Chapter 13: Young and Middle Adults

Chapter 13: Young and Middle Adults

Potter et al.: Fundamentals of Nursing, 9th Edition

MULTIPLE CHOICE

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.

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.

TOP:PlanningMSC:Health Promotion and Maintenance

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

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.

TOP: Implementation MSC: Health Promotion and Maintenance

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.

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.

DIF:Apply (application)REF:166

OBJ: List and discuss the major life events of young and middle adults and the childbearing family.

TOP:PlanningMSC:Health Promotion and Maintenance

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.”

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.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

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

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 the middle adult.

TOP:PlanningMSC:Health Promotion and Maintenance

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

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.

TOP:AssessmentMSC:Health Promotion and Maintenance

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.

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.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

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.

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.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

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.

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.

DIF:Apply (application)REF:160

OBJ: Discuss cognitive and psychosocial changes occurring during the adult years.

TOP:PlanningMSC:Health Promotion and Maintenance

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.

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.

TOP:PlanningMSC:Health Promotion and Maintenance

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.

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.

TOP: Implementation MSC: Health Promotion and Maintenance

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.

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.

DIF:Apply (application)REF:166

OBJ: Describe normal physical changes in young and middle adulthood and pregnancy.

TOP:AssessmentMSC:Health Promotion and Maintenance

13. The nurse is teaching a class to pregnant women about common physiological changes during pregnancy. Which information should the nurse include in the teaching session?

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.

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.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

14. A nurse discusses the risks of repeated sun exposure with a young-adult patient. Which response will the nurse most 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.”

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.

TOP:AssessmentMSC:Health Promotion and Maintenance

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

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.

TOP:AssessmentMSC:Health Promotion and Maintenance

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 nurse take?

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.

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 choice for 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.

TOP: Implementation MSC: Psychosocial Integrity

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

ANS: C

Middle-aged adults also begin to help aging parents while being responsible for their own children, placing them in the sandwich 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

MSC:Health Promotion and Maintenance

MULTIPLE RESPONSE

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

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.

TOP:AssessmentMSC:Health Promotion and Maintenance

2. 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

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

MSC: Psychosocial Integrity

3. 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

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.

TOP: Teaching/Learning MSC: Health Promotion and Maintenance

MATCHING

A nurse is assessing young and middle-aged adults for work-related conditions. Match the job to the work-related conditions that the nurse is assessing.

a.

Liver disease

b.

Carpal tunnel syndrome

c.

Asbestosis

d.

Farmer’s lung

e.

Bladder cancer

1. Insulators

2. Dry cleaners

3. Dye workers

4. Office computer workers

5. Agricultural workers

1.ANS:CDIF:Understand (comprehension)REF:164

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP:AssessmentMSC:Health Promotion and Maintenance

2.ANS:ADIF:Understand (comprehension)REF:164

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP:AssessmentMSC:Health Promotion and Maintenance

3.ANS:EDIF:Understand (comprehension)REF:164

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP:AssessmentMSC:Health Promotion and Maintenance

4.ANS:BDIF:Understand (comprehension)REF:164

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP:AssessmentMSC:Health Promotion and Maintenance

5.ANS:DDIF:Understand (comprehension)REF:164

OBJ: Describe health concerns of the young adult, the childbearing family, and the middle adult.

TOP:AssessmentMSC:Health Promotion and Maintenance