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.****
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.
Thanks for the clarification. We are on the same page : Reorient, but move on if they are resistant arguing will only further their agitation.
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.****
i personally, think that this is a test structure flaw.
patients that are in the late states of alzheimers are not even going to be ambulating or following anything, because that would actually require a conscious brain function of "let's get up and move now" and a late-stage patient cannot do that.
therefore, knowing that, d seems to be the most appropriate answer, however, i would probably use b because b doesn't necessarily require the client to do anything and you never know what the brain may process that we may know nothing about...similar to a coma patient waking up and remembering everything that happened around them.
I thought hospice was about allowing a person to die with dignity. If so, then allow me dignity, help me to remember who I am and who my loved ones are.
But, if your loved ones are dead and you believe they are not, then would you really want to be oriented to that pain over and over again? When I first started as a CNA many yrs ago, I worked on a Gero Psych unit and would tell people that their husband or wife had passed away many yrs ago. These pts would carry on as if the news was fresh. It was horrible to see this and know that I'm forcing them to experience the pain again. It took me about 2 days before I stopped. The grief of losing your sig other is horrendous, but can you imagine feeling the grief over and over? Even if you don't remember from hour to hour, I would think grief would take a huge toll on your physical body.
Sometimes, you have to look beyond what a pt is saying and look for the why. Are they sun downing, stressed, is this the time they usually started dinner and homework with the kids yrs ago. Some of those routines are still in us.
For me, don't bother to reorient me. Play along and ask me questions about my children and husband and work. Let me be as content as possible.
I would have to go with D. Humor is a great tool but it can also be easily misunderstood, especially with people that aren't AO3. Perhaps once you get to know your patient you'll know if/how he responds to humor; until then it's better to play it safe.
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.
Perhaps you're right ! I guess we all think differently, which isn't bad. I often enjoyed healthy debates about nclex styled questions. Its so interesting to see how others people's thought processes are different from our own.
I would have picked A, too. D (the correct answer) doesn't make sense to me...
re read question very carefully..it asks about what you would NOT do...you would NOT-- AVOID humor..if you pick A then you are saying that you would avoid humor..so you dont include "avoid humor" for your careplan...reading through a question quickly can cause errors when taking a test..read carefully, but dont overthink..
I would agree A is the correct answer. We actually just went over this in skills lab, and we were told never argue or question the reality of an A's patient.
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)
I thought that you always try to orient a patient, but you just don't argue with them because you may agitate them. That what my Nursing Assessment teacher told us....
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Nurse Salt
330 Posts
Thanks for the clarification. We are on the same page
: Reorient, but move on if they are resistant arguing will only further their agitation.