Situation: The public health nurse visits a family of six in a farming barangay. The grandmother, 74, has been bedridden since a stroke 3 months ago and has a reddened area over the sacrum that does not blanch when pressed. Her daughter-in-law, 40, cares for her while also selling goods at the market, and feeds her while she lies flat because it is easier. The family's income dropped when the eldest son lost his job. In the family nursing problem prioritization scale, which pairing of a rating with its raw score is CORRECT?

Modifiability scores 2 (easily), 1 (partially), or 0 (not modifiable) out of 2. Preventive potential has no zero score: high is 3, moderate 2, and low 1. For nature of the problem, a foreseeable crisis scores 1, and a wellness state scores 3, the same as a health deficit.

The question asks you to recall the scoring rules for the family nursing problem prioritization scale, specifically the pairing between a rating category and its correct raw score. This scale is used in community health nursing to rank identified family health problems by systematically scoring each problem across dimensions such as the nature of the problem, modifiability, preventive potential, and salience. The correct answer is option 4, which states that a problem rated as not modifiable receives a score of 0 out of 2.

Let’s break down each option to understand why the other pairings are incorrect.

Scoring the nature of the problem

The nature of the problem is scored on a scale of 1 to 3. A wellness state or potential for health promotion receives the highest score of 3, because it represents an opportunity to actively improve health rather than merely treat an existing deficit. A health deficit also scores 3, reflecting the urgency of an actual illness or impairment. A health threat scores 2, and a foreseeable crisis scores 1. Option 2 is therefore incorrect because a wellness state does not score 1; it scores 3. Option 3 is also incorrect because a foreseeable crisis scores 1, not 2.

Scoring preventive potential

Preventive potential is scored on a scale of 1 to 3. A high preventive potential scores 3, moderate scores 2, and low scores 1. There is no zero score for preventive potential. Option 1 is incorrect because it assigns a score of 0 to low preventive potential, but the lowest possible score on this dimension is 1.

Scoring modifiability

Modifiability reflects how easily the family and nurse can change or improve the problem given current resources and circumstances. It is scored on a scale of 0 to 2. Easily modifiable problems score 2, partially modifiable problems score 1, and not modifiable problems score 0. Option 4 is correct because it accurately pairs not modifiable with a score of 0 out of 2.

Key point! The preventive potential scale has no zero, while the modifiability scale does. This distinction is a common source of confusion on licensure exams.

In the scenario, the grandmother’s sacral redness that does not blanch suggests a stage 1 pressure injury. The daughter-in-law feeds her while lying flat, which increases aspiration risk. These are health deficits or threats. When scoring modifiability, the nurse would consider whether the family can realistically change the feeding position or reposition the grandmother. If the daughter-in-law is overwhelmed by caregiving and income loss, the problem may be only partially modifiable or not modifiable at all, depending on available support and resources. The pilot study on stroke caregivers highlights that informal caregivers face evolving emotional and logistical challenges once structured rehabilitation wanes, which can reduce a family’s capacity to modify health problems without additional support . Similarly, the mixed-methods analysis of caregiver perceptions shows that financial concerns—such as lost income or costs of care—can act as barriers that influence how families engage with health interventions . These contextual factors are exactly what a community health nurse weighs when assigning modifiability scores.

The correct pairing is therefore not modifiable with a raw score of 0 out of 2.