,1. A nursing student asks the instructor about the primary difference between the DSM-5 and a
nursing diagnosis. Which response by the instructor is most accurate?
A) "There is no real difference; both classify mental disorders."
B) "The DSM-5 provides diagnostic criteria for mental disorders used by all healthcare
professionals, while the nursing diagnosis describes the patient's response to the mental
disorder."
C) "The DSM-5 is only used by psychiatrists, and nursing diagnosis is only used by nurses."
D) "The nursing diagnosis replaces the DSM-5 in psychiatric settings."
Correct Answer: "The DSM-5 provides diagnostic criteria for mental disorders used by all
healthcare professionals, while the nursing diagnosis describes the patient's response to the
mental disorder."
Rationale: The DSM-5 is the standard classification system for diagnosing psychiatric disorders
based on specific criteria sets. In contrast, the nursing diagnosis describes the patient's unique
human responses to health conditions that nurses are licensed to treat. The DSM-5 describes
what the patient has, while the nursing diagnosis focuses on what the patient experiences as a
result of the illness.
2. A patient tells the nurse, "I'm not going to talk to you. You're a student nurse, and I only want
to talk to the real doctor." According to Peplau's theory, which phase of the nurse-patient
relationship is most challenged by this statement?
A) Termination phase
B) Working phase
C) Orientation phase
D) Pre-interaction phase
Correct Answer: Orientation phase
,Rationale: Peplau's Interpersonal Relations Theory identifies the orientation phase as the period
where the nurse and patient meet, establish rapport, set boundaries, and clarify roles. The
patient's statement challenges this phase because they are questioning the nurse's role and
credibility. The nurse's task is to establish trust, acknowledge the patient's feelings, and clarify
the professional nursing role.
3. A patient with major depressive disorder refuses to take prescribed antidepressant
medication, stating, "I don't need pills. I just need to pray harder and my depression will be
cured." The patient has been deemed competent and is voluntarily admitted. Which action by
the nurse is appropriate?
A) Administer the medication covertly in the patient's food
B) Override the refusal because the patient has a mental illness
C) Respect the patient's right to refuse and explore their beliefs while educating about
medication benefits and risks
D) Discharge the patient immediately for non-compliance
Correct Answer: Respect the patient's right to refuse and explore their beliefs while educating
about medication benefits and risks
Rationale: A competent, voluntarily admitted adult retains the right to refuse treatment,
including medication. Forcing treatment against a competent patient's will constitutes battery.
The appropriate nursing response respects patient autonomy, explores cultural and religious
beliefs (which may be protective factors), and provides thorough education about illness and
treatment options.
4. The nurse is admitting a patient who identifies as a member of the Native American culture.
The patient is accompanied by a tribal elder who wishes to perform a healing ceremony in the
patient's room. What is the nurse's best response?
A) "I'm sorry, but hospital policy prohibits any ceremonies that involve burning materials."
B) "I will need to check with the healthcare provider to see if this is medically approved."
, C) "Tell me more about the ceremony and what it involves so we can work together to
accommodate your cultural and spiritual needs safely."
D) "This is not evidence-based practice, so I would discourage it."
Correct Answer: "Tell me more about the ceremony and what it involves so we can work
together to accommodate your cultural and spiritual needs safely."
Rationale: Culturally competent care requires the nurse to avoid ethnocentrism and
demonstrate cultural humility by exploring the request openly and respectfully. The goal is to
integrate the patient's cultural health beliefs and practices into the care plan whenever possible,
respecting both cultural needs and the inpatient unit's safety requirements. Negotiating safe
alternatives demonstrates cultural competence.
5. Which patient would the nurse consider as meeting criteria for an involuntary admission (civil
commitment)?
A) A patient with schizophrenia who states, "I want to go home. I don't like it here."
B) A patient with bipolar disorder who is refusing to take lithium due to side effects.
C) A patient with major depressive disorder who has a specific plan to hang themselves and
refuses voluntary hospitalization.
D) A patient with generalized anxiety disorder who requests to be discharged.
Correct Answer: A patient with major depressive disorder who has a specific plan to hang
themselves and refuses voluntary hospitalization.
Rationale: Involuntary admission (civil commitment) requires that the patient poses an
imminent danger to self or others, or is unable to care for basic needs. A patient with a specific
suicide plan who refuses voluntary hospitalization meets the criterion of danger to self.
Expressing a desire to leave or refusing medication alone does not justify involuntary
commitment.
nursing diagnosis. Which response by the instructor is most accurate?
A) "There is no real difference; both classify mental disorders."
B) "The DSM-5 provides diagnostic criteria for mental disorders used by all healthcare
professionals, while the nursing diagnosis describes the patient's response to the mental
disorder."
C) "The DSM-5 is only used by psychiatrists, and nursing diagnosis is only used by nurses."
D) "The nursing diagnosis replaces the DSM-5 in psychiatric settings."
Correct Answer: "The DSM-5 provides diagnostic criteria for mental disorders used by all
healthcare professionals, while the nursing diagnosis describes the patient's response to the
mental disorder."
Rationale: The DSM-5 is the standard classification system for diagnosing psychiatric disorders
based on specific criteria sets. In contrast, the nursing diagnosis describes the patient's unique
human responses to health conditions that nurses are licensed to treat. The DSM-5 describes
what the patient has, while the nursing diagnosis focuses on what the patient experiences as a
result of the illness.
2. A patient tells the nurse, "I'm not going to talk to you. You're a student nurse, and I only want
to talk to the real doctor." According to Peplau's theory, which phase of the nurse-patient
relationship is most challenged by this statement?
A) Termination phase
B) Working phase
C) Orientation phase
D) Pre-interaction phase
Correct Answer: Orientation phase
,Rationale: Peplau's Interpersonal Relations Theory identifies the orientation phase as the period
where the nurse and patient meet, establish rapport, set boundaries, and clarify roles. The
patient's statement challenges this phase because they are questioning the nurse's role and
credibility. The nurse's task is to establish trust, acknowledge the patient's feelings, and clarify
the professional nursing role.
3. A patient with major depressive disorder refuses to take prescribed antidepressant
medication, stating, "I don't need pills. I just need to pray harder and my depression will be
cured." The patient has been deemed competent and is voluntarily admitted. Which action by
the nurse is appropriate?
A) Administer the medication covertly in the patient's food
B) Override the refusal because the patient has a mental illness
C) Respect the patient's right to refuse and explore their beliefs while educating about
medication benefits and risks
D) Discharge the patient immediately for non-compliance
Correct Answer: Respect the patient's right to refuse and explore their beliefs while educating
about medication benefits and risks
Rationale: A competent, voluntarily admitted adult retains the right to refuse treatment,
including medication. Forcing treatment against a competent patient's will constitutes battery.
The appropriate nursing response respects patient autonomy, explores cultural and religious
beliefs (which may be protective factors), and provides thorough education about illness and
treatment options.
4. The nurse is admitting a patient who identifies as a member of the Native American culture.
The patient is accompanied by a tribal elder who wishes to perform a healing ceremony in the
patient's room. What is the nurse's best response?
A) "I'm sorry, but hospital policy prohibits any ceremonies that involve burning materials."
B) "I will need to check with the healthcare provider to see if this is medically approved."
, C) "Tell me more about the ceremony and what it involves so we can work together to
accommodate your cultural and spiritual needs safely."
D) "This is not evidence-based practice, so I would discourage it."
Correct Answer: "Tell me more about the ceremony and what it involves so we can work
together to accommodate your cultural and spiritual needs safely."
Rationale: Culturally competent care requires the nurse to avoid ethnocentrism and
demonstrate cultural humility by exploring the request openly and respectfully. The goal is to
integrate the patient's cultural health beliefs and practices into the care plan whenever possible,
respecting both cultural needs and the inpatient unit's safety requirements. Negotiating safe
alternatives demonstrates cultural competence.
5. Which patient would the nurse consider as meeting criteria for an involuntary admission (civil
commitment)?
A) A patient with schizophrenia who states, "I want to go home. I don't like it here."
B) A patient with bipolar disorder who is refusing to take lithium due to side effects.
C) A patient with major depressive disorder who has a specific plan to hang themselves and
refuses voluntary hospitalization.
D) A patient with generalized anxiety disorder who requests to be discharged.
Correct Answer: A patient with major depressive disorder who has a specific plan to hang
themselves and refuses voluntary hospitalization.
Rationale: Involuntary admission (civil commitment) requires that the patient poses an
imminent danger to self or others, or is unable to care for basic needs. A patient with a specific
suicide plan who refuses voluntary hospitalization meets the criterion of danger to self.
Expressing a desire to leave or refusing medication alone does not justify involuntary
commitment.
