PrepU ch.41 self concept
A nurse is reviewing the health history of a client. Which statement documented in the history would lead the nurse to suspect that the client has a negative self-concept? Select all that apply. -"I feel like I'm so ugly." -"I like myself and my life." -"What good am I?" -"I'm such a horrible person." -"Who would want to marry me now the way I look?"
-"I feel like I'm so ugly." -"What good am I?" -"I'm such a horrible person." -"Who would want to marry me now the way I look?" Explanation: People who do not possess a healthy self-concept are less able to cope with life, often expressing feelings of inferiority, self-doubt, and self-dislike. Statements that relate negative feelings (such as being ugly, questioning one's ability, being a horrible person, questioning attractiveness) suggest a dysfunction. Liking one's self and one's life expresses positive feelings that would be associated with a positive self-concept. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1647. Chapter 41: Self-Concept - Page 1647
The nurse is caring for an older adult client who is admitted for a hip replacement related to osteoarthritis. The client expresses distress about the aging process and how it affects appearance. Which would be appropriate nursing intervention for this client? -Exercising to maintain muscle mass -Proper nutrition -Identification of depression -Measures for basic skin care -Yoga to maintain joint flexibility
-Exercising to maintain muscle mass -Proper nutrition -Measures for basic skin care -Yoga to maintain joint flexibility Explanation: Some basic interventions for a diagnosis of disturbed body image for an older adult include teaching preventive self-care measures that reduce discomforting signs of aging (e.g., exercise, which maintains muscle mass and joint flexibility; proper nutrition; and basic hygiene and skin care measures). Teaching this patient about how to identify depression may be appropriate, but is not an intervention for disturbed body image. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1649. Chapter 41: Self-Concept - Page 1649
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 -intensive eye contact -social withdrawal -taking on of additional responsibility
-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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1647. Chapter 41: Self-Concept - Page 1647
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. -refuses necessary help -uses available resources -makes decisions related to his care -declines responsibility for his care -depends on others for care
-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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1642. Chapter 41: Self-Concept - Page 1642
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? a.Assess the client's history of coping mechanisms. b.Tell the client that expectations are unrealistic. c.Place a consult for the client to speak to a social worker. d.Ask the client if alcohol is consumed to help relax.
a. 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 alcohol to relax, it is more appropriate for the nurse to ask what generally makes the client feel better when the client has negative feelings. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, Crises or Life Stressors, p. 1639. Chapter 41: Self-Concept - Page 1639
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? a.Assist the client in exploring thoughts and feelings related to body image changes. b.Provide limits and set boundaries so the client can express grief. c.Assume self-care behaviors for the client. d.Focus on assisting the client through the sequential stages of grief.
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, The Nursing Process for Patients With Alterations in Self-Concept, pp. 1640-1641. Chapter 41: Self-Concept - Page 1640-1641
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? a.Body image b.Self-esteem c.Role performance d.Personal identity
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1641. Chapter 41: Self-Concept - Page 1641
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? a.Discuss the benefit of talking with others who have lost a limb. b.Encourage the client to resume work to divert attention from the loss. c.Demonstrate fashions that conceal the loss of the leg. d.Provide constant privacy to prevent embarrassment.
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, Body Image, p. 1641. Chapter 41: Self-Concept - Page 1641
A client with cancer has a family who is emotionally supportive of the client. Having a supportive family is which type of resource? a.External resource b.Internal resource c.Professional resource d.Financial resource
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1639. Chapter 41: Self-Concept - Page 1639
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? a.Inadequate coping b.Low self-esteem c.Stress tolerance d.Lack of confidence
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, Crises or Life Stressors, p. 1639. Chapter 41: Self-Concept - Page 1639
Which nursing action helps to maintain a sense of self for clients? a.Offering a simple explanation before initiating any procedure b.Assessing weight and overall nutritional status c.Asking the client to refrain from negative expressions d.Maintaining the privacy of the client's room number
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1646. Chapter 41: Self-Concept - Page 1646
Which client outcome indicates effectiveness in a plan of care to promote self-concept? a.The client describes herself as a mother of two who is content with life and loves her husband. b.The client reports that he is content with his feelings and will not leave the house. c.The client is able to get her children dressed and fed and goes to bed when they get on the bus. d.The client refuses to look at the incision site following a mastectomy.
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1641. Chapter 41: Self-Concept - Page 1641
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: a.facilitate as many opportunities as possible for infant-parent attachment. b.give the parents details about their infant's daily routines. remind the parents that their infant's circumstances are just as nurturing as a home environment. c.educate the parents about the fact that the infant is less emotionally d.vulnerable than an infant with no cognitive deficits.
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1636. Chapter 41: Self-Concept - Page 1636
Which of the following factors is most likely to present a challenge to the self-concept of a man 79 years of age? a.the man's increasing level of dependence on his children b.assisting his grandchildren with their college tuition costs c.financial pressures associated with the depletion of his savings d.the realization that his children are themselves undergoing age-related changes
a. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1638. Chapter 41: Self-Concept - Page 1638
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? a."I will discuss treatment options with your doctor and let you know what is decided." b."You can speak with the doctor about all treatment options. I will stay with you while you talk to the doctor, if you like." c."You are not helpless. When the doctor comes in you need to talk for yourself. I will stay with you while you talk." d."I wonder if your spouse would be willing to talk with the doctor for you? I will ask your spouse for you."
b. "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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1645. Chapter 41: Self-Concept - Page 1645
What term best describes a person's sense of his own adequacy and worth? a.Esteem b.Self-esteem c.Love d.Self-actualization
b. Self-esteem Explanation: Self-esteem is a person's sense of his own adequacy and worth. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1635. Chapter 41: Self-Concept - Page 1635
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"? a.Self-knowledge b.Self-expectation c.Social self d.Self-evaluation
b. 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?" Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1635. Chapter 41: Self-Concept - Page 1635
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? a.Internal locus of control b.Control reasoning c.External locus of control d.Expectancy
c. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, p. 1637. Chapter 41: Self-Concept - Page 1637
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? a.Demonstrate bad behavior to educate about good behavior. b.Make decisions for the children to model right from wrong. c.Discipline the children to establish boundaries. d.Encourage participation in family health behaviors.
d. 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. Reference: Taylor, C., Lynn, P., & Bartlett, J., Fundamentals of Nursing, 9th ed., Philadelphia, Wolters Kluwer, 2019, Chapter 41: Self-Concept, Formation of Self-Concept, pp. 1636-1637. Chapter 41: Self-Concept - Page 1636-1637
