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 D
Explanation
Choice A reason: TENS units are effective for chronic pain but less practical 4 hours post-knee arthroplasty due to incision sensitivity; cold packs reduce swelling. Assuming TENS is ideal risks discomfort, critical to avoid in early postoperative pain management, ensuring comfort in acute recovery phases.
Choice B reason: Walking 4 hours post-knee arthroplasty is premature, risking strain or bleeding; cold packs are safer. Assuming walking is appropriate risks complications, critical to prevent in early postoperative care, ensuring pain relief and surgical site protection in clients recovering from knee surgery.
Choice C reason: Lidocaine gel is pharmacological, not nonpharmacological, and inappropriate near fresh incisions; cold packs are correct. Assuming gel is nonpharmacological risks misapplication, potentially causing irritation, critical to avoid in ensuring safe, nonpharmacological pain relief in early post-knee arthroplasty recovery.
Choice D reason: Placing a cold pack reduces swelling and pain 4 hours post-knee arthroplasty, a safe nonpharmacological therapy promoting comfort. This is critical for early recovery, minimizing inflammation, supporting healing, and ensuring effective pain management without medications in clients post-total knee arthroplasty.
Correct Answer is B
Explanation
Choice A reason: Discussing preferences for repositioning schedules is secondary to assessing physical ability in stroke clients, who may have hemiplegia. Evaluating ability ensures safety. Assuming preferences are priority risks unsafe repositioning, potentially causing falls, critical to avoid in ensuring safe mobility and care for stroke patients.
Choice B reason: Evaluating the client’s ability to assist with repositioning is critical post-stroke to assess motor function, ensuring safe technique and preventing injury. This informs whether assistive devices or additional staff are needed, essential for reducing fall risk, promoting recovery, and tailoring care to the client’s physical capacity.
Choice C reason: Repositioning without assistive devices is unsafe for stroke clients with potential weakness or paralysis, risking falls or strain. Evaluating ability is priority. Assuming no devices are needed risks injury, critical to prevent in ensuring safe handling, supporting recovery, and maintaining safety in stroke rehabilitation care.
Choice D reason: Raising side rails ensures safety but is secondary to evaluating the client’s ability to assist, which guides repositioning technique. Assuming rails are the first step risks overlooking physical capacity, potentially leading to unsafe repositioning, critical to avoid in preventing falls and ensuring safe care for stroke clients.
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