Deck 17: Self-Concept Responses and Dissociative Disorders

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."

Answer 1

"If I experienced that as a child, I would feel betrayed, confused, and frightened."

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."

Answer 2

A 15-year-old with Crohn disease who states, "An ileostomy will mean I won't be able to do stuff with my friends."

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.

Answer 3

is responsible for his or her own behavior, including maladaptive coping responses.

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

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."

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.

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."

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."

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.

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.

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

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."

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.

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.

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.

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.

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

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.

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."

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

Question 21

A patient with low self-esteem has begun making behavior changes.A nurse positively reinforces these changes during a therapy session.The patient and nurse are actively engaged in which level of intervention?

A) Commitment to action
B) Expanded self-awareness
C) Realistic planning
D) Self-evaluation

Question 22

A nurse is attempting to help a patient alter negative self-concept.What is the correct order in which these nursing interventions should be implemented?
A.Assisting the patient in the process of self-evaluation.
B.Encouraging the patient's attempts at self-exploration.
C.Introducing skills that expand the patient's ability to be self-aware.
D.Helping the patient formulate a plan of action.
E.Supporting the patient in the achievement of goals.

A) A, B, C, D, E
B) B, C, D, E, A
C) C, B, A, D, E
D) E, B, D, C, A

Question 23

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

A) Providing support measures to reduce the patient's anxiety
B) Clarifying that the patient's beliefs affect the patient's feelings and behaviors
C) Documenting the patient's use of both logical and illogical thinking
D) Helping the patient understand that the patient alone can bring about personal change

Question 24

A nurse is working with a patient to improve self-concept.To best assist the patient in realistic goal planning,the nurse will:

A) note the patient's use of logical and illogical thinking.
B) provide support measures to reduce the patient's anxiety.
C) clarify that the patient's beliefs affect the patient's feelings and behaviors.
D) help the patient understand that the patient alone can bring about personal change.