NCLEX Sexual Disorders: Sexual Dysfunctions and Paraphilias

Question 1

Which of these individuals is experiencing a symptom of the DSM-IV-TR diagnosis sexual aversion disorder?

a. The patient who has genital pain associated with intercourse
b. The patient who avoids genital sexual contact with a partner
c. The patient who has absence of desire to engage in sexual activity
d. The patient who has delayed orgasm following sexual excitement

Answer 1

ANS: B
Aversion disorder is characterized by avoidance of genital sexual contact with a partner. Orgasmic disorder, male or female, is characterized by delayed orgasm following sexual excitement. Hypoactive sexual desire disorder is characterized by absence of drive for sexual activity. Dyspareunia refers to genital pain associated with intercourse.

Question 2

A patient who has a sexual disorder mentions to the nurse, “I don’t know why I bother looking for help. They don’t know much about sex problems.” Which statement best describes the evolution of research on sexuality and should serve as the basis for the nurse’s response?

a. Increased knowledge about sexual dysfunction has been available since the late 1960s.
b. Masters and Johnson were the first persons to explore the area of sexual dysfunction.
c. Kaplan was instrumental in identifying the need for psychoanalysis in treating sexual dysfunction.
d. Sigmund Freud, a sexologist, based his work on scientific data from studying human sexual behavior.

Answer 2

ANS: A
In 1966, research conducted by Masters and Johnson described exactly what happens to the body during erotic stimulation. Since then, there has been considerable research concerning the subject of sexuality and sexual dysfunction. Kaplan identified the need for using behavioral techniques in treating sexual disorders. Freud did not base his work on scientific data. Freud, Newton, and Ellis preceded Masters and Johnson in studying sexual dysfunction

Question 3

A patient who is being treated at the community health clinic complains of lack of sexual desire and mentions the problems this is causing in her marriage. Which of the following data is likely related to her sexual dysfunction?

a. Being an adopted only child
b. Taking an antidepressant medication
c. Growing up in a dysfunctional family
d. Living in an isolated area in the country

Answer 3

ANS: B
Antidepressants, especially SSRIs, are known to decrease sexual desire. The other options are not known to be closely related to development of sexual dysfunction.

Question 4

When a patient’s wife asks the nurse about fetishism, which example could the nurse give as part of an explanation?

a. Being sexually aroused only by touching female shoes
b. Standing on the street corner exposing genitals to others
c. Feeling sexually attracted to a 10-year-old child who lives next door
d. Achieving sexual pleasure from rubbing against a stranger in an elevator

Answer 4

ANS: A
Fetishism refers to using various objects, not individuals, for sexual arousal. Exposing genitals refers to exhibitionism. Rubbing against a stranger is termed frotteurism. Being sexually attracted to children is an example of pedophilia.

Question 5

Which assessment question will be most informative when interviewing a Hispanic female who reports having a sexual aversion?

a. “In your culture is the female expected to be subservient?”
b. “How old were you when you first became sexually active?”
c. “What are your religious beliefs regarding sexual intercourse?”
d. “When did you first begin experiencing pain during intercourse?”

Answer 5

ANS: C
Many religions place restrictions on sexual behavior that is other than procreative and this can result in sexual dysfunction. Although female roles and sexual history can play a role in sexual disorders, they are not frequently viewed in the development of sexual aversion. Painful sexual intercourse is not a symptom of sexual aversion

Question 6

A sexual history begins with the nurse asking the patient when she experienced her first menstrual period. What is the basis for beginning the assessment with this type of question?

a. Medical history is the initial focus of all history assessments.
b. Female sexual dysfunction has its roots in pre-pubescent experiences.
c. Females are more comfortable discussing physical issues than emotional ones.
d. To minimize embarrassment, the history is begun with nonthreatening questions.

Answer 6

ANS: D
The sexual history is an important aspect of the assessment but the questions can be embarrassing. It is suggested that the interview begin with the least awkward topic and then working toward more difficult and personal topics. There is no proof that the remaining options are true.

Question 7

What is the basis of the nurse’s response when a husband reports that, “Our problem is that my wife never initiates sex?”

a. Initiation of sex is generally viewed as the male’s role.
b. Communication between partners is vital to satisfying sex.
c. Men often enjoy sex that is initiated by their female partners.
d. Some women may become aroused only after they experience foreplay.

Answer 7

ANS: D
Research as shown that in longer-term relationships, women did not initiate sex as often; the desire for sex was generated after they were aroused accounting for this woman’s apparent lack of sexual interest. The remaining options are not directly related to sexual interest.

Question 8

Which comment would support the sexual diagnosis of dyspareunia?

a. “I experience genital pain during intercourse.”
b. “I do not enjoy sexual intercourse and try to avoid it.”
c. “I cannot maintain adequate lubrication during intercourse.”
d. “My perineal muscles contract at the wrong times during intercourse.”

Answer 8

ANS: A
Genital pain is a manifestation of dyspareunia. Ineffective muscle contractions are consistent with female sexual arousal disorder. Avoiding sex is consistent with hypoactive sexual disorder. Insufficient lubrication is consistent with vaginismus.

Question 9

Which patient statement shows achievement of an expected outcome for a patient being treated for a paraphilic disorder who is receiving Depo-Provera injections?

a. “The vaginal pain issue is almost totally resolved.”
b. “I don’t have those sexual fantasies nearly as often now.”
c. “Sex is more pleasurable now that I’m getting the injections.”
d. “I haven’t had a problem maintaining an erection since I started the medication.”

Answer 9

ANS: B
Depo-Provera given intramuscularly once a week has been prescribed with some success for patients with paraphilic disorders provides external control that helps patients develop their own internal controls to avoid relapses by lowering the frequency and intensity of inappropriate sexual thoughts and fantasies. The remaining options do not relate to paraphilic disorders. Because of the drug’s effects and side effects, the patient must give written consent before the drug can be administered initially. The patient can withdraw consent at any time.

Question 10

Which assessment question demonstrates knowledge of possible risk factors for the development of a paraphilic disorder?

a. “When were you first diagnosed with schizophrenia?”
b. “Are you aware of a family history of obsessive-compulsive disorder?”
c. “When did you begin relying on printed pornography as a sexual stimulant?”
d. “Why do you find it difficult to take your prescribed antianxiety medication?”

Answer 10

ANS: C
Use of pornography during childhood and adolescence has been shown as a risk factor for the development of inappropriate sexual thinking and behaviors in adulthood. The remaining options have not been associated with being risk factors for this disorder.

Question 11

Which of these statements reflect achievement of discharge criteria for a patient receiving in- hospital treatment for a paraphilic disorder?

a. “My wife is willing to attend counseling with me.”
b. “The medication I’m taking has helped me be less anxious.”
c. “I hope I will be able to know what causes me to think this way.”
d. “This injection I take will help me reach a pleasurable climax again.”

Answer 11

ANS: A
Identification of members of a personal support systems shows achievement of a generally stated discharge criteria. The medication prescribed for this type of disorder is not directed towards managing anxiety or improving performance. The patient should be aware of triggers and causes of behavior prior to discharge.

Question 12

A patient admits to fondling his 3-year-old and 5-year-old nieces. Which statement best indicates that the patient lacks an understanding of the impact of this behavior?

a. “There is absolutely nothing wrong with me.”
b. “My babysitter used to do the same things to me.”
c. “Their mother is going to hate me and it’s your fault.”
d. “The children always want me to hold them in my lap.”

Answer 12

ANS: B
Exhibiting a lack of empathy or ability to express regret is a clear sign of distorted thoughts and lack of insight regarding the effects on the children. The other options show denial and poor insight in general.

Question 13

Which finding would the nurse expect to assess in a 17-year-old patient who has been diagnosed with Klinefelter’s syndrome?

a. Elevated sperm count
b. Decreased secretion of FSH
c. Gynecomastia in a teenage male
d. Hyperplasia of penis and scrotum

Answer 13

ANS:	C
Having gynecomastia (enlarged breasts) at the time of puberty is a characteristic finding in individuals with Klinefelter’s syndrome. Aspermatogenesis, an abnormally low sperm, count is an expected finding. FSH level is expected to be elevated. Penile and scrotal changes are not an expected finding.

Question 14

. Which topic should be addressed when providing medication information to a patient prescribed Depo-Provera injections for a sexual disorder?

a. Nutritional supplementation to offset weight loss
b. Techniques to minimize exposure to viral infections
c. Ability to self-monitor for elevated diastolic blood pressure
d. Safety measures to protect against injuries related to manic activity

Answer 14

ANS: C
Common side effects include weight gain, increased blood pressure, and fatigue. The nurse may suggest a dietary consultation to help the patient maintain a healthy weight and decrease the possibility of weight gain. There is no reason to expect an impaired immune system.

Question 15

Which question would enable the nurse to assess for cognitive distortions during an interview with a patient diagnosed as having pedophilia?

a. “Is there a family history of sexual dysfunction?”
b. “Were you sexually abused as a child or adolescent?”
c. “How do you think the child felt being your sexual partner?”
d. “Will you be willing to take medication to treat your disorder?”

Answer 15

ANS: C
If the patient does not respond with a statement showing empathy for the child, cognitive distortion is present. Similarly, if the patient uses denial or rationalization as he or she discusses the disorder, the nurse can assess the presence of cognitive disorder. The other options, although valid questions, do not assess for cognitive distortion.

Question 16

A patient approaches a clinic nurse in the waiting room and states, “I’d like to talk with you about a sexual problem I’m having.” Which response demonstrates an understanding on the nurse’s initial responsibility to this patient?

a. Offering, “Go ahead if you like. I have time to listen.”
b. Suggesting, “Would you prefer speaking to a sex therapist?”
c. Saying, “Let’s go into my office where there’s more privacy.”
d. Asking, “What type of sexual dysfunction are you experiencing?”

Answer 16

ANS: C
To facilitate a therapeutic nurse-patient alliance, preserve patient confidentiality, and minimize embarrassment, the nurse initially ensures a private and quiet space for the discussion. The nurse should not attempt to suggest another person to talk with the patient since the patient has identified the nurse and assessment is a nursing responsibility. Questions should initially be of a nonthreatening nature.

Question 17

Which intervention should the nurse suggest when a couple expresses the concern that, “Neither of us is interested in sex at the same time.”

a. Scheduling a “sex date” at a time you both agree upon
b. Encouraging role playing to help minimize self-consciousness
c. Exploring new stimulation techniques to renew interest in sex
d. Learning communication techniques that facilitate open expression of feelings

Answer 17

ANS: A
Teaching couples to schedule sexual experiences at agreed upon times will help them focus on sex at the same time. The other options although valid do not address the issue of the timing of mutual interest.

Question 18

A patient is receiving Depo-Provera. He drinks two to three beers a day, smokes, vacations in hot sunny climates, and is slightly overweight. The nurse knows that essential patient teaching should include the fact that:

a. It is vital to use a sunscreen consistently.
b. Smoking may increase the risk for deep vein thrombosis.
c. Drinking alcohol could cause delusions and hallucinations.
d. Losing weight is essential for efficacy of the medication.

Answer 18

ANS: B
Smoking may increase the risk for deep vein thrombosis. There are no alerts about alcohol, sunscreens, or losing weight with this medication.

Question 19

Which interventions would a nurse include in the teaching plan for a patient diagnosed with a sexual dysfunction? Select all that apply.

a. Teach breathing techniques to encourage relaxation during sex.
b. Suggest positive imaging to improve body self-acceptance during sex.
c. Educate the patient regarding the affects of hormones on sexual functioning.
d. Instruct the patient on the use of progressive touch to facilitate sexual pleasure.
e. Suggest an external relaxant such as alcohol to promote self-confidence related to sex.

Answer 19

ANS: A, B, C, D
All the options with the exception of the use of external relaxants to promote self-confidence are appropriate. Alcohol will provide a false sense of confidence and can negatively affect one’s ability to perform sexually.

Question 20

Which topics should be included in a discussion on risk factors for developing a sexually oriented dysfunction? Select all that apply.

a. Diabetes
b. Depression
c. Chronic pain
d. Gastric ulcers
e. Alcohol consumption

Answer 20

ANS: A, B, C, E
All the options reflect conditions that have known risk factors for sexual dysfunction disorders with the exception of gastric ulcers. Currently there is no known connection between the disorders.