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Difficulty: Very hardCoping Mechanisms

A 32-year-old client is admitted to the rehabilitation unit following a traumatic amputation of the left arm. During morning care, the client suddenly yells at the Practical Nurse (PN), "Get out! You have no idea what it's like to be a freak! I don't want to see anyone." The client then begins to cry. Which of the following nursing actions by the PN are appropriate to support the client's coping? (Select all that apply.)

  1. Stand quietly near the door and state, "I can see you are very upset. I will stay here with you for a few minutes."Answer
  2. B
    Attempt to calm the client by logically explaining how physical therapy will help them regain independence.
  3. C
    Tell the client, "I understand how hard this must be for you, but you need to give yourself time to heal."
  4. Acknowledge the client's distress by stating, "You are going through an incredibly difficult change. It is okay to feel angry right now."Answer
  5. E
    Direct the client to look at the surgical site, explaining that confronting reality is necessary to progress through the stages of grief.
  6. Offer to assist the client with a concrete, manageable task, such as washing their face, once the severe crying begins to subside.Answer

Answer

The appropriate actions are to stand quietly near the door to provide therapeutic presence, acknowledge the client's distress by validating their anger, and offer to assist with a concrete task once the crying subsides.
Supporting a client during an acute emotional crisis requires validating their feelings, providing a safe and non-judgmental presence, and helping them regain a sense of control. Standing quietly to offer presence acknowledges their distress without placing demands on them. Validating that it is acceptable to feel angry normalizes their response to a traumatic loss. Offering a concrete, simple task once the client calms down helps ground them and restores a small degree of autonomy and control.

Step-by-Step Solution

1
Analyze the client's behavior and the clinical context.
The client has suffered a traumatic amputation and is exhibiting acute distress, anger, and grief through yelling and crying.
Understanding the emotional phase is crucial for selecting appropriate therapeutic communication techniques.
2
Evaluate each nursing action against the principles of therapeutic communication and crisis management.
Providing presence, validating emotions, and offering simple grounding tasks are therapeutic. Logical reasoning, claiming to understand their unique loss, and forcing confrontation are non-therapeutic blocks.
Interventions must focus on safety, emotional validation, and meeting the client where they are in their grieving process.
3
Select all options that represent safe, therapeutic, and scope-appropriate PN actions.
Options demonstrating presence, validation, and grounding are identified as correct.
These actions directly support adaptive coping during an acute emotional crisis.

Key Concept

Therapeutic Communication and Support for Adaptive Coping
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Topics

Coping Mechanisms

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