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A critical care nurse asks a psychiatric nurse about the difference between a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and a nursing diagnosis. What is the psychiatric nurse's best response?
- A. No functional difference exists between the two diagnoses. Both serve to identify a human deviance.
- B. The DSM-5 diagnosis disregards culture, whereas the nursing diagnosis includes cultural variables.
- C. The DSM-5 diagnosis profiles present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems.
- D. The DSM-5 diagnosis influences the medical treatment; the nursing diagnosis offers a framework to identify interventions for problems a patient has or may experience.
Correct Answer: D
Rationale: The medical diagnosis, defined according to the DSM-5, is concerned with the patient's disease state, causes, and cures, whereas the nursing diagnosis focuses on the patient's response to stress and possible caring interventions. Both the DSM-5 and a nursing diagnosis consider culture. Nursing diagnoses also consider potential problems.
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A nurse must assess several new patients at a community mental health center. Conclusions concerning current functioning should be made on the basis of what factor?
- A. The degree of conformity of the individual to society's norms.
- B. The degree to which an individual appears logical and rational.
- C. A continuum from mentally healthy to mentally unhealthy.
- D. The rate of their intellectual and emotional growth.
Correct Answer: C
Rationale: Because mental health and mental illness are relative concepts, assessment of functioning is made by using a continuum. Mental health is not based on conformity; some mentally healthy individuals do not conform to society's norms. Most individuals occasionally display illogical or irrational thinking. The rate of intellectual and emotional growth is not the most useful criterion to assess mental health or mental illness.
In the majority culture of the United States, which individual is at greatest risk to be incorrectly labeled mentally ill?
- A. Person who is usually pessimistic but strives to meet personal goals.
- B. Wealthy person who gives $20 bills to needy individuals in the community.
- C. Person with an optimistic viewpoint about getting his or her own needs met.
- D. Person who expresses strong beliefs about the existence of alien abductions.
Correct Answer: D
Rationale: Possessing and expressing unpopular or unsubstantiated beliefs often suggests an individual is mentally unstable. In this situation, cultural norms vary, making it more difficult to make an accurate DSM-5 diagnosis. The individuals described in the other options are less likely to be labeled as mentally ill.
A patient in the emergency department reports, 'I hear voices saying someone is stalking me. They want to kill me because I found the cure for cancer. I will stab anyone that threatens me.' Which aspects of mental health have the greatest immediate concern to a nurse?
- A. Happiness
- B. Appraisal of reality
- C. Control over behavior
- D. Effectiveness in work
- E. Healthy self-concept
Correct Answer: B,C,E
Rationale: The aspects of mental health of greatest concern are the patient's appraisal of and control over behavior. The patient's appraisal of reality is inaccurate, and auditory hallucinations are evident, as well as delusions of persecution and grandeur. In addition, the patient's control over behavior is tenuous, as evidenced by the plan to 'stab' anyone who seems threatening. A healthy self-concept is lacking. Data are not present to suggest that the other aspects of mental health (happiness and effectiveness in work) are of immediate concern.
Which basic intervention should a psychiatric mental health nurse plan to provide for a patient diagnosed with a mood disorder?
- A. Sharing clinical expertise to enhance patient treatment
- B. Performing individual or group psychotherapy for the patient
- C. Using appropriate diagnostic tests to monitor patient condition
- D. Conducting stress reduction and health maintenance classes
Correct Answer: D
Rationale: Conducting stress reduction and health maintenance classes is the basic intervention that should be performed by a psychiatric mental health nurse. These classes will provide individualized guidance to patients to prevent or reduce mental illness and improve mental health. Community screenings and stress management classes are examples of health maintenance classes. The other options are advanced practice interventions.
An 86 year old, previously healthy and independent, falls after an episode of vertigo. Which statement made by this patient best demonstrates resilience?
- A. I knew this would happen eventually.
- B. Attending my weekly water aerobics class is too risky.
- C. I don't need that silly walker to get around by myself.
- D. Maybe some physical therapy will help me with my balance.
Correct Answer: D
Rationale: Resiliency is the ability to recover from or adjust to misfortune and change. The correct response indicates that the patient is hopeful and thinking positively about ways to adapt to the vertigo. Saying 'I knew this would happen eventually' and discontinuing healthy activities suggest a hopeless perspective on the health change. Refusing to use a walker indicates denial.