A nurse is caring for a client who states, "I did not take my medication because my partner forgot to remind me." The nurse should identify that the client is demonstrating which of the following defense mechanisms?

Choice A reason: Fluid volume deficit is a condition in which the body loses more fluid than it gains, resulting in dehydration, hypotension, and electrolyte imbalances. It is not a complication of IV fluid therapy, but rather a reason for initiating it.

Choice B reason: Fluid volume excess is a condition in which the body retains more fluid than it needs, resulting in edema, hypertension, and heart failure. It is a potential complication of IV fluid therapy, especially in older adults who have reduced renal function and cardiac output. The nurse's assessment findings of crackles, shortness of breath, and jugular vein distention are indicative of fluid overload and pulmonary congestion.

Choice C reason: Speed shock is a systemic reaction that occurs when a substance is administered too rapidly into the bloodstream, causing adverse effects such as chest pain, dyspnea, hypotension, and cardiac arrest. It is not a complication of IV fluid therapy, but rather a risk associated with IV medication administration.

Choice D reason: Pulmonary embolism is a blockage of one or more pulmonary arteries by a blood clot, fat, or air, causing impaired gas exchange, chest pain, dyspnea, and hemoptysis. It is not a complication of IV fluid therapy, but rather a possible outcome of venous thromboembolism, which can be prevented by using anticoagulants and mechanical devices.

Choice A reason: The client will be able to return to work is not a SMART goal. SMART stands for Specific, Measurable, Achievable, Relevant, and Time-bound. This goal is not specific, as it does not state what kind of work the client will do, or how the client's back pain will affect their work performance. It is also not measurable, as it does not state how the client's work ability will be assessed. It may not be achievable, as the client's work-related injury may prevent them from returning to their previous occupation. It may not be relevant, as the client may have other priorities or preferences than work. It is also not time-bound, as it does not state when the client will return to work.

Choice B reason: The client will verbalize diminished pain at the conclusion of physical therapy is not a SMART goal. This goal is not specific, as it does not state how much pain the client will experience, or what level of pain is acceptable for the client. It is also not measurable, as it relies on the client's subjective report of pain, which may vary depending on the client's mood, expectations, or coping skills. It may not be achievable, as the client's chronic back pain may not be fully resolved by physical therapy. It may not be relevant, as the client may have other outcomes or indicators of improvement than pain. It is also not time-bound, as it does not state how long the physical therapy will last, or when the client will verbalize their pain level.

Choice C reason: The client will be able to perform self-care is not a SMART goal. This goal is not specific, as it does not state what aspects of self-care the client will perform, or how the client's back pain will affect their self-care abilities. It is also not measurable, as it does not state how the client's self-care performance will be evaluated. It may not be achievable, as the client's chronic back pain may limit their range of motion, strength, or endurance for self-care tasks. It may not be relevant, as the client may have other goals or needs than self-care. It is also not time-bound, as it does not state when the client will achieve this goal.

Choice D reason: The client will engage in desired activities without the pain level increasing above a pain scale level of 3 out of 10 within one month is a SMART goal. This goal is specific, as it states what activities the client wants to do, and how the client's pain level will be monitored. It is measurable, as it uses a numeric pain scale that can be easily recorded and compared. It is achievable, as it sets a realistic and attainable pain threshold that allows the client to enjoy their activities. It is relevant, as it reflects the client's personal interests and values, and enhances their quality of life. It is time-bound, as it states a clear and reasonable deadline for achieving this goal.