A nurse is caring for a client who has a new diagnosis of chronic stress. Which of the following findings should the nurse recognize as a manifestation of rationalization?
The client ignores the nurse during the discussion about their diagnosis.
The client states, “I only act this way because my partner makes me so angry.”
The client refuses to accept treatment for their diagnosis.
The client calls the office multiple times per day to speak with their provider.
The Correct Answer is B
Choice A reason: Ignoring the nurse reflects avoidance, not rationalization, where clients justify behaviors, like blaming a partner. Assuming ignoring is rationalization risks misidentifying coping, potentially missing stress management needs, critical to avoid in supporting clients with chronic stress diagnoses.
Choice B reason: Stating behavior is due to a partner’s actions is rationalization, justifying stress responses to avoid responsibility. Recognizing this is critical for addressing maladaptive coping, guiding therapeutic interventions, and supporting healthier stress management strategies in clients with chronic stress diagnoses.
Choice C reason: Refusing treatment reflects denial, not rationalization, where clients provide excuses like blaming others. Assuming refusal is rationalization risks misinterpreting coping, potentially delaying intervention, critical to prevent in addressing chronic stress and promoting treatment acceptance in clients.
Choice D reason: Frequent calls reflect anxiety or dependency, not rationalization, where clients justify behaviors, like blaming others. Assuming calls are rationalization risks missing emotional needs, critical to avoid in ensuring proper stress management and support for clients with chronic stress diagnoses.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A reason: A temperature of 37.6°C is normal post-surgery, not requiring reporting; low urinary output is urgent. Assuming temperature is concerning risks overlooking renal issues, potentially delaying intervention, critical to avoid in ensuring comprehensive postoperative monitoring and client safety after abdominal surgery.
Choice B reason: Serous drainage is expected post-abdominal surgery, indicating normal healing, not requiring reporting. Low urinary output is priority. Assuming drainage is urgent risks misprioritizing, potentially neglecting renal complications, critical to prevent in ensuring proper postoperative care and recovery in surgical clients.
Choice C reason: Urinary output of 20 mL/hr is below normal (30-50 mL/hr), indicating potential renal impairment or dehydration post-surgery, requiring immediate reporting. This ensures timely intervention, critical for preventing kidney injury, maintaining fluid balance, and supporting recovery in clients post-abdominal surgery.
Choice D reason: Blood pressure of 100/70 mm Hg is low but not critical unless symptomatic; low urinary output is more urgent. Assuming blood pressure requires reporting risks overlooking renal issues, critical to avoid in ensuring prioritized monitoring and intervention in postoperative abdominal surgery clients.
Correct Answer is D
Explanation
Choice A reason: Smallpox vaccination is not routine due to eradication; disaster preparedness involves drills. Assuming vaccination is relevant risks misaligned priorities, diverting resources from practical preparedness, critical to avoid in ensuring nurses contribute effectively to community readiness for various disaster scenarios.
Choice B reason: Quarantine for anthrax is specific and reactive, not a primary preparedness activity; drills are broader. Assuming quarantine planning is key risks neglecting comprehensive disaster training, critical to prevent in ensuring nurses are prepared for diverse emergencies through community mock events.
Choice C reason: Assessing disaster types and scopes is typically administrative, not a nurse’s primary role; drills are practical. Assuming assessment is the focus risks overlooking hands-on preparedness, critical to avoid in ensuring nurses gain skills through community drills for effective disaster response.
Choice D reason: Participating in community drills and mock events prepares nurses for disaster response, enhancing skills in triage and coordination, critical for effective emergency management. This ensures readiness, improves response efficiency, and supports community safety, essential for nurses in disaster preparedness roles across various scenarios.
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