Answer to Question 1
ANS: A
Instead of using abstract prompts (like a specific time), the nurse should use words directly applicable to the client's daily routine, like before lunch, to anchor the client's recognition of time frames. The nurse should restate ideas using the same words and sequence and validate the meaning of a client's response. As dementia progresses, clients become increasingly unable to express complete thoughts and eventually cannot carry on even simple conversations. The nurse should use questions that can be answered with a yes or no for clients with less verbal skill. The nurse should note whether the client's behavior is consistent with the yes or no answer and follow up if the behavior is incongruent with the words.
Answer to Question 2
ANS: D
Older adults appreciate having the nurse provide structure to the history-taking interview by explaining the reasons for it and what it will involve. Asking clients to share something about themselves and their life history, apart from the reasons for the health visit or admission, helps to establish rapport and increases the client's comfort level. By relating their life stories and exploring options relevant to their current health situation, older adults are able to step back and look at their situation in the present from a broader perspective. Nurses get to know the client as a person rather than categorically as an older adult. Ego integrity relates to the capacity of older adults to look back on their lives with satisfaction and few regrets, coupled with a willingness to let the next generation carry on their legacy. Integrity involves acceptance of one's one and only life cycle as something that had to be and that by necessity permitted of no substitution. Acceptance develops through self-reflection and dialogue with others about the meaning of one's life. Nursing strategies encouraging life review and reminiscence groups facilitate the process. Old age is shaped by a lifetime of experience. Assessment of older adult clients begins with their story. As they relate their story, the nurse should look for value-laden psychosocial issues (e.g., independence, fears about being a burden, role changes, and vulnerability) and client preferences. These are significant issues for older adult clients that may not be directly expressed.
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