The nurse has recently set limits for a client with borderline personality disorder. The client tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see that I was mistaken. You are hateful." This outburst can be assessed as:

denial.

separation-individuation.

splitting.

reaction formation.

Answer and Explanation

The Correct Answer is C

C. Splitting is characterized by viewing people and situations in extremes, either all good or all bad, without recognizing the complexity that usually exists in most circumstances. This black-and-white thinking can lead to rapidly shifting perceptions of others, as seen in the client's sudden change from idealizing the nurse to devaluing them.
A. Denial is a defense mechanism where the individual refuses to accept reality or acknowledge an aspect of reality that is apparent to others. In this scenario, the client is not denying any aspect of reality.
B. Separation-individuation is a developmental process where individuals establish autonomy and a sense of self separate from others, particularly from primary caregivers. This process is more relevant in infancy and early childhood.
D. Reaction formation is a defense mechanism where an individual behaves in a manner opposite to their true feelings or impulses. In this scenario, the client's expression of hatred towards the nurse does not appear to be a case of reaction formation, as there is no indication that the client actually harbors feelings of care or admiration towards the nurse.

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Correct Answer is ["C","D","E"]

Explanation

C. Identifying community resources is essential as it provides the client with accessible support during crises.
D. Educating the family about creating a safe and structured environment is also important because it involves the client's support system in their care, which can help prevent future crises.
E. Assisting the client in developing more effective coping mechanisms is vital for long-term management and recovery, as it empowers the client to handle stressors more healthily.
A. Isolating the client from all stressful situations is not practical or beneficial as it does not teach coping mechanisms or resilience.
B. Having a one-to-one sitter might be necessary in some inpatient settings but is not feasible or indicated for outpatient care.

A. has a cell phone that is not working in the emergency department. B. is accompanied by a family member who will not let the client answer questions C. is from another state and says they are here on a long vacation. D. speaks another language and is in need of an interpreter to translate.

Correct Answer is B

Explanation

B. This is often a red flag that the client may not be free to act or speak on their own behalf, which is a common situation among victims of human trafficking.
A. A non-working cell phone alone may not be sufficient evidence to conclusively suspect human trafficking, as there could be various reasons for a phone not working.
C. Human traffickers often exploit victims by transporting them across state or international borders under false pretenses, such as offering a vacation or job opportunity. However, it's crucial to gather more information and assess the client's situation further before jumping to conclusions.
D. Language diversity is common in healthcare settings and may not always be indicative of trafficking.

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The nurse has recently set limits for a client with borderline personality disorder. The client tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see that I was mistaken. You are hateful." This outburst can be assessed as:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client with a history of a suicide attempt has been discharged and is being followed in an outpatient clinic. What is/are the most appropriate nursing intervention(s)? (SELECT ALL THAT APPLY)

Correct Answer is ["C","D","E"]

Explanation

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 :

Correct Answer is B

Explanation

A client is admitted to a Chemical Addictions Unit to stop using alcohol and to learn about sobriety. The client asks the nurse what medication the doctor has prescribed for possible alcohol withdrawal. The nurse explains that the physician prescribed:

The nurse understands that when a practitioner corrects subluxation by manipulating the vertebrae of the spinal column, the practitioner is employing which therapy?

The nurse is caring for a client who just received naloxone. Which nursing intervention is highest priority?

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The intervention appropriate for a client who has been manipulating others and has a diagnosis of antisocial personality disorder is to:

The nurse in the Emergency Department (ED) assesses a 17-year-old client exhibiting symptoms of opiate intoxication. Which of the following should be the nurse's priority action?

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