A nurse is assisting in the care of a client whose partner has end-stage lung cancer. The client states, "The doctors say he only has a few months to live, but I know that with treatment he will get better." The nurse should identify that the client is exhibiting which of the following defense mechanisms?

Splitting

Denial

Displacement

Repression

Answer and Explanation

The Correct Answer is B

A. Splitting : Splitting is a defense mechanism where a person sees others as all good or all bad, which is not evident in this scenario.

B. Denial: Denial is refusing to accept reality as a way to cope with distress. The client rejects the prognosis and insists on recovery despite medical evidence.

C. Displacement : Displacement is shifting emotions onto a less threatening target (e.g., being angry at a nurse instead of at the bad news).

D. Repression : Repression is unconsciously blocking out distressing thoughts rather than actively rejecting the reality of a loved one’s condition.

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Correct Answer is B

Explanation

A. "If you do not like your medications, would you like to try an alternative?" This response shifts focus away from the client's emotional state and does not validate their feelings.

B. "You feel like you have no remaining options and are struggling to find a solution." This response uses therapeutic communication by reflecting the client’s emotions, validating their feelings, and encouraging further discussion.

C. "Would you like to speak to a therapist after treatment?" While therapy may be beneficial, this response does not acknowledge the client's feelings in the present moment.

D. "You would like more information. I will get that for you right away." This response assumes the client is seeking information rather than expressing distress.

A. Resolution B. Exploitation C. Orientation D. Identification

Correct Answer is C

Explanation

A. Resolution: The resolution phase occurs at the end of care, focusing on termination and closure, not trust-building.

B. Exploitation: This is not a formal phase of the nurse-client relationship in Peplau’s model; the term is outdated and not appropriate.

C. Orientation: The orientation phase is when the nurse establishes trust and rapport with the client.

D. Identification: The identification phase is when the client begins to recognize the nurse’s role in their care, but trust has already been established.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is interviewing a client who states, "I am at a total loss and don't know what to do anymore. I feel hopeless." Which of the following responses should the nurse make?

Correct Answer is B

Explanation

Which phase of the nurse-client relationship involves establishing trust and rapport with the client?

Correct Answer is C

Explanation

A nurse is interviewing a client who has a substance use disorder. Which of the following client behaviors indicates that the nurse has successfully evoked the client's motivation?

Which statement by the newly hired staff member demonstrates an understanding of the legal guidelines for caring for clients on a mental health unit?

A nurse is discussing torts with a newly licensed nurse. Which of the following information should the nurse include?

During the working phase of the nursing relationship, the nurse and client work together to achieve the client's goals. What is the primary focus of this phase?

A nurse arranges for an aid to sit with a client overnight to avoid the use of restraints. The nurse should identify that this as an example of which of the following ethical principles?

What phase of the therapeutic involves the nurse collects data, assesses knowledge, and works with the patient to develop mutual goals?

A nurse in a mental health unit is caring for a client whose plan of care includes learning work-related skills. Which of the following members of the interprofessional team is appropriate for this client?

A nurse is discussing the scope of practice and responsibilities of mental health nurses who are not advanced practice registered nurses with a peer. Which of the following responsibilities is within the nurse's scope of practice?