A nurse is caring for a client who states, "I smoke because I have a lot of anxiety." The nurse should recognize the client's statement as which of the following defense mechanisms?
Projection
Sublimination
Rationalization
Dissociation
The Correct Answer is C
A. Projection: Projection involves attributing one’s own undesirable feelings or thoughts onto others. This is not applicable here, as the client is not projecting their behavior onto someone else.
B. Sublimation: Sublimation is the process of channeling negative or unacceptable impulses into socially acceptable activities. Smoking due to anxiety is not an example of channeling impulses into a productive or acceptable activity.
C. Rationalization: Rationalization is a defense mechanism where a person justifies or makes excuses for their behavior or feelings. In this case, the client is justifying smoking as a way to manage anxiety, which is a classic example of rationalization.
D. Dissociation: Dissociation involves a detachment from reality or a separation of thoughts, identity, or consciousness, typically as a coping mechanism in response to trauma or stress. It is not applicable in this situation, where the client is not detaching from reality.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. "You should try putting the baby in a carrier so you can take a walk when they start crying.": This response may not address the client's emotional frustration. It's important to first listen and understand the full context before offering advice.
B. "Tell me more about what is going on when the baby starts crying.": This response shows empathy and invites the client to share more about their experience. It allows the nurse to better understand the situation and provide support or guidance tailored to the client’s concerns.
C. "Many parents have told me it gets better when the baby is about 3 months old.": It's important to explore the client’s current experience and feelings rather than assuming their situation will improve without validating their concerns.
D. "As a new parent, you should be enjoying your time with the baby.": This statement may come across as judgmental as it implies the client should be feeling something different. It is important to acknowledge and validate the client's feelings.
Correct Answer is A
Explanation
A. Urine output 25 mL/hr: Urine output less than 30 mL/hr is considered inadequate, especially after surgery. This could indicate possible renal insufficiency or hypovolemia, requiring immediate attention.
B. Heart rate 68/min: A heart rate of 68/min falls within the normal adult range (60-100 beats per minute). This finding is generally considered stable and does not typically indicate an immediate complication requiring urgent reporting to the provider in a postoperative client.
C. Hypoactive bowel sounds: Hypoactive bowel sounds are common in the immediate postoperative period, especially after abdominal surgery. This occurs due to the effects of anesthesia and bowel manipulation.
D. Serosanguineous drainage on surgical dressing: Serosanguineous drainage is typical in the early postoperative period and usually decreases over time. It’s not abnormal unless the amount increases significantly or the drainage becomes purulent.
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