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Question

Difficulty: MediumCoping Mechanisms

A young adult arrives at a community health clinic for a follow-up visit one week after being diagnosed with type 1 diabetes mellitus. The individual tells the practical nurse, "I did not take any insulin over the weekend. I feel perfectly healthy, and I am certain the laboratory mixed up my blood sample with someone else's." Which of the following is the most therapeutic response for the nurse to make?

  1. It sounds like you are having a difficult time accepting this new diagnosis. Can we talk more about how you are feeling?Answer
  2. B
    Why would you choose to skip your prescribed medication when you know it is dangerous?
  3. C
    Do not worry; many people feel this way initially, and everything will be fine once you get used to the routine.
  4. D
    Since you are feeling well without it, I will adjust your care plan to decrease your daily insulin dose.

Answer

The most therapeutic response is to acknowledge the difficulty of the diagnosis and encourage the client to express their feelings.
The correct response utilizes the therapeutic communication techniques of reflecting and exploring. By acknowledging that the client is having a hard time and inviting them to share their feelings, the nurse addresses the psychological distress driving the client's denial without being confrontational. This approach builds trust and gently helps the client begin to process their new reality.

Step-by-Step Solution

1
Identify the client's behavior and underlying coping mechanism.
The client is rejecting their diagnosis and claiming a lab mix-up despite medical evidence, which indicates the defense mechanism of denial.
Recognizing the coping mechanism is essential to formulating an appropriate and supportive nursing response.
2
Evaluate the nursing role and goals of therapeutic communication.
The practical nurse must encourage the expression of emotions while remaining within the defined scope of practice.
Therapeutic communication builds trust and helps the client begin to process the reality of their health condition.
3
Analyze the given options for therapeutic value.
Reflecting the client's feelings and inviting further discussion is the only option that avoids communication blocks and remains within the nursing scope of practice.
Other options use non-therapeutic techniques (asking why, false reassurance) or involve unauthorized alterations to the care plan.

Key Concept

Therapeutic Communication and Denial
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Topics

Coping Mechanisms

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