Nokea
An 11-year-old child says, 'My parents don't like me. They call me stupid and say I never do anything right, but it doesn't matter. I'm too dumb to learn.' Which nursing diagnosis applies to this child?
- A. Chronic low self-esteem, related to negative feedback from parents
- B. Deficient knowledge, related to interpersonal skills with parents
- C. Disturbed personal identity, related to negative self-evaluation
- D. Complicated grieving, related to poor academic performance
Correct Answer: A
Rationale: The child has indicated a belief in being too dumb to learn. The child receives frequent negative and demeaning feedback from the parents. Deficient knowledge is a nursing diagnosis that refers to knowledge of health care measures. Disturbed personal identity refers to an alteration in the ability to distinguish between self and nonself. Grieving may apply, but a specific loss is not evident in this scenario. Low self-esteem is more relevant to the child's statements.
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A 10-year-old child cares for siblings while the parents work because the family cannot afford a babysitter. This child says, 'My father doesn't like me. He calls me stupid all the time.' The mother says the father is easily frustrated and has trouble disciplining the children. The community health nurse should consider which resources to stabilize the home situation? (Select all that apply.)
- A. Parental sessions to teach child-rearing practices
- B. Anger management counseling for the father
- C. Continuing home visits to provide support
- D. Safety plan for the wife and children
- E. Foster placement of the children in foster care
Correct Answer: A,B,C
Rationale: Anger management counseling for the father is appropriate. Support for this family will be an important component of treatment. By the wife's admission, the family has deficient knowledge of parenting practices. Whenever possible, the goal of intervention should be to keep the family together; thus, removing the children from the home should be considered a last resort. Physical abuse is not suspected, so a safety plan is not a priority at this time.
An older adult, diagnosed with Alzheimer's disease, lives with family and has multiple bruises. The home health nurse talks with the older adult's daughter, who becomes defensive and says, 'My mother often wanders at night. Last night she fell down the stairs.' Which nursing diagnosis has priority?
- A. Risk for injury, related to cognitive impairment and lack of caregiver supervision
- B. Noncompliance, related to confusion and disorientation as evidenced by lack of cooperation
- C. Impaired verbal communication, related to brain impairment as evidenced by the confusion
- D. Insomnia, related to cognitive impairment as evidenced by wandering at night
Correct Answer: A
Rationale: The patient is at high risk for injury because of her confusion. The risk increases when caregivers are unable to provide constant supervision. No assessment data support the diagnoses of impaired verbal communication or noncompliance. Sleep pattern disturbance certainly applies to this patient; however, the diagnosis risk for injury is a higher priority.
A patient at the emergency department is diagnosed with a concussion. The patient is accompanied by a spouse who insists on staying in the room and answering all questions. The patient avoids eye contact and has a sad affect and slumped shoulders. Assessment of which additional problem has priority?
- A. Risk of intimate partner violence
- B. Phobia of crowded places
- C. Migraine headaches
- D. Depressive symptoms
Correct Answer: A
Rationale: The diagnosis of a concussion suggests violence as a possible cause. The patient is exhibiting indicators of abuse including fearfulness, depressed affect, poor eye contact, and a possessive spouse. The patient may be also experiencing depression, anxiety, and migraine headaches, but the nurse's advocacy role necessitates an assessment for intimate partner violence.
What feelings are most commonly experienced by nurses working with abusive families?
- A. Outrage toward the victim and sympathy for the abuser
- B. Sympathy for the victim and anger toward the abuser
- C. Unconcern for the victim and dislike for the abuser
- D. Vulnerability for self and empathy with the abuser
Correct Answer: B
Rationale: Intense protective feelings, sympathy for the victim, and anger and outrage toward the abuser are common emotions of a nurse working with an abusive family.
A patient tells the nurse, 'My husband is abusive only when he drinks too much. His family was like that when he was growing up. He always apologizes and regrets hurting me.' What risk factor was most predictive for the husband to become abusive?
- A. History of family violence
- B. Loss of employment
- C. Abuse of alcohol
- D. Poverty
Correct Answer: A
Rationale: An abuse-prone individual is an individual who has experienced family violence and was often abused as a child. This phenomenon is part of the cycle of violence. The other options may be present but are not as predictive.