A client who was just told they have cancer says: 'You must have the wrong chart. I was just at my annual physical last month and everything was fine.' Which defense mechanism is this?

DENIAL as initial response to catastrophic news is psychologically normal and may be adaptive.

Characteristics: Client rejects reality of the diagnosis or situation; may insist there is a mistake; may seek a second opinion (which can be healthy if not excessive); may continue discussing future plans as if unaffected; ADAPTIVE vs MALADAPTIVE: Short-term denial gives the psyche time to absorb the shock — protective in the immediate period; Maladaptive when it prevents the client from pursuing needed treatment or making important decisions.

Nursing approach: Do not aggressively confront the denial; allow some time for the reality to sink in; maintain a supportive, non-judgmental presence; provide factual information when the client demonstrates readiness to receive it; involve social work and support services; avoid false reassurance; check for safety concerns (will denial lead to refusing treatment?).

Versus suppression: Suppression is CONSCIOUS avoidance of a thought; denial is UNCONSCIOUS refusal to accept reality.