A forty-year-old client in the therapist's office coughs and makes awkward sounds when the therapist chooses to talk about his childhood sexual abuse. Where does this reflexive behavior stem from?

Correct Answer: A

Rationale: The correct answer is A because the id, according to Freudian psychology, is the part of the psyche that operates on the pleasure principle, seeking immediate gratification without considering consequences. In this scenario, the client's coughing and awkward sounds stem from an unconscious defense mechanism triggered by the uncomfortable topic of childhood sexual abuse. This reflexive behavior is a way for the client's mind to protect itself from the distressing emotions associated with the discussion. Choices B, C, and D are incorrect because they do not address the underlying psychological mechanism driving the client's behavior and do not align with the principles of Freudian theory.

Correct Answer: C

Rationale: The correct answer is C: Egocentrism. At the preoperational stage (2-7 years) in Piaget's theory, children struggle with understanding others' perspectives, known as egocentrism. In this case, the 4-year-old child's inability to consider another child's ideas about playing house reflects egocentrism. The child is only able to see things from their own point of view and struggles to understand that others may have different thoughts or viewpoints. This lack of perspective-taking is a key characteristic of egocentrism at this stage of cognitive development. Now, let's analyze why the other choices are incorrect: A: Object permanence - This concept is related to the understanding that objects continue to exist even when they are not seen. It is typically developed in the sensorimotor stage (0-2 years), not in the preoperational stage where the child in the question falls. B: Reversibility and spatiality - Reversibility

Correct Answer: D

Rationale: The correct answer is D because it encourages the speaker to express their feelings and allows for open communication. It shows empathy and a willingness to understand the other person's perspective. A: A is an example of a leading question that assumes the speaker is angry due to someone else. B: B is an example of a judgmental question that implies the speaker's idea may be invalid. C: C is an example of a contradictory statement that may confuse the speaker and hinder communication.

Correct Answer: C

Rationale: The correct answer is C because schizophrenia is widely believed to have a biological basis, supported by research showing genetic and neurological factors. This response helps the spouse understand that the disorder is not solely caused by childhood events but rather by underlying biological mechanisms. The other choices are incorrect because A oversimplifies the cause of mental disorders, B does not address the biological aspect of schizophrenia, and D does not provide relevant information about the disorder's cause.

Correct Answer: B

Rationale: The correct answer is B: Assess the patient for a history of renal problems. Elevated BUN and creatinine levels indicate possible renal dysfunction, which can manifest as psychiatric symptoms. By assessing the patient for a history of renal problems, the nurse can gather important information to help determine the underlying cause of the symptoms. This step is crucial in identifying and addressing any potential medical issues contributing to the psychiatric presentation. Incorrect choices: A: Reporting the findings to the health care provider is important, but assessing the patient for a history of renal problems should be done first. C: Assessing the patient's family history for cardiac problems is not relevant to the elevated BUN and creatinine levels. D: Hospitalization on the psychiatric unit may not address the underlying medical issue causing the symptoms; assessing for renal problems is more appropriate.