A female client staggers to day treatment smelling strongly of alcohol. She uses the defense mechanism "rationalization" when approached by the nurse and questioned about her recent alcohol consumption. How is this expressed?

"I have not drunk anything in the last day."

"I can't worry about that problem right now."

"I have to drink to relax to come to day treatment."

"Why does it matter to you if I drink?"

Answer and Explanation

The Correct Answer is C

A)   Incorrect. This statement is a straightforward denial rather than rationalization.
B)   Incorrect. This response is an example of avoidance or distraction, not rationalization.
C)   Correct. Rationalization involves offering logical or reasonable explanations to justify behaviors or actions that might otherwise be unacceptable. In this case, the client is rationalizing her alcohol consumption as a means to relax and cope with the day treatment.

D) Incorrect. This statement reflects a defensive response but is not an example of rationalization.

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Correct Answer is B

Explanation

A. Agitation can be a sign of distress, but sudden cheerfulness may be indicative of a decision to act on suicidal thoughts, as the individual may feel relieved to have made a decision.
B. Sudden cheerfulness can be a concerning sign, as it may indicate that the client has made a decision to carry out suicidal thoughts.
C. Psychomotor retardation is a symptom of depression and may not necessarily indicate imminent risk of suicide.
D. Not attending group therapy may be a sign of withdrawal or isolation, but it does not directly indicate immediate suicidal risk.

A. "Lab work is only needed at the start of taking the medication." B. "Once I feel better, I will not need to take this medication anymore." C. "There is a chance I may become addicted to this medication." D. "I need to be aware of situations that may cause dehydration."

Correct Answer is D

Explanation

A. "Lab work is only needed at the start of taking the medication." This statement is incorrect. Regular monitoring of lithium levels and kidney function through lab work is crucial for ensuring the medication's effectiveness and preventing potential toxicity.

B. "Once I feel better, I will not need to take this medication anymore." This statement is incorrect. Lithium is typically prescribed for long-term maintenance in bipolar disorder to prevent relapses and stabilize mood.

C. "There is a chance I may become addicted to this medication." This statement is incorrect. Lithium is not addictive. It is a mood stabilizer used to manage bipolar disorder.

D. "I need to be aware of situations that may cause dehydration." This statement demonstrates an understanding of an important consideration with lithium. Dehydration can lead to an increase in lithium levels in the body, potentially leading to toxicity. It's important for clients taking lithium to stay well hydrated and be cautious in situations that may lead to dehydration.

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A female client staggers to day treatment smelling strongly of alcohol. She uses the defense mechanism "rationalization" when approached by the nurse and questioned about her recent alcohol consumption. How is this expressed?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While caring for a depressed client, a nurse would evaluate the need for suicide precautions under which circumstance?

Correct Answer is B

Explanation

A client has been prescribed lithium for long-term maintenance of bipolar disorder diagnosis. Which statement by the client shows an understanding of the medication?

Correct Answer is D

Explanation

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