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Question

Difficulty: HardCoping Mechanisms

While collecting morning vital signs on a surgical unit, the practical nurse observes a client polishing a pair of hiking boots. The client, who is scheduled for a below-the-knee amputation the following day due to peripheral vascular disease, states, "I have to get these ready for my mountain trip next month." Which statement by the practical nurse is the most therapeutic response?

  1. You have a major surgery scheduled for tomorrow. Tell me what you are thinking about the procedure.Answer
  2. B
    Why are you planning a hiking trip when you are having your leg amputated in the morning?
  3. C
    Try not to worry too much; modern prosthetics will easily allow you to hike again soon.
  4. D
    Let me put those boots in your closet so you can focus on resting before your surgery.

Answer

The correct answer acknowledges the impending reality of the surgery while using open-ended communication to encourage the client to express their underlying feelings.
The correct response gently presents reality (the surgery scheduled for tomorrow) and uses an open-ended statement ('Tell me what you are thinking') to invite the client to explore their underlying fear and anxiety. This therapeutic approach addresses the client's denial without being overly aggressive or confrontational.

Step-by-Step Solution

1
Analyze the client's behavior and statement.
The client is preparing for a future hiking trip despite an impending amputation, which indicates the use of denial as a defense mechanism to cope with extreme anxiety and impending loss.
Recognizing the defense mechanism is essential to formulating an appropriate therapeutic response.
2
Recall the principles of therapeutic communication when a client is in denial.
The nurse should not play into the denial, nor should they harshly confront the client. The goal is to gently present reality and encourage the exploration of feelings.
Direct confrontation increases anxiety, while playing along reinforces maladaptive coping.
3
Evaluate each option for therapeutic versus non-therapeutic techniques.
Options asking 'why', offering false reassurance, or changing the subject are non-therapeutic communication blocks. Only the option that states the reality of the surgery and asks for the client's thoughts is therapeutic.
Identifying communication blocks eliminates incorrect distractors on the NCLEX.

Key Concept

Therapeutic Communication for Denial
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Topics

Coping Mechanisms

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