The nurse asks the client, “What was it like for you when you first realized you had no place to go?” The client looks down and pauses for quite some time. Which action by the nurse is most therapeutic?

Choice A reason: Defense mechanisms, like denial or projection, can strain relationships by avoiding honest communication or projecting blame, disrupting trust and emotional connection. While they may temporarily reduce anxiety, they hinder interpersonal dynamics, making this a negative outcome rather than a positive one in therapeutic interactions.

Choice B reason: Defense mechanisms can impair problem-solving by avoiding reality (e.g., denial) or displacing emotions, preventing rational analysis of issues. This leads to maladaptive coping, which does not address underlying problems, making it a negative consequence rather than a positive outcome of using defense mechanisms in mental health contexts.

Choice C reason: Defense mechanisms, such as repression or rationalization, temporarily reduce anxiety by shielding the individual from overwhelming emotions or stressors. By mitigating psychological distress, they provide short-term emotional relief, allowing the person to function under stress, making this a positive outcome when used adaptively in mental health management.

Choice D reason: Defense mechanisms can inhibit emotional growth by preventing individuals from confronting and processing emotions, leading to unresolved issues. Overreliance on mechanisms like avoidance stalls emotional development, hindering self-awareness and coping skills, making this a negative outcome rather than a positive benefit of defense mechanisms.

Choice A reason: White crystals (uremic frost) and yellowish skin in CKD indicate severe uremia due to toxin accumulation from impaired kidney function. Applying medicated lotion addresses skin symptoms but does not treat the underlying uremia, which can lead to life-threatening complications like metabolic acidosis, hyperkalemia, or encephalopathy. This action is secondary to addressing systemic toxicity through dialysis.

Choice B reason: Elevated BUN, creatinine, and uremic frost signify advanced CKD with uremia, requiring urgent dialysis to remove toxins and excess fluids. Notifying the provider ensures timely intervention to prevent complications such as seizures, coma, or cardiac arrhythmias due to electrolyte imbalances and toxin buildup, making this the priority action for patient safety.

Choice C reason: A cardiac monitor detects arrhythmias, which may occur in CKD due to hyperkalemia or fluid overload. However, monitoring alone does not address the root cause of uremia. Without dialysis to correct metabolic imbalances, arrhythmias may persist or worsen, making this action less urgent than initiating dialysis to stabilize the patient’s condition.

Choice D reason: Assessing a fistula for bruit and thrill ensures vascular access patency for dialysis. While important, it is not the priority when uremic symptoms are present, as dialysis orders must be secured first to address the acute uremic state and prevent life-threatening complications like encephalopathy or cardiac arrest due to toxin accumulation.