A nurse is caring for a client who is being treated for posttraumatic stress disorder (PTSD). The client states, "I'm not able to fall asleep easily or stay asleep." Which of the following recommendations should the nurse make?

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.

Choice A reason: Autonomy is the principle that addresses the patient's right to make their own decisions regarding their health care, based on their own values and preferences. When the nurse supports the client's refusal of medications, they are respecting the client's autonomy. This principle is fundamental in healthcare ethics, emphasizing the belief that patients are capable of making informed decisions about their own treatment.

Choice B reason: Beneficence involves actions that promote the well-being of others. In the context of healthcare, this principle often refers to the healthcare provider's duty to act in the patient's best interest. While beneficence is important, it must be balanced with autonomy, especially when the patient's wishes are known and legally sound.

Choice C reason: Veracity refers to the obligation to tell the truth and not deceive others. In the healthcare setting, this means providing accurate information to patients about their condition and treatment options. While veracity is crucial, it does not directly relate to the support of a patient's decision to refuse treatment.

Choice D reason: Justice in healthcare is about fairness in the distribution of resources and respect for people's rights. It involves ensuring that all individuals have equal access to treatment and care. The principle of justice does not specifically address the issue of supporting a patient's decision to refuse treatment.