A nurse is caring for a client who has AIDS.
Which of the following solutions should the nurse use to disinfect the client's overbed table following a blood spill?

The correct answer is: a. Displacement.

Choice A Reason: Displacement is a defense mechanism where a person redirects a negative emotion from its original source to a less threatening recipient. In the context of bipolar disorder, a client may displace anger or frustration about their condition or treatment onto the nurse, who is not the source of these feelings. This redirection can occur because the client might feel powerless or uncomfortable expressing these emotions towards their healthcare provider, who is the authority figure prescribing medication changes.

Choice B Reason: Splitting is often associated with borderline personality disorder rather than bipolar disorder. It involves viewing things in extremes—either all good or all bad—with no middle ground. While individuals with bipolar disorder can exhibit black-and-white thinking, especially during mood episodes, the behavior described does not indicate splitting, as it does not involve idealizing or devaluing the nurse or provider.

Choice C Reason: Sublimation is a mature defense mechanism where socially unacceptable impulses or idealizations are unconsciously transformed into socially acceptable actions or behavior, often resulting in a long-term conversion of the initial impulse. For example, a person with aggressive tendencies might take up a sport that channels aggression in a socially acceptable way. The scenario provided does not suggest that the client is channeling their frustrations into a constructive activity.

Choice D Reason: Conversion involves the transfer of mental stress into physical symptoms. This defense mechanism is characteristic of conversion disorder, where psychological stress manifests as neurological symptoms like blindness, paralysis, or other sensory or motor symptoms without a medical cause. The client yelling at the nurse does not reflect a conversion of emotional distress into physical symptoms.

Choice A rationale:

The statement that "we require informed consent for all routine treatments" is not accurate. Informed consent is typically required for procedures and treatments that carry significant risks or require the patient's understanding and agreement. Routine treatments such as taking vital signs or administering routine medications do not typically require informed consent.

Choice B rationale:

The nurse should include in the teaching that the client can sign the informed consent form after the provider explains the pros and cons of the procedure. This statement emphasizes the importance of informed consent, which requires that the patient receives information about the procedure, risks, benefits, and alternatives before providing their consent.

Choice C rationale:

Stating that verbal consent is acceptable unless the surgical procedure is an emergency is not accurate. Informed consent generally requires written documentation, except in true emergencies when obtaining written consent is not possible due to the patient's condition.

Choice D rationale:

The statement that a family member must witness the client's signature on the informed consent form is not a universal requirement for informed consent. While witnesses may be necessary in some cases, it is not a standard requirement for all surgical procedures. The focus should be on ensuring that the client understands the information provided before consenting.