mr. winston is an 89-year-old who was diagnosed with alzheimer's disease 5 years ago. since he is in the last stages of his disease, he has been referred to a local hospice program. the interdisciplinary team meets to discuss his plan of care. which intervention would not appear in this plan of care?
a.challenge the client to alter distorted thought patterns and view self and the world more realistically. b.reminisce about past experiences with the client, as appropriate. c.assist the client in labeling the painful emotion that he is feeling. d.avoid using humor with the client because he will not understand.
****i picked a but the correct answer is d. of course they couldn't offer me a reason. the reason i chose a was because in the last stage of the disease no matter what you say if they want to go ride a plane that is what they are "going" to do.****
Specializes in Utilization Review/Case Management.
I would have picked D. It's the "Best answer" out of the 4. FYI, if an answer has a word such as "avoid" "NOT" "ALL" (or words simliar to that), it's usually the right answer. Assist, challenge, things like that are all good/right choices (usually). This will help you on your NCLEX! (even if you don't know the answer)
Specializes in Utilization Review/Case Management.
Sometimes it's less distressing to the patient to go along with them than reorient them - "your husband isn't here right now" rather than "your husband died six years ago."
Isn't that a way of reorienting the patient? Albeit, only the immediate "now" is being addressed. That is probably all an end stage dementia patient can handle anyway. But it still can be a form of reorienting, without the terrible detail that he is dead. Just a thought...
I would've chosen A because a person in the last stages of Alzheimers doesn't alter his thinking. You can use humor, and most people do in the Alzheimers setting, because someone in the last stages doesn't know what the heck you are talking about, anyway!
I also think A was the correct answer. In late stages, it is much more important to validate their feelings than it is it attempt reorientation - which does not work
I picked D after rereading the question, first would of been A but then thinking like an nclex question I ended up with D thinking that an infant/toddler would not of understood humor but might (small might) understand a more real (reality) train of thought..
I agree with llg. As a Hospice nurse my opinion is that there are many shades to the question. It depends on on the individual patient. D is the most appropriate without knowing the details.
I would have chosen A. This pt, having Alzheimer's for 5 years, and at the point of death with it, is beyond being able to orient to reality. It sounds like a heartless intervention anyway. Why would you want to orient this pt to something so grim as his reality? His distorted thoughts are probably happier.
Simple humor might be a way to connect with this pt. Why would you take any method off the table. If the pt is beyond the point of simple humor, he will certianly never orient to is reality.
Remember, look for those key words in your answers that will key you to an answer. Also watch for the distractions in the questions...example "challenge" does not only mean to confront, but to "test one's abilities or resources in a demanding but stimulating undertaking."*
How do think those people get A's remember everything? They don't, they just know how to read the questions. (took me a while to learn it, too, but once I did, my grades improved from high C's to Low A's...2 letter grades!)
Nursing isn't just knowing the facts, but being able to interpret and use them, that is why the questions are worded the way they are.
My point is that questions such as this are testing a person's test-taking abilities more than their comprehension & retention of relevant nursing knowledge. Yes, nurses need to do more than just recall facts. But identifying the correct answer because it's an always/never/avoid option or because you "know how to read the question" doesn't seem to be testing any relevant nursing knowledge. If it's so important to test whether or not the students truly believe that "avoid the use of humor" is a good intervention, then make the question about THAT specifically, as opposed to mixing it up with the valid issue of whether or not it's appropriate to reorient a late stage Alzheimer's patient? It's not like a nurse would have to choose between "No humor" and "Reorientation". They are two separate and important issues, so why muddy it up by putting them into the same question where you have to choose "the best" of the perhaps less than ideal options? I just think it's an ineffective testing method.
D.Avoid using humor with the client because he will not understand.
D is the answer....why avoid humor..Read the whole Q...choices A, B, & C are good for patient with Alzheimer..While choice D, the question does not state anything about the client being sensitive to humor...you were thinking that because the client is in his last stages of his disease that he could no longer tolerate humor.
For anyone taking NCLEX RN....Choices AB&C are all positive and D is negative..
For Patient admitted to a hospice......you have to make him or her as comfortable as possible.
you were thinking that because the client is in his last stages of his disease that he could no longer tolerate humor.
I was thinking that "Challenge the client to alter distorted thought patterns and view self and the world more realistically" was asking way too much of a late stage Alzheimer's patient. That sounds like a lot more than "Attempt to reorient."
It's true that I couldn't see any reason to avoid humor; however, I COULD see that a late stage Alzheimer's patient wasn't likely to "alter distorted thought patterns and view self and the world more realistically."
I can see how using test taking strategies why D would be the correct answer here and may have even gotten it right on a test, but I still think this type of question does a lousy job of testing useful knowledge and ability to apply that knowledge.
trudlebug
92 Posts
Yes (see my other post)