A nurse is assessing a client for a substance use disorder. The client exhibits yawning, pupillary dilation, rhinorrhea, and reports muscle cramps. The nurse should suspect that the client is withdrawing from which of the following substances?

Choice A reason: Dissociation involves a disruption in consciousness, memory, identity, or perception of the environment. It is often seen when individuals detach from reality to avoid distressing emotions or experiences. In this case, the family member is not detaching from reality or experiencing a break in consciousness. Instead, they are expressing anger outwardly toward the provider. Therefore, dissociation does not apply.

Choice B reason: Rationalization is the use of logical-sounding explanations to justify or excuse unacceptable feelings or behaviors. For example, someone might say, “It was better this way” to justify a loss. The family member is not attempting to justify or excuse the death with reasoning; they are instead directing anger toward the provider. Thus, rationalization is not the defense mechanism being used.

Choice C reason: Repression is the unconscious blocking of unacceptable thoughts, feelings, or memories from awareness. It is a defense mechanism that prevents distressing emotions from surfacing. In this scenario, the family member is openly expressing anger and blame, not unconsciously suppressing emotions. Therefore, repression is not the correct mechanism.

Choice D reason: Displacement occurs when emotions are redirected from their original source to a safer or more acceptable target. The family member is experiencing grief and anger due to the parent’s death but is directing that anger toward the provider instead of confronting the painful reality of losing their parent. This redirection of emotions is a classic example of displacement, making it the correct answer.

Choice A reason: Selective inattention occurs in moderate anxiety, where the client begins to block out or ignore certain stimuli due to difficulty focusing. It is not characteristic of mild anxiety, where awareness is still intact.

Choice B reason: Urinary frequency is a physical manifestation of severe anxiety due to autonomic nervous system activation. It is not expected in mild anxiety.

Choice C reason: Sharpened perceptions are characteristic of mild anxiety. The client is more alert, attentive, and able to focus better on the environment. Mild anxiety can enhance problem-solving and concentration.

Choice D reason: Voice tremors are associated with moderate to severe anxiety, where physiological symptoms become more pronounced. They are not typical of mild anxiety.