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fundamentals_of_nursing_study_guide_2010

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    Chapter 27: Self-Concept   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 client’s:   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 client’s 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 client’s ability to cope. However, when developing goals and implementation strategies, the process is going to begin with the c lient’s 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 client’s interests and past accomplishments may provide information regarding a client’s identity. Identity is only one component of self  -concept. The nurse needs to determine the client’s ideal and perceived self  -concept i n 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 one’s 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 st age of his psychosocial development. Accepting one’s 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 psyc hosocial development. Expressing thoughts about one’s 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 client’s 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 client’s 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 can’t do anything anymore—and I won’t 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 I’d 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 “man’s role” or a “woman’s 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 nurse’s attempt to support the client’s self  -exploration?   1.   “What type of support do you feel you need?”   2.   “Don’t 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; we’ll not judge your past actions.”   ANS: 1   Encouraging the client’s self  -exploration by asking about the type of support needed is achieved by accepting the client’s 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 client’s care, but does not support the client’s self  -exploration. Self-exploration expands self-awareness. Telling the client that staff will not try to judge the client’s 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. Let’s 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  
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