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?
Suppression.
Rationalization.
Reaction-formation.
Compensation.
The Correct Answer is B
Choice A rationale:
Suppression involves the conscious, intentional effort to push unwanted thoughts, feelings, or memories out of awareness. It is not evident in the client's statement, as they are not actively trying to forget or avoid their alcohol use. Instead, they are attempting to justify it.
Choice B Rationale:
Rationalization is the defense mechanism most clearly demonstrated in the client's statement. It involves creating false but seemingly logical reasons to justify unacceptable behavior or feelings. The client is attributing their alcohol use to external factors (their boss and job requirements) rather than taking responsibility for their own choices and actions. This allows them to avoid confronting the reality of their addiction and the need for change.
Key characteristics of rationalization that align with the client's statement:
Externalizing blame: The client places responsibility for their drinking on their boss and job, rather than acknowledging their own agency.
Minimizing the problem: The client suggests that their drinking was merely a necessary part of their job, downplaying the extent of their alcohol use and its negative consequences.
Avoiding negative emotions: By shifting blame, the client protects themselves from feelings of guilt, shame, and responsibility associated with their addiction.
Choice C Rationale:
Reaction formation involves behaving in a way that is opposite to one's true feelings or impulses. This is not evident in the client's statement, as they are not expressing overly negative or critical attitudes towards alcohol. Instead, they are attempting to justify their use of it.
Choice D Rationale:
Compensation involves overemphasizing a desirable trait or behavior to make up for a perceived weakness or deficiency. This is not evident in the client's statement, as they are not highlighting any positive qualities or accomplishments to offset their alcohol use.
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Correct Answer is B
Explanation
Choice A rationale:
Dismissive and unsupportive: This response discounts the client's son's feelings of guilt and obligation toward their parent. It also implies that the client's son's presence is not valuable, which could further increase their distress.
Undermines the client's son's role as a caregiver: It suggests that the client's son has no responsibilities or ability to contribute to their parent's care, which could diminish their sense of agency and potentially lead to resentment or regret.
Fails to address the underlying emotions: It does not acknowledge the client's son's internal conflict and emotional turmoil, which is essential for providing effective support.
Choice C rationale:
Offers a practical solution, but may not address the core issue: While calling the children could provide temporary reassurance, it may not fully alleviate the client's son's feelings of guilt or anxiety about leaving their parent.
May not be feasible or sufficient: The client's son may need more than a phone call to feel comfortable leaving, and they may not be able to reach their children immediately.
Could be perceived as dismissive: It could suggest that the nurse is minimizing the client's son's concerns and not fully understanding their emotional needs.
Choice D rationale:
Reassuring, but may not address the client's son's guilt: While it provides assurance about the client's care, it does not directly acknowledge or validate the client's son's feelings of guilt or obligation.
Focuses on the client's care, but not the client's son's needs: It prioritizes the physical care of the client, but may overlook the emotional needs of the client's son, who is also a primary stakeholder in the situation.
May not be enough to alleviate the client's son's concerns: The client's son may still feel responsible for their parent's well- being, even with reassurance from the nurse.
Choice B rationale:
Empathetic and validates the client's son's feelings: It directly acknowledges the client's son's conflicting emotions and demonstrates understanding of their difficult situation.
Promotes self-reflection and exploration: It encourages the client's son to further express their feelings and explore their options, which can lead to greater clarity and self-awareness.
Facilitates decision-making: It helps the client's son to weigh their priorities and make a decision that aligns with their values and responsibilities, ultimately empowering them to take action.
Strengthens the therapeutic relationship: It demonstrates the nurse's ability to connect with the client's son on an emotional level, building trust and rapport.
Correct Answer is B
Explanation
Choice A rationale:
It is not accurate to state that the provider is required to notify the client's family of their admission. While providers may often choose to involve family members in the care of a client with MDD, this is not a mandatory requirement for voluntary admission.
Disclosing a client's admission without their consent could breach confidentiality and potentially damage trust between the client and healthcare team.
It's essential to respect the client's privacy and autonomy, and to obtain their permission before sharing any information with family members.
Choice C rationale:
It is incorrect to state that a client gives up their right to refuse psychotropic medications upon voluntary admission. Informed consent remains a crucial principle even in an acute mental health setting.
Clients have the right to decline medications or other treatments, even if healthcare providers believe those interventions would be beneficial.
It's important to engage in a collaborative discussion with the client, provide education about treatment options, and respect their decisions.
Choice D rationale:
It is misleading to suggest that a client cannot leave the facility until the provider completes a discharge summary and authorizes discharge.
While providers play a significant role in discharge planning, clients ultimately have the right to request discharge from voluntary admission, even if the provider does not fully agree with the decision.
Providers may need to initiate involuntary commitment procedures if a client poses a serious risk to themselves or others, but this is a separate process with specific legal requirements.
Choice B is the most accurate statement because it emphasizes the importance of informed consent throughout the treatment process. Even in a voluntary admission, clients retain their right to make decisions about their care and to be fully informed about the risks and benefits of any proposed treatments.
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