A nurse is teaching a client with major depressive disorder about their new prescription for bupropion. Which of the following instructions should the nurse include?

Choice A reason: Advising immediate removal from the situation assumes the client’s capacity to act and may oversimplify complex domestic issues. It does not address the client’s hopeless statement, which suggests suicidal ideation, requiring immediate assessment to ensure safety and prevent self-harm.

Choice B reason: The client’s hopeless statement is a red flag for suicidal ideation, common in domestic violence survivors due to trauma and despair. Asking about self-harm directly assesses suicide risk, enabling timely intervention, such as safety planning or psychiatric evaluation, to prevent harm.

Choice C reason: Asking what the client has done may seem judgmental and does not address the immediate risk of hopelessness. It focuses on problem-solving, which is inappropriate before assessing for suicidal ideation or ensuring emotional and physical safety post-dispute.

Choice D reason: Reassuring the client with “you’ll be fine” dismisses their distress and may invalidate their feelings. Hopelessness requires exploration of suicidal thoughts to ensure safety, not generic reassurance, which fails to address the underlying psychological crisis or trauma.

Choice A reason: This statement reflects denial or confusion, not displacement. Denial involves rejecting reality, often seen in personality disorders, but displacement specifically involves redirecting emotions to a less threatening target. This statement does not indicate redirecting feelings from one source to another.

Choice B reason: Displacement involves redirecting emotions from the true source to a safer target. Blaming the night shift nurse suggests the client is projecting anger or frustration, possibly intended for another source (e.g., family or self), onto the nurse, a common maladaptive mechanism in personality disorders.

Choice C reason: This statement reflects magical thinking or bargaining, not displacement. It suggests a belief that compliance will resolve the issue, often seen in anxiety or obsessive-compulsive disorders. Displacement involves emotional redirection, not conditional thinking about problem resolution.

Choice D reason: Expressing anger directly toward the spouse indicates direct expression, not displacement. Displacement involves redirecting emotions to a substitute target, not the original source of the emotion, making this statement an example of direct aggression rather than a maladaptive defense mechanism.