An 85-Year-Old Man Comes to the Office Due to Increasing

question 277

Multiple Choice

An 85-year-old man comes to the office due to increasing dyspnea and fatigue, which are affecting his ability to perform activities of daily living.  His medical conditions include chronic obstructive pulmonary disease and congestive heart failure.  The patient's wife passed away a year ago and he is struggling to come to terms with her death.  He misses her and feels hopeless that his medical conditions will ever improve.  The patient has stopped going to his community recreation center as "it is such an effort to get there and I don't enjoy it anymore."  He admits to occasionally forgetting to take his medications, which include tiotropium, salmeterol, and furosemide.
Physical examination is significant for a prolonged expiratory phase and decreased breath sounds bilaterally, which are unchanged from previous examinations.
Which of the following is the best next step in management of this patient?

• A)Assessment for suicidal thoughts
• B)Education about the importance of medication adherence
• C)Grief counseling
• D)Mini-Mental Status Examination
• E)Referral for senior center support

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Definitions:

Level I

Typically refers to an initial or basic stage in a series of levels or phases, often pertaining to entry-level requirements or classifications.

Stage 1

Represents the initial phase in a process or series of developments.

Bertrand Russell

A British philosopher, logician, mathematician, historian, writer, social critic, and Nobel laureate, known for his work in mathematical logic and analytic philosophy.

Passions

Intense, driving feelings or convictions that motivate individuals to pursue particular activities or goals with enthusiasm and zeal.