Nokea
A college student visits the health clinic for a refill of a prescription for acne medication. In response to the nurse's question about how her semester is going the student bursts into tears and cries, "No one will ever ask me out on a date. I just want to be thin and pretty like the other girls." What response by the nurse could promote the student's examination of their self-esteem?
- A. "You seem to have a negative body image and poor self-esteem."
- B. "What are some things you'd like to change about your body."
- C. "Most college students want to fit in; tell me what you enjoy doing."
- D. "You are quite pretty and have a lovely figure."
Correct Answer: C
Rationale: This patient is likely expressing concern with body image and self-esteem. The nurse seeks further information to support this, rather than suggesting the student has a negative body image or glossing over the student's concern and offering their opinion about the student's appearance or suggesting that their body needs changing. The nurse identifies the etiology of the student's concern, needing to fit in and be desired.
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A mother of an outspoken school-aged child tells the nurse: "I feel incompetent as a parent and have difficulty disciplining my child." What should be the nurse's first action when counseling this patient?
- A. Recommending that she discipline her child more strictly and consistently
- B. Making a "to-do" list for the child's father to allow her more time to focus on improving her parenting skills
- C. Assisting the mother to identify both what she thinks is successful and what she can do to improve
- D. Exploring how the child can improve their behavior and make the mother's role as a parent easier
Correct Answer: C
Rationale: The nurse assesses the issue first, helping the mother identify what they believe is working and what is preventing them from being an effective parent. Next the nurse can explore solutions aimed at improving their parenting skills. Without assessment, there is no indication the child needs more strict discipline or assistance of the father. The child is not responsible for making the mother's parental role easier.
A nurse is conducting a parent workshop on how to build self-esteem in children. Which teaching points would the nurse include to help parents achieve this goal? Select all that apply.
- A. Reinforce their child's positive qualities.
- B. Overlook occasional negative behavior.
- C. Ignore neutral behavior that is a matter of personal preference.
- D. Listen and "fix things" for their children.
- E. Describe the child's behavior and judge it.
- F. Let their children practice skills and make it safe to fail.
Correct Answer: A,C,F
Rationale: The nurse should include the following teaching points for parents: (1) reinforce their child's positive qualities; (2) address negative qualities constructively; (3) ignore neutral behavior that is a matter of taste, preference, or personal style. Parents should allow children to be challenged or fail, rather than "fix things" for their children; avoid judgmental observations and let their child know what to expect, practice the necessary skills, be patient, and make it safe to fail.
A patient is admitted through the emergency department with severe facial burns and cuts to the face after a car accident in which their fianc?© was the driver. Three weeks later, their fianc?© has not yet contacted them. The patient states that they are too tired to have visitors anyway and frequently lies with their eyes closed and head turned away. Based on this information, what action would the nurse take first?
- A. Identify a disturbance in self-concept.
- B. Question the patient about disturbances of body image.
- C. Ask the patient how the accident has affected her.
- D. Explain that the wounds are healing well, but she can consult a plastic surgeon after discharge if needed.
Correct Answer: C
Rationale: The nurse first assesses the patient's response to the accident before documenting a health problem and etiology. The nurse takes cues from the patient regarding their traumatic injuries, their fianc?©'s failure to contact them, and their withdrawal, which point to potential problems with both body image and self-esteem.
A patient who has been in the United States only 3 months has recently suffered the loss of partner and job. They state that nothing feels familiar-"I don't know who I am supposed to be here"-and says "I miss home terribly." For what alteration in self-concept is this patient most at risk?
- A. Disturbed (or Risk for Disturbed) Personal Identity
- B. Disturbed Body Image
- C. Chronic (or Risk for Chronic) Low Self-Esteem or Situational (or Risk for Situational) Low Self-Esteem
- D. Impaired Role Performance
Correct Answer: A
Rationale: An unfamiliar culture, coupled with traumatic life events such as loss of husband and job, result in this patient's total loss of their sense of self, supported by the statement: "I don't know who I am supposed to be here."
A sophomore in high school has missed a great deal of school due to treatment of leukemia. They stated they feel that they are falling behind in everything, and miss "hanging out at the mall" with friends most of all. What statement by the nurse is most appropriate?
- A. "It sounds like you don't know who you are anymore..."
- B. "Have the changes in your body since your diagnosis affected you?"
- C. "How are you viewing yourself these days?"
- D. "This must be difficult as adolescents' friends are very important to them."
Correct Answer: D
Rationale: Important roles for this adolescent include student and a friend; the illness is preventing them from doing either of these well, which reflects a disturbance in role performance. Stating that it sounds like you don't know who you are anymore is a question related to personal identity disturbance; asking about changes in the body would relate to disturbed body image; asking how are you viewing yourself these days relates to self-esteem disturbance.