A nurse is assessing a client who has a recent diagnosis of dissociative identity disorder. The client tells the nurse, "I think my blackouts are actually caused by low blood sugar." The nurse should recognize the client is using which of the following defense mechanisms?

Suppression

Sublimation

Projection

Rationalization

Answer and Explanation

The Correct Answer is D

Choice A reason: Suppression is a conscious decision to delay paying attention to an emotion or need in order to cope with the present reality. It's unlikely that the client is consciously choosing to ignore the cause of their blackouts.

Choice B reason: Sublimation is a way of dealing with unacceptable impulses by unconsciously substituting acceptable forms of expression. This defense mechanism doesn't typically apply to explaining symptoms like blackouts.

Choice C reason: Projection involves attributing one's own unacceptable thoughts or feelings to another person. Since the client is providing an explanation for their own symptoms, rather than attributing them to someone else, projection is not the defense mechanism at play here.

Choice D reason: Rationalization involves justifying behaviors or feelings with logical reasons, even if they are not appropriate. The client's attribution of blackouts to low blood sugar, despite a diagnosis that suggests a psychological cause, is a form of rationalization.

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Correct Answer is A

Explanation

Choice A reason: Listing the negative effects of alcohol use can help the client gain insight into the consequences of their actions and reinforce their motivation to remain sober. Reflecting on personal losses and health issues due to alcohol can be a powerful deterrent against relapse.

Choice B reason: While attending support group meetings can be beneficial, saying "as needed" may not provide the structured support necessary for preventing relapse. Regular attendance at support groups like Alcoholics Anonymous (AA) is often recommended for sustained recovery.

Choice C reason: Lorazepam is not typically prescribed to prevent relapse in alcohol use disorder due to its potential for abuse and dependence. Instead, medications like naltrexone or acamprosate may be considered to help maintain abstinence.

Choice D reason: Revisiting familiar places may trigger cravings and is generally not advised. Instead, clients are encouraged to avoid places associated with their past alcohol use to reduce the risk of relapse.

A. Identify when the client engages in splitting behaviors. B. Give the client a choice of solitary activities. C. Set limits on the client's need for constant social contact with others. D. Assist the client in identifying sources of anger.

Correct Answer is B

Explanation

Choice A reason: Identifying when the client engages in splitting behaviors is more relevant to borderline personality disorder than schizoid personality disorder. Splitting is a defense mechanism where individuals fail to integrate positive and negative aspects of self and others into cohesive images. People with schizoid personality disorder typically exhibit detachment from social relationships and a restricted range of emotional expression, not splitting.

Choice B reason: Giving the client a choice of solitary activities aligns with the characteristics of schizoid personality disorder. Individuals with this disorder often prefer to engage in activities alone, as they feel more comfortable being by themselves than in social situations. Providing options for solitary activities can help meet the client's needs for privacy and personal space while also respecting their autonomy.

Choice C reason: Setting limits on the client's need for constant social contact is not applicable to schizoid personality disorder. In fact, individuals with this disorder typically do not desire social contact and may already isolate themselves. The intervention would be more appropriate for disorders where the individual seeks excessive social interaction.

Choice D reason: Assisting the client in identifying sources of anger may not be a priority in the care of someone with schizoid personality disorder unless there is a specific indication for it. These individuals often do not express emotions openly and may not experience or show anger in the same way as those without the disorder. The focus should be on interventions that respect the client's emotional expression, or lack thereof.

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A nurse is assessing a client who has a recent diagnosis of dissociative identity disorder. The client tells the nurse, "I think my blackouts are actually caused by low blood sugar." The nurse should recognize the client is using which of the following defense mechanisms?

Nursing Test Bank

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