A nurse in an alcohol treatment facility is caring for a client who states, "My job is so stressful that the only way I can cope is to drink should recognize that the client is displaying which of the following defense mechanisms?

A. "If I were you, I would go to a few therapy sessions to give them a try": This statement is not appropriate because it places the nurse's personal perspective onto the client, potentially pressuring them. It does not respect the client's autonomy in making their own decisions.

B. "One of my friends went to group therapy and they improved significantly": Sharing personal experiences can make the client feel uncomfortable and may not be relevant to their own situation. It can also create a sense of comparison, which is not helpful.

C. "You have the right to refuse to attend group therapy": This statement is respectful of the client's autonomy and acknowledges their right to make decisions about their care. It empowers the client and maintains their dignity while respecting their refusal.

D. "You should go to group therapy if you want to get better": This statement may feel coercive, as it implies that the client "should" attend therapy to improve. It might lead the client to feel guilty or pressured rather than supported in their choice.

Rationale for correct choices:

• Seizures: Seizures are a severe and life-threatening manifestation of alcohol withdrawal that require immediate intervention. They may lead to complications like injury or status epilepticus if not managed promptly.
• Increased blood pressure: Elevated blood pressure is a common sign of alcohol withdrawal and increases the risk of cardiovascular events such as stroke. Close monitoring and intervention are necessary to prevent complications.
• Increased heart rate: Tachycardia is commonly seen in alcohol withdrawal, increasing the risk of arrhythmias and cardiovascular stress. Management of heart rate is essential for maintaining stability.
• Diaphoresis: Diaphoresis, or excessive sweating, is part of the autonomic response during alcohol withdrawal and indicates significant distress in the body. It requires monitoring to ensure proper fluid and electrolyte balance.
• Vomiting: Vomiting in alcohol withdrawal can lead to dehydration and electrolyte imbalances, which can worsen the client’s condition. Immediate attention and interventions are needed to prevent further complications.
• Tremulousness: While often mild, tremors indicate CNS hyperexcitability and can escalate to more severe forms of withdrawal, including seizures or delirium tremens. It requires close monitoring and often pharmacological management to prevent progression.

Rationale for incorrect choices:

• Impaired cognition: Impaired cognition may occur due to alcohol intoxication or withdrawal but does not require immediate medical attention unless it is severe enough to affect the client’s ability to function or respond appropriately.
• Insomnia: Insomnia is common in alcohol withdrawal and can be distressing, but it is not life-threatening. It can be managed through appropriate therapeutic interventions but does not require urgent care.
• Lack of appetite: Loss of appetite is a common symptom of alcohol withdrawal and may be associated with gastrointestinal symptoms. It should be monitored but does not require immediate follow-up unless it leads to severe malnutrition.
• Malaise: Malaise is a general symptom of alcohol withdrawal and indicates a general sense of discomfort. It is important to monitor but does not require immediate intervention unless accompanied by more severe symptoms.