# Situation: A 40-year-old woman is admitted to the psychiatric ward with major depressive disorder. She has lost 3 kg in 4 weeks, eats about half of each meal, sleeps 3 to 4 hours a night, and says worrying thoughts keep her awake at bedtime. Her vital signs are within normal limits. The nurse writes nursing diagnoses using NANDA International (NANDA-I) 2024–2026 labels. She tells the nurse, "Ever since I was a small child, I have known I am worthless. I never do anything right." She avoids eye contact and rejects praise from staff. Which nursing diagnosis label BEST fits this cluster of data?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629993  
> language: ko  
> subject: Nursing Practice V — Care of Clients with Maladaptive Patterns of Behavior; Care of Clients with Life-Threatening Conditions, Acute Multi-Organ Problems, High Acuity and Emergency Situations

## 문제

Situation: A 40-year-old woman is admitted to the psychiatric ward with major depressive disorder. She has lost 3 kg in 4 weeks, eats about half of each meal, sleeps 3 to 4 hours a night, and says worrying thoughts keep her awake at bedtime. Her vital signs are within normal limits. The nurse writes nursing diagnoses using NANDA International (NANDA-I) 2024–2026 labels.

She tells the nurse, "Ever since I was a small child, I have known I am worthless. I never do anything right." She avoids eye contact and rejects praise from staff. Which nursing diagnosis label BEST fits this cluster of data?

## 보기

1. Maladaptive coping
2. Chronic inadequate self-esteem **✔ 정답**
3. Risk for chronic inadequate self-esteem
4. Situational inadequate self-esteem

**정답: 2**

## 해설

Negative self-evaluation that has lasted a long time, here since childhood, with avoidance of eye contact and rejection of positive feedback, fits the chronic form of inadequate self-esteem. The situational form describes a negative self-view that develops in response to a current event in a person who previously valued herself.

## 심화 해설

Long-standing self-negation fits the chronic label
The client says, "Ever since I was a small child, I have known I am worthless. I never do anything right." She avoids eye contact and rejects praise from staff. Negative self-evaluation that has lasted a long time, here since childhood, together with rejection of positive feedback, fits Chronic inadequate self-esteem. The NANDA International (NANDA-I) 2024 to 2026 labels use the wording "inadequate self-esteem" in place of the older "low self-esteem", and the defining characteristics remain negative self-statements, rejection of positive feedback, poor eye contact, and exaggerated negative feedback about self.

Chronic versus situational
The key to choosing between the two forms is time course. Chronic inadequate self-esteem describes a long-standing pattern of negative self-evaluation, often beginning early in life, that persists across situations. Situational inadequate self-esteem describes a negative self-view that develops in response to a current event, such as job loss or divorce, in a person who previously valued herself. Her statement that she has felt worthless since childhood points clearly to the chronic form.

| Label | Time course | Fits her? |
| --- | --- | --- |
| Chronic inadequate self-esteem | Long-standing, since childhood | Yes |
| Situational inadequate self-esteem | New, in response to a current situation | No |
| Risk for chronic inadequate self-esteem | Problem not yet present | No: already present |
| Maladaptive coping | Ineffective responses to stressors | No: cluster centers on self-evaluation |

Why the other labels do not fit
A risk diagnosis is used only when the problem has not yet developed but risk factors are present; her negative self-evaluation already exists and is long-standing, so a risk label understates the problem. Maladaptive coping describes ineffective responses to stressors, and while depression may involve poor coping, the data cluster here centers on how she evaluates herself. The diagnosis should match the main pattern in the data.

Watch out! Her weight loss, reduced intake, and poor sleep with worrying thoughts support other diagnoses, but the question asks about the cluster of self-statements, avoidance of eye contact, and rejection of praise. Match the label to the cluster the stem presents.

Exam takeaway
Key point! Chronic means long-standing and pervasive; situational means a recent change triggered by an event. Nursing care includes helping her identify strengths, setting small achievable tasks, giving honest and specific feedback, and challenging negative self-statements gently.

## 임상 시나리오

Chronic Inadequate Self-EsteemChoosing the right NANDA-I label
Feeling worthless "ever since I was a small child", avoiding eye contact, and rejecting praise fit Chronic inadequate self-esteem.

The situational form arises in response to a current event in a person who previously valued herself. A risk label is used only when the problem has not yet developed.

Help her identify strengths, set small achievable goals, and give honest, specific feedback rather than general praise she may reject.

CautionMatch the label to the cluster in the stem; weight loss and poor sleep support other diagnoses.

## 핵심 개념

- **Chronic inadequate self-esteem** — A NANDA-I diagnosis of long-standing negative self-evaluation, often beginning in childhood.
- **Situational inadequate self-esteem** — A negative self-view that develops in response to a current situation in a person who previously valued herself.
- **Risk diagnosis** — A nursing diagnosis used when risk factors are present but the problem has not yet developed.
- **Defining characteristics** — Observable cues or client statements that support a nursing diagnosis.

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