A client in DKA is ordered regular insulin at 7 units per hour for the current blood glucose level. The institution protocol is to add 100 units of regular insulin to a 150 ml bag of normal saline. What is the correct rate for the nurse to set the IV pump for this dose?

(Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

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: “I’d rather be dead than live like this. I do not want to be alive.”

This statement reflects suicidal ideation, which is a common symptom of major depressive disorder (MDD). Individuals with MDD often experience feelings of hopelessness and worthlessness, leading them to believe that life is not worth living. Suicidal thoughts are a serious concern and require immediate attention and intervention.

Choice B Reason: “If I can just keep ignoring my feelings, I’ll be fine.”

This statement indicates a form of denial or avoidance, which is also common in individuals with MDD. People with depression may try to ignore or suppress their feelings in an attempt to cope with their condition. However, this approach is generally ineffective and can lead to worsening symptoms over time.

Choice C Reason: “I deserve to be this way. I’ve not accomplished anything important in my life.”

Feelings of worthlessness and excessive guilt are hallmark symptoms of MDD. Individuals with depression often have a negative self-view and believe that they are failures or that they deserve to suffer. This distorted thinking pattern can significantly impact their overall well-being and quality of life.

Choice D Reason: “This is a bad episode, but I will be well soon.”

This statement reflects a more optimistic outlook, which is less common in individuals with MDD. While some people with depression may have moments of hope, the pervasive nature of the disorder typically leads to a more negative and hopeless perspective. Therefore, this choice is less likely to be heard during an intake assessment for MDD.

Choice E Reason: “I am determined to fight this episode and get through it.”

Similar to choice D, this statement indicates a positive and proactive attitude towards managing depression. While determination and resilience are important for recovery, they are not typically expressed by individuals during the acute phase of MDD. This choice is also less likely to be heard during an intake assessment for MDD.