# Situation: A 24-year-old woman is admitted to the psychiatric unit. Her medical workup, including laboratory tests and a neurologic examination, is normal, and she has not received any psychiatric medicine. The nurse performs a mental status examination (MSE). On day 3 she is still mute, but she nods and writes short, clear answers when given paper. She eats all of her meals when the tray is placed in front of her, and she bathes and dresses by herself after a verbal reminder. Which NANDA International (NANDA-I) 2024–2026 label BEST fits these data?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=630188  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 24-year-old woman is admitted to the psychiatric unit. Her medical workup, including laboratory tests and a neurologic examination, is normal, and she has not received any psychiatric medicine. The nurse performs a mental status examination (MSE).

On day 3 she is still mute, but she nods and writes short, clear answers when given paper. She eats all of her meals when the tray is placed in front of her, and she bathes and dresses by herself after a verbal reminder. Which NANDA International (NANDA-I) 2024–2026 label BEST fits these data?

## 보기

1. Disrupted thought processes
2. Impaired verbal communication **✔ 정답**
3. Decreased self-care ability syndrome
4. Inadequate nutritional intake

**정답: 2**

## 해설

Her main current problem is absent speech, while her written answers are clear and logical, which fits impaired verbal communication. She eats all her meals and bathes and dresses herself with only a reminder, so labels for self-care or nutrition are not supported.

## 심화 해설

Core assessment findings
On day 3, the patient remains mute but is able to nod and produce short, clear written answers when given paper. She eats all meals, and she bathes and dresses independently after a verbal reminder. These data point to a selective loss of spoken output with preserved cognitive clarity and intact basic self-care.

Why this fits Impaired verbal communication
The defining feature of Impaired Verbal Communication is a difficulty in receiving, processing, transmitting, or using the symbol system of language. In this patient, the problem is not comprehension or thought content — her written answers are logical and clear — but rather the motor or expressive channel of speech. A person who cannot speak but can communicate accurately through writing or gestures is demonstrating a verbal communication impairment, not a thought disorder. The NANDA-I label captures the functional deficit in spoken expression without implying that cognition is globally impaired.

Why the other labels are not supported
Disrupted thought processes would require evidence of disorganized, illogical, or delusional thinking. Her written answers are short and clear, so this label is not supported. Decreased self-care ability syndrome is a broad label that requires deficits across multiple self-care domains; she bathes and dresses herself with only a verbal reminder, which is a mild cue, not a self-care deficit. Inadequate nutritional intake is ruled out because she eats all of her meals when the tray is placed in front of her.

| NANDA-I label | Key requirement | Present in this patient? |
| --- | --- | --- |
| Impaired verbal communication | Difficulty with spoken or symbolic language expression | Yes — mute but writes clearly |
| Disrupted thought processes | Disorganized or illogical thinking | No — written answers are logical |
| Decreased self-care ability syndrome | Multiple self-care deficits | No — bathes and dresses with only a reminder |
| Inadequate nutritional intake | Insufficient food or fluid intake | No — eats all meals |

Clinical reasoning for the nursing process
In a psychiatric setting, mutism can occur in conditions such as catatonia, severe depression, or conversion disorder. The key differential point here is that the patient retains the ability to communicate through writing, which means the deficit is specific to the verbal channel. The mental status examination should always assess multiple communication modalities — speech, writing, gestures, and comprehension — before selecting a nursing diagnosis. This prevents the common error of labeling a patient as having a thought disorder when the actual problem is limited to expressive speech.

Link to the evidence base
Concept analyses of Impaired Verbal Communication emphasize that the diagnosis should be defined by the observable difficulty in verbal expression, while cognitive and receptive language functions may remain intact [1]. In psychiatric populations, language dysfunction can occur independently of global cognitive impairment, and careful assessment of each language domain — including written output — is essential to avoid misdiagnosis . This supports the principle that a selective speech deficit with preserved written communication is best captured by the verbal communication label rather than a thought process or self-care label.

Watch out! Do not confuse mutism with thought disorder. The patient's ability to write clear, logical answers is strong evidence that thought processes are intact. Key point! The NANDA-I label should match the specific functional deficit observed — here, spoken expression — not the most dramatic symptom.
References (research sources)

- [1]Impaired Verbal Communication: diagnosis review in patients with Amyotrophic Lateral Sclerosis.Research articleSevero AH, Carvalho ZMF, Lopes MVO, Brasileiro RSF, Braga DCO. (2018) · DOI: 10.1590/0034-7167-2017-0763

## 임상 시나리오

Impaired Verbal Communication in Psychiatric SettingsDifferentiating speech output deficits from thought or self-care disorders
When a patient is mute but writes clear, logical answers, the deficit is in the expressive speech channel, not in cognition or comprehension. This pattern supports the NANDA-I label Impaired verbal communication.

Rule out Disrupted thought processes by confirming that written content is organized and coherent. Rule out Decreased self-care ability syndrome when the patient performs ADLs with only a verbal reminder, and rule out Inadequate nutritional intake when meals are fully consumed.

CautionDo not equate mutism with thought disorder or global cognitive impairment. Always assess alternative communication methods such as writing or gestures before selecting a nursing diagnosis.

## 핵심 개념

- **Impaired verbal communication** — Difficulty in receiving, processing, transmitting, or using the symbol system of language; may involve expressive or receptive deficits.
- **Mental status examination (MSE)** — Structured assessment of cognitive, emotional, and behavioral functioning used in psychiatric evaluation.
- **NANDA-I** — NANDA International; organization that develops and classifies standardized nursing diagnoses.
- **Mutism** — Absence of speech with preserved ability to communicate through other means such as writing or gestures.

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