Nokea
When an elder client asks the nurse whether he will be capable of sexual activity in old age, the best response by the nurse is:
- A. Elder adults are psychologically and physically capable of engaging in sexual activity regardless of age-related changes.'
- B. If you haven't been sexually active throughout your life, you will not be able to participate in sexual activity in old age.'
- C. When intercourse isn't possible, many of your sexual needs can be met through intimacy and touch.'
- D. You might find it takes longer for you to achieve an erection, but you can maintain it for a longer time.'
Correct Answer: A
Rationale: To provide the best response, the nurse must identify what the elder is asking. Concern is being expressed about whether elders can engage in sexual activity. The most therapeutic response by the nurse is Choice 1. In this choice, the nurse acknowledges that elders can physically engage in sexual activity and have no psychological barriers to the same. All of the other choices contain facts but are not the best initial response. Choice 1 opens the conversation for the expression of further concerns about sexual issues.
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Which of the following home-care strategies is most likely to negatively impact the body image of a client with Cushing's syndrome?
- A. providing safety measures to prevent falls
- B. taking medications as prescribed
- C. wearing a medical ID indicating Cushing's syndrome
- D. having regular health assessments
Correct Answer: C
Rationale: All of the strategies listed are included in home care for the client with Cushing's syndrome. Choice 3 is the best answer because wearing a medical ID is a visible sign that something is wrong and a constant reminder to the client that he or she has a loss of body function. Choice 1 might enhance body image because it prevents falls that could cause further injury and debilitation. Taking medications as prescribed should enhance body image because it decreases the symptoms present. Having regular health assessments indicates an enhanced body image because it signals the desire to take care of the body and keep it at its best.
A patient has recently been prescribed Albuterol. Which of the following changes are not associated with Albuterol?
- A. Tachycardia
- B. Hypertension
- C. Bronchodilation
- D. Sensory changes
Correct Answer: D
Rationale: Tachycardia, hypertension, and bronchodilation can all occur with Albuterol.
A 93 year-old female with a history of Alzheimer's Disease gets admitted to an Alzheimer's unit. The patient has exhibited signs of increased confusion and limited stability with gait. Moreover, the patient is refusing to use a w/c. Which of the following is the most appropriate course of action for the nurse?
- A. Recommend the patient remain in her room at all times.
- B. Recommend family members bring pictures to the patient's room.
- C. Recommend a speech therapy consult to the doctor.
- D. Recommend the patient attempt to walk pushing the w/c for safety.
Correct Answer: B
Rationale: Stimulation in the form of pictures may decrease signs of confusion.
Who should receive the hepatitis A vaccine?
- A. children who are 18 months of age
- B. infants, who should receive the vaccination at birth
- C. people who travel to other countries
- D. individuals who might come into contact with blood
Correct Answer: C
Rationale: Hepatitis A is for individuals who travel or persons with chronic liver disease. Infants receive the hepatitis B vaccine at birth. DTaP is administered at 18 months of age. Individuals who come into contact with blood should be immunized against hepatitis B.
A client and his family facing the end stage of a terminal illness might be best served by:
- A. a rehabilitation center.
- B. an extended care facility.
- C. Hospice.
- D. a crisis intervention center.
Correct Answer: C
Rationale: Hospice has the belief that more humanized alternative care for dying clients is needed than is being provided in hospitals, which focus mostly on medical cures. No matter where the care is delivered, Hospice provides a specialized interdisciplinary team of health care professionals who work together to manage client care.