Question 1

A patient who was abused as a child tells a nurse of the abuse in a stilted,unemotional manner.Which intervention would encourage the patient to examine feelings associated with childhood abuse?
A) "You poor thing! I feel deeply sorry for what you endured."
B) "When you described this relationship, you didn't tell me how you felt."
C) "You must be feeling so angry with your parents that you'd like to harm them."
D) "If I experienced that as a child, I would feel betrayed, confused, and frightened."

Accepted Answer

When patients have difficulty describing feelings,the nurse can use the technique of verbalizing how he or she might have felt in the same situation.This demonstrates the nurse's empathy for the patient.

Question 2

Which individual is most in need of measures to reduce the risk for self-concept disturbance associated with health-illness transition?
A) A 15-year-old with Crohn disease who states, "An ileostomy will mean I won't be able to do stuff with my friends."
B) An 18-year-old with an above-the-knee double amputation who states, "I guess I'll be a wheelchair athlete instead of a marathon runner."
C) A 30-year-old with blindness caused by glaucoma who states, "My spouse will help me learn Braille."
D) A 52-year-old with breast cancer who states, "My life is more valuable than any body part."

Accepted Answer

Each patient described faces threats to security,self-control,and wholeness.However,the 15-year-old's perception of the change is the most negative and potentially jeopardizes relationships with peers,thus having a negative effect on self-esteem.

Question 3

During the process of self-exploration,it is important for a nurse to convey the message that the patient:
A) may be the victim of circumstances that created unsolvable psychosocial problems.
B) is responsible for his or her own behavior, including maladaptive coping responses.
C) cannot hope to make any changes without some professional, therapeutic guidance.
D) needs to focus on changing the attitudes and behaviors of significant others.

Accepted Answer

Letting the patient know that he or she is responsible for his or her own behavior reduces the projection of patient problems onto the environment and fosters empowerment.

Question 4

A nurse is working with a patient to improve self-concept by expanding self-awareness.Which intervention is best?
A) Encouraging the patient to examine feelings related to a stressor
B) Creating a climate of acceptance toward the patient
C) Discussing all possible alternatives and solutions
D) Challenging the patient's faulty beliefs

Accepted Answer

Encouraging the patient to expand self-awareness is part of nursing interventions at level 1.Creating a climate of acceptance facilitates this process.The remaining options are directed toward self-exploration,realistic planning,and self-evaluation,not self-awareness.

Question 5

Which patient has best achieved the desired outcome of therapy to improve self-concept?
A) A patient who states, "My abilities are still a long way from comparing favorably with my self-ideal."
B) A patient who states, "I felt pushed to do what the nurse wanted. I wasn't always ready to move forward when the nurse was."
C) A patient who states, "I understand myself better, but I haven't worked out what alternative behaviors will serve me best."
D) A patient who states, "I understand that no one else can make me happy. I'm using my strengths and making my wishes become realities."

Accepted Answer

The patient in this option shows self-awareness and commitment to change,whereas the remarks of the others express only self-awareness.

Question 6

When working with a patient experiencing an alteration in self-concept resulting from dissociative amnesia,a nurse should begin by:
A) identifying and supporting the patient's ego strength.
B) helping the patient to develop a realistic self-ideal.
C) taking measures to prevent further identity diffusion.
D) setting mutual goals for attitudinal and behavioral change.

Accepted Answer

Some degree of ego strength,such as the capacity for reality testing,self-control,or a degree of ego integration,is needed as a foundation for all later nursing care.

Question 7

A patient who is seeking help at the mental health clinic states,"I know my work has gone downhill.I'm a poor spouse,parent,and teacher.I should be able to do better." The best response by the nurse would be:
A) "You have very high expectations for yourself."
B) "Why do you feel you should be all things to all people?"
C) "Have you ever talked this problem over with your spouse?"
D) "Perhaps it would help if you quit work to concentrate on your family."

Accepted Answer

This remark shows understanding of what the patient has said,using the therapeutic technique of reflecting,and would encourage the patient to continue talking.The remaining options are either probing,a change of focus,or premature advising.

Question 8

A patient is acutely psychotic and withdrawn.The patient claims to be a robot,stating,"I can't relate to others.I have no feelings.I can't talk because I have no ideas in my head." Acceptance is shown when the nurse remarks to this patient:
A) "May I sit here with you for a while?"
B) "May I help you loosen up and be less rigid?"
C) "I'll help you get in touch with the feelings you're trying to deny."
D) "I'll make decisions for you regarding your needs until you regain control."

Accepted Answer

Acceptance involves giving support without making demands.Simply sitting with a patient shows acceptance.

Question 9

Select the best goal when working with a patient who has an alteration in self-concept.
A) The patient will develop insight into his or her problems and current life situation.
B) The patient will clarify his or her concept of self in relation to relationships with others.
C) The patient will attain the maximum level of self-actualization to realize his or her potential.
D) The patient will effectively evaluate coping choices made in the past and their consequences.

Accepted Answer

Self-actualization is at the highest level of Maslow's hierarchy of needs and is highly desirable.Attaining self-actualization indicates that the alteration in self-concept has been resolved.

Question 10

Which relationships most significantly affect a 3-year-old child's development of self-concept? Relationships with:
A) peers.
B) parents.
C) extended family.
D) teachers in nursery school.

Accepted Answer

The self-concept development of a young child is most influenced by the parents.Initially the child views himself or herself as an extension of the parents and is highly sensitive to their perceptions of him or her.

Question 11

Which individual would be at greatest risk for self-esteem disturbance?
A) A 5-year-old starting school
B) A 16-year-old high school junior
C) A 26-year-old licensed practical nurse (LPN) entering a college nursing program
D) A 45-year-old working toward a master's degree in business administration

Accepted Answer

Self-esteem is most threatened during adolescence,when concepts of self are being modified and new self-decisions are being made.

Question 12

Which statement made by an adolescent patient represents an indirect expression of low self-esteem?
A) "It seems as if I have been a loser almost since the day I was born."
B) "Drinking beer almost always helps me to forget about my problems."
C) "I don't have many friends, and I tend to stay away from the ones I do have."
D) "If I had only gotten that job, then I could certainly experience happiness in life."

Accepted Answer

Expressions of low self-esteem can be direct or indirect.The statement regarding a job is an indirect statement that is categorized as illusions and unrealistic goals for an adolescent.Other indirect expressions are exaggerated sense of self,boredom,and polarizing view of life.The statements in the other options represent direct expressions of low self-esteem,including self-criticism,physical manifestations,and disturbed relationships.

Question 13

A patient reports feeling detached and says,"It feels as though I'm watching a movie as life unfolds.I'm isolated,on the outside and not involved.I really don't feel anything.I don't know if I'm alive or dead,awake or sleeping." The nurse can determine that the patient is describing:
A) akathisia.
B) hypomania.
C) depersonalization.
D) boundary violations.

Accepted Answer

Depersonalization is characterized by feelings of detachment,isolation,alienation,unreality,confusion,and a dreamlike view of the world.

Question 14

A patient states,"Ever since I was a kid,I knew I should study,get good grades,and go to medical school.I wanted to be helpful and do good for others." From this statement,the nurse obtains information to assess this patient's:
A) self-ideal.
B) self-esteem.
C) self-concept.
D) self-actualization.

Accepted Answer

Self-ideal is a person's perception of how he or she should behave on the basis of personal standards.

Question 15

A patient tells a nurse,"I am a weak person." The patient feels inadequate and vulnerable and states often feeling helpless and frightened.The nursing diagnosis most likely to fit this situation is:
A) personal identity disturbance.
B) chronic low self-esteem.
C) personality fusion.
D) depersonalization.

Accepted Answer

Self-esteem disturbance is defined as having a negative self-evaluation or negative feelings about self or self-capabilities,which may be directly or indirectly expressed.

Question 16

How does a nurse's use of sympathetic communication sometimes hinder a patient's work in developing a more realistic self-concept?
A) Sympathy can reinforce self-pity.
B) Sympathy reduces patient ego strength.
C) Sympathy encourages premature self-revelation.
D) Sympathy limits potential positive effects of transference.

Accepted Answer

Sympathy reinforces self-pity,and self-pity stands in the way of the patient's realizing that the power to change lies within himself or herself,which is the desired outcome of patient self-exploration.

Question 17

A nurse is working with a patient to improve self-concept using an intervention directed toward self-exploration.Which intervention is best?
A) Challenging the patient's faulty beliefs
B) Discussing all possible alternatives and solutions
C) Creating a climate of acceptance toward the patient
D) Encouraging the patient to examine behaviors related to a stressor

Accepted Answer

Encouraging the patient to examine feelings and behavior related to a stressor is part of nursing interventions at level 2,self-exploration.The remaining options relate to realistic planning,self-evaluation,and expanded self-awareness.

Question 18

A patient who is acutely psychotic and withdrawn claims to be a robot.An early intervention designed to help this patient expand self-awareness would be to:
A) confirm the patient's identity.
B) set up a daily schedule for the patient.
C) introduce the patient to two other withdrawn patients.
D) explain to the patient the need to express feelings more openly.

Accepted Answer

The first step in expanding self-awareness may be to confirm the identity of a patient with limited ego resources.

Question 19

A patient is acutely psychotic,withdrawn,claims to be a robot,and cannot think of how to take a shower.Which response by the nurse is best?
A) "If you can't shower independently, the staff will give you a bed bath."
B) "I will turn on the water for you and provide you with step-by-step directions."
C) "You must shower, or you'll risk having people actively avoid being around you."
D) "We can put off the shower for another day because you don't have any body odor."

Accepted Answer

Simple,concrete directions are appropriate interventions for a patient with self-concept disturbance evidenced by distorted thinking,passivity,loss of initiative,and inability to make decisions.

Question 20

When working with a patient with self-concept disturbance,which type of communication would initially be most useful?
A) Probing
B) Empathic
C) Confrontational
D) Sympathetic

Accepted Answer

Empathic communication helps the patient accept his or her own feelings and thoughts.This acceptance is the basis for self-exploration.

Quiz 17: Self-Concept Responses and Dissociative Disorders

A patient who was abused as a child tells a nurse of the abuse in a stilted,unemotional manner.Which intervention would encourage the patient to examine feelings associated with childhood abuse?

Which individual is most in need of measures to reduce the risk for self-concept disturbance associated with health-illness transition?

During the process of self-exploration,it is important for a nurse to convey the message that the patient:

A nurse is working with a patient to improve self-concept by expanding self-awareness.Which intervention is best?

Which patient has best achieved the desired outcome of therapy to improve self-concept?

When working with a patient experiencing an alteration in self-concept resulting from dissociative amnesia,a nurse should begin by:

A patient who is seeking help at the mental health clinic states,"I know my work has gone downhill.I'm a poor spouse,parent,and teacher.I should be able to do better." The best response by the nurse would be:

A patient is acutely psychotic and withdrawn.The patient claims to be a robot,stating,"I can't relate to others.I have no feelings.I can't talk because I have no ideas in my head." Acceptance is shown when the nurse remarks to this patient:

Select the best goal when working with a patient who has an alteration in self-concept.

Which relationships most significantly affect a 3-year-old child's development of self-concept? Relationships with:

Which individual would be at greatest risk for self-esteem disturbance?

Which statement made by an adolescent patient represents an indirect expression of low self-esteem?

A patient reports feeling detached and says,"It feels as though I'm watching a movie as life unfolds.I'm isolated,on the outside and not involved.I really don't feel anything.I don't know if I'm alive or dead,awake or sleeping." The nurse can determine that the patient is describing:

A patient states,"Ever since I was a kid,I knew I should study,get good grades,and go to medical school.I wanted to be helpful and do good for others." From this statement,the nurse obtains information to assess this patient's:

A patient tells a nurse,"I am a weak person." The patient feels inadequate and vulnerable and states often feeling helpless and frightened.The nursing diagnosis most likely to fit this situation is:

How does a nurse's use of sympathetic communication sometimes hinder a patient's work in developing a more realistic self-concept?

A nurse is working with a patient to improve self-concept using an intervention directed toward self-exploration.Which intervention is best?

A patient who is acutely psychotic and withdrawn claims to be a robot.An early intervention designed to help this patient expand self-awareness would be to:

A patient is acutely psychotic,withdrawn,claims to be a robot,and cannot think of how to take a shower.Which response by the nurse is best?

When working with a patient with self-concept disturbance,which type of communication would initially be most useful?