Nokea
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.
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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.
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 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 school nurse is teaching parents how to foster a healthy development of self in their children. Which statement made by one of the parents requires further teaching?
- A. "I love my child so much I 'hug him to death' every day."
- B. "I think children need challenges, don't you?"
- C. "My partner and I grew up in restrictive families; we want our children to be free to do whatever they want."
- D. "We have different ideas about discipline, but we've continued our discussions so we can be consistent."
Correct Answer: C
Rationale: Each option with the exception of correctly addresses some aspect of fostering healthy development in children. Because children need effective structure and development, giving them total freedom to do as they please may actually hinder their development.
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.