m 19, 31, 27

) This client would most likely benefit from participation in a support group, which provides an environment in which to share stories, discuss concerns, and receive personal encouragement and support that may otherwise be lacking. Antidepressant medication is often used for depression or complicated grieving, and nothing in the above scenario suggests the client is affected by either of these conditions. Occupational therapy would not be appropriate because the client is not describing problems in participating in activities of daily living. Similarly, referral to a social worker is not necessary at this point, because nothing in the client's comments suggests the need for targeted social services.

An older adult client whose spouse died 6 months ago tells the nurse stories about the deceased spouse. When care has been completed, the client thanks the nurse for listening and states, "My children will not listen to these stories." From which type of intervention would this client most likely benefit? A) Antidepressant medication B) Referral to a support group C) Occupational therapy D) Referral to a social

A nurse is evaluating the care provided to a client who is experiencing menopause. Which observation indicates that the client is successfully managing her menopausal symptoms? A) The client has lost 5 pounds in 4 months after starting an exercise program. B) The client reports consuming about 800 mg of calcium per day. C) The client has gained 8 pounds in 3 months despite regularly engaging in non-weight-bearing exercise. D) The client states that she is "doing fine" so there's no need for her to keep talking about menopause.

A) Successful outcomes for a client with menopause include demonstrating a positive sense of self as evidenced by stable weight, participation in a regular exercise program, and ability to manage stress; verbalizing feelings related to changes that have occurred; and describing strategies for maintaining health. Two particularly important health maintenance strategies are engaging in regular weight-bearing exercise and consuming at least 1200 mg of calcium per day, because both of these actions help prevent osteoporosis. Of the options given, only a weight loss of 5 pounds in 4 months after starting an exercise program is evidence of successful management of menopause. The other observations are not evidence of successful management of menopause.

The nurse is concerned that a client whose spouse died 2 years ago is experiencing complicated grief. Which interventions should the nurse consider when planning care for this client? Select all that apply. A) Monitoring for suicidal behavior B) Psychotherapy C) Substance abuse assessment D) Alcohol abuse assessment E) Hypnosis

A, B, C, D Nursing care for the client with complicated grief includes psychotherapy, monitoring for suicidal behaviors, and assessment for signs of alcohol and/or substance abuse. There is no evidence that the client would benefit from hypnosis.

During a vaginal examination, a woman's cervix and vaginal fornices are found to have a bluish cast to them. This finding suggests that the client A) is experiencing menopause. B) may be pregnant. C) has a pelvic infection. D) is likely anemic.

B) A bluish color to the cervix and vaginal fornices may be a sign of pregnancy. A pale cervix would be suggestive of anemia. In some women, menopause may cause the vaginal mucosa to become pale and dry, but it would not result in bluish coloration. Similarly, pelvic infection is unlikely to cause the cervix or vaginal mucosa to take on a bluish tint.

The nurse is caring for a client on the unit who has just died. The client's adolescent daughter is very quiet, and the nurse attempts to talk with her. The adolescent remains silent, not wishing to talk about the loss. Which action by the nurse is appropriate to assist the adolescent? A) Ask the doctor to prescribe a sedative for the adolescent. B) Ask the adolescent if any friends are available to talk. C) Provide the adolescent with paper, pens, and pencils. D) Notifying the hospital chaplain to come talk with the adolescent.

B) Adolescent grief responses are very similar to those of most adults, and they may display a wide range of emotions, including depression, denial, and anger. Adolescents should be encouraged, but not forced, to voice their feelings about the loss. Sometimes individuals in this age group feel more comfortable talking to peers or those outside the family. Asking the doctor to prescribe a sedative will only delay the grieving process. Calling the chaplain is an option, but it would be better if the adolescent were given a choice. Providing paper, pens, and pencils is more appropriate for younger children dealing with grief and loss.

The nurse needs to plan interventions to address a client's crisis. Which action by the nurse is appropriate? A) Develop the plan prior to meeting with the client. B) Conduct a complete assessment. C) Determine follow-up. D) Focus on long-term problems.

B) Nursing care is based on assessment. Thus, a plan cannot be developed prior to meeting with the client. The time frame, whether short term or long term, and the need for follow-up will be determined by the findings of the assessment.

The nurse is conducting a history and physical assessment of a sexually active teenage client. Which findings should the nurse identify as consistent with genital herpes? Select all that apply. A) Low blood pressure B) Headache C) Fever D) Dysuria E) Vaginal discharge

B, C, D, E) Manifestations of genital herpes include flulike symptoms (e.g., headache, fever), dysuria, and vaginal discharge. Low blood pressure is not a manifestation of genital herpes.

A female client complains of having a "strange discharge" from her vagina and "stinging" when voiding urine. Which diagnostic test(s) would be useful to aid in the diagnosis of this client's disorder? Select all that apply. A) Biopsy B) Urine culture C) Pregnancy test D) Serum hormone levels E) Papanicolaou test

B, E) The client is complaining of a strange discharge from her vagina, which may be indicative of infection. A Papanicolaou test would therefore be useful because it can diagnose certain types of infection. The client is also complaining of stinging with urination, so a urine culture would be helpful to rule out a urinary tract infection as the cause of the urinary pain. This client's symptoms are not associated with pregnancy, so a pregnancy test would not be useful. The remaining diagnostic tests listed here may or may not help diagnose this client's health problem.

The community nurse is developing a seminar to help children who have experienced a loss. Which information should the nurse include to help these children adapt? A) Explain that magical thinking helps with the pain. B) Remind the child that big children don't cry. C) Help create new memories. D) Pretend that the individual has not really gone.

C) Adults can help children adapt to a loss by listening, helping the child adjust to changes in routines, and encouraging activities that promote new memories. Adults should reinforce that the beloved individual is not returning, not encourage magical thinking or pretend that the individual is not really gone. Adults should encourage children to express their emotions, not tell them not to cry.

Which intervention should the nurse perform to help the family grieve following the loss of an unborn child at 36 weeks' gestation? A) Remove all baby supplies from the mother's room. B) Refrain from talking about the baby. C) Facilitate and support the family viewing and holding the infant. D) Ask to have the mother moved off the postpartum floor.

C) Advocates of seeing the stillborn believe that viewing assists in dispelling denial and allows the couple to take the next step in the grieving process. If the baby was normally formed, it assists the mother to feel less of a failure. The mother should be consulted before moving her off the postpartum unit. Removing baby supplies might assist in the denial process, as will not talking about the baby.

What characteristic is essential for individuals to adapt to crisis in a positive way? A) Security B) Strength C) Resilience D) Independence

C) Resilience is the way in which individuals adapt successfully to crisis events to develop positive outcomes. Security, strength, and independence are all positive character traits that may be helpful during a crisis, but even individuals without these characteristics can respond to a crisis in a positive way if they have resilience.

Which child would the nurse recognize as being at the highest risk of experiencing toxic stress? A) A 15-year-old adolescent who is slightly overweight and didn't make the football team; he regularly gets teased for his weight at school. B) A 2-week-old infant who was born at 31 weeks' gestation and has been in the neonatal intensive care unit (NICU) for the entire 2 weeks; the child's parents are at the hospital as often as possible. C) A 12-year-old child whose father recently died and whose mother works three part-time jobs; this child is expected to care for two younger siblings after school. D) A 4-year-old child who attends preschool or daycare each day while the parents work; the child displays signs of mild separation anxiety.

C) The 4-year-old child and 15-year-old adolescent are experiencing normative stressors, which do not usually lead to toxic stress. The 2-week-old infant may be experiencing non-normative stress, but the infant is receiving appropriate adult support and is likely too young to be cognitively aware of stressors. The 12-year-old child has experienced a non-normative stressor in the death of the father, and the child does not have adequate adult support. This places the child at high risk for toxic stress.

Which clients should the nurse identify as being at risk for prenatal loss? Select all that apply. A) The woman who drinks one cup of coffee every morning B) The woman recovering from a gastrointestinal virus C) The unmarried 14-year-old girl living in the city D) The woman who lacks access to health and prenatal care E) The woman who had a healthy baby 6 months ago resulting from a healthy pregnancy

CD Fetal mortality is highest in mothers who are earlier in their teens or older than 35, mothers who are unmarried, and mothers with multiple pregnancies. Lack of access to healthcare and prenatal care, such as occurs in rural areas, may also increase the risk of perinatal death. A gastrointestinal virus will not negatively impact the pregnancy, and one cup of coffee is not excessive intake of caffeine

Which of these is an accurate description of a crisis? A) An acute event that is detrimental B) A chronic event that is intermittent C) A chronic event that is consistent and ongoing D) An acute event that will resolve

D) A crisis is an acute event, not a chronic event. Crises usually resolve within 4-6 weeks. A crisis can provide opportunities for growth or deterioration, so not all crises are detrimental.

A menopausal client is concerned that intercourse with her spouse has become increasingly painful. What should the nurse explain about the changes in this client's body after menopause? A) Cervical mucus is thicker. B) Estrogen levels increase. C) Sexual desire diminishes. D) Vaginal lubrication decreases.

D) Older women remain capable of multiple orgasms and may, in fact, experience an increase in sexual desire after menopause. However, vaginal lubrication and elasticity decrease with menopause and the accompanying decline in estrogen, and this can lead to painful intercourse. The client's concerns are not related to cervical mucus.

A nursing student has been assigned to present a teaching project to the class, using each of Bloom's taxonomy domains. The student has planned several activities to include when presenting the project to the class. Which activities are within the affective domain? Select all that apply. A) Class members must read a paragraph about a new clinical trial, summarize the information, and present it to the rest of the class. B) Class members must list the technical skills they have learned. C) Class members must demonstrate a favorite nursing skill for the class. D) Class members must reflect on how they felt the first time they provided direct client care. E) Class members must identify two attitudinal changes that have occurred in their lives since beginning their nursing education.

D, E) In cognitive theory, learning occurs across three primary domains: cognitive, or "thinking"; affective, or "feeling"; and psychomotor, or "skill." The affective domain includes emotional responses to tasks, such as feelings, emotions, interests, attitudes, and appreciations. Listing technical skills and reading or summarizing information is part of the cognitive domain, which includes knowing, comprehending, application, analysis, synthesis, and evaluation. The psychomotor domain is the "skill" domain and includes hands-on motor skills, such as demonstration.

The nurse is caring for a client who lost his job and is having a difficult time finding another job. The nurse recognizes that the client is grieving. Which pattern of behavior would be the nurse's priority concern? A) Alcohol or drug use B) Excessive sleeping C) Overeating D) Failing to exercise

A) Although all of these are unhealthy coping mechanisms, the nurse's primary concern would be alcohol or drug use. Alcohol and drug use can prolong the grieving process by masking the pain and delaying the work of grief. It can also quickly result in addiction, which further complicates the situation.

The staff nurse is planning for a client who is grieving the loss of a spouse. Which should the nurse identify as an appropriate independent nursing intervention? A) Teach the client about the grieving process B) Select an appropriate antidepressant C) Conduct complicated grief therapy (CGT) D) Provide chaplain services

A) Interventions helpful in working with adults and older adults who are grieving include teaching the patient about the grieving process. Nurses may discuss the benefits of different forms of therapy, but the selection of an appropriate antidepressant, providing complicated grief counseling, and chaplain services are collaborative interventions.

The nurse is caring for a client who has experienced fetal demise at 23 weeks' gestation and will have labor induced to deliver the fetus. The client's extended family insists on being present for the delivery. Which action is most appropriate for the nurse to take in this situation? A) Ask the client about her preferences regarding the family's request. B) Call security to escort the family out of the hospital. C) Speak with the nurse manager about supporting the family's wishes. D) Show the family to the waiting room.

A) The mother's preferences should determine how the delivery of a stillborn infant takes place; this includes who she wants in the birthing room with her. Before confronting the family by asking them to leave or calling security, the nurse should consult with the client. If the client agrees to the extra visitors, then seeking the nurse manager's assistance is inappropriate.

Which assessment findings indicate to the nurse that a client is experiencing stress? Select all that apply. A) Chewing on a fingernail B) Checking cellular phone C) Reading a magazine D) Talking with others E) Tapping foot

A, E) The client is experiencing both behavioral (nail chewing) and physical (foot tapping) indications of stress. Reading a magazine, checking a phone, and talking with others are not indications of stress.

The nurse is caring for a client who found a loved one who committed suicide. In addition to the normal grief process, the nurse recognizes the client may be at risk for what other complication? A) Seasonal affective disorder (SAD) B) Posttraumatic stress disorder (PTSD) C) Obsessive-compulsive disorder (OCD) D) Major depressive disorder (MDD)

B) Clients who are exposed to trauma such as finding a loved one who has committed suicide are at increased risk for PTSD. The client may also be at higher risk for situational depression, but not usually SAD or MDD. OCD is usually unrelated to grief or trauma.

A client experienced the loss of a spouse due to chronic illness, the loss of a grandchild due to stillbirth, and the loss of a long-time family pet, all within a 6-week period. This individual is experiencing what type of loss? A) Caregiver loss B) Cumulative loss C) Compound loss D) Complicated loss

B) Cumulative loss is defined as several losses within a short period, one after another. The individual who experiences cumulative loss may not recover from the initial loss before the next loss occurs. Each loss has the potential to compound the grief of previous loss to the point where the individual becomes paralyzed with grief. This type of loss is not called caregiver loss, compound loss, or complicated loss.

A nurse is caring for an older adult client who is experiencing grief after the recent loss of a spouse. What should the nurse anticipate with regard to the older adult's response to grief? A) Grief in an older adult initially presents differently than in a younger adult. B) Older adults may seem to experience the emotional aspects of grief more acutely than younger adults. C) Manifestations of grief in older adults are usually less severe than those observed in younger clients. D) Manifestations of grief in older adults are usually trust issues, suspecting once-close friends and family members of judging their pain or not understanding their emotions.

B) Older adults may seem to experience the emotional aspects of grief more acutely than younger adults. Grief in an older adult initially presents similarly to that in a younger adult. Manifestations of grief in older adults are usually more profound than those observed in younger clients. Complicated grief in the older adult manifests as trust issues; this is not a normal manifestation of grief in the older client.

22) A nurse is planning care for a couple who has experienced a miscarriage. Which aspect of the grief response is essential for the nurse to anticipate? A) The grief experienced by fathers after perinatal loss appears similarly to the grief experienced by mothers after perinatal loss. B) Postpartum depression may occur in women who have experienced perinatal loss. C) Grief is typically less severe when the perinatal loss occurs before 20 weeks' gestation. D) Perinatal loss refers only to emotional changes that occur after perinatal loss.

B) Postpartum depression may occur in women who have experienced perinatal loss. The grief experienced by fathers after perinatal loss is less intense and occurs for a shorter duration than grief experienced by mothers. Grief can be mild to severe after perinatal loss, regardless of when the loss occurs. Perinatal loss refers to the physical and emotional changes that occur after perinatal loss.

The nurse is caring for a family whose 8-year-old son recently died. The remaining family members include the mother, father, and two young children. Which of the following questions would best help the nurse assess this family's level of functioning? A) "Have you returned to your normal schedule yet?" B) "How have you expressed your feelings about the loss?" C) "When do you think your grieving process will be complete?" D) "Have any of you experienced prior loss?"

B) When assessing a grieving family's level of functioning, the nurse should inquire about the family's strengths, support systems, needs, perceptions of the coping process, and ways of expressing feelings about the loss. Although it can be helpful to ask whether any of the family members have experienced prior loss, this question will not provide the nurse with information about the family's current level of functioning. It is impossible for a family to anticipate when its grieving process will be complete, so this question is inappropriate. Also, at this point in the grieving process, it is insensitive and inappropriate to ask whether the family has returned to its "normal" daily schedule.

The nurse is caring for a grieving family who is from another culture and has different religious beliefs. The nurse is not familiar with the family's culture or religion. What should the nurse do to provide emotional support for this family? A) Encourage the family to go eat a meal and come back to the hospital later. B) Ask the physician to assess the family for ineffective coping. C) Ask the family how the nurse can meet the family's cultural needs. D) Refer the family to a group counseling session.

C) If the nurse is not familiar with the family's culture or religion, then the best way to support the family is to ask how the nurse can meet the family's cultural and religious beliefs. The nurse should not refer the family to a group counseling session or encourage the family to go eat a meal without determining their cultural and religious needs first. The nurse, not the physician, should assess the family for ineffective coping.

The nurse recognizes that the spouse of a terminally ill client has completed the grieving process, but the ill client is still alive. Because of this, the nurse may need to provide what interventions for the ill client? A) Interventions to prevent physical and spiritual distress of the spouse B) Interventions to prevent despair in other family members C) Interventions to prevent guilt in the client D) Interventions to prevent isolation and loneliness for the client

D) If a family member completes the grieving process before the ill client dies, the family member may become detached, causing isolation and loneliness for the terminally ill client. Therefore, the nurse would need to implement interventions to prevent isolation and loneliness. The client is less likely to feel guilt, despair, or physical and spiritual distress specifically related to the family member's detachment.

The nurse is caring for an adolescent client who has just learned she is pregnant. Which assessment questions is most appropriate to determine the client's risk for perinatal loss? A) "At what age did you begin menstruating?" B) "When was your last menstrual period?" C) "Is this your first pregnancy?" D) "Do you use any substances such as drugs, alcohol, or tobacco products?"

D) The use of drugs, alcohol, or tobacco is a risk factor for pregnancy complications and perinatal loss, so the client should be assessed for use of substances. The other questions are important to ask when gathering the health history of a pregnant adolescent, but they do not directly relate to the risk for perinatal loss.

A nurse working in labor and delivery is planning care for a client who is arriving to the unit with a suspected perinatal loss. Which nursing intervention is most appropriate in this situation? A) Place the client in a room closest to the nurse's station to closely observe the client. B) Call the hospital chaplain to ensure the chaplain can be in the client's room when the client arrives. C) Call the local funeral home and notify them of the client's situation. D) Place the client in the room farthest from the other clients.

D) When planning care for a client with a suspected perinatal loss, the nurse should place the client in the room farthest from the other clients to provide for privacy. The other options are inappropriate and are not sensitive to the client's emotions.

A client who is experiencing menopause expresses an interest in using alternative and complementary therapies to manage her symptoms. Which initial response by the nurse is most appropriate? A) "What types of therapies are of interest to you?" B) "Those therapies seldom work." C) "Have you discussed this with your physician?" D) "Many women report success with these measures."

A) Alternative and complementary therapies are used by many women to manage the manifestations associated with menopause. Because the nurse has a responsibility to collect data from the client, the nurse will need to determine which of these therapies are of interest to the client. The success of such remedies varies by user and by therapy. It is inappropriate for the nurse to meet the client's request with negativity. Although clients who use alternative therapies should be asked to report these therapies to their physician, making such a request should not be the nurse's initial step in this scenario.

The nurse is planning care for a group of clients who are experiencing grief. Which principle from accepted grief models should the nurse use to guide care? A) No clear timetables for grief exist, nor are there clear-cut stages of grief. B) There is strong research evidence indicating that these models are not useful for many dying clients. C) These models serve as clear and definitive predictors of grief behaviors. D) The Kübler-Ross model is primarily used to describe anticipatory grief.

A) Although models of grief are useful in guiding the nursing care of clients who are experiencing loss, there are no clear-cut stages of grief, nor are there exact timetables. The Kübler-Ross model describes all stages of grief and grieving, not just anticipatory grief. None of these models clearly or definitively predict grief behaviors. No research exists that proves these models are not useful.

The nurse is providing counseling to the family of a terminally ill client. The family has children of varying ages. Which statement regarding the reactions of children to death is appropriate for the nurse to include in the counseling session? A) "Older school-age children begin to understand that death is irreversible." B) "Adolescents tend to cope better with death than adults." C) "Preschool children view death as a spiritual release." D) "Toddlers are able to fully comprehend the ideas related to death."

A) At about age 8, a child's concept of death matures, and most understand that death is irreversible and that the individual is gone and will not be coming back. Toddlers are not able to fully comprehend ideas related to death, and preschoolers view death as reversible. Adults generally cope better with death than adolescents.

The nurse has a 7-year-old client recovering from partial-thickness burns to the arms and hands. This client has shown sensitivity to loud noises and bright lights, and at times if she is overstimulated she won't speak to or look at anyone but her parents until she calms down. The nurse considers the best teaching environment for this client to be the A) client's room. B) pediatric ward waiting area. C) hospital cafeteria. D) pediatric ward play area.

A) Be sure all teaching interventions are implemented in a safe environment using a calm approach, and take care to address any concerns or fears of the child or parent/caregiver. In this client's case, the waiting or play areas for the pediatric ward are likely to be busy places and brightly lit. The cafeteria is also likely to be too loud and bright. The client's room, where the nurse can control to a greater degree the amount of light and noise, is best for teaching this client.

Which theory of learning holds that knowledge acquisition is the ongoing assimilation and accommodation of new experiences and interpretations? A) Constructivist B) Behaviorist C) Social learning D) Cognitive

A) Constructivist theory holds that knowledge acquisition is the ongoing assimilation and accommodation of new experiences and interpretations. In behaviorist theory, learning is thought to occur when an individual's response to a stimulus is either positively or negatively reinforced. In social learning theory, learning primarily results from instruction and observation. In cognitive learning theory, learning involves the processes of acquiring, processing, and using new information.

The nurse is caring for a 3-year-old client on the pediatric unit who was in an automobile accident. The client's mother was killed in the accident, and the client recently learned of her mother's death. Which nursing intervention would be most appropriate to support the developmental needs of this client? A) Work with the surviving family members to ensure that the client's routine remains as normal as possible after release from the hospital. B) Do not correct the client when she expresses the belief that her mother will "wake up and come home." C) Provide the client with the same level of reassurance and attention as any other client on the unit. D) Avoid answering the client when she asks questions about her mother's death.

A) For grieving clients between the ages of 2 and 4, caregivers should to try to maintain as a normal a routine as possible. Children in this age range will also benefit from extra reassurance and attention. It is easy to believe that children of this age do not understand the concept of loss and death, but they most certainly do notice and understand when change occurs. Therefore, it is important to provide honest answers to questions about grief when they are asked.

A client worries every day about personal health and states, "I may not have enough medication if the weather takes a turn for the worse." This client is exhibiting a sign of which alteration in stress and coping? A) Generalized anxiety disorder B) Phobia C) Obsessive-compulsive disorder D) Panic disorder

A) Generalized anxiety disorder is excessive worry about everyday problems, with the anxiety being more intense than the situation warrants. The client is demonstrating signs of generalized anxiety disorder. A phobia is an intense, persistent, irrational fear of a simple thing or social situation that compels the individual to avoid the stressor that elicits the fear. Panic disorder is a sudden attack of terror, accompanied by a pounding heart, sweatiness, weakness, faintness, or dizziness. Obsessive-compulsive disorder is characterized by obsessive thoughts and compulsive repetitive behaviors formed in response to the obsessive thoughts to lower the level of anxiety experienced.

The nurse is providing education to sexual partners about the importance of treatment for a chlamydia infection. Which client statements indicate this teaching was effective? Select all that apply. A) "Chlamydia can cause inflammation of the tube that carries urine from the bladder to outside the body." B) "Severe vaginal itching can be a consequence of chlamydia." C) "Rashes commonly occur with this disease." D) "Chlamydia can spread to the uterus and fallopian tubes and result in infertility." E) "Chlamydia can result in pregnancy complications."

A) In men, chlamydia is a major cause of nongonococcal urethritis. In women, chlamydia cervicitis can ascend and become pelvic inflammatory disease, or infection of the uterus, fallopian tubes, and sometimes ovaries. Pregnant women with an untreated chlamydia infection are at greater risk of developing complications such as miscarriage, premature birth, or stillbirth. Chlamydia does not cause vaginal itching or a rash.

Which nursing diagnosis would be a priority for a client who is experiencing a situational crisis? A) Ineffective Coping B) Ineffective Activity Planning C) Readiness for Enhanced Communication D) Chronic Low Self-Esteem

A) Ineffective Coping is a common nursing diagnosis for clients in crisis. Ineffective activity planning would likely be the result of ineffective coping strategies. Clients will not be ready for enhanced communication until they have begun to effectively cope with the crisis. Situational crisis is an acute event that is not the result of chronic low self-esteem.

A client who is postmenopausal confides in the nurse that she has been experiencing pain during intercourse. What should the nurse instruct the client to do? A) Use vaginal lubricants during intercourse. B) Avoid intercourse. C) Tolerate this problem because it is a normal part of aging. D) Decrease the frequency of intercourse to decrease the pain.

A) It is not uncommon for postmenopausal females to report painful intercourse related to a decrease in vaginal lubrication. Vaginal lubricants can be very effective in reducing pain during intercourse. Although decreased vaginal lubrication is a normal change of aging, clients do not have to tolerate the associated discomfort. Avoiding sex and decreasing the frequency of intercourse would not resolve this client's problem. Furthermore, it would be stereotypical for the nurse to assume the client has a reduced desire for intercourse because she is postmenopausal.

Which of the following statements is true with regard to sexually transmitted infections (STIs) and older adults? A) Because pregnancy is no longer a concern, older adults may not use condoms, thereby increasing their risk of STIs. B) Normal age-related changes to the body put older adults at reduced risk of contracting STIs. C) STIs are rare among older adults because of decreased levels of sexual activity among the members of this population. D) Healthcare providers should avoid discussing STIs with older clients unless these clients initiate the conversation.

A) Older adults are living longer, healthier lives and are engaging in sex more than in previous generations. Along with this increase in sexual activity comes an increase in STIs. Normal age-related changes to the body can put older adults at greater risk of infection. In addition, because pregnancy is no longer a concern, older adults may not use condoms or may use them inconsistently. Many older adults are hesitant to discuss sexual practices with their healthcare providers. Thus, providers play a key role in STI prevention by acknowledging that continuation of sexual activity is a normal part of aging, encouraging clients to talk about their sexual practice, dispelling myths about the risk of infection, and providing information that is relevant to older clients.

A client with a history of breast cancer who is entering menopause is seeking information about how to manage hot flashes. Which of information should the nurse provide to the client? A) Soy may be useful in reducing hot flashes, but researchers are still gathering evidence. B) Hot flashes will continue until menopause is complete. C) Estrogen is the only reliable treatment for hot flashes. D) Black cohosh is effective in the management of hot flashes.

A) Recent research suggests that soy is beneficial in reducing hot flashes during menopause; however, more evidence is needed before soy may be recommended as a treatment alternative. Estrogen is not the only reliable method of treatment for hot flashes, as estrogen/progestin combinations and SERMs have also proven useful in symptom reduction. Black cohosh has been found to be ineffective in managing hot flashes. Advising the client to wait until menopause

A 25-year-old client who is taking fluoxetine (Prozac) to treat depression reports decreased sexual desire since starting the medication. What can the nurse anticipate with regard to changes in the client's pharmacological regimen? A) Addition of bupropion to the client's drug regimen B) Immediate discontinuation of fluoxetine therapy C) Addition of flibanserin to the client's drug regimen D) Replacement of fluoxetine with paroxetine therapy

A) SSRI antidepressants, including both fluoxetine (Prozac) and paroxetine (Paxil), are frequently associated with a range of sexual side effects, including reduced desire. Abrupt discontinuation of these medications is not advisable because it can exacerbate a client's depression. Instead, providers may prescribe the atypical antidepressant bupropion (Wellbutrin) along with SSRI therapy, as bupropion can exert desire-increasing effects. Although flibanserin is the only FDA-approved medication specifically aimed at the treatment of low desire in women, it is rarely prescribed and would not be a provider's first treatment option in this scenario.

A 30-year-old client is concerned that he will become impotent after experiencing difficulty sustaining an erection during a recent sexual encounter. What is the nurse's best response to this client's concerns? A) "An occasional incident like this is normal and common." B) "Sexually transmitted infections may result in sexual problems in adults." C) "Erectile dysfunction is the correct term for inability to achieve or sustain an erection." D) "A medical diagnosis of erectile dysfunction is not made until a man has experienced erectile difficulties for a period of at least 3 months."

A) This client is concerned that he may become impotent. The correct answer at this point is to tell him that it is common and normal for men to experience occasional erectile difficulties. The other options are also true, but they do not serve to alleviate the client's concerns. If the client continues to have difficulties achieving or sustaining an erection, further investigation is warranted. Simply correcting the client's use of medical terminology does not address his concerns.

Which intervention can the nurse implement independently when caring for a client with alterations in stress and coping? A) Therapeutic communication B) Cognitive-behavioral therapy C) Psychotherapy D) Administration of medications

A) Using therapeutic communication is an essential intervention that the nurse can implement independently when caring for a client with an alteration in stress and coping. Cognitive-behavioral therapy, psychotherapy, and administration of medications are all collaborative interventions.

The nurse is caring for an adult client who has been diagnosed with high cholesterol. Which is important for the nurse to consider when teaching this adult client? A) Adults are more oriented to learning when the material is useful immediately. B) Adults are more likely to adhere to a regimen than are children. C) Adults usually can find information on their own. D) Adults do not need to be evaluated for understanding as children do.

A) When teaching a client, the nurse considers that most people learn and retain information if the information is immediately useful. Some clients can find information on their own; however, not all information that the client can find is factual, and clients should be taught how to discern the difference between trustworthy information and unreliable and potentially dangerous information. All clients need to be evaluated to ensure that the right information was retained. Adults will not necessarily adhere to a regimen more than children will. Effective teaching and the client's readiness to learn help with adherence.

The nurse is preparing to assess a client whose spouse died several weeks ago. Which of the following symptoms is the nurse most likely to observe in the client as part of the classic grief response? Select all that apply. A) Weight loss B) Frequent headaches C) Difficulty sleeping D) Excessive energy E) Increased appetite

A, B, C) Classic signs of grief include sleep disturbances, decreased appetite, weight loss, and somatic complaints such as abdominal pain or frequent headaches. In addition, clients who are experiencing grief often report intermittent periods of decreased motivation, energy, or activity

A nurse is caring for a client in crisis. While providing care it is imperative that the nurse communicate effectively with this client. Which is true when communicating with clients in crisis? Select all that apply. A) Communication should be frequent. B) Communication should be brief. C) Communication should be simple. D) Communication should be detailed. E) Communication should be directive.

A, B, C, E) Communicating with individuals in crisis requires frequent, brief, simple, and often directive communication. Biologically speaking, the brain of the individual in crisis is in the process of being bombarded with electrochemical reactions. Concentration and the ability to remember and retain information can be impaired.

A client is hospitalized for suicidal ideations as a response to complicated grief. Which collaborative interventions can the nurse anticipate including in this client's care? Select all that apply. A) Social service consult B) Bereavement group C) Antidepressant medication D) Sleep medication E) Psychotherapy

A, B, C, E) Treatment for complicated grief often involves a form of psychotherapy, which may be used in combination with antidepressants. Collaboration may also include requesting a referral to a social worker who can provide expert guidance about coping with loss or assist with linking clients with additional resources. Bereavement groups can be a resource for clients who have experienced a loss. Although impaired sleep patterns may be associated with grieving, medications to promote sleep usually are not indicated for these clients.

The nurse is caring for a client who is diagnosed with complicated grieving after the loss of a child. Which treatment approaches does the nurse anticipate being included in the collaborative plan of care for this client? Select all that apply. A) Antidepressants B) Electroconvulsive therapy C) Talk therapies D) Cognitive therapy E) Anger management

A, C, D) The treatment for complicated grieving is similar to the treatment for depression. Cognitive therapy, talk therapies, and antidepressants are all common treatment options. The description does not indicate that the client has a problem with anger management. Electroconvulsive therapy is typically reserved as a "last resort" treatment for severe depression or bipolar disorder, so it would not be included in an early plan of care.

The nurse is beginning crisis counseling with a client. What actions will the nurse use when counseling the client? Select all that apply. A) Assist in coping with the problem. B) Conduct follow-up assessments. C) Boil down the problem. D) Achieve rapport. E) Assess physiologic status.

A, C, D) When conducting crisis counseling with a client, the nurse will achieve rapport, boil down the problem, and assist the client in coping with the problem. Assessing physiologic status and conducting follow-up assessments are not steps within crisis counseling.

The nurse is caring for a client with erectile dysfunction (ED). Which medication(s) should the nurse anticipate being prescribed for this client? Select all that apply. A) Sildenafil (Viagra) B) Methylphenidate (Ritalin) C) Vardenafil (Levitra) D) Buspirone (BuSpar) E) Tadalafil (Cialis)

A, C, E) Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are all oral medications that act by facilitating relaxation of smooth muscle in the penis, thus allowing increased blood flow and erection. Buspirone (BuSpar) is an antianxiety agent and is not effective in the treatment of ED. Methylphenidate (Ritalin) is a mild central nervous system stimulant and is not effective for ED.

The nurse educator is preparing to teach a group of nursing students how to navigate the internet to research healthcare information. Which does the educator plan to include during lecture? A) A directory of campus internet sites of interest B) How to search for and evaluate health information C) A directory of libraries D) Information technology instruction

B) Campus health centers that use the Internet as a tool for health education must train nursing students regarding how to search for and evaluate the health information they find. Sites of interest for the campus would not directly impact the nursing program. Information technology is a subject that teaches nurses how to use technology for the delivery of care and communication. Libraries are important, but knowing about them would not be a part of this presentation.

A client with genital herpes asks the nurse how to manage pain when urinating and difficulty voiding. Which response by the nurse is correct? A) "Try to limit your fluid intake. That way, you won't have to void so often." B) "Pouring room-temperature water over your genitals may make it easier for you to start urinating." C) "Be sure to keep your genitals as dry as possible. Unnecessary exposure to water can worsen your infection and cause even greater pain upon urination." D) "Unfortunately, there's nothing you can do to eliminate your discomfort. It won't go away until your current herpes outbreak is over."

B) Clients with genital herpes who complain of dysuria and difficulty voiding can be taught to pour water over the genitals to start urination and dilute the urine. Drinking additional fluids also helps dilute the urine and reduce the burning sensation when voiding. The nurse might additionally suggest the use of sitz baths (with tepid water) for 15-30 minutes several times a day. The warm water is soothing and decreases pain from ulcers and an irritated urethral meatus. It facilitates wound healing and facilitates urination.

The nurse provides medication teaching for a client who will be going home on new medications. Which statement by the client best illustrates compliance with the medication plan? A) "I think you should have waited until I was ready to go home. Maybe I'd remember better." B) "I'm glad to know about my new medications. It makes taking them all a lot easier." C) "If I take my medications as prescribed, I'll feel better." D) "I already knew most of what you told me."

B) Compliance is best illustrated when the individual recognizes and accepts the need to learn, then follows through with appropriate behaviors that reflect learning. Learning about the medications helps the client understand why they are prescribed and improves the possibility for following the prescribed regimen. Statements of prior knowledge do not necessarily lead to compliance, and neither does merely restating the advice of the healthcare provider.

A client reports that he is having difficulty ejaculating during sexual activity, even though he is able to maintain an erection for 30-45 minutes. The client tells the nurse that this problem began about 6 months ago and has been a source of significant worry for both him and his partner. Based on this description, the client is most likely affected by which of the following conditions? A) Retrograde ejaculation B) Delayed ejaculation C) Erectile dysfunction D) Male hypoactive sexual desire disorder

B) Delayed ejaculation, once called male orgasmic disorder, involves extreme difficulty ejaculating, despite the ability to maintain an erection for long periods. Delayed ejaculation is a distinct disorder from retrograde ejaculation, in which ejaculation occurs but the fluid travels into the bladder instead of out through the urethra. Erectile dysfunction is an inability to attain or maintain an erection sufficient to permit mutually satisfactory sexual intercourse with a partner. Male hypoactive sexual desire disorder involves a deficiency in or absence of sexual fantasies and persistently low interest or a total lack of interest in sexual activity.

A nurse is caring for a client who is perimenopausal who states that she has recently had frequent bacterial vaginal infections. Which reason for these infections should the nurse include in the response to the client? A) Decreased vaginal pH B) Increased vaginal pH C) Increased estrogen level D) Decreased vasomotor stability

B) During perimenopause, vaginal pH increases, predisposing the client to bacterial vaginal infections. Also during perimenopause, estrogen levels decrease, not increase. Although decreased vasomotor stability is characteristic of perimenopause, it leads to hot flashes, not vaginal bacterial infections.

A pregnant woman has just been informed that her baby will be born with spina bifida. The woman begins to cry, stating "Why is this happening to me? I can't take care of a baby with a disability. I can't afford to pay for all the treatments the baby will need. What am I going to do?" What is the best response by the nurse? A) "If you calm down, we can talk about it. It's not as bad as it sounds." B) "The first step is to learn more about what to expect. Let me help you." C) "I know this is overwhelming, but everything will work out OK." D) "Your love for your baby will outweigh all of the difficulties."

B) Ignoring the woman's concerns or providing platitudes that may not be true are not effective ways to provide support to a pregnant woman in crisis. Instead, nursing interventions that increase knowledge about the crisis situation will increase the woman's ability to cope with the stressor.

A client who has just experienced a crisis is likely to present to the emergency department with which clinical manifestation? A) Depression B) Disorientation C) Fatigue D) Sleeplessness

B) Immediately after experiencing a crisis, the client is likely to present with disorientation. The client likely will not yet be feeling fatigue or sleeplessness immediately after the event, although they may experience these symptoms over the next few days. Depression is a chronic condition that develops over time, not as the immediate result of a crisis.

The nurse is providing care to a client who is "in crisis." The client recently lost a job, was served with divorce papers, and has been sick with back-to-back colds for 1 month. Which nursing statement demonstrates understanding of the care of a client in crisis? A) "Experiencing a crisis is never positive, so we must work to relieve your anxiety as soon as possible." B) "People generally find it easier to work through a crisis if someone is working with them." C) "Men often handle crisis better individually, whereas women do better with a counselor." D) "Once you reach the crisis state, you may remain there for several months until you recover."

B) In general, people are more successful in working through a crisis if they have someone to help them. This need for help is not gender dependent. A crisis results in such a state of disequilibrium that it is generally self-limiting and not a long-term event. Experiencing a crisis may actually offer the family or individual a potential for growth and change.

The nurse is assessing a 68-year-old client who appears disheveled. At previous appointments, the client was well kept with good hygiene practices. Today, the client's clothes do not match, the client's hair is unkempt, and the client has intense body odor. The nurse is concerned about this change in self-care. When conducting the assessment, what is the primary factor the nurse should consider? A) Whether the changes are due to a lack of understanding of technology B) Whether the changes are due to stress or dementia C) Whether the client is taking all medications as prescribed D) Whether the client is living independently

B) In older clients, changes in self-care habits are frequently in response to stress, but they could also be related to dementia and an inability to remember how to use basic grooming tools. The nurse needs to determine the cause of the self-care changes. A lack of understanding of technology and living independently could be causes of stress, and forgetting to take medications could be a sign of dementia, so these are secondary considerations after determining whether the changes are due to stress or dementia.

Which of the following terms describes involuntary tightening of the pelvic muscles that prevents penetration from occurring? A) Female orgasmic disorder B) Vaginismus C) Genito-pelvic pain/penetration disorder D) Dyspareunia

B) In women, vaginismus is involuntary tightening of the pelvic muscles that prevents penetration from occurring. Although often associated with genito-pelvic pain/penetration disorder, it is not necessary for this diagnosis. Dyspareunia is pain experienced by a woman during vaginal penetration. Female orgasmic disorder is the persistent delay or absence of orgasm following a phase of normal sexual excitement.

A college student is being treated for chlamydia. What should the nurse teach this student to decrease the risk of transmitting another sexually transmitted infection? A) Unprotected sex is acceptable if you know the partner well. B) Latex condoms should be used for all sexual activity. C) Birth control pills will help decrease the risk of pregnancy and STDs. D) Condoms should be used with petroleum jelly.

B) Latex condoms should be used for all sexual activity to decrease the risk of contracting and/or spreading a sexually transmitted infection. Although birth control pills can decrease the risk of pregnancy, they do not protect against the transmission of sexually transmitted infections. Petroleum jelly can damage a condom, defeating its purpose for safe sex. Unprotected sex should only be considered when both partners have been tested for STIs and the relationship is mutually monogamous.

The nurse is planning care to address pain in a client with genital herpes. Which intervention would most be appropriate for this plan of care? A) Do not submerge lesions in water. B) Clean lesions two or three times a day with warm water and soap. C) Dry lesions with a hair dryer turned to the hot setting. D) Wear tight cotton clothing.

B) Measures to reduce the discomfort of herpes lesions include cleansing the lesions two or three times a day with warm water and mild soap. Lesions should be dried using a hair dryer turned to the cool setting, and it is important to wear loose cotton clothing that will not trap moisture. Tepid sitz baths are also useful in decreasing pain from ulcers and an irritated urethral meatus.

Which of the following statements is true with regard to surgical menopause and oophorectomy? A) Natural conception is not an option for women who have undergone single oophorectomy. B) Surgical menopause may be successfully treated with hormone replacement therapy. C) Onset of surgical menopause is usually gradual. D) Oophorectomy is always accompanied by either hysterectomy or salpingectomy.

B) Oophorectomy may be done alone or may be combined with hysterectomy and/or salpingectomy. Unlike medical menopause, onset of surgical menopause is abrupt. Symptoms may be severe and may be treated with HRT. If oophorectomy involves one ovary, clients may still be able to conceive naturally; natural conception is not an option if oophorectomy involves both ovaries.

During a home care visit, an older adult client states to the nurse, "My wife died 3 years ago." Which action is a possible indicator that the client is experiencing complicated grief? A) The client tells the nurse that his wife was an awful cook and that he has eaten better meals since she died. B) The client says he hasn't seen the doctor since his wife died because the doctor's office reminds him of his wife. C) The client has an album of photographs of his wife open on the living room table. D) The client indicates that he sends his laundry out to be done because he doesn't know how the washer works.

B) Refusing to go to the doctor's office for over 3 years is considered outside the normal limits of the grieving process for older adults. Talking about the deceased wife's good and bad points and showing photographs of her are normal responses to grief. Sending out the laundry is a healthy response to a problem that this client identified.

A nurse is preparing to discharge a client who experienced a myocardial infarction. The client will have to make many lifestyle changes, and the nurse is providing instruction on how to implement a heart-healthy lifestyle. Which is the best description of the client education the nurse is presenting to this client? A) Dependent function of nursing that needs a healthcare provider's order to implement B) Important independent nursing function C) Activity nurses begin to learn after training on the job D) Way to establish the client's dependence on the nurse

B) State nurse practice acts include client teaching as a function of nursing, thereby making teaching a legal and professional responsibility. Nurses seek to help clients manage their health independently. Nurses begin to learn about teaching during their training. Nurses are not dependent on healthcare providers when determining the learning needs of the client.

A client complains about the stress of having to work long hours and missing daily exercise routines. Which response by the nurse is appropriate? A) "There are other ways to reduce stress, such as meditation." B) "Exercise helps reduce the impact of stress on the body and would be a good thing." C) "Drinking a small glass of wine each day does help reduce stress." D) "Maybe exercising, with all of the work, would be too much for your body anyway."

B) The client had been exercising but has not been recently because of additional work, which is causing stress. The nurse should encourage the client to resume daily exercise to reduce the impact of the stress on the body. The nurse should not reinforce the client's not exercising. Meditation might be beneficial, but because the client mentioned initially exercising and not meditating, this suggestion is not as appropriate in addressing the client's needs. The nurse should not suggest using alcohol to deal with stress.

The nurse is planning care for a client with gonorrhea who also has a history of prior sexually transmitted infections (STIs). What is the priority nursing action for this client? A) Instruction about the need to avoid all future sexual contact B) A plan for the client to contact sexual partners regarding the diagnosis C) Recommendation that the client increase fluids and rest D) Teaching regarding the importance of adequate nutrition

B) The client has gonorrhea and a history of sexually transmitted infections. The nurse should therefore encourage the client to develop a plan for contacting sexual partners regarding the diagnosis. Increasing fluids, rest, and nutrition are important, but not as important as contacting sexual partners to protect their health and limit the spread of disease. In addition, the nurse should instruct the client to avoid sexual contact until recovered from the current illness, but not necessarily to avoid all future sexual contact.

A client states to the nurse that learning how to use the blood glucose machine will have to wait until holiday events are planned. Which cognitive indication of stress is the client demonstrating? A) Problem solving B) Suppression C) Self-control D) Cognitive structuring

B) The client is demonstrating suppression, which is the conscious process of denying unacceptable thoughts or emotions. The client is focusing on other needs and not the need to learn how to use the blood glucose machine. Problem solving involves thinking through a challenging situation, using specific steps to arrive at a solution. Cognitive structuring uses mental processes to make sense of environmental stimuli. Self-control is the ability to restrain oneself from acting on impulse or to act in such a way as to delay gratification.

During a health history, the nurse learns that a male client has a recent onset of erectile dysfunction (ED). Which assessment question is likely to elicit the most useful information about factors that may be contributing to the client's ED? A) "Does this occur often?" B) "For what diseases and disorders have you been treated?" C) "Are you on any medications?" D) "How does your partner feel about this problem?"

B) The client's health history can provide clues regarding the underlying cause of the erectile dysfunction (ED). The question "For what diseases and disorders have you been treated?" would most likely provide useful information as to possible causes for the recent onset of the disorder. Asking the client whether ED occurs often will not help identify the cause of the problem, nor will asking the client how his partner feels about the situation. Inquiring about the client's medication use would be useful; however, the inquiry should be phrased as an open-ended question and not a closed-ended question, as it is here.

A client diagnosed with a sexually transmitted infection reports having "no idea" how the illness was contracted. Which nursing diagnosis would be appropriate for the client at this time? A) Anxiety B) Deficient Knowledge C) Ineffective Coping D) Sexual Dysfunction

B) The client's statement indicates deficient knowledge regarding the transmission of sexually transmitted infections. There is not enough information provided here to determine whether the diagnoses of sexual dysfunction, ineffective coping, and/or anxiety would also be appropriate for this client.

Which intervention would help a client who is demonstrating stress about being hospitalized who is concerned about the needs of the children at home? A) Ask the client if there is anything that is needed once discharged to home. B) Ask the client if there is anyone who would be able to help with the family needs at home during recuperation. C) Find out if the children can be sent to a grandparent's home until the client fully recovers. D) Suggest the client be transferred to a long-term care facility to ensure a full recovery.

B) The nurse needs to focus on what can be done right away to help the client. The best way that the nurse can help this client is to ask if there is anyone who can help the client at home. Transferring the client to a long-term care facility will not help the client with the stress of caring for a family at home. Sending the children to a grandparent's home might not work if the children are in school and the grandparent lives far away. Asking the client if there is anything that is needed once discharged is not enough. The nurse needs to do something else.

Which hormone is one of the primary mediators of stress? A) Glucagon B) Cortisol C) Serotonin D) Somatostatin

B) The two primary stress mediators are glucocorticoids (e.g., cortisol) and catecholamines (e.g., epinephrine). Serotonin is a neurotransmitter that is involved in some mood and anxiety disorders, but it is not a primary mediator of stress. Somatostatin is a hormone released by the pituitary gland. It is not involved in the stress response. Glucagon is secreted by the pancreas to increase blood glucose levels.

A male client tells the nurse that he has no idea why his wife wants to stay married to him because he has not been able to "perform" sexually since his prostate surgery. Based on the client's statement, which nursing diagnosis would be most appropriate? A) Ineffective Coping B) Situational Low Self-Esteem C) Hormonal Imbalance D) Sexual Dysfunction

B) This statement suggests that the client's inability to "perform" in sexual situations is causing him to question his self-worth. Situational Low Self-Esteem is therefore the most appropriate nursing diagnosis for the client at this time. A diagnosis of Sexual Dysfunction is associated with anxiety concerning the cause of the dysfunction, which is not the case for this client. The information given here is insufficient to determine whether the client is experiencing Ineffective Coping. Finally, Hormonal Imbalance is not a nursing diagnosis.

What should the nurse include in the plan of care for a client experiencing erectile dysfunction due to a chronic health condition? Select all that apply. A) Information about herbal supplements that can help treat ED B) Information on prescription medications used in ED treatment C) Brief description of types of devices and surgeries available to help with ED D) Explanation of how to discontinue any prescribed medications that may be contributing to the client's ED E) Information on the exact cause of the client's ED

B, C) When planning care for a client with ED related to a chronic health condition, the nurse should include information on medications for treatment and types of devices and surgeries available to help with the disorder. Because an exact cause of the client's ED may be difficult to determine, this information would not be appropriate for the nurse to include in the plan of care. Discussing herbal supplements would also be inappropriate because none of these substances have been found to be effective in the treatment of ED. The nurse should not encourage the client to discontinue any medications that may be causing sexual side effects; rather, the nurse should advise the client to discuss these medications with his provider before stopping treatment or pursuing other medication options.

A female client is prescribed an androgen medication to treat an estrogen-sensitive type of breast cancer. What should the nurse instruct the client about this medication? Select all that apply. A) This medication is associated with an increased risk of multiple births. B) Secondary male sex characteristics may develop from use of this medication. C) Monitor your weight on a weekly basis when using this medication. D) When taking this medication, immediately report any calf pain or dyspnea to your healthcare provider. E) This medication must be taken with food.

B, C)Androgen hormone replacements may be used to treat estrogen-dependent cancers. The nurse should instruct female clients about the risk of developing secondary male sex characteristics when taking this type of medication. Androgen medications also affect body weight, so the nurse should instruct the client to monitor her weight on a weekly basis. Increased risk of multiple births is associated with female infertility medications, and increased risk of calf pain or dyspnea is associated with estrogen hormone replacement therapy. Also, androgen medications do not need to be taken with food.

After an assessment, the nurse determines that an older adolescent client is experiencing a maturational crisis because of which findings? Select all that apply. A) Relationship with significant other ended B) Inability to focus on school studies C) Cannot sleep at night and skips classes D) Recent death of a friend E) Graduating from high school in 2 months

B, C,E ) Senior year is a transition to work or college. This is a developmental progression to the next level of maturity, a predictable event experienced by nearly all individuals. The client is demonstrating stressors unique to progressing to the next level of maturity. The recent death of a friend and having a relationship with a significant other end are situational crises.

A nurse is gathering the health history of a client with erectile dysfunction (ED). Which finding(s) could indicate a possible cause for the client's ED? Select all that apply. A) Blood pressure of 118/68 mmHg B) Treatment for type 2 diabetes mellitus for 7 years C) Body mass index (BMI) of 24.5 D) Alcohol intake of 4 to 6 beers each day E) Engaging in moderate exercise twice a week

B, D) Risk factors for ED are numerous. They include advancing age, diseases such as heart disease and diabetes, trauma, and the use of prescription or illicit drugs. Excessive use of alcohol can also result in erectile dysfunction. Engaging in moderate exercise, a body mass index within normal limits, and normal blood pressure would not provide a possible cause for the client's recent experience with ED.

A client who is approaching menopause is interested in oral hormone replacement therapy (HRT) to manage her symptoms. Which of the following points should the nurse include in this client's teaching plans? A) HRT decreases a woman's risk for deep vein thrombosis. B) HRT helps protect women against stroke and congestive heart failure. C) HRT is often useful for women who are at increased risk for osteoporosis. D) HRT is associated with a reduced incidence of breast cancer and pulmonary embolism.

C) Although HRT was once thought to exert cardioprotective effects, several large studies suggest it may actually increase a woman's likelihood of stroke and congestive heart failure. HRT is also associated with increased incidence of deep vein thrombosis, breast cancer, and pulmonary embolism. On the positive side, administration of estrogen has been shown to reduce a woman's risk of developing osteoporosis.

A 45-year-old female client tells the nurse that she has not had any interest in sex for about 8 months. During this time, she has also had difficulty with arousal. Which response by the nurse is best? A) "Don't worry; all women go through periods where they are uninterested in sex." B) "It sounds like you might be experiencing female sexual interest/arousal disorder, although your symptoms need to be present for 12 full months before this diagnosis applies." C) "You are not alone. Lack of interest and arousal is the most common sexual problem reported by female clients." D) "A lack of interest in sex is a normal consequence of the aging process, and it often begins around the time a woman enters menopause."

C) Although some declines in desire and arousal are normal with age, a total or near-total lack of interest in sex is not typical and is likely indicative of a larger problem. A diagnosis of female sexual interest/arousal disorder may be appropriate when a woman experiences decreased or absent sexual thoughts, interest in sexual activity, mental or physical feelings of arousal, and/or pleasurable sensation during sexual activity at least 75% of the time for a period of 6 months or more. Female sexual interest/arousal disorder is the most common female sexual dysfunction.

A female client tells the nurse she is having difficulty with sexual relations because of a recent weight gain. When planning this client's care, the nurse should prioritize interventions related to which of the following areas? A) Sexual self-concept B) Gender identity C) Body image D) Gender-role behavior

C) An individual's body image is constantly changing. How people feel about their bodies is related to sexuality, and people who have a poor body image may respond negatively to sexual arousal. This is what the client is experiencing. Sexual self-concept determines the gender and kinds of individuals to whom the person is attracted; the individual's values about when, where, how, and with whom he or she expresses his or her sexuality; and the individual's ability to freely choose sexual partners. Gender identity refers to an individual's self-image as a male, female, or transgender person. Gender-role behavior is the outward expression of an individual's sense of maleness or femaleness, as well as the expression of what is perceived as gender-appropriate behavior.

A female client asks what causes the symptoms of menopause. On which hormonal function should the nurse focus when responding to this client's question? A) Increased estradiol levels B) Increased progesterone levels C) Decreased estrogen levels D) Increased luteinizing hormone levels

C) As ovarian function decreases, the production of estrogen decreases, and estradiol is replaced by estrone as the major ovarian estrogen. Estrone is produced in small amounts and has only about one-tenth the biological activity of estradiol. With decreased ovarian function, production of progesterone is also markedly reduced. Although levels of luteinizing hormone increase, they are not the primary cause of the symptoms of menopause.

A client who gave birth 10 weeks ago via cesarean section tells the nurse that she is having difficulty resuming sexual relations with her husband. She reports both reduced desire for sex and pain upon penetration. What is the nurse's best response to this client? A) "Are you breastfeeding? If so, switching to formula will help resolve these issues." B) "Most women don't report these sorts of problems unless they've delivered vaginally." C) "These problems are common during the postpartum period and usually resolve with time." D) "Based on the symptoms you're reporting, I'm concerned you might be experiencing a postpartum mood disorder."

C) Both reduced desire and sexual pain are common during the postpartum period, regardless of whether a woman gave birth vaginally or via cesarean section. Typically, these problems resolve within several months. Although the hormonal changes associated with breastfeeding may contribute to sexual difficulties, women should be encouraged to continue breastfeeding for the health of their infant. In addition, even though clients with postpartum mood disorders are at increased risk for sexual dysfunction, such dysfunction is not necessarily indicative of a postpartum mood disorder.

A client is experiencing dysuria, urinary frequency, and vaginal discharge. For which sexually transmitted infection(s) should the nurse prepare the client for testing? Select all that apply. A) Syphilis B) HIV C) Chlamydia D) Human papillomavirus (HPV) E) Gonorrhea

C) Chlamydia and gonorrhea are both bacterial infections that invade the same target organs, including the cervix and male urethra, and create the manifestations of dysuria, urinary frequency, and discharge. The other sexually transmitted infections listed here target other organs and/or create other manifestations.

The home health nurse is visiting an older client with a terminal illness for a routine medication check. The nurse determines that the client has declined since the last home visit. The nurse suggests that the client should be transported to the hospital; however, the family members state that they want the client to stay in the home. Which action by the nurse is most appropriate? A) Follow the decision of the family. B) Call for an ambulance to transport the client to a hospital. C) Ask the client's preference regarding transport to the hospital. D) Encourage the family to take the client to the hospital.

C) For cultures that see death as inevitable, clients often prefer to die in their homes with their families. The nurse should ascertain that this is what the client wishes and respect that. Calling for an ambulance is inappropriate, as is encouraging the family to take the client to a hospital against their wishes. The nurse would not follow the family's wishes without finding out what the client wants.

A nurse is caring for a client in menopause. When discussing hormone replacement therapy (HRT) with the client, the nurse should include which of the following statements? A) "Most healthy, recently menopausal women should not use HRT for relief of hot flashes and vaginal dryness." B) "HRT is the least effective treatment of menopausal hot flashes and vaginal dryness." C) "If vaginal dryness and painful intercourse are the only symptoms, then low-dose vaginal estrogen is preferred." D) "The risk of blood clots in the legs or lungs is further increased by using transdermal patches, gels, or sprays."

C) If vaginal dryness and dyspareunia (painful intercourse) are the only symptoms of menopause, then low-dose vaginal estrogen is preferred. Most healthy, recently menopausal women may use HRT for relief of hot flashes and vaginal dryness. Risks for blood clots in the legs and lungs are increased with HRT, but occurrence is rare in women ages 50-59. The risk is further lowered by using low-dose estrogen pills or transdermal patches, gels, or sprays.

After a mammogram, a client is told that she needs a fine needle aspirate of a breast mass. Which action by the client demonstrates engagement in a primary appraisal of the stressful situation? A) Holding her breath while the nurse is talking B) Sitting in the dressing room crying C) Asking the nurse if she has cancer D) Scheduling the procedure in 6 weeks, which is the earliest possible appointment

C) In primary appraisal, the client assesses the potential for benefit, harm, loss, threat, or challenge in a situation. The client asking the nurse if she has cancer is engaging in a primary appraisal. The client holding her breath while the nurse is talking is evaluating coping resources and options. This is a secondary appraisal. The client who sits in the dressing room and cries is applying a coping resource. This is coping. The client who schedules the procedure at the earliest possible appointment is engaging in reappraisal, which is an ongoing reinterpretation of the situation based on new information.

A nurse on the behavioral health unit is caring for a client diagnosed with depression who just lost a spouse in a motor vehicle crash. The client states to the nurse, "My wife would not have wanted to live if she were disabled." Based on this statement, which defense mechanism is the client using? A) Identification B) Denial C) Intellectualization D) Displacement

C) Intellectualization is a mechanism by which an emotional response that normally would accompany an uncomfortable or painful incident is evaded by the use of rational explanations that remove from the incident any personal significance and feelings. Identification is an attempt to manage anxiety by imitating the behavior of someone feared or respected. Denial is an attempt to screen or ignore unacceptable realities by refusing to acknowledge them. Displacement is the transferring or discharging of emotional reactions from one object or individual to another object or individual.

A nurse is caring for a group of clients who are recovering in a rehabilitation hospital following total hip replacements. Which client is exhibiting the highest motivation to learn? A) A client who has been there the longest and is a great "coach" for newcomers B) A client who has been struggling with following nursing directives regarding discharge goals C) A client who is excited to learn ambulation techniques D) The client who has just moved in and is already eager for discharge

C) Motivation is the desire to learn and influences how quickly and to what extent an individual learns. It is generally greatest when an individual recognizes a need and believes the need will be met through learning. The client who is excited to learn about ambulation techniques understands that learning about it will help take his recovery to a high level. Motivation must be experienced by the client, not by someone else (as in being a "coach" for newcomers). Clients who struggle with rules or following prescribed courses of treatment are not motivated to learn the best reason for their particular plan of action; they may be "bucking" the system. The client who is already waiting to go home may be eager for that to occur, but not necessarily to the extent of being ready to learn how to achieve this end.

A nurse is working in a neonatal intensive care unit (NICU). The nurse wants to teach a mother of a premature baby how to give her baby a bath. Which statement by the mother reflects a readiness to learn? A) "You'll give us written instructions before we go home, correct?" B) "When my baby is just a little bigger, I'll feel more comfortable giving him a bath." C) "I want to make sure my husband is here, in case I don't hear everything that's said." D) "I'm so afraid I'll hurt my baby with all these tubes and wires."

C) Readiness to learn is the demonstration of behaviors or cues that reflect a learner's motivation, desire, and ability to learn at a specific time. The client who wants her husband involved is demonstrating motivation and willingness to learn. Statements about fear of the situation need to be addressed so that the fear will not inhibit the learning process. Wanting to wait until discharge or at least until the baby is older reflects uncertainty and possibly fear and should be addressed before learning can occur.

________ is a form of sex therapy that involves several stages of guided touching in which clients and their partners are encouraged to explore each other's bodies. A) Progressive desensitization B) Integrated therapy C) Sensate focus D) Directed masturbation

C) Sensate focus is a type of sex therapy that involves several stages of guided touching. With this method, clients and their partners are encouraged to explore each other's bodies, beginning with areas other than the breasts and genitals, then gradually incorporating these areas as they progress to full intercourse. Directed masturbation is a similar technique, although it is used by clients who do not wish to have a partner participate in the therapeutic process. Integrated sex therapy is a method that involves whatever combination of medical, behavioral, and cognitive techniques the provider(s) determine will be most beneficial to a client's particular problem. Finally, progressive desensitization is not a type of sex therapy.

The nurse is instructing a client about the medication sildenafil (Viagra). Which statement on the part of the client indicates that this teaching has been effective? A) "Viagra should be taken with food." B) "I can take Viagra at the same time I take my daily alpha-adrenergic blocker." C) "I can take only one pill in a 24-hour period." D) "Viagra works by decreasing blood flow to the penis."

C) Sildenafil (Viagra) acts by facilitating relaxation of smooth muscle in the penis, thus allowing increased blood flow. This drug should be taken no more than once per day, should not be used by men who are taking nitrate-based drugs or alpha-adrenergic blockers, and does not need to be taken with food.

A premenopausal client tells the nurse that she is not looking forward to menopause because it means her life is over. When the nurse asks what she means by this statement, the client says, "I can't imagine that anyone will have much use for an old woman who can't have children anymore." Based on this statement, which nursing diagnosis would most likely be appropriate for the client at this time? A) Ineffective Sexuality Pattern B) Deficient Knowledge C) Situational Low Self-Esteem D) Disturbed Body Image

C) The client believes that once she reaches menopause, her life is over. The most appropriate nursing diagnosis for the client at this time would be Situational Low Self-Esteem, because it seems that the client feels that she will no longer have value once she enters menopause; this, in turn, suggests the client has inadequate coping skills to aid with the aging process. There is no information in the client's statement to support the diagnosis of Ineffective Sexuality Pattern. Similarly, based on this statement alone, the client may or may not have deficient knowledge or a disturbed body image.

The nurse is providing care to a client who is experiencing a crisis. Which statement by the client indicates that the goals of care have not been met? A) "I came up with some ideas on how to cope when I am in this position." B) "I feel like I am in control and can begin managing things now." C) "I am not sure whom I am going to call when I start feeling like this again." D) "I can deal with this, I am a strong person, and I have a lot of friends and family."

C) The client who is unsure of whom to call in a crisis has not met goals yet. The other statements demonstrate a good understanding of managing a crisis.

The nurse is caring for a client who has just died due to an intentional drug overdose. The client's partner is still in the room but is dry-eyed and exhibiting somber behavior. The nurse should recognize that the partner's behavior is most likely related to which of the following factors? A) The partner is waiting to grieve until the client's family can join him. B) The partner is seeking support from staff members on the unit. C) The partner anticipates that others will find the client's actions socially unacceptable. D) The partner is concerned that others may view him as weak if he shows too much emotion.

C) The nurse should recognize that the partner may be experiencing disenfranchised grief, which occurs when individuals cannot acknowledge their loss to others. Disenfranchised grief is more common in situations in which the loss is considered socially inappropriate or unacceptable, such as the loss of someone from suicide or a drug overdose.

A public health nurse is educating a group of adults about the incidence and prevalence of sexually transmitted infections (STIs). Which statement should be included? A) "Males have higher rates of gonorrhea and chlamydia, whereas women have higher rates of syphilis." B) "Men are disproportionately affected by STIs as compared to women and infants." C) "Women often experience few early manifestations of infection, which causes them to delay diagnosis and treatment." D) "The incidence of STIs is highest among young Caucasian females."

C) Women often experience few early manifestations of sexually transmitted infection, which can lead to delays in diagnosis and treatment. Women have higher rates of gonorrhea, whereas men have higher rates of chlamydia and syphilis. Women and infants are disproportionately affected by STIs as compared to men.

The nurse is planning care for a client with female orgasmic disorder. Which of the following elements would least likely be included in the client's plan of care? A) Referral to a sex therapist B) Information on the use of vibrators and other mechanical aids C) Teaching on how to perform pelvic floor exercises D) Instruction on how to obtain and use vaginal dilators

D) A variety of treatment options may be useful for women affected by female orgasmic disorder, including sex therapy; use of vibrators and other mechanical aids; and instruction regarding exercises that strengthen the pelvic floor. Vaginal dilators are used in the treatment of genito-pelvic pain/penetration disorder, not female orgasmic disorder.

A postmenopausal client says to the nurse, "I've lost interest in sex over the past few months, but that's normal for women my age." Based on the client's statement, which nursing diagnosis would be most appropriate? A) Situational Low Self-Esteem B) Readiness for Enhanced Communication C) Readiness for Enhanced Relationship D) Deficient Knowledge

D) Although some declines in desire and arousal are normal with age, a total or near-total lack of interest in sex is not typical and is likely indicative of a larger problem. Because the client seems unaware of this fact, a diagnosis of Deficient Knowledge is most likely appropriate. Nothing in the client's statement suggests that she suffers from situational low self-esteem or is having difficulty communicating with her spouse or the healthcare team. Furthermore, nothing in the client's statement indicates that relationship issues are a factor in this situation.

A clinic nurse is assessing a client who is experiencing crisis. The nurse needs to determine the client's immediate needs. Which is the priority action by the nurse? A) Scan for physical distress. B) Explore perceptions of the crisis. C) Develop a follow-up plan. D) Assess for immediate safety needs.

D) Assessing for immediate safety needs would take priority. Scanning for physical distress and exploring perceptions of the crisis are important, but do not take priority over safety. Developing a follow-up plan would occur only after other interventions have been implemented.

The nurse is teaching a client about sexual activity during the pregnancy. Which of the client statements indicate that this teaching has been successful? A) "The elevated androgen levels that accompany pregnancy might reduce my desire for sex." B) "It's a good idea to avoid vaginal sex during the last few weeks of pregnancy, so I don't risk hurting the baby." C) "Sexual dysfunction is uncommon during pregnancy, although many women suffer from low desire during the postpartum period." D) "Pregnant women are most likely to experience sexual difficulties during the third trimester."

D) Between 60% and 70% of women experience sexual dysfunction during pregnancy, and an even higher percentage report difficulties during the postpartum period. Sexual problems during pregnancy often fluctuate by trimester. The third trimester is the time when sexual difficulties are most common. Some of these difficulties are related to the decreased androgen levels of pregnancy, while others involve changes in body size and mechanics, self-esteem, and body image. Although some women fear that penetration will harm the fetus, this is rarely the case.

The nurse is part of a disaster response team caring for individuals after a metro bus collided with a building. What must the nurse consider when assessing the emotional state of each individual? A) The individual's previous healthcare experiences will make them more open to sharing emotions. B) The individual's race or ethnicity will be a predictor of their resiliency. C) The individual's emotional state is not as important as their physical injuries. D) The individual's culture will influence their expression of emotions.

D) Cultural factors may influence how an individual expresses emotions. Just because one person is more reserved than another does not mean they need less care. Although physical injuries may be more urgent, the person's physical and emotional state are both equally important and require nursing care. Individuals of any race or ethnicity can display the characteristic of resilience during a crisis. Individuals who have had a negative experience with the healthcare system may be less open to sharing emotions.

Which instruction by the nurse to a client prescribed diazepam (Valium) for anxiety and stress is appropriate? A) "This medication will be good to take for a long time." B) "Take this medication every time feelings of stress become overwhelming." C) "This medication works best if taken with a meal." D) "This medication is good to use for the short term only."

D) Diazepam (Valium) is a benzodiazepine that is typically used for short-term treatment during an acute phase of an anxiety disorder. It may be effective in quickly lowering the severity of a client's anxiety but is generally not recommended for use beyond a few weeks because of its addictive properties. The nurse should instruct the client that the medication is good to use for the short term only. There is no indication that this medication needs to be taken with a meal. Instructing the client to take the medication every time feelings of stress become overwhelming could lead to an overdose and should not be done.

A community health nurse is educating a group of teenage girls about the prevention of dating violence. Which statement should the nurse include in teaching? A) "Studies suggest that males who monitor their partners' whereabouts are less likely to engage in violence than males who do not keep tabs on their partners." B) "Females can reduce their risk of becoming victims of violence by adopting a submissive role in the dating relationship." C) "Males who own weapons are no more likely to perpetrate dating violence than males who don't have access to weapons." D) "Males with a history of aggressive behavior are more likely to behave violently toward their partners."

D) Early warning signs that a male is at risk of perpetrating dating violence include jealous and possessive behaviors (such as monitoring a partner's whereabouts); ownership of weapons; and a history of aggressive behavior. Men who believe that women should be submissive are also more likely to engage in dating violence, even if their partners behave submissively. Encouraging women to act submissively thus not only places them at greater risk of violence, but erodes their sense of agency and self-worth.

Occupation-specific stressors that are ongoing and unmanaged can lead to what extreme form of stress? A) Distress B) Eustress C) Allostasis D) Burnout

D) Eustress is good stress that leads to accomplishment and victory. Distress is bad stress that is associated with inadequacy, insecurity, and loss. Although occupation-specific stressors can be a type of distress, distress is not the specific term for the extreme form of stress caused by ongoing and unmanaged stress. The term used for that form of extreme stress is burnout. Burnout in nurses can lead to reduced quality of care and decreased patient satisfaction. Allostasis refers to the changes necessary to achieve homeostasis.

Which of the following actions on the part of the nurse is most appropriate when treating an 8-year-old client who is exhibiting the symptoms of a sexually transmitted infection (STI)? A) Immediately perform a detailed examination and collect relevant specimens B) Assume that the child acquired the infection during the perinatal period C) Initiate presumptive treatment of the STI as soon as possible D) Anticipate the need to follow mandatory reporting guidelines

D) In some cases, STIs in young children may be the result of perinatally acquired infections that can persist for 2 to 3 years; however, the general rule is to consider infection evidence of abuse. STI testing should be conducted prior to initiating treatment of children exhibiting STI symptoms in order obtain a reliable diagnosis. It is essential to examine and collect specimens from children in a manner that minimizes trauma to them; thus, examination and collection should be conducted by a clinician with specific experience in the area of child sexual abuse. Because STIs in children are often a result of sexual abuse, and also because public health authorities require the reporting of certain STIs, the nurse should anticipate the need to follow mandatory reporting guidelines.

Which of the following statements is true with regard to human sexuality? A) The term "intersex" is used to describe individuals whose gender identity and/or gender expression differs from the gender they were assigned at birth. B) Members of the medical and psychological professions believe that all transgender individuals are affected by gender dysphoria. C) Today, the terms "transgender" and "transsexual" are typically used interchangeably. D) Transgender individuals are at increased risk for violence, discrimination, poverty, and limited access to healthcare.

D) Intersex individuals are people who have contradictions among their chromosomal gender, gonadal gender, internal sex organs, and external genital appearance, whereas transgender individuals are people whose gender identity and/or expression differs from the gender they were assigned at birth. In the past, transgender individuals were often referred to as transsexual, although use of this term is now usually limited to people who have changed or seek to change their sexual anatomy through medical interventions. Some-but not all-transgender individuals are affected by a condition called gender dysphoria, which involves strong and persistent feelings of discomfort with one's assigned gender. Regardless of terminology and diagnoses, all transgender individuals are at increased risk for violence, discrimination, poverty, and limited access to healthcare.

The nurse is assessing a client who presents with an open sore on his penis. Which question by the nurse best elicits additional data related to this finding? A) "Do you think you have a disease?" B) "Have you had sexual intercourse recently?" C) "Are you promiscuous?" D) "When did you initially notice this open area?"

D) It is important that the nurse record the onset of the open area. The remaining questions are all closed and will not elicit much information, although determining the date of the last episode of sexual intercourse might be indicated later if a disease is diagnosed. Asking the client about promiscuity is judgmental.

An older adult client tells the nurse that he still has erections and wants to have sex with his wife, but she does not have the same interest in sexual activity as he does. What should the nurse do to assist this client? A) Explain that women lose interest in sex as part of the aging process. B) Suggest that the client wait a while and his urge to have sex will pass. C) Ask what the client has been doing to fulfill himself sexually. D) Encourage the client to ask his wife to discuss her lack of interest in sexual activity with her healthcare provider.

D) Lack of interest in sex is not a normal part of the aging process and suggests that the client's wife is experiencing sexual dysfunction. Thus, the nurse's most appropriate course of action would be to encourage the client to ask his wife to discuss the lack of interest with her healthcare provider as a starting point. The other choices are inappropriate and should not be provided to the client.

A client is recently prescribed risperidone (Risperdal) by the healthcare provider. Which would be a priority nursing consideration for this client? A) Assess blood pressure and heart rate. B) Monitor for increased agitation. C) Assess for drowsiness. D) Monitor for neuroleptic malignant syndrome.

D) Monitoring for neuroleptic malignant syndrome is a priority nursing consideration for a client taking risperidone (Risperdal). The nurse must monitor for signs and symptoms of neuroleptic malignant syndrome and tardive dyskinesia and immediately report signs and symptoms of these conditions. Monitoring for increased agitation and assessing for drowsiness are nursing considerations for clients taking Risperdal, but they are not the priority diagnosis. Assessing blood pressure and heart rate would be a priority nursing consideration for the client taking Inderal.

Which of the following clients would be described as experiencing premature ovarian failure? A) A 29-year-old woman who is receiving chemotherapy that damages her ovaries B) A 43-year-old woman who has irregular periods as a result of ovarian dysfunction C) A 35-year-old woman who recently underwent an oophorectomy D) A 32-year-old woman who does not ovulate because of an abnormally low number of ovarian follicles

D) Premature ovarian failure (POF), also known as premature menopause, occurs in women under the age of 40 who do not ovulate each month because of a low number of follicles or ovarian dysfunction. Because of her age, the 43-year-old woman would not be considered to have POF. Similarly, the client undergoing chemotherapy would be experiencing medical menopause, while the client with an oophorectomy would be experiencing surgical menopause.

A client tells the nurse that her boyfriend died 3 weeks ago. The client states that she has been unable to grieve openly because her boyfriend was married and no one knew of their relationship. The nurse recognizes that the client is experiencing which type of grief? A) External grief B) Chronic grief C) Abbreviated grieving D) Disenfranchised grieving

D) Sleep disturbances are common with all types of grief. This client is likely experiencing the form of grief known as disenfranchised grieving, which occurs when individuals cannot acknowledge their loss to others. Disenfranchised grieving is common in situations where the loss is not socially recognized, as is the case with this client, because extramarital affairs are not socially sanctioned. Abbreviated grieving is grieving that is brief but genuinely felt. This client's grief is not yet chronic, as only 3 weeks have passed. External grieving is not a recognized type of grief response.

A client asks for a prescription for tadalafil (Cialis). Given this information, what should the nurse ask the client prior to creating a plan of care? A) "Do you have diabetes mellitus?" B) "Are you comfortable taking this medication twice per day?" C) "Do you have any sexually transmitted infections?" D) "Do you use nitroglycerine?"

D) Tadalafil (Cialis) should not be used by clients who are taking nitroglycerine and other nitrate-based drugs. Neither diabetes mellitus nor a sexually transmitted infection is a contraindication to the use of Cialis. Cialis should be taken no more than once per day, so there is no need to ask the client whether he is comfortable taking multiple doses in a 24-hour period.

The nurse is assessing a postmenopausal client. Which client statement indicates the need for further assessment by the nurse? A) "I use water-soluble lubricant to treat my vaginal dryness." B) "For some reason, I have more sexual desire than ever." C) "Sex certainly takes longer than it used to, but I'm getting used to that." D) "I am so glad that I don't need to worry about sex anymore."

D) The statement "I am so glad that I don't need to worry about sex anymore" merits further assessment by the nurse. This statement is unclear. Does it mean that the client is glad she doesn't have to engage in sex anymore, or does it mean she is happy that she no longer has to worry about getting pregnant? The other statements reflect normal changes associated with aging and healthy responses to those changes.

Why is type 2 diabetes associated with an increased risk of sexual dysfunction in older adults? A) Type 2 diabetes causes a decrease in sex hormone levels that may lead to diminished sexual function. B) Type 2 diabetes contributes to arthritis and other joint problems that can make sexual activity difficult. C) Type 2 diabetes brings about changes in cellular metabolism that may result in atrophy of the male and female reproductive organs. D) Type 2 diabetes leads to vascular and nerve damage that may negatively affect sexual function.

D) Type 2 diabetes can cause both vascular damage and nerve damage that negatively affect sexual arousal and orgasm. Although decreased sex hormone levels, arthritis, and joint pain can contribute to sexual dysfunction in older adults, these conditions are not related to type 2 diabetes. Furthermore, type 2 diabetes does not contribute to atrophy of the reproductive organs.