Chapter 27: Self-Concept Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 7th Edition

Test Bank

MULTIPLE CHOICE

1. The client has just learned that his motorcycle accident has resulted in his left leg being amputated. When helping this client form goals and strategies for realistic goals, the nurse needs to assess the clients:

1.

Ideal and perceived self-concept

2.

Intellectual and spiritual strengths

3.

Involvement with significant others

4.

Interests and past accomplishments

ANS: 1

What individuals think and how they feel about themselves affects the way in which they care for themselves. A physical change in the body, such as an amputation, can lead to an altered body image affecting identity and self-esteem. The nurse should assess the clients ideal and perceived self-concept in order to help the client establish realistic goals and implementation strategies. Intellectual and spiritual strengths may be important when determining a clients ability to cope. However, when developing goals and implementation strategies, the process is going to begin with the clients perception of self-concept, because this will greatly impact his response to the amputation. When assessing coping behaviors of an individual, involvement with significant others may be an indication of available resources as well as a source of strength for a client. Assessing a clients interests and past accomplishments may provide information regarding a clients identity. Identity is only one component of self-concept. The nurse needs to determine the clients ideal and perceived self-concept in order to get the big picture as this will greatly impact his response to the amputation.

DIF: A REF: 413 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

2. A client is manifesting behaviors that are consistent with a negative self-concept. The nurse that is working with him has observed that the client maintains:

1.

Frequent eye contact

2.

Independence in self-care

3.

A passive personal attitude

4.

An interest in the surroundings

ANS: 3

A passive attitude is a behavioral characteristic suggestive of a negative self-concept. Avoidance of eye contact would be a behavior suggestive of a negative self-concept. Being excessively dependent is characteristic of a negative self-concept. A lack of interest in what is happening in ones surroundings is characteristic of a negative self-concept.

DIF: A REF: 412-413 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

3. A 76-year-old client who recently lost his wife is admitted for surgery. The nurse is using Erikson as a psychosocial framework for client assessment. Which of the following behaviors would alert the nurse that the client has an alteration in the integrity stage of his psychosocial development?

1.

Accepting his own limitations

2.

Verbalizing fear about the surgery

3.

Expressing his thoughts about his care

4.

Demanding excessive assistance from his daughter

ANS: 4

Being angry, being excessively dependent, and having a passive attitude are all behaviors suggestive of an altered self-concept. The older client, who has lost a spouse and is now demanding excessive assistance from a child, is demonstrating an alteration in the integrity stage of his psychosocial development. Accepting ones limitations is not consistent with a disturbance in the integrity stage of psychosocial development. Verbalizing fear about the surgery is not consistent with a disturbance in the integrity stage of psychosocial development. Expressing thoughts about ones care is not consistent with a disturbance in the integrity stage of psychosocial development.

DIF: A REF: 418 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

4. A client, while receiving therapies for lung cancer, has been hospitalized for an extended period of time. She has become very depressed, refuses visitors, and does not participate in personal grooming. In order for the nurse to assist in achieving resolution of the clients problem, he should have the client:

1.

Get washed and dressed independently

2.

Think positively instead of negatively

3.

Contact a support group and explore a psychological consultation

4.

Become more physically independent and return to prior activities

ANS: 3

Consultation with significant others, mental health clinicians, and community resources can result in a more comprehensive and workable plan. Clients who are experiencing threats to or alterations in self-concept often benefit from collaboration with mental health and community resources to promote increased awareness. The clients problem of a negative self-concept must be addressed first. As a result, the client may begin to bathe and dress independently. The client needs to express his negative feelings. This would be one step in addressing his self-concept problem. Stating the client should think positively instead of negatively, at this point, is unrealistic. A long-term goal may be that the client will become more independent and return to prior activities. It is not realistic at this time.

DIF: A REF: 420 OBJ: Comprehension

TOP: Nursing Process: Planning

MSC: NCLEX test plan designation: Safe, Effective Care Environment

5. The client is on the orthopedic unit following back surgery. He states, I feel like I cant do anything anymoreand I wont be able to continue my landscaping business. This is predominantly an example of a problem in which of the following components of self-concept?

1.

Body image

2.

Self-esteem

3.

Identity

4.

Role

ANS: 4

A physical health deficit that prevents role assumption can create a problem in the role performance component of self-concept. A client who is verbalizing concern about continuing a previous occupation is not demonstrating a problem in body image, but rather in the role performance component of self-concept. Self-esteem is closely related to self-concept, but is not a component of self-concept. Identity involves the internal sense of individuality, wholeness, and consistency of a person over time and in various circumstances. The client is verbalizing concern about role performance, not necessarily identity.

DIF: A REF: 414 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

6. A recently divorced client, who is a lawyer, comes to the clinic. She has gotten custody of her two teenagers and states, It is going to impossible for me to raise my children the way Id like and keep working as hard as I do. This is an example of:

1.

Role strain

2.

Role conflict

3.

Role ambiguity

4.

Gender role stereotype

ANS: 2

Role conflict results when a person is required to simultaneously assume two or more roles that are inconsistent, contradictory, or mutually exclusive. The single mother who is having difficulty managing working long hours and trying to raise her children as she perceives she would like to, is experiencing role conflict. Role strain is a feeling of frustration when a person feels inadequate or feels unsuited to a role, such as with gender role stereotypes. Role ambiguity involves unclear role expectations. The client is not expressing doubt as to what her roles are. A gender role stereotype is where there is an expectation that something is a mans role or a womans role because the position has been typically held by a man or woman. The client is not expressing concern about a gender role stereotype, but rather in managing two contradictory roles.

DIF: A REF: 415 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

7. A prostitute with HIV and severe complications is being cared for on a medical unit. The nurse is seeking to develop a therapeutic relationship with the client. Which of the following statements best reflects the nurses attempt to support the clients self-exploration?

1.

What type of support do you feel you need?

2.

Dont be embarrassed by your former occupation.

3.

What type of schedule could allow you to eat without being nauseated?

4.

The people who work here are professionals; well not judge your past actions.

ANS: 1

Encouraging the clients self-exploration by asking about the type of support needed is achieved by accepting the clients thoughts and feelings, by helping the client to clarify interactions with others, and by being empathetic. Telling the client not to be embarrassed does not encourage self-exploration. It also assumes that the client is embarrassed, which may not be the case. Asking about the type of schedule involves the client in a decision-making process related to the clients care, but does not support the clients self-exploration. Self-exploration expands self-awareness. Telling the client that staff will not try to judge the clients past is not therapeutic and implies judgment is due and does not encourage open communication and self-exploration.

DIF: A REF: 418 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

8. A school-age client has just been diagnosed with juvenile diabetes. The client is very angry about the new disease. Which of the following statements is most appropriate for the nurse counselor working with this client?

1.

Try not to be angry. You are receiving the best care possible.

2.

You appear upset about the diagnosis. Lets talk about your feelings.

3.

You learn quickly and will probably handle the difficult treatments very well.

4.

It is all right to be angry with your friends, but try not be angry with your parents.

ANS: 2

Stating that the client appears to be upset and then suggesting a discussion clarifies the meaning of verbal and nonverbal communication. This response also demonstrates acceptance of the clients thoughts and feelings and encourages open communication. Telling the client to try not to be angry and that he is receiving the best care possible is not therapeutic. It does not address the clients feelings of anger and conveys a message that feeling angry is not acceptable. Saying that the client is a quick learner and will probably handle the treatment well is not therapeutic. It does not encourage the client to communicate his or her feelings. Explaining that it is all right to be angry with friends but to try to not be so with parents is not therapeutic. It is not addressing the cause of the anger but is putting limits on how the anger may be expressed.

DIF: A REF: 417 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

9. A clients biggest concern is about the interactions that she has with her family, and she is in the process of establishing a positive view of herself. Which group is the client meeting the developmental needs of:

1.

12- to 20-year-old age-group

2.

Early 20s to mid-40s age-group

3.

Mid-40s to mid-60s age-group

4.

Late 60s and older age-group

ANS: 2

The developmental needs of the early 20s to mid-40s age-group include the establishment of intimate relationships with family and significant others; having stable, positive feelings about self; and experiencing successful role transitions and increased responsibilities. The self-concept developmental needs of the 12- to 20-year-old age-group include accepting body changes, examining attitudes and beliefs, establishing goals for the future, and interacting with those whom he or she finds sexually attractive or intellectually stimulating. The self-concept developmental tasks of the mid-40s to mid-60s age-group include accepting changes in appearance and endurance, reassessing life goals, and showing contentment with aging. The self-concept developmental needs of the late 60s and older age-group include feeling positive about ones life and its meaning, and being interested in providing a legacy for the next generation.

DIF: A REF: 412 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

10. In developing role behavior, the child learns which of the following through substitution?

1.

Internalizing beliefs and values of role models

2.

Refraining from behavior even though tempted

3.

Avoiding unacceptable behavior because it is punished

4.

Engaging in an acceptable behavior instead of another unacceptable one

ANS: 4

In the process of substitution, an individual replaces one behavior with another that provides the same personal gratification. The child has learned to substitute one behavior for another for a positive outcome. In the process of identification, an individual internalizes the beliefs, behavior, and values of role models into a personal, unique expression of self. In the process of inhibition, an individual learns to refrain from behaviors, even when tempted to engage in them. Avoiding unacceptable behavior because it is punished is seen in the process of reinforcement-extinction.

DIF: A REF: 414 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

11. The nurse recognizes that self-concept develops throughout an individuals lifetime. Which developmental task associated with self-concept is expected in an assessment of an individual from the 12- to 20-year-old age-group?

1.

Identifying with a gender

2.

Exploring goals for the future

3.

Distinguishing oneself from the environment

4.

Feeling positive about ones life achievements

ANS: 2

The developmental tasks associated with self-concept in the 12- to 20-year-old age-group include accepting body changes; examining attitudes, values, and beliefs; and establishing goals for the future. Identifying with a gender is an expected developmental task associated with self-concept in the 3- to 6-year-old age-group. Distinguishing oneself from the environment is an expected developmental task associated with self-concept in the newborn to 1-year-old age-group. Feeling positive about ones life achievements is an expected developmental task associated with self-concept for the late 60s and older age-group.

DIF: A REF: 412 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

12. The nurse is working with a client and wants to learn about the individuals perception of identity. What question should the nurse use to assess this?

1.

What changes would you make in your appearance?

2.

What activities do you enjoy doing?

3.

How would you describe yourself?

4.

What is your usual day like?

ANS: 3

Asking, How would you describe yourself? is an example of a question a nurse could use to assess a clients perception of identity. Asking, What changes would you make in your appearance? is an example of a question a nurse could use to assess a clients perception of body image. Asking, What activities do you enjoy doing? is an example of a question a nurse could use to assess a clients perception of self-esteem. Asking, What is your usual day like? is an example of a question a nurse could use to assess a clients role performance.

DIF: A REF: 412 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

13. The client has very recently been let go from his place of employment and is very upset about the loss. The nurse is establishing a plan of care for the client, she determines that an appropriate outcome for this client with situational low self-esteem is:

1.

Client will recognize his inability to make decisions

2.

Client will respond to anxiety with decreased amounts of stress

3.

Client will use therapeutic communication skills to discuss his needs

4.

Client will discuss a minimum of two areas where he is functioning well

ANS: 4

An appropriate outcome for the client with situational low self-esteem would be for the client to discuss a minimum of two areas where he is functioning well. Having the client recognize his inability to make decisions would not be an appropriate outcome for the client with low self-esteem. The focus should be on his abilities, not inability. Client responding to the anxiety with decreased amounts of stress does not address the issue of low self-esteem. Being able to use therapeutic communication is always an asset, but the focus should be on improving his self-esteem by determining his strengths, recognizing his worth as a person, realizing what he is able to control, and providing support from others who are having, or had, the same experience.

DIF: A REF: 423 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

14. Which of the following statements best reflects an understanding of the definition of negative client self-concept?

1.

Acne is very difficult to deal with, especially for a youngster.

2.

Managing type 2 diabetes can be very challenging for the client.

3.

An above the knee amputation requires extensive physical therapy.

4.

Clinical depression can make things like going to work quite difficult.

ANS: 1

Self-concept is an individuals conceptualization of himself or herself. It is a subjective sense of self and a complex mixture of unconscious and conscious thoughts, attitudes, and perceptions. Self-concept directly affects ones self-esteem, or how one feels about himself or herself. Adolescence is a particularly critical time when many variables affect self-concept and self-esteem. The remaining options are not necessarily directly reflective of self-concept issues.

DIF: A REF: 412 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

15. The nurse recognizes which of the following clients is at greatest risk of developing negative self-esteem?

1.

A 35-year-old woman who has been diagnosed morbidly obese

2.

A 53-year-old male avid golfer who has lost two fingers on his right hand

3.

A 63-year-old man experiencing erectile dysfunction post prostatectomy

4.

A 14-year-old girl with a facial scar resulting from an automobile accident

ANS: 4

Adolescence is a particularly critical time when many variables affect self-concept and self-esteem. The adolescent experience appears to adversely affect self-esteem, more strongly for girls than for boys. The remaining options, while depicting issues that can affect self-esteem, all relate to the older, more developmentally advanced individual.

DIF: A REF: 411 OBJ: Analysis

TOP: Nursing Process: Analysis

MSC: NCLEX test plan designation: Safe, Effective Care Environment

16. A 73-year-old client who is no longer working as a cabinetmaker begins to make statements that suggest negative self-concept. This is most likely related to:

1.

The prospect of limited financial and health care resources

2.

The loss of family members and friends to death and illness

3.

The physical changes the aging process has had on his health and body

4.

The perceived loss of respect others once had for his woodworking abilities

ANS: 3

Evidence suggests that sense of self is often negatively affected in older adulthood because of the intensity of emotional and physical changes associated with aging. The remaining options can be factors in the self-concept of the older client but are not as predictable as the effect of physical aging.

DIF: C REF: 411 OBJ: Analysis

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

17. A client is seen in a walk-in clinic for a sinus infection. Which of the following statements made by the client shows the most positive attitude regarding personal health?

1.

I havent missed work due to illness in over 15 years.

2.

When do I need to return to the clinic for a follow-up?

3.

I dont like taking medications unless I really need them.

4.

Should I be concerned about giving this infection to someone else?

ANS: 1

How individuals view themselves and their perception of their health are closely related. A clients belief in personal health often enhances his or her self-concept. Statements such as I can get through anything or Ive never been sick a day in my life indicate that a persons thoughts about personal health are positive. The remaining options may reflect the clients personal opinion regarding aspects of health and health care but not as directly as pride in past good health.

DIF: C REF: 411 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

18. The nurse expects which of the following healthy clients to present with the best view of self-esteem?

1.

8-year-old boy

2.

18-year-old male adolescent

3.

38-year-old woman

4.

58-year-old woman

ANS: 1

Self-esteem is usually highest in childhood, drops during adolescence, rises gradually throughout adulthood, and declines again in old age. Although variability exists, in general this pattern holds true across gender, socioeconomic status, and ethnicity.

DIF: A REF: 412 OBJ: Comprehension

TOP: Nursing Process: Evaluation

MSC: NCLEX test plan designation: Safe, Effective Care Environment

19. The nurse is assessing a 16-year-old who has been diagnosed with a sexually transmitted disease (STD). The nurse realizes that such risk-taking behavior (e.g., unprotected sex) is most often a result of:

1.

Peer pressure

2.

Poor self-esteem

3.

Social expectation

4.

Lack of information

ANS: 2

For some adolescents, a decline in self-esteem results in increased risk-taking behavior. This is demonstrated in unsafe behaviors such as premature sexual activity, unprotected sex, risky driving, or substance abuse. The remaining options represent factors that may affect decision making but they do not have as big an impact on this age-group as is poor self-esteem.

DIF: C REF: 412 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

20. The nurse is assessing a 16-year-old who has been diagnosed with a sexually transmitted disease (STD). The nurse realizes that such risk-taking behavior is often a predictor of even more serious self-destructive behaviors, and so this client should be:

1.

Screened for illegal drug use

2.

Assessed for suicidal ideations

3.

Interviewed regarding alcohol consumption

4.

Provided information regarding birth control

ANS: 2

Low self-esteem and stressful life events significantly predict suicidal ideations in adolescents. Nurses in all health care settings need to initiate suicide screening and implement nursing interventions directed toward suicide prevention and early detection. Although the remaining options are areas that should be addressed, suicidal ideations are the most serious possible risk-taking behavior.

DIF: C REF: 416 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

21. A 73-year-old client shares with the nurse that she feels so useless, especially now that arthritis makes her life-long hobby of hand sewing so painful as to make it almost impossible. Which of the following nursing responses is most therapeutic given the clients current poor self-esteem image?

1.

What is it about sewing that makes it so enjoyable for you?

2.

Im sure your sewing is beautiful; have you ever considered teaching others to sew?

3.

Maybe you can find something else that will give you as much satisfaction about yourself.

4.

We can attempt to find the proper pain management plan to minimize the discomfort so you can sew again.

ANS: 2

Researchers have reported a sharp decline in self-esteem around age 70. Based on Eriksons stages of development, a decline in self-concept at this advanced age reflects a diminished need for self-promotion and a shift in self-concept to a more modest and balanced view of the self. The nurse is acknowledging the clients talent as well as providing a possible alternate avenue to improve self-esteem. The remaining options all deal with the issue but either do not provide guidance or may propose unrealistic alternatives.

DIF: C REF: 416 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

22. Which of the following statements best reflects the clients perception of the female role?

1.

My wife bakes the best bread.

2.

All of my daughters are stay-at-home moms.

3.

I dont understand why a woman would want to be a coal miner.

4.

We are so proud; our granddaughter got accepted into law school.

ANS: 4

Gender identity is a persons private view of maleness or femaleness. This option reflects a sense of pride in a female accomplishment that may be typically viewed as being male-oriented, thus showing the clients atypical perception of the female role. The remaining options are either general statements or examples of less predominant perceptions of traditional roles.

DIF: A REF: 414 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

23. Research has shown that Caucasian girls and women appear to experience more pressure to be physically thin than do African American girls and women. The most likely reason for this variation in attitude is the:

1.

Caucasian culture values physical thinness

2.

African American culture does not value physical thinness

3.

Caucasian girls and women are genetically programmed for physical thinness

4.

African American girls and women are not genetically programmed for physical thinness

ANS: 2

Culture and society dictate the accepted norms of body image and influence ones attitudes (Figure 27-2). Racial and ethnic background plays an integral role in body satisfaction in adolescent girls as reflected in the higher incidence of body satisfaction among African American girls compared to Caucasian girls (Kelly and others, 2005). Further, African American girls described more favorable views about physical appearance, reported less social pressure for thinness, and exhibited less tendency to base self-esteem on body image than did Caucasian girls (White and others, 2003). The value placed on thinness by the African American culture would not influence the Caucasian girl or woman, and the options related to genetics are not proven.

DIF: A REF: 413 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

24. A 12-year-old girls expressed goal to be super thin is a body image issue influenced primarily by:

1.

Peer pressure

2.

Societal values

3.

Teenage role modeling

4.

Normal developmental changes

ANS: 2

Cultural and societal attitudes and values influence body image. Culture and society dictate the accepted norms of body image and influence ones attitudes. Peer pressure and role modeling are influenced by the perceived social preference. Normal physical developmental changes resulting from puberty do not typically result in super thin body types.

DIF: A REF: 413 OBJ: Comprehension

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

25. Which of the following statements best reflects a clients healthy sense of identity?

1.

My name is Susan.

2.

My children are my world.

3.

Im looking for my perfect job.

4.

Im happiest when I get to exercise regularly.

ANS: 4

Identity involves the internal sense of individuality, wholeness, and consistency of a person over time and in different situations. Identity implies being distinct and separate from others. Being oneself or living an authentic life is the basis of true identity. Knowing what makes oneself happy is a sign of identify. While looking for the perfect job infers some self-awareness, it is as of yet unfulfilled. Identifying so closely with ones child is not an indicator of a healthy sense of identity nor is simply stating ones name.

DIF: C REF: 412 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

26. Which of the following physical changes that are commonly seen during puberty would be most likely to cause body image problems for a 12-year-old girl?

1.

Having her first menstrual period

2.

Growing 3 inches over the summer

3.

Experiencing a substantial increase in breast size

4.

Experiencing hair growth on legs and underarms

ANS: 3

The development of secondary sex characteristics and changes in body fat distribution have a tremendous impact on the self-concept of an adolescent. The visible changes to the body would likely have more impact than the more covert event of a menstrual period. Although the remaining options might affect the clients body image, the effect is likely to have less of an impact.

DIF: C REF: 415 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

27. Which of the following statements, regarding the physical changes that are associated with the normal aging process, made by a 63-year-old female client best reflects a negative sense of body image?

1.

I felt old when I had to by bifocal glasses.

2.

My aging joints just dont allow me to hike like I used to.

3.

In order to be successful at my work, I need to dye away the gray hair.

4.

Its much more difficult to socialize with friends now that I cant hear as well.

ANS: 3

Changes associated with aging (e.g., wrinkles; graying hair; and decrease in visual acuity, hearing, and mobility) also affect body image in an older adult. Expressing the concern that gray hair would negatively affect her career is the most negative statement regarding body image. The remaining options suggest limitations and personal attitudes about adapting to the changes of aging, but they do not suggest such strong negative personal feelings as does the correct answer.

DIF: C REF: 415 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

28. Which of the following statements best reflects a clients healthy sense of self-esteem?

1.

I always try to do the best I can

2.

Ill keep trying till I get it right.

3.

Im not good at it but I enjoy playing guitar

4.

If I cant build it, it isnt worth being built.

ANS: 1

Self-esteem is positive when one feels capable, worthwhile, and competent. Recognizing that one does the best one can is the best reflection of self-esteem. The other options either state a sense of perseverance, an expression of a lack of talent, or an unrealistic view of self-worth and esteem.

DIF: C REF: 411 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

29. The best indication that a client will regain a good sense of self esteem after experiencing a second below the knee (BTK) amputation is:

1.

The client stating, Ill get over this setback

2.

A solid, caring relationship with family and friends

3.

A healthy sense of self esteem after the first amputation

4.

The client telling his wife, Ill still be able to work from a wheelchair.

ANS: 3

Once established, basic feelings about the self tend to be constant, even though a situational crisis temporarily affects self-esteem. While the remaining options reflect positive behaviors or situations, they are dependent to a large degree on the clients previously established sense of self-esteem.

DIF: C REF: 416 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

30. Which of the following nursing actions will have the most therapeutic impact on the self-esteem of a client with HIV?

1.

Dealing with the clients needs in a nonjudgmental manner

2.

Being aware of how the client will react based on the clients culture

3.

Providing care that will meet the clients emotional and physical needs

4.

Being careful to avoid nonverbal communication that could be misinterpreted

ANS: 1

A nurses acceptance of a client with an altered self-concept helps promote positive change. The nurse must have the ability to convey a nonjudgmental attitude toward clients so as to convey an accepting attitude. The remaining options are therapeutic but they are all outcomes of a nonjudgmental attitude on the part of the nurse.

DIF: C REF: 417 OBJ: Analysis

TOP: Nursing Process: Assessment

MSC: NCLEX test plan designation: Safe, Effective Care Environment

Mosby items and derived items 2009, 2005 by Mosby, Inc., an affiliate of Elsevier Inc.

Leave a Reply