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A patient tells a nurse, 'My new friend is the most perfect person one could imagine - kind, considerate, and good looking. I can't find a single flaw.' This patient is demonstrating which defense mechanism?
- A. Denial
- B. Projection
- C. Idealization
- D. Compensation
Correct Answer: C
Rationale: Idealization is an unconscious process that occurs when an individual attributes exaggerated positive qualities to another. Denial is an unconscious process that calls for the nurse to ignore the existence of the situation. Projection operates unconsciously and results in blaming behavior. Compensation results in the nurse unconsciously attempting to make up for a perceived weakness by emphasizing a strong point.
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A person has minor physical injuries after an automobile accident. The person is unable to focus and says, 'I feel like something awful is going to happen.' This person has nausea, dizziness, tachycardia, and hyperventilation. What is this person's level of anxiety?
- A. Mild
- B. Moderate
- C. Severe
- D. Panic
Correct Answer: C
Rationale: The person whose anxiety is severe is unable to solve problems and may have a poor grasp of what is happening in the environment. Somatic symptoms such as those described are usually present. The individual with mild anxiety is only mildly uncomfortable and may even find his or her performance enhanced. The individual with moderate anxiety grasps less information about a situation and has some difficulty with problem solving. The individual in panic-level anxiety demonstrates significantly disturbed behavior and may lose touch with reality.
Which comment by a person experiencing severe anxiety indicates the possibility of obsessive-compulsive disorder?
- A. I check where my car keys are eight times.
- B. My legs often feel weak and spastic.
- C. I'm embarrassed to go out in public.
- D. I keep reliving the car accident.
Correct Answer: A
Rationale: Recurring doubt (obsessive worry) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. The statement, 'My legs feel weak most of the time,' is more in keeping with a somatoform disorder. Being embarrassed to go out in public is associated with an avoidant personality disorder. Reliving a traumatic event is associated with posttraumatic stress disorder.
A patient who is preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is appropriate?
- A. Reassure the patient that all nurses are skilled in providing postoperative care.
- B. Describe the procedure again in a calm manner, using simple language.
- C. Tell the patient that the staff is prepared to promote recovery.
- D. Encourage the patient to express feelings to his or her family.
Correct Answer: B
Rationale: Providing information in a calm, simple manner helps the patient grasp the important facts. Introducing extraneous topics as described in the incorrect options will further scatter the patient's attention.
A nurse plans health teaching for a patient diagnosed with generalized anxiety disorder (GAD) who takes lorazepam. What information should be included?
- A. Use caution when operating machinery.
- B. Allow only tyramine-free foods in diet.
- C. Restrict intake of caffeine.
- D. Avoid using alcohol and other sedatives.
- E. Take the medication on an empty stomach.
Correct Answer: A,C,D
Rationale: Caffeine is a central nervous system stimulant that acts as antagonist to the benzodiazepine lorazepam. Daily caffeine intake should be reduced to the amount contained in one cup of coffee. Benzodiazepines are sedatives, thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation. Benzodiazepines do not require a special diet. Food will reduce gastric irritation from the medication.
Two staff nurses applied for a charge nurse position. After the promotion was announced, the nurse who was not promoted said, 'The nurse manager had a headache the day I was interviewed.' Which defense mechanism is evident?
- A. Introjection
- B. Conversion
- C. Projection
- D. Splitting
Correct Answer: C
Rationale: Projection is the hallmark of blaming, scapegoating, thinking prejudicially, and stigmatizing others. Conversion involves the unconscious transformation of anxiety into a physical symptom. Introjection involves intense, unconscious identification with another person. Splitting is the inability to integrate the positive and negative qualities of oneself or others into a cohesive image.