After establishing a no-harm contract with the client, the nurse should:

A. Compensation involves offsetting perceived deficiencies by excelling in other areas. The patient claiming weight gain is due to fluid retention is not trying to make up for a perceived weakness or deficiency; instead, they are explaining their behavior in a way that deflects responsibility.
B. Rationalization is a defense mechanism where a person provides logical or reasonable-sounding explanations for behaviors or situations that are actually motivated by irrational or emotional factors. In this case, the patient who overeats is rationalizing their weight gain by attributing it to fluid retention rather than addressing the underlying issue of overeating. This allows them to avoid facing the real cause of their weight gain.
C. Regression involves reverting to earlier stages of development or behavior when faced with stress. For instance, an adult might act childishly when under pressure. The patient in this scenario is not behaving in a more immature or childlike manner but is rather giving an excuse for their behavior.
D. Projection involves attributing one's own undesirable thoughts or feelings to others. For example, someone who is untrustworthy might accuse others of being untrustworthy. The patient in this scenario is not attributing their own issues to others but is offering an excuse for their own behavior.

A. Depression is characterized by persistent feelings of sadness, loss of interest or pleasure in activities, changes in sleep and appetite, and difficulties with daily functioning. However, depression alone might not fully explain the abrupt change if there were no prior context of mood swings or manic behavior.
B. Bipolar disorder is marked by extreme mood swings that include manic or hypomanic episodes and depressive episodes. The observed behaviors—active participation and high energy followed by a
sudden shift to tearfulness and withdrawal—are consistent with the mood cycling seen in bipolar disorder. The manic or hypomanic phase could explain the previous high level of activity, while the depressive phase explains the sudden refusal to engage and withdrawal.
C. Psychotic behavior involves a loss of touch with reality, including hallucinations, delusions, and disorganized thinking. The behaviors described (active participation and then sudden withdrawal) do not specifically indicate psychosis.
D. Dysthymic disorder (now referred to as Persistent Depressive Disorder in the DSM-5) is characterized by a chronic, mild depression lasting for at least two years. It typically involves a more consistent, persistent low mood rather than the abrupt shifts seen in bipolar disorder.