Chapter 13: Sexuality and Aging My Nursing Test Banks

Chapter 13: Sexuality and Aging

Meiner: Gerontologic Nursing, 5th Edition

MULTIPLE CHOICE

1. Which statement made by a nurse reflects a lack of understanding regarding sexual intimacy and the older adult patient?

a.

Older adults express less interest in intimacy as both acute and chronic illnesses develop.

b.

Sexual expression is considered an enhancement to the quality of the older adults life.

c.

Expressing sexual needs may be difficult or impossible for some older adults.

d.

Interest in physical contact tends to persist throughout life for both genders.

ANS: A

Although the need to express interest in sexuality continues among older adults, they face several barriers to sexual expression, including problems arising from low desire, aging, disease, and medications; societal beliefs; and changes in social circumstances. Sexuality remains important as people age and develop chronic and acute illnesses.

DIF: Understanding (Comprehension) REF: Page 241 OBJ: 13-1

TOP: Teaching-Learning MSC: Psychosocial Integrity

2. A 70-year-old female patient shares with the nurse her concern that recently it takes more time to achieve an organism. The nurse responds most therapeutically when answering:

a.

Youve described a common result of aging for both men and women.

b.

If you experience difficulty achieving orgasms, you should discuss that with your doctor.

c.

Your body produces fewer sex hormones now, and you need more stimulation to climax.

d.

I understand your concern. Lets talk more about the changes youve noticed.

ANS: C

In both genders, the reduced availability of sex hormones in older adults results in less rapid and less extreme vascular responses to sexual arousal. The nurse should first share this information with the patient then offer to talk more about concerns. Although this is a normal finding, simply stating this does not give the woman much information. The nurse should be willing to discuss sexual concerns with the patient and not just pass the patient along to someone else.

DIF: Understanding (Comprehension) REF: Page 223 OBJ: 13-1

TOP: Teaching-Learning MSC: Physiologic Integrity

3. A type 2 insulin-dependent diabetic 70-year-old recently lost his wife and is experiencing impotence. Besides educating the patient on the normal effects of aging on sexual function, the nurse should initially include information regarding:

a.

the effect that stress has on sexual performance.

b.

the effect of diabetes mellitus on the vascular system.

c.

the link between depression and sexual dysfunction.

d.

sexual dysfunction related to long-term use of insulin.

ANS: B

Erectile dysfunction (ED) can occur at any age. This patients chronic illness and its effect on the vascular system have priority when educating the patient about possible causes of ED. After discussing physiologic causes of ED, the nurse can then turn to psychosocial causes. Physical issues take priority over psychosocial ones.

DIF: Applying (Application) REF: N/A OBJ: 13-4

TOP: Teaching-Learning MSC: Physiologic Integrity

4. Upon entering the room of a cognitively impaired older adult patient, the nurse observes that he is exposed and rubbing his genitals. The nurses initial concern is to:

a.

alert staff to be aware of this new behavior.

b.

provide the patient with privacy.

c.

assess him for possible pain and fever.

d.

provide a verbal cue for him to stop the behavior.

ANS: C

Dementia may result in unmet sexual needs resulting in such behavior; however, this behavior may also indicate pain, hyperthermia, or the need to be freed from a restrained situation. Later the nurse can inform staff of the behavior, particularly if it is a new behavior, and ensure the patient has privacy. There is no need to cue the patient to stop this behavior as long as it is done in a private setting.

DIF: Applying (Application) REF: N/A OBJ: 13-5

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

5. To effectively assess an older adult patients sexual needs, the nurse must initially:

a.

reflect on personal feelings that create barriers to effective communication with the patient.

b.

be familiar with the sexual needs of the older adult population.

c.

assess the patients physical capacity to engage in sexual activities.

d.

inform the patient of the personal nature of the detailed questioning this assessment requires.

ANS: A

Nurses may feel intimidated or uncomfortable questioning older adults about their sexual desires and needs. To effectively assess the patients sexual history, the nurse must first reflect on his or her personal attitudes concerning sex and the older adult patient. The nurse should also gather information, assess individual patients, and, if needed, let the patient know the nurse will be asking questions related to sexuality.

DIF: Understanding (Comprehension) REF: Page 243 OBJ: 13-2

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

6. An older adult patient recovering from a radical prostatectomy is discussing his postsurgical care plan with the nurse when he expresses concern about long-term impotence. The nurse initially responds:

a.

Id suggest a consult with a sexuality counselor for you and your partner.

b.

When youve healed sufficiently, we can discuss prosthetic devices that help.

c.

There are medications called phosphodiesterase inhibitors that minimize that problem.

d.

While postsurgical erectile dysfunction is likely, it is generally temporary.

ANS: D

Radical prostatectomy, a curative treatment for cancer of the prostate gland, involves a massive disturbance of hormone-producing glands, surrounding nerves, and urinary structures. This often results in temporary urinary incontinence and impotence. It may take 2 to 3 years to regain function. Referring the patient so quickly indicates a lack of willingness to discuss the issue. Prosthetic devices and medications imply the condition is permanent, and while the patient may need such assistive devices, the nurse should first provide encouraging information.

DIF: Understanding (Comprehension) REF: Page 246 OBJ: 13-4

TOP: Teaching-Learning MSC: Physiologic Integrity

7. The charge nurse on an extended care unit recognizes an immediate need for additional unit education regarding sexuality and the older adult when overhearing a staff member state:

a.

Ive had to tell her to stop touching my breasts twice today.

b.

Someone needs to tell him to keep his pants zipped.

c.

I realize they have needs, but Im not sure how to handle that.

d.

Its sad that Alzheimer disease causes them to become sexual perverts.

ANS: D

Although staff education about the sexuality and intimacy of older adults should include recognition of cues, desires, and interest in sexual activities, it needs to immediately address eliminating stereotypes, such as the dirty old man or perverts. The nurse is within his or her rights to limit behavior that includes touching inappropriately. A male patient may need to be reminded to keep his pants zipped. The staff member who is unsure how to help with sexual needs is expressing a legitimate concern.

DIF: Applying (Application) REF: N/A OBJ: 13-6

TOP: Teaching-Learning MSC: Psychosocial Integrity

8. An older adult female patient who has multiple sexual partners asks the nurse if the risk for contracting HIV really does increase as we age. The nurse shows the best understanding of this risk when responding:

a.

Any time one engages in sex with multiple partners, the risk for contracting HIV increases.

b.

Changes in vaginal tissue and immune function increase the risk, especially if sex is unprotected.

c.

Unless you are engaging in unprotected oral sex, your risk does not increase substantially.

d.

Yes, your risk of contracting a sexually transmitted disease (STD) including HIV, dramatically increases as you age.

ANS: B

The age-related thinning of the vaginal mucosa and subsequent vaginal tissue disruption, as well as age-related reductions in immune function, place older adults at increased risk for HIV infection. The risk does increase with increasing numbers of sex partners, but this combined with physical changes is the critical piece of information. HIV can be contracted through any sexual activity.

DIF: Understanding (Comprehension) REF: Page 245 OBJ: 13-3

TOP: Teaching-Learning MSC: Physiologic Integrity

9. Through the open door of the patients room, the nurse observes a male patient and his long-term partner in a romantic embrace. The nurses priority intervention is directed toward:

a.

reinforcing for the staff the patients intimacy needs.

b.

explaining to the patient the challenges that his relationship poses for the staff.

c.

offering to discuss the barriers to intimacy that the patient and his partner face.

d.

quietly closing the door to address the patients right to privacy.

ANS: D

All patients have the right to sexual expression if they are cognitively capable of making decisions. No matter the sexual orientation of the patient, privacy should be respected unless the need for safety is paramount. The nurse should close the door quietly. There is no need for other action unless the staff members need to be reminded of this information.

DIF: Applying (Application) REF: N/A OBJ: 13-6

TOP: Caring MSC: Psychosocial Integrity

10. The gerontologic nurse wants to begin assessing concerns related to sexuality among the population of patients seen in the clinic. What action by the nurse is best?

a.

Give the patients questionnaires to fill out.

b.

Get permission to discuss sexuality with them.

c.

Tell the patients you are now assessing sexuality.

d.

Ask the patients if they have concerns about sex.

ANS: B

Many of todays older population grew up when sexuality was not openly discussed, so they may feel uncomfortable with this topic. The nurse should bring up the subject and ask their permission to discuss this aspect of their lives. The other options are not as likely to start an open-ended conversation.

DIF: Applying (Application) REF: N/A OBJ: 13-7

TOP: Communication and Documentation MSC: Psychosocial Integrity

11. The nursing manager feels that intimacy needs are not being assessed or addressed by the staff on the unit. What action by the manager is best?

a.

Tell the staff sexuality is expected to be assessed.

b.

Provide the staff with education on sexuality.

c.

Obtain tools for staff to use when assessing sexuality.

d.

Allow those with cultural objections to opt out.

ANS: B

Education is the first step in this process. Once staff members understand that sexuality is a normal part of life at any age, the manager can provide tools for staff to use for assessment. Simply telling the staff to assess sexuality does not help them overcome their discomfort. Persons with cultural objections should be given extra time and attention to become comfortable with the practice, but they should realize that their patients needs come first. The manager may be able to negotiate a comfortable agreement with these staff members.

DIF: Applying (Application) REF: N/A OBJ: 13-7

TOP: Nursing Process: Implementation MSC: Psychosocial Integrity

12. The nurse notes the patients chart lists dyspareunia as a complaint. What teaching does the nurse plan to provide?

a.

Use of water-soluble lubricants

b.

Performing Kegel exercises

c.

Deep breathing and relaxation

d.

Use of antifungal medications

ANS: A

Dyspareunia is painful intercourse, which has several causes, one of which is vaginal dryness. The nurse can teach the woman about water-soluble lubricants. Kegel exercises are not related. Deep breathing and relaxation do not address the physical issue. Antifungal medications are not warranted.

DIF: Applying (Application) REF: N/A OBJ: 13-4

TOP: Teaching-Learning MSC: Physiologic Integrity

13. The nurse using the permission, limited information, specific suggestions, and intensive therapy (PLISSIT) model offers specific suggestions when:

a.

Referring the patient to a sex therapist.

b.

Discussing over-the-counter lubricants.

c.

Teaching safer sex practices.

d.

Discussing sexual positioning after hip surgery.

ANS: D

Specific suggestions are those related to concerns about how medical conditions affect or are affected by sexuality. The nurse discussing positions acceptable after hip replacement surgery is offering specific suggestions. Referring is the intensive therapy (IT) component. The other two options fall under limited information (LI).

DIF: Applying (Application) REF: N/A OBJ: 13-7

TOP: Teaching-Learning MSC: Psychosocial Integrity

14. The patient who recently had a radical prostatectomy has the nursing diagnosis of ineffective sexuality patterns. What assessment by the nurse best indicates that the goals for this diagnosis have been met?

a.

Patient states he can live without sex.

b.

Patient says that impotence is temporary.

c.

Patient states his needs are being met.

d.

Patient asks about medication for ED.

ANS: C

Goals for this diagnosis are met when the patient is satisfied with means for sexual expression. The other options do not meet this criterion.

DIF: Evaluating (Evaluation) REF: N/A OBJ: 13-7

TOP: Nursing Process: Evaluation MSC: Psychosocial Integrity

15. An older adult has begun dating after being widowed for many years. The adult confides to the nurse about having several sexual partners. What action by the nurse is best?

a.

Warn the patient that the family may not appreciate the situation.

b.

Teach the patient about safer sexual practices including condoms.

c.

Ask the patient if there are any medical concerns related to sex.

d.

Tell the patient he or she may begin to have feelings of guilt.

ANS: B

The chances of STDs, including HIV, increase with the increased number of sexual partners. Many older patients do not know about safer sexual practices, so for patient safety, this is the priority.

DIF: Applying (Application) REF: N/A OBJ: 13-9

TOP: Teaching-Learning MSC: Psychosocial Integrity

16. What information about sexuality is contrary to research on sexuality in older men?

a.

Erections are not as firm.

b.

It takes longer to obtain erections.

c.

Erectile dysfunction is inevitable.

d.

Ejaculation may not be a strong.

ANS: C

Erectile dysfunction is not an inevitable part of aging. The other statements are true.

DIF: Remembering (Knowledge) REF: Page 243 OBJ: 13-3

TOP: Teaching-Learning MSC: Physiologic Integrity

17.

A patient with arthritis has difficulty participating is sex because of joint pain and stiffness. What action by the nurse is best?

a.

Suggest a warm shower prior to sexual activity.

b.

Ask the patient if he or she needs more pain medication.

c.

Explore other ways of expressing sexuality.

d.

Refer the patient to a rheumatologist.

ANS: A

A warm shower can reduce pain and stiffness, making sexual activity more enjoyable. The patient may need more pain medication, but the sedating effects may be counterproductive. The patient does not indicate he or she cannot or does not want to participate in sex, so suggesting other means of expression is not really addressing the core issue. Referral is possible, but the nurse needs to provide some intervention first.

DIF: Applying (Application) REF: N/A OBJ: 13-9

TOP: Teaching-Learning MSC: Physiologic Integrity

18. An older male patient is seen in the family practice clinic and tells the nurse he no longer takes his metoprolol (Toprol) because it interferes with my lifestyle. What action by the nurse is best?

a.

Warn the patient of the complications of hypertension.

b.

Ask the patient if he can afford the medication.

c.

Tell the patient this drug often causes erectile dysfunction.

d.

Take the patients blood pressure and record the findings.

ANS: C

The nurse should let the patient know that medications in this drug class often cause erectile dysfunction. The nurse can then assess the patient for this issue. Warning the patient of complications does not address the core problem and neither does taking his blood pressure. Asking the patient if he can afford the medications can be addressed later if ED is not a problem.

REF: N/A

19. A male patient takes carbamazepine (Tegretol). The spouse reports sexual dysfunction, but the patient adamantly denies he has this problem. What response by the nurse is best?

a.

Telling him, You need to think of your wifes needs too.

b.

Telling him this is common and can be discussed if wanted.

c.

Questioning the patient again about sexual functioning

d.

Telling the doctor to change the patients prescription

ANS: B

The nurse should provide the information that this drug causes ED and leave the door open for the patient. This way the patient knows he has permission to bring the topic up in the future. Repeatedly questioning the patient about sexual functioning is not likely to encourage the nurse-patient relationship. Telling the doctor to change the prescription is overstepping the patients autonomy.

DIF: Applying (Application) REF: N/A OBJ: 13-4

TOP: Caring MSC: Psychosocial Integrity

20. A patient has many sexual partners but does not use condoms. What action by the nurse is best?

a.

Ask the patient what he or she knows about HIV.

b.

Assess the patient for barriers to using condoms.

c.

Give the patient statistics on HIV in older adults.

d.

Tell the patient safer sex practices should be used.

ANS: B

The nurse should assess for barriers to implementing safer sexual practices. Simply giving the information does not help the patient implement it. Telling the patient what to do does not respect the patients autonomy.

DIF: Applying (Application) REF: N/A OBJ: 13-9

TOP: Nursing Process: Assessment MSC: Physiologic Integrity

21. A recently widowed patient reports new onset of sexual dysfunction. There are no new medications or illnesses. What action by the nurse is best?

a.

Assess the patients alcohol intake.

b.

Refer the patient for counseling.

c.

Ask if there are new partners.

d.

Have the patient speak to the doctor.

ANS: A

Alcohol can have an effect on sexual functioning. The nurse first assesses for this condition, as it is objective in nature. The patient may need a referral or to speak with the provider, but the nurse needs to intervene first. Asking the patient if there are new partners does not address the issue.

DIF: Applying (Application) REF: N/A OBJ: 13-7

TOP: Nursing Process: Assessment MSC: Psychosocial Integrity

22. A patient lives in a long-term care facility and has mild dementia. The patient has been showing interest in another resident. What action by the nurse is best?

a.

Determining if the resident has decision-making capacity.

b.

Refusing to allow the residents to be alone together.

c.

Asking the residents family if the relationship is okay.

d.

Providing time for the residents to be together.

ANS: A

The first step is to determine if the resident (actually both) has decision-making capacity. If so, the nurse allows them to be together and provides privacy when possible. If one or both residents are not capable of making decisions, the nurse enlists the opinion of that residents family.

DIF: Applying (Application) REF: N/A OBJ: 13-5

TOP: Nursing Process: Assessment MSC: Safe Effective Care Environment

23. The family of a resident in an assisted living facility contacts the director to say they are appalled that the resident is allowed to have pornographic magazines in the room. What response by the director is most appropriate?

a.

We will take those away immediately.

b.

Your loved one has the right to have these.

c.

How do you know about these magazines?

d.

He cannot stay here if he has these in the room.

ANS: B

A cognitively intact adult has the right to have and view legal pornographic materials in the privacy of his or her apartment. The director should inform the family of this information.

DIF: Applying (Application) REF: N/A OBJ: 13-9

TOP: Communication and Documentation MSC: Psychosocial Integrity

MULTIPLE RESPONSE

1. The nurse working in long-term care knows there are several barriers to sexual expression for older patients. Which of the following are barriers? (Select all that apply.)

a.

Decreasing desire

b.

Medication side effects

c.

Disease processes

d.

Social circumstances

e.

Increased libido

ANS: A, B, C, D

Many barriers to sexual expression exist for the older patient including decreased desire (libido), side effects of medications, disease processes, and social circumstances.

DIF: Remembering (Knowledge) REF: Page 246 OBJ: 13-6

TOP: Teaching-Learning MSC: Psychosocial Integrity

2. The nurse is learning about postmenopausal changes that can affect sexuality in women. Which of the following are included? (Select all that apply.)

a.

Shortening of the vagina

b.

Need to void after intercourse

c.

Vaginal dryness

d.

Vaginal irritation needs investigation

e.

Vaginal secretions diminish

ANS: A, B, C, E

Shortening of the vagina with decreased secretions and dryness as well as the need to void after intercourse are all normal changes that accompany aging. Vaginal irritation does not necessarily need investigation, as this is a normal finding also.

DIF: Remembering (Knowledge) REF: Page 243 OBJ: 13-3

TOP: Teaching-Learning MSC: Health Promotion

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