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Difficulty: MediumCoping Mechanisms

A client receives a new diagnosis of amyotrophic lateral sclerosis (ALS) from the neurologist. Shortly after the discussion, the nurse enters the room and the client says, "The doctor is just being overly dramatic. I just have a pinched nerve from working in the garden, and it will heal on its own with some rest." Which initial response by the nurse is the most therapeutic?

  1. A
    Your test results clearly show ALS, not a pinched nerve. We need to start planning your care.
  2. You are thinking this might just be a pinched nerve. How are you feeling about the conversation you just had with the doctor?Answer
  3. C
    Why do you feel the doctor is being overly dramatic about your condition?
  4. D
    It is perfectly normal to feel this way. I am sure everything will work out for the best.

Answer

The most therapeutic response is to use reflection and an open-ended question, stating, "You are thinking this might just be a pinched nerve. How are you feeling about the conversation you just had with the doctor?"
The client is exhibiting denial, a common and protective initial defense mechanism when faced with a devastating diagnosis. The most therapeutic nursing response utilizes reflection to gently acknowledge what the client has said without reinforcing the denial, paired with an open-ended question to invite the client to share their feelings when they are ready. This approach keeps communication open while respecting the client's current coping limits.

Step-by-Step Solution

1
Analyze the client's statement and behavior.
The client is minimizing a severe diagnosis (ALS) by attributing symptoms to a minor issue (a pinched nerve).
This identifies the defense mechanism being used, which is denial.
2
Evaluate the purpose of the identified defense mechanism.
Denial acts as a temporary protective barrier against the overwhelming anxiety of a terminal or severe illness diagnosis.
Understanding that denial is a normal initial stage of grief guides the selection of a supportive, non-confrontational intervention.
3
Select the most therapeutic communication technique.
The correct response uses reflection to acknowledge the client's current perception without validating the delusion, followed by an open-ended question to explore feelings.
This approach maintains the therapeutic relationship, allows the client to process the trauma at their own pace, and avoids non-therapeutic blocks like confrontation or false reassurance.

Key Concept

Therapeutic Communication and Coping Mechanisms (Denial)
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Topics

Coping Mechanisms

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