prep u, self concept
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 assessing self-concept?
"How has the loss of your leg affected your body image?" The human body is the self's physical manifestation. How a person pictures and feels about the body describes body image, an integral part of self-concept. 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 is caring for a 26-year-old client who has just delivered a healthy female infant. The client says they want to be a good parent and help their child develop in the best way possible. They ask the nurse, "What kind of self-concept is an infant 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, an infant 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 client is requesting that the nurse speak with the health care provider regarding alternate treatment options. What comment by the nurse would be most appropriate to help the client identify and use personal strength?
"You can speak with the doctor about all treatment options. I will stay with you while you talk to the doctor, if you like." Explanation: Nurses frequently fall into the trap of "doing" for clients. Some clients have even learned to communicate a manipulative helplessness that encourages the nurse to take charge. Using a positive that could occur (the client can hear all the treatment options firsthand) allows the client to use personal strength, and offering to be present affirms that the nurse remains an advocate while "helping" the client speak for oneself.
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 bodily function -social withdrawal
Which client will the nurse monitor most closely for signs of role strain?
A client who is a new parent and who feels inadequate in this new identity Explanation: Role strain occurs when the person perceives themselves as inadequate or unsuited for a role. It does not necessarily exist when public and private roles coexist or when a person is facing an upcoming change.
A client has had abdominal surgery and the creation of a colostomy. The client avoids looking at the colostomy and refuses visitors. Which nursing concern is most appropriate for this client?
Altered body image related to colostomy as evidenced by avoidance of colostomy
The nurse is assessing a client who is a single parent living away from family, attending college, and working full time. How can the nurse assist the client in sustaining a positive self-concept during times of intense stress?
Assess the client's history of coping mechanisms. Explanation: Coping and stress tolerance influence self-concept. People who are able to adapt to stress and resolve conflicts through coping tend to develop healthy self-concepts. Assessment of previous experience should include past problems with self-concept, history of unsuccessful coping mechanisms, and lack of resources and support. Telling the client expectations are unrealistic is not therapeutic and not factual. Although the client may require a consult to speak to a social worker, this does not immediately address the issue of sustaining positive self-concept. Instead of asking the client about using substances to relax, it is more appropriate for the nurse to ask what generally makes the client feel better when the client has negative feelings.
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 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.
The nurse caring for a preschooler has noted that the child exhibits sexual curiosity. The nurse will identify this as helping the child in what way?
Developing 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, continbuting to self-concept. This sexual curiosity is not linked to empathy, cognition or the creation of an ideal self.
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 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.
A client has suffered an amputation of the right leg due to a motor vehicle accident. What would be an example of a maladaptive response?
Expressing they will never be a whole person again Explanation: A maladaptive response is one in which the self concept is disturbed and coping is not evident. The client stating that they will never be a whole person again is an example of this. Asking about a prosthetic device, learning to ambulate with a walker and talking to the family about the accident are all examples of adaptive responses.
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 nurse is providing education to a client newly diagnosed with metastatic cancer. The client states, "It doesn't matter what treatment I receive, my future health is up to God." The nurse understands that this client has which of the following?
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. Such an outlook does not indicate a lack of self-concept, self-esteem or a negative outlook, however.
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.
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.
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 older adult 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 integrates knowledge of developmental levels and their influence on self-concept when planning client care. The nurse would expect a client in which developmental stage to begin to examine the meaning of self?
Older adult Explanation: Older adults begin to examine the meaning of self. They begin to look at the meaning of life in relation to roles previously discarded. The preschooler's sense of self is more defined than that of a toddler but is still undergoing development. Preschoolers often imitate adult roles, but do not question or examine the meaning of self. Adolescents are in the process of defining their identity and self-concept. They do not examine the meaning of self. Early adulthood involves forming intimate relationships, choosing a career, establishing a home base, and starting a family. Young adults are still in the process of experiencing new events and roles. They do not commonly engage in examination of the meaning of self.
When a nurse asks a client to describe her personal characteristics and traits, the nurse is most likely assessing the client for what self-concept factors?
Personal identity Explanation: Personal identity describes a person's conscious sense of who he or she is. Asking the client to describe her personal characteristics and traits assesses a person's 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. Self-esteem can be described as the need to feel good about oneself and to believe that others hold one in high regard.
A nurse is preparing a care plan for a hospitalized school-age client focusing on ways to promote self-concept. Which intervention should the nurse include?
Provide age-appropriate activities to promote engagement Explanation: Interventions that focus on supporting self-concept in school-age children include age-appropriate activities if hospitalized. Privacy should be promoted and protected and visitation should not be limited. The client's parents may or may not need education about their child's socialization.
A new graduate nurse was told there will be two weeks of orientation prior to working independently at a new position. After the first night of work, the nurse was informed the facility is short staffed and the nurse would be working independently. What is this new graduate at risk for developing?
Role ambiguity Explanation: Role ambiguity occurs when the person lacks knowledge of role expectations, which fosters anxiety and confusion which can lead to feelings of uncertainty about how to be successful in this new role. Role conflict is related to expectations concerning the role. Role conflict can be described as intrapersonal (role expectations conflict with the person's values), interpersonal(when the person's expectations differ from that of some significant other), or interrole (exists when a person is expected to fulfill two or more roles simultaneously). Role failure and role dysfunction are not terms in common use.
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.
The nurse is assessing a client's sense of adequacy and worth. What domain is the nurse assessing?
Self-esteem Explanation: Self-esteem is a person's sense of their own adequacy and worth. This perception of worth is independent of identity and self-actualization.
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 nurse is assessing a client's self-perception. Which dimension is reflected by the client's statement, "I want to use my skills to become the best artist I can be"?
Self-expectation Explanation: Self-expectation involves the "ideal" self — the self a person wants to be. It is the setting of present and future goals. Self-knowledge or self-awareness involves a basic understanding of oneself, a cognitive perception. It is consciousness of one's abilities: cognitive, affective, and physical. Self-knowledge involves basic facts (age, weight, sex) and qualities (sincere, athletic, intelligent) related to oneself. 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 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.
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.
A nurse is working with a 16 year-year-old client who is concerned that her parents will shun and reject her upon finding out that she is pregnant. Based upon Coopersmith's four bases of self-esteem, this adolescent is concerned about which base of self-esteem?
Significance Explanation: Significance is the way a person feels he or she is loved and approved of by the people important to that person. Competence is the way tasks that are considered important are performed. Virtue is the attainment of moral-ethical standards. Power is the extent to which a person influences his or her own life and others' lives.
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 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.
A nurse is educating a client about smoking cessation. The nurse determines that the client has high self-efficacy. Which outcome would the nurse expect to occur?
The client will be able to stop smoking. Explanation: Individuals with high self-efficacy believe they can perform well and are thus more likely to perceive difficult tasks as within their abilities and something to be mastered. Conversely, those with low self-efficacy believe they are unable to do well and frequently won't even attempt a difficult task. A person with low self-efficacy may state reasons for not being able to quit smoking, may focus on another activity, or not participate in the smoking cessation at all.
The nurse is preparing a care plan for client who is coping ineffectively with a recent a mastectomy. The client refuses to participate in the care of the surgical site. What goal is appropriate for the client's care plan?
The client will look at the surgical site in a mirror within 2 days. 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 for this client's nursing concern of ineffective coping.
The nurse has identified the nursing concern of altered body image after the client underwent bilateral mastectomy. Based on this concern, which goal is appropriate to include in the nursing plan of care?
The client will participate as able in the daily care of the incisions. Explanation: All of these are appropriate goals. However, the only option that relates directly to body image is the care of the incisions daily. By caring for the incisions the client is showing self-care to the extent that they are able.
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 client who is 5 ft 2 in (1.57 m) tall and weighs 120 lb (54.4 kg) states, "I wish for once I had a normal weight and I were not so fat." What is the priority nursing concern?
altered body image Explanation: Altered body image is a state in which one experiences confusion in the mental picture of one's physical self. The client is not overweight but is unable to see that due to the alteration in body image. There is no indication of alterations in role performance or self-esteem. Altered personal identity is not applicable for this client, because it refers to an inability to distinguish between self and non-self.
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 their body appearance. The nurse identifies a nursing concern of altered body image. When developing the plan of care, which information is 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 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 the person places on the body part or function affected (as well as the feelings associated with altered body image) will influence body image dysfunction.
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.
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.
Which of the following factors is most likely to present a challenge to the self-concept of a man 79 years of age?
the man's increasing level of dependence on his children Explanation: Dependency near the end of life can present a significant challenge to an individual's self-concept. Helping his grandchildren with the costs of education and facing financial challenges may be difficult, but these are likely less of a threat to self-concept than the realization of decreasing independence. The aging of the man's children is less likely to affect his own self-concept.
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 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.
