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Difficulty: MediumCoping Mechanisms

A client receives a new diagnosis of advanced pancreatic cancer from the healthcare provider. Later that afternoon, the client presents the practical nurse (PN) with a binder of medical research articles and spends the interaction calmly asking highly technical questions about the cellular mechanisms of various chemotherapy agents. Which of the following is the most appropriate action by the PN?

  1. Acknowledge the client's need for information and offer to document their specific questions for the healthcare provider.Answer
  2. B
    Attempt to explain the cellular mechanisms of the chemotherapy agents using the provided research articles.
  3. C
    Reassure the client that the healthcare team has chosen the best possible treatment plan so they do not need to worry.
  4. D
    Inform the client that researching medical literature is simply the denial stage of the normal grieving process.

Answer

Acknowledge the client's need for information and offer to document their specific questions for the healthcare provider.
The correct action acknowledges the client's emotional state by safely supporting their current coping strategy (intellectualization). By offering to write down the questions for the healthcare provider, the nurse acts as a patient advocate while strictly remaining within the legal scope of practice for a practical nurse, which excludes initial, complex education on new treatment modalities.

Step-by-Step Solution

1
Analyze the client's behavior and identify the underlying coping strategy.
The client is focusing entirely on complex, factual data rather than the emotional impact of a terminal diagnosis. This indicates the use of the defense mechanism known as intellectualization.
Recognizing the defense mechanism helps the nurse understand that the behavior is currently protecting the client from overwhelming emotional distress.
2
Determine the appropriate therapeutic communication approach.
The nurse should support the client by validating their need for information without aggressively stripping away their emotional defense or offering false reassurance.
Challenging a defense mechanism too early can increase severe anxiety, while false reassurance blocks therapeutic trust.
3
Evaluate the options against the practical nurse (PN) scope of practice.
Teaching complex new pharmacology is outside the PN scope. The PN should facilitate communication by gathering the questions for the provider.
Maintaining safe delegation and scope of practice boundaries is a critical component of every client interaction.

Key Concept

Coping Mechanisms (Intellectualization) and PN Scope of Practice
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Topics

Coping Mechanisms

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