A nurse is assisting with evaluating teaching with a client who reports insomnia. Which of the following client statements indicates an understanding of the teaching?

Choice A reason : Repression is a defense mechanism that involves unconsciously blocking unpleasant feelings, desires, or experiences from one's awareness. It is a way for the ego to protect itself from things that the individual cannot cope with at the moment. In the scenario provided, the client does not seem to be unconsciously blocking out the stress but is instead consciously choosing to focus on different aspects of their life at different times.

Choice B reason : Compartmentalization is a defense mechanism where an individual separates different aspects of their life, allowing them to handle conflicting values or emotions by keeping these aspects in separate 'compartments' in their mind. This seems to be what the client is doing by separating work stress from family life, thus being able to concentrate on family when at home despite the stress at work.

Choice C reason : Regression is a defense mechanism that leads an individual to revert to an earlier stage of development when faced with stress. An example would be an adult throwing a tantrum when they don't get their way, which is not what the client is demonstrating in the scenario⁴.

Choice D reason : Projection is a defense mechanism where an individual attributes their own unacceptable thoughts, feelings, or motives to another person. For instance, someone who is angry at their colleague may accuse the colleague of being hostile towards them. The client's statement does not indicate that they are projecting their feelings onto others⁵.

Choice A reason : Asthma is a chronic condition characterized by respiratory symptoms such as wheezing, shortness of breath, and coughing due to airway inflammation and constriction. While genetic and environmental factors contribute to the development of asthma, there is no direct correlation between advanced maternal age and an increased risk of asthma in offspring. Asthma's etiology is multifactorial and more closely related to family history, exposure to allergens, and respiratory infections during early childhood.

Choice B reason : Spina bifida is a neural tube defect that occurs when the spine and spinal cord don't form properly. It's associated with factors such as folic acid deficiency during early pregnancy, certain medications, diabetes, and obesity. Although advanced maternal age may slightly increase the risk of chromosomal abnormalities, it is not considered a significant risk factor for spina bifida. Adequate intake of folic acid before conception and during early pregnancy is the most effective prevention strategy.

Choice C reason : Down syndrome is a genetic disorder caused by the presence of an extra copy of chromosome 21 (trisomy 21). The risk of conceiving a child with Down syndrome increases with maternal age, particularly after age 35. This is due to the higher likelihood of nondisjunction events during cell division in older eggs, leading to an abnormal number of chromosomes. Advanced maternal age is a well-established risk factor for Down syndrome, and prenatal screening is recommended to assess the risk.

Choice D reason : Facial malformations, such as cleft lip or palate, are congenital anomalies that can affect the appearance and function of a child's face. These conditions are influenced by genetic and environmental factors, including certain medications, nutritional deficiencies, and exposure to harmful substances during pregnancy. While advanced maternal age may contribute to an increased risk of chromosomal abnormalities, it is not specifically linked to an increased risk of isolated facial malformations.