Unit B-Development in the Adult

Question 1

1. A nurse is caring for a young adult. Which goal is priority?
   a. Maintain peer relationships.
   b. Maintain family relationships.
   c. Maintain parenteral relationships.
   d. Maintain recreational relationships.

Answer 1

ANS: B
Family is important during young adulthood. Challenges may include the demands of working and
raising families. Peer is more important in the adolescent years. Young adults are much freer from
parental control. While recreation is important, the family and work are the priorities in young adults.
DIF:Apply (application)REF:159
OBJ: List and discuss major life events of young and middle adults and the childbearing family.

Question 2

The nurse is caring for a hospitalized young-adult male who works as a dishwasher at a local
restaurant. He states that he would like to get a better job but has no education. How can the
nurse best assist this patient psychosocially?
a. By providing information and referrals
b. By focusing on the patient’s medical diagnoses
c. By telling the patient that he needs to go back to school
d. By expecting the patient to be flexible in decision making

Answer 2

ANS: A
Support from the nurse, access to information, and appropriate referrals provide opportunities for
achievement of a patient’s potential. Health is not merely the absence of disease (focusing on
medical diagnoses) but involves wellness in all human dimensions. Telling a patient what to do (go
back to school) is inappropriate. Each person (not the nurse) needs to make these decisions based on
individual factors. Insecure persons tend to be more rigid in making decisions.
DIF:Analyze (analysis)REF:160
OBJ: Discuss cognitive and psychosocial changes occurring during the adult years.

Question 3

Which goal is priority when the nurse is caring for a middle-aged adult?

a. Maintain immediate family relationships.
b. Maintain future generation relationships.
c. Maintain personal career relationships.
d. Maintain work relationships.

Answer 3

ANS: B
Many middle-aged adults find particular joy in helping their children and other young people become
productive and responsible adults. While immediate family is important, this goal is priority in young
adults, not as important in middle-aged adults. During this period, personal and career achievements
have often already been experienced; therefore, these goals are not priority.

Question 4

A nurse is teaching young adults about health risks. Which statement from a young adult indicates
a correct understanding of the teaching?
a. “It’s probably safe for me to start smoking. At my age, there’s not enough time for cancer to develop.”
b. “My mother had appendicitis so this increases my chance for developing appendicitis.”
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.”

Answer 4

ANS: C
Lifestyle habits that activate the stress response increase the risk of illness; so, controlling this will
decrease risk. Smoking is a well-documented risk factor for pulmonary, cardiac, and vascular disease
as well as cancer in smokers and in individuals who receive secondhand smoke. The presence of
certain chronic illnesses (not acute illnesses—appendicitis) in the family increases the family
member’s risk of developing a 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 (comprehension)REF:162
OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

Question 5

A nurse is choosing an appropriate topic for a young-adult health fair. Which topic should the
nurse include?
a. Retirement

b. Menopause
c. Climacteric factors

d. Unplanned pregnancies

Answer 5

ANS: D
Unplanned pregnancies are a continued source of stress that can result in adverse health outcomes for
the mother (young adult), infant, and family. Retirement is an issue for middle-aged, not young
adults. The onset of menopause and the climacteric affect the sexual health of the middle-aged adult,
not the young adult.
DIF:Understand (comprehension)REF:163
OBJ: Describe health concerns of the young adult, the childbearing family, and themiddle adult.

Question 6

A nurse is assessing the risk of intimate partner violence (IPV) for patients. Which population
should the nurse focus on most for IVP?
a. White males

b. Pregnant females
c. Middle-aged adults
d. Nonsubstance abusers

Answer 6

ANS:B
The greatest risk of violence occurs during the reproductive years. A pregnant woman has a 35.6%
greater risk of being a victim of IPV than a nonpregnant woman. White males, middle-aged adults,
and nonsubstance abusers are not as high risk as pregnant women.
DIF:Understand (comprehension)REF:163
OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

Question 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. Which information should the
nurse share with 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.

Answer 7

ANS: A
Childbirth education classes (like Lamaze) 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; however, this does not
relate to the issue the patient reports (lack of knowledge and participation). The stress that many
women experience after childbirth has a significant impact on the health of postpartum women.
Ideally partners should share all responsibilities; however, this does not relate to the patient’s
concerns.
DIF:Apply (application)REF:161
OBJ: Describe developmental tasks of the young adult, the childbearing family, and the middle adult.

Question 8

Which information from the nurse indicates a correct understanding of emerging adulthood?

a. It is a type of young adulthood.
b. It is a type of extended adolescence.
c. It is a type of independent exploration.
d. It is a type of marriage and parenthood.

Answer 8

ANS: C
This newly identified stage of development from age 18 to 25 (emerging adulthood) has been
described as neither an extended adolescence, as it is much freer from parental control and is much
more a period of independent exploration, nor young adulthood, as most young people in their
twenties have not made the transitions historically associated with adult status, especially marriage
and parenthood.
DIF:Understand (comprehension)REF:159
OBJ: Discuss development theories of young and middle adults.

Question 9

A nurse is planning care for a 30 year old. Which goal is priority?

a. Refine self-perception.
b. Master career plans.
c. Examine life goals.
d. Achieve intimacy.

Answer 9

ANS: B
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. Between the ages of 23 and 28, the person refines self-perception and ability for
intimacy.

Question 10

A nurse is planning care for young-adult patients. Which information should the nurse consider
when planning care?
a. Fertility issues do not occur in young adulthood.
b. Young adults tend to suffer more from severe illness.
c. Substance abuse is easy to observe in young-adult patients.
d. Young adults are quite active but are at risk for illness in later years.

Answer 10

ANS: D
Young adults are generally active and experience severe illnesses less frequently. However, their
lifestyles may 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. Substance
abuse is not always diagnosable, particularly in its early stages.
DIF:Understand (comprehension)REF:160
OBJ: Describe normal physical changes in young and middle adulthood and pregnancy.

Question 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. Which action is best for the nurse to take
in response to this finding?
a. Assess the patient as thoroughly as possible.

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

Answer 11

ANS: A
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-aged adult. Increased size of one breast is an abnormal
physical assessment finding in the middle-aged adult.
DIF:Apply (application)REF:166
OBJ: Describe normal physical changes in young and middle adulthood and pregnancy.

Question 12

A 55-year-old female presents to the outpatient clinic describing irregular menstrual periods and
hot flashes. Which information should the nurse share with the patient?
a. The patient’s assessment points toward normal menopause.
b. Those symptoms are normal when a woman undergoes the climacteric.
c. An assessment is not really needed because these problems are normal for older women.
d. The patient should stop regular exercise because that is probably causing these symptoms.

Answer 12

ANS: A
The most significant physiological changes during middle age are menopause in women and the
climacteric in men. Menopause typically occurs between 45 and 60 years of age. 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. Exercise should not be stopped, especially in middle-aged adults.

Question 13

The nurse is teaching a class to pregnant women about common physiological changes during

pregnancy. Which information should the nurse include in the teachingsession?
a. Pregnancy is not a time to be having sexual activity.
b. Urinary frequency will occur early in the pregnancy.
c. Breast tenderness should be reported as soon as possible.
d. Late in the pregnancy Braxton Hicks contraction may occur.

Answer 13

ANS: D
During the third trimester (late pregnancy), increases in Braxton Hicks contractions (irregular, short
contractions), fatigue, and urinary frequency (not early) occur. Normally, women commonly have
morning sickness, breast enlargement and tenderness, and fatigue. Women need to be reassured that
sexual activity will not harm the fetus.
DIF:Apply (application)REF:165
OBJ: Describe normal physical changes in young and middle adulthood and pregnancy.

Question 14

A nurse discusses the risks of repeated sun exposure with a young-adult patient. Which response
will the nursemost expect from this patient?
a. “I should consider participating in a health fair about safe sun practices.”
b. “I’ll make an appointment with my doctor right away for a full skin check.”
c. “I’ve had this mole my whole life. So what if it changed color? My skin is fine.”
d. “I have a mole that has been bothering me. I’ll call my family doctor for an appointment to get it checked

Answer 14

ANS: C
Most typically young adults would say that their skin is fine. 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:Analyze (analysis)REF:160
OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

Question 15

15. Upon assessment of a middle-aged adult, the nurse observes uneven weight bearing and
    decreased range of joint motion. Which area is priority?
    a. Abuse potential
    b. Fall precautions
    c. Stroke prevention
    d. Self-esteem issues

Answer 15

ANS: B
With uneven weight bearing and decreased range of joint motion, falling is a priority. Abuse
potential would indicate other findings such as bruising or unkept appearance. While stroke
prevention is important in a middle-aged adult, these are not the signs of stroke. While self-esteem
issues may arise from physical changes, safety is a priority over self-esteem issues.
DIF:Analyze (analysis)REF:167
OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

Question 16

A young-adult patient is brought to the hospital by police after crashing the car in a high-speed
chase when trying to avoid arrest for spousal abuse. Which action should the nursetake?
a. Question the patient about drug use.
b. Offer the patient a cup of coffee to calm nerves.
c. Discretely assess the patient for sexually transmitted infections.
d. Deal with the issue at hand, not asking about previous illnesses.

Answer 16

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 choicefor
calming nerves. Although sexually transmitted infections occur in the young adult, this is not an
action a nurse should take in this situation. 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 (application)REF:163
OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

Question 17

A nurse determines that a middle-aged patient is a typical example of the “sandwich generation.”
What did the nurse discover the patient is caught between?
a. Job responsibilities or family responsibilities
b. Stopping old habits and starting new ones
c. Caring for children and aging parents
d. Advancing in career or retiring

Answer 17

ANS: C
Middle-aged adults also begin to help aging parents while being responsible for their own children,
placing them in thesandwich generation. It does not include job and family responsibilities; old
habits and new ones; or career and retiring.
DIF:Apply (application)REF:166
OBJ: Discuss the significance of family in the life of the adult. TOP: Assessment

Question 18

1. A nurse is assessing a middle-aged patient’s barriers to change in eating habits. Which areas will
   the nurse assess that are external barriers? (Select all that apply.)
   a. Lack of facilities

b. Lack of materials

c. Lack of knowledge
d. Lack of social supports
e. Lack of short- and long-term goals

Answer 18

ANS: A, B, D
External barriers to change include lack of facilities, materials, and social supports. Internal barriers
are lack of knowledge, insufficient skills, and undefined short- and long-term goals.
DIF:Understand (comprehension)REF:169
OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

Question 19

A home health nurse is providing care to a middle-aged couple with children at home. The patient
has a debilitating chronic illness. Which areas will the nurse need to assess? (Select all that apply.)

a. Adherence to treatment and rehabilitation regimens
b. Coping mechanisms of patient and family
c. Need for community services or referrals
d. Knowledge base of patient only
e. Use of a doula for care

Answer 19

ANS: A, B, C
Along with the current health status of the chronically ill middle-aged adult, you need to assess the
knowledge base of both the patient and family. In addition, you must determine the coping
mechanisms of the patient and family; adherence to treatment and rehabilitation regimens; and the
need for community and social services, along with appropriate referrals. A doula is a support person
to be present during labor to assist women who have no other source of support.
DIF:Understand (comprehension)REF:170
OBJ: Discuss the significance of family in the life of the adult. TOP: Assessment

Question 20

A nurse is providing prenatal care to a first-time mother. Which information will the nurse share
with the patient? (Select all that apply.)
a. Regular trend for postpartum depression
b. Protection against urinary infection
c. Strategies for empty nest syndrome
d. Exercise patterns
e. Proper diet

Answer 20

ANS: B, D, E
Prenatal care includes a thorough physical assessment of the pregnant woman during regularly
scheduled intervals. 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. Empty nest syndrome occurs as children leave the home.
Postpartum depression is rare.
DIF:Understand (comprehension)REF:165
OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

Question 21

1. A nurse is obtaining a history on an older adult. Which finding will the nurse most typically find?
   a. Lives in a nursing home
   b. Lives with a spouse
   c. Lives divorced

d. Lives alone

Answer 21

ANS:B
In 2012, 57% of older adults in non-institutional settings lived with a spouse (45% of older women,
71% of older men); 28% lived alone (35% of older women, 19% of older men); and only 3.5% of all
older adults resided in institutions such as nursing homes or centers. Most older adults have lost a
spouse due to death rather than divorce.

Question 22

A nurse is developing a plan of care for an older adult. Which information will the nurse consider?

a. Should be standardized because most geriatric patients have the same needs
b. Needs to be individualized to the patient’s unique needs
c. Focuses on the disabilities that all aging persons face
d. Must be based on chronological age alone

Answer 22

ANS: B
Every older adult is unique, and the nurse needs to approach each one as a unique individual. The
nursing care of older adults poses special challenges because of great variation in their physiological,
cognitive, and psychosocial health. Aging does not automatically lead to disability and dependence.
Chronological age often has little relation to the reality of aging for an older adult.

Question 23

Which information from a co-worker on a gerontological unit will cause the nurse tointervene?

a. Most older people have dependent functioning.
b. Most older people have strengths we should focus on.
c. Most older people should be involved in care decision.
d. Most older people should be encouraged to have independence.

Answer 23

ANS: A
Most older people remain functionally independent despite the increasing prevalence of chronic
disease; therefore, this misconception should be addressed. It is critical for you to respect older adults
and actively involve them in care decisions and activities. You also need to identify an older adult’s
strengths and abilities during the assessment and encourage independence as an integral part of your
plan of care.

Question 24

4. A nurse suspects an older-adult patient is experiencing caregiver neglect. Which assessment
   findings are consistent with the nurse’s suspicions?
   a. Flea bites and lice infestation
   b. Left at a grocery store
   c. Refuses to take a bath
   d. Cuts and bruises

Answer 24

ANS: A
Caregiver neglect includes unsafe and unclean living conditions, soiled bedding, and animal or insect
infestation. Abandonment includes desertion at a hospital, nursing facility, or public location such as
a shopping center. Self-neglect includes refusal or failure to provide oneself with basic necessities
such as food, water, clothing, shelter, personal hygiene, medication, and safety. Physical abuse
includes hitting, beating, pushing, slapping, kicking, physical restraint, inappropriate use of drugs,
fractures, lacerations, rope burns, and untreated injuries.

Question 25

A nurse is teaching a group of older-adult patients. Which teaching strategy is best for the nurse to
use?
a. Provide several topics of discussion at once to promote independence and making choices.
b. Avoid uncomfortable silences after questions by helping patients complete their statements.
c. Ask patients to recall past experiences that correspond with their interests.
d. Speak in a high pitch to help patients hear better.

Answer 25

ANS: C
Teaching strategies include the use of past experiences to connect new learning with previous
knowledge, focusing on a single topic to help the patient concentrate, giving the patient enough time
in which to respond because older adults’ reaction times are longer than those of younger persons,

and keeping the tone of voice low; older adults are able to hear low sounds better than high-
frequency sounds.

Question 26

An older patient has fallen and suffered a hip fracture. As a consequence, the patient’s familyis
concerned about the patient’s ability to care for self, especially during this convalescence.What
should the nurse do?
a. Stress that older patients usually ask for help when needed.
b. Inform the family that placement in a nursing center is a permanent solution.
c. Tell the family to enroll the patient in a ceramics class to maintain quality of life.
d. Provide information and answer questions as family members make choices among care options.

Answer 26

ANS: D
Nurses help older adults and their families by providing information and answering questions as they
make choices among care options. Some older adults deny functional declines and refuse to ask for
assistance with tasks that place their safety at great risk. The decision to enter a nursing center is
never final, and a nursing center resident sometimes is discharged to home or to another less-acute
residence. What defines quality of life varies and is unique for each person.

Question 27

What is the best suggestion a nurse could make to a family requesting help in selecting a local
nursing center?

a.
Have the family members evaluate nursing home staff according to their ability to get tasks done efficient
safely.
b. Make sure that nursing home staff members get patients out of bed and dressed according to staff’s prefer
c. Explain that it is important for the family to visit the center and inspect it personally.
d. Suggest a nursing center that has standards as close to hospital standards as possible.

Answer 27

ANS: C
An important step in the process of selecting a nursing home is to visit the nursing home. The nursing
home should not feel like a hospital. It is a home, a place where people live. Members of the nursing
home staff should focus on the person, not the task. Residents should be out of bed and dressed
according to their preferences, not staff preferences.

Question 28

A 70-year-old patient who suffers from worsening dementia is no longer able to live alone. The
nurse is discussing health care services and possible long-term living arrangements with thepatient’s
only son. What will the nurse suggest?
a. An apartment setting with neighbors close by
b. Having the patient utilize weekly home health visits
c. A nursing center because home care is no longer safe
d. That placement is irrelevant because the patient is retreating to a place of inactivity

Answer 28

ANS: C
Some family caregivers consider nursing center placement when in-home care becomes increasingly
difficult or when convalescence from hospitalization requires more assistance than the family is able
to provide. An apartment setting and the use of home health visits are not appropriate because living
at home is unsafe. Dementia is not a time of inactivity but an impairment of intellectual functioning.

Question 29

A nurse is caring for an older adult. Which goal is priority?

a. Adjusting to career
b. Adjusting to divorce
c. Adjusting to retirement
d. Adjusting to grandchildren

Answer 29

ANS: C

Adjusting to retirement is one of the developmental tasks for an older person. A young or middle-
aged adult has to adjust to career and/or divorce. A middle-aged adult has to adjust to grandchildren.

Question 30

A nurse is observing for the universal loss in an older-adult patient. What is the nurseassessing?

a. Loss of finances through changes in income
b. Loss of relationships through death
c. Loss of career through retirement
d. Loss of home through relocation

Answer 30

ANS: B
The universal loss for older adults usually revolves around the loss of relationships through death.
Life transitions, of which loss is a major component, include retirement and the associated financial
changes, changes in roles and relationships, alterations in health and functional ability, changes in
one’s social network, and relocation. However, these are not the universal loss.

Question 31

A nurse is discussing sexuality with an older adult. Which action will the nurse take?

a. Ask closed-ended questions about specific symptoms the patient may experience.
b. Provide information about the prevention of sexually transmitted infections.
c. Discuss the issues of sexuality in a group in a private room.
d. Explain that sexuality is not necessary as one ages.

Answer 31

ANS: B

Include information about the prevention of sexually transmitted infections when appropriate. Open-
ended questions inviting an older adult to explain sexual activities or concerns elicit more

information than a list of closed-ended questions about specific activities or symptoms. You need to
provide privacy for any discussion of sexuality and maintain a nonjudgmental attitude. Sexuality and
the need to express sexual feelings remain throughout the human life span.

Question 32

A nurse is teaching a health promotion class for older adults. In which order will the nurse list the
most common to least common conditions that can lead to death in older adults?
1. Chronic obstructive lung disease
2. Cerebrovascular accidents
3. Heart disease
4. Cancer
a. 4, 1, 2, 3
b. 3, 4, 1, 2
c. 2, 3, 4, 1
d. 1, 2, 3, 4

Answer 32

ANS: B
Heart disease is the leading cause of death in older adults followed by cancer, chronic lung disease,
and stroke (cerebrovascular accidents).

Question 33

A nurse is observing skin integrity of an older adult. Which finding will the nurse document as a
normal finding?
a. Oily skin
b. Faster nail growth
c. Decreased elasticity
d. Increased facial hair in men

Answer 33

ANS: C
Loss of skin elasticity is a common finding in the older adult. Other common findings include
pigmentation changes, glandular atrophy (oil, moisture, and sweat glands), thinning hair (facial hair:
decreased in men, increased in women), slower nail growth, and atrophy of epidermal arterioles.

Question 34

An older-adult patient in no acute distress reports being less able to taste and smell. What is the
nurse’s best response to this information?
a. Notify the health care provider immediately to rule out cranial nerve damage.
b. Schedule the patient for an appointment at a smell and taste disorders clinic.
c. Perform testing on the vestibulocochlear nerve and a hearing test.
d. Explain to the patient that diminished senses are normal findings.

Answer 34

ANS: D
Diminished taste and smell senses are common findings in older adults. Scheduling an appointment
at a smell and taste disorders clinic, testing the vestibulocochlear nerve, or an attempt to rule out
cranial nerve damage is unnecessary at this time as per the information provided.

Question 35

A nurse is assessing an older adult for cognitive changes. Which symptom will the nurse report as
normal?
a. Disorientation

b. Poor judgment
c. Slower reaction time

d. Loss of language skills

Answer 35

ANS: C
Slower reaction time is a common change in the older adult. Symptoms of cognitive impairment,
such as disorientation, loss of language skills, loss of the ability to calculate, and poor judgment are
not normal aging changes and require further investigation of underlying causes.

Question 36

An older patient with dementia and confusion is admitted to the nursing unit after hip
replacement surgery. Which action will the nurse include in the plan of care?
a. Keep a routine.
b. Continue to reorient.

c. Allow several choices.
d. Socially isolate patient.

Answer 36

ANS: A
Patients with dementia need a routine. Continuing to reorient a patient with dementia is
nonproductive and not advised. Patients with dementia need limited choices. Social interaction based
on the patient’s abilities is to be promoted.

Question 37

A nurse is helping an older-adult patient with instrumental activities of daily living. The nurse
will be assisting the patient with which activity?
a. Taking a bath
b. Getting dressed
c. Making a phone call
d. Going to the bathroom

Answer 37

ANS:C
Instrumental activities of daily living or IADLs (such as the ability to write a check, shop, prepare
meals, or make phone calls) and activities of daily living or ADLs (such as bathing, dressing, and
toileting) are essential to independent living.

Question 38

A male older-adult patient expresses concern and anxiety about decreased penile firmness during
an erection. What is the nurse’s best response?
a. Tell the patient that libido will always decrease, as well as the sexual desires.
b. Tell the patient that touching should be avoided unless intercourse is planned.
c. Tell the patient that heterosexuality will help maintain stronger libido.
d. Tell the patient that this change is expected in aging adults.

Answer 38

ANS: D
Aging men typically experience an erection that is less firm and shorter acting and have a less
forceful ejaculation. Testosterone lessens with age and sometimes (not always) leads to a loss of
libido. However, for both men and women sexual desires, thoughts, and actions continue throughout
all decades of life. Sexuality involves love, warmth, sharing, and touching, not just the act of
intercourse. Touch complements traditional sexual methods or serves as an alternative sexual
expression when physical intercourse is not desired or possible. Clearly not all older adults are
heterosexual, and there is emerging research on older adult, lesbian, gay, bisexual, and transgender
individuals and their health care needs.

Question 39

A patient asks the nurse what the term polypharmacy means. Which information should the nurse
share with the patient?
a. This is multiple side effects experienced when taking medications.
b. This is many adverse drug effects reported to the pharmacy.
c. This is the multiple risks of medication effects due to aging.
d. This is concurrent use of many medications.

Answer 39

ANS: D
Polypharmacy refers to the concurrent use of many medications. It does not have anything to do with
side effects, adverse drug effects, or risks of medication use due to aging.

Question 40

An outcome for an older-adult patient living alone is to be free from falls. Which statement
indicates the patient correctly understands the teaching on safety concerns?
a. “I’ll take my time getting up from the bed or chair.”
b. “I should dim the lighting outside to decrease the glare in my eyes.”
c. “I’ll leave my throw rugs in place so that my feet won’t touch the cold tile.”
d. “I should wear my favorite smooth bottom socks to protect my feet when walking around.”

Answer 40

ANS:A
Postural hypotension is an intrinsic factor that can cause falls. Changing positions slowly indicates a
correct understanding of this concept. Environmental hazards outside and within the home such as
poor lighting, slippery or wet flooring, and items on floor that are easy to trip over such as throw rugs
are other factors that can lead to falls. Impaired vision and poor lighting are other risk factors for falls
and should be avoided (dim lighting). Inappropriate footwear such as smooth bottom socks also
contributes to falls.

Question 41

A nurse’s goal for an older adult is to reduce the risk of adverse medication effects. Which action
will the nurse take?
a. Review the patient’s list of medications at each visit.
b. Teach that polypharmacy is to be avoided at all cost.
c. Avoid information about adverse effects.
d. Focus only on prescribed medications.

Answer 41

ANS: A
Strategies for reducing the risk for adverse medication effects include reviewing the medications with
older adults at each visit; examining for potential interactions with food or other medications;
simplifying and individualizing medication regimens; taking every opportunity to inform older adults
and their families about all aspects of medication use; and encouraging older adults to question their
health care providers about all prescribed and over-the-counter medications. Although polypharmacy
often reflects inappropriate prescribing, the concurrent use of multiple medications is often necessary
when an older adult has multiple acute and chronic conditions. Older adults are at risk for adverse
drug effects because of age-related changes in the absorption, distribution, metabolism, and excretion
of drugs. Work collaboratively with the older adult to ensure safe and appropriate use of all
medications—both prescribed medications and over-the-counter medications and herbal options.

Question 42

An older-adult patient has developed acute confusion. The patient has been on tranquilizers for
the past week. The patient’s vital signs are normal. What should the nurse do?
a. Take into account age-related changes in body systems that affect pharmacokinetic activity.
b. Increase the dose of tranquilizer if the cause of the confusion is an infection.
c. Note when the confusion occurs and medicate before that time.

d. Restrict phone calls to prevent further confusion.

Answer 42

ANS: A
Some sedatives and tranquilizers prescribed for acutely confused older adults sometimes cause or
exacerbate confusion. Carefully administer drugs used to manage confused behaviors, taking into
account age-related changes in body systems that affect pharmacokinetic activity. When confusion
has a physiological cause (such as an infection), specifically treat that cause, rather than the confused
behavior. When confusion varies by time of day or is related to environmental factors,
nonpharmacological measures such as making the environment more meaningful, providing adequate
light, etc., should be used. Making phone calls to friends or family members allows older adults to
hear reassuring voices, which may be beneficial.

Question 43

Which assessment finding of an older adult, who has a urinary tract infection, requires an
immediate nursing intervention?
a. Confusion

b. Presbycusis
c. Temperature of 97.9° F
d. Death of a spouse 2 months ago

Answer 43

ANS: A
Confusion is a common manifestation in older adults with urinary tract infection; however, the cause
requires further assessment. There may be another reason for the confusion. Confusion is not a
normal finding in the older adult, even though it is commonly seen with concurrent infections.
Difficulty hearing, presbycusis, is an expected finding in an older adult. Older adults tend to have
lower core temperatures. Coping with the death of a spouse is a psychosocial concern to be addressed
after the acute physiological concern in this case.

Question 44

Which patient statement is the most reliable indicator that an older adult has the correct
understanding of health promotion activities?
a. “I need to increase my fat intake and limit protein.”
b. “I still keep my dentist appointments even though I have partials now.”
c. “I should discontinue my fitness club membership for safety reasons.”
d. “I’m up-to-date on my immunizations, but at my age, I don’t need the influenza vaccine.”

Answer 44

ANS: B
General preventive measures for the nurse to recommend to older adults include keeping regular
dental appointments to promote good oral hygiene, eating a low-fat, well-balanced diet, exercising
regularly, and maintaining immunizations for seasonal influenza, tetanus, diphtheria and pertussis,
shingles, and pneumococcal disease.

Question 45

A 72-year-old woman was recently widowed. She worked as a teller at a bank for 40 years and
has been retired for the past 5 years. She never learned how to drive. She lives in a rural area that
does not have public transportation. Which psychosocial change does the nurse focus on as
a priority?
a. Sexuality
b. Retirement

c. Environment
d. Social isolation

Answer 45

ANS: D
The highest priority at this time is the potential for social isolation. This woman does not know how
to drive and lives in a rural community that does not have public transportation. All of these factors
contribute to her social isolation. Other possible changes she may be going through right now include
sexuality related to her advanced age and recent death of her spouse; however, this is not the priority
at this time. She has been retired for 5 years, so this is also not an immediate need. She may
eventually experience needs related to environment, but the data do not support this as an issue at this
time.

Question 46

A recently widowed older-adult patient is dehydrated and is admitted to the hospital for
intravenous fluid replacement. During the evening shift, the patient becomes acutely confused.
Which possible reversible causes will the nurse consider when assessing this patient? (Select all that
apply.)
a. Electrolyte imbalance
b. Sensory deprivation
c. Hypoglycemia
d. Drug effects
e. Dementia

Answer 46

ANS: A, B, C, D
Delirium, or acute confusional state, is a potentially reversible cognitive impairment that is often due
to a physiological event. Physiological causes include electrolyte imbalances, untreated pain,
infection, cerebral anoxia, hypoglycemia, medication effects, tumors, subdural hematomas, and
cerebrovascular infarction or hemorrhage. Sometimes it is also caused by environmental factors such
as sensory deprivation or overstimulation, unfamiliar surroundings, or sleep deprivation or
psychosocial factors such as emotional distress. Dementia is a gradual, progressive, and irreversible
cerebral dysfunction.