A nurse is admitting a client to an alcohol abuse program. The client states, "I'm here because of my boss.
It was part of my job to go to parties and drink with clients." The client's statement is an example of which of the following defense mechanisms?

The correct answer/s is Choices A, B, and C.

Choice A Rationale:

Recent or impending moves can be a significant stressor for adolescents, disrupting their social networks, routines, and sense of belonging. This disruption can exacerbate existing mental health problems or trigger new ones, increasing the risk of suicidal ideation or behavior. Studies have shown that adolescents who relocate are more likely to experience depression, anxiety, and substance abuse, all of which are risk factors for suicide. Additionally, the feeling of loss and displacement associated with moving can lead to feelings of isolation and hopelessness, further increasing the risk.

Choice B Rationale:

A sudden decline in school performance can be a sign of underlying emotional distress in adolescents. This decline may be due to depression, anxiety, or other mental health problems that can impede concentration, motivation, and overall academic functioning. Suicidal ideation or behavior can also lead to a decline in school performance as the adolescent withdraws from their usual activities and struggles to cope with their emotions. Therefore, a sudden drop in grades or academic engagement should raise a red flag for the nurse and warrant further investigation into the adolescent's emotional well-being.

Choice C Rationale:

The death of a parent at a young age is a major life event that can have a profound impact on an adolescent's emotional and psychological development. This loss can lead to feelings of grief, sadness, anger, and isolation, all of which are risk factors for suicide. Additionally, adolescents who lose a parent may be more likely to experience depression, anxiety, and substance abuse, further increasing their vulnerability to suicidal thoughts and behaviors. The nurse should be particularly concerned if the death of the parent was recent or if the adolescent has not adequately processed their grief.

Choice D Rationale:

While low parental expectations can be a negative influence on an adolescent's self-esteem and motivation, it is not directly linked to an increased risk of suicide. In fact, some studies have suggested that high parental expectations can be equally detrimental to adolescent mental health. Therefore, while low parental expectations may not be a standalone risk factor for suicide, it is important to consider this factor in the context of the adolescent's overall psychosocial assessment.

Summary:

A recent or impending move, a sudden decline in school performance, and the death of a parent at a young age are all significant stressors that can increase the risk of suicidal ideation or behavior in adolescents. The nurse should be alert to these warning signs and conduct a thorough psychosocial assessment to identify any underlying mental health issues or risk factors. Early intervention and support can significantly reduce the risk of suicide and help adolescents cope with these challenging life events.

Choice A rationale: The nurse should ask the client to agree to talk to a nurse whenever she feels the urge to exercise. This is because the client with anorexia nervosa who overexercises is using exercise as a means to control her weight and shape, which is a characteristic of this disorder. By asking the client to talk to a nurse when she feels the urge to exercise, the nurse is providing a safe and supportive environment for the client to express her feelings and fears related to her body image and weight. This intervention also helps the client to develop healthier coping mechanisms and reduces the risk of physical harm due to excessive exercise.

Choice B rationale: Praise the client for looking at herself in a mirror may not be the most effective nursing action. While it’s important to encourage positive body image, simply praising the client for looking at herself in a mirror may not address the underlying issues related to her body dissatisfaction and fear of weight gain. It’s crucial to understand that anorexia nervosa is not just about body image, but also about control, perfectionism, and fear of maturity. Therefore, interventions should be comprehensive and target all aspects of the disorder.

Choice C rationale: Restricting the client from being weighed may not be beneficial. While it’s true that clients with anorexia nervosa can become obsessed with their weight, weighing is a necessary part of monitoring their health status. Instead of restricting the client from being weighed, the nurse should provide education about the importance of regular weight checks and involve the client in the process. This can help to reduce anxiety and promote a sense of control.

Choice D rationale: Reprimanding the client about the potential damage that has occurred due to overexercising her body is not therapeutic. It’s important to remember that clients with anorexia nervosa are often in denial about the seriousness of their condition. Therefore, reprimanding or confronting the client may lead to resistance and defensiveness. Instead, the nurse should use a supportive and understanding approach, providing education about the risks of excessive exercise and the benefits of a balanced lifestyle.