Young and Middle Adults

1. According to some developmental theorists, intellectual development and moral development differ between men and women. What did Gilligan propose?

a.
As women progress toward adulthood, concepts, morals, and responsibility remain unchanged.
b.
Providing and protecting remain the sole responsibilities of men in today’s society.
c.
Women continue to play a minor role in the financial well-being of their families.
d.
Women struggle with issues of care and responsibility.

ANS: D

According to Gilligan, women struggle with issues of care and responsibility, and in turn, their relationships progress toward a maturity of interdependence. As women progress toward adulthood, the moral dilemma changes from how to exercise their rights without interfering with the rights of others to “how to lead a moral life,” which includes obligations to themselves and their families and people in general. Traditional masculine roles include providing and protecting. Recently, however, men have been moving into greater disequilibrium. Both men and women are assuming different roles in today’s society. Today, many women pursue careers and contribute significantly to their family’s income.

DIF: Understand REF: 157-158

OBJ: Discuss developmental theories of young and middle adults.

TOP: Assessment MSC: Health Promotion and Maintenance

2. The nurse is caring for a hospitalized young adult male who is uninsured even though he works as a dishwasher at a local restaurant. He states that he would like to get a better job, but he has no education. How can the nurse best assist this patient psychosocially?

a.
By providing information and referrals
b.
By telling the patient that he needs to go back to school
c.
By focusing on the patient’s medical diagnoses
d.
By expecting the patient to be flexible in his decision making

ANS: A

Support from the nurse, access to information, and appropriate referrals provide opportunities for achievement of a patient’s potential. Many young adults lack the necessary resources or support systems to facilitate further education or development of skills necessary for many positions in the workplace. As a result, some young adults have limited occupational choices. Health is not merely the absence of disease but involves wellness in all human dimensions. Insecure persons tend to be more rigid in making decisions.

DIF: Analyze REF: 158-159

OBJ: Discuss developmental theories of young and middle adults.

TOP: Implementation MSC: Health Promotion and Maintenance

3. A nursing student is asked to compare major life events of young adult, middle adult, and childbearing families. Which statement by the student demonstrates understanding?

a.
“Young adults have gained sexual experience and do not need sexual education.”
b.
“Once a woman has her baby, stress levels decrease, as does health risk.”
c.
“The social pressure to get married is greater now than it ever was.”
d.
“When married people both work, income is increased, but so is stress.”

ANS: D

The two-career family has benefits and liabilities. Stressors result from transfer to a new city; increased expenditures of physical, mental, or emotional energy; child care demands; or household needs. To avoid stress, partners should share all responsibilities. Young adults are at risk for sexually transmitted diseases. Consequently, there is an increased need for education regarding mode of transmission, prevention, and symptom recognition and management for sexually transmitted diseases. The stress that many women experience after childbirth has a significant impact on the health of postpartum women. Social pressure to get married is not as great as it once was, and many young adults do not marry until their late 20s or early 30s, or not at all.

DIF: Understand REF: 158-159

OBJ: List and discuss major life events of young and middle adults and the childbearing family.

TOP: Assessment MSC: Health Promotion and Maintenance

4. The nurse knows that the young adult patient understands the health risks that affect his/her age group when the patient states

a.
“It’s probably safe for me to start smoking. At my age, there’s not enough time for cancer to develop.”
b.
“I am sure that I am going to get emphysema. Both my mother and my aunt had it. It’s genetic.”
c.
“Controlling the amount of stress in my life may decrease the risk of illness.”
d.
“I don’t do drugs. I do drink coffee, but caffeine is not a drug. It is perfectly safe and has no side effects.”

ANS: C

Lifestyle habits that activate the stress response increase the risk of illness. Smoking is a well-documented risk factor for pulmonary, cardiac, and vascular disease in smokers and in individuals who receive secondhand smoke. The presence of certain chronic illnesses in the family increases the family member’s risk of developing a disease. Family risk is distinct from hereditary disease. Caffeine is a naturally occurring legal stimulant that is readily available. Caffeine stimulates catecholamine release, which, in turn, stimulates the central nervous system; it also increases gastric acid secretion, heart rate, and basal metabolic rate.

DIF: Understand REF: 157| 160-161

OBJ: Describe developmental tasks of the young adult, the childbearing family, and the middle adult.

TOP: Evaluation MSC: Health Promotion and Maintenance

5. When choosing an appropriate topic for a young adult health fair, the nurse ranks which topic as least relevant?

a.
Unplanned pregnancies
b.
Menopause and climacteric factors
c.
Smoking cessation
d.
Alcohol and drug use

ANS: B

The onset of menopause and the climacteric affect the sexual health of the middle adult, not the young adult. Unplanned pregnancies are a continued source of stress that can result in adverse health outcomes for the mother (young adult), infant, and family. Smoking is a well-documented risk factor for pulmonary, cardiac, and vascular diseases in smokers and in individuals who receive secondhand smoke and constitutes a health risk for the young adult. Substance abuse directly or indirectly contributes to mortality and morbidity in young adults.

DIF: Understand REF: 160-163| 181| 186

OBJ: Describe developmental tasks of the young adult, the childbearing family, and the middle adult.

TOP: Assessment MSC: Health Promotion and Maintenance

6. During middle adulthood, the 50-year-old patient is likely to adapt favorably to a changing body image if he or she

a.
Decreases the amount of physical exercise.
b.
Eats a diet composed of 40% fat.
c.
Gets less than 5 hours of sleep per night.
d.
Engages in good hygiene practices.

ANS: D

High self-esteem, a favorable body image, and a positive attitude toward physiological changes occur when adults engage in physical exercise, balanced diets, adequate sleep, and good hygiene practices that promote vigorous, healthy bodies.

DIF: Knowledge REF: 163-164

OBJ: Describe developmental tasks of the young adult, the childbearing family, and the middle adult.

TOP: Assessment MSC: Health Promotion and Maintenance | Physiological Integrity

7. A patient states that she is pregnant and concerned because she does not know what to expect, and she wants her husband to play an active part in the birthing process. What should the nurse tell the patient?

a.
Lamaze classes can prepare pregnant women and their partners for what is coming.
b.
The frequency of sexual intercourse is key to helping the husband feel valued.
c.
After the birth, the stress of pregnancy will disappear and will be replaced by relief.
d.
After the baby is born, the wife should accept the extra responsibilities of motherhood.

ANS: A

Education such as Lamaze classes can prepare pregnant women, their partners, and other support persons to participate in the birthing process. The psychodynamic aspect of sexual activity is as important as the type or frequency of sexual intercourse to young adults. The stress that many women experience after childbirth has a significant impact on the health of postpartum women. To avoid stress in a two-career family, partners should share all responsibilities.

DIF: Apply REF: 161-163

OBJ: Describe developmental tasks of the young adult, the childbearing family, and the middle adult.

TOP: Assessment MSC: Health Promotion and Maintenance

8. What do changing norms and values about family life in the United States reveal?

a.
Basic shifts in attitudes in our society
b.
Greater resistance to cohabitation without marriage
c.
Decreased numbers of infants born to unmarried women
d.
Greater support and acceptance from the health care system

ANS: A

Changing norms and values about family life in the United States reveal basic shifts in attitudes in our society. The trend toward greater acceptance of cohabitation without marriage is a factor in the greater numbers of infants being born to unmarried women. Many times, parents from alternative family structures feel lack of support and even bias from the health care system.

DIF: Knowledge REF: 159-160

OBJ: Discuss the significance of family in the life of the adult. TOP: Assessment

MSC: Health Promotion and Maintenance

9. When describing relevant family psychosocial factors in middle adulthood that cause stress, the nurse would not include

a.
Singlehood and feeling isolated.
b.
Choices stemming from marital changes.
c.
Financial security and certainty.
d.
Planning for the future when children leave home.

ANS: C

In the middle adult years, as children depart from the household, the family enters the postparental family stage. Time and financial demands on parents decrease, and the couple faces the task of redefining their own relationship. Psychosocial factors involving the family include the stresses of singlehood, marital changes, transition of the family as children leave home, and the care of aging parents.

DIF: Understand REF: 164-165

OBJ: Discuss the significance of family in the life of the adult. TOP: Assessment

MSC: Health Promotion and Maintenance

10. What should the nurse recognize when comparing the physical changes in young and middle adulthood?

a.
Fertility issues do not occur in young adulthood.
b.
Young adults are quite active but are at risk for illness in later years.
c.
Young adults tend to suffer more from severe illness.
d.
Exercise is less important in young adulthood than in middle adulthood.

ANS: B

Young adults are generally active and have a minimum of major health problems. However, their lifestyles put them at risk for illnesses or disabilities during their middle or older adult years. An estimated 10% to 15% of reproductive couples are infertile, and many are young adults. Exercise in young adulthood is increasingly important to prevent or decrease the development of chronic health conditions such as high blood pressure, obesity, and diabetes that develop later in life.

DIF: Understand REF: 158| 164

OBJ: Describe normal physical changes in young and middle adulthood and pregnancy.

TOP: Assessment MSC: Health Promotion and Maintenance

11. During a routine physical assessment, the nurse obtaining a health history notes that a 50-year-old female patient reports pain and redness in the right breast. What is the nurse’s best action in response to this finding?

a.
Explain to the patient that breast tenderness is normal at her age.
b.
Tell the patient that redness is not a cause for concern and is quite common.
c.
Assess the patient as thoroughly as possible.
d.
Inform her that redness is the precursor to normal unilateral breast enlargement.

ANS: C

A comprehensive assessment offers direction for health promotion recommendations, as well as for planning and implementing any acutely needed intervention. Redness or painful breasts are abnormal physical assessment findings in the middle adult. Increased size of one breast is an abnormal physical assessment finding in the middle adult.

DIF: Apply REF: 164-165

OBJ: Describe normal physical changes in young and middle adulthood and pregnancy.

TOP: Assessment MSC: Health Promotion and Maintenance

12. A 55-year-old female presents to the outpatient clinic describing irregular menstrual periods and hot flashes. What should the nurse explain?

a.
Those symptoms are normal when a woman undergoes the climacteric.
b.
An assessment is not really needed because these problems are normal for older women.
c.
The patient’s age and symptoms point toward normal menopause.
d.
The patient should stop regular exercise because that is probably causing her symptoms.

ANS: C

The most significant physiological changes during middle age are menopause in women and the climacteric in men. The nurse should continue with the examination because a comprehensive assessment offers direction for health promotion recommendations, as well as for planning and implementing any acutely needed interventions. High self-esteem, a favorable body image, and a positive attitude toward physiological changes occur when adults engage in physical exercise, balanced diets, adequate sleep, and good hygiene practices that promote vigorous, healthy bodies.

DIF: Apply REF: 164-165

OBJ: Describe normal physical changes in young and middle adulthood and pregnancy.

TOP: Assessment MSC: Health Promotion and Maintenance

13. The nurse is teaching a class to pregnant women about common physiological changes during pregnancy. Which statement by the nurse accurately describes these changes?

a.
“Pregnancy enhances your ability to cope with stress.”
b.
“Being nauseated and feeling tired will not affect your physical body image.”
c.
“You and your partner may experience feelings of uncertainty about assuming the roles of parents.”
d.
“Returning home after delivery will rejuvenate you and foster independence.”

ANS: C

Both partners think about and have feelings of uncertainty about impending role changes. Parents need reassurance that childbirth and childrearing are natural and positive experiences but are also stressful. Parents often are unable to cope with particular stressors. Morning sickness and fatigue contribute to poor body image. New mothers often return home from the hospital fatigued and unfamiliar with infant care.

DIF: Understand REF: 163

OBJ: Discuss cognitive and psychosocial changes that occur during the adult years.

TOP: Implementation MSC: Health Promotion and Maintenance

14. A nurse discusses the risks of repeated sun exposure with a young adult patient. Which of these patient responses would be most expected from this patient?

a.
“I’ll make an appointment with my doctor right away for a full skin check.”
b.
“I should consider participating in a health fair about safe sun practices.”
c.
“I have a mole that has been bothering me. I’ll call my family doctor for an appointment to get it checked.”
d.
“I’ve had this mole my whole life. So what if it changed color? My skin is fine.”

ANS: D

Young adults often ignore physical symptoms and often postpone seeking health care. Making an appointment right away with the doctor and participating in health fairs are not typical behaviors of young adults for the same reason.

DIF: Apply REF: 157-158

OBJ: Discuss cognitive and psychosocial changes that occur during the adult years.

TOP: Implementation MSC: Health Promotion and Maintenance

15. When performing a thorough psychosocial assessment on a young adult, what must the nurse realize?

a.
Having a job is the best way to relieve stress.
b.
Although psychologically disturbing, stress does not lead to physical illness.
c.
Change is inevitable and is not a factor in stress-related illness.
d.
Psychosocial health is often related to job and family stress.

ANS: D

The psychosocial health concerns of the young adult are often related to job and family stressors. If stress is prolonged and the patient is unable to adapt to the stressor, health problems will develop. Job assessment also includes conditions and hours, duration of employment, changes in sleep or eating habits, and evidence of increased irritability or nervousness. When a patient seeks health care and presents stress-related symptoms, the nurse needs to assess for the occurrence of a life change event.

DIF: Apply REF: 158-160

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP: Assessment MSC: Health Promotion and Maintenance

16. A 25-year-old patient is brought to the hospital by police after crashing his car in a high-speed chase when trying to avoid arrest for spousal abuse. What should the nurse do?

a.
Question the patient about drug use.
b.
Offer the patient a cup of coffee to calm his nerves.
c.
Be aware that substance abuse is usually obvious.
d.
Deal with the issue at hand, and put off asking about previous illnesses.

ANS: A

Reports of arrests because of driving while intoxicated, wife or child abuse, or disorderly conduct are reasons for the nurse to investigate the possibility of drug abuse more carefully. Caffeine is a naturally occurring legal stimulant that stimulates the central nervous system and is not the choice for calming nerves. Substance abuse is not always diagnosable, particularly in its early stages. The nurse may obtain important information by making specific inquiries about past medical problems, changes in food intake or sleep patterns, and problems of emotional lability.

DIF: Apply REF: 160-161

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP: Implementation MSC: Health Promotion and Maintenance

17. A 61-year-old obese patient is diagnosed with type 2 diabetes and high blood pressure. The patient states that he is upset about the diet restrictions imposed by the treatment regimen. What is the nurse’s best approach?

a.
Tell the patient that he must do what the doctor tells him.
b.
Offer counseling on nutrition and exercise.
c.
Tell the patient about what happened to other patients who did not change their lifestyle.
d.
Explain that he needs to accept the care provider’s advice without question if he wants to get better.

ANS: B

Counseling related to physical activity and nutrition is an important component of the plan of care for overweight and obese patients. To help the patients develop positive health habits, the nurse becomes a teacher and a facilitator, providing information and positive reinforcement. Ultimately, however, the patient decides which behaviors will become habits of daily living. Scare tactics do not usually work. By providing information about how the body works and how patients form and change habits, the nurse raises the patient’s level of knowledge regarding the potential impact of behavior on health. The nurse should encourage patients to express their feelings to promote problem solving and recognition of risk factors by patients themselves.

DIF: Apply REF: 166-167

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP: Implementation MSC: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. What are the most common life events that occur during young adulthood? (Select all that apply.)

a.
Refining self-perception and ability for intimacy
b.
Achievement and mastery of the surrounding world
c.
Examination of life goals and relationships
d.
Rejection of culture-bound definitions of health and illness
e.
Women surrendering careers to raise families

ANS: A, B, C

Between the ages of 23 and 28, the person refines self-perception and ability for intimacy. From 29 to 34, the person directs enormous energy toward achievement and mastery of the surrounding world. The years from 35 to 43 are a time of vigorous examination of life goals and relationships. Often the stresses of this re-examination result in a “midlife crisis.” Each person holds culture-bound definitions of health and illness. Knowing too little about the patient’s self-perception or beliefs regarding health and illness creates conflict between the nurse and the patient. Women often continue to work during the childrearing years, and many women struggle with the enormity of balancing three careers: wife, mother, and employee.

DIF: Knowledge REF: 157-159

OBJ: List and discuss major life events of young and middle adults and the childbearing family.

TOP: Assessment MSC: Health Promotion and Maintenance

2. Nurses need to provide competent care to young and middle adult patients. Why must nurses be knowledgeable about developmental theories to care for this group? (Select all that apply.)

a.
These theories provide nurses with a basis for understanding the life events and developmental tasks of young and middle adults.
b.
It is important to understand societal structures and roles because they have not changed in the past 20 or 30 years.
c.
Patients present challenges to nurses, who themselves are often young or middle adults coping with the demands of their respective developmental period.
d.
Nurses need to recognize the needs of their patients even if they are not experiencing the same challenges and events.

ANS: A, C, D

Developmental theories provide nurses with a basis for understanding the life events and developmental tasks of young and middle adults. Patients present challenges to nurses who themselves are often young or middle adults coping with the demands of their respective developmental period. Nurses need to recognize the needs of their patients even if they are not experiencing the same challenges and events. Faced with a societal structure that differs greatly from the norms of 20 or 30 years ago, both men and women are assuming different roles in today’s society.

DIF: Knowledge REF: 157

OBJ: Discuss developmental theories of young and middle adults.

TOP: Assessment MSC: Health Promotion and Maintenance

3. When providing prenatal care, what information does the nurse expect to provide? (Select all that apply.)

a.
Protecting against urinary infection
b.
No longer needing condoms
c.
Exercise patterns
d.
Proper diet
e.
Physical assessments only during the last trimester

ANS: A, C, D

Prenatal care includes a thorough physical assessment of the pregnant woman during regularly scheduled intervals (not just the last trimester). Information regarding STIs and other vaginal infections and urinary infections that will adversely affect the fetus and counseling about exercise patterns, diet, and child care are important for a pregnant woman.

DIF: Knowledge REF: 162-163

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP: Implementation MSC: Health Promotion and Maintenance