This was a question on our test today. What do you think the answer is?

longlegsintexas · Feb 4, 2009

My first inclination was D. Even if someone is demented, they can appreciate humor. :bugeyes:

VickyRN, MSN, DNP, RN · Feb 4, 2009

This was a poorly worded test item.

jjjoy, LPN · Feb 5, 2009

BTW, I worked as an item writer for NCLEX once, and I think this is the sort of question that would be a good one for boards, though some of the wording might be considered "tricky" and might be changed slightly.

What exactly is this type of question really testing though? It's not testing one's knowledge of Alzheimer's as you're more likely to get the question wrong if you're aware of the difficulty and sometimes futility of reorienting late stage Alzheimer's patients. And If someone chooses A instead of D, it doesn't necessarily mean that they think that humor has no place in patient care. It just means that they thought A was "the better" answer between the two more reasonable answer choices. So the question isn't really testing if one is aware that humor is okay sometimes. Finally, it takes critical thinking to come up with rationales for either answer, so choosing A also doesn't mean that one lacks critical thinking skills or doesn't understand the underlying rationale for the various "more correct" answer choices.

It seems to me that this type of question is mostly just testing a person's ability to learn to take this particular type of multiple choice test.

Wishinonastar, BSN · Feb 5, 2009

What exactly is this type of question really testing though? It's not testing one's knowledge of Alzheimer's as you're more likely to get the question wrong if you're aware of the difficulty and sometimes futility of reorienting late stage Alzheimer's patients. And If someone chooses A instead of D, it doesn't necessarily mean that they think that humor has no place in patient care. It just means that they thought A was "the better" answer between the two more reasonable answer choices. So the question isn't really testing if one is aware that humor is okay sometimes. Finally, it takes critical thinking to come up with rationales for either answer, so choosing A also doesn't mean that one lacks critical thinking skills or doesn't understand the underlying rationale for the various "more correct" answer choices.
It seems to me that this type of question is mostly just testing a person's ability to learn to take this particular type of multiple choice test.

You are testing the knowledge of appropriate nursing care of the end stage client. These are concepts that were probably given in class and the instructor is applying them to a realistic situation. Remember geriatrics and death and dying lectures? Yes, these type of questions require a skill that the instructor is trying to get the student to develop. The skill is being able to think through each answer as to why it is right or wrong and being able to defend the chosen answer with a rationale. What is your rationale? -always needs to be the bottom line for the nursing student. We remember so little of what we learn that basic concepts become hugely important in practice. Reality orientation, reminiscing, helping a patient who cannot find words- all are things we learn TO DO. Avoid using humor? When did you ever learn to do this except possibly when dealing with certain psych patients? The topic is end of life care. I still like the question except for the word "challenge", but it implies helpng the patient to work his/her brain cells which is always ok to do.

mark08 · Feb 5, 2009

the correct answer is "d". remember not all the time to "avoid" :smokin:

mark08 · Feb 5, 2009

the word "challenge" is interesting. many people automatically assume that a "challenge" is combative or confrontational in nature. however, a gentle challenge can be a positive thing -- a nudge towards helping the patient stay in contact with the moment-to-moment reality of his life to keep his consciousness in this world as much as possible.
having not studied the course content tested on the exam, i am not sure what the right answer is. but i would probably choose d. i don't think humor should be automatically ruled out as a possibility -- though if the patient is completely beyond comprehension, then i would choose a for all the reasons mentioned by the other posters.

the correct answer is "d". remember not all the time to "avoid" :smokin:

Not_them_again!! · Feb 5, 2009

The only logical answer is E, nursing instructors write questions that make entirely no sense due to a lack of experience in the material being taught. Their knowledge is strictly learned from reading various articles, publications and text books and never from actual experience. Most entered the field of nursing only to find it was "not for them." Then having the good fortune of partnering with a financially capable significant other that was able to "foot the bill" while they continued to higher degrees, were able to continue their education and thus become "educators," with no real knowledge and especially experience of the content they are teaching. Ambiguous questions are their forte. Of course they cannot explain or give a rationale, they have none, at least not of their own.

But to get back to the question of "end stage Alzheimers. What can you possibly say to someone who understands probably nothing? Oh! Now I get it...The question is a Joke!!! LOL

ohmeowzer RN, RN · Feb 5, 2009

A is the answer.

kb8221489 · Feb 5, 2009

D is definitely the answer.

C. Thinking · Feb 5, 2009

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 agree that d. is the correct answer.

in a, it says that the team will "challange" the client to alter distorted thought patterns and view self and world more realistically. this means, too me, that they are going to try and devert the patient away from disorientated thoughts as much as possible and try to bring him back to reality. that doesn't mean it will work, but they are at least planning to try.

b - reminiscing is an intervention for alzheimer's dementia

c - the patient will have painful emotional feelings that he may or may not be able to relay to the staff, so it would be important to help him describe and label them.

d - why would you avoid using humor? makes little sense to me.

mommyjskns · Feb 5, 2009

I would definitely say A. At the end stage of Alzheimers, the pt is going to think and believe whatever he wants, no matter what you "challenge" him to think.

trudlebug · Feb 5, 2009

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.****

was this for a psych class? if so, then they definitely would want you to try to re-orient the patient (sorry, client:icon_roll).

in the world of nursing school, the only possible answer is d, but in the real world, both a and d are "wrong", because eventually it becomes impossible to re-orient some patients to reality.

btw, all who answered a, re-read answer d. the question asks for what would not be included, and d states that you would avoid humor...is that what you meant?

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.

(nursing is like texas, it's a whole 'nother country :) )

*thefreedictionary.com