Nokea
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.
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Alprazolam is prescribed for a patient experiencing acute anxiety. Health teaching should include which instructions?
- A. Report drowsiness.
- B. Eat a tyramine-free diet.
- C. Avoid alcoholic beverages.
- D. Adjust dose and frequency based on anxiety level.
Correct Answer: C
Rationale: Drinking alcohol or taking other anxiolytic medications along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs). Drowsiness is an expected effect and needs to be reported only if it is excessive. Patients should be taught not to deviate from the prescribed dose and schedule for administration.
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.
Which assessment question would be most appropriate for the nurse to ask a patient who is at risk for developing generalized anxiety disorder (GAD)?
- A. Have you been a victim of a crime or seen someone badly injured or killed?
- B. Do you feel especially uncomfortable in social situations involving people?
- C. Do you repeatedly do certain things over and over again?
- D. Do you find it difficult to control your worrying?
Correct Answer: D
Rationale: Patients with GAD frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.
A patient tells the nurse, 'I don't go to restaurants because people might laugh at the way I eat, or I could spill food and be laughed at.' The nurse assesses this behavior as consistent with which mental health diagnosis?
- A. Acrophobia
- B. Agoraphobia
- C. Social anxiety disorder
- D. Posttraumatic stress disorder (PTSD)
Correct Answer: C
Rationale: The fear of a potentially embarrassing situation represents social anxiety disorder (social phobia). Acrophobia is the fear of heights. Agoraphobia is the fear of a place in the environment. Posttraumatic stress disorder is associated with a major traumatic event.
A student says, 'Before taking a test, I feel a heightened sense of awareness and restlessness.' What nursing intervention is most helpful for assisting the student?
- A. Explaining that the symptoms are the result of mild anxiety and discussing the helpful aspects
- B. Advising the student to discuss this experience with a health care provider
- C. Encouraging the student to begin antioxidant vitamin supplements
- D. Listening without comment
Correct Answer: A
Rationale: Teaching about the symptoms of anxiety, their relation to precipitating stressors, and, in this case, the positive effects of anxiety serves to reassure the patient. Advising the patient to discuss the experience with a health care provider implies that the patient has a serious problem. Listening without comment will do no harm but deprives the patient of health teaching. Antioxidant vitamin supplements are not useful in this scenario.