A nurse is providing care for a client who is malnourished and appears exhausted. What data would cause the nurse to suspect the client is a victim of human trafficking? The client:

The correct answer is d. Splitting.

Choice A Reason: Denial

Denial is a defense mechanism where an individual refuses to accept reality or facts, blocking external events from awareness. While denial can be present in various mental health conditions, it does not specifically explain the client’s sudden shift from idealizing to devaluing the nurse.

Choice B Reason: Separation-individuation

Separation-individuation refers to a developmental process where an individual differentiates themselves from others, particularly caregivers, and develops a sense of self. This concept is more relevant to early childhood development and does not directly explain the client’s behavior in this context.

Choice C Reason: Reaction formation

Reaction formation is a defense mechanism where an individual expresses feelings or behaviors that are opposite to their true feelings or desires. While this can occur in borderline personality disorder, it does not fully capture the client’s extreme shift in perception from positive to negative.

Choice D Reason: Splitting

Splitting is a hallmark characteristic of borderline personality disorder. It involves viewing people or situations in black-and-white terms, as either all good or all bad, with no middle ground. The client’s outburst, shifting from idealizing the nurse to seeing them as hateful, is a classic example of splitting. This defense mechanism helps individuals with borderline personality disorder manage their intense emotions and fears of abandonment.

Choice A Reason: 0.8 mEq/L

The therapeutic range for lithium is typically between 0.6 and 1.2 mEq/L. A level of 0.8 mEq/L falls within this range and is considered normal. Therefore, it is unlikely that a client with this lithium level would present with symptoms such as mental confusion, frequent urination, and coarse tremors. These symptoms are more indicative of lithium toxicity, which occurs at higher levels.

Choice B Reason: 2.3 mEq/L

A lithium level of 2.3 mEq/L is significantly above the therapeutic range and indicates lithium toxicity. Symptoms of lithium toxicity include mental confusion, frequent urination, and coarse tremors, which match the client’s presentation. Severe toxicity can occur at levels above 2.0 mEq/L and can be life-threatening if not treated promptly. Therefore, this is the most likely lithium level for the client described.

Choice C Reason: 1.8 mEq/L

A lithium level of 1.8 mEq/L is above the therapeutic range but below the level typically associated with severe toxicity. While some symptoms of toxicity might appear at this level, they are generally less severe than those described in the scenario. The client’s symptoms suggest a more severe level of toxicity, making this choice less likely.

Choice D Reason: 1.2 mEq/L

A lithium level of 1.2 mEq/L is at the upper limit of the therapeutic range. While it is possible for some mild side effects to occur at this level, the severe symptoms described (mental confusion, frequent urination, and coarse tremors) are more indicative of a higher, toxic level of lithium. Therefore, this choice is also less likely.