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Question

Difficulty: MediumCoping Mechanisms

A practical nurse (PN) is reinforcing discharge instructions for a client who had a permanent pacemaker implanted the previous day. The client laughs and states, 'I do not need to check my pulse or go to those follow-up appointments. This little machine is a magic fix, and my heart is completely bulletproof now.' Which therapeutic response should the PN provide?

  1. I understand you are feeling relieved, but checking your pulse daily is still a necessary part of your care.Answer
  2. B
    Why do you believe that you no longer need to follow the cardiologist's instructions?
  3. C
    Do not worry, the device is extremely reliable and will take care of your heart automatically.
  4. D
    I will update your nursing care plan to include a psychiatric evaluation for denial.

Answer

The response stating that the nurse understands the client is feeling relieved, but checking the pulse daily is still a necessary part of care.
The correct response is therapeutic because it validates the client's positive feelings ('I understand you are feeling relieved') while gently but firmly presenting reality ('checking your pulse daily is still a necessary part of your care'). This technique addresses the client's denial without being confrontational and ensures that critical safety information is reinforced.

Step-by-Step Solution

1
Identify the client's behavior and underlying coping mechanism.
The client is demonstrating denial by ignoring the reality of needing ongoing cardiac monitoring and follow-up care.
Recognizing the defense mechanism is essential to formulating a therapeutic response.
2
Determine the appropriate practical nurse (PN) intervention.
The PN must use therapeutic communication to acknowledge the client's emotional state while gently orienting them to reality and reinforcing the established teaching plan.
Validating feelings builds trust, while presenting reality ensures client safety and compliance with the medical regimen.
3
Evaluate the options against communication principles and the PN scope of practice.
Eliminate options that use non-therapeutic blocks (like 'why' questions or false reassurance) and options that require RN-level assessment or care plan modification.
This leaves only the therapeutic response that safely reinforces adaptive coping and required health maintenance.

Key Concept

Therapeutic Communication and Adaptive Coping
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Topics

Coping Mechanisms

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