A charge nurse is educating a newly licensed nurse about various defense mechanisms. Which of the following examples should the charge nurse provide when discussing rationalization?

A client who has stomach pain before presenting a project to his coworkers.

A client whose partner died 5 years ago still talks about him in the present tense.

A client who states she will worry about her grades after she finishes planning a party.

A client who states she did not get a promotion because her boss dislikes her.

Answer and Explanation

The Correct Answer is D

Rationalization is a defense mechanism that involves making excuses or justifying one's behavior or failures. The client who blames their boss for not getting a promotion is using rationalization to avoid accepting responsibility or acknowledging their shortcomings. The other examples are not related to rationalization, but to other defense mechanisms, such as somatization, denial, and procrastination.

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Correct Answer is D

Explanation

The priority for the nurse is to ensure safety for the client and others in the facility. Asking the client about his or her intentions can help the nurse determine the level of risk and plan appropriate interventions, such as setting limits, providing supervision, or initiating seclusion or restraint if necessary.

A. Use bargaining skills for behavioral consequences. B. Increase self-esteem. C. Decrease the number of verbal outbursts. D. Use projection during group therapy.

Correct Answer is C

Explanation

A behavioral contract is a written agreement between the client and the nurse that specifies the desired and undesired behaviors and the rewards and penalties for each. A client who has antisocial personality disorder may exhibit impulsive, aggressive, and manipulative behaviors that disrupt the therapeutic milieu and interfere with treatment goals. Decreasing the number of verbal outbursts is a measurable and realistic goal that can improve the client's interpersonal skills and reduce conflict.

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A charge nurse is educating a newly licensed nurse about various defense mechanisms. Which of the following examples should the charge nurse provide when discussing rationalization?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse in a mental health facility is caring for a client who is being aggressive toward other clients. Which of the following actions is the priority for the nurse to take?

Correct Answer is D

Explanation

A nurse is developing a behavioral contract with a client who has antisocial personality disorder. Which of the following client goals should the nurse include in the contract?

Correct Answer is C

Explanation

A nurse in a long-term care facility is caring for a client. The nurse should identify that which of the following conditions places the client at an increased risk for developing delirium?

A nurse in an alcohol rehabilitation facility is creating a discharge plan for a client who has alcohol use disorder. Which of the following recommendations should the nurse include in the plan?

A home health nurse visits a client who lost their partner 2 years ago. Which of the following behaviors by the client indicates a maladaptive grief response?

A nurse is planning care for a newly admitted client who has anorexia nervosa. Which of the following interventions should the nurse include in the plan?

A nurse is assessing a client who has anorexia nervosa and began treatment 1 month ago. Which of the following findings indicates the client's adherence to the treatment plan?

A nurse has placed a client who has become physically aggressive into seclusion. Which of the following actions should the nurse take?

A nurse is caring for a school-age child who has conduct disorder and requires wrist restraints. Which of the following actions should the nurse take?

A nurse is obtaining a medical history from a client who is requesting a prescription for bupropion for smoking cessation. Which of the following assessment findings in the client's history should the nurse report to the provider?