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 B
Explanation
Choice A Reason:
“I live too far from art and history museums to visit them as often as I would like. “This pertains more to self-actualization and leisure activities, which are higher-level needs.
Choice B Reason:
"Four robberies and three assaults occurred in my neighborhood in the past month. “This statement addresses safety concerns, which fall under the second level of Maslow's hierarchy. Ensuring safety is a fundamental need that takes priority before addressing social or esteem needs.
Choice C Reason:
"I feel so alone. I wish I had someone special in my life." This addresses the need for belonging and social connection, which is a higher-level need compared to safety.
Choice D Reason:
"I did not do a good job on the project my supervisor assigned." This relates to self-esteem and job performance, which are higher-level needs.
Correct Answer is A
Explanation
Choice A Reason:
Engaging in friendly interactions with the client is correct. Developing a therapeutic relationship involves creating a supportive and empathetic connection with the client. Engaging in friendly interactions helps build trust and rapport. This approach fosters a positive environment for communication and collaboration.
Choice B Reason:
Instructing the client on how he should behave is incorrect. Instructing the client on how to behave can be perceived as directive and may hinder the development of a collaborative and trusting relationship.
Choice C Reason:
Setting limits for the relationship is incorrect. While setting boundaries is important, using the term "limits" can convey a sense of restriction. It's crucial to establish appropriate boundaries, but the term "limits" may not promote the openness needed in a therapeutic relationship.
Choice D Reason:
Promoting the use of transference by the client is incorrect. Promoting transference involves encouraging the client to project feelings from past relationships onto the nurse. This is generally not considered a therapeutic approach and may lead to misunderstandings in the therapeutic relationship.
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