Chapter 41: Self-Concept

A client verbalizes experiencing a loss of control over life. Which follow-up question will the nurse ask this client?

"How do you view yourself in regard to your importance in your job and in your life?" Explanation: Self-perception is how a person explains behavior based on self-observation. Asking how the client views job and life represents a broad question that will provide a wide range of information regarding self-perception. Asking if the client feels appreciated is a closed-ended question and will not facilitate a discussion about self-perception. Asking about the client's failings is a closed-ended question and also will not lead to a discussion about self-perception. Asking if the client feels threatened at work or in life would be appropriate if the client communicated this fear.

The nurse takes the health history of a soldier who lost the right leg in a roadside bomb. Which question will the nurse ask the client while performing the health history?

"How has the loss of your leg affected your body image?" Explanation: The human body is the self's physical manifestation. How a person pictures and feels about the body describes body image. Any deviation from the ideal body, such as the loss of a limb, might affect a person's body image. Asking how the client feels about family and friends would be part of the social history assessment. Watching the client ambulate is not part of the health history and may be performed during the physical assessment. A support group would be helpful for a client who lost a limb but would not be included in the health history.

The nurse cares for a client who recently sustained a full-thickness (third-degree) burn. Which assessment question(s) will the nurse ask the client to determine the effect of the burn on the client's self-concept? Select all that apply.

"How would you describe yourself?" "Do you have interest in interacting with friends?" "Are you concerned you will not be able to care for your children?" "Are you able to look at your burns?" "What concerns you most about your burns?" Explanation: All answers are correct. Gordon (1997) suggests asking clients how they would describe themselves in the assessment of self-concept. Asking about interaction with family and friends assesses self-esteem. Asking about the concern of caring for children assesses role performance. Asking about the ability to look at burns assesses body image. Self-esteem, role performance, and body image are all part of self-concept.

The nurse is working on an oncology unit and is visiting with colleagues about how to prevent burnout as a professional nurse. The nurse works on a checklist that will provide information about how well the nurse is meeting the need for positive self-concept. The checklist contains statements that are answered with a positive or negative. Which statements would be good to have on the list? Choose all that apply.

"I cope effectively with change and loss." "I have good relationships with others." "I accept and feel good about myself." Explanation: Keeping in mind need for improvement can wear away positive self-esteem. Accentuate the positive. Setting goals that are too high may only wear down self-concept after awhile. The other choices are all good affirmations a person can make about oneself.

The nurse is providing care to a client who is recovering from mild myocardial infarction. The nurse determines that the client has an internal locus of control based on which client statement?

"I've been eating healthy and taking my medication. Otherwise, it could have been a lot worse." Explanation: A person with internal locus of control believes that personal behavior influences outcome and that he can achieve desired results. Therefore, the statement about eating healthy and taking medications indicates that the client believes that his actions influenced the outcome. A person with external locus of control perceives that outcomes happen because of luck, chance, or the influence of powerful others.

The nurse is caring for Mrs. Grace, a 26-year-old woman who has just delivered a healthy baby girl. Mrs. Grace says she wants to be a good mother and help her child develop in the best way possible. She asks the nurse, "What kind of self-concept is a baby born with?" The nurse's best answer is:

"No self-concept is present at birth." Explanation: The newborn has no self-concept at birth. In late infancy, a baby starts to differentiate between self and non-self. In childhood, differences between self and others are strong. During adolescence one's sense of self becomes very consolidated.

Which term refers to our ability to execute societal expectations regarding role-specific behaviors?

Role performance Explanation: Role performance is defined as our ability to execute societal expectations regarding role-specific behaviors.

A client started a nursing program and is trying to balance going to school full-time, a part-time job, and spending time with family. The client states, "I am trying to do everything and doing nothing well." Which role problem is this client experiencing from this role transition?

Role strain Explanation: Role strain occurs when the person perceives himself as inadequate or unsuited for a role and can occur when a person is forced to assume many roles. Role ambiguity occurs when a person lacks knowledge of role expectations. This lack of knowledge causes anxiety and confusion. Role conflict is related to expectations concerning the role.

What term best describes a person's sense of his own adequacy and worth?

Self-esteem Explanation: Self-esteem is a person's sense of his own adequacy and worth.

A student nurse who has not maintained healthy relationships with his or her peers would be at risk for what self-concept disturbance?

Self-esteem disturbance Explanation: The need for self-esteem is the need to feel good about oneself and to believe that others hold one in high regard; therefore, if someone has not maintained healthy relationships with his or her peers, he or she would be at risk for self-esteem disturbance. Personal identity describes a person's conscious sense of who he or she is. The question, "How would you describe yourself to others?" addresses what a person feels is his or her personal identity. Body image is the person's subjective view of one's physical appearance. Role performance is one's ability to successfully live up to societal as well one's own expectations regarding role-specific behaviors.

A 24-year-old man is suffering from depression. He has come to the clinic today for a follow-up visit with his provider and the nurse has been asked to provide some client education on the antidepressants he has been prescribed. When the nurse asks him how he is feeling today, he responds that he is feeling down because he feels as if he is a failure. This scenario best describes which dimension of self-perception?

Self-evaluation Explanation: The client is talking about self-evaluation, which is the conscious assessment of the self. Self-expectations are goals that someone sets. Self-knowledge is a basic understanding of oneself. Social self is how a person sees himself in relation to social situations.

A client with breast cancer needs a bilateral mastectomy. Having already established a strong therapeutic partnership with the client, how can the nurse best assess the client's self-concept in light of this bodily change?

"Now that it's scheduled, how are you feeling about the surgery that you will have?" Explanation: Assessment of a client's self-concept is challenging for the nurse; an open-ended question to the client may elicit the client's feelings on this matter. A client's self-concept is a collection of beliefs about themselves. Discussing reconstruction focuses on the surgical process. Discussing peers in similar circumstances challenges the client to think of others. Asking about the influence of the surgery on the client's lifestyle again focuses on the surgical process and the effects on the client's life.

A pediatric nurse is caring for Beth, a 13-month-old who is admitted with a respiratory infection. Her mother says she wants her child to develop in the best way possible. She asks the nurse, "What kind of self-concept should Beth have at her age?" What is the nurse's best response?

"She has a beginning differentiation of self and non-self." Explanation: The newborn has no self-concept at birth. In late infancy, a baby starts to differentiate between self and non-self. In childhood, differences between self and others are strong. During adolescence one's sense of self becomes very consolidated.

A new mother of twins is struggling with role performance issues related to balancing the demands of motherhood with working outside the home. What question would be most appropriate to help the client move forward with a positive self-concept?

"What new behaviors might be necessary to help modify your current roles?" Explanation: Asking "What new behaviors might be necessary to help modify your current roles?" allows the client to think through what she could do to regain a sense of balance in the performance of her role. The other options are judgmental or impose solutions versus allowing the client to think through the options related to the role struggle.

A nurse assessing children in a pediatrician's office would expect a child to achieve self-recognition at what age?

By 18 months Explanation: Stages in the development of the self include self-awareness (infancy), self-recognition (18 months), self-definition (3 years), and self-concept (6-7 years).

A female client experienced facial burns in a motor vehicle accident. Recently, the client told her nurse, "I can't stop worrying that my fiancé isn't going to want me anymore." Which of the following nursing diagnoses is most clearly suggested by the client's statement?

Anxiety Explanation: While issues related to adjustment, coping, and hopelessness may underlie or result from the client's feelings, her expression of worry is primarily indicative of the nursing diagnosis of Anxiety. Anxiety is a feeling that can cause nervousness, fear, apprehension, and worrying. The client's statement expresses anxiety of the change in her physical appearance. She is not experiencing impaired adjustment, an inability to modify lifestyle/behavior in a manner consistent with a change in health status nor ineffective coping is an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources. The client is not expressing hopelessness or a feeling of despair.

A client had a traumatic amputation of the arm in a motor vehicle accident. Which intervention will the nurse use to assist a client in managing body image disturbance?

Assist the client in exploring thoughts and feelings related to body image changes. Explanation: Interventions for body image disturbances include assisting the client in exploring thoughts and feelings related to body image changes; encouraging the client to participate in self-care behaviors as able; understanding there is no correct way to progress through the various stages of loss and grief; and allowing the client to feel depressed, to cry, and to be angry. The nurse cannot provide limits or set boundaries as to when the client can express grief. Grief may need to be expressed at any time.

The nurse is assessing a young child in the clinic by asking simple questions. Which concept will the nurse predict this toddler to verify as per Sullivan's theory?

Begins integrating good me and bad me into self-concept Explanation: As per Sullivan's interpersonal theory, the toddler begins to integrate the good me, bad me, and not me into self-concept. Freud's theory indicates the toddler is learning role performance in the family. Erikson's theory lists body image and self-esteem develop as the child experiences self-control through exploration in the world. Havighurst's theory indicates the toddler learns body image through walking, talking, and controlling waste.

A nurse is providing care to a client who has undergone skin grafting to her face due to a burn injury. The client states, "I know it could have been worse, but my face will never be the same as it was. I haven't been able to look at myself in the mirror because of what I might see." The nurse interprets this statement as most likely reflecting which pattern?

Body image Explanation: Although self-esteem, role performance, and personal identity are components of self-concept, the client's statements reflect her feelings about her physical appearance, or body image.

A client who is diagnosed with renal failure has been informed about the need to start dialysis. Which assessment information supports the client is struggling with a change in life role?

Client's worry about the inability to continue work Explanation: Life roles, such as one's occupation or profession, can constitute a major portion of a person's identity. The ability to successfully execute societal roles, as well as one's own expectations regarding role-specific behaviors (or role performance), is easily compromised by illness or injury. The inability to work temporarily is an example of this. A lack of interest in sex would be a normal response to illness. The client showing no changes and continuing on with life as usual would not signify struggle. Posttraumatic syndrome is a mental health condition that is triggered by a terrifying event—either experiencing it or witnessing it.

A client who has multiple sclerosis (MS) has been diagnosed with ineffective coping related to a diagnosis of chronic health alteration. What outcome is least appropriate to include in a plan of care?

Communicates a sense of helplessness to his spouse. Explanation: All are appropriate outcomes except communicating a sense of helplessness. Some clients who are struggling with self-concept issues will communicate manipulative helplessness that encourages another (the spouse or nurse) to take charge. This does not promote coping or acceptance of self

A nurse is nervous about interacting with a new client due to the memories of a similar past situation the nurse has experienced. Which action should this nurse prioritize when caring for this client?

Evaluate his or her own self-concept Explanation: Each nurse should conduct a self-assessment of one's own self-concept to be better prepared to assist each client. If the nurse is dysfunctional in this area, he or she will not be able to properly meet the needs of the client. The nurse should be careful about sharing one's own experience with the client. Asking another nurse to take over will not assist this nurse in dealing with this situation properly and will add to a continued lack of self-concept. Discussing the situation with another colleague may help in the process but the priority is for the nurse to evaluate his or her personal self-concept.

The nurse is working on the rehabilitation unit caring for a 16-year-old client who has suffered a traumatic amputation of the left leg. During the physical assessment, the client comments to the nurse, "I hate the way I look now with my leg gone." Which action will the nurse take to support the client?

Discuss the benefit of talking with others who have lost a limb. Explanation: The client should be referred to a support group to learn more about how others cope with such a loss. By beginning that discussion the nurse will support the client to begin healing. An extreme need for privacy may be reflective of impaired self-concept and does not prevent embarrassment. A lack of self-esteem may indicate an impairment in self-worth. Demonstrating fashions to conceal the leg can be beneficial in the long run but cannot take the place of confronting one's feelings. Returning to work can help to maintain role performance but should not be allowed to be a way to deny feelings.

A female client, prominent in the local media, has had surgery for a colostomy. The client avoids looking at the colostomy and refuses visitors. Identify the most appropriate nursing diagnosis.

Disturbed Body Image related to colostomy as evidenced by avoidance of colostomy Explanation: Disturbed Body Image possesses the clinical cues of behaviors of avoidance, monitoring, or acknowledgement of one's body

A 73-year-old man has been the primary caregiver for his wife, who has multiple sclerosis (MS). After 30 years with the disease she died and he has become increasingly withdrawn and refuses to leave the house. Which nursing diagnosis is most appropriate?

Disturbed personal identity related to the unresolved crisis of his wife's death Explanation: The client is experiencing disturbed personal identity as he is no longer a spouse or a caregiver. This is related to the recent death of his chronically ill spouse. Without her to care for he is unable to define who he is or what his role is without her. He does not have low self-esteem or disturbed body image.

A client is telling the nurse about the client's two children, a toddler and a preschool-aged child. The client talks about providing them with colorful toys and puzzles and how much the client enjoys playing with them and reading to them. Which other strategies can be shared with the client to promote healthy development in the children?

Encourage participation in family health behaviors. Explanation: Allowing the children to participate in family health behaviors will focus on good behavior and encourage participation and future development of positive habits. Making decisions for children, rather than helping them to come to a decision, will not model good habits. Disciplining a child only establishes boundaries when a problem arises. Modeling bad behavior as a method of influencing good behavior is not an effective methodology.

A nurse is developing a plan of care for an older adult to promote self-esteem. What intervention would be most appropriate to include?

Explain that his life experience will help to develop a plan of care. Explanation: Using older people's life experiences to shape the plan of care shows value for who they are (unconditional affirmation). While getting older is part of life it does not mean they need to dwell on death or surround themselves with older people. While it is appropriate to encourage older clients to try new things, it is not appropriate to encourage them to be like younger people but rather find hobbies that help define who they are at this stage of life.

An 18-year-old says that it was just bad luck that he got in a motor vehicle accident and broke his arm. What is the client demonstrating by saying this?

External locus of control Explanation: A person with external locus of control perceives that outcomes happen because of luck, chance, or the influence of powerful others.

A client with cancer has a family who is emotionally supportive of the client. Having a supportive family is which type of resource?

External resource Explanation: A person's situational support is considered an external resource, whereas a person's coping mechanisms are internal resources. A health care professional is a professional resource. Financial resources are provided by income, benefits, and contributions.

A client with an altered self-concept would most likely exhibit which emotional responses? Select all that apply.

Feelings of worthlessness Helplessness Guilt Explanation: Emotional changes with self-concept dysfunction include feelings of depersonalization, hopelessness, helplessness, alienation, fear of rejection, anger, sadness, shame, guilt, inadequacy, worthlessness, and suspicion of others. Emotional responses may be blunted or inappropriately intense.

Which question would the nurse include on a self-concept assessment related to body image?

How do you feel about any physical changes you noticed recently? Explanation: Body image is the person's subjective view of one's physical appearance. Therefore, asking a client how he or she feels about physical changes addresses body image. "Do you like who you are?" assesses a person's self-esteem. Asking "Who influenced you the most growing up?" and "Who would you most like to be?" assesses a person's self-expectation.

Which question would provide the nurse with the information needed first when assessing self-concept?

How would you describe yourself to others? Explanation: Global self is the term used to describe the composite of all the basic facts, qualities, traits, images, and feelings one holds about oneself. Global self provides the basis for assessing a person's self-concept. How well one likes themselves refers to self-esteem. The ideal self is assessed by asking clients what they see themselves doing in 5 years. Identifying personal strengths refers to personal identity.

What self-concept is demonstrated when a child says that he wants to be "just like my dad"?

Ideal self Explanation: The ideal self constitutes the self one wants to be. These expectations develop early in childhood and are based on the images of role models such as parents.

The emergency department nurse is triaging a 15-year-old adolescent who is brought in by a family member after finding the client with a bottle filled with a variety of pills. The family member shares that the client's parents recently divorced and the client's mother moved out-of-state, leaving the client and two younger siblings with the father. The father travels frequently for work, leaving the client alone to take care of the younger siblings. Which factor should the nurse prioritize?

Inadequate coping Explanation: Stressful events can lead to inadequate coping. The stress of the divorce, mother leaving without the client and siblings, going to school, and taking care of the siblings without assistance can be extremely stressful and result in low self-esteem and depression and progress to suicidal ideation, which in this case should be assessed due to the bottle of pills. This could be a sign the individual is planning suicide. The other choices can all contribute to inadequate coping.

A client who recently had a bilateral mastectomy is working on developing a positive body image. Which intervention by the nurse is most appropriate?

Intervening when a client's spouse makes the client cry Explanation: Assessing the response of the spouse to an altered body image and intervening if it negatively influences the client is part of the nursing role. The nurse cannot teach how a client will feel about the mastectomy as this is an individual response. Grief is part of the process when there is an significant alteration in body image. The client should be encouraged to participate in care as this helps with accepting the changes.

A student nurse is preparing a care plan for a hospitalized school-age client focusing on ways to promote self-concept. Which intervention would not be appropriate?

Limit visitation of friends. Explanation: Interventions that focus on supporting self-concept in school-age children include allowing for privacy. Educate parents about the need for socialization and belonging. Allow liberal visitation and age-appropriate activities if hospitalized.

How can nurses who provide care in long-term care settings best enhance the self-esteem of older adults who reside in these facilities?

Maximize the autonomy of residents in organizing their routines. Explanation: Maximizing autonomy and control is likely to enhance the self-esteem of older adults who may be very aware of their increasing dependence and loss of control. Encouraging frank discussion and interaction with other generations are also positive interventions, but these are less direct methods of fostering self-esteem. It is inappropriate to completely remove all risk of failure from older adults' activities as this encourages growth even in the elder years.

Which nursing action helps to maintain a sense of self for clients?

Offering a simple explanation before initiating any procedure Explanation: The way nurses care for clients has a direct impact on the client's sense of self. By offering a simple explanation prior to any procedure, the nurse is respecting the client and shows that the client is a person first and foremost. Negative expressions should be encouraged and allowed. Privacy related to condition and keeping the body covered is important. The client's weight assessment does not help or hinder the client's sense of self.

A nurse is providing anticipatory guidance to the parents of an adolescent regarding issues related to developmental changes that affect self-concept. What should the nurse discuss with the parents regarding these changes? Select all that apply.

Peers become more important than parental influences. The adolescent's sense of self is consolidated. The adolescent is developing a sexual identity. The adolescent is developing secondary sex characteristics and experiencing rapid body changes. Explanation: The adolescent is developing a sense of identity. Adolescents move away from the parental unit and toward the peer group as their main focus of influence. Sexual identity is also being developed at this time, along with development of secondary sexual characteristics. Diminished choices and options are developmental factors in the aging adult.

The nurse is assessing for information about a client's self-concept. The information needed first is about which of the following?

Personal identity Explanation: When assessing self-concept, the information needed first is the client's description of self. Personal identity describes an individual's conscious sense of who he is. Sexual orientation may not be how someone identifies themselves, or may only be a small part of their personal identity. Body image and gender identity may also be only part of their self-identity.

A 2-year-old boy has had a bowel repair for gastroparesis. He is doing well but has a colostomy to aid in healing of the surgical bowel. What would be an appropriate nursing intervention for the client to enhance self-concept?

Provide the client with room to move around in, and lots of toys to interact with, while securing his colostomy so it does not get in his way. Explanation: A toddler needs an environment that allows them to practice newly developing skills, especially those related to movement. Providing this encourages the development of a positive body image and self-esteem. Assisting the client's parents to accept their new role is most appropriate for the family of a newborn. Safety should be addressed with the parents of an infant. Preschoolers are more concerned with damage to their bodies so teaching them about good hygiene is important.

The nurse is caring for 13-year-old Carol, who is being seen in the clinic today. She is very worried that the doctor may need to look at her body. Her mother asks the nurse if this behavior is normal for this age. The nurse shares with the mother that the adolescent worries about which of the following related to her body?

Rapid changes Explanation: The adolescent worries about the rapid changes occurring to the body. The adult is concerned with fitness, energy, sexuality, and style. The young child is fearful of bodily mutilation and desires very much to have an intact body.

A child lists his favorite sports figures and tells the nurse he is going to be just like them. How does the nurse identify this human need?

Self-expectations Explanation: Expectations for the self arise from various sources. The ideal self refers to who a person wants to be. These self-expectations develop unconsciously early in childhood and are based on images of role models such as parents, other caregiving figures, and public figures (such as a child wanting to be like a favorite sports figure). A person's self-knowledge includes basic facts (such as sex, age, race, occupation, cultural background, sexual orientation); a person's position within social groups; and qualities or traits that describe typical behaviors, feelings, moods, and other characteristics (e.g., generous, hot-headed, ambitious, intelligent, sexy). Self-evaluation refers to how well a person likes themselves. Self-actualization refers to the need to reach one's potential through full development of one's unique capabilities.

A nurse is working with adolescents in a mental health facility. What aspect of self-esteem does the nurse identify is developed in this age group? Select all that apply.

Sense of self is consolidated. Emphasis is on sexual identity. Parental influences on self-concept are often rejected. Explanation: Developmental changes affecting the self-concept of the adolescent include development of secondary sex characteristics; rapid body changes; sense of self is consolidated; emphasis on sexual identity; parental influences on self-concept are often rejected; peers become more important; and movement is toward development of own identity. Importance on meeting role expectations well is developed in adulthood. A sense of being trusted and loved, along with differentiation of self and non-self, both develop during childhood.

An adolescent client tells the nurse about asking oneself, "Do I like who I see in the mirror?" Which additional strategy can the nurse encourage the client to use to promote self-evaluation?

Setting goals Explanation: A client who asks oneself, "Do I like who I see in the mirror?" is engaging in self-evaluation. Self-evaluation is the conscious assessment of the self, leading to self-respect or self-worth. Setting goals will provide a client with a structured set of actions to attain. Allowing life to unfold does not provide structure for the client. Improving one's knowledge can be useful but does not factor into one's self-evaluation. Being more social may be a goal but is not a strategy for self-evaluation.

Which nursing intervention is inappropriate when developing a plan of care to modify a negative self-concept?

Teaching the client that everything will work out better than she expects Explanation: Replacing negative feelings with positive self-talk is appropriate. Asking clients to explore positive dimensions about themselves will help them to incorporate positive knowledge of themselves into their self-concept. Teaching clients to "red-flag" negative self-talk as soon as they are aware of it is important in the modification process. Teaching clients that everything will work out better than they expect is not true and situational success does not determine self-concept.

Which client outcome indicates effectiveness in a plan of care to promote self-concept?

The client describes herself as a mother of two who is content with life and loves her husband. Explanation: When evaluating a care plan for self-concept the client should be able to meet the following outcomes: the client is comfortable with body image and able to use it effectively to meet human needs; is able to describe herself positively (the client describes herself as a mother of two who is content with life and loves her husband); is able to meet realistic role expectations without undue anxiety and fatigue; is capable of interacting appropriately with the environment while recognizing self to be a separate and distinct entity. A client who reports contentment but refuses to leave the house has not met these outcomes as they are not about to effectively meet human needs. The client who can get her children dressed but then goes to bed does not meet the outcome as they can not meet the role expectation without undue fatigue. A client who cannot look at the incision site following a mastectomy is not comfortable with body image.

A nurse is caring for a middle-age client who has recently been diagnosed with breast cancer. The nurse determines that the client is experiencing a self-concept dysfunction when the client engages in which behavior?

The client refuses to meet visitors by saying she is tired. Explanation: By refusing to meet visitors by saying she is tired, the client is manifesting a behavioral change resulting from self-concept dysfunction. Missing follow-up appointments and forgetting to take prescribed medications on time indicate self-care deficits. The client manifests self-destructive behavior by overeating often, saying she wants to live well the rest of her life.

The nurse is preparing a care plan for client with the nursing diagnosis of Ineffective Coping. The client has had a mastectomy and refuses to participate in the care of the surgical site. What would be an appropriate initial goal for the client?

The client will look at the surgical site in a mirror within 2 days. Explanation: Goals are client focused and must have a time frame. The client looking at the surgical site in the mirror within 2 days is a proper short-term goal.

Which of the following is objective data related to self-concept?

The person refuses to make eye contact. Explanation: Objective data constitutes what the nurse can observe with her own eyes. Other objective data that may be collected include a missing body part, a concealment of a body part, or weeping.

Which question would the nurse ask to assess a client's self-identity during a focused self-concept assessment?

What are your personal strengths? Explanation: Identifying one's own personal strengths describes a person's self-identity. Self-esteem is assessed by asking the client who he or she would like to be. Asking the client what he or she likes most about his or her body assesses body image. Role performance is assessed by asking the client about their satisfaction in his or her job.

A construction worker age 33 years experienced a fall on a job site that resulted in a spinal cord injury. In recent days, the client has alluded to the fact that he feels "useless" because he now sees himself as "a burden instead of a provider." The nurse would be justified in choosing interventions to:

address the client's negative self-concept. Explanation: The client's statements reveal a strongly negative self-concept, a fact that the care team should address in an appropriate way. The client's statements relate more to his role and ability than his body image. Enhancing his mobility may be beneficial, but this will not necessarily change the fundamental way in which the client sees himself. Performing his ADLs may exacerbate, rather than alleviate, his negative self-concept.

A nurse is assessing a client who has experienced significant trauma affecting her body appearance. The nurse identifies a nursing diagnosis of Disturbed Body Image. When developing the plan of care, which information would be most important for the nurse to consider? Select all that apply

client's perception of the alteration client's view of the importance of the alteration on the body part or function feelings associated with the change in body image Explanation: The ability to retain an intact self-concept in the face of illness, trauma, and surgery varies among people. Although the medical treatment plan and any role conflicts that arise due to the trauma may play a role, the person's perception of the alteration and the importance that she places on the body part or function affected (as well as the feelings associated with disturbed body image) will influence body image dysfunction.

A nurse is assessing a client and suspects that the client is experiencing a dysfunction in self-concept based on which behavioral findings? Select all that apply.

difficulty making decisions inability to discuss a change in body function social withdrawal Explanation: Behavioral changes indicating self-concept dysfunction include lack of interest in activities, inability to make decisions, withdrawal from social situations, isolation, refusal to look in the mirror, refusal to look at an affected body part or discuss a limitation, avoidance of responsibility, show of hostility toward others, refusal to make eye contact, and negative statements about self.

A client with uncontrolled hypertension experienced a stroke a week ago, leading to significant motor losses. A successful and normal adaptive response to these new limitations is evident if the client:

exhibits signs of grief. Explanation: Grief is a normal response to a recent deformity or limitation. Signs and symptoms of grief include crying, sleep issues, and a decreased appetite. Changing the subject and refusing participation in physiotherapy would be considered maladaptive responses. Stating that "it is what it is" may possibly signal resignation and defeat, neither of which is associated with an adaptive response.

During a health history, a client states, "Whatever happens, happens because of luck." The nurse interprets this statement as indicating:

external locus of control. Explanation: A person with external locus of control perceives that outcomes happen because of luck, chance, or the influence of powerful others. A person with internal locus of control believes that personal behavior influences outcome and that he can achieve desired results. Self-efficacy is the degree of confidence a person has about the ability to perform specific activities. Expectancy for success means the person has a belief that personal behavior will lead to something desired.

A nurse is attempting to provide education to a newly diagnosed diabetic. The client states, "It doesn't matter what I eat, my future health is up to God." The nurse understands that this client has:

external locus of control. Explanation: A person with external locus of control perceives that outcomes happen because of luck, chance, or the influence of powerful others. A person with internal locus of control believes that personal behavior influences outcome, and that he can achieve desired results.

An infant who was born with Down syndrome, gastrointestinal anomalies, and cardiac defects has required nearly continuous hospitalization in the neonatal intensive care and pediatric care units of the hospital during her first year of life. To counteract the negative effects of prolonged hospitalization, the nurse should:

facilitate as many opportunities as possible for infant-parent attachment. Explanation: Prolonged hospitalization has a strong potential to interfere with the formation of the interpersonal bond between the child and parents. A daily update of the infant's care routines does not allow for the interpersonal bond and the nurse should incorporate the parents in the infant's care routine. A hospital environment is profoundly different from a home environment. The nurse should educate the parents that the infant is very emotionally vulnerable due to the prolonged hospitalization and bonding is essential.

A nurse introduces herself to a visually impaired client, addresses the client by name, speaks to the client respectfully, and explains all the nursing activities. The nurse is implementing health promotion with this client by which mechanism?

fostering a sense of self Explanation: By treating the client respectfully and personally, the nurse is fostering a sense of self. The nurse pays special attention to the client's individuality and emotional needs by explaining all the nursing activities, which will promote the client's self-concept. To implement health promotion by identification of strengths, the nurse would assist the client in identifying and cultivating his personal strengths, such as a nice smile, hobbies, and strong health maintenance patterns. The nurse would assist the client in positive self-evaluation by focusing on positive attributes and pointing out accomplishments that deserve positive feedback. The nurse assists the client in goal formulation by identifying the desired outcome.

A client tells the nurse, "I am not the person I was yesterday, but I can draw on things from the past so that I can achieve in the future." The nurse interprets this statement as reflecting:

personal identity. Explanation: Identity is an organizing principle of the self, the awareness that one is a distinct individual separate from others. Identity provides the person with a sense of continuity through time. For example, "I am not the person I was yesterday, but similarities and consistency provide links for today and the future." Role performance reflects participation in ascribed or assigned roles, which are a person's expected characteristic behavior in a social position. Self-esteem refers to how people feel about themselves. How a person pictures and feels about his body describes body image.

A newly married client is attempting to fulfill the role of wife, professional, and lover. She tells the nurse that she does not feel that she is fulfilling any of the roles well. The nurse will document this as:

role strain. Explanation: Role strain occurs when the person perceives himself as inadequate or unsuited for a role. This can occur in any role or because of numerous roles. People make multiple role transitions in a lifetime. Role ambiguity occurs when the person lacks knowledge of role expectations, which fosters anxiety and confusion. Role conflict is related to expectations concerning the role. Role conflict can be described as intrapersonal, interpersonal, or interrole.

Preschoolers exhibit sexual curiosity. This builds the preschooler's:

self-concept. Explanation: Self-concept continues to develop actively during preschool years. Preschoolers' sense of self becomes more defined as they realize that they are separate and unique. During this stage of development, children exhibit great sexual curiosity.

Asking a client to describe himself is one way to assess his:

self-concept. Explanation: Self-concept is the mental image a person has of himself. It is the person's meaning when stated as "I" or "me." Self-perception is how a person explains behavior based on self-observation. Self-knowledge or self-awareness involves a basic understanding of himself, a cognitive perception. It is consciousness of one's abilities: cognitive, affective, and physical. Social self is how a person sees himself in relation to social situations, including behavior and interaction with others.

During an interview, the client tells the nurse, "I know who I am and I know my strengths and weaknesses." How will the nurse interpret this statement?

self-concept. Explanation: Self-concept is the mental image a person has of oneself. It is the person's meaning when stated as "I" or "me." Self-concept is the frame of reference that influences how a person handles situations and relationships. Self-expectation involves the "ideal" self — the self a person wants to be. It is the setting of present and future goals. Social self is how a person sees himself in relation to social situations, including behavior and interaction with others. Self-evaluation is the conscious assessment of the self, leading to self-respect or self-worth. "Have I met my expectations? Do I like who I see in the mirror? Do I like how I behave?"

A client with paraplegia from a boating accident demonstrates the ability to cope with personal handicaps and to maximize strengths. What does the nurse determine that the client has developed?

self-esteem Explanation: The person with adequate self-esteem has learned to cope with personal deficiencies and to maximize strengths.

A rehabilitation nurse is caring for Steve Branson, a 23-year-old man, who has suffered a spinal cord injury and has tetraplegia. One of the rehabilitative goals for Steve is to attain adaptive patterns of behavior related to his injury. Which of the following would indicate that he is achieving this goal? Choose all that apply.

uses available resources makes decisions related to his care Explanation: Independence-dependence patterns include the following: (a) adaptive responses, in which a client assumes responsibility for care (makes decisions), develops new self-care behaviors, uses available resources, and interacts in a mutually supportive way with family; (b) maladaptive responses, in which a client assigns responsibility for his care to others, becomes increasingly dependent, or stubbornly refuses necessary help.