A nurse is assisting with an admission interview for a client who has schizophrenia. He tells the nurse that he is receiving special audible messages from the Central Intelligence Agency that no one else is able to hear. The nurse should identify that the client is having which of the following alterations in perception?

Answer: A

Rationale:

A) Ampicillin: Ampicillin is contraindicated for this client because it belongs to the penicillin class of antibiotics. Since the client is allergic to penicillin, administering ampicillin could trigger an allergic reaction, which could range from mild rash to severe anaphylaxis.

B) Erythromycin: Erythromycin is a macrolide antibiotic and can be used as an alternative for clients who are allergic to penicillin. It is often prescribed for group B streptococcus infections in penicillin-allergic clients, making it a suitable option in this case.

C) Cefazolin: Cefazolin is a cephalosporin antibiotic and is generally considered safe for clients with a penicillin allergy, except in cases of severe penicillin allergies. Cross-reactivity is low, and cefazolin can be an appropriate choice for treating group B streptococcus.

D) Clindamycin: Clindamycin is a lincosamide antibiotic and is often used for clients with penicillin allergies. It is effective against group B streptococcus and does not belong to the penicillin or cephalosporin classes, making it a suitable option for this client.

b. Rationalization

Explanation:

The correct answer is b. Rationalization.

Rationalization is a defense mechanism characterized by the individual's atempt to justify or explain their behavior or actions in a way that makes it more acceptable to themselves or others. It involves providing logical-sounding reasons or excuses to mask or minimize the real underlying reasons for their behavior.

In this scenario, the client is atributing their recent behavior to the loss of their job, using it as a justification or explanation for their actions. By blaming the job loss, they are rationalizing their behavior as a direct result of the circumstances they faced.

Option a, Projection, involves atributing one's own unacceptable thoughts, feelings, or behaviors to others.

This defense mechanism does not apply to the client's statement about their job loss.

Option c, Repression, involves the unconscious blocking of unwanted thoughts or feelings. It does not relate to the client's behavior or their explanation for it.

Option d, Sublimation, is a defense mechanism where an individual channels or redirects unacceptable impulses or emotions into socially acceptable behaviors or activities. It is not applicable in this context since the client is not expressing their emotions or impulses through alternative constructive means.

By identifying the client's explanation as rationalization, the nurse recognizes the defense mechanism being used and gains insight into how the client is coping with their emotions and justifying their behavior in response to the job loss. This understanding can guide the nurse in providing appropriate support and interventions to help the client manage their anger more effectively.