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Question

Difficulty: HardCoping Mechanisms

Following a severe myocardial infarction, an adult client is prescribed a strict cardiac diet. When the practical nurse enters the room with afternoon medications, the client is eating a large pepperoni pizza brought by a visitor. The client remarks, 'My heart issue was just a minor cramp. Besides, cheese has calcium, which strengthens muscles, so this food is actually helping me heal.' Which response by the practical nurse is the most therapeutic?

  1. It can be overwhelming to make sudden lifestyle changes. What is your understanding of the reason for your hospital admission?Answer
  2. B
    You did not have a muscle cramp; you had a heart attack. Eating this pizza goes directly against your prescribed treatment plan.
  3. C
    Why would you choose to eat outside food when the dietitian has already planned meals specifically for your cardiac recovery?
  4. D
    I will let you finish this slice since it has calcium, but I need to alter your care plan so the dietitian provides more appealing food tomorrow.

Answer

The response validating the client's potential feelings of being overwhelmed and asking about their understanding of the admission.
The correct response effectively uses therapeutic communication by validating the underlying stress of the situation ('overwhelming to make sudden lifestyle changes') without agreeing with the client's distorted rationale. By asking an open-ended question about the client's understanding of their admission, the practical nurse encourages dialogue and assesses the client's current reality orientation and readiness to learn, which is the safest initial step when addressing severe denial and rationalization.

Step-by-Step Solution

1
Identify the defense mechanisms being used by the client.
The client is using denial ('just a minor cramp') and rationalization ('cheese has calcium... helping me heal') to cope with the anxiety of a life-threatening cardiac event.
Recognizing the underlying psychological coping mechanisms is essential before selecting a therapeutic response.
2
Evaluate the provided options against principles of therapeutic communication and the practical nursing scope of practice.
Direct confrontation increases anxiety, 'why' questions cause defensiveness, and altering care plans is outside the PN scope.
Eliminating non-therapeutic and out-of-scope actions isolates the safest and most effective nursing intervention.
3
Select the response that maintains safety while preserving the therapeutic relationship.
The option that acknowledges the difficulty of lifestyle changes and uses an open-ended question to assess understanding is selected.
This approach gathers data about the client's readiness to learn without aggressively stripping away their protective defense mechanisms.

Key Concept

Therapeutic Communication and Defense Mechanisms
Estimated Time:1m 30s
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Topics

Coping Mechanisms

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