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ANCC Medical-Surgical Nursing Exam Prep

Category - Medical-Surgical Nursing Practice Test

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A client undergoes below the knee amputation following a vehicular accident. Three days postoperatively, the client is refusing to eat, talk, or perform any rehabilitative activities. The best initial nursing approach would be to:
  1. Give him an explanation of why there is a need to quickly increase his activity
  2. Emphasize repeatedly that with his prosthesis, he will be able to return to his normal lifestyle.
  3. Appear cheerful and non-critical, regardless of his response to attempts at intervention.
  4. Accept and acknowledge that his withdrawal is an initially normal and necessary part of grieving.
Explanation
Answer - D - Accept and acknowledge that his withdrawal is an initially normal and necessary part of grieving. The withdrawal provides time for the client to assimilate to what has occurred and integrate the change in the body image. Acceptance of the client’s behavior is an important factor in the nurse’s intervention.
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