During a follow-up visit, a female patient is describing new onset of marital discord with her terminally ill spouse to the hospice nurse. Which Kübler-Ross stage of dying is the patient experiencing?

Choice A reason: The ego defense model, rooted in psychoanalytic theory, describes psychological mechanisms (e.g., denial) to cope with stress, not a normal line of defense for health. It focuses on mental protection, not holistic wellness, making it unrelated to the nursing theory described with a line of defense.

Choice B reason: The immunity model is not a recognized nursing theory. While immunity relates to biological defense, it does not encompass a “normal line of defense” for person, family, or community health. This choice is incorrect, as it lacks the holistic framework described in the question.

Choice C reason: Pender’s Health Promotion Model focuses on behaviors to enhance health but does not use the concept of a normal line of defense. It emphasizes individual motivation and barriers, not systemic protection against stressors, making it an incorrect match for the described nursing theory.

Choice D reason: The Neuman Systems Model views individuals, families, or communities as systems with a normal line of defense, a protective barrier against stressors. This holistic theory emphasizes maintaining stability through primary, secondary, and tertiary prevention, aligning with the described concept, making it the correct theory.

Choice A reason: Depression is strongly linked to insomnia in older adults, causing difficulty falling asleep due to rumination, low mood, or altered sleep architecture. Assessing for depression is critical, as it may underlie the sleep disturbance, requiring targeted interventions like therapy or antidepressants to improve sleep and mental health.

Choice B reason: Muscle fatigue may cause physical discomfort but is not a primary cause of difficulty falling asleep. It is more likely to affect sleep quality than initiation. Depression is a more common and significant contributor to insomnia in older adults, making this an incorrect choice.

Choice C reason: Hypertension can be associated with sleep apnea but is not directly linked to difficulty falling asleep. It may result from poor sleep but is less likely the cause. Depression is a more prevalent cause of insomnia, making this a less relevant condition to assess.

Choice D reason: Hypothyroidism can cause fatigue and sleepiness, not difficulty falling asleep. It is less commonly associated with insomnia compared to depression, which significantly disrupts sleep onset in older adults. This condition is less relevant to the patient’s presentation, making it incorrect.