# Situation: The nurse at the clinic of a public high school talks with students who come in for consultation. A 14-year-old girl with a small scar on her chin refuses to join the school dance program. She says, "Everyone will be staring at my chin the whole time," and adds, "Nobody has ever felt as ugly as I do." Which belief MAINLY drives her refusal to perform?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629520  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: The nurse at the clinic of a public high school talks with students who come in for consultation.

A 14-year-old girl with a small scar on her chin refuses to join the school dance program. She says, "Everyone will be staring at my chin the whole time," and adds, "Nobody has ever felt as ugly as I do." Which belief MAINLY drives her refusal to perform?

## 보기

1. Role confusion
2. Identity foreclosure
3. Imaginary audience **✔ 정답**
4. Personal fable

**정답: 3**

## 해설

Both forms of adolescent egocentrism appear in her words, but her refusal rests on the belief that everyone will watch and judge her appearance, which is the imaginary audience. Her second remark, that no one has ever felt as she does, reflects the personal fable (feeling unique), but that belief does not explain why she will not perform in front of others. Role confusion is the negative outcome of Erikson's identity stage, and identity foreclosure is committing to an identity without exploring alternatives.

## 심화 해설

Core concept: Adolescent egocentrism

The girl’s refusal to join the dance program is driven by a specific cognitive distortion common in early adolescence. Her statement that “everyone will be staring at my chin the whole time” reflects the belief that she is the center of others’ attention and that an audience is constantly observing and evaluating her appearance. This is the defining feature of the imaginary audience, one of two components of adolescent egocentrism described by David Elkind [2][3].

The imaginary audience is the adolescent’s conviction that others are as preoccupied with her appearance and behavior as she is herself. It emerges from the cognitive transition to formal operational thought, where the adolescent can now think about what others might be thinking, but has not yet fully separated her own self-focus from the perspectives of others. In social situations such as performing in a school dance program, this leads to heightened self-consciousness and avoidance [1][2].

Her second remark, “Nobody has ever felt as ugly as I do,” reflects the personal fable, the belief that one’s feelings and experiences are entirely unique and that no one else could possibly understand. The personal fable explains why she feels her suffering is singular, but it does not explain why she refuses to perform in front of others. The refusal itself—the avoidance of being seen and judged—is specifically tied to the imaginary audience [2][4].

Key point! When a question asks what *mainly* drives avoidance of public performance or social exposure, focus on the mechanism of being watched and evaluated. The imaginary audience is about perceived observation; the personal fable is about perceived uniqueness of experience.

The other options do not fit the scenario. Role confusion is the negative outcome of Erikson’s psychosocial stage of identity versus role confusion, involving an inability to settle on a coherent sense of self across roles. The girl is not describing confusion about who she is; she is describing fear of being scrutinized. Identity foreclosure refers to committing to an identity—such as a career, religion, or political stance—without exploring alternatives, often by adopting parental or societal expectations wholesale. Neither concept is reflected in her statements about her chin or her appearance.

| Concept | Core belief | What it explains in this scenario |
| --- | --- | --- |
| Imaginary audience | Others are watching and judging me | Refusal to perform because “everyone will be staring” |
| Personal fable | My feelings are unique; no one understands | “Nobody has ever felt as ugly as I do” |
| Role confusion | Uncertainty about one’s identity and life direction | Not present in the scenario |
| Identity foreclosure | Commitment without exploration of alternatives | Not present in the scenario |

Research on the imaginary audience has shown that younger adolescents display significantly more imaginary audience behavior and externally driven self-consciousness than older adolescents and adults, which aligns with the developmental timing of this 14-year-old’s concern [1]. Contemporary studies also confirm that imaginary audience ideation is more pronounced in early to middle adolescence and interacts with factors such as sex and age, though the core construct remains useful for understanding self-conscious avoidance in social situations [4]. The conceptual literature cautions that the imaginary audience should not be treated as a fixed, universal bias in all adolescents, but in the context of a nursing licensure question, the classic definition remains the expected framework for interpreting this type of clinical vignette [2][3].

For nursing practice, recognizing the imaginary audience helps the nurse respond therapeutically rather than dismissively. The nurse can acknowledge the student’s distress without reinforcing the distorted belief, and can gently explore whether the feared scrutiny is as intense as it feels. This understanding also guides anticipatory guidance for parents and teachers about normal adolescent self-consciousness, which tends to diminish as formal operational thinking matures and the adolescent learns to differentiate her own perspective from that of others [1][4].References (research sources)

- [1]Adolescent self-consciousness and the imaginary audience.Research articleLechner CR, Rosenthal DA (1984)

- [2]Revisiting the imaginary audience and personal fable constructs of adolescent egocentrism: a conceptual review.Research articleVartanian LR (2000)

- [3]Imaginary audience and personal fable: a brief review.Research articleBuis JM, Thompson DN (1989)

- [4]Adolescent egocentrism: a contemporary view.Research articleSchwartz PD, Maynard AM, Uzelac SM. (2008)

## 임상 시나리오

Adolescent Egocentrism in School NursingRecognizing Imaginary Audience vs. Personal Fable
When an adolescent refuses social performance due to fear of being watched, assess for imaginary audience—the belief that others are as focused on their appearance as they are. This stems from formal operational thought emerging around ages 11–15.

Statements like “nobody has ever felt as ugly as I do” reflect personal fable, the sense of unique suffering. While it intensifies distress, it does not explain avoidance of being seen—that is specifically the imaginary audience.

CautionDo not dismiss these concerns as mere drama. Validate the student’s feelings, avoid arguing about reality, and gently explore whether fear of judgment is limiting school participation or social development.

## 핵심 개념

- **Imaginary audience** — Adolescent egocentrism component where the adolescent believes others are constantly watching and evaluating their appearance and behavior.
- **Personal fable** — Adolescent egocentrism component reflecting the belief that one's feelings and experiences are unique and not understood by others.
- **Adolescent egocentrism** — Cognitive distortion in early adolescence described by David Elkind, consisting of imaginary audience and personal fable.
- **Identity foreclosure** — Commitment to an identity without exploring alternatives, a concept from Marcia's identity status theory.
- **Role confusion** — Negative outcome of Erikson's identity vs. role confusion stage, characterized by failure to form a stable identity.

## 같은 주제 문제

- [Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for…](https://mymerci.kr/pages/nclex_q.php?qn_id=629416)
- [Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for…](https://mymerci.kr/pages/nclex_q.php?qn_id=629417)
- [Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for…](https://mymerci.kr/pages/nclex_q.php?qn_id=629418)
- [Situation: A 20-month-old boy is admitted to the pediatric ward of a district hospital for…](https://mymerci.kr/pages/nclex_q.php?qn_id=629419)
- [Situation: In the treatment room of a district hospital, the nurse prepares a 4-year-old g…](https://mymerci.kr/pages/nclex_q.php?qn_id=629420)
- [Situation: In the treatment room of a district hospital, the nurse prepares a 4-year-old g…](https://mymerci.kr/pages/nclex_q.php?qn_id=629421)
- [Situation: In the treatment room of a district hospital, the nurse prepares a 4-year-old g…](https://mymerci.kr/pages/nclex_q.php?qn_id=629422)
- [Situation: The nurse at a Rural Health Unit (RHU) holds a class for parents of young child…](https://mymerci.kr/pages/nclex_q.php?qn_id=629423)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._