During a group therapy session, a nurse observes several clients using multiple defense mechanisms.
Which of the following client statements demonstrates the use of maladaptive coping mechanisms?

“I mentally separate myself from distractions around me when I paint on canvas.”

“I wrote a short story about a heroic woman when I was really mad at my boss.”

“I still cannot remember the scene of my husband’s car accident.”

“I don’t care about work anymore since I was not given a promotion.”

Answer and Explanation

The Correct Answer is D

Choice A rationale:

Mental separation from distractions during painting is a healthy coping mechanism, allowing for focus and mindfulness.

It falls under the adaptive defense mechanism of compartmentalization, which involves temporarily separating thoughts and emotions to manage stress effectively.

It doesn't deny or distort reality, but rather creates a temporary mental space for relaxation and creativity.

Choice B rationale:

Writing a short story about a heroic woman is a form of sublimation, channeling negative emotions into a productive and creative outlet.

It's a mature defense mechanism that allows for indirect expression of anger or frustration without causing harm to oneself or others.

It can lead to personal growth and insight, as it encourages reflection and exploration of emotions through storytelling.

Choice C rationale:

Inability to recall the scene of a traumatic event is likely a dissociative defense mechanism, protecting the individual from overwhelming psychological distress.

It's a common response to trauma, and while it may be maladaptive in the long term if it prevents processing the trauma, it serves a protective function in the acute phase.

It doesn't necessarily indicate a maladaptive coping style overall, but rather a specific response to a traumatic experience.

Choice D rationale:

Declaring disinterest in work after being denied a promotion exemplifies disengagement, a maladaptive coping mechanism involving withdrawal and apathy.

It reflects an inability to cope with disappointment or setbacks in a constructive way.

It can lead to social isolation, decreased motivation, and potentially depression or other mental health issues.

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Correct Answer is D

Explanation

Choice A rationale:

Shellfish is generally safe for clients taking MAOIs. However, it's important to ensure shellfish is fresh and properly refrigerated to avoid tyramine buildup due to spoilage.

Some individuals with shellfish allergies may need to avoid it regardless of MAOI use.

Choice B rationale:

Milk and milk products are typically safe for clients taking MAOIs.

However, some aged cheeses, such as cheddar, Swiss, and Parmesan, can contain high levels of tyramine and should be avoided.

Choice C rationale:

Canned tuna is generally safe for clients taking MAOIs.

However, it's essential to check labels carefully, as some brands may contain added tyramine-rich ingredients like soy sauce or fermented flavorings.

Choice D rationale:

Aged cheeses contain high levels of tyramine, an amino acid that can interact with MAOIs and cause a hypertensive crisis.

This is a potentially life-threatening condition characterized by a sudden and severe increase in blood pressure.

It's crucial for clients taking MAOIs to avoid all aged cheeses, including cheddar, Swiss, Parmesan, blue cheese, feta, and others.

A. Seizures B. Nystagmus C. Tremors D. Hallucinations

Correct Answer is ["A","C","D"]

Explanation

Choice A rationale:

Seizures are a potentially serious complication of alcohol withdrawal. They occur due to the sudden decrease in GABA (gamma-aminobutyric acid), a neurotransmitter that has inhibitory effects on the central nervous system. Chronic alcohol consumption leads to an upregulation of GABA receptors in the brain to compensate for the depressant effects of alcohol. When alcohol is abruptly withdrawn, the brain is left in a hyperexcitable state, as there is less GABA to suppress neuronal activity. This hyperexcitability can manifest as seizures.

Mechanism of seizures in alcohol withdrawal:

Neuroadaptation: Chronic alcohol exposure leads to adaptations in neuronal excitability to counteract the depressant effects of alcohol. These adaptations include:

Upregulation of GABA receptors: The brain increases the number of GABA receptors to enhance the inhibitory effects of GABA.

Downregulation of glutamate receptors: The brain decreases the number of glutamate receptors to reduce the excitatory effects of glutamate.

GABA rebound: When alcohol is abruptly withdrawn, the upregulated GABA receptors become hypersensitive, leading to an excessive inhibitory response. This is known as GABA rebound.

Glutamate rebound: Concurrently, the downregulated glutamate receptors become more sensitive, leading to an enhanced excitatory response. This is known as glutamate rebound.

Imbalance: The combination of GABA rebound (excessive inhibition) and glutamate rebound (excessive excitation) creates a state of neuronal hyperexcitability, which can trigger seizures.

Risk factors for seizures in alcohol withdrawal:

Severity of alcohol dependence: Individuals with a long history of heavy alcohol consumption are at higher risk.

Previous alcohol withdrawal seizures: A history of seizures during past withdrawal episodes increases the likelihood of recurrence.

Comorbid medical conditions: Certain medical conditions, such as electrolyte imbalances, head injuries, or infections, can increase the risk of seizures.

Concurrent medication use: Certain medications, such as benzodiazepines or barbiturates, can lower the seizure threshold.

Management of seizures in alcohol withdrawal:

Benzodiazepines: Benzodiazepines are the mainstay of treatment for alcohol withdrawal seizures. They enhance the effects of GABA, helping to suppress neuronal excitability and prevent seizures.

Anticonvulsants: In some cases, anticonvulsants, such as gabapentin or valproate, may be used in addition to benzodiazepines.

Electrolyte replacement: Electrolyte imbalances, such as hyponatremia or hypomagnesemia, can contribute to seizures and should be corrected.

Monitoring: Close monitoring of vital signs, neurological status, and seizure activity is essential to ensure prompt intervention if seizures occur.

Choice B rationale:

Nystagmus, or involuntary eye movements, is not a common symptom of alcohol withdrawal. While it can occur in some cases, it is not considered a primary feature of the syndrome.

Choice C rationale:

Tremors are a very common symptom of alcohol withdrawal. They are caused by the same underlying mechanism as seizures, namely, the hyperexcitability of the central nervous system due to decreased GABA activity. Tremors typically manifest as shaking hands, arms, or legs, and can range in severity from mild to severe.

Choice D rationale:

Hallucinations, both auditory and visual, can occur in alcohol withdrawal. They are thought to be due to a combination of factors, including the hyperexcitability of the central nervous system, disruptions in neurotransmitter systems, and sleep deprivation. Hallucinations can be very distressing and can lead to agitation, confusion, and disorientation.

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During a group therapy session, a nurse observes several clients using multiple defense mechanisms. Which of the following client statements demonstrates the use of maladaptive coping mechanisms?

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Correct Answer is D

Explanation

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Correct Answer is ["A","C","D"]

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During a group therapy session, a nurse observes several clients using multiple defense mechanisms.
Which of the following client statements demonstrates the use of maladaptive coping mechanisms?