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:

Taylor-Johnson Temperament Analysis

A psychological test that assesses personality traits and temperaments to evaluate personal relationships and potential conflicts.

Projective Personality

A type of personality assessment that relies on projecting one's own interpretations onto ambiguous stimuli to uncover underlying thoughts and feelings.

Objective Personality

Personality assessment tools or methods that rely on structured, standardized questions or prompts to evaluate personality traits with minimal subjective interpretation.

Bender Visual-Motor Gestalt Test

A psychological assessment tool that evaluates visual-motor functioning, planning, and organizational abilities through the copying of geometric shapes.