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According to psychodynamic theory, what purpose do delusions serve?
- A. Delusions are a defense against anxiety caused by real or imagined threats.
- B. Magical thinking is a delusion that ensures desirable outcomes.
- C. Delusions are a method of dealing with and interpreting external stimuli.
- D. Subconsciously, delusions are a way to safely express anger and hostility.
Correct Answer: A
Rationale: According to psychodynamic theory, delusions serve as a defense mechanism against anxiety triggered by real or perceived threats. Delusions are the individual's unconscious way of protecting themselves from overwhelming feelings of anxiety. Magical thinking, on the other hand, involves believing that one's thoughts can influence external events. This is not the same as delusions. Delusions are not a way of interpreting external stimuli but rather a defense mechanism. Expressing anger and hostility is typically associated with defense mechanisms like displacement or projection, not delusions.
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The nurse leads group therapy for clients diagnosed with substance abuse. A client diagnosed with alcoholism, and who occasionally uses marijuana and cocaine, attends the meeting. During the meeting the client states, 'I am having trouble sitting still. Am I bothering anybody? Maybe I should not come to these meetings.' Which action by the nurse is most appropriate?
- A. Encourage the client to share problems with the group.
- B. Remove the client from the group and further assess needs.
- C. Recognize this as manipulative behavior and encourage the client to remain in the group.
- D. Tell the other group members to ignore the client and continue with the group meeting.
Correct Answer: A
Rationale: Encouraging the client to share promotes engagement and allows the group to support them, addressing their restlessness therapeutically. Removing them isolates, labeling as manipulative is judgmental, and ignoring dismisses their needs.
A 28-year-old woman is recovering from her third consecutive spontaneous abortion in 2 years. Which is the most therapeutic nursing intervention for this client at her follow-up appointment?
- A. Focusing on the client's physical needs
- B. Encouraging the client to verbalize her feelings about the loss
- C. Reminding the client that she will be able to become pregnant again
- D. Encouraging the client to think of herself, her husband, and their future
Correct Answer: B
Rationale: The most therapeutic nursing intervention for a client recovering from multiple spontaneous abortions is to encourage the client to verbalize her feelings about the loss. This allows the client to express and process her emotions, facilitating the grieving process and emotional healing. Focusing solely on the client's physical needs, as in choice A, overlooks the importance of addressing the emotional aspect of the client's experience. Choice C, reminding the client that she will be able to become pregnant again, fails to acknowledge the current loss and may minimize the client's feelings of grief. Choice D, encouraging the client to think of herself, her husband, and their future, does not directly address the client's immediate emotional needs related to the recent loss. Therefore, choice B is the most appropriate intervention to support the client in coping with her emotional distress.
A client diagnosed with cancer is placed on permanent total parenteral nutrition as a means of providing nutrition. Which is the rationale for the nurse to include psychosocial support when planning care for this client?
- A. Death is imminent.
- B. The client will need to adjust to the idea of living without eating by the usual route.
- C. Total parenteral nutrition requires disfiguring surgery for permanent port implantation.
- D. Nausea and vomiting occur regularly with this type of treatment and will prevent the client from participating in social activity.
Correct Answer: B
Rationale: Permanent total parenteral nutrition is indicated for clients who can no longer absorb nutrients via the enteral route. These clients will no longer take nutrition orally. The remaining options are inaccurate. There is no indication in the question that death is imminent. Permanent port implantation is not disfiguring. Total parenteral nutrition does not cause nausea and vomiting.
Which defense mechanism would the nurse conclude a female client with obsessive-compulsive disorder, who washes her hands more than 20 times a day, is using to ease anxiety?
- A. Undoing
- B. Projection
- C. Introjection
- D. Displacement
Correct Answer: A
Rationale: The correct answer is 'Undoing.' Undoing is a defense mechanism where the individual tries to negate a previous act to relieve guilt or anxiety. In this case, the client washing her hands excessively is trying to 'undo' perceived contamination or guilt associated with not washing. Projection (choice B) involves attributing one's own unacceptable thoughts or impulses to others, which is not demonstrated in this scenario. Introjection (choice C) is the process of internalizing beliefs or values of others, which is also not applicable in this context. Displacement (choice D) involves redirecting emotions from one target to another, which does not align with the client's behavior of handwashing as a response to anxiety in this case.
The nurse observes that a client is restless, tense, and reports feeling empty. The nurse notes the client has a history of threatening self-mutilation. Which nursing action is appropriate?
- A. Monitor weight and dietary intake.
- B. Administer chlordiazepoxide.
- C. Provide food in client's own containers.
- D. Take inventory of the client's room.
Correct Answer: D
Rationale: Taking inventory of the client’s room ensures safety by identifying and removing potential tools for self-harm, given the history of threatened self-mutilation. Other actions do not directly address the immediate risk.