Chapter 34 Self Concept

What are the chief factors that determine the self-concept of an individual? Select all that apply. 1 Age 2 Identity 3 Body image 4 Gender 5 Role performance

2, 3, 5 The way an individual identifies herself or himself, how the person perceives his or her body image, and the person's role performance determine the self-concept in the individual. Age and gender do affect the self-concept of a person, but they are not the main components.

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.

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.

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.

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.

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.

How does the nurse ensure that he or she meets the goals related to self-concept alterations in an acute care setting? Select all that apply. 1 Plan for the patient's discharge to home. 2 Make referrals to other health care professionals. 3 Schedule routine follow-up appointments. 4 Renew prescriptions. 5 Schedule diagnostic tests periodically.

1, 2, 3 In an acute care setting in which the length of stay for the patient is short, the nurse should arrange for the patient's discharge to home, make appropriate referrals to other health care professionals, and schedule routine follow-up appointments to evaluate progress. Renewing prescriptions and scheduling diagnostic tests would help the patient's medical condition, not his or her self-concept.

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.

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.

The nurse is teaching the proper technique for using an inhaler to a 12-year-old patient who suffers from asthma; the nurse is also teaching exercises to improve the breathing process. What should the nurse focus on to avoid development of an altered self-concept? Select all that apply. 1 Awareness of limitations 2 Awareness of strengths 3 Reassessment of life goals 4 Acceptance of changes in physical endurance 5 Providing reinforcement for mastery of a new skill

1, 2, 4, 5 Awareness of the limitations and strengths helps the child to strengthen self-concept. Providing reinforcement for mastering a new skill also helps to strengthen the self-concept that the child has developed. The nurse is helping the patient to accept the changes in physical endurance. Learning alternative techniques to deal with the asthma will help in developing a new self-concept. A 12-year-old is unlikely to have a set of goals in life. Thus, reassessment of goals is not usually required at this age.

What are the familial factors that contribute to the development of high self-esteem? Select all that apply. 1 Parental support 2 Social support 3 Authoritarian parenting style 4 Peer relations 5 Positive communication

1, 2, 5 Parental support and monitoring play a vital role in developing high self-esteem. Social support and acceptance are other important factors. Positive communication in the family helps foster the self-esteem of an individual. An authoritarian parenting style is characterized by strict rules, harsh punishments, and little warmth towards the child. This style of parenting fosters a negative self-concept. Influences of peer relations do not come under the family domain.

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 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.

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.

What elements influence the achievement of identity in a person? Select all that apply. 1 Sexuality 2 Gender 3 Ethnicity 4 Place of birth 5 Physical appearance

1, 2, 3 Identity is the individual's sense of individuality. Sexuality and gender are essential components of identity. Ethnicity or racial differences are integral to a person's identity because they identify a person within an established set of values, traditions, customs, and rituals. The place of birth and physical appearance do not necessarily influence identity.

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 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.

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.

The nurse is interviewing a 15-year-old female patient and finds that the patient has an altered body image. Which factors can affect body image in this patient? Select all that apply. 1 Cognitive and physical growth 2 Cultural and societal attitudes 3 Role performance 4 Fulfillment of role expectations 5 Achievement of identity

1, 2 An altered body image can lead to a negative self-concept. Cognitive and physical growth during adolescence and aging can affect the body image. The hormonal changes during adolescence and puberty affect the way one perceives oneself. The cultural and societal attitudes and values may also affect body image. Some cultures consider aging to be a normal growth process, whereas other cultures are more youth oriented. Role performance and fulfillment of role expectations do not affect body image but have an impact on self-concept. Achievement of identity does not affect body image.

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.

What factors should the nurse look for when assessing the emotional development of a 15-year-old patient? Select all that apply. 1 Positive feelings of self 2 Maturation 3 Goals for the future 4 Acceptance of bodily changes 5 Enhanced self-awareness

1, 2, 3, 4 Eric Erickson's fifth stage of the psychosocial theory of development involves identity versus role confusion. The nurse should look for positive feelings of self and maturation level in the patient. The nurse should ask the patient if he or she has planned any goals in the future. The patient should also have an acceptance of the changes that occur in the body. Failure to attain any of these benchmarks may lead to role confusion in the patient. Enhanced self-awareness is the task of the Erickson's third stage, initiative versus guilt, in which the ability to complete a particular task increases awareness of the adolescent's own capabilities.

A 30-year-old patient suffering from osteoarthritis is unable to move without using a splint and lives with her mother. The patient no longer has a job. The patient refuses to meet anyone and feels worthless. What factors are responsible for this change in self-concept? Select all that apply. 1 Chronic illness 2 Dependency on others 3 Physical impairment 4 Loss of job identity 5 Self-absorption

1, 2, 3, 4 The factors that influence the self-concept of a person are chronic illness, dependency on others, and physical impairments. Loss of job identity also leads to alteration of self-concept and role performance. Self-absorption is the seventh stage of Erickson's psychosocial theory of development. Self-absorption may be a result of an inability to accept the changes in appearance and physical endurance. Accepting the changes due to the aging process leads to generativity.

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.

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.

What stressors is a patient likely to experience in an acute care setting? Select all that apply. 1 Stress related to diagnostic tests and results 2 Stress related to the family's response to the patient's condition 3 Stress related to an altered body image 4 Stress related to lifestyle modifications 5 Stress related to socialization

1, 3, 4 Stressors affecting a patient in an acute care setting are fear and anxiety related to diagnostic tests and their results. There is also potential fear and stress about a disturbed body image due to surgery or other physical condition. The patient also experiences the stress of adapting to an altered lifestyle because of the medical or physical condition. The patient may not be greatly affected by what the family thinks about his or her condition. Stress related to socialization is more common in elderly patients.

A 43-year-old female patient has come into the clinic for her annual physical examination. The patient has chronic arthritis, states that she feels incompetent doing simple tasks, and that she is a burden to others. Which techniques would the nurse perform to assess for low self-esteem? Select all that apply. 1 Observe patient's behavior. 2 Ignore patient's nonverbal indicators of distress. 3 Ask patient to explain thoughts and feelings about self. 4 Ask family members to leave the room when assessing the patient. 5 Note clues about both stressful and supportive relationships.

1, 3, 5 Observing the patient's behavior and asking the patient to explain his or her thoughts and feelings about himself or herself are assessment activities the nurse should perform. The nurse should also observe the clues about the stressful and supportive relationships to which the patient refers in conversations. In addition, the nurse should observe the patient's nonverbal behavior and ask the family members about the patient's behavioral changes.

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.

The nurse is caring for an 80-year-old patient. What factors influence this particular patient's current self-concept? Select all that apply. 1 The living conditions 2 Adjustment to a role change 3 Adjustment to the loss of a spouse 4 Assurance of sexual intimacy 5 Behaviors of relatives providing care

2, 3 An 80-year-old patient's self-concept is likely to be altered by changes in the role in the family and by the loss of the spouse. Living conditions do not influence self-concept at this age. Sexual intimacy is generally not desired at this age, because the production of sexual hormones lowers. The behavior of relatives providing care is not a significant factor for altering self-concept at this age.

Which body image stressors would likely damage the self-concept of an individual? Select all that apply. 1 A new haircut 2 Alopecia due to chemotherapy 3 Amputation of the foot 4 Knee replacement surgery 5 Plastic surgery

2, 3 Body image involves an individual's attitude toward his or her physical appearance, structure, and bodily functions. Various stressors influence body image. The loss of hair due to chemotherapy and the loss of a foot due to amputation influence a person's body image. A new haircut would not act as a stressor because it is transient and may improve physical appearance. Knee replacement surgery and plastic surgery would enhance the physical appearance or functioning of the body and thus would not be stressors.

Self-esteem stressors vary with developmental stages. In children, what are the stressors that affect self-esteem and self-worth? Select all that apply. 1 Unsuccessful relationships 2 An inability to meet parents' expectations 3 Sibling rivalry 4 Late onset of education 5 Loss of companionship

2, 3 In children, the inability to meet the expectations of parents and sibling rivalry issues can decrease the level of self-esteem and self-worth. An unsuccessful relationship is a stressor that affects the self-esteem of an adult. The late onset of education has a limited, if any, effect on a child's self-esteem. The loss of a companion or a spouse can affect self-concept in an older adult.

A patient has a large facial scar after the removal of a tumor of the buccal mucosa. The patient is extremely depressed due to this facial disfiguration. Which nursing actions would be helpful in motivating the patient? Select all that apply. 1 Allow a negative natural reaction to show when seeing the patient. 2 Examine the scar and assuring the patient that it is healing well. 3 Tell the patient about a good plastic surgeon who can improve the appearance of the scar. 4 Avoid looking at the patient. 5 State that the scar does not look as bad as anticipated.

2, 3, 5 When dealing with a patient with a disturbed body image, the nurse should be aware that both verbal and nonverbal communication might affect the patient and family. The nurse should encourage the patient with positive expressions, such as telling him or her that the scar is healing well and that it can be further improved by a plastic surgeon. The nurse may reinforce that the patient's condition is better than originally anticipated, which creates a positive feeling in the patient and family. The nurse should be careful to control facial expressions and never exhibit disgust or discomfort, even if that is a natural reaction to the patient's condition. Showing negative reactions to the patient may further lower the self-esteem of the patient. By not looking directly at the patient, the nurse may create a feeling of nonacceptance in a patient with low self-esteem.

The nurse is assigned to care for a patient who has low self-esteem after undergoing a right leg amputation. The goal for the patient is that the patient's self-esteem will improve in 2 weeks. What are the expected outcomes to achieve the goal? Select all that apply. 1 The patient will have difficulty in making eye contact. 2 The patient will verbalize acceptance of the prosthetic leg. 3 The patient will become less depressed. 4 The patient will interact in a social setting. 5 The patient will talk about his or her feelings

2, 4, 5 Expected outcomes for a patient with low self-esteem include nonverbal behaviors that indicate positive self-esteem. The expected outcomes include the patient verbalizing acceptance of the use of the prosthetic leg, having social interactions, and making eye contact. The patient will talk about his or her feelings. Ambiguous outcomes such as "become less depressed" don't provide the patient with small, manageable goals.

Which interventions should the nurse implement while caring for a patient with a disturbed body image who has undergone a modified radical mastectomy? Select all that apply. 1 Explore the need for opioid and nonnarcotic analgesics. 2 Show acceptance of breast surgery when providing care. 3 Ask the patient to identify personal strengths and talents. 4 Assist the patient in developing a realistic perception of or her body. 5 Tell the patient that her feelings are similar to feelings of other people in the same situation.

2, 4, 5 The nurse implements various interventions to enhance the patient's self-concept. These include showing acceptance of the breast surgery while providing care. This results in reducing the emotional response to the loss of breasts. The nurse should assist the patient in developing a realistic perception of her body because it increases the acceptance of the present physical appearance. The nurse tells the patient that her feelings are similar to feelings of other people who underwent a modified radical mastectomy; this promotes new social interactions. Opioid and nonnarcotic analgesics are needed to decrease acute pain due to surgery. Therefore, exploring the need for analgesics has no role in improving body image. Personal strengths and talents help a person to cope with low self-esteem. Therefore, the nurse should ask the patient to identify personal strengths and talents to enhance self-esteem.

A patient is scheduled for colostomy in 2 days. The nurse finds the patient very anxious, stressed, and states, "How am I going to live with a poop bag for the rest of my life?" What nursing actions would influence the patient's self-concept and prepare her for an altered body image? Select all that apply. 1 Showing the patient a colostomy bag and where it is fitted on the abdomen 2 Showing the patient a video about a healthy functioning body after a colostomy 3 Teaching the patient to do relaxation exercises to deal with anxiety 4 Informing the surgeon about the patient's stress and anxiety 5 Introducing the patient to other patients who have colostomies

2, 5 Informing the patient with a practical and realistic approach, such as by showing her a video on her future condition, may help her prepare for the outcomes. The patient may have a better sense of well-being if she interacts with other people with the same problem. Showing the bag and where it is fitted would have no effect on the patient's self-concept. Teaching the patient relaxation exercises would be helpful in reducing the patient's anxiety, but it would not positively affect the self-concept of the patient. It is the nurse's duty to help prepare the patient for surgery psychologically, so the problem should not be reported to the health care provider.

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 patient survived a motor vehicle accident; the driver of the other car did not. The patient feels extremely guilty and says, "I am never going to touch the wheel again in my life." If the nurse intervened to improve the patient's self-esteem, what would be the most likely immediate outcome? 1 The patient would talk to the victim's family. 2 The patient would drive back to work in a month. 3 The patient would at least sit in the driver's seat in 3 days. 4 The patient would drive his or her kids to school in a month

3 The patient survived a major motor vehicle accident and suffers from situational low self-esteem. The nursing interventions should be directed towards improving the self-esteem of the patient. The most likely immediate outcome of these interventions would be that the patient thinks about being able to drive again and would sit in the driver's seat within 3 days. It would take more time for the patient to drive back to work, drive his or her kids, or talk to the victim's family.

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."

3 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.

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.