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Difficulty: MediumCoping Mechanisms

A client recovering on a surgical unit following an emergent below-the-knee amputation turns away, refuses to look at the surgical site during a dressing change, and loudly demands that the practical nurse (PN) leave the room immediately. Which actions are appropriate for the PN to take to support the client's coping? Select all that apply.

  1. Remain quietly in the room at a comfortable distance to provide a supportive presence.Answer
  2. Acknowledge that feeling angry and overwhelmed is an expected response to the procedure.Answer
  3. Document the client's reaction and notify the supervising registered nurse about the refusal of care.Answer
  4. D
    Reassure the client that modern prosthetics will allow for a rapid return to their previous lifestyle.
  5. E
    Insist that the client briefly look at the surgical site so that the acceptance phase can begin.
  6. F
    Inform the client that yelling at the nursing staff will not change the outcome of the surgery.

Answer

The appropriate actions are to remain quietly in the room to provide a supportive presence, acknowledge the client's feelings of anger as an expected response, and document the behavior while notifying the supervising registered nurse.
Remaining quietly in the room provides a non-threatening therapeutic presence, allowing the client space to process acute emotions without feeling abandoned. Acknowledging the client's anger validates their emotional experience and demonstrates empathy. Documenting these coping behaviors and notifying the RN aligns with the PN scope of practice for reporting escalating distress and alterations in the care plan.

Step-by-Step Solution

1
Identify the defense mechanisms the client is utilizing.
The client is demonstrating denial (refusing to look at the surgical site) and displacement or anger (yelling at the nurse).
Recognizing acute psychological defense mechanisms is the first step in formulating a safe, empathetic response.
2
Select interventions that fall within the practical nursing scope to support adaptive coping.
Therapeutic presence, validation of feelings, and communication with the healthcare team are selected as safe actions.
These actions address the client's emotional state without forcing a premature confrontation with the physical reality of the loss.
3
Eliminate interventions that utilize non-therapeutic communication blocks.
Options that offer false reassurance, argue with the client, or attempt to force the client out of denial are rejected.
Non-therapeutic blocks increase patient anxiety, damage trust, and impair the coping process.

Key Concept

Supporting adaptive coping during acute denial and anger through therapeutic communication and presence.
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Topics

Coping Mechanisms

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