A nurse is counseling a client for the management of anxiety. The client is consistently late for appointments and ignores household chores. The client states, "I'm just too stressed. I need someone to take care of me." The nurse identifies this behavior as an example of which of the following defense mechanisms?

Repression

Introjection

Dissociation

Regression

Answer and Explanation

The Correct Answer is D

A. Repression: Repression involves unconsciously pushing unwanted thoughts, memories, or feelings out of conscious awareness. It involves burying distressing emotions or memories deep in the unconscious mind to avoid dealing with them consciously. In this scenario, the client's behavior does not suggest the repression of any specific thoughts or memories but rather a coping mechanism related to their current stress and anxiety.

B. Introjection: Introjection occurs when an individual internalizes the values, beliefs, or attitudes of others as if they were their own. It involves incorporating external standards or influences into one's own identity. While introjection may contribute to the client's behavior indirectly by influencing their beliefs about needing external support, the primary defense mechanism at play in this scenario is regression.

C. Dissociation: Dissociation involves a disruption in the integration of consciousness, memory, identity, or perception of the environment. It often manifests as a detachment from reality or a sense of being disconnected from oneself or the surrounding environment. While dissociation may occur in response to severe stress or trauma, it typically involves more extreme symptoms than those described by the client in this scenario.

D. Regression: Regression involves reverting to earlier, less mature behaviors or stages of development in response to stress or anxiety. It reflects a retreat to a more comfortable or familiar state in an attempt to cope with overwhelming emotions or situations. In this scenario, the client's statement about needing someone to take care of them suggests a desire to return to a state of dependency, which is characteristic of regression as a defense mechanism.

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Correct Answer is D

Explanation

A. Negative Chvostek's sign: Chvostek's sign is a clinical sign of hypocalcemia, characterized by twitching of the facial muscles elicited by tapping over the facial nerve. A negative Chvostek's sign means that there is no twitching response, which is expected in individuals with normal calcium levels or hypercalcemia. Therefore, a preschooler with a calcium level of 8.0 mg/dL would likely not exhibit a negative Chvostek's sign.

B. Polyuria: Polyuria, or increased urine output, is not typically associated with hypocalcemia. Instead, it may be seen in conditions such as diabetes mellitus or diabetes insipidus, which affect water balance and urine production.

C. Dry, sticky mucous membranes: Dry, sticky mucous membranes are not characteristic findings of hypocalcemia. Instead, hypocalcemia may manifest with symptoms such as numbness or tingling around the mouth, hands, and feet; muscle cramps; and seizures. Mucous membrane changes are not typically specific to calcium levels.

D. Muscle tremors: Muscle tremors are a common manifestation of hypocalcemia. Low calcium levels can lead to increased neuromuscular irritability, resulting in muscle twitching or tremors. Other neuromuscular symptoms of hypocalcemia may include muscle cramps, tetany (prolonged muscle spasms), and seizures. Therefore, a preschooler with a calcium level of 8.0 mg/dL is more likely to exhibit muscle tremors as a result of hypocalcemia.

A. "Placing your child on her back when sleeping will decrease the risk of SIDS. B. "Sleep apnea is the main cause of SIDS." C. "SIDS is directly correlated with the diphtheria, tetanus, and pertussis vaccines" D. "SIDS rates have been rising, over the last 10 years"

Correct Answer is A

Explanation

A. "Placing your child on her back when sleeping will decrease the risk of SIDS." This statement is accurate. The American Academy of Pediatrics (AAP) recommends that infants be placed on their backs to sleep to reduce the risk of SIDS. This sleep position has been associated with a significant decrease in the incidence of SIDS since it was introduced in the 1990s. It's essential to educate parents about safe sleep practices to protect their newborns.

B. "Sleep apnea is the main cause of SIDS." This statement is incorrect. Sleep apnea is a separate condition characterized by pauses in breathing during sleep. SIDS, on the other hand, is the sudden and unexplained death of an otherwise healthy infant, usually during sleep. While the exact cause of SIDS is unknown, it is not related to sleep apnea.

C. "SIDS is directly correlated with the diphtheria, tetanus, and pertussis vaccines." This statement is incorrect. There is no direct correlation between SIDS and the diphtheria, tetanus, and pertussis (DTaP) vaccines. Extensive research has shown that vaccines, including the DTaP vaccine, do not cause SIDS. In fact, vaccines are essential for preventing serious infectious diseases and protecting infants' health.

D. "SIDS rates have been rising over the last 10 years." This statement is incorrect. SIDS rates have actually been declining over the past few decades due to public health campaigns promoting safe sleep practices, including placing infants on their backs to sleep. While there may be fluctuations in rates from year to year, the overall trend has been a decrease in SIDS rates, not an increase.

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a preschooler who has a calcium level of 8.0 mg/dL. Which of the following findings should the nurse expect?

Correct Answer is D

Explanation

A nurse is caring for a newborn whose mother voices concerns about sudden Infant death syndrome (SIDS). The nurse should include which of the following statements in a discussion with the mother?

Correct Answer is A

Explanation

A nurse is preparing to administer digoxin to a 6-month-old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate? below ___________ beats/min

A nurse is caring for a toddler who has acute laryngotracheobonchitis after a repair of an intussusception. Which of the indicates that the treatment has been effective?

A nurse is collecting data from an infant at a well-child visit. The nurse should understand that birth weight typically doubles by what age?

A nurse in a PACU is admitting a client who is postoperative following ad from the waist down. Which of the following statements by the client take to prevent aspiration?

A nurse is assessing a preschooler. Which of the following findings should indicate to the nurse a need for speech therapy? (Select all that apply.)

A nurse is assessing a toddler at a well-child visit. At what point in the physical examination should the nurse examine the child's tympanic membrane??

A parent tells a nurse that her toddler drinks a quart of milk a day and has a poor appetite for solid foods. The nurse should explain that the toddler is at risk for which of the following disorders?

A nurse is caring for a client who has been hospitalized for treatment of bipolar disorder and will be discharged with a prescription for lithium. The nurse's discharge teaching should include information cautioning against which of the following factors that may cause lithium toxicity?