10.9 PREP U: Unit 3

An older female expresses remorse for a past indiscretion. What is the nurse's best response? a) "Not forgiving yourself for something in your past can affect your health." b) "There is a bridge group meeting this evening you could attend." c) "There is nothing you can do to change the past." d) "Thinking about the past can cause unnecessary stress."

a) "Not forgiving yourself for something in your past can affect your health." Carrying the burden of the wrongs committed by or to oneself is very stressful and can detrimentally affect health. Forgiving and accepting forgiveness is healing. For older adults, forgiveness can facilitate the important process of putting things in order and achieving closure to unfinished business.

While the nurse is performing a recently admitted hospital patient's morning care, the patient states, "I'm pretty sure I'll never see my own apartment again." Which of the following responses by the nurse best demonstrates effective communication? a) "What is it that makes you feel that way, ma'am?" b) "I'm sure that's not going to be the case." c) "All in all, you're doing quite fine actually." d) "There's a lot that we can do, dear, to make sure that you do."

a) "What is it that makes you feel that way, ma'am?" Option A demonstrates empathy and respect, while also facilitating further assessment findings around the patient's beliefs for recovery through the use of an open-ended question. Option B demonstrates false reassurance of recovery, while Option C downplays the patient's concerns. Option D includes a patronizing term of address.

Which lab can the nurse exclude when identifying changes in hormone levels that can affect sexual function? a) Albumin b) Complete blood count c) Estradiol d) Prostate-specific antigen

a) Albumin An albumin level is most likely not included in the assessment of labwork that can identify changes in hormone levels affecting sexual function.

A geriatric nurse is preparing information for an older adult sexual health awareness course. Which contributing factors to sexual dysfunction in older adults should the nurse include in the course? (Select all that apply.) a) Cardiovascular disease b) Religious conflict c) Diabetes mellitus d) Excessive secretion of bartholin's glands e) Obesity

a) Cardiovascular disease b) Religious conflict c) Diabetes mellitus e) Obesity There are numerous causative or contributing factors to sexual dysfunction in older adults, including all of the answer options excessive secretions of bartholin's glands. In the older female, usually less secretion and vaginal lubrication occurs resulting in vaginal dryness.

Which statements describe age-related changes in sexual response? Select all that apply. a) Dyspareunia in women b) May gain a new interest in sex c) Thinning of the vaginal walls d) Premature ejaculation e) Increase in frequency of orgasm

a) Dyspareunia in women b) May gain a new interest in sex c) Thinning of the vaginal walls Age-related changes in sexual response include: dyspareunia, decrease in frequency of orgasm, possible new interest in sex, thinning of vaginal walls, and slower to ejaculate.

The nurse assessing an older adult male client with low testosterone levels should be alert for which finding? a) Elevated glucose level b) Enlarged testes c) Reports of increased stamina d) Increased upper arm circumference

a) Elevated glucose level Low testosterone levels are associated with a higher risk for type 2 diabetes, manifested by elevated glucose levels. Decreased arm circumference would be an expected finding due to the occurrence of decreased muscle mass. Shrinkage of the testes can occur with low testosterone levels. Decreased, not increased stamina, is an expected finding with low testosterone levels.

The nurse expects which labs to be ordered when an older female is being assessed for menopausal symptoms? Select all the apply. a) Follicle-stimulating hormone (FSH) b) Thyroid function panel c) Liver panel d) Testosterone levels e) Lutienizing hormone (LH)

a) Follicle-stimulating hormone (FSH) b) Thyroid function panel d) Testosterone levels e) Lutienizing hormone (LH) Diagnostic blood tests to assess the menopausal state include: FSH, LH, estrogen, testosterone, and free testosterone levels. If sexual dysfunction is present or low libido is present, thyroid function, not liver function, should be evaluated.

An older adult client states she has been reincarnated from a previous life in order to complete her purpose in this life. This client most likely practices which religion? a) Hinduism b) Judaism c) Islam d) Buddhism

a) Hinduism Hinduism involves the belief in karma and reincarnation. Enlightenment and meditation are most indicative of Buddhism. Islam is a monotheistic religion characterized by belief in Mohammed. Judaism is characterized by the belief in one universal God and one life on earth.

An older female client complains of decreased libido and sexual pleasure. The nurse suspects that the client's complaints are due to which lab finding? a) Low testosterone level b) Low serotonin level c) Low estrogen level d) Low dopamine level

a) Low testosterone level Some women can have declines in testosterone, which affects libido and sexual pleasure. Estrogen enhances the availability of serotonin and dopamine, resulting in higher levels of these neurotransmitters. Low estrogen can result in cognitive, physical, and emotional problems, but low testosterone most likely is the reason for decreased libido and sexual pleasure.

Which statements describe age-related changes in sexual response? Select all that apply. a) May gain a new interest in sex b) Increase in frequency of orgasm c) Premature ejaculation d) Dyspareunia in women e) Thinning of the vaginal walls

a) May gain a new interest in sex d) Dyspareunia in women e) Thinning of the vaginal walls

The nurse caring for a client practicing Christian Science might expect the client is least likely to refuse which treatment? a) Meditation b) Flu vaccination c) Psychiatry referral d) Antibiotics

a) Meditation The Christian Science religion is based on the use of faith for healing. Clients may decline drugs, psychotherapy, and vaccination.

A practicing Protestant client states he's retired but he enjoys volunteering at the thrift store through his church. With what denomination does this client most likely associate? a) Salvation Army b) Christian Church c) Episcopal d) Mennonite

a) Salvation Army The Salvation Army offers social welfare programs and centers. The Christian Church, and those of Episcopal or Mennonite faith are not known to encourage a lot of participation in community service ministries as much as the Salvation Army.

An older male tells the nurse he is concerned that he won't be able to remain intimate with his wife due to erectile dysfunction. What is the nurse's best response? a) Sexuality includes warmth, caring, and sharing between people. b) What medications are you currently taking? c) Both of you will experience less desire over time and will adjust. d) All men experience loss of sexual response sooner than women.

a) Sexuality includes warmth, caring, and sharing between people. Sexuality includes love, warmth, caring, and sharing between people and identification with a sexual role. Older adults do not necessarily experience less sexual desire. Erectile dysfunction may be a side effect of medications, but this question does not address the client's concern of remaining intimate. Individual differences occur in the intensity and duration of sexual response in older adults.

An older female diagnosed with arthritis complains of limited movement during sex. What is the nurse's best recommendation? a) Suggest alternate positions. b) Suggest abstinence. c) Increase the dose of nonsteroidal anti-inflammatory drugs (NSAIDS). d) Ask the health care provider about aspirin use.

a) Suggest alternate positions. Arthritis can result in limited movement during sex. Initial best recommendations include instructing clients about alternative positions. NSAIDS can actually cause sexual dysfunction. Aspirin is anti-inflammatory medication. Before suggesting more medication, initially the nurse can suggest alternative positions. Abstinence is not an ideal solution because desire is still present even when clients are uncomfortable.

The nurse knows which finding characterizes menopause? a) Low estrogen levels that occur due to an emotional conflict in a woman's life b) Absence of menstrual periods for at least 12 consecutive months c) Sudden onset of missed periods following decreased progesterone levels d) Low testosterone levels occurring due to stress and weight gain as a woman ages

b) Absence of menstrual periods for at least 12 consecutive months Menopause is a naturally occurring process characterized by the absence of menstrual periods for at least 12 consecutive months. Menopause is a multihormone process. Estrogen and progestin decline. Low testosterone can occur as a result of thyroid suppression that may lead to weight gain.

Mr. Thomas and Mrs. Young are residents of a long-term care facility who are both physically frail but cognitively healthy. Last night, the nurse at the facility discovered Mr. Thomas and Mrs. Young in bed together in Mr. Thomas' room and engaging in foreplay. How should care providers best respond to these residents' new sexual relationship? a) Teach Mr. Thomas and Mrs. Young about sexual health promotion. b) Accommodate the residents' relationship and provide them with appropriate privacy. c) Ensure that each residents' family members are aware of this development. d) Have each resident assessed to ensure that the relationship is medically safe and appropriate.

b) Accommodate the residents' relationship and provide them with appropriate privacy. Sexual relationships between competent and consenting residents in institutional settings should be accommodated by care providers. It is likely unnecessary to directly involve family members. Education and medical assessment are likely unnecessary and may be inappropriate.

An older client of Muslim faith has died of natural causes. Which action is permissible by the Protestant nurse when handling the client's body according to his spiritual beliefs? a) Autopsy b) Allowing family to wash the body c) Performing organ donation assessment d) Praying over the body

b) Allowing family to wash the body Muslims prefer for family to wash and prepare the body of the deceased. Autopsies are prohibited except when legally mandated. This client died of natural causes; an autopsy is likely not legally necessary. Organ donation is not allowed. Only family or a practicing Muslim can pray with the dying person of Muslim faith.

What is the most important reason for the nurse telling the medical examiner that the deceased older male is Jewish? a) So the body is buried within 48 hours b) Any removed parts must be returned to the body c) To allow the Torah to be buried with the client d) To allow time for client's beard to be shaven

b) Any removed parts must be returned to the body Orthodox Jews believe that all parts of the body need to be returned to earth. The Torah does not need to be buried with the client. The body must be buried within 24 hours. Shaving the beard is not a high priority of preparing the body for burial.

Which dinner tray would be best to serve a client who attests to be a Seventh-Day Adventist believer? a) Chicken on a wheat bun with iced tea b) Baked chicken and mixed vegetables c) Shrimp, vegetables, and pasta d) Barbeque pork and cole slaw

b) Baked chicken and mixed vegetables Seventh-Day Adventists promote healthy lifestyle practices because the body is seen as the temple of the Holy Spirit. Alcohol, tobacco, coffee, tea, and recreational drugs are prohibited. Pork and shellfish are avoided by most, and many are vegetarians.

The nurse is caring for an older client who identifies himself as Episcopalian. On Fridays, what is the nurse's best action in accordance with the client's religious beliefs? a) Ask nursing assistant to wash client's feet. b) Exclude meat on client's food trays. c) Offer to walk client outside to smoke. d) Serve communion after evening meal.

b) Exclude meat on client's food trays. Some Episcopalians abstain from meat on Fridays. The clergy usually serve communion; that's not the most appropriate action by the nurse. Walking the client outside to smoke is not the best action by the nurse in accordance with the client's religious practices. Washing feet is important in the Mennonite faith.

The nurse should notify the healthcare provider about which condition in the client's history before she starts progestin and estrogen treatment? a) Arthritis b) Hypertension c) Insomnia d) Bladder infections

b) Hypertension According to research, the client with any type of cardiac history must be fully evaluated before beginning hormone replacement therapy (HRT). Bladder infections, arthritis, and insomnia are not contraindications to HRT and are listed as expected physical symptoms of menopause that may improve once treatment has begun.

Which benefits of regular exercise can enhance the older female's quality of life? (Select all that apply.) a) Delayed orgasm b) Improved physical health c) Decreased anxiety d) Decreased need for medication e) Decreased depression

b) Improved physical health c) Decreased anxiety d) Decreased need for medication e) Decreased depression Delayed orgasm is considered a sexual dysfunction in older women and does not occur as a benefit of regular exercise. Decreased depression, anxiety, need for medication, and improved physical health are all benefits of regular exercise.

After interviewing an older adult, the nurse is unable to determine what may be the cause of the client's reported sexual dysfunction. What is the nurse's next best action? a) Send the client for serologic lab studies. b) Refer the client for a comprehensive physical examination. c) Schedule an appointment with a sexual counselor or therapist. d) Ask to interview the client's sexual partner privately at the next visit.

b) Refer the client for a comprehensive physical examination. If the cause of sexual dysfunction is not readily available through the history, refer the older person for a comprehensive physical examination. If the client suffers from a physical problem, interviewing the partner and sexual counseling may not be necessary. Lab studies are part of a physical examination after the client has been evaluated head to toe to determine what lab tests are needed.

An older female expresses that she want to avoid hormone replacement therapy (HRT) for her menopausal symptoms. What is the nurse's best response? a) Increase your dose of daily multivitamins with calcium. b) Talk to your healthcare provider before taking any herbal supplements. c) Hormone replacement therapy is harmless for older women. d) Decrease your amount of physical activity in your daily exercise routine.

b) Talk to your healthcare provider before taking any herbal supplements. Clients should consult with healthcare providers before taking any herbal supplements. Herbal supplements known to help relieve menopausal symptoms include rhubarb and ginseng, not calcium. There are risks the client needs to be screened for before taking HRT. Exercise can help reduce symptoms.

A 78-year-old home health client has admitted to his nurse that his level of sexual activity with his wife has declined in recent months and become wholly absent over the past several weeks. The client has implied that this is due to a lack of performance, rather than lack of desire, on his part. In light of this revelation, the nurse should prioritize the assessment of the client's: a) cardiovascular status. b) medication regimen. c) musculoskeletal system and active range of motion. d) cognitive status and level of consciousness.

b) medication regimen. Sexual wellness and sexual performance are affected by multiple factors. However, the effects of medications are highly significant and likely supersede potential changes in strength, cognition, or cardiovascular status.

Which lab can the nurse exclude when identifying changes in hormone levels that can affect sexual function? a) Complete blood count b) Prostate-specific antigen c) Albumin d) Estradiol

c) Albumin An albumin level is most likely not included in the assessment of labwork that can identify changes in hormone levels affecting sexual function.

An older male expresses concern about missing the men's prayer meeting at church while he's hospitalized. What is the nurse's best action? a) Refer him to a mental health counselor. b) Tell the client not to worry about one missed meeting. c) Ask the client about the prayer meeting and listen attentively. d) Offer to telephone the chaplain the next day.

c) Ask the client about the prayer meeting and listen attentively. This client is displaying a sign of spiritual distress. The nurse should be available so the client can express concerns and listen attentively. Concern over a missed prayer meeting does not indicate a mental health problem. Telling the client not to worry is not helpful and does not address the client's concern. Offering to telephone the chaplain the next day does not address the client's immediate concern.

An older woman of Muslim faith is scheduled for urgent surgery. What is the nurse's most appropriate action? a) Sign the consent form for the surgeon. b) Ask the client to sign the consent right away. c) Ask the client for her husband's telephone number. d) Witness the consent form while waiting on the husband.

c) Ask the client for her husband's telephone number. Practicing Muslim women are very modest and usually not allowed to sign consent or make decisions without the husband. The nurse can obtain the husband's telephone number and get the husband on the phone while the surgeon is explaining the risks and benefits of the surgery. The nurse should not witness any consent until it is signed by the surgeon and the client. The nurse should never sign for a surgeon; this practice is illegal.

An older female client is diagnosed with a cystocele. The nurse should assess for what sign or symptom? a) Vaginal dryness b) Elevated temperature c) Dribbling urine d) Genital itching

c) Dribbling urine A cystocele affects the bladder and results in discomfort and dribbling urine. The treatment for a cystocele is surgery. Itching is not a common complaint of this disorder. A subsequent urinary tract infection may result in an elevated temperature, but a cystocele itself is not an infectious process. Vaginal dryness usually results from hormonal changes.

The charge nurse on a geriatric unit should intervene when observing a nursing assistant perform which action with a client of the Muslim faith? a) Removing the Bible from the room b) Closing the client's door during prayer time c) Handing the client his Koran d) Ordering a pork-free lunch

c) Handing the client his Koran Muslims believe the Koran is God's word, not the Bible. The Koran cannot be touched by anyone who is ritually unclean. The nursing assistant should not be touching the Koran. Privacy during prayer time is important. Muslims abstain from pork and alcohol.

What is likely the most important spiritual need of all individuals? a) Gratitude b) Forgiveness c) Love d) Dignity

c) Love Love is probably the most important spiritual need of individuals. People need to feel that they are cared for and can offer caring feelings.

A malnourished older male of Jewish faith enjoys seafood and is not wearing a skullcap. Which branch of Judaism does this client likely practice? a) Strict b) Orthodox c) Reformed d) Conservative

c) Reformed The reform branch of Judaism involves less stringent adherence to laws; do not strictly follow Kosher diet; do not wear skullcaps; attend temples on Fridays for worship but do not follow restrictions during Sabbath; men can touch women. The three branches of Judaism are: Orthodox, Conservative, and Reform.

An older female is upset while explaining to the nurse that when she starts to get in bed with her husband, who suffers from Alzheimer's, he shouts at her and states he doesn't recognize her. What is the nurse's best advice to this distraught wife? a) Speak to his health care provider about increasing the dose of his medication or starting a different medication. b) Sleep in separate beds until he begins to recognize you better. c) Simply remain calm and tell your husband you are not a stranger, you are his wife. d) Recommend nursing home placement.

c) Simply remain calm and tell your husband you are not a stranger, you are his wife. Rather than becoming upset, the client's wife should be instructed to try to remain calm and tell her husband she's not a stranger, she's his wife.

An older couple who are residents in different halls at a nursing home and require the same levels of care request privacy to engage in sex. What is the charge nurse's best action? a) Suggest masturbation as an alternative. b) Offer supervised visitation for one hour everyday. c) Designate a time when one client's door could be locked during the day. d) Allow the two clients to share a room.

d) Allow the two clients to share a room. Older people in an institutional setting have a right to privacy. They should be able to share a room and have privacy as long as they both require the same level of care and can be placed on the same unit. Locking a door in a nursing home is not feasible due to fire safety regulations. Instead, the charge could hang a "do not disturb" sign on the clients' door. Supervised visitation doesn't provide total privacy.

The nurse is caring for a Unitarian Christian. Which practice will the nurse likely see exhibited by the client? a) Prayer to father God b) Verbalize that condition is result of God's will c) Highly conservative views d) Declare willingness for organ donation

d) Declare willingness for organ donation Unitarian christianity is a highly liberal branch of Christianity. Belief is in one God as single being, rather than a trinity. Individuals are responsible for their own health state, and they're advocates for organ donation.

An older male client complains of recurrent local genital infections. What is the nurse's most appropriate assessment question? a) Have you experienced a decreased libido? b) Do you have difficulty maintaining an erection? c) Do you have any other signs of heart failure? d) Do you have a history of diabetes?

d) Do you have a history of diabetes? Diabetes can interfere with sexual function by leading to recurrent local genital infections. Erectile dysfunction is not the concern. Recurrent infections are not signs of heart failure. A change in libido does not directly lead to infection.

The nurse should notify the healthcare provider about which condition in the client's history before she starts progestin and estrogen treatment? a) Arthritis b) Insomnia c) Bladder infections d) Hypertension

d) Hypertension According to research, the client with any type of cardiac history must be fully evaluated before beginning hormone replacement therapy (HRT). Bladder infections, arthritis, and insomnia are not contraindications to HRT and are listed as expected physical symptoms of menopause that may improve once treatment has begun.

Which is a contributing factor to the unavailability of a sexual partner in older adulthood? a) The ratio of men to women increases after age 85 b) Most older men tend to be widowed c) Older women tend to marry younger men d) Infirmity of spouse

d) Infirmity of spouse Even when an older person has a spouse or partner, that person may be too infirm to remain sexually active. Older men tend to marry younger women under age 65. The number of women to men increases by age 85. More older women tend to be widowed.

Which spiritual behavior is the nurse most likely to observe when a family of the Baptist Protestant faith visits a client? a) Providing a vegetarian meal b) Rosary bead prayer c) Hypnosis d) Laying on of hands

d) Laying on of hands Baptist practices include scripture reading, prayer, and laying on of hands for healing. Rosary beads are used in the Catholic faith. Hypnosis may be practiced in the Christian Science faith. Many Seventh-Day Adventists are vegetarians.

An older adult couple is discussing their concern of the husband not being able to achieve erection. What is an appropriate suggestion for the nurse to offer this couple? a) A variety of over-the-counter erectile dysfunction medications is now available. b) You should consider eliminating physical sex due to health concerns as you age. c) A water-based lubricant may help achieve erection and painless ejaculation. d) Longer time for foreplay and physical stimulation may be required to achieve erection.

d) Longer time for foreplay and physical stimulation may be required to achieve erection. Increased physical stimulation may be required to achieve erection. Vaginal dryness and pain during sex is usually a female concern for which a water-based lubricant would be recommended. Erectile dysfunction medications are prescribed by a healthcare provider who has screened the client's health history first. Physical sex can usually be continued into old age.

An older male asks the nurse what is meant by "male menopause." What is the nurse's best response? a) All men experience this change in life with increased cortisol levels. b) Men do not experience menopause due to the lack of estrogen. c) Male hormone changes result in increased muscle mass and strength. d) Men may experience decreased energy due to lower testosterone levels.

d) Men may experience decreased energy due to lower testosterone levels. Some men, not all, experience hormonal changes with age. Andropause, or male menopause, occurs as a result of a decline in testosterone levels. Symptoms include reduced muscle mass, energy levels, strength, and stamina.

An older client is observed by the nurse as being in a calm, nonreactive state. Which type of meditation is this client practicing? a) Existential b) Transcendental c) Concentrative d) Mindfulness

d) Mindfulness With mindfulness meditation, attention is paid to sensations being experienced, such as sounds or thoughts; this promotes a calm, nonreactive mental state. Attention is focused on breathing, a sound, or an image; this calms and promotes mental clarity and acuity in concentrative meditation. Transcendental meditation involves guiding the body to a level of profound relaxation while the mind becomes more alert. Existential is not a known form of meditation.

An older female complains of pain and discomfort with penile penetration. The nurse should assess for signs of which condition? a) Hyperglycemia b) Cystocele c) Thick hymen d) Prolapsed uterus

d) Prolapsed uterus Prolapsed uterus results in pain and difficulty with penile penetration. A pessary placement and/or surgery is recommended. Cystocele results in discomfort and dribbling of urine. Virginity results in a thick or large hymen. Hyperglycemia can result in frequent vaginal infections.

A malnourished older male of Jewish faith enjoys seafood and is not wearing a skullcap. Which branch of Judaism does this client likely practice? a) Strict b) Conservative c) Orthodox d) Reformed

d) Reformed The reform branch of Judaism involves less stringent adherence to laws; do not strictly follow Kosher diet; do not wear skullcaps; attend temples on Fridays for worship but do not follow restrictions during Sabbath; men can touch women. The three branches of Judaism are: Orthodox, Conservative, and Reform.

An older adult is diagnosed with Peyronie's disease. When developing a teaching plan for this client, what information should the nurse include? a) Cope with dribbling of urine. b) Complete entire course of antibiotics. c) Physical therapy. d) Side effects of steroids.

d) Side effects of steroids. Peyronie's disease is a painful bending of the penis due to fibrous scarring from the inflammatory process. Treatment includes local injection of corticosteroids and/or surgery. Dribbling of urine is not a common symptom. This condition is not bacterial in origin. Physical therapy is not useful for this condition.