NSG 526- EXAM 1
,Uploaded my Study Guide for NSG 526-Exam 1. Yellow highlights are what my instructor
emphasized during her weekly videos. Just a few practice questions generated from Study Fetch
There is another Study Guide I created and will upload: NSG526Exam1. It has over 50 questions
generated from Study Fetch. Study Fetch questions are generated from both of my Study
Guides. If anyone has any power-points or study guides from their instructors and will share I
will add to mine and enter in Study Fetch.
Module I- Understanding DSM5/ Coding/ Documentation
What is NOT considered a Mental Disorder
• Expectable or culturally approved response to a common stressor or loss
• Socially deviant behavior (i.e. political, religious, or sexual) and conflicts that are
primarily between the individual and society (unless the behaviors are due to a
dysfunction)
Mental Disorder per the DSM5
• Associated with significant distress or disability in social, occupation, or other important
activities
• Significant disturbance in cognition, emotion regulation, or behavior that reflects a
dysfunction in the psychological, biological or developmental processes underlying
mental functioning
Purpose of Scope of Practice
• Define NP roles: defines the boundaries of the practitioner’s license.
• Identify competencies assumed to be held by all NPs who function in a particular role
• Varies broadly from state-to-state Scope and Standards of Practice provides definitions
and descriptions of basic and advanced psychiatric-mental health clinical nursing
practice. It delineates the scope, functions, and roles of the clinical practice of
psychiatric-mental health nurses as well as the diverse settings in which they practice.
In addition, it establishes the clinical practice standards for the specialty.
Purpose of Standard of Practice
• Authoritative statements regarding the quality and type of practice that should be
provided
• Provide a way to judge the nature of care provided
• Reflect the expectation for the care that should be provided to clients with various
illnesses
• Reflect professional agreement focused on the minimum levels of acceptable
performance
• Can be used to legally describe the standard of care that must be met by a provider
• May be precise protocols that must be followed or more general guidelines that
recommend actions
, • Standards are authoritative statements that describe the level of care or performance
common to the profession of nursing and are used to judge the quality of nursing
practice. Scope and standards guide our actions and help us manage our practice along
with the challenges we face in nursing
What is Therapeutic Alliance: essential aspect of successful therapy
• Create a relationship with client by being calming, warm, understanding, kind,
respectful, concerned and focused
• therapeutic alliance comprises bonds, goals, and tasks
• Bonds are constituted by the core conditions of therapy, the client’s attitude toward
the therapist, and the therapist’s style of relating to the client
• goals are the mutually negotiated, understood, agreed upon, and regularly reviewed
aims of the therapy
• tasks are the activities carried out by both client and therapist
Important components of a therapeutic alliance
• Therapist and patient work collaboratively to create therapeutic change through an
affectionate bond
• Agreement on goals of therapy
• The therapist’s ability to be empathetic and involved in therapy
• The ability of the patient to do the work of therapy
What is Psychotherapy
Holistic treatment that relies on the nurse’s processing of what the patient is experiencing
During the Psychotherapy process the Psychiatric APN addresses individual and family
problems with the patient
• assesses identified problems during the orientation phase of the therapeutic
relationship; determines the underlying healthcare issues with the patient
• collects psychiatric data; and establishes a trusting relationship
• Applying core principles of psychotherapy as well as nursing theory to promote
recovery through adaptation.
Legal and Ethical considerations (Beneficence, Duty, Malfeasance, Fiduciary duty, Autonomy)
- Beneficence: The ethical principle of doing good or acting in the best interest of the
patient.
- Duty to warn: Most states have laws that either require or permit mental health
professionals to disclose info about patients who may become violent.
- Malfeasance: The willful, intentional act of doing harm; physical or monetary.
- Nonmaleficence: Do no harm.
- Fiduciary duty: The legal responsibility to act solely in the best interest of another party.
- Autonomy: The state or condition of self-governance, or leading one's life according to
reasons, values, or desires that are authentically one's own.
, DSM IV vs. DSM V TR
DSM 5 TR
• No longer uses a multiaxial system, but instead allows for rating of disorder along a
continuum of severity
• Global assessment of functioning (GAF) replaced by more detailed tool known as World
Health Organization-Disability Assessment schedule version 2.0
• Recognizes the increased importance of culture and social context in mental health care
• Includes dimensional aspects of diagnosis along with categories
• Number of specifiers and subtypes has been expanded to dimensionalize disorders more
so than in past versions
• Handful of new disorders included- hoarding disorder, disruptive mood dysregulation
disorder, premenstrual dysphoric disorder, binge eating disorder, restless leg syndrome,
& REM sleep behavior disorder
• Mental retardation replaced by intellectual developmental disorder
• Substance abuse and substance dependence replaced by substance use disorder
• "Not otherwise specified" categories renamed as "other specified" and "unspecified" to
keep with ICD-10 language.
The five axes of the multi-axial system (DSM-IV, prior to DSM-5):
1. Axis 1- Mental health and substance use disorders (example anxiety, depression)
2. Axis 2- Personality disorders and mental retardation (now known as intellectual
development disorder) (example antisocial personality disorder)
3. Axis 3- General medical conditions: medical conditions that cause the mental disorder
(example Alzheimer's disease, cancer)
4. Axis 4- Psychosocial and environmental problems (example inadequate social support,
recent divorce, death of a parent)
5. Axis 5- Global assessment of functioning (GAF) (numerical scale that measures level of
functioning of client from 0-100 with 0=inadequate information and 100=high functioning
with no symptoms of mental illness present)
DSM 5-TR classification of Psychiatric illness o The DSM-5 is a diagnostic manual. It does not
provide theories of cause, management, or treatment options. It lists 22 major categories
of mental disorders with more than 150 individual illnesses. The DSM-5 is organized to
follow the lifespan with neurodevelopmental disorders that occur early in life listed first
and neurocognitive disorders that occur at the end of life listed last. It is organized this way
to assist the diagnostic decision-making process.
Mnemonic:
"Depressed Patients Seem Anxious, So Claim Psychiatrists"
o Depression and other mood disorders (major depression, bipolar disorder, dysthymia)
Personality disorders (primarily borderline personality disorder)
Substance abuse disorders
,Uploaded my Study Guide for NSG 526-Exam 1. Yellow highlights are what my instructor
emphasized during her weekly videos. Just a few practice questions generated from Study Fetch
There is another Study Guide I created and will upload: NSG526Exam1. It has over 50 questions
generated from Study Fetch. Study Fetch questions are generated from both of my Study
Guides. If anyone has any power-points or study guides from their instructors and will share I
will add to mine and enter in Study Fetch.
Module I- Understanding DSM5/ Coding/ Documentation
What is NOT considered a Mental Disorder
• Expectable or culturally approved response to a common stressor or loss
• Socially deviant behavior (i.e. political, religious, or sexual) and conflicts that are
primarily between the individual and society (unless the behaviors are due to a
dysfunction)
Mental Disorder per the DSM5
• Associated with significant distress or disability in social, occupation, or other important
activities
• Significant disturbance in cognition, emotion regulation, or behavior that reflects a
dysfunction in the psychological, biological or developmental processes underlying
mental functioning
Purpose of Scope of Practice
• Define NP roles: defines the boundaries of the practitioner’s license.
• Identify competencies assumed to be held by all NPs who function in a particular role
• Varies broadly from state-to-state Scope and Standards of Practice provides definitions
and descriptions of basic and advanced psychiatric-mental health clinical nursing
practice. It delineates the scope, functions, and roles of the clinical practice of
psychiatric-mental health nurses as well as the diverse settings in which they practice.
In addition, it establishes the clinical practice standards for the specialty.
Purpose of Standard of Practice
• Authoritative statements regarding the quality and type of practice that should be
provided
• Provide a way to judge the nature of care provided
• Reflect the expectation for the care that should be provided to clients with various
illnesses
• Reflect professional agreement focused on the minimum levels of acceptable
performance
• Can be used to legally describe the standard of care that must be met by a provider
• May be precise protocols that must be followed or more general guidelines that
recommend actions
, • Standards are authoritative statements that describe the level of care or performance
common to the profession of nursing and are used to judge the quality of nursing
practice. Scope and standards guide our actions and help us manage our practice along
with the challenges we face in nursing
What is Therapeutic Alliance: essential aspect of successful therapy
• Create a relationship with client by being calming, warm, understanding, kind,
respectful, concerned and focused
• therapeutic alliance comprises bonds, goals, and tasks
• Bonds are constituted by the core conditions of therapy, the client’s attitude toward
the therapist, and the therapist’s style of relating to the client
• goals are the mutually negotiated, understood, agreed upon, and regularly reviewed
aims of the therapy
• tasks are the activities carried out by both client and therapist
Important components of a therapeutic alliance
• Therapist and patient work collaboratively to create therapeutic change through an
affectionate bond
• Agreement on goals of therapy
• The therapist’s ability to be empathetic and involved in therapy
• The ability of the patient to do the work of therapy
What is Psychotherapy
Holistic treatment that relies on the nurse’s processing of what the patient is experiencing
During the Psychotherapy process the Psychiatric APN addresses individual and family
problems with the patient
• assesses identified problems during the orientation phase of the therapeutic
relationship; determines the underlying healthcare issues with the patient
• collects psychiatric data; and establishes a trusting relationship
• Applying core principles of psychotherapy as well as nursing theory to promote
recovery through adaptation.
Legal and Ethical considerations (Beneficence, Duty, Malfeasance, Fiduciary duty, Autonomy)
- Beneficence: The ethical principle of doing good or acting in the best interest of the
patient.
- Duty to warn: Most states have laws that either require or permit mental health
professionals to disclose info about patients who may become violent.
- Malfeasance: The willful, intentional act of doing harm; physical or monetary.
- Nonmaleficence: Do no harm.
- Fiduciary duty: The legal responsibility to act solely in the best interest of another party.
- Autonomy: The state or condition of self-governance, or leading one's life according to
reasons, values, or desires that are authentically one's own.
, DSM IV vs. DSM V TR
DSM 5 TR
• No longer uses a multiaxial system, but instead allows for rating of disorder along a
continuum of severity
• Global assessment of functioning (GAF) replaced by more detailed tool known as World
Health Organization-Disability Assessment schedule version 2.0
• Recognizes the increased importance of culture and social context in mental health care
• Includes dimensional aspects of diagnosis along with categories
• Number of specifiers and subtypes has been expanded to dimensionalize disorders more
so than in past versions
• Handful of new disorders included- hoarding disorder, disruptive mood dysregulation
disorder, premenstrual dysphoric disorder, binge eating disorder, restless leg syndrome,
& REM sleep behavior disorder
• Mental retardation replaced by intellectual developmental disorder
• Substance abuse and substance dependence replaced by substance use disorder
• "Not otherwise specified" categories renamed as "other specified" and "unspecified" to
keep with ICD-10 language.
The five axes of the multi-axial system (DSM-IV, prior to DSM-5):
1. Axis 1- Mental health and substance use disorders (example anxiety, depression)
2. Axis 2- Personality disorders and mental retardation (now known as intellectual
development disorder) (example antisocial personality disorder)
3. Axis 3- General medical conditions: medical conditions that cause the mental disorder
(example Alzheimer's disease, cancer)
4. Axis 4- Psychosocial and environmental problems (example inadequate social support,
recent divorce, death of a parent)
5. Axis 5- Global assessment of functioning (GAF) (numerical scale that measures level of
functioning of client from 0-100 with 0=inadequate information and 100=high functioning
with no symptoms of mental illness present)
DSM 5-TR classification of Psychiatric illness o The DSM-5 is a diagnostic manual. It does not
provide theories of cause, management, or treatment options. It lists 22 major categories
of mental disorders with more than 150 individual illnesses. The DSM-5 is organized to
follow the lifespan with neurodevelopmental disorders that occur early in life listed first
and neurocognitive disorders that occur at the end of life listed last. It is organized this way
to assist the diagnostic decision-making process.
Mnemonic:
"Depressed Patients Seem Anxious, So Claim Psychiatrists"
o Depression and other mood disorders (major depression, bipolar disorder, dysthymia)
Personality disorders (primarily borderline personality disorder)
Substance abuse disorders
