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Difficulty: MediumCoping Mechanisms

A 28-year-old client is admitted to an inpatient rehabilitation unit following a traumatic bilateral lower extremity amputation. The client refuses to participate in physical therapy, throws a water cup at the wall, and yells, "Leave me alone! My life is completely ruined!" Which actions should the practical nurse (PN) take to support the client's coping? Select all that apply.

  1. Sit quietly at eye level with the client while maintaining a safe distance.Answer
  2. State to the client, "It is understandable that you are feeling angry right now."Answer
  3. Ask the client to describe methods they have used to handle highly stressful situations in the past.Answer
  4. D
    Reassure the client that modern prosthetics will allow them to walk normally again.
  5. E
    Advise the client that experiencing anger is a stage of grief they must quickly move past to reach acceptance.
  6. F
    Attempt to logically explain the physical benefits of attending therapy while the client is yelling.

Answer

The correct actions include sitting quietly with the client to offer a supportive presence, validating the client's anger as an understandable response, and asking about past methods used to handle stressful situations.
When a client is experiencing acute grief and exhibiting intense anger due to a severe loss, the priority is to provide a safe, supportive environment. Therapeutic presence (sitting quietly at a safe distance) and validation (acknowledging the anger) help de-escalate the immediate distress. Exploring past coping strategies is a vital data collection step within the PN scope to help the client eventually transition to adaptive coping.

Step-by-Step Solution

1
Analyze the client's behavior and current emotional state.
The client has experienced a severe traumatic loss, is actively expressing intense anger (yelling, throwing objects), and is refusing care.
Understanding the acuity of the emotional distress determines the immediate nursing priorities.
2
Evaluate each nursing action for therapeutic value and safety during an escalated emotional crisis.
Therapeutic presence, validation, and exploring past coping skills are appropriate. False reassurance, dictating grief stages, and rationalizing during acute anger are inappropriate.
The PN must use therapeutic communication to de-escalate the situation and support adaptive coping mechanisms without invalidating the client's feelings.

Key Concept

Therapeutic Communication and Coping Support in Acute Grief
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Topics

Coping Mechanisms

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