During a group therapy session, a nurse observes several clients using multiple defense mechanisms.
Which of the following client statements demonstrates the use of maladaptive coping mechanisms?
“I mentally separate myself from distractions around me when I paint on canvas.”
“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 don’t care about work anymore since I was not given a promotion.”
The Correct Answer is D
Choice A rationale:
Mental separation from distractions during painting is a healthy coping mechanism, allowing for focus and mindfulness.
It falls under the adaptive defense mechanism of compartmentalization, which involves temporarily separating thoughts and emotions to manage stress effectively.
It doesn't deny or distort reality, but rather creates a temporary mental space for relaxation and creativity.
Choice B rationale:
Writing a short story about a heroic woman is a form of sublimation, channeling negative emotions into a productive and creative outlet.
It's a mature defense mechanism that allows for indirect expression of anger or frustration without causing harm to oneself or others.
It can lead to personal growth and insight, as it encourages reflection and exploration of emotions through storytelling.
Choice C rationale:
Inability to recall the scene of a traumatic event is likely a dissociative defense mechanism, protecting the individual from overwhelming psychological distress.
It's a common response to trauma, and while it may be maladaptive in the long term if it prevents processing the trauma, it serves a protective function in the acute phase.
It doesn't necessarily indicate a maladaptive coping style overall, but rather a specific response to a traumatic experience.
Choice D rationale:
Declaring disinterest in work after being denied a promotion exemplifies disengagement, a maladaptive coping mechanism involving withdrawal and apathy.
It reflects an inability to cope with disappointment or setbacks in a constructive way.
It can lead to social isolation, decreased motivation, and potentially depression or other mental health issues.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
- Answer and explanation The correct answers are:
Condition:
- Mania Actions:
- Daily weight
D. Suicidal behavior
Parameters to monitor:
Blood pressure and pulse rate
Food intake during meals
Rationale for condition:
Choice A: Mania
The client's presentation is consistent with the manic phase of bipolar disorder.
Key features of mania include:
Elevated mood or irritability
Increased energy and activity levels
Racing thoughts and rapid speech
Decreased need for sleep Impulsive behavior
Distractibility
Poor judgment
Grandiosity
Auditory hallucinations Rationale for actions:
Choice B: Daily weight
Weight loss is a common symptom of mania due to increased activity levels and decreased appetite.
Monitoring weight helps assess the severity of mania and the need for nutritional interventions.
Choice D: Suicidal behavior
Individuals with bipolar disorder are at increased risk for suicide, especially during manic episodes.
Close monitoring for suicidal ideation and behavior is crucial for safety.
Rationale for parameters to monitor:
Choice A: Blood pressure and pulse rate
Mania can lead to physiological changes such as increased heart rate and blood pressure.
Monitoring these vital signs helps assess the physical impact of mania and the potential need for medical interventions.
Choice C: Food intake during meals
As mentioned, decreased appetite is common in mania.
Monitoring food intake ensures adequate nutrition and prevents dehydration.
Correct Answer is A
Explanation
Choice A rationale:
Pseudoparkinsonism is an extrapyramidal side effect (EPSE) of antipsychotic medications, particularly first-generation antipsychotics (FGAs) like haloperidol, that closely resembles the symptoms of Parkinson's disease. It's characterized by:
Stooped posture: A forward-leaning posture, often with rounded shoulders and a head that is bent forward.
Shuffling gait: Small, slow steps with reduced arm swing, often described as a "shuffling" or "dragging" walk.
Rigidity: Increased muscle stiffness throughout the body, leading to resistance to movement and a feeling of tightness.
Bradykinesia: Slowness of movement, both in initiating and completing actions.
Tremor: Involuntary shaking, often most noticeable in the hands, but can also affect the arms, legs, head, or jaw.
Masked facies: A decreased facial expression, often described as a "flat" or "expressionless" face.
Mechanism of pseudoparkinsonism:
Haloperidol primarily blocks dopamine D2 receptors in the nigrostriatal pathway of the brain.
Dopamine plays a crucial role in motor control, and its blockade in this pathway leads to a disruption in the balance of dopamine and acetylcholine, another neurotransmitter involved in movement.
This imbalance results in the characteristic symptoms of pseudoparkinsonism.
Risk factors for pseudoparkinsonism:
Older age
Female sex
Higher doses of antipsychotic medication
Prolonged use of antipsychotic medication
History of Parkinson's disease or other movement disorders
Presence of other EPSEs
Management of pseudoparkinsonism:
Dose reduction: If possible, the dose of the antipsychotic medication may be reduced.
Switching to a different antipsychotic: Some antipsychotics, such as second-generation antipsychotics (SGAs), have a lower risk of causing EPSEs.
Anticholinergic medications: These medications can help to counteract the effects of dopamine blockade on the acetylcholine system, but they can have their own side effects, such as dry mouth, constipation, and urinary retention.
Amantadine: This medication can also be used to treat pseudoparkinsonism, but it has the potential to cause side effects such as insomnia, anxiety, and livedo reticularis (a mottled skin rash).
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