A nurse is assessing a client who has a recent diagnosis of dissociative identity disorder. The client tells the nurse, "I think my blackouts are actually caused by low blood sugar." The nurse should recognize the client is using which of the following defense mechanisms?

Choice A reason: Napping during the daytime can interfere with nighttime sleep patterns and is generally not recommended for individuals with insomnia. It can create a cycle of fragmented sleep and may exacerbate difficulties in falling and staying asleep at night.

Choice B reason: While avoiding stimulating activities such as reading in the evening can be helpful for some individuals, it is not a universal recommendation. Reading can actually be a relaxing activity for many people and may help them wind down before bedtime.

Choice C reason: Dimming the screen on electronic devices can reduce exposure to blue light, which can interfere with the body's natural sleep-wake cycle. However, it is generally recommended to avoid the use of electronic devices altogether in the bedroom to promote better sleep hygiene.

Choice D reason: Meditation is a relaxation technique that can be beneficial for individuals with PTSD and sleep disturbances. It can help calm the mind, reduce stress, and prepare the body for sleep. Mindfulness meditation, in particular, has been shown to improve sleep quality and is a recommended practice for those experiencing insomnia.

Choice A reason: Denial is a defense mechanism where a person refuses to accept reality or facts, acting as if a painful event, thought, or feeling did not exist. It is considered one of the most primitive of the defense mechanisms because it is characteristic of early childhood development. In this scenario, the client does not deny the event but rather does not remember it, which does not align with the characteristics of denial.

Choice B reason: Rationalization involves explaining an unacceptable behavior or feeling in a rational or logical manner, avoiding the true reasons for the behavior. This defense mechanism is often used to justify actions or feelings that may otherwise be unacceptable. In the case of the client, there is no indication that they are trying to justify or rationalize their behavior or feelings; they simply do not recall the event.

Choice C reason: Displacement transfers emotions, ideas, or wishes from a stressful situation to a less anxiety-producing substitute. It involves taking out our frustrations, feelings, and impulses on people or objects that are less threatening. Displacement can manifest as a kick to a door after an argument with a person. Since the client's statement does not involve shifting emotional responses to another object or person, displacement is not the defense mechanism at play here.

Choice D reason: Repression is an unconscious mechanism employed by the ego to keep disturbing or threatening thoughts from becoming conscious. In the case of the client, forgetting the details of a traumatic event like a physical assault could be a form of repression, where the mind avoids the pain of recalling such events by keeping those memories out of conscious awareness. This aligns with the client's statement of not remembering the assault.