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Difficulty: MediumCoping Mechanisms

An older adult resident at a skilled nursing facility is participating in a scheduled physical therapy session following a total hip arthroplasty. After struggling to complete a walking exercise, the resident abruptly pushes the walker away, shouts at the practical nurse (PN), "You are all incompetent and making me worse!" and refuses to continue. Which actions should the PN take? Select all that apply.

  1. Remain present with the resident while maintaining a calm, non-threatening posture.Answer
  2. Recognize the resident's outburst as a manifestation of the displacement defense mechanism.Answer
  3. C
    Reassure the resident by stating that every patient struggles and feels this way after joint surgery.
  4. D
    Question the resident about why they believe the healthcare team is incompetent.
  5. E
    Cancel the remaining physical therapy sessions for the week to minimize the resident's stress.
  6. Notify the supervising registered nurse regarding the resident's escalating emotional distress and refusal of care.Answer

Answer

The appropriate actions are to remain calmly present with the resident, recognize the behavior as the defense mechanism of displacement, and notify the supervising registered nurse.
The correct actions prioritize client safety, emotional support, and appropriate role delegation. Remaining calmly present provides support without escalating the situation. Recognizing the outburst as displacement helps the nurse maintain clinical objectivity rather than taking the insult personally. Finally, notifying the RN ensures the client's care plan can be properly reassessed by the healthcare team.

Step-by-Step Solution

1
Analyze the resident's coping behavior.
The resident is projecting anger about their physical limitations onto the staff, which identifies the use of displacement.
Understanding the psychological defense mechanism guides the nurse in formulating a therapeutic, non-judgmental response.
2
Determine the most appropriate therapeutic communication approach.
Remaining quietly present is therapeutic, whereas asking demanding questions or offering false reassurances will block communication.
A calm, silent presence supports a highly distressed client without provoking further escalation or defensiveness.
3
Apply the practical nursing scope of practice to the scenario.
The PN must report the escalating distress and therapy refusal to the RN, but cannot independently cancel the therapy orders.
Altering the multidisciplinary plan of care is outside the PN scope, but data collection and reporting are mandated responsibilities.

Key Concept

Therapeutic communication, coping mechanisms (displacement), and practical nursing scope of practice.
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Topics

Coping Mechanisms

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