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

Answer and Explanation

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.

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Free Nursing Study Resources

Correct Answer is A

Explanation

a. Clean the stoma using an inward to outward circular motion.

When providing tracheostomy care, the nurse should clean the stoma using an inward to outward circular motion to remove any secretions or debris. It is important to avoid using excessive force or pressure, which can cause trauma to the stoma. Cleansing the inner cannula with isopropyl alcohol may be appropriate for some clients, but it is important to follow the healthcare provider's orders regarding inner cannula care.

When securing the tracheostomy ties, the nurse should ensure that there is enough space for two fingers, not three. Finally, the nurse should prepare sterile supplies before removing the inner cannula to ensure that they are readily available and reduce the risk of infection.

A. "I will set my blood pressure goal at 130 over 84," B. "I can have two glasses of wine with dinner." C. "I should decrease my salt intake to 2 grams per day." D. "I should exercise for 15 minutes two times per week!"

Correct Answer is C

Explanation

Maintaining a healthy lifestyle is crucial for managing mild hypertension. One of the key lifestyle changes recommended for individuals with hypertension is reducing salt (sodium) intake.

The American Heart Association recommends limiting sodium intake to no more than 2,300 milligrams (about 2 grams) per day. By expressing the goal to decrease salt intake to 2 grams per day, the client demonstrates an understanding of the teaching.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to provide tracheostomy care for a client. Which of the following actions should the nurse plan to take?

Correct Answer is A

Explanation

A nurse is reinforcing teaching about healthy lifestyle changes with a female client who has mild hypertension. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is C

Explanation

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