During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, Im here for my heart, not my head problems. Which is the nurses best response?

Correct Answer: C

Rationale: The correct answer is C because it directly addresses the client's resistance by providing relevant information linking psychological factors to medical conditions. By explaining the impact of stress on health, the nurse demonstrates the importance of addressing psychosocial aspects during the assessment. Choice A is incorrect as it does not acknowledge the client's concerns and may come off as dismissive. Choice B is also incorrect as it focuses on the client's feelings rather than providing information to address the issue. Choice D is incorrect as it offers to skip the questions, which goes against the best practice of conducting a comprehensive assessment.

Correct Answer: D

Rationale: The correct answer is D because the client is using denial as a defense mechanism to cope with the stress of being confronted about her alcohol abuse. By saying "I don't drink too much," she is refusing to acknowledge the reality of her excessive alcohol consumption. This denial allows her to avoid facing the uncomfortable truth and the need for change. A: Hiding liquor bottles in a closet is an example of a defense mechanism called displacement, not denial. B: Yelling at their son for slouching in his chair is an example of a defense mechanism called projection, not denial. C: Burning dinner on purpose is an example of a defense mechanism called passive-aggression, not denial.

Correct Answer: B

Rationale: The correct answer is B because excessive use of defense mechanisms can hinder problem-solving skills by avoiding facing reality and finding constructive solutions. Defense mechanisms are psychological strategies that individuals unconsciously use to cope with anxiety and protect the ego. By relying too heavily on these mechanisms, individuals may overlook important issues, leading to limited problem-solving abilities. This can result in difficulties in adapting to challenges and impede personal growth. Emotions being experienced intensely (A) is not the most significant consequence as it is a natural response to certain situations and does not directly relate to defense mechanisms. The superego being suppressed (C) is not a direct consequence of defense mechanisms but may occur as a result of unresolved conflicts. Learning and growth being enhanced (D) is incorrect as excessive defense mechanisms can actually hinder learning and personal development.

Correct Answer: C

Rationale: The correct answer is C because repression is a defense mechanism in which traumatic memories are unconsciously blocked from awareness. In this scenario, the woman's inability to remember the rape incident at age 12 is a classic example of repression. She has pushed the memory out of consciousness to avoid the emotional distress associated with it. Choice A is incorrect as it describes denial, where the woman refuses to accept the truth. Choice B is incorrect as it reflects sublimation, where the man channels his unhappiness into a positive pursuit. Choice D is incomplete, making it impossible to evaluate.

Correct Answer: B

Rationale: In Erikson's theory, the developmental task for a 47-year-old client aligns with the stage of Generativity vs. Stagnation. Choice B, reflecting on life events for pleasure and meaning, corresponds to this stage where individuals assess their accomplishments and seek fulfillment. This phase involves contributing to society and future generations. Choice A pertains to the earlier stage of Identity vs. Role Confusion in adolescence. Choice C aligns with the later stage of Integrity vs. Despair in older adulthood. Choice D is incomplete. Therefore, the correct answer is B as it best fits the age and developmental stage of the client in question.