Chapter 17: Self-Concept Responses and Dissociative Disorders My Nursing Test Banks

Chapter 17: Self-Concept Responses and Dissociative Disorders

Test Bank

MULTIPLE CHOICE

1. 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 masters degree in business administration

ANS: B

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

DIF: Cognitive Level: Application REF: Text Pages: 264-265

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

2. 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.

ANS: B

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.

DIF: Cognitive Level: Comprehension REF: Text Page: 267

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

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

a.

akathisia.

b.

hypomania.

c.

depersonalization.

d.

boundary violations.

ANS: C

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

DIF: Cognitive Level: Comprehension REF: Text Pages: 263-264

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

4. 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 wont be able to do stuff with my friends.

b.

An 18-year-old with an above-the-knee double amputation who states, I guess Ill 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.

ANS: A

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

DIF: Cognitive Level: Analysis REF: Text Page: 264

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

5. A patient is acutely psychotic and withdrawn. The patient claims to be a robot, stating, I cant relate to others. I have no feelings. I cant 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.

Ill help you get in touch with the feelings youre trying to deny.

d.

Ill make decisions for you regarding your needs until you regain control.

ANS: A

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

DIF: Cognitive Level: Application REF: Text Page: 278

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

6. 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 patients 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.

ANS: A

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

DIF: Cognitive Level: Application REF: Text Page: 278

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

7. 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 cant 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 youll risk having people actively avoid being around you.

d.

We can put off the shower for another day because you dont have any body odor.

ANS: B

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.

DIF: Cognitive Level: Application REF: Text Page: 278

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

8. 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 didnt tell me how you felt.

c.

You must be feeling so angry with your parents that youd like to harm them.

d.

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

ANS: D

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 nurses empathy for the patient.

DIF: Cognitive Level: Analysis REF: Text Pages: 268-269

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

9. 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.

ANS: B

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.

DIF: Cognitive Level: Application REF: Text Page: 279

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

10. 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

ANS: B

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

DIF: Cognitive Level: Application REF: Text Page: 282

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

11. 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 wasnt always ready to move forward when the nurse was.

c.

A patient who states, I understand myself better, but I havent worked out what alternative behaviors will serve me best.

d.

A patient who states, I understand that no one else can make me happy. Im using my strengths and making my wishes become realities.

ANS: D

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

DIF: Cognitive Level: Application REF: Text Page: 277

TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

12. 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 patients:

a.

self-ideal.

b.

self-esteem.

c.

self-concept.

d.

self-actualization.

ANS: A

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

DIF: Cognitive Level: Comprehension REF: Text Pages: 279-280

TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

13. Which relationships most significantly affect a 3-year-old childs development of self-concept? Relationships with:

a.

peers.

b.

parents.

c.

extended family.

d.

teachers in nursery school.

ANS: B

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.

DIF: Cognitive Level: Comprehension REF: Text Pages: 279-280

TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

14. A patient who is seeking help at the mental health clinic states, I know my work has gone downhill. Im 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.

ANS: A

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.

DIF: Cognitive Level: Application REF: Text Pages: 280-281

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

15. 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.

ANS: C

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

DIF: Cognitive Level: Analysis REF: Text Page: 276

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

16. 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 patients 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.

ANS: A

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.

DIF: Cognitive Level: Analysis REF: Text Page: 276

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

17. How does a nurses use of sympathetic communication sometimes hinder a patients 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.

ANS: A

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

DIF: Cognitive Level: Comprehension REF: Text Page: 280

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

18. 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 dont 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.

ANS: D

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.

DIF: Cognitive Level: Application REF: Text Page: 267

TOP: Nursing Process: Diagnosis|Nursing Process: Analysis

MSC: NCLEX: Psychosocial Integrity

19. 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 patients faulty beliefs

ANS: B

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.

DIF: Cognitive Level: Application REF: Text Page: 278

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

20. 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 patients 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

ANS: D

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.

DIF: Cognitive Level: Application REF: Text Pages: 279-280

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

21. 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 patients anxiety

b.

Clarifying that the patients beliefs affect the patients feelings and behaviors

c.

Documenting the patients use of both logical and illogical thinking

d.

Helping the patient understand that the patient alone can bring about personal change

ANS: B

Clarifying that the patients beliefs affect his or her feelings and behaviors helps the patient to define the problem clearly and is part of level 3, self-evaluation. The remaining options relate to expanded self-awareness, self-exploration, and realistic planning.

DIF: Cognitive Level: Application REF: Text Pages: 279-280

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

22. 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 patients use of logical and illogical thinking.

b.

provide support measures to reduce the patients anxiety.

c.

clarify that the patients beliefs affect the patients feelings and behaviors.

d.

help the patient understand that the patient alone can bring about personal change.

ANS: D

Helping the patient to understand that only the patient, and not others, can bring about personal change is part of level 4, realistic planning. The remaining options relate to self-exploration, expanded self-awareness, and self-evaluation.

DIF: Cognitive Level: Application REF: Text Page: 283

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

23. 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

ANS: A

Commitment to action is the fifth level of nursing intervention. At this time the nurse helps the patient to commit to the goal and relates to the patient how the nurse sees the patient, correcting a poor self-image.

DIF: Cognitive Level: Comprehension REF: Text Pages: 283-284

TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

24. 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 patients attempts at self-exploration.

C. Introducing skills that expand the patients 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

ANS: C

This answer gives the correct sequence for addressing the problem of helping the patient alter self-concept. Self-awareness and self-exploration allow self-evaluation. Self-evaluation makes formulation of a plan possible, and support helps the patient achieve goals.

DIF: Cognitive Level: Analysis REF: Text Page: 277

TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

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