A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient's self-esteem but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario?

Correct Answer: D

Rationale: The correct answer is D) The nurse should have assessed the patient's culture before making this diagnosis and plan. This is the most accurate analysis because culture plays a significant role in shaping an individual's behaviors, beliefs, and values, including social norms related to eye contact. In the case of the Filipino American patient, cultural factors may have influenced their behavior, such as cultural norms around eye contact or communication styles. Option A is incorrect because while role-playing could be a helpful intervention, it may not address the underlying cultural factors impacting the patient's behavior. Option B is incorrect as nurses are trained to independently assess, diagnose, and plan care for patients, but cultural competence is essential in providing effective care. Option C is incorrect as assuming the patient's poor eye contact indicates anger and hostility without further assessment can lead to misinterpretation and inappropriate interventions. In an educational context, this scenario highlights the importance of cultural competence in nursing practice. Nurses must consider the cultural background of each patient to provide individualized and effective care. Understanding how culture influences behavior can prevent misunderstandings, improve patient outcomes, and promote a more holistic approach to care. This case underscores the need for ongoing cultural education and awareness in healthcare settings to deliver patient-centered care.

Correct Answer: A

Rationale: In this scenario, the most appropriate nursing diagnosis for the patient expressing feelings of fatigue and lack of motivation to get out of bed is option A) Fatigue. This choice aligns best with the patient's reported symptoms and reflects the assessment data provided. Option B) Ineffective coping may be a common nursing diagnosis for patients with major depressive disorder, but in this specific case, the patient's primary concern is related to physical fatigue rather than coping mechanisms. Option C) Imbalanced nutrition: Less than body requirements is not supported by the information provided in the question. The patient's symptoms point more towards fatigue and lack of energy rather than nutritional deficits. Option D) Hopelessness does not directly address the patient's reported symptoms of fatigue and lack of motivation. While hopelessness may be a relevant concern for patients with major depressive disorder, it is not the most appropriate diagnosis based on the information provided. Educationally, it is crucial for nurses to effectively assess and diagnose patients based on their reported symptoms and assessment findings. Understanding the nuances of different nursing diagnoses and selecting the most appropriate one based on the patient's individual situation is vital for providing quality care and developing effective care plans.

Correct Answer: B

Rationale: In this scenario, option B, 'I understand that you feel ashamed, but we are here to help you,' is the most appropriate response. This response shows empathy and support, acknowledging the patient's feelings while also indicating the nurse's commitment to providing assistance and care. Option A is incorrect as it dismisses the patient's feelings of shame, which can be detrimental to building trust and rapport. Option C overlooks the emotional aspect of the patient's statement and focuses solely on a behavioral aspect. Option D is inappropriate as it uses a judgmental and confrontational approach, which can further exacerbate the patient's feelings of shame and guilt. In an educational context, it is crucial for nurses to develop strong therapeutic communication skills to effectively support patients with eating disorders. Showing empathy, validating feelings, and offering support are key components of building a therapeutic relationship with patients struggling with mental health issues like bulimia nervosa. By choosing option B, the nurse demonstrates a patient-centered approach that fosters trust and encourages the patient to engage in treatment.

Correct Answer: D

Rationale: The correct response to this question involves applying the evaluation step of nursing process. Sleeping a total of 5 hours at night remains a reasonable outcome. Extending the period for attaining the outcome may be appropriate. Examining interventions might result in planning an activity during the afternoon rather than permitting a nap. Continuing the current plan without changes is inappropriate. Removing this nursing diagnosis from the plan of care would be correct when the outcome was met and the problem resolved. Writing a new nursing diagnosis is inappropriate because no other nursing diagnosis relates to the problem.

Correct Answer: C

Rationale: In caring for a patient diagnosed with anorexia nervosa who is refusing to eat and at risk for malnutrition, the priority nursing intervention is option C) Provide the patient with a structured meal plan and closely monitor food intake. This intervention is crucial because patients with anorexia nervosa often have distorted perceptions of their body weight and food intake. By providing a structured meal plan, the nurse can help establish a routine for the patient's eating habits and ensure they are receiving adequate nutrition. Close monitoring of food intake allows for early identification of any deviations from the plan, enabling prompt intervention to prevent further malnutrition. Option A is less of a priority because monitoring weight and nutrition levels, although important, does not address the immediate need to ensure the patient is consuming necessary nutrients. Option B may not be effective as patients with anorexia nervosa may find it challenging to increase intake on their own. Option D is incorrect as reassurance alone is not sufficient to address the complex psychological and physical issues associated with anorexia nervosa. In an educational context, understanding the rationale behind the priority intervention emphasizes the significance of structured care plans and close monitoring in managing patients with eating disorders. It highlights the role of nurses in providing holistic care to address both the physical and psychological aspects of the patient's condition.