Unit 12 Young & Middle Adult

Front 1

Anxiety

Back 1

A vague, uneasy feeling, the source of which is often non-specific and unknown to the individual, manifested by restlessness, apprehension, tachycardia, dilated pupils, and poor eye contact, and is a normal response to a stressful situation

Front 2

Depression

Back 2

A mood disorder that manifests itself as exaggerated feelings of sadness, melancholy, and hopelessness out of proportion to reality. The most frequent age of onset is between 25 and 44.

Front 3

Developmental task- (Havigurst)

Back 3

- a series of essential tasks that arise from predictable internal and external pressures.
- These pressures include increasing physical maturity, cultural pressure of society, and the individual’s personal goals and aspirations.
- In the young adult these tasks are things such as mate selection/marriage, establishing a family/child rearing, home management, starting a career, and beginning civic responsibilities.

Front 4

Major depression

Back 4

- Usually treated with antidepressant agents such as elavil (great sleeping pills), Zoloft, paxil, and prozac.
- These meds can cause dry mouth, blurred vision, urinary retention, postural hypotension, and tachycardia

Front 5

Maturity

Back 5

- When an individual has reached a balance of growth in psychological, psychosocial, and cognitive areas.
- Mature individuals feel comfortable with their abilities, knowledge, and responses that they have developed over the years.

Front 6

Mild Depression

Back 6

A normal response to life stresses and losses and usually goes untreated

Front 7

Young Adulthood- A young adulthood is the period between the late teens and the mid to late 30’s. (Young adults comprise approximately 27% of the population)

Back 7

Middle adulthood- Late 30’s to mid 60’s. 39 % of the population

Front 8

~ Young Adult -Psychosocial Changes
- Period of significant changes related to education and employment
- Caught in the transition from the dependence of adolescence to adult responsibilities
~ Erikson- Stages of Development young adult:
- lasts from about 18 to about 30
- Successful navigation results in the ability to love
~ Characteristics of Young Adulthood
- Physical Growth Complete
- Generally period of high activity/productivity with multiple demands

Back 8

~ Young Adult Cognitive Changes
- Critical thinking habits continues to increase
- Healthy adults demonstrate flexibility in problem solving
- Consider Individuality in learning styles
~ Major developmental tasks of the young adult:
1) Selecting a mate
2) Learning to live with a marriage partner
3) Starting a family
4) Rearing children
5) Getting started in occupation
6) Taking on civic responsibilities
7) Finding a congenial social group
8) Moving out of the house

Front 9

~ Middle Adult- Psychosocial Changes
- More time and $ to spend on self interests
- Concerns/focus on “time Left”
- Increase in Religiosity/Spirituality
- Exploration of the meaning of life
- Transition to golden years
- Mid-life crisis

Back 9

• Developmental tasks of the middle adult according to Havigurst:
1) Achieving adult civic responsibility such as volunteering for a group, becoming active in church
2) Establishing and maintaining a standard of living
3) Helping teenage children become responsible and happy adults
4) Develop leisure activities (kids are older or gone, have more time)
5) Relating to one’s spouse as a person
6) Accepting and adjusting to the physiological changes that occur with middle age
7) Adjusting to and caring for aging parents

Front 10

• 2 common psychosocial health concerns in the middle adult
1. Anxiety – response to the physiological & psychosocial changes of middle age.
- For some adults, anxiety can stimulate productivity, for others, promotes psychosomatic illness & preoccupation with death.
- Anxiety is treated with Benzodiazepines (xanax, Librium, klonopin, valium), which are metabolized in the liver and cleared by the kidneys (when used, these organ functions should be checked to avoid toxicity).
- They can lead to dependence and thus should be withdrawn from slowly. can cause drowsiness & mild memory loss.

Back 10

2. Depression- Risk factors for depression: being female, disappointments or losses at work/school/relationship/family.

Front 11

~ Middle adult- Erikson- Stage of Development- To have and nurture children and/or become involved with future generations
~ Middle Adult-Characteristics
- stage of middle adulthood beginning somewhere between the late 20s to early 40s and continues until about age 50 to 65
- Middle Age is getting Older
- Generally characterized by being actively involved in raising and caring for children.

Back 11

Levinson- believed there were 4 transition periods:
1) Early adult transition- (18-22) the young adult breaks away from the family selects personal goals, values, and lifestyle
2) Entering the adult world- (22-28) the young adult begins doing what they thing “should be done” as defined by family, peers, culture, and media; they explore alternative opportunities
3) The thirties transition- (28-33) enrichment or dramatic changes to life structure, begin to feel, “I want a stronger identity”, evaluation of previous commitments and decisions; mirage, divorce, child rearing; career change
4) Settling down- (30’s) Invest in areas of importance such as family, work, friends, and community; becoming a full-fledged adult, strive towards gaining status and recognition.

Front 12

intimacy vs isolation

Back 12

- The young adult fuses their self-identity with the identity of others.
- Intimacy requires commitment, which necessitates sacrifice, compromise, and self-abandonment for the benefit of others.
- Individuals who avoid this due to fear or loss of identity experience a sense of isolation.
- Young adults having developed a sense of identity, deepen their capacity to love others and care for them through work.
- This is the time to participate in the community, and enjoy adult freedom and responsibility.
- If a young adult has not developed a sense of personal identity, they may experience feelings of isolation from others and the inability to form attachments.
- The willingness to share and mutually regulate their lives with another marks completion of this task. (The ability to form relationships is a sign that the adult has achieved intimacy)

Front 13

4 Types Generativity:- nurturing others

Back 13

1. Biological
2. Parental
3. Work
4. Cultural

Front 14

Stagnation

Back 14

- Self indulgent
- Empty
- Unfulfilled

Front 15

Young Adult-Health Screenings

Back 15

• Routine Physical Exam
• Immunizations and TB test
• Annual Dental assessments
• Breast examination and Pap smear
• Testicular self exam
• Regular eye exam (1-2 years)
• Hearing exam
• Cardiovascular screening

Front 16

Middle Adult-Health Screening

Back 16

- Routine physical examination
- Immunizations and Tuberculosis test
- Regular dental assessments
- Vision exam
- Breast self exam
- Pap smear
- Testicular self exam
- Screenings for cardiovascular disease
- Screenings for colorectal, breast, cervical, uterine and prostate cancer
- Glucose checks

Front 17

Osteoporosis- Loss of minerals from bone, especially calcium, begins at around 40

Back 17

• Therapy:
–Calcium supplementation
–Regular weight bearing exercise
–Possible HRT
–Fosamax (alendronate)
–Miacalcin (calcitonin)

Front 18

Stress related illnesses:

Back 18

1) Heart attack
2) Hypertension
3) Migraines
4) Ulcers
5) Colitis

Front 19

male climacteric

Back 19

- Male characteristics such as muscle mass, hair growth, libido, erections, and sperm production are the consequence of testosterone
- With the male, Climacteric (Andropause or lower testosterone levels) occurs in the late 40’s – 50’s.
- Most men continue to produce sperm into old age, but they experience a decreased libido (sex drive), slower sexual arousal and climax, and an increased refractory period.
- The pleasure of sexual intercourse is not lessened.

Front 20

menopause

Back 20

- the cessation of menses associated with decreased ovarian function (the ovaries no longer produce estrogen and progesterone which regulate the menstrual cycle).
- considered to have occurred after a woman goes one year without menstruation.
- occurs between the ages of 47-52
- a normal physiologic occurrence, and a woman will live 1/3 of her life during her post-menopausal years.
- After menopause, a woman can achieve lifetime desires put off during child rearing years.
- experiences a gradual decline in reproductive abilities and monthly menses becomes irregular and less frequent as she approaches menopause.

Front 21

Levinson- believed there were 4 transition periods:

Back 21

1) Early adult transition- (18-22) the young adult breaks away from the family selects personal goals, values, and lifestyle
2) Entering the adult world- (22-28) the young adult begins doing what they thing “should be done” as defined by family, peers, culture, and media; they explore alternative opportunities
3) The thirties transition- (28-33) enrichment or dramatic changes to life structure, begin to feel, “I want a stronger identity”, evaluation of previous commitments and decisions; mirage, divorce, child rearing; career change
4) Settling down- (30’s) Invest in areas of importance such as family, work, friends, and community; becoming a full-fledged adult, strive towards gaining status and recognition.

Front 22

Generativity

Back 22

is the willingness to care for and guide others) (giving oneself to the next generation….what are you going to pass on

Front 23

Osteoporosis therapy

Back 23

- calcium supplementation
- regular weight bearing exercise
- hormone replacement therapy (HRT).

Front 24

Indications for hormone replacement therapy:

Back 24

1) To reduce symptoms of menopause
2) To prevent osteoporosis
3) To prevent cardiovascular disease (because lack of estrogen increases LDL)

Front 25

Contraindications for hormone replacement therapy:

Back 25

1) Risk of endometrial and breast cancer
2) Unexplained vaginal bleeding
3) Impaired liver or kidney function
4) Acute vascular thrombosis
5) Increases the risk of gall bladder disease

Front 26

Hormone therapies:

Back 26

1) Estrogen along- can cause a high risk of endometrial cancer
2) Estrogen and progesterone together =’s no menstration
3) Cycling (omitted 5-7 days/month) estrogen and progesterone =’s reestablished menstration

Front 27

A nurse teaches the importance of folic acid to a group of pregnant women. This is considered which level of preventive care?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Illness behavior

Back 27

a. Primary prevention is considered true prevention, and it is applied to an already healthy individual in an effort to maintain physical and emotional health.
b. Secondary prevention is a type of prevention geared towards individuals who are already experiencing health problems or illness and who are at risk for developing complications or worsening conditions.
c. Tertiary prevention activities are directed towards rehabilitation rather diagnosis or treatment because the individual has a defect or disability that is permanent and irreversible.
d. Illness behavior is defined as the reaction to illness.

Front 28

_______________ are described as a person’s ideas, convictions, and attitudes about health and illness.
A. Health beliefs
B. Moral beliefs
C. Holistic views
D. Negative health behaviors

Back 28

a. Health beliefs are an individual's perception of health or illness that may be based on factual information or misinformation, common sense or myths, or reality or false expectations.
b. Moral beliefs are learned behaviors that are in accordance with the principles of right or wrong.
c. Holistic views consider the emotional and spiritual well-being of the individual.
d. Negative health behaviors include behaviors that are typically harmful to health such as smoking, drug or alcohol abuse, poor diet, and refusal to take appropriate medications.

Front 29

Which of the following models of health or illness defines health as a positive, dynamic state, not merely the absence of disease?
A. Pender’s health promotion model
B. Maslow’s hierarchy of needs
C. Rosenstoch’s health belief model
D. The holistic health model of nursing

Back 29

a. Pender's health promotion model was developed to be a "complementary counterpart to models of health protection." This model defines health as a positive, dynamic state, not merely the absence of disease.
b. Maslow's hierarchy of needs defines what is necessary for human survival and health. These items include food, water, safety, and love.
c. Rosenstoch's health belief model addresses the relationship between a person's belief and behaviors. It predicts how clients will behave in relation to their health and how they will comply with their health regimen.
d. The holistic health model creates conditions that promote optimal health.

Front 30

All of the following are considered internal variables that influence a client’s health beliefs and practices except:
A. Perception of functioning
B. Emotional factors
C. Developmental stage
D. Socioeconomic factors

Back 30

d. Socioeconomic factors are considered external variables. A person seeks approval and support from neighbors, peers, and co-workers; this affects health beliefs and practices. Economic variables may affect a client's level of health. For example, a client with a fixed income who needs chronic illness medications may determine that food and shelter are more important than the medication; therefore the client's health suffers.
a. Perception of functioning is an internal variable. It is defined as the way an individual perceives his or her physical functioning and how it affects health beliefs and practices.
b. Emotional factors are internal variables. These include a client's degree of stress, depression, or fear, which can influence health beliefs and practices.
c. An individual's developmental stage is considered an internal variable. A client's thought of health is dependent upon his or her level of development.

Front 31

Clients maintain health or enhance their present health by routine exercise and proper nutrition. This is known as_________________.
A. Wellness education
B. Illness
C. Health promotion
D. External variables

Back 31

c. Health promotion activities help clients maintain and enhance their present level of health.
a. Wellness education instructs persons on how to care for themselves in healthy ways and includes topics such as physical awareness, stress management, and self- responsibility.
b. Illness is defined as poor condition or disease.
d. External variables influence a person's health beliefs and practices. They include family practices, socioeconomic factors, and cultural background.

Front 32

The nurse in a diabetic clinic conducts monthly seminars for diabetic clients. During these seminars, the importance of taking insulin as directed to prevent diabetic complications is emphasized. This is considered which level of preventive care?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Illness prevention

Back 32

b. Secondary prevention is a type of prevention geared towards individuals who are already experiencing health problems or illness and who are at risk for developing complications or worsening conditions.
a. Primary prevention is considered true prevention, and it is applied to an already healthy individual in an effort to maintain physical and emotional health.
c. Tertiary prevention activities are directed towards rehabilitation rather than diagnosis or treatment because the individual has a defect or disability that is permanent and irreversible.
d. Illness behavior is defined as the reaction to illness.

Front 33

A client comes into the clinic for a complete physical examination. The nurse obtains a health history and determines the client is at risk for heart disease. Which of the following would lead the nurse to believe this?
A. Father died of a heart attack at age 40.
B. The client is 25 years old.
C. The client lives near a chemical plant.
D. The client works as a carpet salesman.

Back 33

a. Genetic predisposition to specific illnesses is considered a major physical risk factor. In this example the client's father died of a documented heart attack at the age of 40, thereby increasing the client's risk of heart disease and heart attack.
b. Age may increase or decrease a client's susceptibility to certain illnesses. Age risk factors are often closely associated with other risk factors such as family history and personal habits. In this example the client is 25 years old; therefore risk is low for heart disease at this time.
c. The client lives near a chemical plant; this constant exposure to chemicals may lead to health problems.
d. The physical environment in which a person works and lives can increase the likelihood that certain illnesses will occur.

Front 34

The World Health Organization defines health by which of the following statements?
A. “State of complete physical, mental, and social well-being, not merely the absence of disease”
B. “A state of being that people define in relation to their own values, personality, and lifestyle”
C. “Mental, social, and spiritual well-being”
D. “All people free of disease”

Back 34

a. The World Health Organization defines health as a "state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity."
b. There are several definitions of health. Health is a state of being that people define in relation to their own values, personality, and lifestyle.
c. Health and illness must be defined in terms of the individual. Health can include conditions previously considered to be illness. Pender, Murdaugh, and Parsons note that views of health include mental, social, and spiritual well-being.
d. Pender explains that "all people free of disease are not equally healthy."

Front 35

All of the following are examples of active strategies of health promotion except:
A. Weight reduction
B. Smoking cessation
C. Fluoridation of drinking water
D. Exercise training

Back 35

c. Passive strategies of health promotion benefit individuals without the individuals themselves acting. The fluoridation of municipal drinking water and the fortification of homogenized milk with vitamin D are examples of passive health promotion strategies.
a. Weight reduction is considered an active strategy of health promotion. With active strategies of health promotion, individuals are motivated to adopt specific health programs.
b. Smoking cessation requires clients to be actively involved in measures to improve their present and future levels of wellness while decreasing the risk of disease.
d. Exercise training meets the criteria for active strategies of health promotion because it actively involves the client in his or her own health.

Front 36

_______________ is defined as a mental self-image of strengths and weaknesses in all aspects of personality.
A. Body image
B. Self-concept
C. Emotional change
D. Family roles

Back 36

b. Self-concept is a mental self-image of strengths and weaknesses in all aspects of personality. Self-concept is important in relationships with other family members. When a client is ill, his or her self-concept changes and this may lead to tension and conflict.
a. Body image is defined as a subjective concept of physical appearance. Many illnesses can cause changes in physical appearance, and clients and families react differently to these changes.
c. Clients react differently to illness or the threat of illness. Individual behavioral and emotional reactions depend on the nature of the illness.
d. Illness impacts family roles. When an illness occurs, parents and children try to adapt to major changes resulting from a family member's illness.

Front 37

The personal lifestyle assessment of the young adult will most likely focus on:
A. Risk factors for cardiac disease
B. Decreased hearing and visual acuity
C. Onset of menopause
D. Family history of depression

Back 37

a. Habits and lifestyles that increase the risk for many diseases should be assessed and intervened in young adulthood. Young adults are more flexible in change.
b. This assessment would be appropriate for a middle to older adult.
c. Menopause is more likely to occur naturally in the middle adult.
d. Family history of depression is focused on at the time the diagnosis of depression is made. This is more common in middle adulthood.

Front 38

The nurse gathers the following data during an interview with a young adult client. Which statement requires further investigation?
A. “I rarely have to go to the doctor for anything.”
B. “There is a lot of competition where I work. I’m determined to advance.”
C. “I need to find a way to ease my stress. I feel like I could explode.”
D. “It’s all about the kids now. We don’t get to travel like we used to.”

Back 38

c. There is a sense of urgency here. The nurse should explore what the client means by "stress" and "explode."
a. The young adult is generally healthy and happy and does not seek health care.
b. Young adulthood is the time for career building, and this would be expected.
d. Young adulthood is characterized by starting families, and this indicates a healthy reaction, which is to focus on the family needs

Front 39

A psychosocial assessment on an emotionally healthy young adult should reveal:
A. Sensitivity to criticism
B. Less need for friends and social interaction
C. A sense of where his or her life is heading
D. Attainment of all the life goals he or she has set

Back 39

c. The young adult does display a plan for his or her life and a sense of direction. This is a time the young adult builds a career, has a family, and begins to attain some of his or her goals.
a. The young adult does not normally react strongly to criticism. This is a period of increased self-esteem and confidence for the healthy young adult.
b. Friends and social activities are an important part of the young adult's life.
d. The young adult may attain some of his or her goals, but this is just the beginning of a process.

Front 40

The young adult woman who is planning to become pregnant would benefit from developing health practices such as:
A. Weight reduction dieting
B. Cutting back the number of cigarettes smoked
C. Scheduling regular dental checkups
D. Limiting alcohol intake to 2 to 3 drinks per day

Back 40

c. Regular dental checkups can prevent serious infections that can have serious effects on a developing fetus.
a. Weight reduction diets can result in serious deficiencies in nutrients needed for health and early fetal health.
b. Cessation of smoking is recommended.
d. Cessation of alcohol consumption during conception and pregnancy is recommended.

Front 41

The nurse assessing a young adult woman in her first trimester of pregnancy would expect to observe:
A. Fatigue
B. Fetal movement
C. Increasing size of uterus
D. Pigmentation of the nipple and breast

Back 41

a. Fatigue is common in the first trimester related to the increased demands on the body and the hormonal changes.
b. Fetal movement is detected in the second trimester
c. Fundal size increases in the second and third trimesters
d. Pigmentation is evident in the second trimester.

Front 42

The term “sandwich generation” is applied to middle adulthood primarily due to which of the following?
A. Middle adults typically make career changes.
B. Menopause tends to put middle adult women between two phases of sexual function.
C. Middle adults may take on caring for aging parents while still caring for their own children.
D. Socioeconomic stability can now be threatened by corporate downsizing and loss of positions.

Back 42

c. Middle adults may be "sandwiched" between caring for children and aging parents, which can be a source of stress.
a. Middle adults may retire during this stage and, excluding loss of job due to downsizing or other external factors, do not typically change careers.
b. Menopause may affect sexual function in some ways but does not change to this extent.
d. Although socioeconomic stability may be an issue, this is not what "sandwich generation" refers to

Front 43

Assessment data that might indicate that the middle adult male is experiencing the climacteric would include:
A. Renewed interest in sexual activity
B. Loss of memory for recent events
C. Thickening of the waistline
D. Less firm penile erection

Back 43

d. Decreased firmness of erection and increased refractory period are common symptoms of the climacteric.
a. Interest in sexual activity may wane during the climacteric.
b. This is an occurrence in the older adult but is not due to climacteric.
c. This is a common occurrence in middle adults but not related to the climacteric.

Front 44

The nurse might suspect depression in the middle adult client who reports which of the following?
A. “My job has a lot of competition and deadlines.”
B. “I think I’m going through menopause.”
C. “I want to sleep all the time.”
D. “My husband and I could use a vacation.”

Back 44

c. Alteration in sleeping patterns, insomnia, or sleeping too much is a sign of depression.
a. Job stress can be a factor leading to anxiety and depression but is not indicated here.
b. Menopause is natural process and may cause anxiety and depression but not as a rule.
d. This does not indicate the typical hopeless feeling associated with depression. This is a healthy response to stress.

Front 45

A young adult client presents to the clinic with symptoms associated with stress. Knowledge of the young adult should guide the nurse to assess for:
A. Pressure at the workplace
B. Flexibility in his or her decision-making ability
C. Occurrence of a life-change event
D. Use of caffeine on a regular basis

Back 45

c. A life-change event such as loss of job, unplanned pregnancy, or loss of family member has profound effects on young adults, which create symptoms.
a. Young adults handle this well
b. This is healthy, normal reaction of the young adult.
d. Although not good for the heart, caffeine is not a stress producer.

Front 46

Health teaching for the young adult client would include as a priority:
A. Regular mammograms
B. Colon cancer screening by colonoscopy
C. Frequent monitoring of blood pressure and blood cholesterol
D. Safe sex practices and genital self-examination

Back 46

d. Common problems for the young adult are sexually transmitted diseases (STDs).
a. Breast self-examination, unless family history indicates otherwise, is recommended.
b. Colonoscopy is recommended after the age of 40 or if warranted by symptoms or history.
c. "Frequently" may be too aggressive until middle age. Although important, STDs are a higher priority in this age-group.

Front 47

The most accurate description of sexual development in the school-age child would be that the child:
A. Identifies himself as male
B. Asks specific questions about sexuality
C. Makes decisions regarding sexual activity
D. Demonstrates maturity in sexual relationships

Back 47

b. This describes the child age 6 to 12 years who is curious and able to communicate his or her questions about sex.
a. his is typical of early childhood.
c. his describes an adolescent.
d.This is typical of the young adult.

Front 48

An adolescent asks the nurse what birth control is best if she has sexual activity infrequently. The nurse’s response should be based on the fact that:
A. Sterilization is the most effective contraception method.
B. Sexually transmitted disease (STD) is prevalent in adolescents, and risk can be decreased by the use of condoms.
C. Hormonal contraception methods such as birth control pills are not effective in adolescents.
D. A method of timing intercourse during infertile times in the menstrual cycle is effective in young women

Back 48

b. STDs are a major problem in adolescents and young adults. This fact plus infrequent sexual activity makes condoms a good choice.
a. Sterilization would not be appropriate for teenagers who have not had pregnancies.
c. Birth control pills are effective in adolescents but due to the nature of this client's sexual activity seem impractical compared to the risks.
d. The rhythm method requires a good understanding of the reproductive cycle and careful attention to subtle body changes. This plus the higher failure rate makes this a poor choice for the adolescent.

Front 49

A young woman talking to a nurse about sexually transmitted diseases makes the following comments. Which one requires further intervention by the nurse?
A. “I’m safe from AIDS because my boyfriend is my only sexual partner.”
B. “I’m concerned that some STDs cannot be cured.”
C. “I use a spermicide even though my boyfriend uses a condom.”
D. “You don’t have to be gay or use IV drugs to get AIDS.”

Back 49

a. This is a false sense of security, considering previous sexual experiences of either partner.
b. Diseases such as acquired immunodeficiency syndrome (AIDS) and genital herpes and warts have no cure.
c. The condom is effective in decreasing STDs. The spermicide is an extra precaution and can help.
d. This is correct statement by the client and requires no intervention.

Front 50

A woman who has just delivered her fourth child asks the nurse what to do to prevent further pregnancies. The nurse’s best response should be:
A. “I would get my tubes tied if I were you.”
B. “You’re so lucky to be able to have children so easily.”
C. “Tell me how you feel about birth control.”
D. “I’ll tell the physician that you want to get on birth control pills.”

Back 50

c. The priority would be to assess the client's values and feelings about birth control and see what she has already considered. Start where the client is.
a. The nurse should not impose his or her feelings on the client.
b. This makes the client feel guilty for asking and thus blocks the chance for therapeutic communication.
d. Do not assume the client wants birth control pills. Open the communication to find out the clients needs and wishes.

Front 51

The school nurse suspects a child may be the victim of sexual abuse based on which one of the following symptoms?
A. The child is reluctant to talk to the school nurse.
B. Other children complain that the child touches them inappropriately.
C. The child is frequently late for school.
D. The child wears the same clothes 2 days in a row.

Back 51

b. A child's showing awareness of sex and exhibiting seductive behavior may indicate that the child is being victimized.
a. Shyness and reluctance to talk to adults, especially health care personnel, is typical in young children.
c. Lateness for school in itself is not cause for suspicion of sexual abuse. It would be risky to assume sexual abuse without more specific evidence.
d. This may be a hygiene issue or a child care problem and should not be expanded to a sexual abuse suspicion without further evidence.

Front 52

When assessing a client for any sexual concerns, it is most important to:
A. Compare sexual behavior to established norms
B. Make opening statements that encourage discussion
C. Use a written form to obtain data without embarrassment
D. Ask questions only if the client is sexually active

Back 52

b. This creates a climate of respect and dignity. The client can set the environment of the discussion.
a. The "norm" is what is normal for the client.
c. Written forms without communication convey a sense of unimportance to the client and may not be understood. This also promotes the idea that it is too embarrassing to "talk" about.
d. There may be concerns the client will not volunteer but may welcome the opportunity to discuss.

Front 53

A postmenopausal woman is concerned about the effect of vaginal dryness on sexual intercourse. The nurse should suggest:
A. Inserting a spermicide for lubrication
B. Avoiding intercourse when dryness is noticed
C. Using a water-based lubricant each time she has intercourse
D. Exploring alternate methods of sexual fulfillment to avoid damaging vaginal tissue

Back 53

c. A water-based lubricant replaces moisture lost in tissues due to hormonal changes.
a. Spermicide is not needed in postmenopausal women and is costly compared to lubricant.
b. There are many lubricants available to treat the problem that are simple and effective.
d. This is drastic and not necessary.

Front 54

An older adult male client states that he has difficulty maintaining an erection during sexual intercourse. A priority nursing intervention would be to:
A. Refer the client to a sex therapist
B. Tell the client to talk to a physician who can prescribe medication
C. Assess the client for factors that may be contributing to the problem
D. Reassure the client that this is normal for his age and is to be expected

Back 54

c. Assessment is priority. There may be medical or other conditions affecting the client that can be corrected.
a. The problem has not been identified, and this may not be what is needed.
b. The nurse needs to assess, diagnose, and plan to deal with the problem and not "write off" by telling him to talk to the physician. He may not pursue this and see it as not being considered important.
d. There may be some age-related factors, but further assessment should rule out other potential factors.

Front 55

The best way to tell if a client’s sexual concerns have been dealt with effectively is by:
A. Having a follow-up discussion with the client
B. Asking the client’s sexual partner if the relationship is doing well
C. Observing the couple for subtle expressions of sexual interest
D. Noticing that the client has no further questions about sexual concerns

Back 55

a. It is important to communicate with the client to assess whether needs have been met or if there are additional concerns.
b. The client is the one to ask. Talking to the sexual partner (unless done as a couple at the same time) can be a breech of trust.
c. A private couple may not demonstrate this behavior.
d. The client may need encouragement to discuss these issues. The nurse needs to ask and assess.

Front 56

Outcome criteria for evaluating the client’s goal, “The client will express increased interest in sexual intimacy,” should come from:
A. What the client identifies as desired outcome
B. What the nurse determines to be appropriate for the client
C. Outcomes set by the sexual partner
D. Criteria listed in a standardized care plan

Back 56

a. The client is the one who ultimately sets the goals and determines if they have been met.
b. Outcome criteria are centered on the client.
c. The client is the one who determines what criteria are significant .
d. The outcome criteria, as well as the entire care plan, should be individualized for the client.

Front 57

- whith the exception of lactating women, the young adult has completed physical growth by the age of 20
- It is important for a nurse to direct young adults to Health Promotion
- The US has the highest rate of STDs
- The most effective contraception method other than abstinence is Sterilization

Back 57

- gender identity is the individuals sense of preferring one sex over the other
- Sexual health refers to open and positive attitudes toward sexual functioning
- inability or difficulty in sexual functioning caused by numerous factors is called Sexual dysfunction
- When the nurse is gathering a sexual history from an older adult the nurse keeps in mind that older adults may not reveal intimate details