A nurse in an emergency department is caring for a school-age child who has physical injuries due to maltreatment. The parent states, "My partner was fired today and was really angry. I don't think this will ever happen again." Which of the following responses should the nurse make?

Choice A reason: Encouraging rest periods is anticipated because clients experiencing mania often have decreased need for sleep and heightened psychomotor activity. Structured rest periods help reduce exhaustion, stabilize mood, and prevent escalation of manic symptoms. Rest periods also promote recovery by counteracting the hyperactivity and insomnia commonly associated with mania.

Choice B reason: Daily weights are anticipated because clients with mania often neglect nutrition due to distractibility, hyperactivity, and poor insight. Monitoring weight provides objective data on nutritional status and helps the healthcare team intervene early if significant weight loss occurs. This is critical since malnutrition can worsen physical health and exacerbate psychiatric symptoms.

Choice C reason: Increasing environmental stimuli is contraindicated because clients with mania are already overstimulated. Additional stimuli can intensify agitation, distractibility, and restlessness, worsening the manic episode. The therapeutic environment should instead be calm, structured, and low-stimulation to promote focus and reduce hyperactivity.

Choice D reason: Offering finger foods is anticipated because clients with mania often cannot sit still long enough to consume a full meal. Finger foods allow them to eat while pacing or moving, ensuring adequate caloric intake despite their inability to remain seated. This intervention directly addresses nutritional deficits while accommodating the client’s psychomotor agitation.

Choice E reason: Applying restraints is contraindicated unless the client poses an immediate danger to themselves or others. Mania is best managed through therapeutic interventions such as medication, structured environment, and supportive care. Restraints can increase agitation, cause trauma, and damage the therapeutic relationship. They are not indicated in this scenario since the client is restless but not violent or self-harming.

Choice A reason: Dissociation involves a disruption in consciousness, memory, identity, or perception of the environment. It is often seen when individuals detach from reality to avoid distressing emotions or experiences. In this case, the family member is not detaching from reality or experiencing a break in consciousness. Instead, they are expressing anger outwardly toward the provider. Therefore, dissociation does not apply.

Choice B reason: Rationalization is the use of logical-sounding explanations to justify or excuse unacceptable feelings or behaviors. For example, someone might say, “It was better this way” to justify a loss. The family member is not attempting to justify or excuse the death with reasoning; they are instead directing anger toward the provider. Thus, rationalization is not the defense mechanism being used.

Choice C reason: Repression is the unconscious blocking of unacceptable thoughts, feelings, or memories from awareness. It is a defense mechanism that prevents distressing emotions from surfacing. In this scenario, the family member is openly expressing anger and blame, not unconsciously suppressing emotions. Therefore, repression is not the correct mechanism.

Choice D reason: Displacement occurs when emotions are redirected from their original source to a safer or more acceptable target. The family member is experiencing grief and anger due to the parent’s death but is directing that anger toward the provider instead of confronting the painful reality of losing their parent. This redirection of emotions is a classic example of displacement, making it the correct answer.