A client with major depressive disorder is receiving cognitive-behavioral therapy (CBT). Which outcome indicates that the therapy is effective?

Correct Answer: A

Rationale: In cognitive-behavioral therapy, identifying and challenging negative thoughts is a fundamental aspect of the treatment process. This cognitive restructuring helps individuals with major depressive disorder to develop healthier thinking patterns and cope more effectively with their emotions, which ultimately leads to improvement in their mental health. Therefore, when a client is able to identify and challenge negative thoughts, it indicates that they are actively engaging in the therapeutic process and making progress towards better mental well-being.

Correct Answer: A

Rationale: During a manic episode in bipolar disorder, individuals may exhibit increased energy levels, impulsivity, and reduced need for sleep, which can lead to risky behaviors and accidents. Providing a structured environment with minimal stimuli helps to reduce the risk of overstimulation and impulsive actions, thereby promoting the client's safety. This intervention aims to create a calm and controlled setting that can prevent potential harm to the client during this phase of the disorder.

Correct Answer: D

Rationale: The correct answer is D because sertraline, used for depression, typically takes several weeks to become effective. It is important for clients to understand this delayed onset of action to manage their expectations and continue taking the medication as prescribed despite not seeing immediate results.

Correct Answer: C

Rationale: Projection is a defense mechanism where an individual unconsciously attributes their own unacceptable thoughts, feelings, or impulses to another person, thereby avoiding responsibility for them. This allows the person to externalize internal conflicts and perceive others as the source of their own emotions or traits. In the context of this question, the healthcare professional is looking for a statement that clearly demonstrates this process of displacing one's own feelings onto others. Option C, "The client attributes his own feelings of hostility to others," directly exemplifies projection. Here, the client is taking his internal experience of hostility—an emotion he may find difficult to accept in himself—and assigning it to others instead. This shifts the blame and discomfort away from the self, a hallmark of projection. For instance, if the client feels aggressive but doesn't want to confront that, he might claim that everyone around him is hostile, thus protecting his self-image while maintaining emotional equilibrium. This matches classic psychological descriptions, such as in Freudian theory, where projection serves to reduce anxiety by denying personal flaws. In contrast, option A, "The client accuses others of being angry when it is the client who is angry," might seem similar at first glance but actually aligns more closely with displacement rather than pure projection. Displacement involves redirecting emotions from their original source to a safer or less threatening target, often without the full attribution of the entire feeling to the other person. In A, the accusation of anger in others could be a form of venting one's own anger indirectly, but it doesn't explicitly involve attributing the client's own emotional state as originating from others; it's more about misdirecting blame or expression. Projection requires the unconscious belief that the feeling belongs to the other, not just accusing them while knowing it's oneself. Option B, "The client refuses to acknowledge a problem despite evidence to the contrary," describes denial, not projection. Denial is the refusal to accept reality or facts that cause emotional pain, essentially blocking out threatening information. For example, a client might deny a serious health diagnosis even with clear medical proof, which protects the ego by avoiding confrontation with the truth. This differs from projection because it involves internal suppression rather than externalizing and attributing unacceptable aspects to others; there's no displacement of feelings onto external targets here. Option D, "The client avoids dealing with painful feelings by focusing on something else," represents displacement or, more precisely, distraction/sublimation in some contexts, but it most closely fits intellectualization or diversion as a coping strategy. This mechanism allows the individual to sidestep emotional distress by shifting attention to neutral or unrelated activities, such as immersing in work to avoid grief. Unlike projection, which involves actively projecting one's own traits onto others, D focuses on avoidance through redirection without any attribution or blaming of external parties. It's an internal evasion tactic, not an interpersonal one. Understanding these distinctions is crucial for healthcare professionals, as misidentifying defense mechanisms can lead to ineffective therapeutic interventions. Projection often signals deeper unresolved conflicts, like paranoia or interpersonal distrust, requiring techniques such as empathetic exploration to gently uncover the client's true feelings. By recognizing C as the precise indicator, professionals can tailor support to address the client's externalization patterns, fostering self-awareness and healthier emotional processing over time. This nuanced differentiation helps students grasp how defense mechanisms operate in real clinical scenarios, emphasizing the importance of precise language in assessments.

Correct Answer: A

Rationale: The correct answer is A. Clients should avoid alcohol while taking diazepam (Valium) as it can potentiate the effects of the medication, leading to excessive sedation and other adverse effects. Mixing alcohol with diazepam can also increase the risk of overdose and other serious complications. Therefore, it is crucial for the client to refrain from consuming alcohol while on this medication to ensure their safety and optimize the therapeutic benefits of diazepam for managing anxiety.