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A supervisor assigns a worker a new project. The worker initially agrees but feels resentful. The next day, when asked about the project, the worker says, 'I've been working on other things.' When asked 4 hours later, the worker says, 'Someone else was using the copier, so I couldn't finish it.' The worker's behavior demonstrates the use of what mechanism?
- A. Acting out
- B. Projection
- C. Suppression
- D. Passive aggression
Correct Answer: D
Rationale: A passive-aggressive person deals with emotional conflict by indirectly expressing aggression toward others. Compliance on the surface masks covert resistance. Resistance is expressed through procrastination, inefficiency, and stubbornness in response to assigned tasks. Acting out refers to behavioral expression of conflict. Projection is a form of blaming. Suppression is the conscious denial of a disturbing situation or feeling.
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A person consistently rationalizes their cruel and abusive behavior. Which comment is most characteristic of this person defense mechanism?
- A. I don't know why it happens.
- B. I have always had poor impulse control.
- C. That person should not have provoked me.
- D. Inside I am a coward who is afraid of being hurt.
Correct Answer: C
Rationale: Rationalization consists of justifying one's unacceptable behavior by developing explanations that satisfy the teller and attempt to satisfy the listener. The abuser is suggesting that the abuse is not his or her fault; it would not have occurred except for the provocation by the other person.
A patient with a high level of motor activity runs from chair to chair and cries, 'They're coming! They're coming!' The patient does not follow instructions or respond to verbal interventions from staff. The initial nursing intervention of highest priority is to:
- A. provide for patient safety.
- B. increase environmental stimuli.
- C. respect the patient's personal space.
- D. encourage the clarification of feelings.
Correct Answer: A
Rationale: Safety is of highest priority; the patient who is experiencing panic is at high risk for self-injury related to an increase in non-goal-directed motor activity, distorted perceptions, and disordered thoughts. The goal should be to decrease the environmental stimuli. Respecting the patient's personal space is a lower priority than safety. The clarification of feelings cannot take place until the level of anxiety is lowered.
A patient in the emergency department has no physical trabaja injuries but exhibits disorganized behavior and incoherence after a minor traffic accident. In which room should the nurse place the patient?
- A. Interview room furnished with a desk and two chairs.
- B. Small, empty storage room with no windows or furniture.
- C. Room with an examining table, instrument cabinets, desk, and chair.
- D. Nurse's office, furnished with chairs, files, magazines, and bookcases.
Correct Answer: A
Rationale: Individuals who are experiencing severe to panic-level anxiety require a safe environment that is quiet, non-stimulating, structured, and simple. A room with a desk and two chairs provides simplicity, few objects with which the patient could cause self-harm, and a small floor space around which the patient can move. A small, empty storage room without windows or furniture would be like a jail cell. The nurse's office or a room with an examining table and instrument cabinets may be overstimulating and unsafe.
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 is undergoing diagnostic tests. The patient says, 'Nothing is wrong with me except a stubborn chest cold.' The spouse reports that the patient smokes, coughs daily, has recently lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using?
- A. Displacement
- B. Regression
- C. Projection
- D. Denial
Correct Answer: D
Rationale: Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one's own unacceptable thoughts or feelings to another.