Chapter 1: Holistic Caring

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____	1.	According to the 2002 U.S. Census, approximately how many Americans are older than age 65?
a.	5%	
b.	20%	
c.	12%	
d.	2%	

____	2.	Today, the average life expectancy is
a.	70.2 years	
b.	75 years	
c.	79 years for women and 72.9 for men	
d.	longer for men than for women	

____	3.	All of the following would be good explanations of “holistic nursing” except
a.	Holistic nursing focuses on the specific disease or disorder a person has in order to treat it effectively	
b.	Holistic nursing aims to treat the whole person, not just a specific disease or disorder the person may have	
c.	Holistic nursing focuses on the individual patient and uses many techniques such as empathetic listening, music, and imagery as well as specific clinical skills	
d.	Holistic nursing weaves the technical skills of nursing with the social science skills that enhance communication and rapport between the nurse and the person receiving care	

____	4.	The Science of Human Caring was developed by
a.	Florence Nightingale	
b.	Clara Barton	
c.	Jean Watson	
d.	Savage and Money	

____	5.	The Science of Human Caring emphasizes all of the following except
a.	Transpersonal caring	
b.	A focus on the person while you are with him or her	
c.	Ensuring that all nonessential tasks, such as bathing, are given according to a strict schedule	
d.	Reaching out to the patient, making eye contact, touching if appropriate, speaking softly	

____	6.	Basic concepts of holistic nursing include
a.	Using your developed clinical expertise	
b.	Developing a close relationship with the patient’s family members and significant others	
c.	Remembering the personal intuition and creativity of patients in your nursing plan	
d.	All of the above	

____	7.	Most elderly people having a heart attack have
a.	Pain diffused over the entire chest area	
b.	No pain	
c.	Crushing sternal pain	
d.	Pain on the left side of the chest and pain that radiates down the left arm	

____	8.	Compared with the doses of medication given to a young adult, the doses given to an old-old person are usually
a.	Smaller	
b.	Larger because the old-old person is probably sicker	
c.	The same	
d.	Minimal because the person is very old and probably near death	

____	9.	What communication technique has been developed specifically for dealing with demented elderly persons?
a.	Cognitive therapy	
b.	Validation therapy	
c.	Geriatric Depression Scale	
d.	MMSE (Mini-Mental Status Examination)	

____	10.	Mr. Leopold is an 82-year-old man in your care. He has been diagnosed with liver cancer and has long-standing cardiovascular problems. He begins to scream at you and pushes his meal tray away. What would be an appropriate response?
a.	Take the meal tray and leave the room without saying anything	
b.	Tell him to stop screaming in a loud voice	
c.	Calmly ask him what he is upset about and listen carefully to him	
d.	Call your supervisor	

____	11.	You enter the room of Mrs. Brewster, an 87-year-old frail woman with congestive heart failure. As you enter, you say, “Good morning, dear. I’d like to bathe you now, honey.” Later, your supervisor reprimands you because your way of speaking to Mrs. Brewster was an example of
a.	Beneficence	
b.	Paternalism	
c.	Caring	
d.	Malfeasance	

____	12.	Mr. Johnson is recovering from abdominal surgery and complains of pain and asks for pain-relieving medication. What should be your first action?
a.	Ask him to rate the pain on a 1-to-10 scale, with 10 being the most severe pain	
b.	Observe him and try to ascertain his level of pain	
c.	Tell him he must tell his physician and that you can do nothing for him	
d.	Tell him that the pain medication he had been given earlier should be controlling his pain	

____	13.	The term “elite old” is used for people
a.	85 to 100 years old	
b.	Older than 100 years	
c.	75 to 84 years old	
d.	65 to 74 years old	

____	14.	Which of the following are key concepts in holistic nursing?
a.	Following physician instructions and follow-up with the physician	
b.	Developing a relationship with family members of the patient	
c.	Using what you have learned—your clinical experience	
d.	All of the above	

Chapter 1: Holistic Caring
Answer Section

MULTIPLE CHOICE

	1.	ANS:	C
According to the census, 1 in 8 Americans was older than age 65 years in 2002. That corresponds to 12.5%. There were 20.8 million women and 14.8 million men older than age 65.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	2.	ANS:	C
The average life expectancy has increased dramatically in the last 75 years—from 59.7 years in 1930 to 79 years for women and 72.9 years for men, according to the 2002 U.S. Census Bureau.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	3.	ANS:	A
The word “holism” is derived from the Anglo-Saxon root “hal,” which means “whole” or “to heal.” Holistic nursing focuses on the whole person, not the person’s specific disease or disorder, and it employs many alternative therapies as well as specific clinical skills of modern medicine to help the patient.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	4.	ANS:	C
The Science of Human Caring is a nursing philosophy developed by Dr. Jean Watson of the University of Colorado. This philosophy is taught worldwide and serves as the basis for teaching and caregiving. Florence Nightingale, known as the Mother of Modern Nursing, practiced holistic nursing long before the term was even used. Clara Barton served as an exemplary nurse during the Civil War, and Savage and Money have written on the concepts of holistic nursing.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	5.	ANS:	C
It is important that essential tasks, such as giving medications, be done according to schedule, but if a patient is in distress, needs to talk, or needs answers, there should be some flexibility for nonessential tasks. The nurse needs to treat the whole person, not just give out drugs and see to it that certain grooming tasks are performed routinely.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	6.	ANS:	D
The practice of holistic nursing includes following physicians’ orders, using your clinical expertise, respecting and drawing on a person’s knowledge of and intuition of his or her own body, and integrating significant others in the patient’s life into their care.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	7.	ANS:	B
Most elderly people who have a heart attack do not have chest pain. The symptoms associated with chest pain, described in responses A, C, and D, are symptoms often found in younger people.

PTS:	1	KEY:	Nursing Process Step: Assessment | Patient Care Area: Cardiovascular

	8.	ANS:	A
Medication doses for a young or middle-aged person may overwhelm the systems of an elderly person with devastating results. As people age, their metabolism often slows, and there are many changes in body systems that can affect a drug’s absorption and excretion. Older people often require smaller drug dosages. For these reasons, responses B and C are incorrect. Response D is also wrong—and insensitive and uncaring.

PTS:	1	KEY:	Nursing Process Step: Implementation | Patient Care Area: Medication

	9.	ANS:	B
Validation therapy is a communication technique that has been developed specifically for dealing with demented elderly persons (including persons with Alzheimer’s disease). It focuses on accepting the person’s view of reality and age-appropriate behavior and can be used to calm a pacing, agitated older person. Responses C and D refer to tools used in neurological and psychological assessment. Cognitive therapy (response A), also known as cognitive behavioral therapy, is a method of treating many emotional and psychological problems, including anxiety, depression, and phobias.

PTS:	1	
KEY:	Nursing Process Step: Implementation | Patient Care Area: Mental health, psychology

	10.	ANS:	C
You should try to find out what is bothering him and ask specific questions—for example, is it the food? You should remember that he has been given a very serious and probably terminal diagnosis, and anger is understandable. There is a reason for every behavior, and you have the responsibility to learn the reason before reacting. Response A is uncaring and insulting to the patient. Response B is responding with anger and does not allow you to determine the cause of the outburst. If the patient becomes unruly, you should ask for assistance, but you should first try to determine the reason for the outburst and provide comfort if you can.

PTS:	1	
KEY:	Nursing Process Step: Implementation | Patient Care Area: Mental health, psychology

	11.	ANS:	B
You were speaking to Mrs. Brewster as if she were a child, a form of paternalism. Elderly people should be addressed with respect, usually by Mr. or Mrs., unless they specifically ask you to use their first name. Responses A and D are ethical principles in nursing—beneficence to be aimed for, malfeasance to be avoided. Response C is also incorrect: your supervisor would not reprimand you for that. More importantly, caring includes respect, and paternalism is not respectful to an older adult.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	12.	ANS:	A
A cardinal rule is “A patient’s pain is what the patient tells you it is.” If he reports a pain level of 9 and you think it might be 5, you should act on the basis of the reported level of 9. You cannot determine how he feels (response B). Most physicians leave standing orders for postoperative pain, so response C is incorrect. His pain is not being controlled, so response D would be belittling.

PTS:	1	KEY:	Nursing Process Step: Implementation | Patient Care Area: Pain management

	13.	ANS:	B
The increased numbers of elderly people in the United States has resulted in new definitions. The term “young old” is used for people 65 to 74 years old; “middle-old,” for people 75 to 84 years old; “old-old,” for people 85 to 100 years old; and “elite old,” for people older than 100 years.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable

	14.	ANS:	D
Key concepts in holistic nursing include following physician instructions and communicating with the physician; using your own clinical experience; respecting the ideas the elderly patient has about his or her own body and how to make it well and incorporating those ideas into the nursing plan, if possible; and involving family members in the care of the elderly patient.

PTS:	1	KEY:	Nursing Process Step: Not applicable | Patient Care Area: Not applicable