A client with bipolar disorder is experiencing a manic episode. Which intervention should the nurse implement to ensure the client's safety?

Correct Answer: A

Rationale: During a manic episode in bipolar disorder, individuals may exhibit increased energy levels, impulsivity, and reduced need for sleep, which can lead to risky behaviors and accidents. Providing a structured environment with minimal stimuli helps to reduce the risk of overstimulation and impulsive actions, thereby promoting the client's safety. This intervention aims to create a calm and controlled setting that can prevent potential harm to the client during this phase of the disorder.

Correct Answer: C

Rationale: Projection is a defense mechanism where an individual unconsciously attributes their own unacceptable thoughts, feelings, or impulses to another person, thereby avoiding responsibility for them. This allows the person to externalize internal conflicts and perceive others as the source of their own emotions or traits. In the context of this question, the healthcare professional is looking for a statement that clearly demonstrates this process of displacing one's own feelings onto others. Option C, "The client attributes his own feelings of hostility to others," directly exemplifies projection. Here, the client is taking his internal experience of hostility—an emotion he may find difficult to accept in himself—and assigning it to others instead. This shifts the blame and discomfort away from the self, a hallmark of projection. For instance, if the client feels aggressive but doesn't want to confront that, he might claim that everyone around him is hostile, thus protecting his self-image while maintaining emotional equilibrium. This matches classic psychological descriptions, such as in Freudian theory, where projection serves to reduce anxiety by denying personal flaws. In contrast, option A, "The client accuses others of being angry when it is the client who is angry," might seem similar at first glance but actually aligns more closely with displacement rather than pure projection. Displacement involves redirecting emotions from their original source to a safer or less threatening target, often without the full attribution of the entire feeling to the other person. In A, the accusation of anger in others could be a form of venting one's own anger indirectly, but it doesn't explicitly involve attributing the client's own emotional state as originating from others; it's more about misdirecting blame or expression. Projection requires the unconscious belief that the feeling belongs to the other, not just accusing them while knowing it's oneself. Option B, "The client refuses to acknowledge a problem despite evidence to the contrary," describes denial, not projection. Denial is the refusal to accept reality or facts that cause emotional pain, essentially blocking out threatening information. For example, a client might deny a serious health diagnosis even with clear medical proof, which protects the ego by avoiding confrontation with the truth. This differs from projection because it involves internal suppression rather than externalizing and attributing unacceptable aspects to others; there's no displacement of feelings onto external targets here. Option D, "The client avoids dealing with painful feelings by focusing on something else," represents displacement or, more precisely, distraction/sublimation in some contexts, but it most closely fits intellectualization or diversion as a coping strategy. This mechanism allows the individual to sidestep emotional distress by shifting attention to neutral or unrelated activities, such as immersing in work to avoid grief. Unlike projection, which involves actively projecting one's own traits onto others, D focuses on avoidance through redirection without any attribution or blaming of external parties. It's an internal evasion tactic, not an interpersonal one. Understanding these distinctions is crucial for healthcare professionals, as misidentifying defense mechanisms can lead to ineffective therapeutic interventions. Projection often signals deeper unresolved conflicts, like paranoia or interpersonal distrust, requiring techniques such as empathetic exploration to gently uncover the client's true feelings. By recognizing C as the precise indicator, professionals can tailor support to address the client's externalization patterns, fostering self-awareness and healthier emotional processing over time. This nuanced differentiation helps students grasp how defense mechanisms operate in real clinical scenarios, emphasizing the importance of precise language in assessments.

Correct Answer: A

Rationale: The correct answer is A. Clients should avoid alcohol while taking diazepam (Valium) as it can potentiate the effects of the medication, leading to excessive sedation and other adverse effects. Mixing alcohol with diazepam can also increase the risk of overdose and other serious complications. Therefore, it is crucial for the client to refrain from consuming alcohol while on this medication to ensure their safety and optimize the therapeutic benefits of diazepam for managing anxiety.

Correct Answer: B

Rationale: Displacement is a defense mechanism in psychology where an individual redirects their emotions, impulses, or frustrations from their original, often threatening or unacceptable source toward a substitute target that is safer or more accessible. This redirection helps alleviate anxiety but can manifest in harmful ways if the substitute is innocent or unrelated. Now, let's examine the choices step by step to understand why B exemplifies displacement clearly, while the others align with different mechanisms. First, consider choice B: A woman yells at her children after a stressful day at work. This is a textbook example of displacement because the woman's stress and frustration originate from her workplace—likely a source she can't confront directly due to power dynamics, job security fears, or social norms. Instead, she redirects her pent-up aggression toward her children, who are a safer, more immediate target at home. This substitution allows her to release tension without addressing the real issue, but it unfairly burdens those closest to her. The mechanism here is purely redirective: the emotional energy from work is displaced onto family, not transformed or sublimated into something productive. In contrast, choice A: A man kicks his dog after an argument with his boss, appears similar at first glance but is not the best fit for displacement in this context because it represents an even more impulsive and direct outlet, often classified under acting out rather than true displacement. While it involves redirection from boss to pet, the action is too visceral and lacks the emotional buildup of a "stressful day," making it more akin to immediate aggression spillover. Displacement typically involves a buildup of unresolved tension, as in B, whereas A feels like raw, unfiltered lashing out without the protective redirection intent. Choice C: A student immerses herself in studying to avoid thinking about a recent breakup, illustrates intellectualization or denial through distraction, not displacement. Here, the student is avoiding the painful emotions of the breakup by channeling energy into a productive activity—studying—which serves as a substitute focus but doesn't redirect the emotions aggressively or harmfully toward another target. Instead, it's a form of repression or sublimation, where the breakup anxiety is buried under academic pursuits, allowing indirect coping without substituting one object of emotion for another. Finally, choice D: A person channels aggressive impulses into playing a sport, demonstrates sublimation, a mature defense mechanism where unacceptable impulses (like aggression) are redirected into socially acceptable and constructive outlets, such as athletics. Unlike displacement, which often targets innocent bystanders and can be maladaptive, sublimation transforms the raw energy into something beneficial, like physical exercise that builds skills or relieves stress positively. The key difference is that sublimation elevates the impulse rather than just shifting it downward to a weaker target. By comparing these, B stands out as displacement because it involves harmful redirection from an unattainable source (work stress) to a vulnerable one (children), without the productive transformation seen in D or the avoidance in C. Understanding displacement helps students recognize how unaddressed emotions can strain relationships, emphasizing the need for healthier coping strategies like direct communication or therapy to confront root causes. This mechanism, first described by Freud, underscores why redirecting frustration often perpetuates cycles of emotional harm if not managed mindfully.

Correct Answer: B

Rationale: For a client experiencing severe anxiety, the primary goal of intervention is to reduce immediate distress and promote safety by minimizing external stimuli that could exacerbate the symptoms. Providing a quiet and calm environment, as in option B, is the most appropriate initial intervention because severe anxiety often involves heightened physiological arousal, such as rapid heartbeat, hyperventilation, and sensory overload. A serene setting helps lower sensory input, allowing the client's nervous system to downregulate naturally. This aligns with evidence-based practices like those from the American Psychiatric Association, which recommend de-escalation through environmental control for acute anxiety episodes. By dimming lights, reducing noise, and ensuring privacy, the healthcare professional creates a space for the client to regain composure without added pressure, preventing escalation to panic or crisis. In contrast, option A—encouraging the client to talk about their feelings—may be beneficial in therapeutic settings for processing emotions during milder anxiety or post-acute phases, but it's unsuitable for severe anxiety. At this intensity, verbal expression can feel overwhelming or impossible due to cognitive fog or racing thoughts, potentially increasing agitation rather than alleviating it. Therapeutic talking is more appropriate after stabilization, as forcing it prematurely could heighten vulnerability and lead to emotional flooding. Option C—encouraging vigorous exercise—is counterproductive for severe anxiety because it can mimic or intensify the physical symptoms of anxiety, such as elevated heart rate, sweating, and adrenaline surges, confusing the client's body signals and worsening the panic response. While moderate exercise aids long-term anxiety management by releasing endorphins, vigorous activity during an acute severe episode risks physical exhaustion or injury, especially if the client is already breathless or disoriented. Guidelines from the National Institute for Health and Care Excellence (NICE) advise against high-intensity interventions in acute states, favoring rest instead. Option D—encouraging participation in group activities—introduces social pressures and interpersonal dynamics that could amplify anxiety for someone in severe distress, as it involves exposure to multiple people, noise, and expectations of interaction. This might trigger social anxiety components or feelings of inadequacy, leading to withdrawal or further isolation. Group interventions are valuable for building support networks in recovery phases but are contraindicated initially when the client needs individualized calming to rebuild a sense of control. Overall, selecting B prioritizes immediate safety and physiological relief, forming the foundation for subsequent interventions like those in A, C, or D once the severity subsides. This step-by-step approach ensures ethical, client-centered care rooted in crisis intervention principles.