Sexuality and Aging

1. The nurse is aware that sexuality:

a.
becomes absent with age.
b.
remains part of life until death.
c.
as expressed through intercourse is not possible after the age of 65 years.
d.
must be expressed in sexual intercourse.

ANS: B

Sexuality is an integral part of the makeup of each person. Although sexual expression may change, the need for sexual affection does not diminish. Intercourse is only one method of sexual expression.

DIF: Cognitive Level: Knowledge REF: 259 OBJ: 1

TOP: Sexuality KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse counsels the 70–year-old female who has remained on hormone replacement therapy (HRT) that she needs to have a:

a.
semiweekly douche to wash out cervical debris.
b.
liver function assessment annually.
c.
mammogram biannually.
d.
Pap smear annually.

ANS: D

Persons on HRT should have an annual Pap smear and mammogram.

DIF: Cognitive Level: Application REF: 259 OBJ: 1

TOP: Hormone Replacement Therapy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

3. The nurse evaluates a need for further instruction to reduce the symptoms of vaginal dryness when the 70–year-old patient says:

a.
“Vaseline was good enough for my mother. It’s good enough for me.”
b.
“I use a water-soluble lubricant to aid intercourse.”
c.
“I’m trying an estrogen cream to see if it works.”
d.
“I’ll let you know how wild yams work for vaginal dryness.”

ANS: A

Vaseline and petroleum products should be avoided because they do nothing for long-term dryness.

DIF: Cognitive Level: Application REF: 260 OBJ: 4

TOP: Vaginal Dryness KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. The nurse identifies the person most likely to experience erectile dysfunction as the 65–year-old who has _____ sexually active in earlier years.

a.
diabetes and was very
b.
irritable bowel syndrome and was minimally
c.
chronic pancreatitis and was very
d.
osteoarthritis and was moderately

ANS: A

Diabetic men are at risk for erectile dysfunction even at young ages.

DIF: Cognitive Level: Analysis REF: 260 OBJ: 4

TOP: Erectile Dysfunction KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The 65-year-old male who, although he is having painful symptoms related to a benign enlargement of the prostate, refuses to consider a prostatectomy because he fears that the surgery will make him impotent. The nurse reassures him that:

a.
a prostatectomy will enhance sexual function.
b.
new techniques for a prostatectomy do not damage nerves.
c.
the prostate has nothing to do with erection or seminal fluid production.
d.
impotence following a prostatectomy is entirely psychological.

ANS: B

Newer techniques do not damage nerves as was once the case when impotence following surgery was a real risk.

DIF: Cognitive Level: Application REF: 260 OBJ: 1

TOP: Erectile Dysfunction KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. The 70-year-old woman who is considering coming off of hormone replacement therapy (HRT) for the reduction of postmenopausal discomfort asks the nurse what advantage is offered by tamoxifen, also called a “designer estrogen.” The nurse’s best response is that tamoxifen:

a.
provides estrogen to some tissues while acting as an antiestrogen to others.
b.
has no side effects.
c.
needs to be taken only once a week.
d.
improves the skin turgor and complexion.

ANS: A

“Designer estrogens” selectively act as an estrogen on some tissues and an antiestrogen on others. There are side effects, and the drug is usually taken twice a day.

DIF: Cognitive Level: Analysis REF: 260 OBJ: 1

TOP: Tamoxifen KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. The nurse teaches that some persons have found relief from postmenopausal discomfort by using phytoestrogens, which act as estrogens on some tissue and antiestrogens on others. Phytoestrogens are found in:

a.
mangos.
b.
soybeans.
c.
broccoli.
d.
lima beans.

ANS: B

Soybeans are rich in phytoestrogens.

DIF: Cognitive Level: Comprehension REF: 260, Complementary and Alternative Therapies

OBJ: 1 TOP: Phytoestrogens

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. The nurse recognizes a need for further instruction about sexual activity when the 65–year-old man who had a myocardial infarction 6 months ago says:

a.
“I’m enjoying the same sexual activities now as I did before my heart attack.”
b.
“I’m still pretty cautious, but our sex lives are very satisfactory.”
c.
“I’ve been told that I’m at risk for another heart attack if we have sex.”
d.
“My heart medications have made me impotent, but we’ve found other methods of sexual expression.”

ANS: C

Fear, rather than an actual threat, can cause cessation of sexual relations following a heart attack.

DIF: Cognitive Level: Application REF: 260 OBJ: 2

TOP: Illness and Sexual Function KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. The nurse makes it clear to older adults in a long-term care facility that condoms are available from the medicine cart on request to:

a.
guarantee safe sex practices.
b.
reduce the incidence of sexually transmitted diseases (STDs).
c.
show acceptance of sexual expression.
d.
prevent soiling bed linens or furniture.

ANS: B

STDs can still be transmitted in the older adult. Studies have shown that 10% of persons older than 50 years have been exposed to the human immunodeficiency virus (HIV). Nothing can guarantee safe sex practices.

DIF: Cognitive Level: Application REF: 261-262 OBJ: 6

TOP: STDs and the Older Adult KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

10. The home health nurse stresses to the 70-year-old gay man who has been in a monogamous relationship for 20 years that it is especially important to name his partner as his medical power of attorney (POA) and file advance directives because:

a.
all persons older than 60 years should have a medical POA and advance directives.
b.
gay and lesbian couples are estranged from their families.
c.
life partners frequently abandon unions when terminal illness occurs.
d.
life partners have no legal standing and can be prohibited from medical decisions by family.

ANS: D

Life partners have no legal standing for medical decisions unless named as medical POA.

DIF: Cognitive Level: Application REF: 262 OBJ: 5

TOP: Sexual Orientation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

11. The horrified CNA runs to the nursing station and blurts out, “Do you know what Mr. and Mrs. Smith are doing? They’re having sex right there in room 210!” The nurse’s best response would be to:

a.
knock discreetly on the door and enter the room.
b.
call the charge nurse to report inappropriate sexual activity.
c.
request an order from the physician to allow intercourse.
d.
give the CNA a “Do Not Disturb” sign to put on the door of room 210.

ANS: D

Privacy should be protected for appropriate sexual expression. Orders and notifying the charge nurse are not necessary, but recording the event in the nursing notes as a conjugal visit is suggested.

DIF: Cognitive Level: Application REF: 262-263 OBJ: 7

TOP: Privacy KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

12. When the cognitively impaired man is openly masturbating in the dayroom of a long-term care facility, the nurse’s best response would be to say:

a.
“This is inappropriate behavior in public areas.”
b.
“Oh my God! Don’t you know that will make you go blind?”
c.
“I think you may need some privacy” and take him to his room.
d.
“Here’s a blanket for your legs” and cover his lap with it.

ANS: C

A person who is masturbating in public should be conducted to the privacy of his or her room.

DIF: Cognitive Level: Application REF: 263 OBJ: 7

TOP: Masturbation KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

13. When a married couple is admitted to the long-term care facility, the admitting nurse should show willingness to discuss sexual matters by asking:

a.
“How often do you have intercourse?”
b.
“Do you have any sexual concerns related to your admission here?”
c.
“What can we do to keep your sex life active?”
d.
“Any sexual activity should be done in private.”

ANS: B

Asking about sexuality in broad terms communicates a willingness to discuss the issue.

DIF: Cognitive Level: Application REF: 261 OBJ: 7

TOP: Sexual Concerns KEY: Nursing Process Step: Implementation

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

14. When the CNA tearfully reports that a resident deliberately exposes himself to her and makes lewd suggestions, the nurse could best deal with this behavior by modifying the nursing care plan to:

a.
assign only males to care for the resident.
b.
chastise the resident for lewd behavior.
c.
restrain the hands of the resident during routine care.
d.
modify clothing choices to one-piece garments or elastic waist trousers.

ANS: D

Modification of the clothing to make exposure more difficult is the best initial approach to the problem.

DIF: Cognitive Level: Application REF: 263 OBJ: 7

TOP: Inappropriate Genital Exposure KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

MULTIPLE RESPONSE

1. The nurse discusses factors that alter the sexual practice of older adults, which are __________. (Select all that apply.)

a.
altered health status
b.
inability to achieve orgasm
c.
erectile dysfunction
d.
loss of sexual partner
e.
slowed sexual response time

ANS: A, C, D, E

Although the response is slowed, the ability to achieve orgasm remains throughout life.

DIF: Cognitive Level: Comprehension REF: 259 OBJ: 1

TOP: Age-Related Sexual Impairment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse lists the age-related changes in the female reproductive system that affect sexual intercourse, which are __________. (Select all that apply.)

a.
pruritus vulvae
b.
atrophic vaginitis
c.
frequent yeast infections
d.
dyspareunia
e.
decreased response time

ANS: A, B, C, D

The response time is not decreased. All of the other options are age-related changes in the female that affect satisfactory intercourse.

DIF: Cognitive Level: Application REF: 259 OBJ: 1

TOP: Age-Related Impediments to Intercourse

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

3. The nurse is aware that many women have abandoned hormone replacement therapy (HRT) because of the risk of __________. (Select all that apply.)

a.
stroke
b.
myocardial infarction
c.
liver disorders
d.
cancer
e.
bone demineralization

ANS: A, B, C, D

Bone demineralization is not a risk associated with HRT, which is prescribed to prevent bone demineralization.

DIF: Cognitive Level: Application REF: 259 OBJ: 1

TOP: Hormone Replacement Therapy Risks

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. The nurse lists the sexual changes experienced by the older man, which are impairments to intercourse, such as __________. (Select all that apply.)

a.
erections take longer to achieve and are less firm than in younger years
b.
orgasm takes longer to achieve
c.
orgasm occurs at each intercourse
d.
erection loss occurs immediately after orgasm
e.
an increase in time between orgasms

ANS: A, B, D, E

Orgasms are not always achieved with each intercourse.

DIF: Cognitive Level: Application REF: 260 OBJ: 1

TOP: Sexual Impairment KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. The nurse screening patients who complain of erectile dysfunction is aware that many drugs cause this problem, such as __________. (Select all that apply.)

a.
digitalis
b.
pancreatic enzyme replacement
c.
antihistamines
d.
antiparkinson drugs
e.
antidepressants

ANS: A, C, E

Digitalis, antihistamines, and antidepressants all have a negative effect on sexual function.

DIF: Cognitive Level: Application REF: 261, Table 16-1

OBJ: 2 TOP: Medication and Sexual Function

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. The nurse is aware that many constraints prevent an older widow from engaging in sexual activity, which are that __________. (Select all that apply.)

a.
older women outnumber older adult men by 4:1
b.
there is an expectation that men should initiate contact
c.
display of sexual interest is considered improper
d.
older women do not desire sexual expression
e.
older women associate sexual activity with marriage

ANS: A, B, C, E

Older women do retain a sexual appetite.

DIF: Cognitive Level: Application REF: 261 OBJ: 4

TOP: Loss of Sexual Partner KEY: Nursing Process Step: Assessment

MSC: NCLEX: Psychosocial Integrity: Psychosocial Adaptation

7. Marriage between older adults is frequently impeded by __________. (Select all that apply.)

a.
disapproval of children
b.
financial loss in case of remarriage
c.
concerns about chronic illness with either partner
d.
the lack of opportunity for sexual expression outside of marriage
e.
religious and personal values that inhibit cohabitation

ANS: A, B, C

Lack of opportunity for sexual expression outside of marriage and distaste for cohabitation are factors that might encourage marriage rather than impede it.

DIF: Cognitive Level: Analysis REF: 261 OBJ: 1

TOP: Marriage and the Older Adult KEY: Nursing Process Step: N/A

MSC: NCLEX: N/A

8. The home health nurse takes into consideration the concerns of aging gay and lesbian couples, which include __________. (Select all that apply.)

a.
health care providers being willing to discuss a homosexual union
b.
the health care system’s focus on heterosexuality as the norm
c.
difficulty finding senior housing as a homosexual couple
d.
fear of discrimination based on sexual orientation, resulting in substandard health care
e.
delay of entry to a long-term care facility because of the possibility of not being able to share a room

ANS: B, C, D, E

Health care providers are reluctant to discuss homosexual unions. All other options are possible problems related to the health care of older gay and lesbian couples.

DIF: Cognitive Level: Comprehension REF: 262 OBJ: 5

TOP: Sexual Orientation and Health Care

KEY: Nursing Process Step: Planning

MSC: NCLEX: Psychosocial Integrity: Coping and Adaptation

9. While asking questions about the patient’s reproductive system, the nurse is aware that sexual function can be affected by __________. (Select all that apply.)

a.
increasing age
b.
grief
c.
illness
d.
religion
e.
physical changes

ANS: A, B, C, E

Religion does not affect sexual function. All other options can affect the individual physically and result in sexual dysfunction.

DIF: Cognitive Level: Comprehension REF: 259 OBJ: 1

TOP: Age-Related Sexual Impairment KEY: Nursing Process Step: N/A

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

10. Questions that the nurse might ask to assess sexual function include __________. (Select all that apply.)

a.
“How many alcoholic beverages do you drink a day?”
b.
“What over-the-counter and prescription medications do you take?”
c.
“How often do you engage in sexual activity?”
d.
“Have you had any recent health problems?”
e.
“When do you see your significant other?”

ANS: A, B, C, D

Asking when the individual sees the significant other does not necessarily indicate that the individual is sexually active. Sexual function can be affected by excessive alcohol intake, medications, availability of sexual partners, and illness.

DIF: Cognitive Level: Application REF: 260-261 OBJ: 3

TOP: Age-Related Sexual Impairment KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

COMPLETION

1. The nurse explains that a decrease in estrogen and __________ are responsible for the changes in the female reproductive system.

ANS: progesterone

DIF: Cognitive Level: Knowledge REF: 259 OBJ: 1

TOP: Age-Related Changes in the Female Reproductive System

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation