Chapter 40, Self-Concept

A nurse always addresses clients by the preferred name when entering a client's home or room. What is the nurse facilitating by this action? A) A sense of self and worth B) Reorientation to who they are C) Personal strengths D) Negative self-concept

Ans: A Feedback: Clients who are acutely ill are often separated from their personal strengths, but also from real sense of self. One action by the nurse that will help clients maintain a sense of self and worth is by addressing the client by preferred name when entering the home or room.

A nurse working with clients in a health care facility influences them to make healthy lifestyle choices. According to Coopersmith, which base of self-esteem for the nurse does this example represent? A) Power B) Significance C) Competence D) Virtue

Ans: A Feedback: Coopersmith (1967) identified the four bases of self-esteem as (1) significance—the way a person feels he or she is loved and approved of by the people important to that person; (2) competence—the way tasks that are considered important are performed; (3) virtue—the attainment of moral-ethical standards; and (4) power—the extent to which a person influences his or her own life, and others' lives.

To obtain subjective data about a burn client's self-concept, the nurse should do what? A) Ask the client how she would describe herself. B) Observe the client's interactions with others. C) Document the client's lack of eye contact. D) Note how the client conceals her wound.

Ans: A Feedback: Gordon (1997) suggests asking clients how they would describe themselves in the assessment of self-concept.

An infant learns that the physical self is different from the environment. What term is used to describe this stage of selfconcept? A) Self-awareness B) Self-recognition C) Self-definition D) Self-concept

Ans: A Feedback: The stages in the development of the self include self-awareness (infancy), self-recognition (18 months), self-definition (3 years), and self-concept (6 to 7 years).

The nurse cares for a successful chemical engineer, age 29 years, who is admitted with a respiratory infection. The client reports feeling more stress than ever since a job promotion six months ago and asks, Why would something so positive and wonderful cause so much stress for me? Which is an appropriate response by the nurse? Select all that apply. A) All major life events can cause stress for us. B) People vary greatly in their perception of what constitutes a crisis or stressor. C) Your job promotion probably has nothing to do with the stress you feel. D) Positive life events do not cause stress or illness. E) Even positive life events can affect us in negative ways.

Ans: A, B, E Feedback: People vary greatly in their perception of what constitutes a crisis or stressor, as well as the degree to which such experiences might disrupt or diminish self-concept. Major stressors place anyone at relative risk for maladaptive responses such as withdrawal, isolation, depression, extreme anxiety, substance abuse, or exacerbation of physical illness. It is true that even positive events, such as marriage, a new baby, or a job promotion can place us at risk for great stress and all that goes with us. The client's promotion probably has a great deal to do with her stress level.

The nurse is caring for a girl 13 years of age, who is admitted after taking some of her mother's sleeping pills. She is withdrawn and declines to eat or engage in conversation, except to say she doesn't like herself. The nurse is aware that potential causes of poor self-concept at this age can be related to which of the following? Choose all that apply. A) Inability to accept bodily changes B) Identify confusion C) Failure to accept role responsibility D) Failure to develop meaningful goals E) Inability to resolve child versus adult roles

Ans: A, B, E Feedback: The adolescent can develop a poor self-concept related to bodily changes, the pull between adult and childhood roles, and identity confusion. The adult can have poor self-concept related to failure to accept role responsibilities, such as parenting or failure to develop meaningful goals, and therefore just drifting through life.

The nurse is assessing his client's self-concept. The client is status post-myocardial infarction and is due to be discharged tomorrow. Which of the following focuses will give the nurse the most information about the client's selfconcept? Choose all that apply. A) Body image B) Gender identity C) Self-esteem D) Role performance E) Sexual orientation

Ans: A, C, D Feedback: The nurse assessing self-concept focuses on the client's personal identity, body image, self-esteem, and role performance. Sexual orientation and gender identity do not always provide information about self-concept.

A young woman has been in an automobile crash and sustained a laceration across the left side of her face, resulting in a large scar. What nursing diagnosis would be appropriate for this disfigurement? A) Anxiety B) Disturbed Body Image C) Deficient Knowledge D) Impaired Memory

Ans: B Feedback: Body image is the subjective view a person has about his or her physical appearance. Disturbances in body image occur with any alteration in bodily appearance, structure, or function.

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. A) Altered self-esteem related to colostomy and poor self-image B) Disturbed body image related to colostomy as evidenced by avoidance of colostomy C) Fear of rejection by others related to colostomy and altered self-image D) Altered role performance related to inability to cope with visitors

Ans: B Feedback: Disturbed body image possesses the clinical cues of behaviors of avoidance, monitoring, or acknowledgement of one's body.

The wife of an older adult man has recently died. The couple was married for 32 years. What part of the man's selfconcept may be influenced by this loss? A) Ideal self B) Global self C) Body image D) False self

Ans: B Feedback: Global self is the term used to describe the composite of all the basic facts, qualities, traits, images, and feelings one holds about oneself. Some conditions associated with alterations in the global self include developmental changes, life crisis, illness, and loss.

A child learns to feel secure within the bonds of his immediate family by interacting with his caretakers. What is the term for this process? A) Self-reflection B) Adaptation C) Attachment D) Globalization

Ans: C Feedback: Bowlby (1969) developed attachment theory, which describes modes by which a young child develops and maintains feelings about the self, as well as values and beliefs about the world. Attachment is a process by which the child maintains security via an interpersonal bond with close caregivers, most notably parents. Through a learning process based on the child's perception of the caregiver's thoughts and reactions toward him or her, the child forms a sense of self as secure or insecure, calm or anxious, likable or not.

A young woman client admits to a nurse that she cannot control her jealousy when she and her partner are out together and states, "It's like we're back in high school again." This is an example of which identity disorder? A) Self-actualization B) Identity diffusion C) Depersonalization D) Lack of self-esteem

Ans: B Feedback: Identity diffusion is the failure to integrate various childhood identifications into a harmonious adult psychosocial identity, which can lead to disruptions in relationships and problems of intimacy. The need for self-actualization is the need to reach one's potential through full development of one's unique capability. Depersonalization is the subjective experience of the partial or total disruption of one's ego, and the disintegration and disorganization of one's self-concept (Stuart & Laraia, 2005). The need for self-esteem is the need to feel good about oneself and to believe that others hold one in high regard.

Which statement is an example of the effect of aging, illness, or trauma on self-concept? A) Society values the wisdom of aging B) Society devalues aging and chronic illness C) Few people take a healthy body for granted D) Most people accept the inevitability of illness

Ans: B Feedback: Many people take a healthy body for granted. Society encourages a denial of the eventuality of aging and chronic illness. Society emphasizes and rewards youth, health, and physical attractiveness while devaluing aging, chronic illness, and less-than-perfect physical attractiveness.

While interviewing a compulsive gambler 45 years of age, the woman blames her loss of job, estrangement from spouse, and lack of friends on destiny. The nurse interprets this information as indicative of which aspect of altered selfconcept? A) Self-care deficit B) Self-destructive behavior C) Behavioral changes D) Anxiety and depression

Ans: B Feedback: Self-destructive behaviors are addictive, giving immediate gratification only. The client is bound to gambling because of the temporary gratification it provides. She is unable to see the cause-and-effect relationship between her addiction and her current situation due to her self-concept dysfunction. Self-care deficit may manifest as disregard for special diet restriction, refusal to take medication, or missing follow-up appointments. 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 verbalizations about self. Anxiety and depression are psychological manifestations of self-concept dysfunction.

A client states, "I am not smart enough to learn how to take care of my mother, and I just don't think I can do it." This is an example of ... A) Self-perception B) Self-knowledge C) Self-expectation D) Social self

Ans: B Feedback: Self-knowledge or self-awareness involves the basic understanding of oneself, a cognitive perception. It is consciousness of one's abilities: cognitive, affective, and physical. Self-concept is the way a person thinks about himself or herself. Self-perception is how a person explains behavior based on self-observation.

During a self-esteem assessment of a young woman undergoing a complicated divorce, a nurse states: "Tell me something about the moral-ethical principles that govern your life." What aspect of self-esteem is the nurse assessing? A) Significance B) Virtue C) Power D) Competence

Ans: B Feedback: Virtue is the ability to live according to one's moral-ethical standards. Significance involves nurturing relationships in which needs for love and worth are mutually met. The ability to accomplish what is desired is power. The ability to assume role-related responsibilities with confidence is competence.

The nurse promotes the self-concept of the parents of an infant age 6 months admitted to the hospital with a fever and dehydration by doing what? A) Telling the parents that the infant's condition was not their fault B) Allowing the parents to participate in the infant's care C) Encouraging the parents to visit the infant every other day D) Educating the parents on health-maintenance behaviors

Ans: B Feedback: When a person suffers from an illness or exhibits a self-concept dysfunction, family members may also be affected. Family members may need to assist the individual to perform activities of daily living, or may have to change the living situation with the use of adaptive equipment or other assistive devices.

Which strategy can be used to help clients overcome powerlessness? A) Encourage clients to identify their weaknesses. B) Encourage clients to identify their strengths. C) Provide advice on how to handle problems. D) Set goals and make decisions for the client.

Ans: B Feedback: When confronted with a major stressor, many people forget they have histories of successful coping and numerous personal strengths. Nurses frequently fall into the trap of doing for clients, rather than helping those who are experiencing powerlessness identify personal strengths.

Who or what plays the most influential role in the internalization of self-concept in children? A) Peers B) Parents C) School D) Church

Ans: B Feedback: While forming the self-concept, the child internalizes other people's attitudes toward self. This internalization forms the foundation of self-concept. Parents or other direct caregivers play the most influential role; peers play the second most influential role.

The nurse is caring for a female client 64 years of age who is admitted for knee replacement. As the nurse performs the shift assessment, the client comments, I wouldn't mind getting old if it were not for the physical losses, like the wrinkles, all the drooping, and the wearing out of everything. People like to be around youthful, beautiful men and women; I feel so unattractive. Is the client correct about how society views older people? In general, which of the following does society emphasize and reward? Choose all that apply. A) Wisdom for sharing B) Youthfulness C) Mentoring the inexperienced D) Health and fitness E) Physical attractiveness

Ans: B, D, E Feedback: Society encourages a kind of denial of the eventuality of aging, chronic illness, and the necessity to integrate crisis and change throughout each person's lifetime. Society emphasizes and rewards youth, health, and narrow norms for physical attractiveness while devaluing seniors, those with chronic illness, and those whose appearance does not correspond to movie-star standards. Wisdom with the ability to mentor the inexperienced is important, but not as valued by society as physical attractiveness.

A teenager describes herself as "tall, attractive, female, student, intelligent." What part of her self-concept is she describing? A) Self-expectations B) Self-esteem C) Self-knowledge D) Self-evaluation

Ans: C Feedback: As a component of global self-concept, self-knowledge is used to describe the composite of all the basic facts, qualities, traits, images, and feelings one holds about oneself.

The children of immigrants may have different values and practices than do their parents, causing them to abandon their parents' cultural beliefs. What is this called? A) Cultural expectations B) Cultural competence C) Cultural dissonance D) Cultural modernization

Ans: C Feedback: Children of immigrants whose values and practices of their culture or origin vary from the culture of adoption may face cultural dissonance. Conflict between parents and children, as well as cultural confusion, may occur.

During an assessment of a client's self-esteem, a man age 45 years tells the nurse that he lost his job due to downsizing and has been unemployed for six months. What would be the appropriate response from the nurse? A) "You shouldn't feel bad about losing a job; it happens to everyone." B) "Do you need your job to support a family?" C) "How has losing your job affected your life and the lives of your significant others?" D) "There are more important things in life to worry about other than losing a job."

Ans: C Feedback: Life stressors or crises (e.g., marriage, divorce, acute or chronic illness, an exam, a new job or job loss, a gray hair, a fire) might call forth a personal response and mobilize an individual's talents, resulting in good feelings about oneself. It also may result in emotional paralysis with diminished self-concept. People vary greatly in their perception of what constitutes a crisis or stressor, as well as the degree to which such experiences might disrupt or diminish self-concept. The nurse should investigate the client's feelings about losing his job by asking open-ended questions, and by not being judgmental or minimalizing the client's feelings.

A nurse visits a diabetic client age 60 years in his home after the client's above-the-knee amputation of his left leg. The client appears disheveled and with poor hygiene. He also avoids making eye contact with the nurse. Which of the following is likely to occur as a result of the client's reduced self-esteem? A) Lethargy B) Withdrawal C) Self-care deficit D) Lack of interest

Ans: C Feedback: Physical changes such as decreased strength, skin turgor, and sensory acuity affect body image in later life. Because of the valuation of youth in the media and popular culture, some older people experience lowered self-esteem with the changed body image.

What is the name given to the evaluative and affective component of the self-concept? A) Ideal self B) Body image C) Self-esteem D) Self-knowledge

Ans: C Feedback: Self-esteem is the evaluative and affective component of the self-concept, sometimes termed self-respect, self-approval, or self-worth.

A nurse caring for critically ill clients uses interventions to help clients maintain a sense of self. Which of the following are recommended interventions? A) Disregard the client's status. B) Do not use touch out of respect for the client's privacy. C) Converse with the client about his or her life experience. D) Do not acknowledge or allow expression of negative feelings.

Ans: C Feedback: The nurse should converse with the client about his or her life experience; acknowledge the client's status, roles, and individuality; use looks, speech, and judicious touch to communicate worth; acknowledge and allow expression of negative feelings.

An adolescent rapidly develops secondary sex characteristics and body changes. What should the nurse assess to determine how these changes might affect the adolescent's self-concept? A) Expectations of the parents B) Developmental environment C) Meaningful use of time D) Understanding of changes

Ans: D Feedback: An adolescent rapidly develops secondary sex characteristics and body changes that may affect self-concept. The nurse should assess the adolescent's knowledge of, and understanding of, body changes.

The nurse is attending a nursing conference about enhancing self-concept in relation to professional nursing practice. As the nurse is waiting for the first speaker to begin, she tries to recall what she knows and has read about this subject. Which of the following would be good for the nurse to keep in mind to enhance her self-concept as a professional nurse? A) Don't worry about team esteem until your own is good. B) Avoid your weaknesses until they become strengths. C) Remember past errors so you do not repeat them. D) You don't have to know everything to be a good nurse.

Ans: D Feedback: Dispel the myth that it is necessary to know all there is to know about nursing to be a good nurse. At no one point in time does any nurse ever have it all together. Take errors seriously but do not dwell on them; accentuate the positive. Do not avoid your weaknesses until they become stronger; they won't improve without hard work on your part. Work to develop team self-esteem. A basic interpersonal principle that seems to work well in practice is to offer to others what you want yourself.

As a child grows, he unconsciously develops a component of self-concept based on the image of role models. What part of the self-concept does this describe? A) False self B) Evolving self C) Self-knowledge D) Self-expectations E) `

Ans: D Feedback: Expectations for the self arise from various sources. The ideal self makes up the self one wants to be, and develops unconsciously early in childhood based on images of role models such as parents, caregivers, and public figures.

The nurse is caring for a man client, age 47 years, who suffers from myasthenia gravis. He has periods of great weakness and is unable to do the things for his family that he would like to. He tells the nurse that he is not worth much these days. Knowing that sometimes clients focus on things they cannot do, which of the following statements by the nurse might be helpful? A) I'm sure that things will be better soon. B) Some days are like that. C) Does your family pitch in and help you? D) What are some of the things you do well?

Ans: D Feedback: Many clients focus naturally on their deficiencies; asking pointed questions about personal strengths can help a client identify positive factors. Telling this client that things will be better soon is untruthful; his disease is not curable. Asking if his family is helpful will make him feel even more worthless. Saying, Some days are like that tells the client that you agree with his opinion that he is worthless.

A nurse who works on the pediatric unit wants to help a child cope with the loss of a leg in a hunting accident. What would the nurse implement to help the child express feelings? A) Support from other family members B) Television cartoons C) Story books D) Dolls or animals

Ans: D Feedback: Nurses can use play therapy with children to help them describe their feelings and work through their grief using the nonthreatening medium of dolls and animals.

Which term best describes an individual's self-concept? A) Self-esteem B) Self-actualization C) Self-realization D) Self-image

Ans: D Feedback: One's self-concept is synonymous with one's self-image. Self-esteem and self-actualization are components of selfconcept.

In which age group do interpersonal losses play a role in disturbances in self-concept? A) Child B) Teenager C) Adult D) Older adult

Ans: D Feedback: The many losses associated with aging (e.g., diminished strength and physical health, interpersonal losses, retirement, shrinking income) make older adults especially vulnerable to disturbances in self-concept, particularly chronic, low selfesteem.

A school nurse is teaching parents how to build self-esteem in their children. Which is a recommended strategy? A) Use praise and compliments judiciously B) Wait for your child to initiate conversation C) Focus on remedying the child's negative qualities D) Give your child many opportunities to display abilities

Ans: D Feedback: To reinforce the positive qualities, (1) notice examples of ability in many different circumstances and point this out to the child, (2) find occasion to frequently and honestly praise the child, and (3) give the child an opportunity to show ability frequently.

What might a nurse ask during a health history to assess personal identity? A) "Tell me how your illness has affected you in your job." B) "Tell me what you do for fun and what you do for work." C) "How do you believe others see you? Why do you believe that?" D) "How would you describe yourself to others?"

Ans: D Feedback: 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 or she is. It can be assessed by asking, for example, "How would you describe yourself to others?"