Which of the options below would be a priority nursing diagnosis?
Anxiety
Ineffective coping
Chronic low self-esteem
Self-harm
The Correct Answer is D
Choice A Reason:
Anxiety is incorrect. While anxiety is a valid concern, it may not be an immediate threat to the individual's safety.
Choice B Reason:
Ineffective coping is incorrect. This is relevant, but it doesn't address the urgency associated with potential self-harm.
Choice C Reason:
Chronic low self-esteem is incorrect. Low self-esteem is a significant issue, but it may not require immediate intervention compared to the risk of self-harm.
Choice D Reason:
Self-harm is correct. Assessing and addressing the risk of self-harm takes precedence, as it involves ensuring the immediate safety and well-being of the individual. Once the risk of self-harm is addressed, the nurse can then explore and address other related concerns, such as anxiety, coping mechanisms, and self-esteem.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A Reason:
Formulating a nursing diagnosis is incorrect. This occurs after a comprehensive assessment of the patient's needs, and it helps guide the planning and implementation of nursing care.
Choice B Reason:
Planning for continued care is incorrect. Once the nursing diagnosis is formulated, the nurse can develop a plan of care, including interventions and goals for the patient.
Choice C Reason:
Promoting patient's insight is incorrect. This is a part of the ongoing therapeutic process and involves helping the patient gain self-awareness and understanding of their thoughts, feelings, and behaviors. It typically occurs after the initial assessment and planning.
Choice D Reason:
Examining personal biases is correct. In the nurse-patient relationship, examining personal biases is a foundational and essential step that should happen first. It involves the nurse being self-aware and acknowledging any personal biases or prejudices that might affect the therapeutic relationship. Recognizing and addressing personal biases is crucial for providing unbiased and patient-centered care.
Correct Answer is A
Explanation
Choice A Reason:
Safety needs is correct. In this scenario, the individual's safety is compromised both at work (due to the potential layoff) and at home (due to intimate partner violence). Safety needs, which include physical and emotional security, are fundamental in Maslow's hierarchy and take precedence over other needs in this situation.
Choice B Reason:
Physiological needs is incorrect. While a possible layoff can impact financial stability, it may not directly threaten immediate access to basic physiological needs like food, water, and shelter. The immediate safety concern takes precedence.
Choice C Reason:
Love and belonging needs is incorrect. Although witnessing intimate partner violence can strain relationships and affect the sense of belonging, the primary concern in this scenario is the immediate threat to safety.
Choice D Reason:
Esteem needs is incorrect. The threat of a layoff and exposure to domestic violence can impact self-esteem, but the more critical issue at the moment is ensuring physical safety.
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