A school nurse is talking with a 13-year-old female at her annual health-screening visit. Which of the following comments made by the adolescent should be the nurse's priority to address?

A. Regression: Incorrect

Regression is a defense mechanism in which a person reverts to an earlier stage of development in response to stress or anxiety. For example, an adult might start behaving like a child when faced with a difficult situation. In this case, the student berating the teacher doesn't demonstrate a return to an earlier developmental stage, so regression is not the correct choice.

B. Conversion: Incorrect

Conversion refers to the conversion of emotional distress into physical symptoms, such as experiencing physical pain without any apparent physical cause. This mechanism is often seen in conditions like conversion disorder. The student berating the teacher is not exhibiting physical symptoms as a response to emotional distress, so conversion is not the correct choice.

C. Projection: Correct

Projection is the act of attributing one's own unacceptable feelings or thoughts to another person. In this scenario, the student is projecting their own failure onto the teacher and the course by blaming them for the failure. They are unable to accept their own role in the failure and are instead placing the blame on external factors. This aligns with the behavior described in the scenario.

D. Undoing: Incorrect

Undoing involves trying to compensate for or negate an unacceptable action or thought with a contrary action. For instance, someone who had angry thoughts might engage in excessive acts of kindness to "undo" those thoughts. The student berating the teacher is not engaging in actions to negate their negative feelings or thoughts; they are expressing their frustration directly.

A. Joining a group discussion about a local election: While group discussions can be productive, a person in the manic phase of bipolar disorder may have difficulty focusing and may become overly talkative or agitated. Engaging in a group discussion about a local election may exacerbate their symptoms and lead to increased energy and agitation.

B. Watching a video with a group in the day room: Watching a video in a group setting may not be suitable for a person in the manic phase, as they might find it hard to sit still and concentrate. The fast-paced and changing nature of videos may contribute to increased restlessness and agitation.

C. Participating in a basketball game in the gym: Engaging in physical activities like basketball can be too stimulating for someone in the manic phase. Their heightened energy levels may cause them to become overly competitive, agitated, or impulsive, potentially leading to risky behavior or increased symptoms.

D. Walking with the nurse in the courtyard: Taking a walk in a calm and soothing environment, such as a courtyard, can help a person in the manic phase expend excess energy in a controlled manner. Walking provides physical activity without overstimulating or overwhelming the individual, making it a more appropriate choice to address boredom while managing their symptoms.