Exam 3 PDF

# CH 22 ## NCLEX-Style Questions - A mother of a 6-month-old infant asks about normal developmental milestones. Which of the following would indicate normal development? - The baby can sit without support. - The baby can say three words. - The baby can roll over from back to stomach. -...

# CH 22 ## NCLEX-Style Questions - A mother of a 6-month-old infant asks about normal developmental milestones. Which of the following would indicate normal development? - The baby can sit without support. - The baby can say three words. - The baby can roll over from back to stomach. - A 2-year-old is being evaluated for speech delay. What is the most appropriate initial action by the nurse? - Refer the child to a speech therapist - A 10-month-old infant is unable to pull to stand. What should the nurse's response be? - "We should evaluate the baby's muscle tone and strength." - A 3-year-old child still exhibits a strong Moro reflex. What should the nurse do? - Refer the child to a neurologist for evaluation. - A parent is worried because their 9-month-old baby has not started crawling yet. What should the nurse recommend? - "Babies typically start crawling between 6 to 10 months." - A nurse observes that a 2-year-old has difficulty stacking blocks. Which recommendation is most appropriate for the parents? - "Encourage activities that build fine motor skills, like using playdough." ## During a well-baby visit, a nurse assesses a 1-year-old who is not walking yet. What advice should be given to the parents? - "It's normal for some children to start walking closer to 18 months." ## A parent asks how they can promote their 4-year-old's cognitive development. Which activity should the nurse suggest? - "Play with age-appropriate puzzles and read books." ## ADPIE/Priority Intervention Questions - A 5-month-old infant is brought to the clinic for failure to thrive. What is the nurse's priority nursing diagnosis? - Risk for Delayed Growth and Development - The nurse is caring for a toddler who has not met language milestones. What is the priority intervention? - Refer the child to a speech pathologist. - A nurse assesses a 3-month-old infant who does not respond to loud noises. What should the nurse do first? - Refer the child to an audiologist. - A child presents with delayed gross motor skills. What is the nurse's initial assessment focus? - Check for family history of developmental delays. ## Clinical Reasoning Questions - A nurse is assessing a 4-year-old child who is not interacting with other children. What is the best response? - Encourage the child to play with age-appropriate toys. - A parent is concerned that their 18-month-old is not saying any words yet. How should the nurse assess this situation? - "Let's assess your child's ability to follow simple commands." - A nurse notices that a 2-year-old is not engaging in parallel play. What should the nurse consider? - Encourage more social playtime with peers. - A 10-month-old is not yet sitting up without support. What should the nurse's assessment focus on? - Muscle tone and motor coordination. ## Integrated Concept Questions - How does early childhood nutrition impact cognitive development, and what nursing interventions are key? - Adequate nutrition supports brain growth; nurses should encourage balanced diets. - Explain the role of genetic factors in growth delays and the implications for pediatric nursing care. - Environmental factors are more important than genetics in growth delays. - What nursing actions are critical in preventing developmental delays in preterm infants? - Provide early intervention programs to stimulate development. - How can nurses support parents in understanding the developmental variations between children? - Educate parents on normal variability in milestones. - All children should develop at the same pace regardless of genetics. # Chapter 23: Conception Through Young Adult ## NCLEX-Style Questions - A pregnant woman asks the nurse when she should feel the baby move for the first time. The nurse's best response is: - 16 weeks - A woman in her second trimester asks about the importance of folic acid. The nurse explains that it helps to prevent: - Neural tube defects - During a prenatal visit, a patient asks how to avoid teratogens. The nurse should instruct her to: - Avoid alcohol and certain medications. - A nurse is assessing a newborn. Which finding would indicate a need for immediate intervention? - Jaundice on the first day of life. # Chapter 24: Middle and Older Adulthood ## NCLEX-Style Questions - A nurse is educating a 60-year-old patient about normal aging. Which of the following would be considered a typical change in middle adulthood? - Decreased bone density - During a health assessment of a 70-year-old patient, the nurse notes that the patient has a slower reaction time. The best explanation for this is: - Normal age-related change - A 55-year-old patient asks the nurse how to maintain cognitive function as they age. The nurse should recommend: - Engaging in regular physical exercise. - A nurse is assessing a patient in late adulthood who expresses feelings of sadness and loss of purpose. The most appropriate nursing intervention is: - Encourage the patient to reflect on life achievements. ## Application-Based Questions - A 68-year-old patient expresses concerns about feeling less energetic than they used to. What advice should the nurse provide? - "Increased fatigue is common in aging; balance rest with activity." - A nurse is teaching a group of older adults about preventing osteoporosis. Which activity should be encouraged? - Walking or weight-bearing exercises. - A middle-aged patient is concerned about gaining weight despite no changes in diet. Which explanation should the nurse provide? - "Your metabolism slows as you age, which can lead to weight gain." - A 50-year-old patient wants to maintain muscle tone. What is the best recommendation from the nurse? - "Engage in strength training exercises regularly." ## ADPIE/Priority Intervention Questions - A 70-year-old patient is admitted with dehydration. What is the priority nursing diagnosis? - Deficient fluid volume - During a home visit, a nurse finds that an older adult patient has been neglecting personal hygiene. What is the nurse's priority intervention? - Assess the patient's ability to perform activities of daily living. - A nurse is planning care for an older adult with mild cognitive decline. What is the initial nursing intervention? - Encourage participation in activities that stimulate memory. - A middle-aged adult expresses anxiety about aging. What is the priority focus for the nurse? - Discuss common age-related changes and coping strategies. - A nurse is assessing an 80-year-old patient who appears disoriented during the evening but is alert in the morning. What should the nurse consider? - Delirium due to changes in environment. - A 55-year-old patient is reluctant to retire, fearing loss of purpose. What is the best nursing response? - "It's normal to have concerns; let's discuss your feelings." - A 72-year-old patient reports frequent falls. Which assessment should the nurse prioritize? - Visual acuity test ## Integrated Concept Questions - How does decreased mobility in older adults affect cardiovascular health, and what nursing interventions can help? - Increased immobility can lead to reduced cardiac out; encourage daily walking. - What role does social interaction play in preventing cognitive decline in older adults, and how can nurses support this? - Encourage group activities to enhance mental stimulation. - How does age-related decreased renal function impact medication metabolism, and what adjustments are necessary? - Reduce dosages to prevent drug toxicity. - What is the relationship between osteoporosis and hormonal changes in middle-aged women, and how should nurses educate patients? - Decreased estrogen levels increase the risk of osteoporosis; recommend calcium and vitamin D. # Chapter 42: Self-Concept ## NCLEX-Style Questions - A patient recovering from a stroke expresses feelings of frustration and low self-esteem due to difficulty in performing basic tasks. What is the most appropriate nursing intervention? - Assist the patient in setting realistic goals for improvement. - A nurse is assessing the self-concept of a 16-year-old patient. Which question is most appropriate to determine how the patient views themselves? - "How do you see yourself as a person?" - During a health assessment, a patient with a recent amputation states, "I feel like half a person." Which aspect of self-concept is this patient struggling with? - Body image - A nurse is working with a patient who has a negative self-concept after a recent divorce. Which intervention should be prioritized? - Focus on developing a new role or identity. - A patient recovering from surgery expresses feelings of worthlessness because they cannot perform activities they used to. What is the best response by the nurse? - "You are still valuable even if you can't do those activities." ## Application-Based Questions - A nurse is working with a patient who is struggling with low self-esteem. Which action should the nurse take to promote a positive self-concept? - Encourage the patient to participate in social activities. - A teenager with acne reports feeling embarrassed and avoiding social events. What is the most appropriate nursing intervention? - Reassure the patient that acne is common. - A nurse is planning a support group session for patients with body image disturbances. Which topic should be included? - Strategies to adapt to changes in body image. ## ADPIE/Priority Intervention Questions - A nurse is caring for a patient who is experiencing role strain after becoming the primary caregiver for an elderly parent. What is the priority nursing diagnosis? - Caregiver role strain - During a self-concept assessment, a patient expresses feelings of inadequacy in their job role. What is the first nursing intervention? - Explore the reasons behind the patient's feelings. - A patient is admitted for depression and states, "I don't think I'm good at anything anymore." What is the initial nursing intervention? - Tell the patient that everyone feels this way sometimes. - A patient with a recent spinal cord injury is struggling with their new limitations. What is the priority focus for the nurse? - Focus on developing adaptive strategies for self-care. ## Clinical Reasoning Questions - A mother is worried that her baby, who is 2 months old, is not making eye contact. What should the nurse do? - Ask about the baby's interactions with family - A 6-month-old is not yet rolling over. What is the most appropriate nursing action? - Reassure the parents that this is within normal limits. - A nurse observes that a newborn has a weak cry and poor muscle tone. What is the priority action? - Call for immediate medical evaluation. - A 4-week-old infant presents with projectile vomiting after feeding. What should the nurse do first? - Document feeding patterns. ## Integrated Concept Questions - How does maternal nutrition in pregnancy influence fetal development, and what dietary advice should nurses provide? - High sugar diets are beneficial for cognitive stimulation in children. # Chapter 43: Stress and Adaptation ## NCLEX-Style Questions - A nurse is teaching a patient about the body's response to stress. Which of the following best describes the initial stage of the General Adaptation Syndrome (GAS)? - Alarm - A patient is experiencing chronic stress and asks the nurse how this can affect their health. The nurse's best response is: - "Chronic stress can lead to high blood pressure and heart problems." - During a stress assessment, the nurse notes that a patient is using relaxation techniques to cope. Which stage of GAS does this best represent? - Resistance ## Application-Based Questions - A patient recently diagnosed with a terminal illness tells the nurse, "If I can just make it to my daughter's graduation, I will be satisfied." Which stage of grief is this? - Bargaining - During a grief counseling session, a patient who has lost a spouse two months ago expresses a lack of interest in daily activities and feelings of deep sadness. Which response by the nurse is most appropriate? - "This is a normal part of the grieving process." - A nurse is caring for a patient receiving palliative care who asks about the role of hospice. The nurse's best response is: - "Hospice care aims to improve quality of life and provide comfort. " ## ADPIE/Priority Intervention Questions - A newborn presents with jaundice on the second day of life. What is the nurse's priority nursing diagnosis? - Risk for dehydration. - The nurse is caring for a woman in her third trimester who reports dizziness when lying on her back. What is the priority nursing intervention? - Elevate her legs. - A baby is born at 35 weeks gestation with difficulty feeding. What is the initial focus of nursing care? - Encourage breastfeeding every hour. - A nurse is caring for a pregnant woman with a history of preeclampsia. What should be the priority focus of care? - Monitor for signs of high blood pressure. - A newborn presents with jaundice on the second day of life. What is the nurse's priority nursing diagnosis? - Risk for dehydration ## Clinical Reasoning Questions - A mother is worried that her baby, who is 2 months old, is not making eye contact. What should the nurse do? - Refer to a pediatric ophthalmologist. - A 6-month-old is not yet rolling over. What is the most appropriate nursing action? - Reassure the parents that this is within normal limits. - A nurse observes that a newborn has a weak cry and poor muscle tone. What is the priority action? - Provide stimulation to the newborn. - A 4-week-old infant presents with projectile vomiting after feeding. What should the nurse do first? - Assess for signs of dehydration ## Integrated Concept Questions - How does maternal nutrition in pregnancy influence fetal development, and what dietary advice should nurses provide? - Avoid alcohol and certain medications. # Chapter 44: Loss, Grief, and Dying ## NCLEX-Style Questions - A nurse is caring for a terminally ill patient who expresses feelings of anger toward their family for not visiting often. According to Kübler-Ross's stages of grief, which stage is the patient most likely experiencing? - Anger - A patient recently diagnosed with a terminal illness tells the nurse, "If I can just make it to my daughter's graduation, I will be satisfied." Which stage of grief is this? - Bargaining - During a grief counseling session, a patient who has lost a spouse two months ago expresses a lack of interest in daily activities and feelings of deep sadness. Which response by the nurse is most appropriate? - "This is a normal part of the grieving process." ## Application-Based Questions - A nurse is caring for a family after the loss of a child. Which intervention is most appropriate for the nurse to provide during the grieving process? - Listen to the family's memories and feelings about the child. - A patient diagnosed with a terminal illness expresses a desire to write letters to their children. How should the nurse respond? - "Writing letters is a wonderful way to share your thoughts." - A patient expresses feelings of hopelessness after a new diagnosis of cancer. Which action by the nurse best supports the patient's spiritual needs? - Offer to pray with the patient if they wish. ## ADPIE/Priority Intervention Questions - A newborn presents with jaundice on the second day of life. What is the nurse's priority nursing diagnosis? - Risk for dehydration - The nurse is caring for a woman in her third trimester who reports dizziness when lying on her back. What is the priority nursing intervention? - Elevate her legs. - A patient is nearing death and the nurse notices that the patient's breathing has become irregular with periods of apnea. What should the nurse recognize this as? - A normal part of the dying process called Cheyne-Stokes respiration. - A nurse is caring for a patient who has stopped eating and drinking as death nears. How should the nurse respond to the family's concerns about this? - "Loss of appetite is normal at this stage." - A patient in the palliative care unit expresses a desire to discuss their wishes for end-of-life care. What should the nurse do? - Focus on discussing only the current treatment options. - A nurse notices that a terminally ill patient's pain is not controlled despite scheduled doses of pain medication. What is the nurse's best action? - Discuss the patient's pain with the healthcare provider ## Clinical Reasoning Questions - A patient presents with increased blood pressure, headaches, and muscle tension. The nurse suspects stress as a contributing factor. What should the nurse do next? - Ask the patient about recent life changes or stressors. - A patient reports feeling "burned out" from work and has been experiencing difficulty sleeping. What is the nurse's best response? - Let's discuss some strategies to help manage your stress and sleep. - A nurse is caring for a patient who has been admitted for high blood pressure. The patient mentions experiencing stress at home. What should the nurse consider in the plan of care? - Discuss stress-reducing activities as part of the plan. - A patient who is caring for an ill spouse reports feeling overwhelmed and is having difficulty sleeping. What should the nurse assess for? - Signs of depression ## Integrated Concept Questions - How does chronic stress impact immune function, and what should nurses emphasize in patient education? - Chronic stress can weaken immunity; focus on stress management strategies. - What is the relationship between stress and cardiovascular health, and how can nurses support patients at risk? - Chronic stress can contribute to hypertension; recommend relaxation techniques. - How can nurses support patients experiencing stress-induced changes in appetite and eating habits? - Encourage balanced meals and mindful eating to manage stress. - How does stress influence mental health conditions such as anxiety and depression, and what role does the nurse play? - Stress can exacerbate mental health conditions; nurses should promote coping mechanisms. - How can changes in body image after surgery affect a patient's self-esteem, and what should the nurse focus on during care? - Support the patient in adapting to physical changes - How do role changes, such as becoming a caregiver, impact an individual's self-concept, and what is the nurse's role in addressing these changes? - Nurses should provide resources and support for the new role - How can nurses help patients reconcile their self-identity with new physical limitations due to illness or injury? - Encourage exploration of new roles and interests. # Chapter 45: Sensory Functioning ## NCLEX-Style Questions - A patient with diabetes has decreased sensation in their feet. What is the most important instruction the nurse should give? - Check your feet daily for any injuries or sores. - A nurse is assessing a patient's sensory function. Which of the following is the most appropriate method to assess proprioception? - Observing the patient's gait and balance. - A patient with macular degeneration is having difficulty reading. What is the most appropriate intervention by the nurse? - Recommend using magnifying lenses for reading. - A nurse is caring for a patient in an isolation room who complains of feeling lonely and disoriented. Which condition is the patient most likely experiencing? - Sensory deprivation ## Application-Based Questions - A patient with a recent hearing loss is feeling frustrated in social situations. What is the best intervention the nurse can provide? - Advise the patient to sit at the back of the room during conversations. - A nurse is teaching a patient with vision impairment how to safely navigate their home. Which recommendation is most appropriate? - Install bright lighting in hallways and staircases. - A patient who has experienced a stroke has difficulty distinguishing between hot and cold sensations. Which safety measure should the nurse prioritize? - Instruct the patient to test water temperature with their elbow. - A nurse is planning care for a patient who is experiencing sensory overload. Which intervention is most appropriate? - Limit the number of visitors and reduce environmental stimuli. ## ADPIE/Priority Intervention Questions - A nurse is caring for a patient who has impaired vision. What is the priority nursing diagnosis? - Risk for injury - A patient reports difficulty hearing conversations in noisy environments. What should the nurse's initial assessment focus on? - Checking for cerumen buildup in the ears. - During a home visit, a nurse finds that a patient with peripheral neuropathy has multiple bruises on their legs. What is the nurse's priority intervention? - Assess the home environment for potential safety hazards ## Integrated Concept Questions - How can sensory deficit like impaired vision increase the risk of injury in older adults, and what is the nurse's role in preventing this? - Impaired vision can lead to falls; nurses should conduct home safety assessments and provide recommendations. - What is the relationship between peripheral neuropathy and foot care in diabetic patients, and how should nurses address this? - Reduced sensation increases the risk of foot injuries; nurses should emphasize daily foot inspection. - How does sensory overload in hospitalized patients affect their recovery, and what interventions can nurses implement to reduce it? - Overstimulation can delay recovery; reduce noise and provide a calm environment - How can hearing loss affect communication and social interaction, and what strategies can nurses suggest to patients? - It can lead to isolation; recommend face-to-face communication and the use of hearing aids. - A patient with sensory deprivation asks the nurse for advice on how to improve their environment. What should the nurse suggest? - Try listening to audiobooks or music. - A patient with diabetic neuropathy reports not feeling a blister on their foot until it became infected. What should the nurse include in the plan of care? - Emphasize the importance of daily foot inspection. - A patient in the ICU is experiencing anxiety and restlessness due to continuous alarms and bright lights. What is the nurse's best response? - Let's adjust the lights and try to reduce unnecessary noise. - A nurse is assessing a patient with a history of stroke who has difficulty detecting touch on their left side. What is the most appropriate action for the nurse to take? - Teach the patient to scan their environment using their right side. - A patient with progressive hearing loss is frustrated with their inability to hear family members. What should the nurse suggest to improve communication? - Face your family members when they speak to you. # Chapter 46: Sexuality ## NCLEX-Style Questions - A nurse is assessing a 19-year-old female who states, "I feel uncomfortable with my body and don't feel like myself." Which area of sexuality is the patient most likely struggling with? - Gender identity - A patient undergoing chemotherapy reports decreased libido and concerns about intimacy with their partner. What is the most appropriate nursing response? - "This is a normal response to chemotherapy; let's discuss your concerns." ## Application-Based Questions - A patient asks the nurse about the side effects of taking oral contraceptives. Which statement by the nurse is accurate? - "Oral contraceptives can increase the risk of blood clots." - During a health assessment, a male patient reports erectile dysfunction. What is the most appropriate question for the nurse to ask to further assess this condition? - "How does this problem affect your relationship with your partner?" - A nurse is caring for a patient who has expressed difficulty in discussing sexual health with their partner. What is the most appropriate intervention? - Encourage open communication with their partner about their feelings. - A 55-year-old patient is concerned about changes in sexual function due to aging. Which response by the nurse is most appropriate? - "It is common to experience changes, but intimacy can still be fulfilling." - A patient with diabetes expresses concerns about sexual dysfunction. What should the nurse emphasize during the discussion? - "It's important to manage blood glucose levels to reduce this risk." - A young adult female is seeking information on contraceptive options. What should the nurse include in the discussion? - Discuss a variety of options including implants, injections, and barrier methods. ## ADPIE/Priority Intervention Questions - A nurse is planning care for a patient with sexual dysfunction. What is the priority nursing diagnosis? - Sexual dysfunction - A patient undergoing treatment for prostate cancer expresses concerns about sexual function. What is the initial nursing intervention? - Provide information on potential sexual side effects of treatment. - During a wellness check, a teenager asks about safe sexual practices. What is the nurse's first intervention? - Provide education on STI prevention and contraceptive use. - A nurse is educating a patient with a new diagnosis of erectile dysfunction. What should the nurse prioritize in the teaching plan? - Emphasize the importance of open communication with the patient's partner. ## Clinical Reasoning Questions - A nurse is caring for a patient who expresses concerns about intimacy with their partner following a mastectomy. What is the best response? - "Let's talk about how you are feeling about your body and intimacy." - A patient with spinal cord injury is worried about their sexual function. How should the nurse respond? - "Many patients with spinal cord injuries have satisfying intimate relationships." ## Integrated Concept Questions - How can chronic illness, such as diabetes, impact sexual function, and what role does the nurse play in patient education? - Diabetes can lead to sexual dysfunction; nurses should educate on blood sugar control and address concerns. - How should nurses address concerns about body image changes related to treatment for conditions such as cancer? - Encourage open discussion about body image changes and provide support. - How can nurses support patients who are experiencing stress-related changes in sexual function? - Suggest relaxation techniques and open communication with partners. - How can nurses provide comprehensive education about contraceptive options to patients seeking information? - Provide information on various methods and help patients choose the best option for their lifestyle. # Chapter 47: Understanding Spirituality ## NCLEX-Style Questions - A patient nearing the end of life tells the nurse, "I feel like I need to make peace with my past." Which spiritual need is this patient expressing? - Need for forgiveness - A nurse is caring for a patient who expresses a desire to see a chaplain. Which nursing action is most appropriate? - Contact the chaplain and arrange for a visit. - A patient tells the nurse, "I am not religious, but I still want to find meaning in my illness." Which concept is this an example of? - Spirituality ## Application-Based Questions - A patient expresses feelings of hopelessness after a new diagnosis of cancer. Which action by the nurse best supports the patient's spiritual needs? - Offer to pray with the patient if they wish. ## ADPIE/Priority Intervention Questions - A patient in hospice care expresses fear of dying. Which is the most appropriate intervention for the nurse to provide? - Encourage the patient to express their fears and listen actively. - A nurse is caring for a patient who identifies as spiritual but not religious. What is the best approach to provide spiritual care? - Offer non-religious spiritual support, such as meditation or nature therapy. - A nurse notices that a patient has a religious symbol at their bedside. What is the most appropriate action? - Ask the patient if they would like time alone for prayer. - A patient expresses feelings of spiritual distress related to their terminal illness. What is the priority nursing diagnosis? - Spiritual distress ## Clinical Reasoning Questions - A patient undergoing a major surgery asks the nurse to pray with them. What is the nurse's best initial response? - "I would be happy to pray with you if that helps you feel comforted." - A patient is nearing death and the nurse notices that the patient's breathing has become irregular with periods of apnea. What should the nurse recognize this as? - A normal part of the dying process called Cheyne-Stokes respiration. - A patient in palliative care expresses a desire for spiritual guidance. What is the nurse's priority intervention? - Encourage the patient to avoid thinking about spiritual matters. - A patient with a chronic illness tells the nurse that they are questioning their faith. What is the best response by the nurse? - "It's normal to have questions about faith during challenging times." - A patient with a serious illness expresses a desire to reconnect with their religious community. What should the nurse suggest? - "Reconnecting with your community could provide support." - A nurse is caring for a patient who refuses a certain treatment due to religious beliefs. What is the nurse's best action? - Respect the patient's beliefs and explore alternative treatments. - A patient expresses that they feel their illness is a punishment from a higher power. What is the most appropriate response from the nurse? - "Would you like to talk more about why you feel this way?" ## Integrated Concept Questions - How can spiritual well-being impact a patient's recovery, and what role does the nurse play in supporting this? - Positive spiritual well-being can improve recovery; nurses should support the patient's spiritual needs. - How can a nurse support a patient experiencing spiritual distress due to a terminal diagnosis? - Encourage the patient to express their feelings and offer spiritual support. - How does spirituality influence end-of-life care, and what interventions should nurses provide? - Spiritual needs should be respected and integrated into care to provide comfort. - How can the nurse address the spiritual needs of a patient who does not identify with a specific religion? - Focus on providing non-religious spiritual support, such as mindfulness. - A patient in palliative care expresses a desire for spiritual guidance. What is the nurse's priority intervention? - Encourage the patient to avoid thinking about spiritual matters. - A patient with a chronic illness tells the nurse that they are questioning their faith. What is the best response by the nurse? - "It's normal to have questions about faith during challenging times." - A patient with a serious illness expresses a desire to reconnect with their religious community. What should the nurse suggest? - "Reconnecting with your community could provide support." - A nurse is caring for a patient who refuses a certain treatment due to religious beliefs. What is the nurse's best action? - Respect the patient's beliefs and explore alternative treatments. - A patient expresses that they feel their illness is a punishment from a higher power. What is the most appropriate response from the nurse? - "Would you like to talk more about why you feel this way?" # Chapter 48: Sexuality ## NCLEX-Style Questions - A patient asks the nurse about the side effects of taking oral contraceptives. Which statement by the nurse is accurate? - "Oral contraceptives can increase the risk of blood clots." - During a health assessment, a male patient reports erectile dysfunction. What is the most appropriate question for the nurse to ask to further assess this condition? - "How does this problem affect your relationship with your partner?" - A patient in palliative care expresses a desire for spiritual guidance. What is the nurse's priority intervention? - Encourage the patient to avoid thinking about spiritual matters. ## Application-Based Questions - A nurse is caring for a patient who has expressed difficulty in discussing sexual health with their partner. What is the most appropriate intervention? - Encourage open communication with their partner about their feelings. - A 55-year-old patient is concerned about changes in sexual function due to aging. Which response by the nurse is most appropriate? - "It is common to experience changes, but intimacy can still be fulfilling." - A patient with diabetes expresses concerns about sexual dysfunction. What should the nurse emphasize during the discussion? - "It's important to manage blood glucose levels to reduce this risk." - A young adult female is seeking information on contraceptive options. What should the nurse include in the discussion? - Discuss a variety of options including implants, injections, and barrier methods. ## ADPIE/Priority Intervention Questions - A nurse is planning care for a patient with sexual dysfunction. What is the priority nursing diagnosis? - Sexual dysfunction - A patient undergoing treatment for prostate cancer expresses concerns about sexual function. What is the initial nursing intervention? - Provide information on potential sexual side effects of treatment. - During a wellness check, a teenager asks about safe sexual practices. What is the nurse's first intervention? - Provide education on STI prevention and contraceptive use. - A nurse is educating a patient with a new diagnosis of erectile dysfunction. What should the nurse prioritize in the teaching plan? - Emphasize the importance of open communication with the patient's partner. ## Clinical Reasoning Questions - A nurse is caring for a patient who expresses concerns about intimacy with their partner following a mastectomy. What is the best response? - "Let's talk about how you are feeling about your body and intimacy." - A patient with spinal cord injury is worried about their sexual function. How should the nurse respond? - "Many patients with spinal cord injuries have satisfying intimate relationships." ## Integrated Concept Questions - How can chronic illness, such as diabetes, impact sexual function, and what role does the nurse play in patient education? - Diabetes can lead to sexual dysfunction; nurses should educate on blood sugar control and address concerns. - How should nurses address concerns about body image changes related to treatment for conditions such as cancer? - Encourage open discussion about body image changes and provide support. - How can nurses support patients who are experiencing stress-related changes in sexual function? - Suggest relaxation techniques and open communication with partners. - How can nurses provide comprehensive education about contraceptive options to patients seeking information? - Provide information on various methods and help patients choose the best option for their lifestyle. # Chapter 48: Sexuality ## NCLEX-Style Questions - A patient asks the nurse about the side effects of taking oral contraceptives. Which statement by the nurse is accurate? - "Oral contraceptives can increase the risk of blood clots." - During a health assessment, a male patient reports erectile dysfunction. What is the most appropriate question for the nurse to ask to further assess this condition? - "How does this problem affect your relationship with your partner?" ## Application-Based Questions - A nurse is caring for a patient who has expressed difficulty in discussing sexual health with their partner. What is the most appropriate intervention? - Encourage open communication with their partner about their feelings. - A 55-year-old patient is concerned about changes in sexual function due to aging. Which response by the nurse is most appropriate? - "It is common to experience changes, but intimacy can still be fulfilling." - A patient with diabetes expresses concerns about sexual dysfunction. What should the nurse emphasize during the discussion? - "It's important to manage blood glucose levels to reduce this risk." - A young adult female is seeking information on contraceptive options. What should the nurse include in the discussion? - Discuss a variety of options including implants, injections, and barrier methods. ## ADPIE/Priority Intervention Questions - A nurse is planning care for a patient with sexual dysfunction. What is the priority nursing diagnosis? - Sexual dysfunction - A patient undergoing treatment for prostate cancer expresses concerns about sexual function. What is the initial nursing intervention? - Provide information on potential sexual side effects of treatment. - During a wellness check, a teenager asks about safe sexual practices. What is the nurse's first intervention? - Provide education on STI prevention and contraceptive use. - A nurse is educating a patient with a new diagnosis of erectile dysfunction. What should the nurse prioritize in the teaching plan? - Emphasize the importance of open communication with the patient's partner. ## Clinical Reasoning Questions - A nurse is caring for a patient who expresses concerns about intimacy with their partner following a mastectomy. What is the best response? - "Let's talk about how you are feeling about your body and intimacy." - A patient with spinal cord injury is worried about their sexual function. How should the nurse respond? - "Many patients with spinal cord injuries have satisfying intimate relationships." ## Integrated Concept Questions - How can chronic illness, such as diabetes, impact sexual function, and what role does the nurse play in patient education? - Diabetes can lead to sexual dysfunction; nurses should educate on blood sugar control and address concerns. - How should nurses address concerns about body image changes related to treatment for conditions such as cancer? - Encourage open discussion about body image changes and provide support. - How can