Clinical Dilemma Activity
Name: Margot Davis, 18 years old
Primary Concept
Stress/Coping
Interrelated Concepts (In order of emphasis)
1. Clinical Judgment
2. Communication
3. Collaboration
4. Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
, Clinical Dilemma Activity:
I. Scenario
History of Present Problem:
Margot is an 18-year-old female who presents to the emergency department (ED) with burning and pain “down
there.” She is wearing a halter top and an extremely short skirt despite moderate temperatures outside. Margot
is quite thin and looks younger than her stated age. An older female accompanies her; she calls “Aba.” During
the initial triage assessment, Aba insists on staying with Margot because “Margot is so nervous around
strangers.” Margot frequently looks at Aba before answering questions. At times, Aba answers the intake
questions in place of a response from Margot. When questioned about her sexual history, Margot admits to
being sexually active but states “I don’t know” to more detailed questions about her sexual history. Margot has
a flat affect (no expression) and poor eye contact. Aba is asked to leave the room during the intake and physical
exam, but she declines.
Margot is placed in a room in the ED. During the initial nursing assessment, the nurse notices different stages of
healed bruising on arms and inner thighs. There is a possible scarring of the antecubital area (inner aspect) of
the arm. When Margot is asked about the bruising on her arms and inner thighs, Aba states that Margot can be
extra clumsy sometimes. There is a tattoo of a crown on her chest just above her right breast.
Personal/Social History
Margot reports she ran away from home a couple of months ago when her mother’s boyfriend started making
sexual advances towards her. Margot’s mother dismissed Margot’s concerns telling her to just stay away from
the boyfriend. Margot tells the nurse that Aba is a friend of her deceased grandmother who took her in after
she ran away from home. Margot does not have health insurance, but Aba agrees to pay for this visit.
Aba speaks with a Hispanic accent. Margot and Aba sometimes converse in Spanish during the intake
interview. Margot listed “other” on her intake form when asked to identify her own ethnicity/race.
What data from the histories is important & RELEVANT; therefore, it has clinical significance to the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
-She is 18 years old -This means she is of age and considered an adult
-Burning and pain "down there" -This may be a genitourinary issues
-Wearing a halter top and extremely short skirt -Clothes are not appropriate for the moderate
despite the weather temperatures outside; sex trafficking indecator
-Strays away from answering specific answers -This may be because of Margot's age. It is normal to
about sexual history and frequently looking to Aba feel discomfort when talking about sexual history.
when answering Keep looking for s/sx for possible abuse.
-This is another sign of physical/ sexual abuse
-Bruising in various stages of healing on arms
-The story of how the injuries happen does not add up
and inner thighs. Possible scarring of the
-We would need to find out how old she really is,
antecubital area.
getting some identification
-The explanation of the cause "She can be clumsy"
-May be a branding
-States that she is 18 years old, but appears to be -This may be indication that she is not getting good
younger nutrition
-Tattoo above her breast
-She appears to be very thin
RELEVANT Data from Social History: Clinical Significance:
-Margot ran away from home when her -Running away at such a young age puts
mothers boyfriend started making sexual Margot as risk for being taken advantage of.
advances towards her. -She may feel self doubt and abandoned
-Mother dismissed concerns and told her to because of the way her mother reacted to the
stay away situation
-She does not have any health insurance -This may be a way to hide who she really is
-Putting other as her background and her age
© 2019 KeithRN LLC. All rights
reserved.
Name: Margot Davis, 18 years old
Primary Concept
Stress/Coping
Interrelated Concepts (In order of emphasis)
1. Clinical Judgment
2. Communication
3. Collaboration
4. Patient Education
NCLEX Client Need Categories Percentage of Items from Each Covered in
Category/Subcategory Case Study
Safe and Effective Care Environment
Management of Care 17-23%
Safety and Infection Control 9-15%
Health Promotion and Maintenance 6-12%
Psychosocial Integrity 6-12%
Physiological Integrity
Basic Care and Comfort 6-12%
Pharmacological and Parenteral Therapies 12-18%
Reduction of Risk Potential 9-15%
Physiological Adaptation 11-17%
, Clinical Dilemma Activity:
I. Scenario
History of Present Problem:
Margot is an 18-year-old female who presents to the emergency department (ED) with burning and pain “down
there.” She is wearing a halter top and an extremely short skirt despite moderate temperatures outside. Margot
is quite thin and looks younger than her stated age. An older female accompanies her; she calls “Aba.” During
the initial triage assessment, Aba insists on staying with Margot because “Margot is so nervous around
strangers.” Margot frequently looks at Aba before answering questions. At times, Aba answers the intake
questions in place of a response from Margot. When questioned about her sexual history, Margot admits to
being sexually active but states “I don’t know” to more detailed questions about her sexual history. Margot has
a flat affect (no expression) and poor eye contact. Aba is asked to leave the room during the intake and physical
exam, but she declines.
Margot is placed in a room in the ED. During the initial nursing assessment, the nurse notices different stages of
healed bruising on arms and inner thighs. There is a possible scarring of the antecubital area (inner aspect) of
the arm. When Margot is asked about the bruising on her arms and inner thighs, Aba states that Margot can be
extra clumsy sometimes. There is a tattoo of a crown on her chest just above her right breast.
Personal/Social History
Margot reports she ran away from home a couple of months ago when her mother’s boyfriend started making
sexual advances towards her. Margot’s mother dismissed Margot’s concerns telling her to just stay away from
the boyfriend. Margot tells the nurse that Aba is a friend of her deceased grandmother who took her in after
she ran away from home. Margot does not have health insurance, but Aba agrees to pay for this visit.
Aba speaks with a Hispanic accent. Margot and Aba sometimes converse in Spanish during the intake
interview. Margot listed “other” on her intake form when asked to identify her own ethnicity/race.
What data from the histories is important & RELEVANT; therefore, it has clinical significance to the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
-She is 18 years old -This means she is of age and considered an adult
-Burning and pain "down there" -This may be a genitourinary issues
-Wearing a halter top and extremely short skirt -Clothes are not appropriate for the moderate
despite the weather temperatures outside; sex trafficking indecator
-Strays away from answering specific answers -This may be because of Margot's age. It is normal to
about sexual history and frequently looking to Aba feel discomfort when talking about sexual history.
when answering Keep looking for s/sx for possible abuse.
-This is another sign of physical/ sexual abuse
-Bruising in various stages of healing on arms
-The story of how the injuries happen does not add up
and inner thighs. Possible scarring of the
-We would need to find out how old she really is,
antecubital area.
getting some identification
-The explanation of the cause "She can be clumsy"
-May be a branding
-States that she is 18 years old, but appears to be -This may be indication that she is not getting good
younger nutrition
-Tattoo above her breast
-She appears to be very thin
RELEVANT Data from Social History: Clinical Significance:
-Margot ran away from home when her -Running away at such a young age puts
mothers boyfriend started making sexual Margot as risk for being taken advantage of.
advances towards her. -She may feel self doubt and abandoned
-Mother dismissed concerns and told her to because of the way her mother reacted to the
stay away situation
-She does not have any health insurance -This may be a way to hide who she really is
-Putting other as her background and her age
© 2019 KeithRN LLC. All rights
reserved.
