions

ANS: B

The purpose of the NIC is to identify and document those activities that nurses carry out to assist client

status or behavior. The other options are not purposes of NIC.

PTS: 1 DIF: Knowledge

REF: Nursing Interventions Nursing Outcomes Classifications

When a nurse is questioned about his or her nursing care and held accountable for deciding how to

provide that care, the BEST way to substantiate the delivery of quality care is to:

a. b. c. d. provide testimonials from previous satisfied clients and colleagues

produce an unblemished nursing practice licensure record

augment the medical records in question with additional, corroborating evidence

document his or her rationales using standardized nursing taxonomy

ANS: D15. 16. 17. A nurse should document his or her care by using rationales from a standardized nursing taxonomy

such as NIC. NIC provides the standardized language for nurses to use when researching which

interventions are most likely to produce positive outcomes in particular client situations.

PTS: 1 DIF: Application

REF: Nursing Interventions Nursing Outcomes Classifications

A NANDA diagnosis consists of a name (or diagnostic label), a definition, a statement of etiology, and

which of the following?

a. statement of pathology

b. length of time of problem

c. defining characteristics

d. nurse’s responsibility

ANS: C

In addition to the diagnostic label, definition, and etiology, a NANDA diagnosis consists of the

defining characteristics. The defining characteristics provide the observable criteria that must be

present to make the diagnosis. For example, for the nursing diagnosis of hopelessness, the defining

characteristics include “passivity, decreased affect, and verbal cues.”

PTS: 1 DIF: Knowledge

REF: NANDA Taxonomy of Nursing Diagnoses| Domains of Nursing Diagnoses

A nurse is developing a care plan for a newly admitted client. Which database would provide the nurse

with potential outcomes related to client care?

a. NIC

b. NOC

c. NANDA-I

d. DSM-IV-TR

ANS: B

The Nursing Outcomes Classification (NOC) provides another tool to assist nurses to relate three

aspects of nurses’ work: diagnosis, interventions, and outcomes. Outcomes are for use at the

individual, family, and community/population levels. There are seven domains used to categorize the

outcomes list. Domain III–Psychosocial Health describes outcomes related to psychological and social

functioning.

PTS: 1 DIF: Application

REF: Nursing Interventions Nursing Outcomes Classifications

Under which human response pattern would the nursing diagnosis Parental Role Conflict be found?

a. choosing

b. communicating

c. perceiving

d. relating

ANS: D

Parental Role Conflict would be included under the Role/Relationships human response patterns.

Other diagnoses included in this pattern include Caregiver/Role Strain, Family Processes: Alcoholism,

and Family Processes.

PTS: 1 DIF: Comprehension

REF: Selected Domains from NANDA Taxonomy II and Associated Nursing Diagnoses Frequently

Used in Psychiatric Mental Health| Role/Relationships18. 19. 20. 21. Under which grouping of human response patterns would the nursing diagnosis of Powerlessness be

found?

a. choosing

b. communicating

c. perceiving

d. relating

ANS: C

Powerlessness would be included under the self-perception human response patterns. Other diagnoses

included in this pattern are Body Image, Personal Identity, Hopelessness, Loneliness, and Self-Esteem

(chronic or situational).

PTS: 1 DIF: Comprehension

REF: Selected Domains from NANDA Taxonomy II and Associated Nursing Diagnoses Frequently

Used in Psychiatric Mental Health| Self-Perceptions

When you work with a client with the DSM-IV diagnosis of Major Depression, you might expect to

have a nursing diagnosis of:

a. Potential Risk for Violence to Self

b. Personal Identity Disturbance

c. Perceptual Sensory Alterations

d. Potential Parental Role Conflict

ANS: A

A client with a DSM-IV-TR diagnosis of Major Depression would have a nursing diagnosis of

Potential Risk for Violence to Self. Clients with major depression may experience feelings of

hopelessness and low self-esteem. Nursing actions would be directed at preventing the client from

harming him- or herself.

PTS: 1 DIF: Application

REF: History of NANDA| Reflective Thinking| What Is Unnamed Is Unnoticed

What is the major issue related to computerized health records that has most concerned providers and

clients?

a. accuracy

b. encoding

c. length

d. privacy

ANS: D

Widespread access to health records raises important issues of confidentiality and privacy. Clients are

currently concerned about the privacy of their records, particularly when these reflect some of the

highly sensitive personal disclosures that may occur in mental health and psychiatric practice.

Inappropriate disclosure of medical or psychiatric data may threaten an individual’s employment,

community status, or general future prospects.

PTS: 1 DIF: Comprehension

REF: Diagnostic Systems and Computerized Health Records| Issues of Privacy and Confidentiality

The primary focus of diagnostic coding is to ensure that:

a. b. c. d. all descriptions use a controlled vocabulary

clients cannot decipher the medical information

passwords are manageable across the agency

systems for record-keeping are simple and storable22. 23. 24. ANS: A

The primary focus of diagnostic coding is to ensure that all descriptions make maximum use of a

controlled vocabulary. A controlled vocabulary means the use of words that have well-established

descriptive and diagnostic meaning.

PTS: 1 DIF: Comprehension

REF: Diagnostic Systems and Computerized Health Records| Diagnostic Coding

As computerization of medical systems and health records progresses, and numerous systems become

linked, a likely outcome might be:

a. b. c. d. obscuration or piracy of individual identities

longer delays in aggregate and individual processing of data

misdiagnosis because individual data are not considered

ability to comprehensively search information on any condition

ANS: D

Once numerous systems become linked, the ability to comprehensively search information on any

condition will be available. Currently records are frequently unavailable either within a single

institution or between health institutions. This unavailability results in unnecessary delays, costly

unneeded repetition of tests when data are inaccessible, complete loss of important information, and

inability to provide appropriate coordination and continuity of care.

PTS: 1 DIF: Analysis

REF: Diagnostic Systems and Computerized Health Records

The Health and Human Services (HHS) regulations of the amended Health Insurance Portability and

Accountability Act (HIPAA) implemented in April 2003:

a. b. c. d. allow psychotherapists to release client information without client consent

provide for a separate client authorization to release psychotherapy notes

do not address privacy of electronic records

allow each therapist to exercise his or her own judgment as to what information to release

ANS: B

The regulations do include a provision for client consent to release medical information and a separate

client authorization to release psychotherapy notes. Originally, the rules required separate forms for

consent to release information for treatment, payment, or peer review and for authorization to release

information for all other disclosures, including for client records to be disclosed to the client’s attorney.

PTS: 1 DIF: Comprehension

REF: Diagnostic Systems and Computerized Health Records| Issues of Privacy and Confidentiality

When selecting NANDA diagnoses appropriate for a specific client, the nurse independently assesses

for which of the following types of problems?

a. physical illnesses

b. d. psychiatric diagnoses as listed in the DSM-IV

c. ineffective areas of function

physical health problems as listed in the ICD-9-CM

ANS: C

The nurse independently assesses for ineffective areas of client function when selecting NANDA

diagnoses. Specific physical illnesses (diseases) are part of the physician’s diagnosis.

PTS: 1 DIF: Application REF: Domains of Nursing Diagnoses25. 26. 27. 28. A client becomes upset after speaking with his wife on the telephone. He begins to pace the floor and

rub his chest. The interventions that are collaborative nursing roles are to:

a. console the client

b. offer to sit and talk with the client

c. obtain an electrocardiogram (EKG)

d. assist the client to practice relaxation exercises

ANS: C

Obtaining an electrocardiogram (EKG) is a collaborative role of the nurse. This role involves the nurse

collaborating with other health professionals such as the physician who writes the order and the

technician who performs the EKG.

PTS: 1 DIF: Application REF: NANDA Taxonomy of Nursing Diagnoses

A psychiatric nurse has been instructed to begin using nursing diagnoses based on NANDA-I. Terms

relating to nursing judgment about the client’s condition would be found on which of the seven axes of

NANDA-I?

a. Axis 1

b. Axis 3

c. Axis 5

d. Axis 7

ANS: B

Terms relating to nursing judgment would be found on Axis 3. Axis 3 is the area where the nurse must

use professional knowledge and skill to determine if the concept is limited or best described by a

number of adjectives (e.g., disturbed, dysfunctional, impaired, or ineffective).

PTS: 1 DIF: Comprehension

REF: Domains of Nursing Diagnoses

A psychiatric nurse reviewing the DSM-IV-TR would recognize that which of the following is

considered a con for use of this system?

a. b. c. d. Diagnoses are standardized and bias is removed.

Human experience is reduced to a diagnostic label

Practitioners are held accountable for language used.

Observable behaviors are identified as necessary to make a diagnosis.

ANS: B

A negative related to the use of the DSM-IV-TR is the fact that the human experience is reduced to a

diagnostic label. The other three options are positive factors for use of this system.

PTS: 1 DIF: Comprehension

REF: DSM-IV-TR| Reflective Thinking| Pros and Cons of a Psychiatric Diagnostic System

Which of the following is designed to capture clinical information “behind the scenes” for use in

computerized health records?

a. DSM-IV-TR c. ICD-9

b. SNOMED-CT d. NMDS

ANS: BThe Systematized Nomenclature of Medicine–Clinical Terms (SNOMED-CT) is designed to capture

clinical information “behind the scenes” for use in computerized health care records. SNOMED-CT is

a coding system that is far more inclusive than ICD-9, as it includes nursing diagnoses and nursing

interventions as well as multiple axes that identify causative factors of illness and related functional

deficits and social factors. SNOMED-CT is a system that patterns ICD after the axial system in the

DSM and includes nursing taxonomies as well.

PTS: 1 DIF: Comprehension

REF: Advances in Diagnostic Nomenclature