Sally is 5′7″, weighs 105 lb, and believes that she is fat. Which of the following most represents this perception?
1. Altered body image
2. Altered personal identity
3. Excessive self-expectation
4. Altered core self-concept
- Answer: 1. Rationale: Sally has an inappropriate view of her physical self, which is body image. Personal identity is a sense of uniqueness (option 2); self-expectation consists of those things one believes the self should be able to do (option 3); and core self-concept includes the most vital central beliefs about one’s identity (option 4). Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Diagnosing. Learning Outcome: 39-2.
Students juggling the responsibilities of work, school, and family are most likely to experience which of the following?
1. Role ambiguity
2. Role strain
3. Role conflict
4. Role enhancement
- Answer: 3. Rationale: This is role conflict—several different roles are competing for the person’s time, energy, and abilities. Role ambiguity results when there are unclear expectations of the role (option 1). Role strain exists when there are feelings of inadequacy in performing a role (option 2). Role enhancement is a nursing intervention (option 4). Cognitive Level: Understanding. Client Need: Psychosocial Integrity. Nursing Process: Diagnosing. Learning Outcome: 39-2.
An appropriate desired outcome for clients with Situational Low Self-Esteem includes which of the following?
1. Restored self-esteem
2. Consistently verbalizes self-acceptance
3. Teaches adaptive skills
4. Describes preoccupation with altered self
- Answer: 2. Rationale: This is a realistic and measurable outcome. Restored self-esteem is vague and not measurable (option 1). Teaching is an intervention, not an outcome (option 3). Decreased preoccupation with altered self relates to body image rather than self-esteem (option 4). Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Planning. Learning Outcome: 39-6.
An 89-year-old client states, “I’m a lost cause. I can’t even stand long enough to cook my own meals anymore.” Which is the most appropriate response?
1. “That must be difficult. What things are you still able to do?”
2. “Well, that is to be expected at your age.”
3. “Do you have someone else who can cook for you?”
4. “Are you a good cook?”
- Answer: 1. Rationale: This response encourages the client to say more and focuses on the positive. Option 2 is condescending and closes the discussion. Both options 3 and 4 ignore the emotional component of the client’s statement and do not address the person’s feelings of worthlessness. Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Implementation. Learning Outcomes: 39-6; 39-7.
An adult who has failed to satisfactorily resolve the developmental task of adolescence—identity versus confusion—is most likely to show which behavior?
1. Asserts independence
2. Is unable to express personal desires
3. Has difficulty working as a member of a team
4. Goes along with the crowd in all activities
- Answer: 4. Rationale: A person who follows the crowd is demonstrating unsuccessful resolution of this task. Successful resolution would result in assertion of independence (option 1). Inability to express desires is symptomatic of unresolved toddlerhood autonomy versus shame and doubt (option 2), while difficulty being a team player suggests unresolved early school-age industry versus inferiority (option 3). Cognitive Level: Understanding. Client Need: Psychosocial Integrity. Nursing Process: Assessment. Learning Outcome: 39-1.
During an annual performance review, which statement by the nurse indicates the area of self-awareness? 1. “I rarely make any medication errors.”
2. “I am willing to mentor new nurses.” 3. “My client satisfaction reports agree that I am friendly and helpful.”
4. “All of my clients have recovered quickly from their health problems.”
- Answer: 3. Rationale: Self-awareness consists of the relationship between own and others’ perceptions of the person. The other options reflect only how the nurse sees himself or herself. Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Evaluation. Learning Outcome: 39-2.
When asked to describe herself, a client newly diagnosed with a chronic illness describes only those roles involving others (e.g., wife, mother, medical assistant) and no personal hobbies or interests. What should the nurse include when planning her care?
1. How her treatment will affect her ability to perform those roles
2. How to set goals for her to develop personal hobbies or interests
3. That the family must be present while the treatment plan is being developed
4. That she will need psychological counseling for role performance in addition to her medical treatment
- Answer: 1. Rationale: A person who perceives herself primarily in terms of relationships with others must have the ability to perform those roles considered in planning care. Although it may seem important for her to develop outside interests, she may not be able to do this, especially with a new diagnosis of a chronic condition. It is not mandatory for the family to be present during care planning, although items impacting their lives should be validated with them before the plan is finalized. Psychological counseling is not automatically indicated unless her role performance is unhealthy. Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Planning. Learning Outcomes: 39-4; 39-6.
You are caring for a client who has a nursing diagnosis of Chronic Low Self-Esteem. Which behaviors are consistent with this diagnosis? Select all that apply.
1. Confronts authority
2. Verbalizes own weaknesses
3. Is unable to perform consistent with his/her family role (e.g., mother, father)
4. Sets unrealistically high goals
5. Has difficulty making positive observations about self 6. Has difficulty sleeping
- Answer: 2 and 5. Rationale: A person with chronic low self-esteem often is able to only make negative statements about self. The client would have difficulty confronting authority (option 1). Option 3 relates to role performance. Option 4 is incorrect because the client would have difficulty achieving even common/realistic goals and is not likely to set extremely high goals. Option 6, sleeping, is generally not impaired with low self-esteem. Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Diagnosing. Learning Outcome: 39-5
Which interventions are appropriate for a client with low/poor self-concept? Select all that apply.
1. Encourage the client to compare self with others.
2. Suggest the client not say negative things about self.
3. Suggest the client say positive things about self.
4. Recommend the client avoid situations of having to care for others. 5. Communicate very low-level expectations of the client’s behavior.
- Answer: 2 and 3. Rationale: The client with poor self-concept should be encouraged to say positive self-statements and minimize negative ones. Such clients should not be encouraged to compare themselves with others (option 1). Having them care for others can be a very therapeutic intervention for such individuals (option 4). They should be given realistic and normal levels of expectations for their behavior. Cognitive Level: Applying. Client Need: Psychosocial Integrity. Nursing Process: Implementation. Learning Outcome: 39-6.
Self-concept may vary according to a variety of conditions affecting the individual. The nurse recognizes that even appropriate nursing interventions are least likely to alter which of the following?
1. Resources
2. Self-knowledge
3. Core self-concept
4. Social self
- Answer: 4. Rationale: The social self is how one is perceived by others and is difficult, if not impossible, to influence since the client does not control the viewpoints of other persons. With planning, the number of the client’s resources can be increased, self-knowledge improved, and core self-concept broadened since these are within the client’s control. Cognitive Level: Analyzing. Client Need: Psychosocial Integrity. Nursing Process: Planning. Learning Outcome: 39-3.
