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A nurse is performing a psychological assessment of an adolescent patient who has Down syndrome with mild intellectual disability. The patient tells the nurse, "I'm a good helper. I can carry things because I'm strong, but I'm not real smart, so I help with things I know how to do." What findings for self-concept and self-esteem would the nurse document for this patient?
- A. Negative self-concept and low self-esteem
- B. Negative self-concept and high self-esteem.
- C. Positive self-concept and fairly high self-esteem.
- D. Positive self-concept and low self-esteem
Correct Answer: C
Rationale: The data point to the patient's positive self-concept ("I'm a good helper") and fairly high self-esteem (realizes their strengths and limitations). Stating, "But I'm not really smart" is likely accurate compared to non-disable peers and is not an indication of a negative self-concept.
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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.
A nurse asks a 25-year-old patient to describe themself with a list of 20 words. After 15 minutes, the patient listed, "25 years old, male, named Joe," then declared he could not think of anything else. What should the nurse document regarding this patient?
- A. This patient presents with lack of self-esteem.
- B. The patient does not possess self-knowledge.
- C. This person has unrealistic expectations of themselves.
- D. There is an inability to evaluate himself realistically.
Correct Answer: B
Rationale: The patient's inability to list more than three items about themselves indicates deficient self-knowledge and lack of familiarity with their own qualities and traits. There is insufficient data to determine whether they lack self-esteem, have unrealistic self-expectations, or are unable to evaluate themselves.
An older adult patient has a health problem of Disturbed Body Image documented on their care plan. The nurse discovers that patient feels they look old and feeble when ambulating with an assistive device often walking without it. The patient has fallen several times. What is an appropriate goal for this patient?
- A. The patient will state the need to use the assistive device both inside and outside the house.
- B. The patient will demonstrate proper use of the assistive device as observed by the nurse and physical therapist.
- C. The patient will discuss their feelings about the device and compare that with the need for safety.
- D. The patient will be given a wheelchair for mobility, as it is safer.
Correct Answer: C
Rationale: The patient is demonstrating a maladaptive response. Patients who deny and avoid dealing with limitations or deformity, engage in self-destructive behavior, or fail to estimate relationship of body to environment are experiencing a disturbed self-concept. The patient will need to discuss their feelings to reframe the situation and prioritize safety.
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 young adult businessperson attends counseling, attempting to deal with a history of sexual abuse by their father. "I should feel satisfied with what I've achieved, but nothing I accomplish makes me feel good about myself.... I hate my father for making me feel like I'm no good. This is an awful way to live." What statement by the nurse would be most helpful?
- A. "You've managed to overcome a lot since your childhood."
- B. "Can you identify some positive attributes about yourself."
- C. "Perhaps it's time to accept you're an adult and the abuse is in the past."
- D. "What might make you feel more content? Go after it!"
Correct Answer: B
Rationale: This patient's self-concept disturbance is mainly one of devaluing themselves and thinking that they are no good. The nurse assists the patient in reframing their negative thoughts into positive thoughts by identifying positive attributes.