A nurse is caring for a client who begins yelling and pacing around the room. Which of the following actions should the nurse take? (Select all that apply.)

Choice A reason: Identifying when the client engages in splitting behaviors is more relevant to borderline personality disorder than schizoid personality disorder. Splitting is a defense mechanism where individuals fail to integrate positive and negative aspects of self and others into cohesive images. People with schizoid personality disorder typically exhibit detachment from social relationships and a restricted range of emotional expression, not splitting.

Choice B reason: Giving the client a choice of solitary activities aligns with the characteristics of schizoid personality disorder. Individuals with this disorder often prefer to engage in activities alone, as they feel more comfortable being by themselves than in social situations. Providing options for solitary activities can help meet the client's needs for privacy and personal space while also respecting their autonomy.

Choice C reason: Setting limits on the client's need for constant social contact is not applicable to schizoid personality disorder. In fact, individuals with this disorder typically do not desire social contact and may already isolate themselves. The intervention would be more appropriate for disorders where the individual seeks excessive social interaction.

Choice D reason: Assisting the client in identifying sources of anger may not be a priority in the care of someone with schizoid personality disorder unless there is a specific indication for it. These individuals often do not express emotions openly and may not experience or show anger in the same way as those without the disorder. The focus should be on interventions that respect the client's emotional expression, or lack thereof.

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.