A nurse is counseling a client for the management of anxiety. The client is consistently late for appointments and ignores household chores. The client states, "I'm just too stressed. I need someone to take care of me." The nurse identifies this behavior as an example of which of the following defense mechanisms?

Repression

Introjection

Dissociation

Regression

Answer and Explanation

The Correct Answer is D

A. Repression: Repression involves unconsciously pushing unwanted thoughts, memories, or feelings out of conscious awareness. It involves burying distressing emotions or memories deep in the unconscious mind to avoid dealing with them consciously. In this scenario, the client's behavior does not suggest the repression of any specific thoughts or memories but rather a coping mechanism related to their current stress and anxiety.

B. Introjection: Introjection occurs when an individual internalizes the values, beliefs, or attitudes of others as if they were their own. It involves incorporating external standards or influences into one's own identity. While introjection may contribute to the client's behavior indirectly by influencing their beliefs about needing external support, the primary defense mechanism at play in this scenario is regression.

C. Dissociation: Dissociation involves a disruption in the integration of consciousness, memory, identity, or perception of the environment. It often manifests as a detachment from reality or a sense of being disconnected from oneself or the surrounding environment. While dissociation may occur in response to severe stress or trauma, it typically involves more extreme symptoms than those described by the client in this scenario.

D. Regression: Regression involves reverting to earlier, less mature behaviors or stages of development in response to stress or anxiety. It reflects a retreat to a more comfortable or familiar state in an attempt to cope with overwhelming emotions or situations. In this scenario, the client's statement about needing someone to take care of them suggests a desire to return to a state of dependency, which is characteristic of regression as a defense mechanism.

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Correct Answer is B

Explanation

A. A semi-private room with a roommate who has a similar diagnosis. Placing a client experiencing a manic episode in a semi-private room with another client who also has a similar diagnosis could potentially exacerbate symptoms or lead to conflict. Manic clients may have increased energy levels, impulsivity, and decreased need for sleep, which could disrupt the roommate's rest and compromise their safety.

B. A private room close to the nursing station. Assigning a private room close to the nursing station is the most appropriate option for a client in the manic phase of bipolar disorder. This allows for closer monitoring and supervision by nursing staff, as well as easier access for interventions and assistance when needed. It also helps to minimize stimulation and provide a more controlled environment for the client.

C. A private room in a quiet location on the unit. While a quiet location may be beneficial for some clients, a private room close to the nursing station offers better access to supervision and support from staff, which is particularly important for clients experiencing mania. Additionally, a quiet location may not always be feasible in a busy psychiatric unit.

D. A seclusion room until the client's activity level becomes more subdued. Using a seclusion room should only be considered as a last resort and when absolutely necessary to ensure the safety of the client and others. It should not be the first choice for a client in the manic phase of bipolar disorder. Placing the client in seclusion may further escalate agitation and increase feelings of isolation and distress.

A. "You are being unreasonable, and I will not call your doctor at this hour." B. "I can't call a doctor in the middle of the night unless it's an emergency C. "You must be very upset about something." D. "Go back to your room, and I'll try to get in touch with your doctor"

Correct Answer is C

Explanation

A. "You are being unreasonable, and I will not call your doctor at this hour."

This response may escalate the situation by invalidating the client's feelings and refusing to address their request. It fails to recognize the client's distress and could lead to increased agitation or frustration.

B. "I can't call a doctor in the middle of the night unless it's an emergency."

While it's true that non-urgent matters may be deferred until regular hours, this response comes across as dismissive and may exacerbate the client's distress. It does not validate the client's feelings or offer support.

C. "You must be very upset about something."

This response acknowledges the client's emotions and shows empathy. It opens the door for the client to express their concerns, allowing the nurse to assess the situation further and address any immediate needs. It also avoids dismissing the client's request outright and maintains a therapeutic relationship.

D. "Go back to your room, and I'll try to get in touch with your doctor."

This response instructs the client to return to their room without addressing their emotional state or concerns. It lacks empathy and fails to engage with the client's needs effectively.

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Naxlex Comprehensive Predictor Exams

A nurse is admitting a client who is in the manic phase of bipolar disorder. The nurse should plan to make which of the following room assignments for the client?

Correct Answer is B

Explanation

A nurse who works in a psychiatric unit is caring for a client who has bipolar disorder. The client comes to the nurse's station at 0300 demanding that the nurse call the provider immediately. Which of the following responses by the nurse is appropriate?

Correct Answer is C

Explanation

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