# Which nursing problem should the nurse address first?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=491181  
> language: ko  
> subject: Nursing

## 문제

Which nursing problem should the nurse address first?

## 보기

1. Powerlessness
2. Anxiety
3. Sleep disturbance **✔ 정답**
4. Low self-esteem
5. Disturbed body image

**정답: 3**

## 해설

Actual physiologic problems are addressed first.

## 심화 해설

Key Nursing Concept
This item tests the principles for prioritizing nursing problems within the nursing process. According to Maslow's hierarchy of needs, physiologic needs (basic survival needs) are the most fundamental and take precedence over psychosocial needs.

The correct answer, **sleep disturbance**, is a direct and immediate physical problem that falls under physiologic needs. Adequate sleep is the foundation of recovery and healing, and sleep deprivation can lead to secondary problems such as heightened pain perception, impaired immune function, and decreased cognitive function. It therefore takes priority over the other psychosocial problems.

Incorrect options: Watch out! Powerlessness, anxiety, low self-esteem, and disturbed body image all reflect psychosocial and self-actualization needs. These are very important, but unless they pose a direct threat to life, they rank below physiologic needs. When a patient is not yet stable, physical stabilization always comes first.

High-Yield Exam Point
Prioritize nursing problems in this order: **life-threatening problems > physiologic needs > safety/security needs > love/belonging needs > self-esteem needs > self-actualization needs**. Once you have verified that "ABCs (airway, breathing, circulation)" are intact, assess basic physiologic needs such as pain, sleep, and nutrition next.

## 임상 시나리오

Clinical Nursing Practice Guide
When you care for a patient who reports sleep disturbance in actual practice, priority nursing interventions include the following:

1. **Assess the sleep pattern:** Use a sleep diary to evaluate actual hours slept, number of awakenings, napping patterns, and the sleep environment (noise, light).

2. **Identify underlying causes:** Look for physiologic and psychological factors that disrupt sleep, such as pain, dyspnea, frequent urination, medication side effects, and anxiety.

3. **Try nonpharmacologic measures first:** Offer a warm bath at bedtime, relaxation techniques, white noise, dimmed lighting, and clustered care to minimize interruptions.

4. **Administer medication:** When giving a prescribed sleep aid, consider the patient's fall risk and use it for the shortest duration possible.

A Word from an Experienced Nurse
"A patient has to sleep well before the body can heal and the mind can settle. You may want to ease their anxiety first, but remember that any conversation loses half its effect with an exhausted patient. **Sleep is part of the treatment.**"

## 핵심 개념

- **Maslow's hierarchy of needs** — A theory that classifies human needs into five levels—physiologic, safety, love/belonging, esteem, and self-actualization—holding that lower-level needs must be met before higher-level needs become motivating. It is the foundation for setting nursing problem priorities.
- **Sleep disturbance** — A condition involving persistent problems with sleep onset, maintenance, quality, or timing that causes significant distress or impairment in daily functioning. Examples include insomnia, sleep apnea, and restless legs syndrome.
- **Powerlessness** — A helpless psychological state arising from the perception that one cannot control or change one's situation or environment. It is commonly seen in patients with chronic illness and in hospitalized patients.
- **Disturbed body image** — A state in which a person's mental image of the structure, function, or appearance of the body becomes distorted or negatively altered. It may result from surgery, trauma, or illness.
- **Prioritization of nursing problems** — The key step of the nursing process in which the order for addressing a patient's multiple problems is determined by their urgency and importance. Life-threatening problems receive the highest priority.

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