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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.
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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 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 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.
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 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.