The nurse used the term “labile” in describing a client’s mood and behavior. What does this term indicate?

Displacement is a defense mechanism in which an individual redirects their negative feelings or impulses from an object or person that is causing discomfort to a substitute object or person that is less threatening. In this scenario, the client is experiencing negative emotions due to losing their job but instead of dealing with the situation directly, they have redirected their anger towards the car windshield by throwing a rock. This behavior is maladaptive because it does not resolve the root cause of the negative emotions and instead causes harm to others.

Sublimation is a defense mechanism in which an individual channels their negative impulses or energy into socially acceptable behaviors or activities. Repression involves pushing unwanted thoughts or memories into the unconscious mind. Denial involves refusing to acknowledge the reality of a situation. None of these defense mechanisms are applicable to the scenario described.

Confidentiality is a critical aspect of the nurse-patient relationship. However, there are specific circumstances where confidentiality must be breached to ensure the patient's safety and well-being. For instance, if a patient is expressing suicidal ideation or harm to others, the nurse has an ethical and legal obligation to report it to the treatment team to prevent harm. It is essential to explain this to the client to establish trust and clarify the limitations of confidentiality.

Option (a) is incorrect because not all information can remain confidential.

Option (b) is incorrect because not all information requires the client's approval to share.

Option (d) is incorrect because the nurse has the responsibility to disclose certain information to other healthcare professionals for the patient's benefit.