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Difficulty: MediumCoping Mechanisms

During morning rounds on a cardiac telemetry unit, the nurse observes a client who sustained a myocardial infarction 48 hours ago performing vigorous push-ups on the floor. When instructed to stop, the client aggressively states, "Leave me alone! My heart is perfectly fine and I am discharging myself today!" Which action by the nurse is the most therapeutic priority?

  1. State, "It can be overwhelming to deal with a heart problem, but we need you to rest in bed right now."Answer
  2. B
    State, "Your heart muscle is currently damaged, and this level of exercise could cause a life-threatening complication."
  3. C
    Immediately notify the healthcare provider and document the client's nonadherence to the prescribed activity restrictions.
  4. D
    State, "Why do you feel the need to perform strenuous exercise when you were just admitted for a heart attack?"

Answer

State, "It can be overwhelming to deal with a heart problem, but we need you to rest in bed right now."
The correct answer therapeutically addresses the situation by recognizing that the client's behavior is rooted in denial, which serves to protect them from the terrifying reality of a heart attack. By validating the unspoken emotion (feeling overwhelmed or fearful) without directly challenging the denial, the nurse builds trust. It also sets a clear, immediate limit to return to bed, prioritizing physiological safety without initiating an argument.

Step-by-Step Solution

1
Identify the client's coping mechanism.
The client is using denial, as evidenced by ignoring the reality of the myocardial infarction and engaging in contraindicated strenuous exercise.
Recognizing the defense mechanism is essential to formulating a therapeutic response.
2
Determine the priority need of the client.
The immediate priorities are physical safety (stopping the exertion) and psychosocial support (addressing the underlying fear driving the denial).
A myocardial infarction recovery requires strict activity management to prevent further cardiac damage, while psychological recovery requires a supportive environment.
3
Select the nursing response that addresses both priorities therapeutically.
Acknowledging the overwhelming nature of the situation validates the client's fear, and calmly directing them back to bed addresses the physical safety risk without aggressively confronting the denial.
Therapeutic communication should reduce anxiety and promote safety simultaneously.

Key Concept

Coping Mechanisms: Denial and Therapeutic Communication
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Topics

Coping Mechanisms

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