Self Concept

1. Sally is 5'7", weighs 105 lbs, and believe 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 (option2); self-expectation consists of those things
one believe the self should be able to do (option3); and core self-concept includes the most vital
central beliefs about one's identity (option4).
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 (option1). Role strain exists when there are feelings of inadequacy in performing a role
(option2). Role enhancement is a nursing intervention (option4).
3. The spouse tells the nurse that the client is not making progress in developing a
more positive self-esteem. What should the nurse's response to the spouse be?
1. "Most clients make quicker progress."
2. "self-esteem work takes time and is not easily evaluated."
3. "what have you done to help the client with this work?"
4. "do you think that the client is really trying?"
Answer: 2. Rationale: It is not appropriate to reinforce her feelings by comparing the client to
other clients (option1), or to blame the spouse for the slowness (option3), or to instill doubt by
asking if the client is really trying (option4).
4. An 89-yr-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.
5. A client recovering from a lumpectomy for breast cancer tells the nurse that she
"feels ugly." For which nursing diagnosis should the nurse plan interventions?
1. powerlessness
2. social isolation
3. grieving
4. hopelessness
Answer: 3. Rationale: the diagnosis Grieving is appropriate, since the client is expressing a
feeling related to a change in physical appearance. The client's feelings of being ugly do not
support the diagnosis of Powerlessness, Social Isolation, and Hopelessness.
6. 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.
7. Which statement should the nurse make first when assessing the client's self-
concept?
1. describe yourself as a person.
2. tell me about your family.
3. describe what you do when you have free time.
4. tell me about the work you do.
Answer: 1. Rationale: The first information the nurse gathers when assessing self-concept
should focus on the client's personal identity. Option 2 assesses role performance. Option 3
assesses social role and option 4 assesses work role.
8. 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 (option1).
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.
Option6, sleeping, is generally not impaired with low self-esteem.
9. 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 (option1). Having them care for others can be a very
therapeutic intervention for such individuals (option4). They should be given realistic and normal
levels of expectations for their behavior.
10. 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.
11. Robert, aged 19 years, has down syndrome and is mildly developmentally disabled
with an intelligence quotient of 82. He told his nurse, "I'm a good helper. You see I can
carry these trays because I'm so strong. But I'm not very smart, so I have just learned
to help with the things I know how to do." Robert most likely has
a. negative self-concept and low self-esteem
b. negative self-concept and high self-esteem
c. positive self-concept and fairly high self-esteem
d. positive self-concept and low self-esteem
Answer: C. Rationale: The data point to Robert's having a positive self-concept ("I'm a good
helper") and fairly high self-esteem (realizes his strengths and limitations). The statement "but
I'm not very smart" is accurate and is not an indication of a negative self-concept (a and b)
12. Joe was asked to make a list of 20 words that describe him. After 15 minutes, Joe
listed the following; 25 years old, male, named Joe; then declared he couldn't think of
anything else. Joe has demonstrated
a. lack of self-esteem
b. deficient self-knowledge
c. unrealistic self-expectation
d. inability to evaluate himself
Answer: B. Rationale: Joe's inability to list more than three items about himself indicates
deficient self-knowledge. There are not enough data provided to determine whether he lacks
self-esteem (a), has unrealistic self-expectations (c), or is unable to evaluate himself (d).
13. Joe was able to list only three facts, traits, or qualities to describe himself. The nurse
then asked him to list facts, traits, or qualities that he would like to be descriptive of
himself or that he thinks he should have. Joe quickly listed 25, all of which were
characteristic of a successful man. When asked if he knew anyone like this, he
replied, "my father." this discrepancy between Joe's description of himself as he is
and as he would like to be indicates
a. negative self-concept
b. Joe's modesty (lack of conceit)
c. body image disturbance
d. Joe's affection for his father
Answer: D. Rationale: Low self-esteem is characterized by great discrepancy between the ideal
and real selves. There are no data in this item to suggest that Jerry has either a negative self-
concept (a) or a body image disturbance (c). The data do indicate something more serious than
modesty (b).
14. David and his wife decided that she will get a job so that David can go to pharmacy
school, as he has wanted to do for some time. Their three teenagers, who were
involved in the decision, are also getting jobs to buy their own clothes. David plans to
work 12 to 16 hours weekly. He states, "I was always an A student, but I may have to
settle for Bs now because I don't want to neglect my family, and I need to work a few
hours so that my wife won't have to work overtime." David's self-expectations are
a. realistic and positively motivating his development
b. unrealistic and negatively motivating his development
c. unrealistic but positively motivating his development
d. realistic but negatively motivating his development
Answer: A. Rationale: David's self-expectations are realistic, given his multiple commitments,
and seem to be positively motivating his development.
15. Which of the following statements made by the parent of a child you are seeing in
clinic needs to be followed up with teaching about how to foster healthy development
of the self in children?
a. "I love my child so much I 'hug him to death' every day."
b. "I think children need challenges, don't you?"
c. "my husband and I both grew up in very restrictive families. We want our children to be
free to do whatever they want."
d. "my husband and I have different ideas about discipline, but we're talking this out because
we know it's important for Johnny that we be consistent."
Answer: C. Rationale: Each option with the exception of C correctly addresses some aspect of
fostering healthy development in children. Because children need effective structure and
development, giving them total freedom to do as they please may actually hinder their
development.
16. Which intervention would you take first to assist a woman who states that she feels
incompetent as the mother of a teenage daughter?
a. recommend that she discipline her daughter more strictly and consistently
b. make a list of things her husband can do to help her improve
c. assist the mother to identify both what she believe is preventing her success and what
 she can do to improve
d. explore with the mother what the daughter can do to improve the behavior
Answer: C. Rationale: The first intervention priority with a mother who feels incompetent to
parent a teenage daughter is to assist the mother to identify what is preventing her from being
an effective parent and then to explore solutions aimed at improving her parenting skills. The
other interventions may prove helpful, but they do not directly address the mother's problem
with her feelings of incompetence.
17. Which of the following patients is least likely to develop problems related to self-
concept?
a. 55-yr-old woman television news reporter undergoing a hysterectomy
b. young clergyperson whose vocal cords are paralyzed after a motorbike accident
c. 32-yr-old accountant who survives a massive heart attack
d. 23-yr-old model who just learned that she has breast cancer.
Answer: A. Rationale: Based simply on the facts given, the 55-yr-old news reporter would be
least likely to experience body image or role performance disturbance because she is beyond
her childbearing years, and the hysterectomy should not impair her ability to report the news.
The young clergyperson's inability to preach (b), the 32-yr-old's massive myocardial infarction
(c), and the model's breast resection (d) have much greater potential to result in self-concept
problems.
18. Juanita Sanchez has been in the U.S. only 3 months and has recently suffered the
loss of her husband and job. She states that nothing feels familiar..."I don't know who
I am supposed to be here" and she misses home (Nicaragua)terribly.
a. personal identity disturbance
b. body image disturbance
c. self-esteem disturbance
d. altered role performance
Answer: A. Rationale: An unfamiliar culture, coupled with traumatic life events and loss of
husband and job, had resulted in this patient's total loss of her sense of self: "I don't know who I
am supposed to be here." Her very sense of identity is at stake, not merely her body image,
self-esteem, or role performance.
19. Jim Boa, a sophomore in high school, has missed a lot of school this year because of
leukemia. He said he feels like he is falling behind in everything and misses "hanging
out at the mall" with his friends most of all.
a. personal identity disturbance
b. body image disturbance
c. self-esteem disturbance
d. altered role performance
Answer: D. Rationale: Important roles for Jim are being a student and a friend. His illness is
preventing him from doing either of these well. This self-concept disturbance is basically one
that concerns role performance.
20. "Why did I have to be born into a family of big bottoms and short fat legs! No one will
ever ask me out for a date. Oh why can't I have long thin legs like everyone else in my
 class? What a frump I am."
a. personal identity disturbance
b. body image disturbance
c. self-esteem disturbance
d. altered role performance
Answer: B. Rationale: Clearly, this patient's concern is with his or her body image.
21. Marissa Yule, a 33-yr-old businessperson, is now in counseling attempting to deal
with a long-repressed history of sexual abuse by her father. "I guess I should feel
satisfied with what I've achieved in life, but I'm never content, and nothing I achieve
makes me feel good about myself...I hate my father for making me feel like I'm no
good. This is an awful way to live."
a. personal identity disturbance
b. body image disturbance
c. self-esteem disturbance
d. altered role performance
Answer: C. Rationale: Marissa's self-concept disturbance is mainly one of devaluing herself and
thinking that she is no good. This is a self-esteem disturbance.
22. Nancy, 36-yr-old, who was divorced 5 years earlier, entered the ED with severe burns
and cuts on her face after an auto accident in a car driven by her fiancé of 3 months.
Three weeks later, her fiancé has not yet contacted her. Nancy states that he is so
busy and she is too tired to have visitors anyway. Nancy frequently lies with her eyes
closed and head turned away. These data suggest that
a. there is no disturbance in self-concept
b. this patient has ego strength and high self-esteem but may have a disturbance of body
image
c. the area of self-esteem has very low priority at this time and should be ignored until much
later.
d. it is probable that there are disturbances in self-esteem and body image.
Answer: D. Rationale: The traumatic nature of Nancy's injuries, her fiancé's failure to contact
her, and Nancy's response, that is, her withdrawal, all point to potential problems with both body
image and self-esteem. It is not true that self-esteem needs are of low priority.
23. Which of the nursing interventions below is least likely to assist a severely ill patient
with cancer to maintain a positive sense of self?
a. making it a point to address the patient by name each time you enter the room
b. fatiguing the patient as little as possible by performing all procedures in silence
c. continuing to respect the patient's privacy and sensibilities
d. offering the patient a simple explanation before moving her in any way.
Answer: B. Rationale: Each option with the exception of B should assist the patient to maintain a
positive sense of self. Working in silence with the patient may be preferable to idle chatter, but
the ideal is to address the patient by name, give simple explanations of procedures, and
communicate by simple words of caring that he or she is a person of worth.
24. Doris, 16-yr-old, has a nursing diagnosis of Body Image Disturbance related to severe
acne. In planning nursing care, an appropriate goal for this nursing diagnosis is "the
patient will
a. make above-B grades in all tests at school"
b. demonstrate by diet control and skin care increased interest in control of acne."
c. report that she feels more self-confidence in her music and art, which she enjoys."
d. express that she is very smart in school"
Answer: B. Rationale: All of these patient goals may be appropriate for Doris, but the only goal
that directly addressed her body image disturbance is B.
25. A 4.5-yr-old boy required stitches for a laceration on the eyebrow. After the doctor
held him, visited with him, and explained what was going to be done and that his eye
would get better and look just like it did before, the boy placed his hands under his
hips as instructed and quietly permitted the procedure. He then expressed pride in
himself. Evaluation of the effect of this healthcare experience is best expressed in
which of the following?
a. the doctor did an excellent job.
b. the child's self-esteem was enhanced and fear of bodily mutilation decreased, and the
parents were given an excellent role model.
c. the child was made the center of attention and the situation exaggerated, thus
encouraging the child to become self-centered.
d. these interventions consumed too much physician time to be evaluated positively.
Answer: B. Rationale: The physician enhanced the child's self-esteem by teaching him how to
participate effectively, decreased his fear of bodily mutilation by telling him that his eyebrow
would heal and look normal, and gave the parents an excellent role model.

Critical Thinking & Clinical Reasoning

1. A client with diarrhea also has a primary care provider's order for a bulk laxative daily.
The nurse, not realizing that bulk laxatives can help solidify certain types of diarrhea,
concludes, "The primary care provider does not know the client has diarrhea." What
type of statement is this?

1. Fact

2. Inference

3. Judgment

4. Opinion
2. Inference
2. A client reports feeling hungry, but does not eat when food is served. Using critical
thinking skills, the nurse should perform which of the following?

1. Assess why the client is not ingesting the food provided

2. Continue to leave the food at the bedside until the client is hungry enough to eat

3. Notify the primary care provider that tube feeding may be indicated soon

4. Believe the client is not really hungry

1. Assess why the client is not ingesting the food provided
3. A client complains of shortness of breath. During assessment the nurse observes
that the client has edema of the left leg only. The nurse reviews evidence-based
practice literature and reflects on a previous client with the same clinical
manifestations. What do these actions represent?

1. Clinical Judgement

2. Clinical Reasoning

3. Reflection

4. Intuition
2. Clinical reasoning
4. The client who is short of breath benefits from the head of the bed being elevated.
Because this position can result in skin breakdown in the sacral area, the nurse
decides to study the amount of sacral pressure occurring in other positions. What
decision making is the nurse engaging in?

1. The research method

2. The trial-and-error method

3. Intuition

4. The nursing process

1. The research method
5. In the clinical reasoning process, the nurse sets and weighs the criteria, examines
alternatives, and performs which of the following before implementing a plan?

1. Reexamines the purpose for making the decision.

2. Consults the client and family members to determine their view of the criteria.
 3. Identifies and considers various means for reaching the outcomes.

4. Determine the logical course of action should intervening problems arise.

4. Determine the logical course of action should intervening problems arise.
6. The nurse is concerned about a client who begins to breathe
very rapidly. Which action by the nurse reflects clinical reasoning?

1. Notify the primary care provider.

2. Obtain vital signs and oxygen saturation.

3. Request a chest x-ray.

4. Call the rapid response team.

2. Obtain vital signs and oxygen saturation.
7. The nurse is teaching a client about wound care during a follow- up visit in the
client's home. Which critical thinking attitude causes the nurse to reconsider the plan
and supports evidence- based practice when the client states, "I just don't know how I
can afford these dressings"?

1. Integrity

2. Intellectual humility

3. Confidence

4. Independence
1. Integrity
8. When the nurse considers that a client is from a developing country and may have a
positive tuberculosis test due to a prior vaccination, which critical thinking attitude
and skill is the nurse practicing?

1. Creating environments that support critical thinking

2. Tolerating dissonance and ambiguity

3. Self-assessment

4. Seeking situations where good thinking is practiced

1. Creating environments that support critical thinking
9. A client in a cardiac rehabilitation program says to the nurse, "I have to eat a low-
sodium diet for the rest of my life, and I hate it!" Which is the most appropriate
 response by the nurse?

1. "I will get a dietary consult to talk to you before nest week."

2. "What do you think is so difficult about following a low-sodium diet?"

3. :At least you survived a heart attack and are able to return to work."

4. "You may not need to follow a low-sodium diet for as long as you think."
2. "What do you think is so difficult about following a low-sodium diet?"
10. Which reasoning process describes the nurse's actions when the nurse evaluates
possible solutions for care of an infected wound for optimal client outcomes?

1. Intuition

2. Research process

3. Trial and error

4. Problem solving
4. Problem solving