Eliopoulos Chapter 16- Sexuality and Intimacy
9. The nurse identifies which patient as having the highest risk of erectile dysfunction? A) Patient who is obese and has poorly controlled type 2 diabetes B) Patient who is 80 years old and has a colostomy following colon cancer 7 years prior C) Patient who is 71 years old and was recently diagnosed with Parkinson disease D) Patient who has a diagnosis of lung cancer following a work history that included asbestos exposure
A Feedback: Diabetes is a noted, direct cause of erectile dysfunction. The other cited pathologies are not noted to be directly causative of erectile dysfunction.
18. The nurse learns about an older male and older female resident in a long-term care facility who spend time together in a locked room. What should the nurse do about this situation? A) Nothing. The residents have a right to privacy B) Talk to the residents' adult children about the situation C) Initiate a meeting with the residents to discuss the situation D) Institute a "no locked doors" policy and make sure all residents know about it
A Feedback: Elders have a right to privacy and a right to sexual expression. Their sexuality should not be sanctioned, screened, or severed by anyone, even in an institutional setting. The older residents have a right to privacy and should be able to close and lock a door. The adult children of the residents should not be consulted about the situation. It is really none of their business.
27. A patient explains a lack of interest in sex since her spouse passed away 3 years ago. After completing the health history what would the nurse suspect as contributing to the patient's lack of interest in sex? A) Prescribed antidepressants for sadness B) Change in the patient's Medicare benefits C) Participating in arthritis swimming classes D) Reduced intake of red meat and carbohydrates
A Feedback: Medications prescribed to older people can affect libido. One classification of drugs that have adverse sexual effects is antidepressants. The other assessment findings would not directly affect the patient's interest in sexual activity.
6. An older male patient has disclosed to the nurse his recent inability to achieve an erection. How should the nurse respond to the patient's statement? A) "It's not unusual for older men to have the problem occasionally, but we need to make sure that it's not the result of something we can change." B) "This is a very normal part of the aging process. Are there other ways of achieving sexual fulfillment that you and your wife could try?" C) "It's a myth that older men have difficulty gaining and maintaining erections, so a thorough medical investigation is likely the best plan." D) "This is often an unintended result of medications. Try withholding your medications for a few days and see if the problem resolves itself."
A Feedback: Occasional difficulty gaining and maintaining erections is common in older men. However, this does not rule out the presence of a modifiable cause such as medication side effects, and the situation would warrant further assessment. It would be inappropriate for the nurse to discount his concerns as normal and suggest alternative activity or to arbitrarily suggest he withhold his medications.
26. While completing an assessment the nurse learns that an older female patient has many misconceptions about having sex at this time in her life. What did the patient say for the nurse to come to this conclusion? A) Sex can refracture a broken hip. B) Some medications can reduce the desire for sex. C) Menopause changes the amount of estrogen in the body. D) Different positions can be used to help with the limits of arthritis.
A Feedback: One common misconception about having a fulfilling sex life in old age is that sex can refracture a broken hip. The other statements are not misconceptions about sex in old age.
10. Two residents of a long-term care facility have been married for over 50 years and lived in the same house until health problems caused them to be admitted to the facility. They are currently assigned to different rooms. How can the nursing staff best facilitate the couple's sexuality? A) Facilitate a move into the same room if possible B) Locate a place in the facility where they can spend time alone C) Regularly assess and document their feelings and issues around sexuality D) Educate the couple on the ways that they can expect their situation to affect their sexuality
A Feedback: The ideal situation for these residents would be to remain in the same room if possible. The other cited interventions and assessments are valid, but would not supersede the couple's need to stay together at this stage of life.
11. At which point should the nurse assess a senior patient's sexual health? A) After gaining the elder's permission B) Before receiving approval from a physician C) After reviewing the results of the elder's physical exam D) Before checking the patient's prescription and over-the-counter drug use
A Feedback: The nurse should begin a sexual assessment after asking for the senior patient's permission to ask the questions. The nurse does not need to receive approval from the physician before assessing a senior patient's sexual health. The nurse does not need to review the results of the physician exam or check medication use before conducting a sexual history with a senior patient.
20. A female patient in menopause asks why estrogen levels change during and after menopause. What should the nurse explain about estrogen in a postmenopausal woman? A) Conversion of androstenedione to estrone occurs in the skin and fatty tissue B) Secretion of estradiol and complementary progesterone from the adrenal glands C) Synthesis by the ovarian follicles in response to gonadotropic hormone stimulation D) Coenzyme action in the parathyroid gland prompted by stimulation from the thyroid
A Feedback: When the ovaries decline in function, most estrogen is obtained through the conversion of androstenedione to estrone in the skin and adipose tissue. The other choices do not explain the hormone estrogen in the postmenopausal patient.
24. During an assessment the nurse suspects an older male patient is experiencing andropause. What did the nurse assess in this patient? (Select all that apply.) A) Breast enlargement B) Testicular shrinking C) Dark spots on the skin D) Reduced muscle mass E) Bruising and petechiae
A, B, D Feedback: Andropause is a decline in testosterone levels. Characteristics of low testosterone levels in men include breast enlargement, testicular shrinking, and reduced muscle mass. Dark spots on the skin and bruising and petechiae are not manifestations of andropause.
23. A female patient is experiencing hot flashes and anxiety since beginning menopause. What should the nurse teach the patient about managing these symptoms? (Select all that apply.) A) Consider meditation B) Cut down on exercise C) Take rhapontic rhubarb D) T'ai chi can help with stress E) Reduce sleep to 6 hours a night
A, C, D Feedback: Herbs such as standardized extract of rhapontic rhubarb have been shown to reduce hot flashes and other symptoms of menopause. Meditation and t'ai chi are considered complementary and alternative approaches to help control menopausal symptoms. Exercise and regular adequate sleep are recommended to control menopausal symptoms. Exercise and sleep should not be reduced.
17. The nurse is helping an older female patient understand the difficulty of finding a sexual partner at this time in her life. What is generally true of the elderly population? A) Most men and most women are still married B) Most men are married and most women are widowed C) Most men are widowers and most women are married D) Most men are widowers and most women are widows
B Feedback: A practical interference with sexual function in later life is the lack of a partner, particularly for older women. By 65 years of age, there are only 7 men to every 10 women; by 85 years of age, the ratio becomes 1 to 5. Furthermore, there is a tendency for men to marry women younger than themselves; one-third of men older than 65 years of age have wives younger than 65 years of age; therefore, most older men are married and most older women are widowed.
3. A female patient asks about using hormone replacement therapy (HRT) for menopausal symptoms but is concerned about the risks. How can the health care provider best guide the patient decision to begin or forego HRT? A) "The significant increases in the risk of heart disease make HRT a risky treatment that is best avoided." B) "You won't likely be increasing your risk of heart disease if you begin HRT, but neither will you be preventing." C) "The overall effectiveness of HRT in alleviating the unwanted changes that following menopause has been disproven." D) "HRT can best be described as a tradeoff, where menopausal symptoms decrease but there is a significantly increased risk of hip fractures and breast cancer."
B Feedback: Although women can feel reassured that they are not increasing their risk for cardiovascular disease by using hormones to treat symptoms as they go through menopause, it is not wise to extrapolate from the data that women should take hormones for the prevention of heart disease. HRT is not noted to increase the risk of breast cancer or hip fractures, while the effectiveness at relieving symptoms of low estrogen is significant. The health care provider would be unlikely to categorically rule out HRT as a treatment option, but would more likely weigh the potential risks and benefits with the client.
14. The nurse recognizes that older men may decide they are too old for sex because of a cycle involving which of the following? A) Erection and flaccidity B) Impotence and anxiety C) Masturbation and impotence D) Climax and a failure to ejaculate
B Feedback: An episode of erectile dysfunction can trigger a cycle wherein anxiety over the potential loss of sexual function interferes with the ability to become erect, which in turn further heightens anxiety. The other choices do not describe cycles that cause older men to decide they are too old for sex.
13. A 70-year-old male patient has erectile dysfunction, but he tells the nurse that he is no longer interested in sexual activity. What is the best advice the nurse can give to the patient? A) Suggest that he ask his physician for Viagra in case he changes his mind B) Encourage the patient to have a medical exam to find the cause of his erectile dysfunction C) Recommend counseling, because most erectile dysfunction is psychological in origin D) Point out that erectile dysfunction affects one in four elderly men and is no reason for concern
B Feedback: Erectile dysfunction can have multiple causes, including atherosclerosis, diabetes, hypertension, multiple sclerosis, thyroid dysfunction, alcoholism, renal failure, structure abnormalities, medications, and psychological factors. Given the range and complexity of potential causes, a thorough physical examination is essential. Even if the patient is not interested in being sexually active, he should be encouraged to have this dysfunction evaluated to identify underlying conditions that warrant medical attention.
22. A patient experiencing menopausal symptoms asks what dietary changes can be made to reduce the manifestations of menopause. What should the nurse instruct the patient? A) Eat meats and dairy products rich in animal estrogens B) Eat whole grains, nuts, and soybeans rich in plant estrogens C) Eat fruits and vegetables rich in vitamin C to increase estrogen retention D) Drink coffee and caffeinated sodas to stimulate estrogen release from the adrenal glands
B Feedback: Foods rich in plant estrogens may offer some relief from menopausal symptoms. Caffeine should be avoided. Fruits and vegetables, high in boron, not vitamin C, promote estrogen retention.
15. Which statement does the nurse recognize as being a myth about sex and the elderly? A) Sexual responsiveness diminishes in old age. B) Most women lose interest in sex after menopause. C) Most men in their eighties achieve erections and are capable of intercourse. D) An individual's sexual preferences and behaviors are the same in old age as in midlife.
B Feedback: Sexual behaviors and preferences remain stable into old age, and elderly men are capable of intercourse. Although sexual responsiveness typically declines, many postmenopausal women gain a new interest in sex, possibly because they no longer have to fear an unwanted pregnancy or because they have more time and privacy with their children grown and gone.
19. The nurse is planning a presentation for nursing staff on supporting the sexual needs of the long-term care residents. Which statement would the nurse include that best defines sexuality? A) Any behavior involving the genital organs B) Identification with a socialized gender role C) Any physical interaction between two people D) Any behavior undertaken to attract a member of the opposite sex
B Feedback: Sexuality encompasses more than a physical act. It includes love, warmth, caring, and sharing between individuals and identification with a sexual role. Sexuality may or may not include behavior involving the genital organs. Any physical interaction between two people is not a definition of sexuality. Behavior taken to attract a member of the opposite sex is not a definition of sexuality.
25. A male patient who experienced a heart attack 6 months ago tells the nurse that he did not realize that his sexual life would be over so early in life. What information would be appropriate for the nurse to share with this patient? (Select all that apply.) A) Encourage to cultivate hobbies B) Teach about alternative positions to avoid strain C) Instruct to avoid large meals for several hours before sex D) Plan to take medications for peak effectiveness during sex E) Explain that everyone experiences an end to sexual experiences
B, C, D Feedback: Heart disease can interfere with sexual functioning. The nurse should teach the patient about alternative positions to avoid strain, avoiding large meals for several hours before sex to reduce the strain on the heart, and taking medications for peak effectiveness during sex. The nurse should not support the patient's belief that his sex life is over by encouraging him to cultivate hobbies and explaining that everyone experiences an end to sexual experiences because this is not true.
2. The nurse who cares for patients at an assisted living facility is planning a program to address safer sex in older adults. Why would this program be important? (Select all that apply.) A) Susceptibility to sexually transmitted infections (STIs) increases with age. B) HIV/AIDS is spreading more quickly among older adults than among younger adults. C) Older adults frequently forego condom use because the risk of pregnancy does not exist. D) Many older adults assume that STIs are problems of younger adults only. E) Because of the hormonal changes that accompany menopause, older women are in fact more prone to sexually transmitted diseases than younger adults.
B, C, D Feedback: Older adults often forego condom use and assume STIs are not a problem, despite the increasing incidence of HIV/AIDS in older adults. Susceptibility to STIs does not necessarily increase in older adults in general or in older women specifically. In the older population, the use of condoms is often avoided because the risk of pregnancy does not exist. Hormonal changes in menopause do not increase an older woman's susceptibility to sexually transmitted diseases.
7. Which older adult client would the nurse identify as being susceptible to decreased libido or sexual function as a result of the medication regimen? A) A 78-year-old woman who takes an antiplatelet aggregator for the prevention of ischemic heart disease. B) An 80-year-old male client with osteoporosis who is taking vitamin D and calcium supplements. C) A 77-year-old man who takes a diuretic and a -adrenergic receptor blocker for the treatment of hypertension. D) An 81-year-old woman who takes HRT and nebulized bronchodilators for her chronic obstructive pulmonary disease.
C Feedback: Diuretics are noted to diminish sexual function. The other noted medications are not included in the list of medications with this effect.
12. What is the first thing the nurse should check when an elderly widower reports a sudden onset of erectile dysfunction? A) His mental health history B) His heart rate and blood pressure C) What drugs he has started taking D) His attitudes toward sex outside marriage
C Feedback: Frequently, medications prescribed to the elderly affect potency, libido, orgasm, and ejaculation. Drugs should be reviewed when new sexual dysfunction occurs. A sudden onset of erectile dysfunction is not typically associated with mental health problems in the older patient. Heart rate, blood pressure, and attitudes toward sex outside of the marriage would not be the first thing that the nurse would check in the older patient with a new onset of erectile dysfunction. These areas can be assessed later in the process.
16. An older female patient is providing information about her sexual history with the nurse. What does the nurse realize as being true about the sexual response in older women? A) Orgasm is more easily achieved B) Sexual interest and receptivity decline after age 60 C) Intercourse may be painful as a result of reduced lubrication D) Poor muscle tone in the vaginal wall makes penetration difficult
C Feedback: Older women may experience dyspareunia (painful intercourse) as a result of less lubrication, decreased distensibility, and thinning of the vaginal walls. Orgasm is not more easily achieved in older women. Sexual interest and receptivity do not decline after age 60. Poor muscle tone in the vaginal wall does not make penetration difficult.
4. The nurse wants to acknowledge and accommodate the sexual needs of older residents in a long-term care facility. Which statement provides the most accurate guide for the nurse's practice? A) Erectile dysfunction drugs can be used to significantly enhance older adults' lack of interest in sex. B) The nurse should gently and creatively seek to liberate older adults from the rigid gender roles of their youth. C) The nurse should remember that the general pattern and character of sexual behavior and identity is consistent throughout the life. D) The nurse should recognize that older adults experience an increased desire for emotional comfort and intimacy along with an accompanying decrease in desire for physical, sexual activity.
C Feedback: Sexual interest and identity is generally consistent throughout the life span. It is not the nurse's role to deliberately seek to change residents' gender identities, and interest in physical sexual activity does not necessarily wane. It would be inappropriate and ineffective to attempt to create sexual interest through the use of erectile dysfunction drugs.
8. Which statements does the nurse identify as reasons for many older adults being unable to find a sex partner? (Select all that apply.) A) Most men are married to older women. B) There are many more men over age 65 than women. C) Most older men are married while older women are widowed. D) The number of older women far exceeds the number of older men. E) Most women marry men who are significantly older than themselves.
C, D, E Feedback: Most older men are married while older women are widowed. The number of older women exceeds the number of older men. And most women marry men who are significantly older than themselves. Most men are not married to older women. And there are not many more men over age 65 than women.
21. A female patient believes she is experiencing menopausal symptoms but the health care provider wants to perform additional testing. What manifestations did the patient most likely demonstrate? A) An onset of migraine headaches B) Rising to urinate several times each night C) Moodiness, depression, and forgetfulness D) Occasional weakness and numbness on her right side
D Feedback: A new onset of migraine headaches, nighttime voiding, moodiness, depression, and forgetfulness are symptoms associated with menopause. Weakness and numbness are not typical symptoms of menopause; they are symptoms of a possible stroke.
1. Which statement best captures the predominant societal view of sexuality in general and sexuality in older adults? A) Sexuality has recently become valued and normalized in both older and younger adults. B) There is an acknowledgment that sexual interest and activity do not necessarily decline with age. C) There is societal recognition that the overall importance of sexuality remains high across the life span. D) Stigma and prejudice around sexuality in older adults persists despite changes in the societal view of sexuality in general.
D Feedback: Inaccuracies and misconceptions around sexuality and older adults persist, despite profound changes in the societal views of the topic of sexuality in general. Sexuality is not commonly valued or recognized by society, and interest and activity are presumed to decline and even disappear in older age.
5. The nurse manager overhears health care providers make inaccurate comments about the sexuality of older patients. Which comment should the nurse correct or follow up with teaching? A) "Overall, sex takes longer for older men than younger men." B) "Older people are less sexually responsive than young people." C) "Both men and women have orgasms less often than younger people do." D) "Sexual intercourse is usually not physically possible for older women because vaginal lubricant production ceases with menopause."
D Feedback: Though decreased lubrication can result in dyspareunia for older women, lubricant production does not completely cease at menopause and it would be inaccurate to generalize that sex is usually not possible physically. Sex does take longer for older men than younger men. Older people are less sexually responsible than younger people. There is a reduction in orgasm in older people.
