A nurse is planning care for a client who has adjustment disorder following a traumatic below-the-knee amputation. Which of the following actions should the nurse include?

Respect the client's need for social isolation.

Encourage the client's family members to perform the client's ADLS.

Discourage the client from talking about activities he did prior to the amputation.

Determine the client's stage of grief.

Answer and Explanation

The Correct Answer is D

A. Respect the client's need for social isolation:
While it's important to respect the client's need for moments of solitude and privacy, complete social isolation can lead to feelings of loneliness and exacerbate depressive symptoms. Balance is key; the nurse should encourage social interactions and support while respecting the client's need for personal space and alone time.

B. Encourage the client's family members to perform the client's ADLs:
Encouraging the client's family members to take over all activities of daily living (ADLs) can strip the client of their independence and self-efficacy. Instead, the nurse should support the client in actively participating in their self-care activities to the extent they are able. This promotes a sense of control and empowerment during a challenging time.

C. Discourage the client from talking about activities he did prior to the amputation:
Discouraging the client from discussing their life before the amputation can hinder the process of accepting the loss. Allowing the client to talk about their past experiences, activities, and memories can be therapeutic. It helps them process the grief associated with the amputation and allows for a healthy expression of emotions.

D. Determine the client's stage of grief:
Understanding the client's stage of grief is crucial. Grieving is a natural and individual process, and different people progress through stages like denial, anger, bargaining, depression, and acceptance at their own pace. By identifying the client's current stage of grief, the nurse can offer tailored support and interventions, ensuring the client's emotional needs are met effectively.

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Correct Answer is A

Explanation

A. Encourage participants to express conflicts and work toward resolution:
Explanation: During the working phase of therapy, the nurse encourages participants to express their conflicts, fears, and concerns openly. The working phase is characterized by active participation and problem-solving. Encouraging clients to express their feelings and conflicts helps them work through their issues and promotes resolution. It's a crucial step in the therapeutic process, allowing clients to explore their emotions and gain insight into their anxieties.

B. Inform participants about principles for listening to and respecting each other:
Explanation: Setting ground rules for respectful communication is typically done in the initial or pre-working phase of therapy. While maintaining a respectful environment is important throughout the therapeutic process, it's not specific to the working phase.

C. Suggest that participants reflect on their progress as individuals and as a group:
Explanation: Reflection and assessment of progress can occur throughout therapy, not just in the working phase. It's essential for clients to evaluate their progress, but this action is not exclusive to the working phase.

D. Ask participants to become acquainted with and talk to each other:
Explanation: Building rapport and getting acquainted with other group members often occurs in the initial phase of therapy. During the working phase, the focus shifts more toward discussing and resolving specific issues and conflicts rather than introductory activities.

A. "I will do my best to avoid crying in front of my loved ones." B. “I will stay in bed on days when I feel exhausted." C. “I’ll use the coping mechanisms that helped me in the past." D. “I will avoid talking about events that upset me."

Correct Answer is C

Explanation

A. "I will do my best to avoid crying in front of my loved ones."
This statement suggests the client might be trying to hide their emotions, which can lead to further emotional distress. Suppressing emotions, like crying, is not a healthy coping mechanism and can exacerbate feelings of sadness and isolation.

B. “I will stay in bed on days when I feel exhausted."
Staying in bed excessively, especially during the day, is a behavior associated with depression and can worsen depressive symptoms. Encouraging the client to maintain a regular sleep schedule and engage in activities, even if they are small, is a more beneficial approach. Physical activity and exposure to natural light can positively impact mood.

C. “I’ll use the coping mechanisms that helped me in the past."
This is the correct choice. Reverting to previously effective coping mechanisms indicates an understanding of self-awareness and the ability to recognize what has worked positively in the past. Coping mechanisms such as relaxation techniques, hobbies, social support, or therapy can be valuable tools in managing depressive symptoms.

D. “I will avoid talking about events that upset me."
Avoiding discussions about upsetting events can prevent the client from addressing and processing their emotions, hindering the therapeutic process. Encouraging open communication and expressing feelings with a trusted individual, therapist, or support group can help the client work through emotional challenges.

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