A nurse is caring for a client who states, "I am under a great deal of stress at work, but I am able to forget my work and concentrate on my family when I get home at night." The nurse should identify that the client is demonstrating which of the following defense mechanisms?

Choice A reason : While assisting the client in identifying coping strategies that have worked in the past is important, it is not the first step in assessing self-concept. Coping strategies are part of a broader plan to manage self-concept issues once they have been identified.

Choice B reason : Identifying health alterations that are related to self-concept is the first step in the assessment process. Understanding how health changes affect the client's perception of themselves can provide a foundation for further exploration and intervention planning.

Choice C reason : Collaborating with the client to establish short and long-term goals is an important part of the care plan but should come after a thorough assessment of the client's self-concept and related health alterations.

Choice D reason : Determining whether the desired outcome has been achieved is part of the evaluation phase of the nursing process and should occur after interventions have been implemented, not during the initial assessment of self-concept.

Choice A reason : Denial is the first stage of the Kübler-Ross model of grief. In this stage, individuals believe the diagnosis is somehow mistaken, and cling to a false, preferable reality. It is a defense mechanism that buffers the immediate shock of the loss, numbing us to our emotions.

Choice B reason : Anger is the second stage of grief. As the masking effects of denial begin to wear off, reality and its pain re-emerge. The intense emotion is deflected from our vulnerable core, redirected and expressed instead as anger. The anger may be aimed at inanimate objects, complete strangers, friends, or family.

Choice C reason : Bargaining is the third stage. It involves the hope that the individual can avoid a cause of grief. Usually, the negotiation for an extended life is made with a higher power in exchange for a reformed lifestyle.

Choice D reason : Acceptance is the final stage of grief. In this stage, individuals embrace mortality or the inevitable future, or that of a loved one, or other tragic event. People dying may precede the survivors in this state, which typically comes with a calm, retrospective view for the individual, and a stable condition of emotions.