Chapter 26- Sexual Function

15. While discussing sexual behavior at a sex and aging seminar, one older adult states, "No condoms for me, I can't get pregnant!" Which of the following responses is most appropriate? A) "Condoms protect you from sexually transmitted diseases including HIV." B) "How freeing to not have to be concerned about unwanted pregnancies anymore." C) "The youth of society have so much to be concerned with, what with AIDS killing people." D) "Your generation is soon going to have the largest population of HIVinfected persons."

Ans: A Condoms are an important protection for sexually active adults who are sexual with anyone other than a long-term monogamous partner. Condoms protect from many sexually transmitted diseases. Acquired immunodeficiency syndrome is considered a chronic disease. Eleven percent of new human immunodeficiency virus (HIV) infections occur in adults aged 50 years, and by 2015, 50% of HIV-infected individuals will be 50 and older. This is true, but doesn't answer the question.

9. Which of the following older adult clients is most likely to have physiologic barriers to sexual wellness? A) One who has chronic obstructive pulmonary disease and a recent MI B) One who has early stages of lung cancer and who is being treated for hypothyroidism C) One who had an ostomy created several years ago as treatment for colon cancer D) One who recently recovered from urinary tract infection that progressed to urosepsis

Ans: A Chronic obstructive pulmonary disease and coronary heart disease are associated with sexual dysfunction. The other noted health problems are not associated with physiologic barriers to sexual health and function. Early stages of lung cancer symptoms include cough, which potentially produces bloody sputum, not shortness of air. The ostomy may psychologically impact a client, but not physiologically. Recovered urinary tract infection/urosepsis would not specifically cause a physiologic barrier.

8. 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. What assessment should the nurse prioritize in light of this revelation? A) Client's medication regimen B) Client's musculoskeletal system and active range of motion C) Client's cognitive status and level of consciousness D) Client's cardiovascular status

Ans: A 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

1. A 65-year-old woman is speaking to her nurse at the primary care clinic. She states that it is very painful for her when she has sexual relations. She asks the nurse what she could do to alleviate the pain. Which of the following suggestions could the nurse make to the woman? A) Decrease the incidence of sexual relations. B) Use a water-soluble lubricant or estrogen cream. C) While engaging in intercourse, have your partner thrust his penis upward. D) Use a polyisoprene (non-latex) condom for intercourse

Ans: B With age, there is a thinning of the vaginal mucosa, which creates dryness and predisposes women to irritation and inflammation so using a water-soluble lubricant or estrogen cream may be helpful. The male partner should thrust downward instead of upward during sexual intercourse. Decreasing the incidence of sexual relations may lead to a "use it or lose it" principle. Use of a condom, latex or polyisoprene, will not decrease vaginal wall irritation.

4. Which of the following processes should a nurse address first when assessing sexual function in older adults? A) Identify risk factors that may interfere with the older adult's sexual functioning. B) Assess own personal attitudes toward sexuality and aging. C)Obtain permission from the individual to initiate a discussion on sexual relations. D) Provide detailed information about sexual function to the older adult.

Ans: B A personal attitude assessment about sexuality and aging is a nurse's prerequisite to discussing sexual function with older adults. The next step would be to obtain permission from the individual to initiate discussion about sexual relations

2. A nurse is discussing sexual activity with older adults in a wellness clinic. Which of the following statements by an individual indicates a need for further exploration? A) "I know my diabetes can affect my sexual activity." B) "My husband has an enlarged prostate." C) "I use Premarin cream to help with vaginal dryness." D) "I will not use petroleum jelly as a lubricant."

Ans: B The husband's prostate problem can affect his sexual performance and needs further exploration. Premarin cream helps when vaginal dryness occurs because of estrogen withdrawal. Diabetes has an effect on vaginal lubrication. Petroleum jelly increases risk for infection

13. A nurse reviews the medications of a 58-year-old man who has erectile dysfunction. Which of the following prescribed medications can interfere with sexual functioning? (Select all that apply.) A) Acetylsalicylic acid (aspirin) B) Metoprolol (Lopressor) C) Clopidogrel (Plavix) D) Lisinopril (Prinivil) E) Ezetimibe (Zetia)

Ans: B, D Metoprolol and lisinopril interfere with libido and can cause erectile dysfunction in men. Acetylsalicylic acid, clopidogrel, and ezetimibe do not. Of note, these medications indicate cardiovascular disease which is strongly associated with sexual dysfunction

14. A nurse administrator incorporates older adults' sexuality into the policies of a long-term care facility. Which of the following should be included in this plan? (Select all that apply.) A) Allow public masturbation. B) Ask permission to enter a room. C) House spouses separately. D) Knock on door before entering. E) Redirect inappropriate sexual behaviors.

Ans: B, D, E Masturbation is normal, but not appropriate for public places, assuring that the clients' rooms are their own personal space and assuring privacy while in those rooms are important to sexuality. Sexual behaviors that impinge on others' comfort should be redirected. Components of sexuality that are especially important for older adults include kissing, hugging, intimacy, fantasy, masturbation, oral sex, loving words, physical closeness, and expressions of affection

11. A 52-year-old woman discusses her menstrual cycles with the nurse. The client states that she still has menses, but that she "never knows when they might begin or end." Which of the following is the most appropriate response by the nurse? A) "It sounds like you are frustrated with this change; it is a difficult part of life." B) "Reproduction is no longer possible so that is one thing less to worry about." C) "We can't say how long this perimenopausal phase might last." D) "You are in the postmenopausal cycle and should expect further changes."

Ans: C Perimenopause refers to the several years before menopause when women begin experiencing changes in menstrual cycles. The client doesn't express frustration, nor does she sound like she is "worrying" about reproduction (which still could happen, even with low probability). Menopause typically occurs around the age of 49 to 51 years and postmenopause begins 12 months after last period

12. A nurse in the ambulatory clinic assesses a 53-year-old woman who states, "last night all of the sudden I got really sick, got really hot, and started sweating; then I had chills, and my chest was pounding." Which action by the nurse is priority? A) Ask if the client had been exposed to anyone who was ill. B) Check the client's troponin and B-type natriuretic peptide (BNP) labs. C) Discuss the client's menstrual cycle with her. D) Review the client's medication history

Ans: C Asking about "anyone who was ill" is broad and generic. Illness is often spread in the prodromal phase when there are no symptoms. Troponin and BNP are indicators of cardiac functioning; women who have an MI are more likely to experience severe fatigue, not heat and chills. Hot flashes are a vasomotor symptom characterized by the sudden onset of heat, perspiration, and flushing that spreads from the head to the trunk. Symptoms last from 1 to 5 minutes and may be accompanied by chills, nausea, anxiety, palpitations, and clamminess. Medications do not relate to these symptoms

6. A gerontological nurse is aware that the aging process is accompanied by numerous, multifactorial changes that affect sexual wellness in older adults. Among women, which of the following factors is usually the primary cause of changes in sexual functioning? A) Psychosocial factors B) Environmental factors C) Hormonal factors D) Spiritual factors

Ans: C Changes in sexual functioning are influenced by many factors. In women, however, the influence of hormonal factors is often primary. Diminished estrogen levels can directly affect sexual function for older women in several ways

3. A 64-year-old man had a myocardial infarction (MI) 2 months ago. He has recovered to the point that he is able to climb up two flights of stairs, but he and his spouse have not resumed sexual relations. Which of the following responses by the nurse is most appropriate? A) "Is angina interfering with your sexual functioning?" B) "This lack of libido is caused by vasoconstriction in the genital area." C) "You are safe to have sex; you can resume sexual relations when you desire." D) "You may have a problem with retrograde ejaculation."

Ans: C Even when no physiologic basis exists for abstaining from sexual intercourse after an MI, sexual activity is often limited or absent because of fatigue, depression, diminished sexual desire, and fears and anxiety of the person or the sexual partner. Diabetes can cause retrograde ejaculation. An MI does not cause vasoconstriction

7. 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) Ensure that each resident's family members are aware of this development. B) Teach Mr. Thomas and Mrs. Young about sexual health promotion. C) Accommodate the residents' relationship and provide them with appropriate privacy. D) Have each resident assessed to ensure that the relationship is medically safe and appropriate.

Ans: C 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.

10. A nurse who provides care in a nursing home occasionally encounters colleagues' prejudices and misperceptions around the sexual wellness of residents. Which of the following statements reflects an appropriate view of sexual health in older adults? A) "I think it's just so cute when residents think that they're dating each other." B) "We need to make sure that residents get the teaching they need before we allow a sexual relationship." C) "Older adults need companionship and comfort much more than they need sex." D) "Let's do all we can to facilitate competent residents' sexual relationships."

Ans: D Among competent older adults, autonomy around sexual relationships should be protected and fostered. It is untrue that older adults have little need for sex and it is inappropriate for a nurse to prohibit a relationship pending education. Referring to older adults' relationships as "cute" is patronizing and inappropriate.

5. A nurse is conducting a health education class for older adults with arthritis that will address relevant issues of sexual function. Which of the following statements indicates that the nurse's teaching has been successful? A) "I will decrease the amount of time spent in foreplay before engaging in sexual intercourse." B) "I will avoid taking a warm bath before engaging in sexual activity." C) "I will avoid experimenting with different positions during sexual relations." D) "I will use a vibrator since my ability to massage is limited."

Ans: D People with arthritis will want to increase foreplay. Warm baths will decrease stiffness. People with arthritis should experiment with sexual positions for comfort and support. A vibrator may help if the ability to massage is limited for the person with arthritis