A nurse is caring for a client who states, "No wonder we can't get control of my pain! You don't even believe me when I tell you how much I hurt!" Which of the following defense mechanisms should the nurse identify the client using?

Conversion

Displacement

Introjection

Projection

Answer and Explanation

The Correct Answer is D

Rationale:

A. Conversion: Conversion involves the expression of psychological stress through physical symptoms without an underlying medical cause. The client is describing real pain rather than expressing a psychological conflict as a physical symptom, so this does not match conversion.

B. Displacement: Displacement occurs when a person redirects emotions or feelings from the original source to a safer target. The client is addressing the nurse directly about pain management, not redirecting feelings onto another target, so this is not displacement.

C. Introjection: Introjection involves internalizing the beliefs or values of another person. The client is expressing frustration about pain management rather than adopting someone else’s values or attitudes, so introjection does not apply here.

D. Projection: Projection occurs when a person attributes their own feelings, motives, or thoughts onto someone else. In this case, the client is suggesting that the nurse does not believe them, which reflects the client projecting their feelings of frustration and mistrust onto the nurse.

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Correct Answer is ["A","C","D","E","F"]

Explanation

Rationale:

A. Respiratory rate: The client’s respiratory rate decreased from 20/min to 18/min, indicating improved cardiopulmonary function and reduced physiological stress, which reflects overall improvement in health status.

B. Pain level: The client’s pain level remains at 0/10 both at baseline and follow-up, showing no change. Pain was not a concern initially, so this does not indicate improvement.

C. Blood pressure: Blood pressure decreased from 164/92 mm Hg to 138/84 mm Hg, demonstrating better hypertension management through lifestyle modifications and/or medications, indicating cardiovascular improvement.

D. LDL: LDL cholesterol improved significantly from 220 mg/dL to 90 mg/dL, reflecting effective hyperlipidemia management and reduced risk for cardiovascular disease.

E. Weight: The client’s weight decreased from 88.6 kg to 83.2 kg, reducing BMI from 30.5 to 28.7. This weight loss indicates successful lifestyle modifications and improvement in overall metabolic health.

F. Hemoglobin A1c: HbA1c decreased from 7% to 6%, showing improved long-term glycemic control and reduced risk for diabetes-related complications, reflecting an overall improvement in metabolic health.

A. Dietary intake B. Sore throat C. Heart rate D. Blood pressure

Correct Answer is B

Explanation

Rationale:

A. Dietary intake: The client ate 75% of breakfast, which indicates adequate oral intake. While monitoring nutrition is important in schizophrenia, this finding does not pose an immediate safety concern or require urgent reporting.

B. Sore throat: A sore throat in a client taking clozapine is significant because clozapine can cause agranulocytosis, a potentially life-threatening reduction in white blood cells. Any signs of infection, such as sore throat or fever, must be reported immediately to prevent serious complications.

C. Heart rate: A heart rate of 98/min is slightly elevated but within acceptable limits for many adults. This finding alone does not indicate an urgent issue requiring immediate provider notification.

D. Blood pressure: A blood pressure of 102/56 mm Hg is slightly low but may be within the client’s normal range, particularly if the client experiences dizziness when changing positions. While it should be monitored, it does not require urgent reporting unless symptoms worsen.

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A nurse is caring for a client who states, "No wonder we can't get control of my pain! You don't even believe me when I tell you how much I hurt!" Which of the following defense mechanisms should the nurse identify the client using?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse has reviewed the Nurses' Notes, Vital Signs, and Laboratory Results from 3 months ago. Exhibits The nurse is reviewing the client's plan of care. Which of the following findings indicate the client's condition has improved? Select all that apply.

Correct Answer is ["A","C","D","E","F"]

Explanation

Exhibits A nurse is reviewing the medical record of a client who has schizophrenia. Which of the following findings should the nurse report to the provider? (Click on the exhibit tabs for additional information about the client. There are three tabs that contain separate categories of data.)

Correct Answer is B

Explanation

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