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.****
When a medical pt is dying from something incurable we are essentially fighting a losing battle, but we as caregivers are obligated to fight that battle... Why would you not at least TRY to orient a demented pt and even if we lose at least we tried...
Perhaps I did not express myself the way in which I intended. I interpreted the word "challenge" as 'to dispute.' Inform....yes. Encourage....yes. Dispute....No.
eg. if he was saying that it was 1929, I feel it's totally appropriate and necessary to try to orient him to the current day and time, but not go back and forth (i.e. ARGUE) with him.
The word "challenge" is what got me. It can be interpreted many different ways.
Perhaps I did not express myself the way in which I intended. I interpreted the word "challenge" as 'to dispute.' Inform....yes. Encourage....yes. Dispute....No.
eg. if he was saying that it was 1929, I feel it's totally appropriate and necessary to try to orient him to the current day and time, but not go back and forth (i.e. ARGUE) with him.
The word "challenge" is what got me. It can be interpreted many different ways.
For the most part, I think "challenge the patient to ____" on boards, etc... should be interpreted in a positive manner. On the other hand, "confront" is more negative.
Having the "correctness" of an answer hinge upon how a person interprets a word like "challenge" doesn't seem like a good way to test a person's knowledge of Alzheimers, nursing care, or critical thinking skills in general. If the instructor meant "attempt to reorient", then why not just say it? I could imagine a different instructor saying A was best and that "avoid using humor" meant to avoid introducing non-reality based input to the patient or to discourage simply making a joke of the patient's confusion as opposed to meaning never use humor under any circumstance.
This just seems like nothing more than a trick question. If you know your stuff about Alzheimers, you will immediately think that in late stage Alzheimers, attempting to reorient a patient may not help much and may even unnecessarily upset the patient. So you are immediately drawn to answer A. "Avoid the use of humor" doesn't sound great plan either but there's no reason to specifically use humor either. On the other hand, it IS good to know that in some cases one shouldn't push too hard to reorient. Since we're supposed to choose the "best" answer, it seems reasonable to think the best answer would incorporate your applied knowledge about that particular condition, not your ability to sniff out a trick question.
I don't think that was a trick question at all. Many times these test throw in alot of "stuff" in the questions that many times are used as distractions.
I believe the whole point the instructor is trying to make is to not avoid humor with any type of patient. Humor is great, as long as its appropiate. The fact that the patient had dementia, was probably irrelevant. Many times us nursing students read too much into these questions. Ask yourself ' What does the instructor want me to know in general. Yes, instructors may throw in a curve ball every now and then, however we must be prepared and focus on what exactly is being asked. Please forgive me if I'm wrong, but I've seen too many times when other "read in to the question" and make it harder on themselves. I'm a very good test taker, so I try my best to really decipher the question and ask my self, What is it that I need to know ?
Which would not appear: 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.
Okay, I'd have picked D and here's why. Think CARE PLAN. What does a care plan book say about dementia/alzheimers? A, B, and C. In the real world, are you going to reorient an Alzheimer's patient to the fact that the loved one they are calling for is dead, OF COURSE NOT. However, nursing school and the NCLEX are not about the real world, they are about the fantasy world at NCLEX general hospital, where you always have time, you always have staff, and your patients are perfect, and an Alzheimer's patient would react to redirection positively. D doesn't "fit" and therefore, D's the answer.
Is it right, is it teaching you anything, of course not. That's why my first day on the floor as a new LPN, my preceptor told me to "forget all that crap they taught you in school.":bugeyes:
To me this kind of distraction IS a trick. Why set up a scenario specifically with an Alzheimers patient only to test if, in general, a student is aware that humor is okay to use in some situations - though maybe or maybe not in THIS specific scenario?
I agree that it's very easy to "read too much into" nursing test questions. In clinical and on care plans, you are supposed to be thinking about all angles of a problem and possible interventions and rationales but on the test, you have to suspend this type of thinking and pay careful attention to the exact wording of the question and not think one step beyond what is stated, despite all of the "distractions" thrown in.
I'm a good test-taker as well and I managed to get good grades in nursing school as well in my other classes. Regardless, I thought too many questions didn't test applicable knowledge as opposed to one's ability to decipher what the question was "really" asking.
Nerdtonurse - I think you hit the nail on the head. The fact that the instructor specifically noted that it was late stage Alzheimers is what can throw off an otherwise knowledgable student. But I do think you're right in terms of explaining why D was deemed the best answer on this question.
I would go with A. I am a board certified psych RN. I worked hopice for a short while. Your teacher should be referred to the nursing intervention called Validation Therapy which extols the virtue of therapeutic communication through going with the dementia patient's reality rather than insistance on the practitioner's reality.
I would go with A. I am a board certified psych RN. I worked hopice for a short while. Your teacher should be referred to the nursing intervention called Validation Therapy which extols the virtue of therapeutic communication through going with the dementia patient's reality rather than insistance on the practitioner's reality.
That must have been what was practiced with my Grandfather. When he talked to the nurses about plowing the fields that morning, they didn't insist that he hadn't (when, in fact, he hadn't farmed in over 40 years).
back2thebooks
266 Posts
Perhaps I did not express myself the way in which I intended. I interpreted the word "challenge" as 'to dispute.' Inform....yes. Encourage....yes. Dispute....No.
eg. if he was saying that it was 1929, I feel it's totally appropriate and necessary to try to orient him to the current day and time, but not go back and forth (i.e. ARGUE) with him.
The word "challenge" is what got me. It can be interpreted many different ways.