Which nursing diagnosis is most appropriate for a patient whose friends and family have grown distant after the death of the patient's spouse?

Readiness for enhanced spiritual well-being related to expressed desire for prayer

Impaired verbal communication related to alteration in sensory perception

Risk for loneliness related to insufficient interactions with friends and family

Health-seeking behavior related to the desire for increased control of personal health

Answer and Explanation

The Correct Answer is C

A. Readiness for enhanced spiritual well-being related to expressed desire for prayer: While this may be a valid diagnosis in some cases, the stem focuses on social isolation, not spiritual health.

B. Impaired verbal communication related to alteration in sensory perception: There is no mention of sensory deficits or communication issues.

C. Risk for loneliness related to insufficient interactions with friends and family: The core issue is social withdrawal after the loss of a spouse, leading to potential loneliness.

D. Health-seeking behavior related to the desire for increased control of personal health: The scenario doesn’t mention any actions or goals related to health improvement.

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Correct Answer is D

Explanation

A. Identity vs. Role Confusion: This stage occurs in adolescence (12–18 years), not infancy.

B. Integrity vs. Despair: This stage is associated with older adults reflecting on life.

C. Autonomy vs. Shame and Doubt: This occurs in toddlers (1–3 years), who are exploring independence.

D. Trust vs. Mistrust: This is the first stage (birth–1 year). Responsive caregiving helps infants develop a sense of trust in the world.

A. Assist the client to acknowledge that he has a distorted body image. B. Encourage the client to talk about his feelings regarding his body image C. Determine the client's perception of his body image. D. Discuss alternative coping strategies to relieve the stress he feels about his body image.

Correct Answer is C

Explanation

A. Assist the client to acknowledge that he has a distorted body image:
This may be important later, but first the nurse must assess the client’s current perception of his body image to guide interventions.

B. Encourage the client to talk about his feelings regarding his body image:
While therapeutic communication is crucial, assessment comes before intervention. Understanding the client’s perception helps tailor the discussion.

C. Determine the client's perception of his body image:
According to the nursing process, assessment is the first step. This helps guide individualized care for disturbed body image.

D. Discuss alternative coping strategies to relieve the stress he feels about his body image:
Coping strategies are appropriate after assessing the client’s emotional and psychological needs.

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Which nursing diagnosis is most appropriate for a patient whose friends and family have grown distant after the death of the patient's spouse?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for an infant whose caregiver comforts them as soon as they cry. The nurse should identify that the client is experiencing which of the following stages of Erikson's theory of psychosocial development?

Correct Answer is D

Explanation

A nurse is contributing to the plan of care for a client who has a disturbed body image following a motor vehicle crash that resulted in a right arm amputation. Which of the following actions should the nurse take first?

Correct Answer is C

Explanation

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