Chapter 34: Relationships, Roles, and Transitions

Touhy: Ebersole & Hess' Toward Healthy Aging, 9th Edition

Multiple Choice

1. Which of the following reactions to the loss of a spouse or long-term partner is a unique example of older adult male bereavement?

a. Withdrawing from friends and family b. Remarrying within months of the loss c. Focusing on “doing” rather than “feeling” d. Experiencing moderate to severe depression

ANS: B

Bereaved males may be more socially and emotionally vulnerable. Widowers adapt more slowly than widows to the loss of a spouse and often remarry quickly. The remaining options reflect reactions that are typically seen in both grieving men and women.

DIF: Cognitive Level: Applying REF: p. 465

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. “How long have you been in this relationship?” b. “Have you experienced prejudice and discrimination in your life?” c. “As a couple are you financially secure?” d. “Do you as a couple share similar religious beliefs?”

2. Which question will best assess the ability of the LGBT older couple to successfully adjust to the challenges of aging?

ANS: B

Some research has suggested that this population may adapt more successfully to old age as a result of successful coping over a lifetime with discrimination and prejudice. While the remaining options are positive factors, they do not have the same degree on influence on the development of coping skills that the correct option has.

DIF: Cognitive Level: Applying REF: pp. 469–470

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Being responsible for paying the client’s bills b. Organizing the client’s birthday celebration c. Accompanying the client to doctor’s appointments d. Assuring the client has clean, appropriate clothing available

3. When acting as a fictive kin, in which activity will a paid caregiver engage?

ANS: B

Fictive kin are nonrelatives who become surrogate family members. These individuals take on instrumental and affectional attributes of family such as described in the correct option. The remaining options lack the element of affection and familial concern.

DIF: Cognitive Level: Applying REF: p. 471

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Reviewing the developmental milestones of childhood b. Identifying local sources of child counseling services c. Discussing the common challenges of parenting a 6-year-old d. Teaching stress management and relaxation techniques

4. A widowed grandmother is about to assume the role of custodial parent for her 6- year-old grandchild. Which intervention has priority when preparing the grandmother for long-term success in this new role?

ANS: D

Grandmothers raising grandchildren reported the most stress, intrafamily strain, and perceived problems in family functioning with the stress increasing over time. The introduction of the skills identified in the correct option will serve to improve and maintain the family’s quality of life. While the remaining options are appropriate, they lack attention to the long-term, fundamental barrier to a successful transition into this new role.

DIF: Cognitive Level: Applying REF: p. 476 | p. 478

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. He smiles when reminiscing about the trips they took together over the years. b. He explains that he can’t make a decision about moving “just yet.” c. He agrees to eat some of his “favorite soup” that his daughter has made. d. He is heard saying, “I’ll never get over the loss, but my life has a purpose.”

5. Which behavior suggests that an older adult who has lost his life partner is successfully managing the exploration stage of the adjustment process?

ANS: A

The exploration stage is characterized by the ability to accept the loss and look back fondly upon it. The reactionary stage would be a time when indecision is typical. During the withdrawal stage, eating is often affected. Integration is successful when the individual again shows satisfaction with his life.

DIF: Cognitive Level: Applying REF: pp. 465–466

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Establishing a new budget that will allow them to travel to see the grandchildren b. Reading magazines devoted to making decisions about retirement plans c. Looking for ways to “fill up the days” d. Volunteering at the local animal shelter

6. Which activity would a couple in the reorientation phase of their retirement engage in?

ANS: A

The reorientation phase is one where the couple is developing a realistic and satisfactory lifestyle that would include the opportunity to travel. The near phase includes both planning and fantasizing about the retirement. The disenchantment phase is where the couple deals with letdown and boredom, while the engagement in meaningful activities such as volunteering occurs in the stability phase.

DIF: Cognitive Level: Applying REF: p. 465, Box 34-1

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Facilitating a support group for children being raised by grandparents b. Helping the grandparents express their feeling regarding this unexpected role change c. Offering a monthly parenting class for this cohort of grandparents d. Suggesting couple’s therapy to assist in managing any new stress on their marriage

7. Which nursing intervention best addresses the need for social support demonstrated by an older adult couple who will be assuming responsibility for the raising of two grandchildren?

ANS: C

Primary care grandparents with a network of social support seem to experience fewer negative consequences, but instrumental supports such as assistance with child rearing are often lacking. Education and training programs and support groups are valuable resources, and nurses can be instrumental in developing and conducting these types of interventions. While the remaining options are appropriate, they do not focus on the needs that are identified as currently unaddressed.

DIF: Cognitive Level: Applying REF: pp. 475–476

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. Which statements made by a couple who have recently retired support the nurse’s evaluation that the transition to retirement has been a successful one? (Select all that apply.)

a. “I’m afraid we can’t make it that weekend; we’ll be visiting the grandchildren.” b. “I’m not accustomed to sharing my kitchen with anyone else.” c. “One week I was working 50 hours and the next I didn’t have to get up until noon.” d. “I often wonder if my buddies from the plant miss me.” e. “We have found a few painless ways to reduce our monthly expenses.”

ANS: A, E

The correct options demonstrate a sense of purpose and adjustment to the realities of retirement and so that the transition has been a successful one. The remaining options suggest that the couple is not adjusting well to having each other around so much and involved in activities they previously used as being theirs alone. Feeling lonely or abandoned is also a sign of ineffective adjustment. A transition into a retirement rather than an abrupt one is also a barrier to a successful adjustment into retirement.

DIF: Cognitive Level: Applying REF: p. 464

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Asking about when she plans to retire b. Assessing her ability to handle the stresses of retirement c. Engaging her in a conversation about her interests d. Inquiring about the existence of any chronic illnesses e. Scheduling a full physical examination

2. Which intervention demonstrates effective care for an individual who has expressed a wish to “retire sometime soon”? (Select all that apply.)

ANS: A, B, C, D, E

Talking with clients about retirement plans, providing anticipatory guidance about the transition to retirement, identifying those who may be at risk for boredom and health concerns, and referring to appropriate resources for retirement planning and support are important nursing interventions. The client could also take this time to consider prevention and lifestyle changes, which can be identified by scheduling a full physical examination.

DIF: Cognitive Level: Applying REF: pp. 464–465

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. “Have you chosen an area of the house for your mom to live in?” b. “Have you considered scheduling regular visits for your mom with your sister who lives out of state?” c. “You have every right to be nervous; multigenerational households are usually not successful.” d. “Have you investigated what activities are available at the senior center near your home?” e. “Since your mom is so computer literate she can stay in touch with her friends when she moves.”

3. An older woman is preparing to move in with her daughter following the death of her spouse of 55 years. The daughter asks a nurse, “I know we are doing the right thing for mom, but I am a bit nervous about this. Do you have any suggestions about things that we should do in preparation?” The nurse responds: (Select all that apply.)

ANS: A, B, D, E

There are some important modifications that may need to be made when adding an older person to the household, which include arranging semiprivate living quarters if possible, scheduling regular visits to other relatives to give each family time for respite and privacy, and arranging senior activities for the older person to help keep contact with members of his or her own generation. It is important to consider how the older person will feel about giving up familiar surroundings and friends. There are a growing number of intergenerational families.

DIF: Cognitive Level: Understanding REF: p. 468, Box 34-5

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity