A man is admitted to the intensive care unit with chest pain, an abnormal ECG, and elevated enzymes. When the significance of this is explained to him, he says, "I can't be having a heart attack. No way. You must be mistaken." The nurse suspects the client is using which defense mechanism?

1. A

   Sublimation

2. B

   Regression

3. C

   Dissociation

4. D

   Denial

Appeared in: DHS 2018 shift 1st

Explanation

• Denial is an unconscious defense mechanism where a person refuses to accept a reality that is too painful or threatening to acknowledge.
• The patient in the scenario is presented with clear, objective evidence of a myocardial infarction (chest pain, ECG changes, elevated enzymes).
• His immediate response, "You must be mistaken," is a direct rejection of this painful reality, which is the hallmark of denial.
• This mechanism temporarily protects the individual from the overwhelming anxiety and fear associated with a life-threatening diagnosis like a heart attack.

Why Other Options Were Wrong

• Option A: Sublimation involves redirecting unacceptable impulses into socially productive activities. The patient is not channeling his feelings into a new activity; he is rejecting a diagnosis.
• Option B: Regression is the act of reverting to an earlier, less mature stage of development. The patient's response is a cognitive refusal, not a return to childlike behavior.
• Option C: Dissociation involves a detachment from reality, such as memory loss or feeling disconnected from one's own body. The patient is fully engaged in the conversation but is actively disagreeing with the information provided.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Psychological Defense Mechanisms to guide bedside assessment, documentation, and the next nursing action.
• Nurses frequently encounter patients in denial, especially after a new, serious diagnosis. The initial nursing approach should be therapeutic and non-confrontational, allowing the patient time to process the information.
• It is crucial to provide clear, factual information in a calm manner and reinforce it over time, but avoid arguing with the patient. The goal is to build trust so the patient can eventually accept the diagnosis and participate in their care.
• Patient safety is a concern. A patient in denial may refuse necessary treatments, medications, or lifestyle changes, increasing their risk of complications. The nurse must monitor for non-adherence and continue education.

How to Approach the Question

• First, identify the core question: you need to identify a specific defense mechanism.
• Analyze the patient's statement: "I can't be... You must be mistaken." This is a direct rejection of information.
• Define the four options in your mind: Sublimation (channeling), Regression (reverting to childlike state), Dissociation (detaching), and Denial (refusing).
• Compare the patient's behavior to the definitions. The patient's verbal refusal to accept the facts directly matches the definition of denial.
• Eliminate the other options by confirming the patient's behavior does not fit their definitions (he is not channeling energy, acting like a child, or detaching from reality).

Concept Tested & Keywords

• Concept Tested: Psychological Defense Mechanisms
• Stem keywords: chest pain, abnormal ECG, elevated enzymes, heart attack, defense mechanism
• Lead-in keywords: which defense mechanism
• Clinical cues: Patient's direct quote: "I can't be having a heart attack. No way. You must be mistaken." This is a direct verbalization of refusal to accept reality.

Question ID

Qj4EqZdBkXq3YmIQOaL0Tj

Copy ID

Reference Book

E6 Kaplan Sadock's Synopsis of Psychiatry-2022 (pp 1-3768 of 3768) p. 3344-3346

E6 Nursing Fundamentals Taylor p. 1026-1028