A nursing student new to psychiatric mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific psychiatric disorder. The best answer would be:
NANDA-I nursing diagnoses
Nursing Outcomes Classification (NOC)
Nursing Interventions Classification (NIC)
DSM-5
The Correct Answer is D
Choice A reason: NANDA-I provides standardized nursing diagnoses but does not list or categorize symptoms for specific psychiatric disorders.
Choice B reason: The Nursing Outcomes Classification focuses on measurable patient outcomes after interventions, not on identifying symptoms of mental disorders.
Choice C reason: The Nursing Interventions Classification outlines evidence-based nursing actions and strategies, but it does not define or organize psychiatric symptoms.
Choice D reason: The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition) is the authoritative resource for identifying and categorizing symptoms of mental disorders. It provides diagnostic criteria and symptom patterns for each psychiatric condition, making it the correct choice.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A reason: Nurses have a duty to protect potential victims from harm. Breaking confidentiality is justified to warn the intended victim and involve the healthcare team, consistent with the Tarasoff duty to warn principle.
Choice B reason: Warning the victim without involving the treatment team ignores the collaborative care process and may compromise safety planning.
Choice C reason: Waiting to act places the potential victim at risk and disregards the ethical duty to prevent harm.
Choice D reason: Maintaining confidentiality in this situation endangers others and violates the ethical principle of nonmaleficence.
Correct Answer is A
Explanation
Choice A reason: This response acknowledges the patient’s feelings without confirming or denying the delusion. It helps establish trust while maintaining therapeutic communication. By focusing on the patient’s underlying concern, it avoids reinforcing the delusional content.
Choice B reason: Stating that the CIA is prohibited in health care facilities engages with the delusion, which is non-therapeutic because it validates the false belief.
Choice C reason: Redirecting away from the delusion may seem dismissive and does not address the patient’s immediate feelings of fear or concern. This could cause the patient to feel unheard.
Choice D reason: Telling the patient they have “lost touch with reality” is confrontational and could increase defensiveness. It is not supportive or therapeutic in building rapport.
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