Mental Health EAQ

Which activity is the least therapeutic for a severely depressed client?

Activity selected by the client

A nurse is evaluating statements made by the nursing student about the care to be rendered to a client with a personality disorder. Which statement by the nursing student indicates a need for further teaching?

"I should use gestures when talking with the client."

Survivors of a major earthquake are being interviewed on admission to the hospital. The nurse notes that they exhibit a flattened affect, make minimal eye contact, and speak in a monotone. These behaviors are indicative of the defense mechanism known as what?

ISOLATION: is the separation of thought or memory from feeling. Splitting is the polarization of positive and negative feelings. Introjection is the integration of the beliefs and values of another into one's own ego. Compensation is making up for a real or imagined lack in one area by overemphasizing another.

A client with a history of obsessive-compulsive behaviors has a marked decrease in symptoms and expresses a wish to obtain a part-time job. On the day of a job interview the client arrives at the mental health center with signs of anxiety. What is the most therapeutic response to the client's behavior by the nurse?

"Going for your interview triggered some feelings in you. Perhaps you could call a friend to drive you there."

A client experiencing hallucinations tells a nurse, "The voices are telling me I'm no good." The client asks whether the nurse hears the voices. What is the most appropriate response by the nurse?

"I don't hear the voices, but I believe that you can hear them.

A client with the diagnosis of an antisocial personality disorder responds to limit-setting by a nurse by saying, "You sure do look messy today." What is the most appropriate response by the nurse?

"I get the feeling you're angry with me."

A nurse is counseling the caregiver of a client with a personality disorder about antipsychotic medication. Which statement made by the caregiver during evaluation indicates a need for further teaching?

"I should cut down on the salt content in her food."

Which client is most likely to exhibit increased forgetfulness, low self-esteem, and depression as a result of abuse?

A married 31-year-old woman

Which side effect may be experienced by a client taking an antianxiety agent?

Ataxia

A nurse is caring for a client with a diagnosis of conversion disorder manifesting as paralysis of the legs. Which is the most therapeutic nursing intervention?

Avoiding focusing on the client's physical symptoms

How can a nurse minimize agitation in a disturbed client?

By limiting unnecessary interactions with the clien

Which treatment strategy is beneficial for a client with panic disorder?

Debriefing technique

Which herb used in the treatment of Alzheimer's disease lowers the blood glucose level?

Ginseng

The primary healthcare provider notices that a client exhibits a period of mania followed by hypomania and depression and prescribes lithium carbonate. What is the mode of administration of the prescribed drug?

Oral route

A 6-year-old child has been wetting the bed at night since the birth of a baby brother. What defense mechanism is the child using to cope with the stress of accepting a new family member?

Regression

Which subtypes of schizophrenia have a poor prognosis?

Residual and disorganized

A 22-year-old client with antisocial personality disorder is being discharged and is to continue psychotherapy on an outpatient basis. When evaluating the client's chance of improvement, what should the nurse anticipate?

That the client's ability to change will be limited unless there is a readiness to accept the uncertainty associated with change

The nurse cares for a client who has schizophrenia and is taking chlorpromazine. The nurse instructs the family members to inform the nurse if any adverse effects develop. Which side effects are considered late extrapyramidal side effects?

worm-like tongue movements

A client with generalized anxiety disorder is prescribed chlordiazepoxide hydrochloride. The primary health care provider gives instructions regarding the medication regimen to the client. Which statement by the client indicates that further instruction is needed?

"I'll stop the medication as soon as I feel less anxious." Chlordiazepoxide hydrochloride is an antianxiety agent used in the treatment of generalized anxiety disorder. Such medications should not be stopped abruptly after long-term use, because withdrawal symptoms may occur. The client is right to avoid drinking alcohol with this medication, because drinking may further aggravate depression. Antianxiety agents may cause drowsiness, so the client is right to not drive immediately after taking the medication. Taking the medication with food in case of stomach upset will help ensure the client's comfort, so this statement demonstrates understanding as well.

A licensed practical nurse (LPN) is learning about delirium tremens (DTs), an alcoholism-associated disorder that occurs as a complication of alcohol withdrawal. Which statement made by the LPN indicates effective understanding?

"It is characterized by shaking, an increase in activity, disorientation, hallucinations, and increased temperature."

A client tells the nurse in the mental health clinic that the practitioner said that the cornerstone of therapy used in the clinic is cognitive therapy. The client asks what this therapy entails. What concept should the nurse explain as the basis of cognitive therapy?

"Negative thoughts can precipitate anxiety."

A female client with acute schizophrenia tells the nurse, "Everyone hates me." What is the best response by the nurse?

"Tell me more about this."

A client with the diagnosis of schizophrenia, paranoid type, is admitted to the hospital. The client says to the nurse, "I know they're spying on me in here, too. I'm not safe anywhere!" What is the most therapeutic response by the nurse?

"You don't feel safe anywhere, not even in the hospital?"

A client has recently started taking a new neuroleptic drug, and the nurse notes extrapyramidal effects. Which drug does the nurse anticipate will be prescribed to limit these side effects?

Benztropine mesylate (Cogentin)

A nurse is assessing the symptoms of four different clients in a psychiatric ward. Which client does the nurse expect to have the highest risk for obsessive-compulsive disorder (OCD)?

Client B: ODC has uncontrollable recurrent, intrusive, and senseless thoughts that produce anxiety, as described in Client B. Client A is likely to have bipolar disorder, marked by rapid speech, flight of ideas, unrealistic belief in her abilities, and poor judgment.

Which medication is used in the treatment of obsessive-compulsive disorder (OCD)?

Clomipramine

An older client with the diagnosis of dementia of the Alzheimer type is admitted to a long-term care facility. What should the nurse keep in mind regarding confusion when planning care for this client?

Confusion occurs with a transfer to new surroundings.

A client is to receive donepezil for treatment of dementia of the Alzheimer type. The nurse sits down with the primary caregiver and the client and reviews the purpose of the drug, its dosage, and the usual side effects. What side effect identified by the caregiver leads the nurse to conclude that further teaching is needed?

Constipation

In which mood disorder are there repeated swings between hypomania and depression?

Cyclothymic disorder

The parents of a young adult client visit regularly. After one visit the client becomes very agitated. What should the nurse do to relieve the client's distress?

Explore the client's response to the parents' behavior

Which of these are symptoms of depression commonly observed in older adults? Select all that apply.

Fatigue Sadness Agitation

A client with a history of schizophrenia attends the mental health clinic for a regularly scheduled group therapy session. The client arrives agitated and exhibits behaviors that indicates that she is hearing voices. When a nurse begins to walk toward her, the client pulls out a large knife. What is the best approach by the nurse?

Firm

Which statement regarding anxiety is correct?

Generalized anxiety disorder is characterized by a high degree of anxiety or avoidance behavior. Panic is an acute, not chronic, form of anxiety. Anxiety trait is learned but is not in response to a specific event. Signal anxiety is a learned response to a specific event such as test-taking.

An older resident in a nursing home who has a diagnosis of dementia hoards leftover food from the meal tray and other seemingly valueless articles and stuffs them into pockets "so the others won't steal them." What should the nurse plan to do?

Give the resident a small bag in which to place selected personal articles and food

A young adult client with schizophrenia is prescribed haloperidol. When the nurse administers the medication, the client asks, "What's this for?" The nurse responds that the medication has which effect?

Helps the client relax and think more clearly

A client who recently was diagnosed as having myelocytic leukemia discusses the diagnosis by referring to statistics, facts, and figures. The nurse determines that the client is using which defense mechanism?

INTELLECTUALIZATION: Intellectualization is the use of reasoning and thought processes to avoid the emotional aspects of a situation; this is a defense against anxiety. Projection is denying unacceptable traits and regarding them as belonging to another person. Sublimation is a defense wherein the person redirects the energy of unacceptable impulses into socially acceptable behaviors or activities. Identification is the reduction of anxiety by imitating someone respected or feared.

Which is a symptom of generalized anxiety?

Imsomnia

A female client in the mental health clinic has pressured speech and mumbles incoherently. What is the most appropriate nursing intervention?

Indicating to the client that she needs to slow down because what she says is important and cannot be understood

Which treatment strategies are beneficial to a client with generalized anxiety disorder? Select all that apply.

Massage Visual imagery Relaxation therapy

A young client who has become a mother for the first time is anxious about her new parenting role. With the nurse's encouragement, she joins the new mothers' support group at the local YMCA. What kind of prevention does this activity reflect?

Primary prevention

A 23-year-old woman is admitted to a psychiatric unit after several episodes of uncontrolled rage at her parents' home, and borderline personality disorder is diagnosed. While watching a television newscast describing an incident of violence in the home, the client says, "People like that need to be put away before they kill someone." What does the nurse conclude that the client is using?

Projection

A client with a diagnosis of borderline personality disorder (BPD) has negative feelings toward the other clients on the unit and considers them all "bad." Which defense is the client using when identifying the other clients thusly?

SPLITTING: Splitting is the compartmentalization of opposite-affect states and failure to integrate the positive and negative aspects of self or others. Ambivalence is the experience of feeling opposite emotions at the same time. Passive aggression is the expression of hostility toward another in an indirect, nonassertive way. Reaction formation is the expression of unacceptable desires by adopting opposite behaviors in an exaggerated way.

A client is responding within an hour of receiving naloxone to combat respiratory depression from an overdose of heroin. Why should a nurse continue to closely monitor this client's status?

Symptoms of the heroin overdose may return after the naloxone is metabolized.

A nurse reminds a client that it is time for group therapy. The client responds by shouting, "You're always telling me what to do, just like my father!" What defense mechanism is the client using?

TRANSFERENCE: a client assigns to someone the feelings and attitudes originally associated with an important significant other. In regression a client reverts to past levels of coping to reduce anxiety. In reaction formation a client displays the exact opposite behavior, attitude, or feeling to that which is demonstrated in a given situation. Cognitive distortions are thought patterns that exaggerate reality or are irrational, such as black-and-white thinking or overgeneralization.

A secretary in a home health agency gossips about coworkers and then writes them notes to tell them how valuable they are to the organization and how much she likes working with them. What defense mechanism is being used by the secretary?

UNDOING: Undoing is atonement for or an attempt to dissipate unacceptable acts or wishes. Denial is the refusal to accept or perceive unpleasantness as it actually exists. Displacement is the discharge of pent-up feelings onto something or someone that is less threatening than the original source of the feelings. Intellectualization is the use of abstract thinking to minimize painful feelings.

A client is undergoing treatment for generalized anxiety disorder. Which outcome indicates that the nursing interventions are effective?

The client recognizes the signs of escalating anxiety

Three days after a stressful incident a client can no longer remember why it was stressful. The nurse, in relating to this client, can be most therapeutic by identifying that the inability to recall the situation is an example of which defense mechanism?

The client's inability to recall is an example of repression, which is the unconscious and involuntary forgetting of painful events, ideas, and conflicts. There is nothing to demonstrate that denial, an unconscious refusal to admit an unacceptable situation, exists. There is nothing to demonstrate that regression, a return to an earlier, more comfortable developmental level, has occurred. There is nothing to demonstrate that dissociation, the separation and detachment of emotional affect and significance from a particular idea, situation, or incident, has occurred.

How should a nurse intervene when a confused and anxious client voids on the floor in the sitting room of the mental health unit?

Toilet the client more frequently with supervision.

A client's hands are raw and bloody from a ritual involving frequent hand washing. Which defense mechanism does the nurse identify?

UNDOING: is an act that partially negates a previous one; the client is using this primitive defense mechanism to reduce anxiety. Clients who wash their hands compulsively may be having thoughts that they consider "dirty." Projection is the attribution of one's thoughts or impulses to another. Introjection is treating something outside the self as if it is actually inside the self. Suppression is a process that is often considered to be as a defense mechanism, but it is actually a conscious, intentional exclusion of material from one's awareness.

A nurse administers an antipsychotic medication to a client. For which common manageable side effect should the nurse evaluate the client?

Unintentional tremor

A client with psychosis is receiving olanzapine. What special information about this drug does the nurse recall?

It dissolves instantly after oral administration

Why is observation an especially important aspect of nursing care for a withdrawn client?

It helps the nurse understand the client's behavior.

A male client with the diagnosis of antisocial personality disorder takes a female nurse by the shoulders, kisses her, and shouts, "I like you." What is the most appropriate response by the nurse?

"Your behavior is inappropriate. Don't do that again."

A nurse is caring for a client exhibiting compulsive behaviors. The nurse concludes that the compulsive behavior usually incorporates the use of which defense mechanism?

DISPLACEMENT: is the unconscious redirection of an emotion from a threatening source to a nonthreatening source. Projection is the attribution of one's unacceptable feelings and thoughts to someone else

What treatment should a nurse anticipate will be prescribed for a client with severe, persistent, intractable depression and suicidal ideation?

Electroconvulsive therapy

Before a treatment requiring informed consent can be performed, what information must the client be given? Select all that apply.

Alternative treatment options The risks and benefits of the treatment The risks involved in refusing the treatment The nature of the problem requiring the treatment

With the client's permission, the nurse should inform the family about what is happening. What is the main reason for this action?

An informed family is better equipped to assist the client.

A hospitalized 7-year-old boy wakes up crying because he has wet his bed. What is it most appropriate for the nurse to do?

Change the child's bed while he changes his pajamas

What should a nurse recognize that a client who uses the defense mechanism of sublimation is doing?

Channeling unacceptable impulses into socially approved behavior

An older adult who lives alone tells a nurse at the community health center, "I really don't need anyone to talk to. The TV is my best friend." What defense mechanism does the nurse identify?

DENIAL: The client's statement is an example of the use of denial, a defense that blocks problems by unconsciously refusing to admit that they exist. Projection is a defense that is used to deny unacceptable feelings and emotions and attribute them to others. Sublimation is a defense in which socially acceptable behavior is substituted for unacceptable instincts. Displacement is a defense that is used to allow the shifting of feeling from an emotionally charged person or object to a safe substitute person or object.

An older client reports fatigue, restlessness, insomnia, slowed speech, and anxiety lasting longer than two weeks. Which disease does the nurse suspect?

DEPRESSION: Symptoms such as fatigue, restlessness, enduring anxiety, insomnia, and slowed speech are manifestations of depression in older adults. Nocturia is decreased bladder capacity and increased voiding at night. The behavior of a client with dementia is marked primarily by mental deterioration. The main symptoms of Huntington's disease are uncontrollable writhing movements and mental deterioration that may result in severe dementia.

A client with type 1 diabetes is found to have a psychosis and is to receive haloperidol (Haldol). Which response should a nurse anticipate with this drug combination?

Decreased control of the diabetes

A healthcare provider prescribes divalproex for a client with the diagnosis of bipolar I disorder, manic episode. What side effects of this medication might the client report during a follow-up visit?

Dizziness, nausea, and vomiting

A client's parents ask about the treatment of their child who has a recent diagnosis of schizophrenia. Before responding, what should the nurse consider?

Drug therapy, although it does not eliminate the underlying problem, reduces the symptoms of acute schizophrenia.

A client is admitted to the psychiatric hospital with a diagnosis of obsessive-compulsive disorder. The client's anxiety level is approaching a panic level, and the client's ritual is interfering with work and daily living. Which selective serotonin reuptake inhibitor (SSRI) does the nurse anticipate that the primary healthcare provider may prescribe?

Fluvoxamine

A client with schizophrenia sees a group of visitors sitting together talking. The client tells the nurse, "I know they're talking about me." Which altered thought process should the nurse identify?

Ideas of reference

A client with catatonic schizophrenia who is in a vegetative state is admitted to the psychiatric hospital. The nurse identifies short- and long-term outcomes in the client's clinical pathway. What is the priority short-term outcome of care that the client should be able to attain?

Ingesting adequate fluid and food with assistance

A day after an explanation of the effects of surgery to create an ileostomy, a 68-year-old client remarks to the nurse, "It will be difficult for my wife to care for a helpless old man." This comment by the client regarding himself is an example of Erikson's conflict of what?

Integrity versus despair

A client who has a history of psychiatric problems, including an antisocial personality disorder, is admitted to the hospital. What typical behavior does the nurse anticipate?

Interpersonal difficulties

What conflict associated with Erikson's psychosocial stages of development should the nurse remember when caring for a client 30 years of age?

Intimacy versus isolation

An adult is found to have schizotypal personality disorder. How should a nurse describe the client's behavior?

Introverted and emotionally withdrawn

The nurse understands that paranoid delusions may be related to which defense mechanism?

PROJECTION: is a mechanism in which inner thoughts and feelings are projected onto the environment, seeming to come from outside the self rather than from within. Regression is the use of a behavioral characteristic appropriate to an earlier level of development. Repression is the involuntary exclusion of painful or conflicting thoughts from awareness. Identification is taking on the thoughts and mannerisms of an individual who is admired or idealized.

A client with schizophrenia is demonstrating waxy flexibility. Which intervention is the best way to manage the possible outcome of this behavior

Performing passive range-of-motion exercises three times a day for effective joint health

Incidences of child molestation often are revealed years later when the victim is an adult. Which defense mechanism reflects this situation?

REPRESSION: is a coping mechanism in which unacceptable feelings are kept out of conscious awareness; later, under stress or anxiety, thoughts or feelings surface and come into one's conscious awareness. Isolation is the separation of a thought from a feeling tone. Regression is the use of an unconscious coping mechanism through which a person avoids anxiety by returning to an earlier more satisfying or comfortable time in life. Introjection is the integration of the beliefs and values of another into one's own ego structure.

An older female client is concerned about maintaining her independent living status. What initial intervention strategy is of primary importance?

Reinforcing routines and supporting her usual habits

A shy, withdrawn adolescent boy, newly admitted to the psychiatric unit, asks one of the female psychiatric nurses for a date. What is the best initial response by the nurse?

Restating the purpose of the nurse-client relationship

A client with schizophrenia is prescribed antipsychotic medications and instructed to increase fluid intake. What is the rationale behind this instruction?

To provide relief from autonomic reactions

Hospitalization or day-treatment centers are often indicated for the treatment of a client with obsessive-compulsive disorder because these settings do what?

Provide the neutral environment the client needs to work through conflicts

What is important when the nurse plans care for a client with paranoid ideation?

Providing the client with opportunities for nonthreatening social interaction

Which personality disorder is characterized by anxious and fearful behavior?

Dependent Personality Disorder

How should the nursing staff fulfill the nutritional needs of a client experiencing periods of extreme mania and hyperactivity?

Offering high-calorie snacks frequently that the client can hold

A client is found to have an adjustment disorder with mixed anxiety and depression. What should the nurse anticipate as the client's primary problem?

Low self-esteem

Which nursing intervention is beneficial for the client with mania?

Increasing intake of fresh vegetables and fruits

One afternoon the nurse on the unit overhears a young female client having an argument with her boyfriend. A while later the client complains to the nurse that dinner is always late and the meals are terrible. What does the nurse identify the defense mechanism that the client is using as?

DISPLACEMENT: reduces anxiety by transferring the emotions associated with an object or person to another emotionally safer object or person. Projection is the attempt to deal with unacceptable feelings by attributing them to another. Dissociation is an attempt to detach emotional involvement or the self from an interaction or the environment. Intellectualization is the use of facts or other logical reasoning rather than feelings to deal with the emotional effect of a problem; it is a form of denial.

A disturbed client who has been out of touch with reality has been hospitalized for several weeks. One day the nurse notes that the client's hair is dirty and asks whether the client wants to wash it. The client answers, "Yes, and I'd like to shower and change my clothes, too." What can the nurse conclude about the client in relation to this response?

He has some feelings of self-worth

While caring for a client displaying inappropriate emotional responses, delusions, and bizarre behavior, the nurse finds that the client is unable to relate to other people because of an impairment in communication. Which other psychological findings may be present in this client? Select all that apply.

Ineffective coping Disturbed sleep pattern Disturbed personal identity

When a nurse enters a room to administer an oral medication to an agitated and angry client with schizophrenia, paranoid type, the client shouts, "Get out of here!" What is the most therapeutic response?

Saying, "I'll be back in a few minutes so we can talk."

A client who has exhibited bizarre behavior and an inability to relate to other people reports to the nurse, "I hear my father calling me. He died 2 years ago." Which psychological condition does the nurse suspect on the basis of the client's statement?

Schizophrenia

A nurse has been assigned to care for a client with the diagnosis of obsessive-compulsive disorder (OCD). Before providing care for this client, the nurse should consider what about clients with OCD?

They do not want to repeat the ritual but feel compelled to do so

A 6-year-old child recently started school but has been refusing to go for the past 3 weeks. What does the nurse determine is an appropriate intervention for this child?

Develop a behavior modification program with the child

A client who had to be cut out of a car after a motor vehicle collision has no visible physical effects from the ordeal. The client responds to the emergency department nurse's questions factually in a soft voice with a composed manner. What may this behavior indicate about the client?

The client is controlling the expression of feelings.

A nurse notes that a client with dementia tries to cope with anxiety by using confabulation. What does the nurse plan to teach the family about confabulating?

The client will make up what they cannot be remembered

A client in the early dementia stage of Alzheimer disease is admitted to a long-term care facility. Which activities must the nurse initiate?

Weighing the client once a week Having specialized rehabilitation equipment available Establishing a schedule with periods of rest after activities

The nurse is reviewing the medical data of four clients with depression. Which client is most likely to exhibit the clinical manifestation of irritability?

13-year-old

What are the symptoms of major depression? Select all that apply

Apathy Guilt feelings Sleep disturbances

A client with schizophrenia is unable to feel happiness and joy. What is the name of this condition?

Anhedonia

A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. What defense mechanism does the nurse determine that the client is using?

COMPENSATION: By developing skills in one area, the individual compensates for a real or imagined deficiency in another, thereby maintaining a positive self-image. Had the student incorporated the qualities of the college athlete, that would be introjection. Sublimation is related to unacceptable impulses that may pose a threat. This person is trying to make amends not for unacceptable feelings (reaction formation) but rather for a believed deficiency and an inadequate self-image.

When a person who is nonathletic and uncoordinated is successful in a musical career, it may be related to which defense mechanism?

COMPENSATION: is replacing a weak area or trait with a more desirable one. Sublimation is rechanneling unacceptable desires and drives into those that are socially acceptable. Transference is the unconscious tendency to assign to others in the current environment feelings and attitudes associated with another person. Rationalization is the use of justification to make tolerable certain feelings, behaviors, and motives.

A male long-distance jumper improves his distance by 3 ½ inches (8 cm) and earns the praise of his coach, but on another day, when he does not reach his mark, he forcefully kicks the door of his locker. What defense mechanism does his outburst demonstrate?

DISPLACEMENT: is the discharging of pent-up feelings on a less threatening object, in this case the locker door. Anger is not a defense mechanism. Projection is attributing one's own unacceptable feelings, impulses, or thoughts to another. Rationalization is behavior that attempts to prove that one's feelings or behavior is justifiable.

A client who survived a train accident 8 months ago reports illusions and hallucinations of the incident and expresses guilt over being a survivor. Which psychological condition is likely present in this client?

Delayed post-traumatic stress disorder

A client with phobias about elevators and large crowds comes to the clinic for help because of feelings of depression related to these fears. What is an appropriate short-term goal for this client?

Describing the thoughts and feelings experienced in terrifying situations

What does the nurse determine is the therapy that has the highest success rate for people with phobias?

Desensitization involving relaxation techniques

When attempting to evaluate the behavior of an older adult with a diagnosis of vascular dementia, a nurse knows that the client is probably what?

Making exaggerated use of old, familiar mechanisms

After an automobile collision involving a fatality and a subsequent arrest for speeding, a client has amnesia regarding the events surrounding the accident. Which defense mechanism is being used by the client?

REPRESSION: is coping with overwhelming emotions by blocking awareness or memory of the stressful event. Projection is attributing one's own unacceptable feelings and thoughts to others. Suppression is consciously keeping unacceptable feelings and thoughts out of awareness. Rationalization is the attempt to mask unacceptable feelings or behaviors by providing excuses and explanations.

A client with diabetes mellitus is able to discuss in detail the diabetic metabolic process while eating a piece of chocolate cake. What defense mechanism does the nurse identify when evaluating this behavior?

INTELLECTUALIZATION: is the avoidance of a painful emotion with the use of a rational explanation that removes the event from any personal significance. Projection is the attribution of unacceptable thoughts and feelings to others. Dissociation is a temporary alteration of consciousness or identity used to handle conflict; amnesia is an example. Displacement is the discharge of a pent-up feeling, generally hostility, on an object or person perceived to be weaker than the person who aroused the feelings.

A client in the mental health clinic who has been seeing a therapist for more than 6 months begins to talk and act like a therapist who is analyzing coworkers. What defense mechanism does the nurse identify?

INTROJECTION: is treating something outside the self as if it is actually inside the self; it is unconsciously incorporating the wishes, values, and attitudes of another as if they were one's own. Undoing is taking some action to counteract or make up for a wrongdoing. Projection is attributing to another person or group one's own unacceptable attitudes or characteristics. Intellectualization is using logical explanations without feelings or an affective component.

A client with schizophrenia is prescribed antipsychotic medication. During the follow-up visit, the primary health-care provider (PHP) administers parenteral diphenhydramine to the client. Which symptom required the administration of parenteral diphenhydramine by the PHP?

Lip smacking and tongue protrusion

What is the priority nursing intervention for a forgetful, disoriented client with the diagnosis of dementia of the Alzheimer type?

Managing the client's unsafe behaviors

When talking with a client who has alcoholism, the nurse notes that the client becomes irritable, makes excuses, and blames family and friends for the drinking problem. Which defense mechanisms does the nurse conclude that the client is using? Select all that apply.

PROJECTION: Projection is the unconscious denial of unacceptable feelings and emotions in one's self while attributing them to others. This defense mechanism commonly is used by clients with alcoholism because it helps make reality more acceptable. RATIONALIZATION: Rationalization is making acceptable excuses for behavior; this defense is used by people with alcoholism because it makes reality more acceptable.

A client in the mental health clinic who has concerns about getting married says to the nurse, "I guess I'd better get married. All the plans are made and paid for, and the invitations have all been mailed." What defense mechanism is the client using?

RATIONALIZATION: seemingly logical reasons are used to justify behaviors or feelings that are unacceptable or painful. This is not introjection, because the client has not assumed the feelings of another. This is not identification, because the client has not attempted to emulate another person. This is not compensation, because the client is not counterbalancing deficiencies in one area by excelling in another area.

As the nurse is discussing psychiatric care with an older adult client, the client says, "When I was growing up I was taught to accept my lot in life and not complain. I'm proud of the fact that despite my issues I can still function independently. I don't want to be just put away." The nurse understands that the factors that influence the client's mental health are examples of what?

Attitudes and beliefs