Chapter 33 Sexual Health Flashcards
You are caring for a healthy 28-year-old man with a fractured tibia (bone in the lower leg). The patient has asked you to place his penis in the urinal and hold it while he voids. You should:
1) assist the patient as he has requested.
2) immediately leave the room.
3) tell him his behavior is inappropriate.
4) report him to your supervisor.
Answer:
3) tell him his behavior is inappropriate.
Rationale:
The patient’s request is unnecessary and should be considered a request for sexual stimulation. If you believe a client is demonstrating inappropriate sexual behaviors, immediately tell the client that his behavior is inappropriate. If this is unsuccessful, you may need to inform your supervisor or request a change in assignment.
Which topic is most important to include when educating all clients about sexuality?
1) Contraception
2) Sexually transmitted infections (STIs)
3) Sexual orientation
4) Sexual identity
Answer:
2) Sexually transmitted infections (STIs)
Rationale:
STIs are among the most common infectious diseases in the United States today. More than 20 different STIs have been identified, and they affect millions of men and women in this country each year. In 2000, the Centers for Disease Control and Prevention (CDC) estimated 18.9 million new cases were reported. Educating about prevention is absolutely critical.
NANDA-I has two nursing diagnoses for describing sexual problems: Ineffective Sexuality Patterns and Sexual Dysfunction. How would you determine which diagnosis to use on a client?
1) Use Ineffective Sexuality Patterns when the patient expresses concern about the ability to achieve his perceived sex role.
2) Use Ineffective Sexuality Patterns when the patient is seeking confirmation of desirability.
3) Use Sexual dysfunction when the patient is experiencing values conflicts in the area of sexuality.
4) Use Sexual Dysfunction when the patient expresses dissatisfaction with an actual change in sexual functioning.
Answer:
4) Use Sexual Dysfunction when the patient expresses dissatisfaction with an actual change in sexual functioning (e.g., difficulty maintaining an erection).
Rationale:
There is much overlap between these two NANDA diagnoses; however, Sexual Dysfunction is the more specific diagnosis for physiological and performance problems.
What is the term for a person who feels a personal identity as the opposite gender for which he or she was born?
1) Transvestite
2) Intersexual
3) Homosexual
4) Transsexual
Answer:
4) Transsexual
Rationale:
Transgendered (or “differently gendered”) is a broad term used to describe people whose gender identity differs in some way from their apparent biological gender. A transsexual is a person who identifies his or her own self-image as the opposite gender of birth. This is also referred to as a gender identity disorder. Intersexed people are born with ambiguous sexual organs. For example, the person may have female internal organs (ovaries, a uterus), but an external penis. An older term for this is hermaphrodite. A homosexual person is one whose focus of sexual attraction is on those of the same gender. A cross-dresser (or transvestite) is a person who occasionally or frequently wears the clothing characteristic of the opposite sex, particularly the undergarments, as a form of sexual expression.
Which of the following is a DSM category of sexual deviation that a client might require mental health care?
1) Homosexuality
2) Voyeuristic disorder
3) Bisexuality
4) Transgenderism
Answer:
2) Voyeuristic disorder
Rationale:
The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) describes eight categories of sexual deviation or paraphilias: exhibitionistic disorder, fetishistic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, sexual sadism disorder, transvestic disorder, and voyeuristic disorder. Homosexuality and bisexuality are forms of sexual orientation. A transgendered person is someone with a gender identification issue.
A 17-year-old woman with Down syndrome is brought to the emergency department by her parents after an incident of sexual assault by her uncle. What would you do when providing care to her after the incident?
Select all that apply.
1) Document pregnancy status with a urine or blood sample.
2) Advise parents to have her tested for STIs 1 week after the incident.
3) Administer the hepatitis B and HPV vaccines, as ordered.
4) Refer the victim to a sexual assault center for further information and counseling.
Answer:
1) Document pregnancy status with a urine or blood sample.
2) Advise parents to have her tested for STIs 1 week after the incident.
3) Administer the hepatitis B and HPV vaccines, as ordered.
Rationale:
The risk for sexually transmitted infections (STIs) is extremely high in cases of sexual assault. Not only should prophylactic treatment be given for STIs, such as gonorrhea or chlamydia, but you might also administer vaccines to prevent hepatitis B and human papillomavirus (HPV), as prescribed and according to your agency’s policy. If there is a significant risk for HIV, prophylaxis may be prescribed within 72 hours of exposure. The victim should receive follow-up care 1 week after the event to assess for healing of injuries and presence of sexually transmitted infection. Female adolescents who have experienced a sexual assault should be offered emergency contraception, even if vaginal penetration cannot be determined with certainty. At the time of the evaluation, pregnancy status should be documented with either a blood or urine sample. Because of the long-term psychological and emotional consequences of sexual assault, victims most often benefit from counseling. Consider referring the victim to a sexual assault center for support, counseling, and additional information; although this is not immediate care.
Which of the following is the most important information to collect at a women’s health examination for a 52-year-old woman?
1) Age at first sexual encounter
2) History of PMS
3) Birth control method used
4) Date of last menstrual period
Answer:
4) Date of last menstrual period
Rationale:
A 52-year-old woman may be experiencing erratic periods of perimenopause. The date of her last menstrual period will help determine her perimenopausal status and guide the discussion of physical, emotional, and sexual changes that commonly occur during a period of declining estrogen production. The nurse will need to determine her menstrual status, which also includes the length and heaviness of flow, the regularity of her cycle, and any change in symptoms associated with menstruation. The nurse will also need to assess for birth control requirements in a heterosexual or bisexual woman.
An 18-year-old high-school senior comes to the local family planning clinic requesting birth control pills. When discussing sexual health with the adolescent girl, your first nursing priority would be to do which of the following?
1) Urge the teen to practice healthful sexual behaviors.
2) Inform her about the risk of pregnancy and STIs.
3) Assess the teen’s knowledge of sexuality and reproduction.
4) Provide detailed information about birth control pills.
Answer:
3) Assess the teen’s knowledge of sexuality and reproduction.
Rationale:
You cannot assume that adolescents or young adults have adequate sexual knowledge, and it is difficult for most people to admit a lack of knowledge to a professional. Therefore, when discussing sexual health with a client, the nurse must first assess the client’s knowledge and understanding of reproduction and sexuality
Which is the first stage of sexual arousal?
1) Desire
2) Excitement
3) Stimulation
4) Orgasm
Answer:
1) Desire
Rationale:
The sexual response cycle is the sequence of physiological events that occurs when a person becomes sexually aroused. A theorist named Basson identified five stages of physiological events that occur when a person becomes sexually aroused: desire, excitement, plateau, orgasm, and resolution. Desire precedes all other stages of the cycle, but sexual response does not necessarily proceed beyond desire.
A 65-year-old widow is being given an annual physical exam. She states she has been dating a widowed man for 9 months and that the relationship is fulfilling in most areas. However, she is unable to have sexual relations because she feels she is “cheating” on her husband, who died 5 years ago. Her partner is very understanding, although her inability to have sexual relations is becoming a strain on their relationship. What is an appropriate nursing diagnosis for this woman?
1) Sexual Dysfunction related to conflicted sexual orientation
2) Ineffective Sexuality Patterns related to values conflicts
3) Ineffective Sexuality Patterns related to impaired relationship with partner
4) Sexual Dysfunction related to fear of the unknown
Answer:
2) Ineffective Sexuality Patterns related to values conflicts
Rationale:
The nursing diagnosis Ineffective Sexuality Patterns in used when the patient expresses concerns about her own sexuality, whereas Sexual Dysfunction is used when there is an actual change in sexual function that the patient views as unsatisfying, unrewarding, or inadequate. In this situation, the patient still views herself as being committed to her deceased husband, causing a conflict in values.
You are caring for 35-year-old man who tells you that he feels distress about being a male, and ever since he was a young child has thought of himself as a female. He describes the isolation he feels and concern about fitting in socially and at work because of these recurrent thoughts. How would you respond to your patient?
1) Provide information about support groups and other community resources for transsexual people.
2) Reassure him that he is normal, saying there are more people than we know who feel this way.
3) Share with him that you personally have had thoughts like this but have coped with these thoughts.
4) Suggest your patient seeks mental health care for medication to help him deal with his anxiety.
Answer:
1) Provide information about support groups and other community resources for transsexual people.
Rationale:
Those experiencing a sexual identity disorder, such as transsexualism, typically feel overwhelming cultural disapproval and isolation. The lifelong stresses associated with being transsexual penetrate nearly every aspect of life: medically, socially, and emotionally. Competent and responsive healthcare is essential, and nurses can be an especially valuable source of information and support during a time of isolation and emotional inner conflict. Reassuring the patient he is normal discounts his feelings and conveys insensitivity on the part of the nurse as well as a lack of willingness to listen openly. Genuine support and active listening are important for the transsexual who is struggling with his gender identity. Interjecting your own experiences trivializes the patient’s experience. The nurse’s first action is to offer information rather than imply that the patient has a mental health issue requiring anti-anxiety agents.
Based on a nursing diagnosis of Ineffective Sexuality Patterns related to values conflicts, what would be the most effective nursing intervention for a patient?
1) Educate the patient about sexual orientation and function.
2) Encourage the patient to discuss relationship problems with her partner.
3) Advise the patient to discuss her value conflict with a counselor.
4) Instruct the patient on effective methods to identify fears.
Answer:
3) Advise the patient to discuss her value conflict with a counselor.
Rationale:
Effective nursing interventions address the etiology of the identified nursing diagnoses. This patient is experiencing a values conflict. Therefore, interventions must address this concern rather than issues, such as fears and relationship problems. The partner might not be the most suitable person for the patient to talk to because she would be too close to the matter; a counselor is trained to discuss sexuality and values conflicts in a professional and objective manner.
What do shared touching, celibacy, masturbation, and developing intimate relationships have in common? They are all:
1) forms of sexuality or sexual orientation.
2) cues to use in formulating a nursing diagnosis.
3) important in the development of sexual identity.
4) forms of sexual expression.
Answer:
4) forms of sexual expression.
Rationale:
People express their sexuality and gain satisfaction in many ways. Developing intimate relationships, fantasies and erotic dreams, masturbation, shared touching, oral–genital stimulation, anal stimulation or intercourse, sexual intercourse, and celibacy are all forms of sexual expression—even a lack of activity is an expression of sexuality.
Below are the four steps of a guideline for counseling for sexual problems. Put them in the correct order.
1) Intensive therapy
2) Specific suggestions
3) Permission
4) Limited information
ANS - 3,4,2,1
The steps of a guideline for counseling for sexual problems are as follows: 1. Permission, 2. Limited information, 3. Specific suggestions, and 4. Intensive therapy.
You are providing teaching to a 16-year-old girl who says she is about to become sexually active. You should encourage this client to be vaccinated against which of the following sexually transmitted infections (STIs), associated with cervical cancer?
1) Chlamydia
2) Gonorrhea
3) Human papillomavirus
4) Syphilis
ANS - 3
Chlamydia can cause serious damage to a female’s reproductive system if untreated, but it is not associated with cervical cancer and there is no vaccine for it.
Gonorrhea is caused by a bacterium and is a common STI among sexually active teen-agers and young adults. It is not associated with cervical cancer and there is no vaccine for it.
Human papillomavirus (HPV) is an STI that can infect the genital areas, mouth, and throat of males and females. It can also cause genital warts and certain types of cancers (e.g., cervical, genital, oropharyngeal). The HPV vaccine is recommended to minimize the chance of contracting HPV.
Syphilis is caused by a bacterium that is transmitted from person to person by direct contact with the syphilis sore, which can occur on the external genitalia, vagina, lips, mouth, anus, and in the rectum. If left untreated, long-term neurological complications and even death may occur. However, it is not associated with cervical cancer and there is no vaccine for it.
Which of the following are male reproductive glands that add secretions that mix with the sperm to produce semen? SELECT ALL THAT APPLY. 1) Epididymis 2) Ductus deferens 3) Seminal vesicles 4) Prostate 5) Urethra 6) Bulbourethral glands
ANS - 3, 4, 6
Feedback 1: Sperm are produced in the testes and transported through the epididymis, ductus deferens, ejaculatory duct, and urethra.
Feedback 2: Sperm are produced in the testes and transported through the epididymis, ductus deferens, ejaculatory duct, and urethra.
Feedback 3: Along the path, the reproductive glands (seminal vesicles, prostate, and bulbourethral glands) add secretions that mix with the sperm to produce semen.
Feedback 4: Along the path, the reproductive glands (seminal vesicles, prostate, and bulbourethral glands) add secretions that mix with the sperm to produce semen.
Feedback 5: Sperm are produced in the testes and transported through the epididymis, ductus deferens, ejaculatory duct, and urethra.
Feedback 6: Along the path, the reproductive glands (seminal vesicles, prostate, and bulbourethral glands) add secretions that mix with the sperm to produce semen.
Below are the phases of the menstrual cycle. Put them in the correct order.
1) Follicular phase: begins on the first day of menstrual bleeding
2) Ovulatory phase: the follicle ruptures and releases the egg for fertilization
3) Menstrual phase: the uterus sheds the endometrial lining and ovarian follicles develop
4) Luteal phase: if the egg is fertilized, the endometrium thickens and chorionic gonadotropin is produced; if not, progesterone levels drop and menses begins
ANS - 3, 1 , 2, 4
The phases of the menstrual cycle are as follows: 1. Menstrual phase: the uterus sheds the endometrial lining and ovarian follicles develop. 2. Follicular phase: begins on the first day of menstrual bleeding. 3. Ovulatory phase: the follicle ruptures and releases the egg for fertilization. 4. Luteal phase: if the egg is fertilized, the endometrium thickens and chorionic gonadotropin is produced; if not, progesterone levels drop and menses begins.
You are discussing sexual health with a client who has diabetes. Which of the following conditions associated with diabetes should you mention to the client?
1) Infertility
2) Erectile dysfunction
3) Fatigue
4) Painful intercourse
ANS - 2
Orchiectomy (removal of the testicle), which is usually performed for testicular cancer, can cause infertility in males, which is associated with loss of self-concept, sexual identity, and intimacy. Diabetes is not associated with infertility.
Diabetes mellitus leads to neurological changes that may cause male erectile dysfunction.
Cancer, not diabetes, may be accompanied by body image changes, fatigue, treatments that create nausea, and fear of death—all of which may lead to feeling unattractive, with a reduced desire for sexual activity.
Women with diabetes may experience vaginal dryness and loss of orgasmic ability. In addition, vaginal yeast infections are common with diabetes, causing itching and painful intercourse.