Self-Concept and Sexuality

1.The patient is a 66-year-old patient who has been admitted to the hospital for a transient ischemic attack (TIA). Her health care provider has told her that she should consider retiring from her high-stress position as a hospital administrator. The patient is distraught over this suggestion. The nurse caring for her recognizes the most likely cause of distress is a result of a change in which of the following?

a.
Body image
b.
Role performance
c.
Self-esteem
d.
Identity

ANS: B

Role performance is the way in which a person views his or her ability to carry out significant roles. This patient is being told that she will have to give up her role as an administrator. Body image involves attitudes related to the perception of the body, including physical appearance, femininity and masculinity, youthfulness, health, and strength. There are no overt bodily changes here. Self-esteem is an individual’s overall sense of personal worth or value. This could be an issue, but it is based in the change in her role. Identity involves the sense of individuality and being distinct and separate from others. Being “oneself” or living a life that is genuine and authentic is the basis of true identity. What was true of self-esteem can be true of identity.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:598 | 599

OBJ: Discuss factors that influence the following components of self-concept: identity, body image, and role performance. TOP: Nursing Process: Implementation

MSC: NCLEX: Psychosocial Integrity

2.The patient is a 16-year-old teenager who is in the clinic for his annual check-up. During the assessment, the nurse asks the patient about his use of tobacco. Although he denies smoking, he tells the nurse that he dips snuff. He tells the nurse that he started last year because all his friends do it. The nurse recognized this as a stressor of which of the following?

a.
Body image
b.
Identity
c.
Role performance
d.
Sexuality

ANS: B

Identity involves the sense of individuality and being distinct and separate from others. Cultural identity develops from identifying and socializing within an established group and through incorporating the responses of individuals who do not belong to that group into one’s self-concept. Body image involves attitudes related to the perception of the body, including physical appearance, femininity and masculinity, youthfulness, health, and strength. Role performance is the way in which a person views his or her ability to carry out significant roles. Common roles include mother or father, wife or husband. Sexuality is a broad term that refers to all aspects of being sexual. Our sexual health is based on our ability to form healthy relationships with others.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:596 | 598 | 599

OBJ: Discuss factors that influence the following components of self-concept: identity, body image, and role performance. TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity

3.Body image is an important concept relative to psychosocial development. In dealing with body image issues, the nurse must do which of the following?

a.
Understand that skinny people always see themselves as thin.
b.
Realize that body image is never associated with self-esteem.
c.
Recognize that physical changes always lead to changes in body image.
d.
Be aware that female adolescents more frequently struggle with issues than males.

ANS: D

The development of secondary sex characteristics and changes in body fat distribution has a tremendous impact on the self-concept of an adolescent. Female adolescents struggle more with body image issues than do their male counterparts. Body image depends only partly on the reality of the body. When physical changes occur, individuals may or may not incorporate these changes into their body image. For example, people who have experienced significant weight loss do not perceive themselves as thin and may still tell you there is still a “fat person” inside. Body image issues are often associated with negative self-concept and self-esteem.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:599

OBJ: Discuss factors that influence the following components of self-concept: identity, body image, and role performance. TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

4.After a large weight loss a patient tells the nurse, “There still is a fat person inside of me.” This type of statement illustrates a flaw in what self-concept component?

a.
Role performance
b.
Identity stressor
c.
Self-esteem
d.
Body image

ANS: D

Body image depends only partly on the reality of the body. When physical changes occur, individuals may or may not incorporate these changes into their body image. For example, people who have experienced significant weight loss do not perceive themselves as thin and may still tell you there is still a “fat person” inside. Role performance is the way in which a person views his or her ability to carry out significant roles. Common roles include mother or father, wife or husband, daughter or son, sister or brother, employee or employer, and nurse or patient. Identity stressors affect an individual’s identity, but identity is particularly vulnerable during adolescence. Self-esteem is an individual’s overall sense of personal worth or value.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:599

OBJ: Discuss factors that influence the following components of self-concept: identity, body image, and role performance. TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

5.A nurse is caring for an adult patient who retired last year. While rendering care, the nurse identifies that the patient is struggling emotionally with this change. This situation is most likely associated with what self-concept component?

a.
Role performance
b.
Identity stressors
c.
Self-esteem
d.
Body image stressors

ANS: A

Role performance is the way in which a person views his or her ability to carry out significant roles. Common roles include mother or father, wife or husband, daughter or son, sister or brother, employee or employer, and nurse or patient. Identity stressors affect an individual’s identity, but identity is particularly vulnerable during adolescence. Self-esteem stressors vary with developmental stages. Potential self-esteem stressors in older adults include health problems, declining socioeconomic status, spousal loss or bereavement, loss of social support. Body image stressors involve attitudes related to the body, including appearance, femininity and masculinity, youthfulness, health, and strength.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:599

OBJ: Discuss factors that influence the following components of self-concept: identity, body image, and role performance. TOP: Nursing Process: Assessment

MSC: NCLEX: Psychosocial Integrity

6.The mother of a 7-year-old boy asked the nurse what factors tended to increase self-esteem in boys. Which of the following is the nurse’s best response?

a.
Positive family communication supporting the child’s self-worth.
b.
It does not really matter because self-esteem varies widely throughout life.
c.
Avoid situational crises because they lead to permanent changes in self-esteem.
d.
Let the child know that it is OK to be incompetent.

ANS: A

Self-esteem is an individual’s overall sense of personal worth or value. Self-esteem is positive when one feels capable, worthwhile, and competent. Once established, basic feelings about the self tend to be constant, even though there is sometimes a little fluctuation. A situational crisis, like a hospitalization, often temporarily affects one’s self-esteem.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:599

OBJ: Discuss factors that influence the following components of self-concept: identity, body image, and role performance. TOP: Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

7.As a nurse caring for a patient with a colostomy that resulted from the treatment of a benign tumor of the bowel. The most appropriate classification of this self-concept component is which of the following?

a.
Role performance stressor
b.
Sexuality stressor
c.
Identity stressor
d.
Body image stressor

ANS: D

Changes in the appearance or function of a body part require an adjustment in body image. An individual’s perception of the change and the relative importance placed on body image in the individual’s self-concept will affect the significance of the loss or change. Throughout life a person undergoes many role changes. Normal changes associated with maturation result in changes in role performance. Sexuality stressors are issues related to sexuality on a regular basis. Identity stressors affect an individual’s identity, but identity is particularly vulnerable during adolescence.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:599 | 600 | 601

OBJ: Identify stressors that affect self-concept, self-esteem, and sexuality.

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

8.A male patient shares that, although he has a satisfying relationship with his wife, he is also attracted to men. He is confused and does not know how to deal with this issue. The nurse should do which of the following?

a.
Explain that the patient’s problem is one of orientation and high risk.
b.
Tell the patient that he has a sexual dysfunction and needs medication.
c.
Inform the patient that having relationships with other men is normal and risk free.
d.
Teach that STIs are fewer with men because most STIs are spread vaginally.

ANS: A

Lesbian, gay, bisexual, or transgender (LGBT) individuals have unique stressors related to their sexual orientation. Peer, family, and social support is often lacking for this population that is at high risk for health issues such as STIs, HIV, depression, and victimization. Sexual dysfunction interferes with sexual health and is a problem with desire, arousal, or orgasm. Sexually transmitted infections (STI) are infections spread through oral, anal, or vaginal activity. The use of latex condoms can reduce the risk of STIs via any route of transmission.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:601 | 602

OBJ: Discuss your role in maintaining or enhancing a patient’s sexual health.

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

9.The nurse is caring for a 34-year-old woman, who was admitted to the hospital with multiple rib fractures. The patient states, “I fell down the stairs. It was all my fault. I can be so stupid at times.” The nurse notices healing bruises on the patient’s back and buttocks. The patient’s husband seems very caring, always holding her hand and often answering questions for her. The nurse should do which of the following?

a.
Direct her questions toward the husband because he answers most of them anyway.
b.
Accept the patient’s report on how she received her broken ribs.
c.
Ask the husband to step into the waiting room while the patient is examined.
d.
Treat the patient’s wounds and discharge her home.

ANS: C

If you suspect abuse, interview the patient privately. A patient will probably not admit to problems of abuse with the abuser present. Sexual abuse, assault, and rape are also stressors that affect self-concept. Be alert to clues that suggest abuse. In addition, observe the interaction between the patient and partner for additional clues. Controlling behaviors such as speaking for the person or refusing to leave him or her alone with a caregiver are suggestive of emotional and perhaps physical or sexual abuse.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:602

OBJ: Identify stressors that affect self-concept, self-esteem, and sexuality.

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

10.The nurse is caring for a patient who has been diagnosed with chronic pain. The nurse is especially concerned about the patient’s self-concept because chronic pain does which of the following?

a.
Normally has no effect on the ability to function once patients learn to deal with it
b.
Can often cause increased irritability that can affect self-concept
c.
Often leads to increased sleep as patients try to “escape” the pain
d.
Requires pain medication that prevents self-concept alterations

ANS: B

When you care for patients who have alterations in self-concept, be particularly alert to the patient who is experiencing chronic pain. Chronic pain predisposes a person to decreased ability to function, irritability, and decreased sleep. These changes negatively affect self-concept. Many medications have actions and side effects that influence a patient’s self-concept and sexuality.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:604

OBJ: Apply the nursing process to promote a patient’s self-concept and sexual health.

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

11.The nurse is attempting to obtain a sexual history on a patient who is being evaluated for a possible hysterectomy. The nurse should do which of the following?

a.
Assume that the patient will not appreciate questions about sexual practices.
b.
Avoid information relative to medication effect on sexuality.
c.
Use specific gender terms to emphasize sexuality.
d.
Recognize that many patients welcome the chance to talk about their sexuality.

ANS: D

With experience you will come to recognize that many patients welcome the opportunity to talk about their sexuality, especially when they are experiencing difficulty in sexual functioning. Once you approach the topic, the patient is able to talk about concerns and explore possible ways to resolve the problem. You may worry that the patient will not appreciate being asked about sexuality and sexual practices. However, patients want to know how medications, treatments, and surgical procedures influence their sexual relationships. Use gender-neutral terms and questions when completing the sexual history.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:605

OBJ: Apply the nursing process to promote a patient’s self-concept and sexual health.

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

12.Reviewing sexuality changes associated with aging is important because:

a.
very few older women experience any type of sexual problems.
b.
in older men, the penis does not become firm as quickly.
c.
ejaculation remains the same throughout life.
d.
ejaculation is quicker with aging.

ANS: B

Approximately 50% of older women experience some type of sexual problem such as low desire or vaginal dryness. In men, the penis does not become firm as quickly and is not as firm as it is at a younger age. Ejaculation takes longer to achieve and is shorter in duration, and the erection often diminishes more quickly.

PTS: 1 DIF: Cognitive Level: Understanding (Comprehension)

REF:606

OBJ: Discuss your role in maintaining or enhancing a patient’s sexual health.

TOP: Nursing Process: Assessment MSC: NCLEX: Physiological Adaptation

13.The nurse is caring for a 65-year-old mother of three who recently underwent abdominal surgery and has a colostomy as a result. The patient has a history of multiple surgeries, including a tracheostomy after lung surgery about 20 years earlier that has since healed over. To determine how to best work with this patient, the nurse should do which of the following?

a.
Determine how the patient dealt with her previous surgeries.
b.
Realize that past coping mechanisms are always positive in nature.
c.
Approach care in a standard method because all patients are the same.
d.
Avoid using family input in determining the course of care.

ANS: A

Your nursing assessment includes consideration of previous coping behaviors. Knowing how a patient has dealt with self-concept stressors in the past provides insight into the patient’s style of coping. Not all patients address issues in the same way, but often a person uses a familiar coping pattern for newly encountered stressors. As you identify previous coping patterns, it is useful to determine whether these patterns have contributed to healthy functioning or created more problems. Exploring resources and strengths, such as availability of significant others or prior use of community resources, is important when formulating a realistic and effective plan.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:606

OBJ: Apply the nursing process to promote a patient’s self-concept and sexual health.

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

14.The nurse is caring for an elderly patient who has a urinary catheter in place and is showing signs of altered self-concept. In dealing with this age group it is probably safe to assume which of the following?

a.
Sexuality concerns are not an issue.
b.
Sexual activity is probably harmful.
c.
Sexually active seniors are always heterosexual.
d.
Sexually active elderly adults have better overall health.

ANS: D

Give priority to patients in middle and older adulthood when you address sexuality concerns caused by illness, medications, or physical changes. Research has shown middle and older age adults who are sexually active have greater independence, better overall health, and longer life expectancy. In addition, you should not assume all older patients are heterosexuals.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:612 | 613

OBJ: Discuss ways in which your self-concept and nursing actions affect your patient’s self-concept and self-esteem. TOP: Nursing Process: Implementation

MSC: NCLEX: Psychosocial Integrity

15.The student nurse is discussing her 4-year-old patient with her nursing instructor. The instructor asks her about how Erikson’s Developmental Tasks have an impact on a 4-year-old child’s self-concept and sexuality. What is the best response?

a.
“Mike identifies with his father.”
b.
“Mike likes to help dress himself.”
c.
“Mike is aware that he is too small to play football.”
d.
“Mike is looking forward to going to college when he gets bigger.”

ANS: A

Identifying with his father shows that the patient is in the proper stage for his age. In the Initiative Versus Guilt (3 to 6 years) the individual takes initiative, identifies with a gender, enhances self-awareness, and increases language skills, including identification of feelings. In the Autonomy Versus Shame and Doubt (1 to 3 years) the individual begins to communicate likes and dislikes, becomes increasingly independent in thoughts and actions, and appreciates body appearance and function (including dressing, feeding, talking, and walking). In the Industry Versus Inferiority stage (6 to 12 years) the individual incorporates feedback from peers and teachers, increases self-esteem with new skill mastery (e.g., reading, math, sports, music), strengthens sexual identity, and becomes aware of strengths and limitations. In the Identity Versus Role Confusion stage (12 to 20 years) the individual accepts body changes/maturation, examines attitudes, values, and beliefs; establishes goals for the future, and feels positive about expanded sense of self.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:598

OBJ:Describe the components of self-concept as each relates to Erikson’s developmental stages.TOP:Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

16.A 35-year-old new mother returns to the clinic for her 6-week postpartum check. When discussing questions regarding the patient’s sexual health the nurse should do which of the following?

a.
Assume that permission to discuss sexuality issues is implied.
b.
Seek knowledge about sexual health in general.
c.
Make therapeutic suggestions early and adjust as needed.
d.
Refer the patient to a professional with advanced training if necessary.

ANS: D

The PLISSIT Assessment of Sexuality method suggests that the nurse gain permission to discuss sexuality issues, limit information to sexual health problems being experienced, make specific suggestion only when the nurse is clear about the problem, and refer the patient to professionals with advanced training if necessary.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:605

OBJ: Apply the nursing process to promote a patient’s self-concept and sexual health.

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

17.A middle-age single woman has breast cancer and needs a mastectomy. She is concerned with future male relationships. She is crying and indicates that her life is over. According to Erikson, she occupies which stage?

a.
Intimacy versus Isolation
b.
Autonomy versus Shame and Doubt
c.
Identity versus Role Confusion
d.
Ego Integrity versus Despair

ANS: A

Intimacy versus Isolation (mid-20s to mid-40s): Intimate relationships with family and significant others; has stable, positive feelings about self; experiences successful role transitions and increased responsibilities. Autonomy versus Same and Doubt is usually found in children (1 year old to 3 years old) and involves increasing independence in thoughts and actions. In the Identity versus Role Confusion stage (usually in people 12 to 20 years of age) the individual accepts body changes/maturation, examines attitudes, values and beliefs, and feels positive about an expanded sense of self. In the late 60s until death, the person is usually in the Ego Integrity versus Despair stage and is interested in providing a legacy for the next generation.

PTS:1DIF:Cognitive Level: Analyzing (Analysis)

REF:598

OBJ:Describe the components of self-concept as each relates to Erikson’s developmental stages.TOP:Nursing Process: Diagnosis

MSC: NCLEX: Psychosocial Integrity

MULTIPLE RESPONSE

1.A middle-age female model is admitted for a double mastectomy. On admission the nurse notes that she is depressed and withdrawn. The most appropriate patient-centered nursing intervention(s) might be which of the following? (Select all that apply.)

a.
Use a positive and matter-of-fact approach to care.
b.
Include the patient in decision making about her care.
c.
Be aware of nonverbal behaviors when providing care.
d.
Focus on the task when an unpleasant task must be done.
e.
Focus matter-of-fact statements on positive aspects of patient healing.

ANS: A, B, C, E

A positive and matter-of-fact approach to care provides a model for the patient and family to follow. General nursing interventions, such as appropriately including the patient in decision making, supports most patients’ self-concept. Your nonverbal behavior conveys the level of caring that exists for your patient and affects your patient’s self-esteem. For example, when an incontinent patient perceives that you find the situation unpleasant, this threatens the patient’s self-concept. Anticipate your own reactions, acknowledge them, and focus on the patient instead of the unpleasant task or situation. Matter-of-fact statements such as, “This wound is healing nicely” or “This looks healthy” enhance the body image of the patient.

PTS:1DIF:Cognitive Level: Applying (Application)

REF:603

OBJ: Apply the nursing process to promote a patient’s self-concept and sexual health.

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