A nurse is caring for a client who is experiencing active auditory hallucinations. Which of the following actions should the nurse take?

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: While ECT has been used to treat various mental health conditions, its effectiveness in treating borderline personality disorder is not well-established. Borderline personality disorder is typically managed with psychotherapy, and there is limited evidence to support the use of ECT for this condition.

Choice B reason: ECT is not typically used to treat phobias such as a fear of heights. Phobias are usually addressed with cognitive-behavioral therapy and sometimes medication, but not with ECT. Therefore, a decreased fear of heights would not be a typical indicator of ECT's effectiveness.

Choice C reason: ECT may be used in some cases of epilepsy to reduce the frequency of seizures, but it is not a common treatment for this condition. The primary use of ECT is for severe psychiatric conditions, particularly major depressive disorder, and not for neurological disorders like epilepsy.

Choice D reason: ECT is most commonly used to treat severe depression, especially when it is resistant to other treatments. It is known for its rapid and significant improvements in severe symptoms of depression. An improvement in the manifestations of depression, such as a better mood, increased appetite, and improved sleep, is a clear indication that ECT is effective.