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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.
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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.
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.
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 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.