Nokea
The nurse provides care for a client diagnosed with substance abuse. The nurse recognizes the client is using projection as a defense mechanism when the client makes which statement?
- A. There is genetic predisposition in my family to alcoholism.
- B. My spouse takes handfuls of medications, and I don't do that.
- C. I have one or two glasses of wine at dinner with my spouse.
- D. Many psychologists do not believe addiction is a disease.
Correct Answer: B
Rationale: Projection involves attributing one's own undesirable behaviors to others. The client blaming their spouse for excessive medication use reflects projection by deflecting their own substance abuse issues onto another person.
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A client states to the nurse, 'I don't do anything right. I'm such a loser.' Which therapeutic statement should the nurse make to the client?
- A. You don't do anything right?
- B. You do things right all the time.
- C. Can we identify things you do right?
- D. You are not a loser, you are depressed.
Correct Answer: A
Rationale: Option 1 provides the client with the opportunity to verbalize. With this statement, the nurse can learn more about what the client really means by the statement. The remaining options are closed statements and do not encourage the client to explore further.
A client who is receiving total parenteral nutrition (TPN) tells the nurse, 'I'm not sure that I want to receive an infusion of lipids because it could make me obese.' Which initial action should the nurse take?
- A. Inquire how illness affects the client's self-concept.
- B. Ask the provider to discuss the benefits of intralipids.
- C. State that intralipids supply essential fatty acids for life.
- D. Explain how intralipids replace dietary sources of lipids.
Correct Answer: A
Rationale: A client who receives TPN is at risk for developing an essential fatty acid deficiency; however, this client's comment requires more than a simple informational response initially. Thus, the nurse responds with option 1 to assist the client with self-expression and to deal with aspects of illness and treatment. Option 2 delays client self-expression and devalues the client's feelings. Options 3 and 4 provide information only.
The nurse is caring for a client in the psychiatric unit who has issues with coping and defense mechanisms. The nurse understands that which is true regarding coping and defense mechanisms? Select all that apply.
- A. Coping mechanisms are destructive ways to avoid dealing with reality.
- B. Physical symptoms, general irritability, and self-destructive behaviors are some of the signs of inadequate coping.
- C. Criticizing ineffective defense mechanisms will guide the client toward better coping techniques.
- D. Ineffective coping mechanisms allow anxiety to increase, triggering the client to utilize defense mechanisms in order to protect himself from the anxiety.
- E. The inability to cope can be caused by a lack of an adequate support system, a serious medical diagnosis, situational crises, or a lack of psychological resources.
Correct Answer: B,D,E
Rationale: Coping mechanisms are constructive, not destructive, making A incorrect. Criticizing defense mechanisms is nontherapeutic, making C incorrect. Signs of inadequate coping, anxiety escalation, and causes of poor coping are accurate.
The nurse is caring for a client diagnosed with Hodgkin's disease who will be receiving radiation and chemotherapy. Which statement by the client indicates a positive coping mechanism to be used during these treatments?
- A. I won't leave the house bald.'
- B. Losing my hair won't bother me.'
- C. I will be one of the few who doesn't lose my hair.'
- D. I have selected a wig, even though I will miss my own hair.'
Correct Answer: D
Rationale: A combination of radiation and chemotherapy often causes alopecia. To make use of positive coping mechanisms, the client must identify personal feelings and positive interventions to deal with side effects. None of the remaining options are positive coping mechanisms.
The nurse provides care for a client who exhibits the signs and symptoms of acute confusion and delirium. Which strategy is appropriate for the nurse to implement?
- A. Keep the room organized and clean.
- B. Maintain a high environmental noise level.
- C. Keep lights in the room dimmed during the day.
- D. Use restraints as needed for client safety.
Correct Answer: A
Rationale: Keeping the room organized and clean minimizes sensory overload and confusion, promoting a calming environment for a client with delirium. High noise, dim lights, or restraints can worsen agitation and are not appropriate unless safety is imminently threatened.