Nokea
A mother of an outspoken school-aged child tells the nurse: "I feel incompetent as a parent and have difficulty disciplining my child." What should be the nurse's first action when counseling this patient?
- A. Recommending that she discipline her child more strictly and consistently
- B. Making a "to-do" list for the child's father to allow her more time to focus on improving her parenting skills
- C. Assisting the mother to identify both what she thinks is successful and what she can do to improve
- D. Exploring how the child can improve their behavior and make the mother's role as a parent easier
Correct Answer: C
Rationale: The nurse assesses the issue first, helping the mother identify what they believe is working and what is preventing them from being an effective parent. Next the nurse can explore solutions aimed at improving their parenting skills. Without assessment, there is no indication the child needs more strict discipline or assistance of the father. The child is not responsible for making the mother's parental role easier.
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An older adult patient has a health problem of Disturbed Body Image documented on their care plan. The nurse discovers that patient feels they look old and feeble when ambulating with an assistive device often walking without it. The patient has fallen several times. What is an appropriate goal for this patient?
- A. The patient will state the need to use the assistive device both inside and outside the house.
- B. The patient will demonstrate proper use of the assistive device as observed by the nurse and physical therapist.
- C. The patient will discuss their feelings about the device and compare that with the need for safety.
- D. The patient will be given a wheelchair for mobility, as it is safer.
Correct Answer: C
Rationale: The patient is demonstrating a maladaptive response. Patients who deny and avoid dealing with limitations or deformity, engage in self-destructive behavior, or fail to estimate relationship of body to environment are experiencing a disturbed self-concept. The patient will need to discuss their feelings to reframe the situation and prioritize safety.
A young adult businessperson attends counseling, attempting to deal with a history of sexual abuse by their father. "I should feel satisfied with what I've achieved, but nothing I accomplish makes me feel good about myself.... I hate my father for making me feel like I'm no good. This is an awful way to live." What statement by the nurse would be most helpful?
- A. "You've managed to overcome a lot since your childhood."
- B. "Can you identify some positive attributes about yourself."
- C. "Perhaps it's time to accept you're an adult and the abuse is in the past."
- D. "What might make you feel more content? Go after it!"
Correct Answer: B
Rationale: This patient's self-concept disturbance is mainly one of devaluing themselves and thinking that they are no good. The nurse assists the patient in reframing their negative thoughts into positive thoughts by identifying positive attributes.
A nurse asks a 25-year-old patient to describe themself with a list of 20 words. After 15 minutes, the patient listed, "25 years old, male, named Joe," then declared he could not think of anything else. What should the nurse document regarding this patient?
- A. This patient presents with lack of self-esteem.
- B. The patient does not possess self-knowledge.
- C. This person has unrealistic expectations of themselves.
- D. There is an inability to evaluate himself realistically.
Correct Answer: B
Rationale: The patient's inability to list more than three items about themselves indicates deficient self-knowledge and lack of familiarity with their own qualities and traits. There is insufficient data to determine whether they lack self-esteem, have unrealistic self-expectations, or are unable to evaluate themselves.
A sophomore in high school has missed a great deal of school due to treatment of leukemia. They stated they feel that they are falling behind in everything, and miss "hanging out at the mall" with friends most of all. What statement by the nurse is most appropriate?
- A. "It sounds like you don't know who you are anymore..."
- B. "Have the changes in your body since your diagnosis affected you?"
- C. "How are you viewing yourself these days?"
- D. "This must be difficult as adolescents' friends are very important to them."
Correct Answer: D
Rationale: Important roles for this adolescent include student and a friend; the illness is preventing them from doing either of these well, which reflects a disturbance in role performance. Stating that it sounds like you don't know who you are anymore is a question related to personal identity disturbance; asking about changes in the body would relate to disturbed body image; asking how are you viewing yourself these days relates to self-esteem disturbance.
A school nurse is meeting with the parent of a child who stated the child's other parent has been given a lengthy prison sentence. Which action by the nurse would be most helpful to mitigate an adverse child experience?
- A. Assessing the student's grades and ability to complete class work
- B. Suggesting a mentoring program for children of incarcerated parents
- C. Asking the parent to tell you what happened
- D. Suggesting the parent help the child identify their strengths
Correct Answer: B
Rationale: Factors that can mitigate adverse child experiences include strengthening economic support to families; promoting social norms that protect against violence and adversity; and ensuring a strong start for children including support groups, mentoring, and teaching needed skills.