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

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:   1

 

3. 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

 

4. According to the DSM-IV classification system, information about general medical conditions would appear on the axis known as ____________________.

 

ANS:  Axis III

 

PTS:   1

 

5. 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

 

6. 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

 

7. 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

 

8. The minimal information necessary to meet information demands of nursing practice is known by the acronym ____________________.

 

ANS:  NMDS

 

PTS:   1

 

9. 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:   1

 

10. 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:

International Classification for Nursing Practice

ICNP

 

PTS:   1

 

MULTIPLE CHOICE

 

1. Which of the following statements regarding the International Classification of Diseases (ICD) system codes is true? The ICD codes:

a.	allow for a limited listing of the rarer clinical diagnoses
b.	describe clinical symptoms specific to the client
c.	can be evaluated by a computer for epidemiological analysis
d.	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

 

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

a.	a clearer view of an individual client’s situation
b.	less information relevant to diagnoses
c.	less information describing the phenomena of mental disorders
d.	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

 

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

a.	does not address cultural sensitivity in any way
b.	has one axis designated for cultural data only
c.	alerts the clinician to evaluate each client’s cultural frame of reference in the assessment
d.	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.

 

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

 

4. 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

 

5. 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.	which psychiatric diagnoses are included in the DSM
b.	some of the accompanying descriptions of diagnoses
c.	the criteria for some of the psychiatric diagnoses contained in the DSM-IV
d.	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

 

6. 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

 

7. 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)

 

 

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

 

8. 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

 

9. 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

 

10. Which statement is true about the diagnostic labels identified as the Psychiatric Nursing Diagnoses, First Edition (PND-1)? The PND-1:

a.	was developed because psychiatric nurses did not like NANDA diagnoses
b.	was written by the American Psychiatric Association
c.	met serious resistance in nursing arenas
d.	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:    Comprehension

REF:   NANDA Taxonomy of Nursing Diagnoses| Development of Psychiatric Nursing Diagnoses

 

11. 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

 

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

a.	a list of general nursing interventions
b.	a listing of specific nursing interventions for specific diseases
c.	four categories of nursing interventions
d.	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

 

13. 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

 

14. 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.	provide testimonials from previous satisfied clients and colleagues
b.	produce an unblemished nursing practice licensure record
c.	augment the medical records in question with additional, corroborating evidence
d.	document his or her rationales using standardized nursing taxonomy

 

 

ANS:  D

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

 

15. 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

 

16. 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

 

17. 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/Relationships

 

18. 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

 

19. 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

 

20. 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

 

21. The primary focus of diagnostic coding is to ensure that:

a.	all descriptions use a controlled vocabulary
b.	clients cannot decipher the medical information
c.	passwords are manageable across the agency
d.	systems for record-keeping are simple and storable

 

 

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

 

22. As computerization of medical systems and health records progresses, and numerous systems become linked, a likely outcome might be:

a.	obscuration or piracy of individual identities
b.	longer delays in aggregate and individual processing of data
c.	misdiagnosis because individual data are not considered
d.	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

 

23. The Health and Human Services (HHS) regulations of the amended Health Insurance Portability and Accountability Act (HIPAA) implemented in April 2003:

a.	allow psychotherapists to release client information without client consent
b.	provide for a separate client authorization to release psychotherapy notes
c.	do not address privacy of electronic records
d.	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

 

24. 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.	psychiatric diagnoses as listed in the DSM-IV
c.	ineffective areas of function
d.	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 Diagnoses

 

25. 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

 

26. 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

 

27. 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.	Diagnoses are standardized and bias is removed.
b.	Human experience is reduced to a diagnostic label
c.	Practitioners are held accountable for language used.
d.	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

 

28. 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:  B

The 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