During a group therapy session, a nurse notes several clients using multiple defense mechanisms. Which of the following client statements demonstrates the maladaptive use of regression?

"I don't care about work anymore since I was not given a promotion"

"I wrote a short story about a heroic woman when I was really mad at my boss."

" I still cannot remember the scene of my husband's car accident"

"I mentally separate myself from distractions around me when I paint on canvas. "

Answer and Explanation

The Correct Answer is A

A. "I don't care about work anymore since I was not given a promotion":

This statement demonstrates the maladaptive use of regression. Regression involves reverting to an earlier stage of development in the face of unacceptable thoughts or impulses. In this case, the client's response to not receiving a promotion is to display a lack of interest in work, which can be seen as regressing to a less mature coping mechanism.

B. "I wrote a short story about a heroic woman when I was really mad at my boss."

This statement describes the defense mechanism of sublimation rather than regression. Sublimation involves channeling unacceptable impulses or emotions into more socially acceptable activities or behaviors. In this case, the client channels their anger into writing a short story, which is a constructive and creative outlet.

C. "I still cannot remember the scene of my husband's car accident":

This statement does not demonstrate regression. Instead, it suggests repression, which involves the unconscious blocking of unpleasant memories, thoughts, or feelings from conscious awareness. The client's inability to remember the scene of the accident may indicate repression as a defense mechanism.

D. "I mentally separate myself from distractions around me when I paint on canvas."

This statement describes the defense mechanism of dissociation rather than regression. Dissociation involves a disconnection between a person's thoughts, identity, consciousness, or memory. In this case, the client mentally separates themselves from distractions while painting, which is a form of dissociative coping.

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Correct Answer is B

Explanation

A. A semi-private room with a roommate who has a similar diagnosis. Placing a client experiencing a manic episode in a semi-private room with another client who also has a similar diagnosis could potentially exacerbate symptoms or lead to conflict. Manic clients may have increased energy levels, impulsivity, and decreased need for sleep, which could disrupt the roommate's rest and compromise their safety.

B. A private room close to the nursing station. Assigning a private room close to the nursing station is the most appropriate option for a client in the manic phase of bipolar disorder. This allows for closer monitoring and supervision by nursing staff, as well as easier access for interventions and assistance when needed. It also helps to minimize stimulation and provide a more controlled environment for the client.

C. A private room in a quiet location on the unit. While a quiet location may be beneficial for some clients, a private room close to the nursing station offers better access to supervision and support from staff, which is particularly important for clients experiencing mania. Additionally, a quiet location may not always be feasible in a busy psychiatric unit.

D. A seclusion room until the client's activity level becomes more subdued. Using a seclusion room should only be considered as a last resort and when absolutely necessary to ensure the safety of the client and others. It should not be the first choice for a client in the manic phase of bipolar disorder. Placing the client in seclusion may further escalate agitation and increase feelings of isolation and distress.

A. Withhold fluids until the client demonstrates a gag reflex. B. Suction the nasopharynx as needed. C. Perform chest physiotherapy. D. Place a bedside humidifier at the head of the client's bed

Correct Answer is B

Explanation

A. Withhold fluids until the client demonstrates a gag reflex: Withholding fluids until the gag reflex returns is not an appropriate intervention to prevent aspiration. The presence of a gag reflex does not guarantee the absence of aspiration risk. Additionally, depriving the client of fluids can lead to dehydration, which is not conducive to recovery.

B. Suction the nasopharynx as needed: This is the correct intervention to prevent aspiration in a client who is postoperative following anesthesia. Suctioning the nasopharynx helps remove secretions or blood that could obstruct the airway and lead to aspiration.

C. Perform chest physiotherapy: While chest physiotherapy may be beneficial for promoting lung expansion and clearing respiratory secretions, it is not specifically aimed at preventing aspiration. This intervention is more commonly used to manage conditions such as pneumonia or cystic fibrosis.

D. Place a bedside humidifier at the head of the client's bed: Using a bedside humidifier may help maintain airway moisture, but it does not directly address the risk of aspiration. While it can be a comfort measure, it is not a primary intervention for preventing aspiration in a postoperative client.

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