A nurse is caring for a client who has bipolar disorder. The client yells at the nurse whenever medication changes are prescribed by the client's provider. The nurse should identify that the client is using which of the following defense mechanisms?
Displacement
Conversion
Splitting
Sublimation
The Correct Answer is A
Displacement is a defense mechanism where a person redirects their emotional impulses, such as anger or frustration, from the original source to a less threatening or more accessible target. In this scenario, the client is redirecting their anger towards the nurse when medication changes are prescribed by the provider. The nurse becomes the target of the client's anger, even though the nurse is not directly responsible for the medication changes.
Conversion is a defense mechanism where psychological distress is expressed as physical symptoms or ailments.
Splitting is a defense mechanism where a person sees things as either all good or all bad, with no middle ground or ambivalence.
Sublimation is a defense mechanism where unacceptable impulses or behaviors are channeled into socially acceptable and constructive outlets.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
The correct answer is Choice A.
Choice A rationale: By stating expectations for the client’s behavior, the nurse is addressing the immediate situation and setting clear boundaries.This intervention allows the nurse to assertively communicate with the client, reminding them of appropriate behavior and potentially diffusing the situation1.
Choice B rationale: Requesting security personnel to restrain the client should be a last resort, used only when the client poses a significant risk to themselves or others and all other de-escalation techniques have failed. Restraint can be traumatic and has potential physical and psychological risks.
Choice C rationale: Placing the client in seclusion is another measure that should be used sparingly and only when necessary for the safety of the client or others. It’s important to try less restrictive measures first, such as verbal de-escalation techniques or offering a quiet, private space where the client can regain control.
Choice D rationale: Debriefing staff members about the conflict is an important step, but it should not be the first action. The immediate priority is to ensure the safety of all clients and to de-escalate the situation.
Correct Answer is C
Explanation
When collecting a stool specimen to check for occult blood, it is important to avoid certain foods that can affect the test results, such as red meat. Red meat can cause false-positive results due to the presence of heme, which can mimic the appearance of blood in the stool.
By avoiding red meat for at least three days before the test, the client can help ensure more accurate results. pasteurized dairy products do not have a direct impact on stool occult blood test results. However, it is important to note that certain medications, such as bismuth subsalicylate (found in Pepto-Bismol), can affect the test results.
The presence of urine in the stool sample can potentially dilute or mask the presence of blood, leading to false-negative results. It is important
Occult blood testing is typically done as a one-time test unless otherwise specified by a healthcare provider. Collecting a specimen once each week for four weeks is unnecessary unless specifically instructed by the healthcare provider.
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