ch 21 Flashcards
A nurse is reviewing concepts related to physiological responses that occur during sexual acts. Which statement should the nurse identify as not being accurate?
a. During resolution, ADH and oxytocin are released.
b. Most often in males, orgasm occurs with ejaculation.
c. Genital congestion occurs as part of a reflexive response.
d. Dopamine secretion acts as an inhibitory transmitter.
ANS: D
The general phases of sexual arousal include motivation, arousal, genital congestion, orgasm and resolution. Dopamine secretion is considered to be an excitatory and released during the arousal stage. Orgasm and ejaculation occur more frequently in males. Genital congestion is under reflexive autonomic response.
The nurse is obtaining a sexual history from an adolescent patient. Which finding has the greatest implication for this patient’s care?
a. Patient denies any sexual activity.
b. Patient states that he/she uses “safe sex” practices.
c. Patient states that he/she is in a monogamous relationship.
d. Patient has been intimate with more than one person in the last year.
ANS: D
The Center for Disease Control (CDC) had identified the 5P’s with regard to obtaining information for a sexual history. They focus on partners, practices, protection from infection, past history of infection, and prevention of pregnancy. An individual who has had more than one partner within the time frame should be questioned regarding condom use. Denial of sexual activity is part of the patient’s self-disclosure. The patient stating that he/she is in a monogamous relationship again represents self-disclosure. Use of “safe sex” practices may need to be further explored but it does not have the greatest implication at this point.
A 45-year-old female patient, gravida 3 para 3, presents with complaints of decreased desire to engage in sexual activity with her husband as it is becoming more painful. What physical assessment data should the nurse focus on?
a. Urine culture to identify potential STD.
b. Obtain vital signs as a baseline to rule out infection.
c. Prepare for a vaginal exam.
d. Inspection of the abdomen for pelvic mass.
ANS: C
Based on the patient’s reported complaint and obstetrical history, it may be likely that the patient has a pelvic prolapse. Therefore, a vaginal exam would be indicated to help identify possible anatomical changes. There is no clinical data that supports a potential pelvic mass and inspection alone would not confirm this finding. Obtaining vital signs as well as a urine culture may be needed, but the focus should be on determination of physical findings related to the pelvic area.
An adult patient comes for a well-check up to the primary care provider’s office. In completing the office admission form, the patient does not indicate gender on the form and seems somewhat agitated when providing the form back to the nurse. How should the nurse respond?
a. Ask the patient to complete all of the information at this time.
b. Ask the patient if you can assist with completing the form.
c. The nurse should just indicate which gender she/he thinks is appropriate.
d. Tell the patient that if the form is not completed, then the doctor will not see you.
ANS: B
Gender identity is defined by the individual patient. The nurse should not designate this description or identity nor should the nurse tell the patient that if the form is not completed, that the patient will not be seen by the healthcare provider. Asking the patient to complete the information without acknowledging that the patient is exhibiting signs of distress is not therapeutic. The nurse should offer to provide assistance to the patient.
A nurse is working with a male patient being treated for erectile dysfunction. Which statement indicates that additional teaching is needed?
a. “I like to go walking around my community each night after dinner.”
b. “I have a few drinks during the week when I go out after work.”
c. “I have maintained my weight for the past 5 years after losing 20 pounds.” d. “I monitor my blood pressure at home using a portable cuff.”
ANS: B
Erectile dysfunction (ED) is a common problem affecting the male population and can be chronic or transient in nature. Alcohol use can affect ED, so the patient’s reported alcohol intake indicates that additional teaching is warranted. Exercise, maintaining a healthy weight and monitoring of blood pressure are examples of appropriate activities.
A nursery nurse performing the first physical assessment of the newborn observes that there is no clear identification of genitalia as being either female or male. How should the nurse identify this newborn?
a. Gender neutral
b. Bisexual
c. Observation of intersex d. Asexual
ANS: C
Intersex represents a group of conditions where the external genitalia of an infant does not appear as either male or female and/or is not consistent with genetic sex or organs. The nurse cannot attribute sexual preference such as asexual or bisexual. Gender neutral does not apply to this clinical situation.
A nurse working with a family whose child has recently told them that he identifies with the LGBTQ community asks the nurse to explain how this happened considering the fact that the child was raised as a male and played with appropriate toys. What is the best nursing response to the family’s concerns?
a. Tell them that there is no need for concern for their child has shared this
information with them.
b. Ask the parents if they ever noticed something different about their son as he was
growing up.
c. Explain that sexual orientation changes can occur over time.
d. Suggest that this behavior may be temporary.
ANS: C
Sexual orientation and gender identification is now thought of as a fluid concept, with the term sexual fluidity being used to convey this meaning for individuals who identify with other than heterosexual relationships. The nurse should respond to the parent’s concerns and not minimize their reaction but rather let them know that it is the chosen response of their child. Relating the sexual orientation or gender identification to how one was raised indicates an implied bias. Telling the family that the behavior may be temporary is not correct.
