Chapter 36: Self-Actualization, Spirituality, and Transcendence

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

Multiple Choice

1. Which statement best demonstrates an older adult’s success at achieving self-actualization?

a. “My father was an alcoholic, but he did love us.” b. “I always feel safe when my son is visiting.” c. “My heart problems are better since I had the surgery.” d. “I’ve been elected president of my service organization again.”

ANS: A

Self-actualization is the highest level of human functioning according to Maslow and would be reflected in the ability to see both the good and the bad in others. Biological or physiological integrity, safety and security, and self-esteem are all part of the hierarchy of human needs but they are not the highest level of human functioning.

DIF: Cognitive Level: Applying REF: p. 503

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. An economically disadvantaged older black man who regularly checks out books from the local library to read to neighborhood children b. A wealthy white older woman who is constantly searching for a better laxative c. A middle-class white man who was forced into an early retirement and is living in fear of being evicted from his apartment d. The older wife of a famous celebrity who travels the world but starves herself and seeks plastic surgery in her quest to fight the physical signs of aging

2. Which description would be most characteristic of a self-actualized individual?

ANS: A

The individual described here is displaying three of the characteristics of a self-actualized individual: altruism, courage, and self-renewal. This individual displays altruism in that he is helping others by reading to the children in the neighborhood and improving their literacy. Despite being economically disadvantaged, he displays courage by conquering despair and giving of himself. He is also displaying self-renewal in that he is connected to the world around him and is giving back to it. The other scenarios listed are all incorrect because the individuals described are all focused on their own personal problems despite having fewer challenges than the economically disadvantaged older black man.

DIF: Cognitive Level: Applying REF: pp. 503–504

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Suggesting that they travel with a seniors’ group b. Addressing arrangements to have medical care, if needed, during their travels c. Providing information regarding pet care services for their beloved dog d. Reassuring the client that their concerns about safety are unfounded

3. What is the role of the nurse in assisting older adults with travel interests?

ANS: B

The role of the nurse is to assist older people by addressing potential problems and planning ahead for contingencies that would support them in continuing to experience and express their passions. Addressing potential health care needs would best fulfill this role. The remaining options are not as powerful in helping to achieve their goal of traveling.

DIF: Cognitive Level: Applying REF: p. 508

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Arranging care so that the client’s prayer time is not interrupted b. Assuming the responsibility of notifying the hospital chaplain of the client’s admission c. Providing the client with the schedule of religious services offered in the chapel d. Suggesting that the family attend worship services with the client whenever possible

4. Which intervention best demonstrates that the nurse understands the spiritual needs of a terminally ill client?

ANS: A

Private time for prayer, meditation, and reflection may be needed. Nurses may neglect to explore this issue with elders because religion and spirituality may not seem a high priority. The client should be assured that religious longings and rituals are important and that opportunities will be made and respected. The nurse should never assume a client’s desire or need to see clergy or to have family accompany him or her to services, and should respond only when asked to.

DIF: Cognitive Level: Applying REF: p. 509

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Introduce a sensory distraction, such as television b. Reassure him that this is normal phase that everyone experiences c. Listen and help him express his feelings about life and death d. Ask the doctor to order a psychiatric consult for possible depression

5. An elder is experiencing severe chronic pain resulting from a terminal illness. Which intervention by the nurse would be most appropriate when he verbalizes a desire to find “some sort of meaning to all of this”?

ANS: C

The most appropriate intervention at this time is to listen and facilitate the expressions of feelings about life and death. The patient may have the need to talk; the role of the nurse is to assist the patient to find meaning and reconciliation. By attempting to distract the client, you are negating the patient’s feelings. It is not true that “everyone experiences it” and each person’s experience is different and the patient needs to be allowed room for expression. It is within the role of the nurse to listen to the patient and assist him in expressing concerns. A psychiatric consultation is not warranted at this time.

DIF: Cognitive Level: Applying REF: p. 510 | p. 514

TOP: Integrated Process: Caring MSC: Client Needs: Psychosocial Integrity a. It is efficient and usually takes less than 5 minutes to implement. b. It has been shown to decrease anxiety and depression. c. It improves cognitive abilities. d. It has been known to eliminate emotional distress.

6. When a terminally ill client expresses a need “for something more to help me cope with the pain,” the nurse bases the recommendation of meditation on which principle concerning this alternative therapy?

ANS: B

Meditation has been shown to produce a sense of calm, better health, and a higher energy levels in its wake. Meditation usually lasts 20 minutes at a time. It does not cause changes in cognitive abilities, nor does it eliminate emotional distress, but it does help manage it.

DIF: Cognitive Level: Applying REF: p. 513

MSC: Client Needs: Psychosocial Integrity

TOP: Integrated Process: Caring

7. When the daughter of a client diagnosed with moderate Alzheimer’s disease (AD) asks about the possible benefits of enrolling her mother in art classes, the nurse’s response is based on the knowledge that: a. creative activities are not limited to cognitively intact older adults; even individuals with dementia can benefit from creative activities. b. individuals with dementia who have rational language skills can benefit from creative activities. c. cognitively impaired elders cannot benefit from creative activities due to altered brain processes. d. cognitively impaired elders are usually too agitated to participate in creative arts.

ANS: A

Creative arts offer great value to individuals with dementia; the arts offer opportunities for individuals to express themselves and their vision of the world. Language skills are not required for individuals with dementia to participate in some of the arts. Individuals with dementia can benefit from creative activities. Not all individuals with dementia are agitated.

DIF: Cognitive Level: Applying REF: pp. 506–507

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. These types of activities can help establish new relationships. b. Intergenerational activities can foster a sense of meaning and purpose. c. Such partnering can increase the self-esteem of the younger people. d. These activities can decrease social isolation in the older people.

8. Which statement best demonstrates the primary benefit of intergenerational partnering and the activities that it creates?

ANS: B

Intergenerational activities primarily focus on fostering a sense of meaning and purpose in those involved. Establishing new relationships, increasing self-esteem of younger people, and decreasing isolation in older people are goals, but will occur most often when the individual has a life with purpose and meaning.

DIF: Cognitive Level: Applying REF: p. 507

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Donating his body to the local teaching hospital for research purposes b. Discussing his experiences as a World War II veteran in Europe to a reporter c. Keeping a journal to be passed on to his great-grandchildren d. Making a pilgrimage to a location with personal religious significance

9. Which activity assures the nurse that the client’s wish to “leave a living legacy” has been accomplished?

ANS: A

The purpose of a living legacy is to transcend death. Anatomical gifts are an example of a living legacy. Discussing war experiences is an example of a collective/group legacy. A written journal and a religious trip represent personal/self-legacies.

DIF: Cognitive Level: Applying REF: p. 516

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A 77- year-old client recently lost her husband to a chronic progressive neurological disease. She has a history of osteoarthritis and hypertension and was newly diagnosed with metastatic gastric cancer. She sold her home and moved to another state to be closer to her children, but she misses her many close friends. What makes her at risk for spiritual distress? (Select all that apply.)

a. Metastatic cancer b. Age (77) c. Moving far away from other family and friends d. Loss of a spouse e. Chronic conditions: hypertension and arthritis

ANS: A, C, D

Conditions that most predispose an individual to spiritual distress include those that are life threatening, such as a terminal illness, loss of interpersonal support, and those that affect the ability to participate in spiritual rituals. Metastatic cancer is a life-threatening illness, and moving to another state and the loss of a husband result in the loss of interpersonal support. Spiritual distress is not directly associated with a specific age; that is, it is not true that the older a person is, the more spiritual distress she feels. Chronic conditions are usually not associated with spiritual distress unless they affect the ability to participate in spiritual rituals, which is not indicated in this scenario.

DIF: Cognitive Level: Applying REF: p. 510

TOP: Integrated Process: Teaching/Learning

MSC: Client Needs: Psychosocial Integrity a. Intergenerational activities can help all participants establish new relationships. b. Intergenerational activities are required by state and local geriatric regulatory agencies.

2. The nurse managers of the geriatric and pediatric units arrange an intergenerational holiday party. The rationale for arranging such a partnering is based on which principle? (Select all that apply.)