Chapter 34. Self Concept EAQ

The nurse cares for a family of four, offering routine medical care throughout the year. Which member of the family does the nurse expect to exhibit the highest levels of self-esteem? 1 The 42-year-old father 2 The 8-year-old boy 3 The 15-year-old girl 4 The 71-year-old grandmother

2 Low self-esteem is a risk factor for health problems, so the nurse would monitor this in a family that he or she sees often. Self-esteem is highest in childhood. When a person reaches adolescence, self-esteem levels decline. Self-esteem then gradually rises during adulthood and again declines slightly in old age. The pattern may vary slightly in individuals but seems unaffected by gender, socioeconomic status, and ethnicity. The 8-year-old boy is in the childhood stage and thus is expected to show the highest levels of self-esteem in the family. The father will have high self-esteem but it may not be as high as in the child. The girl, an adolescent, will generally have a low level of self-esteem. The grandmother is elderly and thus is expected to have a lower level of self-esteem.

Several staff members complain about a patient's constant questions such as "Should I have a cup of coffee or a cup of tea" and "Should I take a shower now or wait until later?" Which interpretation of the patient's behavior helps the nurses provide optimal care? 1 Asking questions is attention-seeking behavior. 2 The inability to make decisions reflects a self-concept issue. 3 A dependence on staff must be stopped immediately. 4 Indecisiveness is aimed at testing how the staff reacts.

2 Patients with deficits in self-concept often have difficulty making decisions. It is essential for the nurse to remain accepting of the patient and to support him or her in decision making.

The nurse is teaching a 10-year-old patient about personal hygiene. What observation would indicate that the child has not reached an age-appropriate developmental stage? 1 An inability to understand and master brushing technique 2 An inability to accept age-related body changes 3 An inability to assess life goals 4 An inability to decide on a future career

1 As per Erikson's developmental stages, a 10-year-old child should be able to understand and reinforce information provided and master new skills, such as the basic hygiene tasks the nurse discusses. A person starts to accept age-related body changes and begins to establish goals in adolescence, but may not do so as young as 10 years of age. The assessment of life goals is not expected until adulthood. Setting goals for the future, such as deciding which school to attend or what career to pursue, is a developmental behavior for children 12 to 20 years old.

Which question should the nurse ask a patient with low self-esteem in order to assess the nature of the problem? 1 "What do you like about your appearance?" 2 "Can you remember a time when you felt good about yourself?" 3 "What impact does your self-esteem have on your relationships?" 4 "When did you start thinking or feeling differently about yourself?"

1 During the assessment process, the nurse asks open-ended, focused, and specific questions in order to determine accurate data. The nurse asks the patient about the perception of his or her own appearance to understand the nature of the problem. The nurse asks about the times the patient has felt good about himself or herself in order to determine which area is important for patient care. To determine the effects of low self-esteem on a patient, the nurse asks about the impact of relationships on the patient's self-esteem. To assess the onset and duration of symptoms, the nurse asks when the patient began to feel differently.

The nurse is trying to assess if a patient is free from identity stressors. What would suggest that the patient has a strong identity? 1 The patient has been happily married for 10 years. 2 The patient exercises daily. 3 The patient does not abuse substances. 4 The patient is involved in church activities.

1 Identity achievement is reflected by a patient's intimate relationships. The patient who has been happily married for 10 years probably has a strong identity. Positive behaviors such as exercising daily, not abusing substances, and being involved in church activities do not indicate that the patient is free of identity stressors.

The nurse determines that a patient is experiencing repeated failures, having conflicts, with others, and is more dependent on his or her parents. Which component of self-concept is affected in the patient? 1 Identity 2 Self-esteem 3 Body image 4 Role performance

1 Identity is defined as an internal sense of individuality, wholeness, and consistency of a person in different situations. The experiences of repeated failures, conflicts with others, and dependency on parents disturb the internal sense of individuality and consistency of an individual. Therefore, identity is affected in the patient. Self-esteem is an individual's overall feeling of self-worth or the emotional appraisal of self. Body image is the physical appearance, structure, and function of the person. The individual has significant roles throughout life. Failure in meeting role expectations results in deficits.

What is the most common reason for elective cosmetic surgery? 1 Improve self-image 2 Remove deep acne scars 3 Lighten the skin in individuals with pigmentation problems 4 Prevent skin changes associated with aging

1 Improvement of body image is the most common reason for undergoing cosmetic surgery, because appearance is an important part of confidence and self-assurance. Acne scars, pigmentation problems, and wrinkling can also be treated with cosmetic surgery, but the surgery does not prevent the skin changes associated with aging.

A 20-year-old patient is diagnosed with an eating disorder. Which nursing intervention would be best to address self-esteem? 1 Offer independent decision-making opportunities. 2 Review previously successful coping strategies. 3 Provide a quiet environment with minimal stimuli. 4 Support a dependent role throughout treatment.

1 Offering opportunities for decision making promotes a sense of control, which is essential for promoting independence and enhancing self-esteem. Reviewing successful coping strategies is a priority intervention for patients who cannot cope. Providing a quiet environment and supporting a dependent role throughout treatment won't address self-esteem.

A 20-year-old woman who lives with her parents gives birth to a baby. Around the same time, her parents adopt a 5-year-old child. The young woman is overwhelmed and has difficulty balancing her role as a mother with her role as a sister. What kind of role performance stressor does the woman experience? 1 Role conflict 2 Role ambiguity 3 Role strain 4 Role overload

1 Role conflict happens when a person has to assume two or more inconsistent roles. This new mother is trying to cope with the physical and psychological burdens of raising a child and is stressed by the addition of a new relationship with a young sibling, creating role conflicts. Role ambiguity occurs when a person is confused and not sure of his or her role. Role strain results from role conflict and role ambiguity. When a person has more responsibilities within a role than she can manage, she experiences role overload.

Based on knowledge of the developmental tasks of Erikson's industry-versus-inferiority stage, the nurse emphasizes proper technique for use of an inhaler with a 10-year-old boy. Why does the nurse do this? 1 It increases the patient's self-esteem with the mastery of a new skill. 2 It helps him to accept changes in his appearance and physical endurance. 3 It helps him to experience success in role transitions and increased responsibilities. 4 It helps him appreciate his body appearance and function.

1 The developmental stage of industry versus inferiority (ages 8 to 12) is focused on incorporating feedback from peers and teachers, increasing self-esteem with the mastery of new skills, and promoting awareness of strengths and limitations.

Which factor will the nurse observe in the 22-year-old patient with low self-esteem who is in the intimacy-versus-isolation stage of psychosocial development, according to Erikson's theory of self-concept? 1 Increased responsibilities 2 Negative feelings about the sense of self 3 Changes in appearance and physical endurance 4 Need for the provision of a legacy for the next generation

1 The intimacy-versus-isolation stage of psychosocial development occurs from the mid-20s to the mid-40s. Due to increased responsibilities of caring for children and older adults, these individuals are said to be living in the sandwich generation. Therefore, increased responsibilities are found in this stage. Negative feelings about themselves result in role confusion in individuals from 12 to 20 years of age. Changes in appearance and physical endurance occur in individuals in the mid-40s to mid-60s age group. Failure to accept the changes results in self-absorption, not isolation. The need for the provision of a legacy for the next generation occurs in the psychosocial development stage of ego integrity versus despair.

An adult woman is recovering from a mastectomy for breast cancer and is frequently tearful when left alone. On what should the nurse's approach be based? 1 Patients need support in dealing with the loss of a body part. 2 The patient's family should take the lead role in providing support. 3 The nurse should explain that breast tissue is not essential to life. 4 The patient should focus on the cure of the cancer rather than loss of the breast.

1 The nurse should encourage the patient to talk about the threats to body image, including the meaning of the loss, the reactions of others, and the ways in which the patient is grieving.

When developing an appropriate outcome for a 15-year-old girl, what primary developmental task of adolescence should the nurse consider? 1 The ability to form a sense of identity 2 The ability to create intimate relationships 3 The ability to separate from parents and live independently 4 The ability to achieve a positive self-esteem through experimentation

1 Understanding developmental tasks across the life span is essential in designing nursing care. Adolescents are focused on establishing their identities outside of their families and should be supported in meeting this developmental task.

The nurse is examining a patient who just had a spontaneous abortion. What observations suggest to the nurse that the patient has good self-esteem post incident and is coping well? Select all that apply. 1 The patient's husband stays by her side and holds her hand. 2 The patient seems depressed but is asking the health care provider about conceiving again. 3 The patient does not want to conceive another child. 4 The patient does not talk to anybody about the incident. 5 The patient asks the health care provider about permanent contraception methods.

1, 2 The fact that the patient's spouse is supportive helps her cope with the stress and loss of self-esteem. Healthy social support from family and loved ones has a very positive effect on a person's self-esteem. The patient's willingness and ability to make decisions about conceiving again show that the patient has a good self-esteem level. A patient who does not want to conceive another child may be depressed and fears that she could face the situation again. If the patient does not talk to anybody about the incident, she may not want to face the emotions related to the incident. Asking the health care provider about permanent contraceptive methods indicates that the patient does not want to go through the process of childbirth again. This behavior may indicate that the patient has low self-esteem and is not coping well.

After assessing a 2-year-old child, the nurse observes that the child is in the psychosocial development stage of autonomy versus shame and doubt, according to Erikson's theory of self-concept. Which developmental tasks does the nurse observe in the child? Select all that apply. 1 Communication of likes and dislikes 2 Appreciation of body appearance and function 3 Increased independence in thoughts and actions 4 Incorporation of feedback from peers and teachers 5 Increased language skills, including identification of feelings

1, 2, 3 Children between the ages of 1 and 3 years of age are in the psychosocial development stage of autonomy versus shame and doubt. During this stage, children begin to communicate likes and dislikes that promote the development of self-concept. The positive appreciation of body appearance and function increases the self-esteem and self-concept. Children from 1 to 3 years of age gain independence in actions and thoughts due to self-exploration. This also promotes development of self-concept due to increased autonomy. Children between 1 and 3 years of age cannot understand feedback given by peers and teachers. Children from 3 to 6 years of age have increased language skills, including the identification of feelings.

How can the nurse increase a patient's self-awareness? Select all that apply. 1 Help the patient define his or her problems clearly. 2 Allow the patient to openly explore thoughts and feelings. 3 Reframe the patient's thoughts and feelings in a more positive way. 4 Have family members assume more responsibility during times of stress. 5 Arrange for the patient to work with an occupational therapist.

1, 2, 3 Helping a patient define his or her problems, allowing the patient to explore his or her feelings, and reframing the patient's thoughts and feelings in a more positive way are techniques designed to promote self-awareness and a positive self-concept. Having a family member assume more responsibility does not help a patient achieve self-awareness; instead it is important to encourage a patient to assume more self-responsibility.

In assessing a patient for self-concept and self-esteem, on what components should the nurse focus? Select all that apply. 1 Identity 2 Body image 3 Role performance 4 Physical condition 5 Medical condition

1, 2, 3 When assessing a patient's self-esteem, the nurse should focus on assessing individual components such as identity, body image, and role performance. This helps the nurse determine which factor is affecting the self-concept. The physical and medical conditions are not components of self-concept.

Which events in life can alter the self-concept of a person significantly? Select all that apply. 1 Having a child 2 Losing a child 3 Being promoted at work 4 Taking an exam at school 5 Being diagnosed with a chronic illness

1, 2, 3, 5 Having a child changes the role of a person to a parent and affects a person's self-concept. Losing a child brings shock and depression, which negatively influence the self-concept. Being promoted at work boosts an individual's self-concept. A diagnosis of a chronic illness may reduce the self-esteem of the patient considerably. Events such as taking an exam would not influence an individual's self-concept.

What statements made by the patient indicate that the patient's self-concept is improving following treatment? Select all that apply. 1 "I am pretty comfortable with my crutches." 2 "It is easier to administer insulin than I had imagined." 3 "The prosthesis hurts; I cannot endure it." 4 "Physical therapy is going well. I'm going to be on my feet soon." 5 "I don't find the social gathering very interesting."

1, 2, 4 Acceptance of the use of assistive devices and understanding teaching, such as how to administer insulin, suggest good progress. Positive attitudes toward returning to previous levels of functioning also indicate good progress. Not wanting to put additional efforts into rehabilitation and not wanting to socialize indicate negative self-concept.

A 50-year-old female patient with breast cancer is admitted to the hospital for surgical management. On the second postoperative day, the nurse finds the patient crying. She tells the nurse that she had agreed to take care of her 8-month-old granddaughter but knows she will be unable to do so. The patient also expresses concern about her looks and that she feels worthless. Which aspects of the patient's self-concept are affected? Select all that apply. 1 Body image 2 Self-esteem 3 Concentration 4 Role performance 5 Memory and recall

1, 2, 4 Body image is the way a person perceives her body including physical appearance, structure, and function. The patient is unhappy with the way she looks. Self-esteem is the feeling of self-worth. The patient indicates a negative self-esteem. Role performance is the way in which a person perceives the ability to carry out a significant role. The patient doubts she can handle the responsibility of looking after her granddaughter. This shows negative role performance. Concentration, memory, and recall are intellectual aspects and are unaffected in this patient.

For what should the nurse look when assessing an altered self-concept in a patient? Select all that apply. 1 The patient has a slumped posture. 2 The patient is overly apologetic. 3 The patient has a well-groomed appearance. 4 The patient uses hesitant speech. 5 The patient avoids eye contact.

1, 2, 4, 5 A patient who has an altered self-concept exhibits behaviors such as a slumped posture, is generally overly apologetic, and is hesitant while speaking. The patient may have difficulty in sharing views and opinions and usually avoids eye contact. Having a well-groomed appearance is a sign that the patient has a good self-concept.

The nurse is assessing a patient who lost his fingers in an accident with a meat mincer. What patient behavior is suggestive of an altered self-concept? Select all that apply. 1 The patient does not make eye contact while talking. 2 The patient discusses prosthetics with the nurse. 3 The patient still cannot believe he was so careless. 4 The patient states that he wants to be left alone. 5 The patient informs a co-worker that he will be back to work in a few days.

1, 3, 4 Avoiding eye contact, excessive self-criticism, and denial of self-expression are all signs of altered self-concept. A patient who discusses treatment options and future goals has a high self-concept and has a good chance of a speedy recovery. The patient who is positive about going to work and not blaming others for his condition also has a very good self-concept.

A 55-year-old male patient recently underwent a colostomy. Prior to the colostomy, the patient underwent coronary artery bypass graft (CABG) surgery. The nurse finds the patient depressed and weeping. The patient expresses that he is fed up with his poor health. He feels that he has become a burden on his family because he can't work now. Which factors are responsible for lowering the patient's self-esteem? Select all that apply. 1 The colostomy 2 Abuse or neglect 3 Dependency on others 4 A change in marital status 5 A physical deficit preventing role assumption

1, 3, 5 Procedures such as colostomies alter the physical appearance of people, thereby lowering their self-esteem. This patient is dependent on his family due to his physical deficits. This can be a major stressor and further reduce his self-esteem. His self-esteem is also lowered by the fact that he is unable to handle his responsibilities. Abuse or neglect and change in marital status do affect a person's self-esteem, but in this case, these factors are not evident.

A 55-year-old male patient underwent a colostomy. Earlier he underwent coronary artery bypass graft (CABG) surgery. The nurse finds the patient depressed and weeping. The patient expresses that he is fed up with his poor health. He feels that he has become a burden on his family because he can't work now. The nurse concludes that the patient is experiencing role performance issues. Which statement is true about role performance? 1 It is an individual's holistic feeling of self-worth or emotional appraisal. 2 It is the way an individual perceives his or her ability to responsibly carry out significant roles. 3 It involves the ideas and views of an individual related to physical appearance, structure, and function. 4 It is a conflict experienced when an individual has to perform two or more mutually exclusive responsibilities.

2 Role performance is the way in which an individual perceives his or her ability to carry out significant roles responsibly. Self-esteem is an individual's holistic feeling of self-worth or emotional appraisal. Body image involves ideas and views of an individual related to the body including physical appearance, structure, or function. Role conflict is a conflict a person experiences when he or she has to perform two or more mutually exclusive responsibilities.

What term describes how one thinks of oneself? 1 Self-awareness 2 Self-concept 3 Self-esteem 4 Self-expression

2 Self-concept is how one thinks of oneself. It is subjective and is a mixture of conscious and unconscious thoughts, attitudes, and perceptions. Self-awareness is having knowledge about one's feelings, thoughts, and attitudes. Self-esteem is how one feels about oneself. Self-expression is expressing one's own character, feelings, thoughts, and mind-sets.

In planning nursing care for an 85-year-old male, what is the most important, basic need that must be met? 1 Assurance of sexual intimacy 2 Preservation of self-esteem 3 Expanded socialization 4 Increase in monthly income

2 Self-esteem is essential for physical and psychological health across the life span.

The nurse asks the patient, "How do you feel about yourself?" What is the nurse assessing? 1 Identity 2 Self-esteem 3 Body image 4 Role performance

2 Self-esteem is how a person feels about himself or herself. Asking open-ended questions about self-esteem is important during the nursing assessment.

A patient underwent six cycles of chemotherapy for her cancer. She lost all of her hair due to drug effects. She is very worried and says, "My children may find me ugly. I will not be able to tolerate that." What stressor is most affecting her self-concept? 1 Chemotherapy 2 Body Image 3 Role performance 4 Identity

2 The patient is very concerned about her physical appearance and is worried that her children will be shocked on seeing her with no hair. She has low self-concept related to body image. Chemotherapy does not affect the patient's self-concept as much as body image. The patient does not doubt herself in the role of a mother and is not facing any identity issues.

A 55-year-old male patient underwent a colostomy. Earlier he underwent coronary artery bypass graft (CABG) surgery. The nurse finds the patient depressed and weeping. The patient expresses that he is fed up with his poor health. He feels that he has become a burden on his family because he can't work now. The nurse finds that the patient's body language is suggestive of altered self-concept. Which behaviors suggest low self-esteem? Select all that apply. 1 Normal speech 2 Frequent crying 3 Hesitant speech 4 Avoidance of eye contact 5 Maintaining good eye contact

2, 3 ,4 Behaviors that are suggestive of altered self-esteem include frequent crying, hesitant speech, avoiding eye contact, slumped posture, and an unkempt appearance. Normal speech and maintaining good eye contact are suggestive of a normal and positive self-esteem.

The self-concept of an individual is influenced by various environmental, social, and psychological factors. How is a self-concept stressor defined? 1 It is the inability of an individual to distinguish self-concept from self-esteem. 2 It is an individual's belief that establishes that he or she is unworthy. 3 It is a real or perceived change that threatens a person's identity and body image. 4 It is the inability of an individual to reach an age-appropriate developmental stage.

3 Any real or perceived change in a person's life that would threaten or alter the person's identity, body image, or role performance is identified as a self-concept stressor. The ability to distinguish between self-concept and self-esteem does not alter a person's level of self-concept. A person's belief that he or she is unworthy indicates a low level of self-concept but is not necessarily a stressor. A person's inability to reach an age-appropriate developmental stage is not considered a self-concept stressor.

Due to a shortage of staff, the nurse has been on duty for both morning and night shifts for the last 2 days. Which role performance is the nurse experiencing? 1 Role strain 2 Role conflict 3 Role overload 4 Role ambiguity

3 Every person undergoes numerous role changes throughout life. Role overload is not being able to meet the demands of work and carve out some personal time for family. Therefore, the nurse is experiencing role overload in this situation. Role strain is the expression of feelings of frustration due to an illness or inadequate satisfaction. Role conflict occurs when a person has to assume two or more roles that are inconsistent and contradictory. Role ambiguity is unclear role expectations that create stress and confusion.

A patient diagnosed with major depressive disorder has long-term low self-esteem related to negative view of the self. Which action would be the most appropriate cognitive intervention by the nurse? 1 Promote active socialization with other patients. 2 Role-play to increase assertiveness skills. 3 Focus on identifying strengths and accomplishments. 4 Encourage journaling of underlying feelings.

3 Focusing on strengths and accomplishments to minimize the emphasis on failures assists the patient in altering distorted and negative thinking. The other interventions are important, but they are not designed to impact thoughts.

A 50-year-old female patient is admitted to the hospital for surgical management of breast cancer. On the second postoperative day, the nurse finds the patient crying. She tells the nurse that she had agreed to take care of her 8-month-old granddaughter, but knows she will be unable to do so. The patient also expresses concern about her looks and that she feels worthless. Identify the stressor that influenced the patient's self-esteem. 1 Pain 2 Job loss 3 Mastectomy 4 Repeated failures

3 Mastectomy is a surgical procedure for removal of affected breast tissues. Mastectomy has a negative effect on the physical appearance of a female and may be unacceptable to many women. This can be a major factor in lowering their self-esteem. Chronic illness and the idea of depending on others also lower self-esteem. In this case, there is no mention of pain, job loss, or repeated failure, which may also reduce self-esteem.

A person tries to meet the strenuous demands of employment while taking care of a family of six and manages to fulfill the responsibilities with great difficulty. What kind of role performance stressor is affecting this person? 1 Role conflict 2 Role ambiguity 3 Role overload 4 Role strain

3 When the expectations and responsibilities of a role are unmanageable, it is referred to as role overload. A person may experience role overload when trying to meet employment demands and caring for a family. Role conflict happens when a person has to assume two or more inconsistent and mutually exclusive roles. Role ambiguity occurs when a person is confused and not sure of his or her role. Role strain results from role conflict and role ambiguity combined.

The nurse is teaching a group of young adults about the normal changes in role performance associated with maturation. What are the common stressors related to role performance in this stage of life? Select all that apply. 1 Societal attitudes 2 Dependency on others 3 Transition from school to work setting 4 Physical, emotional, or cognitive deficits preventing role assumption 5 Death of a loved one

3, 4, 5 Role performance is the way in which individuals perceive their abilities to carry out significant roles (e.g., parent, supervisor, or close friend). Normal changes associated with maturation result in changes in role performance. The common stressors include transition from school to work setting, and the physical, emotional, or cognitive deficits preventing role assumption. The death of a loved one creates an emotional deficit that may prevent a person from assuming his or her roles. Societal attitudes and dependency on others are related to identity.

The nurse is caring for an 87-year-old patient. What factor most directly influences this patient's current self-concept? 1 Attitude and behaviors of relatives providing care 2 Caring behaviors of the nurse and health care team 3 Level of education, economic status, and living conditions 4 Adjustment to role change, loss of loved ones, and physical energy

4 Older adults experience significant challenges to self-concept, including mental and physical changes associated with aging and changes in identity and roles following retirement and/or loss of significant others. The adjustment to stressors is most important. The other influences are important but to a lesser degree.

The nurse plans her nursing care with the knowledge that old age is primarily focused on which of Erikson's stages of growth and development? 1 Intimacy versus isolation 2 Autonomy versus shame and doubt 3 Generativity versus self-absorption 4 Ego integrity versus despair

4 The developmental stage of ego integrity versus despair (late 60s to death) is focused on feeling positive about life and its meaning and providing a legacy for the next generation.

A patient suffers from situational low self-esteem following the death of her pet dog. What are the appropriate questions for the nurse to ask during assessment of her self-esteem? 1 "What recreational activities do you like?" 2 "What is your favorite food?" 3 "What are the three activities that you used to do with your dog?" 4 "How do you feel about yourself?"

4 The nurse's assessment should focus on individual components, and asking the patient how she feels about herself helps the nurse to identify any identity crises the patient might have. Asking about recreational activities, favorite foods, and activities with the pet would not be useful in assessing the problems related to the patient's identity, role performance, or body image.

Following a bilateral mastectomy, a 50-year-old patient refuses to eat, discourages visitors, and pays little attention to her appearance. One morning the nurse enters the room to see the patient with her hair combed and makeup applied. Which statement is the best response from the nurse? 1 "What's the special occasion?" 2 "You must be feeling better today." 3 "This is the first time I have seen you look this good." 4 "I see that you've combed your hair and put on makeup."

4 When the nurse uses a matter-of-fact approach and acknowledges a change in the patient's behavior or appearance, it allows the patient to establish its meaning.

Which statement made by a patient with cancer reflects positive thoughts about personal health? 1 "I will not get better soon." 2 "I am a burden to my family." 3 "I have the ability to get well quickly." 4 "I can't stand to look at myself anymore."

A person's belief about personal health helps the nurse to understand the patient's self-concept. The patient who feels he or she has the ability to get well reflects positive thoughts about personal health. A verbalization such as, "I will not get better soon," indicates that the patient is suffering from chronic illnesses. If the patient states that he or she is a burden to his or her family, it indicates negative perceptions about personal health. The patient who states, "I can't stand to look at myself anymore" is indicating that he or she does not have positive thoughts about personal health.