Question 1

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?

Accepted Answer

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.

Question 2

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

Accepted Answer

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.

Question 3

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?

Accepted Answer

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.

Question 4

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

Accepted Answer

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.

Question 5

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:

Accepted Answer

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.

Question 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:

Accepted Answer

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.

Question 7

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

Accepted Answer

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.

Question 8

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

Accepted Answer

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 patient's autonomy.

Question 9

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?

Accepted Answer

Many of today's 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.

Question 10

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

Accepted Answer

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).

Question 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?

Accepted Answer

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.

Question 12

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

Accepted Answer

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

Question 13

To effectively assess an older adult patient's sexual needs,the nurse must initially:

Accepted Answer

Nurses may feel intimidated or uncomfortable questioning older adults about their sexual desires and needs.To effectively assess the patient's 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.

Question 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?

Accepted Answer

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

Question 15

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:

Accepted Answer

Erectile dysfunction (ED)can occur at any age.This patient's 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.

Question 16

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:

Accepted Answer

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.

Question 17

The nurse notes the patient's chart lists "dyspareunia" as a complaint.What teaching does the nurse plan to provide?

Accepted Answer

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.

Question 18

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:

Accepted Answer

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.

Question 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?

Accepted Answer

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 patient's autonomy.

Question 20

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

Accepted Answer

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.

Quiz 13: Sexuality and Aging