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Zorluk: ZorCoping Mechanisms

A 24-year-old client is admitted to the inpatient behavioral health unit with severe anorexia nervosa.

Objective cues:
- BMI is 14.2
- Vital signs: heart rate 52 bpm
- Recent laboratory results indicate hypokalemia (K+ 2.9 mEq/L)

During mealtime, the client abruptly pushes the food tray away, crosses their arms tightly, and shouts at the nurse, "You are constantly trying to control every aspect of my life! You are exactly like my mother, always forcing your rules on me. You don't care about my health; you just want to make me fat!"

Based on the client's presentation, which of the following nursing actions represents the most appropriate response to the client's coping mechanisms?

  1. Recognize the use of projection and displacement, maintain a non-defensive posture, and clearly reinforce the therapeutic boundaries and expectations for the meal.Cevap
  2. B
    Confront the use of displacement by explaining to the client that their anger is actually directed toward their mother to promote immediate insight.
  3. C
    Acknowledge the use of rationalization and ask the client to explain why they believe the nursing staff's nutritional interventions are harmful.
  4. D
    Identify the use of denial regarding their physical state, remove the meal tray to de-escalate the situation, and delegate monitoring of the client to an unlicensed assistive personnel (UAP).

Cevap

The correct action is to recognize the use of projection and displacement, maintain a non-defensive posture, and clearly reinforce the therapeutic boundaries and expectations for the meal.
The correct answer accurately identifies the client's maladaptive defense mechanisms (projection of control issues and displacement of anger from the mother). During an acute state of anxiety and psychiatric distress, the most therapeutic nursing action is to avoid becoming defensive, maintain a calm and neutral demeanor, and set clear, consistent limits regarding the unit's behavioral and nutritional expectations. This provides a safe, structured environment without escalating the client's anxiety.

Adım Adım Çözüm

1
Analyze the client's verbal statements to identify the specific defense mechanisms being used.
The statement 'You are constantly trying to control every aspect of my life!' demonstrates projection (attributing their own internal conflict over control onto the nurse). The statement 'You are exactly like my mother' demonstrates displacement (redirecting unresolved emotions about the mother onto the nurse).
Accurately identifying the underlying coping mechanisms is the first step in formulating a targeted, therapeutic response.
2
Evaluate the client's physical and psychological stability based on the provided objective cues.
The client is medically unstable (BMI 14.2, bradycardia, severe hypokalemia) and experiencing acute psychological distress, making them a high-priority client.
The client's physiological instability dictates that nutritional intake is a critical medical priority, while their psychological state indicates that deep, insight-oriented therapy would currently be ineffective and potentially harmful.
3
Select the nursing intervention that safely addresses the behavior while maintaining therapeutic communication and boundaries.
The most therapeutic action is to remain non-defensive, avoid arguing with the client's projected feelings, and firmly but calmly set limits by reinforcing the expectations for the meal.
Confronting defenses or asking 'why' blocks communication. Delegating an unstable client is unsafe.

Anahtar Kavram

Therapeutic Response to Maladaptive Coping Mechanisms
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Konular

Coping Mechanisms

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