Title: Exam 3 - Health & Physical Assessments Part II
Course: NUR 1008C Transition to Prof Nursing > Section: Module 4

Q: The nurse can best assess the patient’s self-concept by evaluating the patient’s
- Drug abuse history.
- Nonverbal behavior.
- Personal journal.
- Social networking site.
A: Nonverbal behavior.
If right: Nonverbal behaviors are key indicators of a patient’s self-concept. A history of drug abuse does not necessarily indicate current self-concept, and people who do not have a drug abuse history may have a low self-concept. It would be an invasion of privacy and trust for a nurse to read a patient’s personal journal or social networking site.
If wrong: Nonverbal behaviors are key indicators of a patient’s self-concept. A history of drug abuse does not necessarily indicate current self-concept, and people who do not have a drug abuse history may have a low self-concept. It would be an invasion of privacy and trust for a nurse to read a patient’s personal journal or social networking site.

Q: Based on current evidence, the nurse who plans smoking cessation interventions for adolescent girls should focus on interventions directed toward
- Obeying parents and reducing television viewing.
- Fostering generativity over self-absorption.
- Role overload, addiction counseling, and depression.
- Weight management, self-esteem, and stress management.
A: Weight management, self-esteem, and stress management.
If right: Current research indicates that smoking cessation efforts should include stress management and improvement of self-esteem and body image. Weight concerns, especially in females, promote continued smoking. Obeying parents and reducing television viewing are not effective smoking cessation strategies. The developmental task of generativity versus self-absorption occurs in adulthood. Role overload is not a usual contributor to smoking in adolescents, although it could be; addiction counseling is not a smoking cessation intervention; depression is associated with decreased self-esteem but is not a primary smoking cessation target for adolescent girls in general.
If wrong: Current research indicates that smoking cessation efforts should include stress management and improvement of self-esteem and body image. Weight concerns, especially in females, promote continued smoking. Obeying parents and reducing television viewing are not effective smoking cessation strategies. The developmental task of generativity versus self-absorption occurs in adulthood. Role overload is not a usual contributor to smoking in adolescents, although it could be; addiction counseling is not a smoking cessation intervention; depression is associated with decreased self-esteem but is not a primary smoking cessation target for adolescent girls in general.

Q: A 9-year-old is proudly telling everyone about mastering the yellow belt in her martial arts class. Identify the appropriate developmental task.
- Initiative versus guilt
- Industry versus inferiority
- Identity versus role confusion
- Autonomy versus shame and doubt
A: Industry versus inferiority
If right: Industry versus inferiority occurs between the ages of 6 and 12 years. It is during this developmental task that a person gains self-esteem through new skill mastery. The other self-concept development tasks occur at other stages of life and would not apply to this situation.
If wrong: Industry versus inferiority occurs between the ages of 6 and 12 years. It is during this developmental task that a person gains self-esteem through new skill mastery. The other self-concept development tasks occur at other stages of life and would not apply to this situation.

Q: A newly hired nurse is struggling with night shift work and caring for multiple family members at home. The nurse manager calls the new nurse in to talk about how the nurse is negatively affecting patient self-concept by ignoring patients’ concerns. The nurse manager should focus on the new nurse’s
- Role overload.
- Self-esteem.
- Ego integrity.
- Ethics and morals.
A: Role overload.
If right: Role overload involves having more roles or responsibilities than are manageable. Self-esteem is the overall feeling of self-worth. The nurse is not involved in an ethical or moral dilemma. Ego integrity is part of a developmental task associated with older adults.
If wrong: Role overload involves having more roles or responsibilities than are manageable. Self-esteem is the overall feeling of self-worth. The nurse is not involved in an ethical or moral dilemma. Ego integrity is part of a developmental task associated with older adults.

Q: Identify the assessments suggestive of an altered self-concept.
- Limping gait and large smile
- Slumped posture and poor personal hygiene
- Verbally responds when asked a question
- Appropriately dressed with clean clothes
A: Slumped posture and poor personal hygiene
If right: A self-concept is created by an individual’s identity, body image, and role performance. Poor personal hygiene and slumping posture best describe a person with an impaired self-concept. Smiling, appropriate responses, and appropriate appearance are all signs of normal self-concept.
If wrong: A self-concept is created by an individual’s identity, body image, and role performance. Poor personal hygiene and slumping posture best describe a person with an impaired self-concept. Smiling, appropriate responses, and appropriate appearance are all signs of normal self-concept.

Q: Which of the following individuals is most likely to need the nurse’s assistance because of the presence of identity confusion?
- 49-year-old male with stable employment
- 35-year-old recently divorced mother of twins
- 22-year-old in third year of college
- 50-year-old self-employed woman
A: 35-year-old recently divorced mother of twins
If right: Identity confusion can occur when people do not maintain a clear, consistent, and continuous consciousness of personal identity. A newly divorced woman would be trying to adapt to a new lifestyle of being single while handling parenting of twins as a single parent. This situation could lead to identity confusion. A college sophomore would have had at least 2 years to adjust to the new life setting, and a self-employed woman would likely be content with creating her own employment opportunity. There is no indication that the middle-aged man with stable employment should have identity confusion.
If wrong: Identity confusion can occur when people do not maintain a clear, consistent, and continuous consciousness of personal identity. A newly divorced woman would be trying to adapt to a new lifestyle of being single while handling parenting of twins as a single parent. This situation could lead to identity confusion. A college sophomore would have had at least 2 years to adjust to the new life setting, and a self-employed woman would likely be content with creating her own employment opportunity. There is no indication that the middle-aged man with stable employment should have identity confusion.

Q: The nurse in an addictions clinic is working with a patient on priority setting before the patient’s discharge from residential treatment. An appropriate priority for a patient at this clinic would be
- Identifying local self-help groups before being discharged from the program.
- Staying away from all triggers that cause substance abuse.
- Stating a plan to never be tempted by illicit substances after discharge.
- Identifying personal areas of weakness to grow stronger.
A: Identifying local self-help groups before being discharged from the program.
If right: Providing the patient with resources such as local self-help groups can help to turn limitations into strengths. It is not realistic to avoid ALL triggers that can result in addictive behaviors. It is unrealistic to believe that the patient will never be tempted because temptation can arise from multiple sources. On the other hand, an appropriate priority would be to recognize that triggers will arise, and that the patient should learn how to handle being confronted in the postdischarge setting. Having a person talk about his or her weaknesses without recognizing a person’s strengths could be a trigger to return to an addictive lifestyle, so this would not be the most appropriate priority.
If wrong: Providing the patient with resources such as local self-help groups can help to turn limitations into strengths. It is not realistic to avoid ALL triggers that can result in addictive behaviors. It is unrealistic to believe that the patient will never be tempted because temptation can arise from multiple sources. On the other hand, an appropriate priority would be to recognize that triggers will arise, and that the patient should learn how to handle being confronted in the postdischarge setting. Having a person talk about his or her weaknesses without recognizing a person’s strengths could be a trigger to return to an addictive lifestyle, so this would not be the most appropriate priority.

Q: A priority nursing intervention for a postoperative mastectomy patient is which of the following?
- Using therapeutic silence to encourage the patient to talk
- Using communication skills to clarify family and patient expectations
- Telling her that you know she will do fine because many other women have
- Rotating nursing personnel in the patient’s care, so the patient can talk to many people
A: Using communication skills to clarify family and patient expectations
If right: The nurse recognizes the need to use therapeutic communication skills, allowing the opportunity to talk openly about issues that are important to a person who has undergone body-altering surgery. When a nurse does not allow for the development of a patient-nurse therapeutic relationship, open and honest conversation is impossible. Silence can be useful, but building rapport and opening the conversation are necessary first. Reassurance that a person will do fine dismisses any potential concerns the patient may have. Rotating nursing personnel does not allow time for the patient to build rapport with any one nurse.
If wrong: The nurse recognizes the need to use therapeutic communication skills, allowing the opportunity to talk openly about issues that are important to a person who has undergone body-altering surgery. When a nurse does not allow for the development of a patient-nurse therapeutic relationship, open and honest conversation is impossible. Silence can be useful, but building rapport and opening the conversation are necessary first. Reassurance that a person will do fine dismisses any potential concerns the patient may have. Rotating nursing personnel does not allow time for the patient to build rapport with any one nurse.

Q: The nurse can assist the patient in becoming more self-aware by using which technique?
- Setting up an appointment to allow the patient to vent
- Allowing the patient to openly explore thoughts and feelings
- Assisting the patient to physically punch a pillow when upset
- Providing materials for the patient to write complaint letters
A: Allowing the patient to openly explore thoughts and feelings
If right: By allowing open communication about thoughts and feelings, the nurse creates an environment for therapeutic communications. Punching pillows does not create self-awareness. Writing complaint letters and venting can create more internal turmoil in a person and do not promote self-awareness.
If wrong: By allowing open communication about thoughts and feelings, the nurse creates an environment for therapeutic communications. Punching pillows does not create self-awareness. Writing complaint letters and venting can create more internal turmoil in a person and do not promote self-awareness.

Q: Potential predictors for suicidal thoughts and behaviors in adolescents are
- Stressful life events and a scholarship.
- Very high self-esteem and work failure.
- Health problems and developmental milestones.
- Negative body image and low self-esteem.
A: Negative body image and low self-esteem.
If right: Low self-esteem and negative body image can be predictors for suicidal thoughts and behaviors. High self-esteem would help a person cope with work failure. Stressful life events when balanced with positive issues, such as receipt of a scholarship, are less likely to induce depression. Suicidal tendencies are based more on the individual’s frame of mind than on individual events such as health problems and developmental milestones.
If wrong: Low self-esteem and negative body image can be predictors for suicidal thoughts and behaviors. High self-esteem would help a person cope with work failure. Stressful life events when balanced with positive issues, such as receipt of a scholarship, are less likely to induce depression. Suicidal tendencies are based more on the individual’s frame of mind than on individual events such as health problems and developmental milestones.

Q: Two 50-year-old men are discussing their Saturday activities. The first man describes how he tutors children as a volunteer at a community center. The other man says that he would never work with children, and that he prefers to work out at the gym to meet young women to date. The second man’s statement reflects which developmental stage?
- Inferiority
- Role confusion
- Self-absorption
- Mistrust
A: Self-absorption
If right: In the generativity versus self-absorption developmental task, a self-absorbed person is concerned about his or her own personal wants and desires in a self-centered manner. Mistrust versus trust occurs in the first year of life. Industry versus inferiority commonly occurs in school children. Identity versus role confusion commonly occurs at the start of adolescence into young adulthood.
If wrong: In the generativity versus self-absorption developmental task, a self-absorbed person is concerned about his or her own personal wants and desires in a self-centered manner. Mistrust versus trust occurs in the first year of life. Industry versus inferiority commonly occurs in school children. Identity versus role confusion commonly occurs at the start of adolescence into young adulthood.

Q: A verbally abusive partner has told his significant other many negative comments over the years. In the crisis center, the nurse would anticipate that the patient may have which of the following self-concept deficits?
- Body image
- Role confusion
- Rigidity
- Yearning
A: Body image
If right: Consistent negative comments can cause devaluation of an individual’s self-concept. The impact of negative self-esteem can invade all areas of a person’s life, including body image. Role confusion is part of a developmental task (identity versus role confusion). Rigidity and yearning are not components of self-concept.
If wrong: Consistent negative comments can cause devaluation of an individual’s self-concept. The impact of negative self-esteem can invade all areas of a person’s life, including body image. Role confusion is part of a developmental task (identity versus role confusion). Rigidity and yearning are not components of self-concept.

Q: The developmental self-concept task known as initiative versus guilt would occur in which person?
- 3-week-old neonate
- 5-year-old kindergarten student
- 11-year-old student
- 15-year-old high school student
A: 5-year-old kindergarten student
If right: The initiative versus guilt developmental stage occurs between the ages of 3 and 6 years. If a child shows initiative, the outcome of this developmental task is to develop purpose. A neonate developmental task is to develop trust. An 11-year-old is into new skill mastery, and a 15-year-old is struggling with identity versus role confusion.
If wrong: The initiative versus guilt developmental stage occurs between the ages of 3 and 6 years. If a child shows initiative, the outcome of this developmental task is to develop purpose. A neonate developmental task is to develop trust. An 11-year-old is into new skill mastery, and a 15-year-old is struggling with identity versus role confusion.

Q: Based on the following data, which person is likely to have the highest self-esteem?
- Latino adolescent female who has strong ethnic pride
- Caucasian boy who lives below federal poverty level
- African American adolescent male who has severe acne
- Adolescent who was suspended twice from high school
A: Latino adolescent female who has strong ethnic pride
If right: Ethnic and cultural differences in self-concept and self-esteem have been noted across the life span. Ethnic pride and self-esteem often are positively correlated. Environmental stressors such as low-income, body image stressors such as acne, and role performance failure often influence self-esteem negatively.
If wrong: Ethnic and cultural differences in self-concept and self-esteem have been noted across the life span. Ethnic pride and self-esteem often are positively correlated. Environmental stressors such as low-income, body image stressors such as acne, and role performance failure often influence self-esteem negatively.

Q: Children learn to live an authentic lifestyle through culturally accepted behaviors, values, and role modeling. A child who does this is attempting to create his or her own
- Body image.
- Self-esteem.
- Identity.
- Role performance.
A: Identity.
If right: Identify versus role confusion occurs between the ages of 12 and 20 years. Body image and self-esteem are attitudes related to personal reflection and attitudes. Role performance is the result of creating an identity.
If wrong: Identify versus role confusion occurs between the ages of 12 and 20 years. Body image and self-esteem are attitudes related to personal reflection and attitudes. Role performance is the result of creating an identity.

Q: “I’m such a loser. I only had that job for a month.” Identify appropriate nursing outcome criteria for this individual.
- The patient will verbalize two life areas in which he or she functions well.
- The patient will find new employment before the next clinic visit.
- The patient will confront his or her former boss about work problems.
- The patient will identify why he or she is considered a bad employee.
A: The patient will verbalize two life areas in which he or she functions well.
If right: Verbalizing two life areas in which a person functions well is an individualized measurable outcome that is realistic. Confronting a former boss could have physical and emotional repercussions for the patient. If the person is voicing that he or she has problems obtaining employment, then putting extra pressure to obtain employment would be detrimental to the patient and does not reflect a supportive and caring nursing outcome.
If wrong: Verbalizing two life areas in which a person functions well is an individualized measurable outcome that is realistic. Confronting a former boss could have physical and emotional repercussions for the patient. If the person is voicing that he or she has problems obtaining employment, then putting extra pressure to obtain employment would be detrimental to the patient and does not reflect a supportive and caring nursing outcome.

Q: A nurse who grimaces when seeing a patient’s colostomy opening while changing the colostomy bag is most likely to have what effect on the patient?
- Assist recovery by using honest communication.
- Motivate the patient to increase physical activity.
- Promote development of a negative body image.
- Develop a kind nickname for the colostomy opening.
A: Promote development of a negative body image.
If right: Negative nonverbal reactions by a nurse to a patient’s scar or surgical alterations contribute to the patient’s developing a negative body image. Expressions of distaste by the nurse will not facilitate recovery or ongoing communication; encourage physical activity; or promote acceptance of the colostomy opening by adopting a positive nickname.
If wrong: Negative nonverbal reactions by a nurse to a patient’s scar or surgical alterations contribute to the patient’s developing a negative body image. Expressions of distaste by the nurse will not facilitate recovery or ongoing communication; encourage physical activity; or promote acceptance of the colostomy opening by adopting a positive nickname.

Q: An adult is adjusting to the idea of his chronically ill parent moving into the family home. The community health nurse would assess the adult son for which potential stressor secondary to the new family living arrangement?
- Role confusion
- Role ambiguity
- Role performance
- Role overload
A: Role overload
If right: Role overload involves having more roles or responsibilities within a role than are manageable. Role overload is common in individuals who unsuccessfully attempt to meet the demands of work and family while trying to find some personal time. Role confusion is an aspect of the developmental task of adolescence and young adulthood (identity versus role confusion). Role ambiguity involves unclear role expectations. Role performance itself is not a stressor unless it is judged ineffective.
If wrong: Role overload involves having more roles or responsibilities within a role than are manageable. Role overload is common in individuals who unsuccessfully attempt to meet the demands of work and family while trying to find some personal time. Role confusion is an aspect of the developmental task of adolescence and young adulthood (identity versus role confusion). Role ambiguity involves unclear role expectations. Role performance itself is not a stressor unless it is judged ineffective.

Q: While gathering an adolescent’s health history, the nurse recognizes that the patient began to act out behaviorally and engage in risky behavior when her parents divorced. In considering an altered self-concept nursing diagnosis, the nurse would gather what information?
- How long the parents were married
- How the patient views her behaviors
- Why the parents are divorcing
- Why she is acting out of control
A: How the patient views her behaviors
If right: A nurse can identify situational life stressors that can impact a person’s self-concept. By openly exploring a patient’s thoughts and feelings, the nurse will be able to use communication skills in a therapeutic manner. This will facilitate the patient’s insight into behaviors and will enable the nurse to make referrals or provide needed health teaching. The length of time married and the reason for the parents’ divorce do not explain the patient’s behaviors. Why the patient is out of control is not as important as how the patient views her actions when out of control.
If wrong: A nurse can identify situational life stressors that can impact a person’s self-concept. By openly exploring a patient’s thoughts and feelings, the nurse will be able to use communication skills in a therapeutic manner. This will facilitate the patient’s insight into behaviors and will enable the nurse to make referrals or provide needed health teaching. The length of time married and the reason for the parents’ divorce do not explain the patient’s behaviors. Why the patient is out of control is not as important as how the patient views her actions when out of control.

Q: The nursing student can help geriatric patients’ self-concept by using which technique?
- Discussing current weather
- Reviewing old photos with patients
- Encouraging patients to sing
- Allowing patients extra computer time
A: Reviewing old photos with patients
If right: Nurses can improve self-image by reviewing old photographs when working with elderly patients. This form of life review is helpful to older adults in remembering positive life events and people. Discussing weather does not involve personal reflection. Singing improves global cognition, not self-concept. Giving patients extra computer time is not applicable to improving self-concept.
If wrong: Nurses can improve self-image by reviewing old photographs when working with elderly patients. This form of life review is helpful to older adults in remembering positive life events and people. Discussing weather does not involve personal reflection. Singing improves global cognition, not self-concept. Giving patients extra computer time is not applicable to improving self-concept.