Chapter 33 Sexual Health Flashcards

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1
Q

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.

A

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.

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2
Q

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

A

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.

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3
Q

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.

A

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.

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4
Q

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

A

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.

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5
Q

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

A

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.

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6
Q

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.

A

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.

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7
Q

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

A

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.

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8
Q

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.

A

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

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9
Q

Which is the first stage of sexual arousal?

1) Desire
2) Excitement
3) Stimulation
4) Orgasm

A

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.

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10
Q

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

A

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.

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11
Q

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.

A

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.

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12
Q

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.

A

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.

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13
Q

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.

A

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.

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14
Q

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

A

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.

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15
Q

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

A

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.

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16
Q
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
A

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.

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17
Q

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

A

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.

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18
Q

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

A

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.

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19
Q

Which of the following is the pad of fatty tissue over the symphysis pubis that is covered with coarse hair and contains sensitive nerve endings?

1) Mons pubis
2) Clitoris
3) Vulva
4) Labia minora

A

ANS - 1

The mons pubis is a pad of fatty tissue over the symphysis pubis. It is covered with coarse hair and contains sensitive nerve endings.

The clitoris contains erectile tissue, blood vessels, and nerves. It is extremely sensitive and reacts to pleasurable stimuli.

The external genitalia, or vulva, consist of the clitoris, labia majora, labia minora, Bartholin’s glands, urinary meatus, and vaginal introitus.

The labia minora also engorge and become sensitive during sexual stimulation.

20
Q

You are discussing sexual health with a client. He tells you that he frequently is unable to achieve or maintain an erection and that it is hurting his sexual life and relationship. Which of the underlying conditions should you most suspect to be the cause of this condition in this client, as it is the most common?

1) Spinal cord injury
2) Performance anxiety
3) Blood vessel disorder
4) Mental illness

A

ANS - 3

Erectile dysfunction (ED), formerly known as impotence, is a sexual arousal disorder in men. Men with ED have persistent or recurring inability either to achieve or to maintain an erection sufficient for satisfactory sexual performance. ED may result from underlying neurological (e.g., spinal cord injury, Parkinson’s disease, stroke) or endocrine problems (diabetes). However, the most common cause of ED is disease of the blood vessels.

Common psychological problems that contribute to ED include performance anxiety, childhood sexual abuse, relationship issues, or mental illness. However, the most common cause of ED is disease of the blood vessels.

The most common cause of ED is disease of the blood vessels (e.g., hypertension, high cholesterol, or diabetes).

Common psychological problems that contribute to ED include performance anxiety, childhood sexual abuse, relationship issues, or mental illness. However, the most common cause of ED is disease of the blood vessels.

21
Q

In discussing a client’s sexual health, you learn that he is sexually attracted to both males and females and has sexual relationships with both genders. Which of the following is this client’s sexual orientation?

1) Transgendered
2) Transsexual
3) Intersexed
4) Bisexual`

A

ANS - 4

Being transgendered pertains to gender identity, not to sexual orientation. When a person forms a gender identity that is not the same as his or her biological gender, he or she is considered transgendered (or “differently gendered”).

Transsexual is a gender identity, not a sexual orientation. Transsexuals are people who identify with the opposite gender from their biology—for example, a person with the physical appearance and reproductive organs of a woman who “feels” and perceives herself to be a man.

Intersexed is a gender identity, not a sexual orientation. Intersexed people (formerly referred to as hermaphrodites) are born with ambiguous sexual organs. For example, the person may have female internal organs (ovaries, a uterus), but enlarged clitoral tissue resembling a penis.

A person who is bisexual is sexually and emotionally attracted to both males and females.

22
Q

You are giving a tub bath to an older client who has Alzheimer’s disease. He keeps trying to move your hand down toward his genitals. How should you respond?
SELECT ALL THAT APPLY.
1) Ignore the behavior and finish the bath as quickly as possible.
2) Tell the client, “Stop moving my hand. That makes me uncomfortable.”
3) Tell the client, “Take the washcloth and wash that area yourself.”
4) Yell at the client, “Stop that, you dirty old man!”
5) Leave the room immediately without saying a word.
6) Tell the client, “I need you to keep your hands to yourself, please.”

A

ANS - 2, 3, 6

Feedback 1: If you believe a client is demonstrating inappropriate sexual behaviors, immediately tell the client that the behavior is inappropriate. Don’t just ignore it, or the client will likely persist.
Feedback 2: If you believe a client is demonstrating inappropriate sexual behaviors, immediately tell the client that the behavior is inappropriate. Do not express anger, but use clear statements, such as, “I don’t like your comments. They are inappropriate and make me feel uncomfortable. Please stop.”
Feedback 3: Refocus the client’s attention to the care you are delivering (“Hold still now, while I tape your IV”).
Feedback 4: Avoid getting angry and yelling at the client.
Feedback 5: Leaving the room should be a last resort, especially because it would be dangerous to leave a client with Alzheimer’s alone in a bathtub. It would be better to call another nurse or an aide to assist you with the client.
Feedback 6: Let the client know what behavior you expect. Be direct with your comments. If the client is exposing himself, let him know what you expect him to wear (“I expect you to keep your pajama bottoms on).” If the client is attempting to touch you, tell him, “Don’t touch me.”

23
Q

Below are the five phases of the sexual response cycle. Put them in the correct order.

1) Desire
2) Plateau
3) Resolution
4) Excitement
5) Orgasm

A

ANS - 1, 4, 2, 5, 3

The five phases of the sexual response cycle are as follows: 1. Desire, 2, Excitement, 3. Plateau, 4, Orgasm, and 5. Resolution.

24
Q

You are providing counsel about sexual health to a 15-year-old boy, helping him separate truths from myths. Which of the following statements are true?
SELECT ALL THAT APPLY.
1) You can’t get pregnant the first time you have sex.
2) You can’t get pregnant if you’re using a condom.
3) A man’s penis is proportional in size to his feet.
4) You don’t always have symptoms when you have a sexually transmitted infection (STI).
5) You can get an STI from a partner who has good hygiene habits.
6) If the relationship is good, the man and woman will achieve simultaneous orgasm.

A

ANS - 4, 5

Feedback 1: It is a myth that you can’t get pregnant the first time you have sex.
Feedback 2: It is a myth that you can’t get pregnant if you’re using a condom.
Feedback 3: It is a myth that a man’s penis is proportional in size to his feet.
Feedback 4: It is true that you don’t always have symptoms when you have an STI.
Feedback 5: It is true that you can get an STI from a partner who has good hygiene habits.
Feedback 6: It is a myth that if the relationship is good, the man and woman will achieve simultaneous orgasm.

25
Q

You are performing a nursing assessment of a 9-year-old boy and talking with him and his mother. Which of the following would you most expect to be true of this stage of the boy’s sexual development?

1) The boy touches his genitals often in public.
2) The boy strongly identifies with his father, and all his friends are boys.
3) The boy is sexually active with girls his age.
4) The boy has established his gender identity and sexual orientation.

A

ANS - 2

It is common for younger children (infants to preschoolers) to touch their genitals and enjoy being nude. By the time they enter school, however, children are generally too self-conscious to touch their genitals in public.

The school-age child strongly identifies with the same-sex parent and has mostly same-sex friends.

Adolescence is a time of heightened sexual interest and activity. A boy of 9 years old is not likely to be sexually active.

During early adulthood, people define their sexual identity and resolve issues related to their sexual orientation and self-concept.

26
Q

You are providing counsel to a woman who has four children aged 6 to 15 years. She says that it has been difficult for her and her husband to find time to have sex because they are always worried that one of their kids will knock on their bedroom door. Which of the following nursing diagnoses would be appropriate for this client?

1) Sexual Dysfunction related to fear of discovery
2) Ineffective Sexuality Pattern related to lack of privacy
3) Fear related to ineffective sexuality pattern
4) Anxiety related to sexual dysfunction

A

ANS - 2

Sexual Dysfunction applies when there is an actual change in sexual function during the phases of desire, excitation, or orgasm that the patient views as unsatisfying, unrewarding, or inadequate. In this case, however, there is no evidence of sexual dysfunction—just difficulty finding uninterrupted time to have sex.

The diagnosis Ineffective Sexuality Pattern should be used when the patient expresses concerns about his or her sexuality. Examples of such concerns might include conflict about sexual orientation, value conflicts, fear of acquiring a sexually transmitted infection, lack of knowledge about how to adapt sexual techniques to altered body function, lack of privacy, not having a partner, or impaired relationship with the partner.

Fear is not the primary problem in this case, although it may be part of the etiology. The primary problem is Ineffective Sexuality Pattern.

Anxiety is not the primary problem in this case, although it may be part of the etiology. The primary problem is Ineffective Sexuality Pattern.

27
Q

You are working with a client who is biologically female but who identifies as male. Which of the following gender identities applies to this client?

1) Intersexed
2) Transvestite
3) Transsexual
4) Homosexual

A

ANS - 3

Intersexed people (formerly referred to as hermaphrodites) are born with ambiguous sexual organs. For example, the person may have female internal organs (ovaries, a uterus), but enlarged clitoral tissue resembling a penis.

A transvestite (or cross-dresser) is a person (male or female) who occasionally or frequently wears the clothing characteristic of the opposite sex, particularly the undergarments, as a form of sexual expression.

Transsexuals are people who identify with the opposite gender from their biology—for example, a person with the physical appearance and reproductive organs of a woman who “feels” and perceives herself to be a man.

Homosexuality is not a gender identity but a sexual orientation. The focus of sexual attraction for homosexuals is a person of the same gender.

28
Q
You are discussing various forms of sexual expression with a 15-year-old client. Which of the following forms of sex are considered "safer sex" because of the low risk of transmitting a sexually transmitted infection?
SELECT ALL THAT APPLY.
1) Masturbation
2) Shared touching
3) Sexual intercourse
4) Fellatio
5) Cunnilingus
6) Anal intercourse
A

ANS - 1, 2

Feedback 1: Masturbation is self-stimulation of the genitals. It is “safe” because it does not involve any physical contact with another person.
Feedback 2: Mutual masturbation, or shared touching, may be an alternative to sexual intercourse. This is particularly appealing to individuals who seek to maintain their virginity, decrease the risk of sexually transmitted infection, or for those who have mobility or other physical problems that make intercourse difficult. Mutual masturbation is recognized as a form of safer sex because body fluids are not likely to be exchanged.
Feedback 3: Sexual intercourse and coitus are terms used to describe penile penetration of the vagina. Because it involves exchange of body fluids, sexual intercourse may also lead to the transmission of infections. Using a lubricated condom decreases this risk, but it is not a foolproof measure to prevent sexually transmitted infections (STIs).
Feedback 4: Fellatio is stimulation of the male genitals by a partner’s mouth. Oral–genital contact may lead to STIs.
Feedback 5: Cunnilingus is the oral stimulation of a woman’s genitals. Oral–genital contact may lead to STIs.
Feedback 6: Anal intercourse (also termed sodomy) is the insertion of the penis into the partner’s rectum. A lubricated condom can be used to lessen the chance of STIs, but the risk is still there.

29
Q

The nurse is aware that sexuality is part of growth and development. The preschooler’s interest in gender sexuality is characterized by an interest in:

  1. Exploring his or her own genitalia
  2. Learning how and why his or her anatomy differs from other children
  3. Playing and developing friendships with children of the opposite sex
  4. Spending most of his or her time with the parent of the opposite sex
A

ANS: 1

The first step of gender identity development occurs as the child becomes aware of the differences of the sexes and perceives that he or she is male or female. This is characterized by an interest in his or her genitalia. This is not characteristic of the preschool child. Learning how and why his or her anatomy differs from other children would require a higher level of cognitive ability. Children of this age-group primarily focus on their parents and family, not other children. According to Freud, the preschool child identifies with the parent of the same sex and develops a complementary relationship with the parent of the opposite sex. The preschool child does not spend most of his or her time with the parent of the opposite sex.

30
Q

While working with a male client and administering medications, the female nurse is approached sexually. The nurse should:

  1. Have a male nurse assume care for this client
  2. Immediately report the incident to the client’s physician
  3. Tell the client that his behavior is offensive and leave the room
  4. Review and define the limits of a professional relationship for the client
A

ANS: 4

The nurse should convey a message of acceptance of the client, but not the inappropriate behavior. Reviewing and defining the professional relationship with the client can accomplish this. Matching the gender of the health care worker with the gender of the client may be beneficial when dealing with assessment of sexual needs or sex education. However, in this instance, the client needs to be informed that inappropriate sexual behavior is unacceptable. To turn the client’s care over to a male nurse would not resolve the problem, and would convey a message of dislike and lack of acceptance of the client. Reporting the incident immediately to the client’s physician would not be the nurse’s best action. The client needs to be made aware of the problem in order to discontinue such behavior. Telling the client his behavior is offensive and then leaving the room is not therapeutic. The client needs to be reminded of the professional relationship he shares with the nurse.

31
Q

A client is concerned that she and her husband, now that they have a baby in the house, will be unable to maintain a healthy sexual relationship. To assist these clients, it would be most helpful for the nurse to know:

  1. If they share parenting beliefs
  2. How long they have been married
  3. How comfortable they are in communicating their feelings to each other
  4. The level of knowledge they have regarding healthy sexual relationships
A

ANS: 3

In response to identified concerns, the nurse may initiate discussion. Knowing of the comfort level in communicating their feelings provides an open dialogue enabling the client to talk freely with the nurse to address the concerns. To assist the clients in their situational change, the nurse needs to explore communication and sexual patterns of the couple. Having similar parenting beliefs will have less impact on their sexual relationship. To assist the couple in adjusting to the change of becoming a family, the nurse needs to explore communication patterns of the couple. How long they have been married would be less significant. The level of knowledge they have regarding healthy sexual relationships would not be as impacting on their sexual relationship as would their ability to discuss their feelings with one another.

32
Q

The nurse, after completion of an assessment in the medical clinic of a client, the nurse documents that the client has dyspareunia based on the client’s experience of:

  1. Delay or absence of an orgasm
  2. Deficient or absent sexual desire
  3. Involuntary constriction of the vagina
  4. Recurrent genital pain during intercourse
A

ANS: 4

Dyspareunia is recurrent or persistent genital pain in either a male or a female before, during, or after sexual intercourse that is not associated with vaginismus or with lack of lubrication. Orgasmic disorder is the recurrent delay in, or absence of, orgasm following normal sexual excitement. Hypoactive sexual desire disorder is the persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity. Vaginismus is an involuntary constriction of the outer one third of the vagina that prevents penile insertion and intercourse.

33
Q

An adolescent female student, who is sexually active, visits the office of the school nurse. Which of the following statements best reflects her understanding of the effective use of contraception devices?

  1. “My boyfriend is able to withdraw before ejaculation, and that prevents me from getting pregnant.”
  2. “I take my temperature every morning; when it goes down for at least two days, we have unprotected sex.”
  3. “We always use ‘foam’ before each time that we have sex and as you can see I haven’t gotten pregnant yet.”
  4. “We have decided that I should have a diaphragm inserted and to use contraceptive cream with each intercourse.”
A

ANS: 4

In order to be an effective contraceptive method, the diaphragm should be used with a contraceptive cream or jelly. The client is verbalizing understanding. Any act of unprotected intercourse can result in pregnancy. The boyfriend withdrawing prior to ejaculation is not an effective contraceptive method. Any act of unprotected intercourse can result in pregnancy. This statement is not demonstrating understanding of the basal body temperature method of contraception. Using spermicidal foam alone is not recommended. The client should use a condom and foam to be more effective in preventing pregnancy.

34
Q

A school nurse is responsible for teaching adolescents about sexually transmitted diseases (STDs). When discussing chlamydia, the nurse instructs the students that it is:

  1. A viral infection that cannot be cured
  2. Treated with a full course of antibiotics
  3. Contracted via blood-borne exchange
  4. Prevented with the use of spermicidals
A

ANS: 2

Diseases that are caused by bacteria and that can usually be cured with antibiotics include gonorrhea, chlamydia, syphilis, and pelvic inflammatory disease. All clients need to understand that antibiotics need to be taken for the full course of treatment. Chlamydia is caused by bacteria that can be treated, not a virus. Sexually transmitted diseases, such as chlamydia, are transmitted from infected individuals to partners during intimate sexual contact. It is not contracted via blood-borne exchange, but rather through body fluids. Chlamydia is not prevented with the use of spermicidals.

35
Q

A client is scheduled for cardiac surgery. The nurse is conducting a sexual history and is told that he is nervous about resuming sexual activities. The nurse uses therapeutic communication with the client when responding:

  1. “You can have sexual intercourse after your surgery, but there are serious risks.”
  2. “Your partner will be nervous about resuming sexual activities, but that is only normal.”
  3. “Don’t worry. In about 2 months you will be able to return to your normal sexual patterns.”
  4. “You are expressing a very normal concern, Perhaps we could discuss your feelings further.”
A

ANS: 4

Open communication and positive self-esteem, such as explaining that their concern is very normal and offering to discuss further are essential factors in effectively resolving concerns. Telling the client that there are serious risks may only worry the client more. Stating that the client’s partner will be nervous about resuming sexual activities does not focus on the client and, therefore, does not encourage the client to express his concerns. Telling the client not to worry is nontherapeutic. At this point, not even knowing the outcome of the surgery, the nurse should not predict resumption of sexual activity for the client. Furthermore, this response does not encourage the client to communicate his feelings.

36
Q

The nurse is teaching sexuality to a group of senior adults. Which of the following comments by a participant reflects that he or she has an understanding of the changes in sexuality that occur with aging?

  1. “So, sexual intercourse will be more painful for my wife, and we should have sex less frequently?”
  2. “We have recently seen the need to begin using a lubricant. That’s because we make love less often.”
  3. “My orgasms seem to not last as long, but my husband and I are probably more satisfied now than when we were younger.”
  4. “I understand that it is natural not to have such an interest in sex anymore. People our age shouldn’t still have those feeling.”
A

ANS: 3

Orgasms may not last as long in the older adult as a result of aging. Older adults may feel more sexually satisfied because they no longer have to be concerned with contraception and are not experiencing the pressures of raising children and working. Decreased levels of estrogen may lead to diminished vaginal lubrication and decreased vaginal elasticity, making intercourse more painful. The couple should not be advised to have sex less frequently, but rather to use a vaginal lubricant and allow more time for caressing. The need to use a lubricant is not due to having sex less often, but is due to decreasing levels of estrogen in the woman. Saying that people of a certain age shouldn’t still have sexual feelings is not a true statement. Sexual feelings in older adulthood are normal. Sexuality and continued interest in sex throughout late life generally reflect life patterns.

37
Q

The nurse has completed an assessment on an adult male client and finds that he is having difficulty having an erection and has less interest in sex. The nurse notes that the client has recently started taking an antihypertensive medication. A nursing diagnosis of sexual dysfunction related to side effects of antihypertensive is identified by the nurse. An appropriate outcome for this client is:

  1. Client will avoid taking medication before intercourse
  2. Client will relate renewed interest in sex within 1 month
  3. Client will be interviewed by a sexual therapist immediately
  4. Client will seek out other satisfying substitute activities or hobbies
A

ANS: 2

An appropriate expected outcome for the nursing diagnosis of sexual dysfunction related to side effects of antihypertensive would be client will relate renewed interest in sex within 1 month. An appropriate goal would be client will express satisfaction with sexual relationship with wife within 1 month. The client should not avoid taking his antihypertensive medication before intercourse, but should be taught that there are other blood pressure medications available that can maintain blood pressure control and that do not negatively affect sexual function. He can then discuss this with his physician. Being interviewed by a therapist is not an appropriate expected outcome. Seeing a sexual therapist immediately is not necessary and may only intensify his concern. Seeking out substitute activities or hobbies is not an appropriate expected outcome. It does not address or resolve the problem.

38
Q

A 58-year-old woman asks the nurse what she can do to promote healthy physical sexual relations. Based on the client’s age, the nurse responds by saying:

  1. “Using a water-based lubricant may be helpful.”
  2. “Reducing the frequency of intercourse may help you.”
  3. “I will refer you to a sexual therapist to better assist you.”
  4. “Continue what you’ve been doing. Nothing should have changed.”
A

ANS: 1

The perimenopausal and menopausal woman may have diminished vaginal lubrication as a result of decreased levels of estrogen, thus using a water-based lubricant may help. Decreasing the frequency of intercourse would not promote healthy sexual relations. If a nurse is uncomfortable discussing sexual issues with a client, then he or she should get another nurse who is comfortable to talk with the client. A sex therapist is not necessary in this situation. Sex therapists address more complex sexual issues. There are some physical changes with aging that may affect sexuality. The client should be educated on the expected changes and how to best address them.

39
Q

The nurse is putting together a presentation on the prevention of sexual abuse. She should incorporate which of the following?

  1. Abusers fit into easily identified, classic profiles.
  2. Intensity is generally increased during pregnancies.
  3. Sexual abuse is found primarily in lower socioeconomic groups.
  4. Most of the incidents occur with strangers or unknown assailants.
A

ANS: 2

Sexual abuse may begin, continue, or even intensify during pregnancy. The abuser may not fit any classic description. Sexual abuse crosses all gender, socioeconomic, age, and ethnic groups. Most often sexual abuse is at the hands of a former intimate partner or family member.

40
Q

To increase the tone and sensation of the pelvic floor for a female client, the nurse teaches:

  1. Kegel exercises
  2. Vaginal dilation
  3. Stop-start techniques
  4. Sensate focus exercises
A

ANS: 1

Kegel exercises increase the tone and sensation of the pelvic floor (pubococcygeus muscle) for the female client. Vaginal dilation will not increase the tone and sensation of the pelvic floor. Stopping urination may help identify proper muscle contraction, but once the muscle is identified, Kegel exercises should not be repeated during urination. Stopping urination midstream may create a backflow of urine into the bladder, predisposing a person to infection. Sensate focus exercises do not increase muscle tone.

41
Q

The nurse who is discussing safe sex with a group of teenage students must realize that safe sex practice includes: (Select all that apply.)

  1. Having sex with only partners you know well
  2. Willingness to resist peer pressure to have sex
  3. Insisting upon the use of barrier protective devices
  4. An understanding that the goal is to prevent the spread of STDs
  5. Openly discussing a history of STDs (sexually transmitted diseases)
  6. Not making the decision to be sexually active while using drugs or alcohol
A

ANS: 1, 3, 4, 5, 6

“Safe sex” is a term that describes responsible sexual behavior aimed at preventing the spread of STDs, including HIV/AIDS. Responsible sexual behavior includes knowing one’s sexual partner, being able to openly discuss sexual and drug-use history with the partner, not allowing drugs or alcohol to influence decision making, and using protective devices.

42
Q

In order to therapeutically counsel clients regarding issues related to sexuality, a nurse should have knowledge on which of the following topics? (Select all that apply.)

  1. Abortion
  2. Birth control
  3. Sexual techniques
  4. Sexual orientation
  5. Sexual development
  6. Sexually transmitted diseases (STD)
A

ANS: 1, 2, 4, 5, 6

Nurses help clients achieve sexual health by having a sound scientific knowledge base regarding sexuality. A basic understanding of sexual development, sexual orientation, contraception, abortion, and sexually transmitted diseases (STDs) is necessary. A sex therapist would be better suited to discuss sexual techniques with a client.

43
Q

The most common characteristics shared by individuals most likely to contract a sexually transmitted disease (STD) are that they: (Select all that apply.)

  1. Use illegal drugs
  2. Possess poor reading skills
  3. Are economically deprived
  4. Have multiple sexual partners
  5. Have ineffective immune systems
  6. Frequently engage in unprotected sex
A

ANS: 4, 6

People most likely to be infected share one key characteristic: unprotected sex with multiple partners. Additionally, social factors such as poverty, low literacy, discrimination, use of illegal drugs (e.g., crack cocaine, meth), incarceration, sexual abuse, and racial segregation contribute to racial disparities in rates of STDs.

44
Q

Which of the following sexually transmitted diseases (STDs) are considered curable with antibiotic treatment? (Select all that apply.)

  1. Syphilis
  2. Gonorrhea
  3. Chlamydia
  4. Genital warts
  5. Genital herpes
  6. Pelvic inflammatory disease (PID)
A

ANS: 1, 2, 3, 6

Gonorrhea, chlamydia, syphilis, and pelvic inflammatory disease (PID) are caused by bacteria and are usually curable with antibiotics. All clients need to understand that antibiotics need to be taken for the full course of treatment. Genital herpes and genital warts are viral and are not curable.

45
Q

When discussing sexually transmitted diseases (STDs) with a group of college students, the nurse identifies which of the following as the more common signs and symptoms? (Select all that apply.)

  1. Fever
  2. Joint pain
  3. Genital rash
  4. Anal discharge
  5. Genital lesions
  6. Painful urination
A

ANS: 1, 4, 5, 6

Common symptoms of an STD include discharge from the vagina, penis, or anus; pain during sex or when urinating; blisters or sores in the genital area; and fever. The remaining options are not typical signs or symptoms of STDs.

46
Q

Which of the following conditions should the nurse discuss as possible outcomes of untreated chlamydia with a client newly diagnosed with the disease? (Select all that apply.)

  1. Infertility
  2. Uterine cancer
  3. Ectopic pregnancy
  4. Neonatal complications
  5. Pelvic inflammatory disease (PID)
  6. Human immunodeficiency virus (HIV)
A

ANS: 1, 3, 4, 5

If it is not treated, chlamydia can cause PID, ectopic pregnancy, infertility, and neonatal complications. Either uterine cancer or HIV is directly connected to chlamydia.