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A nurse asks a patient who has few descriptors of themselves to list facts, traits, or qualities that they would like to apply to themselves. The patient quickly lists 25 traits of a successful person, stating, "My father is like this; I wish I were like him." How does the nurse best interpret the discrepancy between the patient's description of themselves as they are and how they would like to be seen?
- A. The patient suffers from a negative self-concept.
- B. This person demonstrates modesty (lack of conceit).
- C. This individual has a disturbed body image.
- D. The patient likely has a low self-esteem.
Correct Answer: D
Rationale: The nurse can obtain a quick indication of a patient's self-esteem by using a graphic description of self-esteem as the discrepancy between the "real self" (what we think we really are) and the "ideal self" (what we think we would like to be). The greater the discrepancy, the lower the self-esteem; the smaller the discrepancy, the higher the self-esteem.
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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 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.
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 practicing in a health clinic assesses patient's self-concept during the patient intake. Which of these patients would the nurse identify has risk for problems related to self-concept?
- A. Older adult scheduled for a hysterectomy next week
- B. Young adult pastor whose vocal cords were paralyzed after a surgical procedure
- C. Young accountant who survives a heart attack and near-death experience
- D. Model who just learned that they have breast cancer
- E. Adolescent recovering from a spinal cord injury who will be wheelchair "mobile"
Correct Answer: B,C,D,E
Rationale: Based on the data, those who are at risk for negative self-concept include the pastor who will face challenges without his voice, the survivor of the near-death experience, and the model, whose work and livelihood depends on their physical appearance. The older adult would be least likely to experience body image or role performance disturbance because they are beyond childbearing years, and the surgery should not impair their functional ability.
A nurse is providing care for a patient with cancer who is approaching the end of life. Which nursing interventions will the nurse use to help the patient to maintain a positive sense of self? Select all that apply.
- A. Making a point to address the patient by name upon entering the room
- B. Avoiding fatiguing the patient by performing all procedures in silence
- C. Performing care in a manner that respects the patient's privacy and preferences
- D. Offering the patient a simple explanation before moving them in any way
- E. Ignoring the patient's negative feelings since they are part of the grieving process
- F. Avoiding conversing with the patient about their life, family, and occupation
Correct Answer: A,C,D
Rationale: Interventions to assist the patient to maintain a positive sense of self include addressing the patient by name when entering the room; performing care in a manner that respects the patient's privacy; offering simple explanations before moving the patient; acknowledging the patient's status, role, and individuality; and conversing with the patient about the patient's life experiences.