A patient undergoing diagnostic tests says. "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes, coughs daily. lost 15 pounds and is easily fatigued. Which defense mechanism is the patient using?

Regression

Projection

Denial

Displacement

Answer and Explanation

The Correct Answer is C

A. Regression is reverting to earlier developmental behaviors (e.g., thumb-sucking under stress). The patient is not showing childlike behaviors.

B. Projection involves attributing one’s own unacceptable feelings to others. The patient is not blaming others for symptoms.

C. Denial is refusing to acknowledge a painful reality. Despite clear symptoms and diagnostic testing, the patient minimizes illness by attributing it to "just a stubborn chest cold."

D. Displacement is redirecting emotions onto a safer target (e.g., yelling at spouse instead of boss). Not evident here.

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Correct Answer is A

Explanation

A. The highest priority is monitoring for refeeding syndrome, a potentially fatal complication when nutrition is reintroduced after prolonged starvation. It causes severe electrolyte shifts (especially hypophosphatemia, hypokalemia, and hypomagnesemia) and cardiac/respiratory complications.

B. Important, but not priority. Therapeutic communication builds trust, but physiological safety is the first concern.

C. Help the patient balance energy expenditures with caloric intake. – Useful long-term. This supports recovery but is not immediately life-saving.

D. Assess for depression and anxiety. – Necessary, but secondary. Mental health evaluation is part of holistic care, but immediate physical safety takes precedence.

A. "My family will be better off without me." B. "Life is not worth living." C. "I wish I were dead." D. "I have a plan that will fix everything"

Correct Answer is A

Explanation

A. "My family will be better off without me" is an indirect or covert suicidal statement (passive ideation) that suggests the patient believes others would be better off if they were gone. Such remarks require immediate assessment of suicide risk (ask directly about thoughts, intent, plan, access to means) and appropriate safety interventions.
B. "Life is not worth living" is an explicit expression of hopelessness and indicates suicidal ideation, but it is more overt than covert. It still warrants urgent assessment, but the question asked specifically for the covert message.
C. "I wish I were dead" is a direct statement of suicidal desire (overt) rather than a covert hint.
D. "I have a plan that will fix everything" is the most concerning because it indicates a specific plan (high lethality risk), but it is overt rather than covert.

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A patient undergoing diagnostic tests says. "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes, coughs daily. lost 15 pounds and is easily fatigued. Which defense mechanism is the patient using?

Nursing Test Bank

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Correct Answer is A

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