AH3- Sexual Dysfunction (Exam #1)
A client is concerned about becoming impotent because of the inability to sustain an erection and a history of a sexually transmitted infection as a young adult. What is the nurse's best response to this client's concerns? A) An occasional incident like this is normal and common, and there is no reason to be concerned. B) Sexually transmitted infections may result in sexual problems in adults. C) Erectile dysfunction is the correct term for the inability to achieve or sustain an erection. D) The medical diagnosis of erectile dysfunction is not made until the man has erection difficulties in 25% or more of his interactions.
A) An occasional incident like this is normal and common, and there is no reason to be concerned. Rationale: This client is concerned about his masculinity and sexual abilities. The correct answer at this point is to tell him that it is common and normal for men to experience occasional erectile difficulties. The other options are also true, but they do not serve to alleviate the client's concerns. If the client continues to have difficulties achieving or sustaining an erection, further investigation should take place. Simply correcting the client's use of medical terminology does not address his concerns.
The nurse identifies that a client is at risk for dysfunctional uterine bleeding. What did the nurse assess in this client? Select all that apply. A) High level of stress B) Weight gain of 20 lbs. in 2 months C) Uses birth control pills for contraception D) Has a history of peptic ulcer disease E) Limits intake of high-fat foods
A) High level of stress B) Weight gain of 20 lbs. in 2 months C) Uses birth control pills for contraception Rationale: A number of factors may predispose a woman to dysfunctional uterine bleeding. These factors include stress, extreme weight changes, and use of oral contraceptive agents. Dysfunctional uterine bleeding is usually related to hormonal imbalances and not associated with peptic ulcer disease or low-fat diets.
The nurse is caring for a client with erectile dysfunction (ED). Which medication should the nurse anticipate being prescribed for this client? Select all that apply. A) Sildenafil (Viagra) B) Methylphenidate (Ritalin) C) Vardenafil (Levitra) D) Buspirone (BuSpar) E) Tadalafil (Cialis)
A) Sildenafil (Viagra) C) Vardenafil (Levitra) E) Tadalafil (Cialis) Rationale: Sildenafil (Viagra) works to relax the smooth muscles in the penis, allowing increased blood flow to the penis resulting in an erection. Vardenafil (Levitra) works to relax the smooth muscles in the penis, allowing increased blood flow to the penis resulting in an erection. Tadalafil (Cialis) works to relax the smooth muscles in the penis, allowing increased blood flow to the penis resulting in an erection. Buspirone (Buspar) is an antianxiety agent and is not effective for erectile dysfunction (ED). Methylphenidate (Ritalin) is a mild central nervous system stimulant and is not effective for ED.
A client with a history of breast cancer who is entering menopause is seeking information about how to manage hot flashes. What information can be provided to the client? A) Soy and black cohosh can be used to manage the hot flashes associated with menopause. B) The client should be advised that she will have to wait until menopause has finished for the hot flashes to cease. C) Estrogen is the only reliable method of treatment for hot flashes. D) Olive oil and black cohosh are effective in the management of hot flashes.
A) Soy and black cohosh can be used to manage the hot flashes associated with menopause. Rationale: The hot flashes can be successfully managed with soy and black cohosh. Estrogen is not the only reliable method of treatment for hot flashes. Olive oil is not used to manage hot flashes. Advising the client to wait is inappropriate.
During a physical assessment, a client tells the nurse that his penis "hurts" when the shaft is touched. What should the nurse suspect is occurring with this client? A) Urethral stricture B) Acute orchitis C) Inflammatory disease D) Acute epididymitis
A) Urethral stricture Rationale: Normally, palpation of the penis should not cause tenderness. The client's complaint of pain could indicate a urethral stricture. Redness or lesions on the penis could indicate inflammatory disease. Acute epididymis and acute orchitis are associated with a tender scrotum.
A client who is postmenopausal confides in the nurse about pain experienced during intercourse. What should the nurse instruct the client to do? A) Use vaginal lubricants during intercourse. B) Avoid intercourse. C) Tolerate this problem because it is a normal part of aging. D) Decrease the frequency of intercourse to decrease the pain.
A) Use vaginal lubricants during intercourse. Rationale: It is not uncommon for a postmenopausal female to report painful intercourse that is related to a decrease in vaginal lubrication. Vaginal lubricants can be very effective in reducing the pain experienced during intercourse. Although this is a normal change of aging, clients do not have to tolerate the discomfort. Avoidance and decreasing frequency of intercourse would not resolve the problem for the client. It is stereotypical to assume the client would have less of a desire for intercourse at an older age.
The nurse is evaluating care provided to a client experiencing menopause. Which observation indicates that the client is successfully managing menopausal symptoms? A) Weight loss of 5 pounds in 4 months after starting an exercise program at the local gym B) Client's stated desire to stay at home and limit social activities C) Weight gain of 10 pounds in 3 months D) Client's stated loss of interest in recreational activities
A) Weight loss of 5 pounds in 4 months after starting an exercise program at the local gym Rationale: Evidence of successful outcomes for a client with menopause include: demonstrating a positive sense of self as evidenced by stable weight; participation in a regular exercise program; ability to manage stress; verbalizing feelings related to changes that have occurred; and describing strategies for maintaining health. A weight loss of 5 pounds in 4 months after starting an exercise program is evidence of successful management of menopause. The other observations are not evidence of successful management of menopause.
The nurse is caring for a client who is using complementary therapies to manage menopausal symptoms. Which client statement should indicate to the nurse the need for further discussion? (Select all that apply.) A. "Herbs have not been proven to be effective, but they can't hurt." B. "Ginseng may not help with my hot flashes, but it may help me sleep better." C. "A friend used black cohosh for relief of her hot flashes, so I think I will try it." D. "As long as I take soy supplements, I can go back to eating spicy foods." E. "I understand that there is little high-level research on alternative treatments for menopausal symptoms."
A. "Herbs have not been proven to be effective, but they can't hurt." B. "Ginseng may not help with my hot flashes, but it may help me sleep better." C. "A friend used black cohosh for relief of her hot flashes, so I think I will try it." D. "As long as I take soy supplements, I can go back to eating spicy foods." Rationale: Little high-level research has been done on alternative treatment options for menopause symptoms. While research has shown some herbs to be beneficial, they can interact with other medications and need to be discussed with the healthcare provider. Research suggests that soy is beneficial in reducing hot flashes, but diet adjustments should also be made to help reduce hot flashes. Although black cohosh has been a popular alternative to HRT for years, a Cochrane Database review (Leach & Moore, 2012) examined 16 studies and found that, compared to placebo, black cohosh did not decrease hot flashes and other symptoms. The authors concluded that evidence for use of black cohosh is lacking and further research is needed. Ginseng may not help with symptoms of hot flashes, but it can be used for some other symptoms of menopause
A client is experiencing severe symptoms of menopause. About which treatment should the nurse prepare teaching for this client? (Select all that apply.) A. Acupuncture B. Bioidentical hormones C. Muscle relaxers D. Soy and ginseng E. Hormone replacement therapy
A. Acupuncture B. Bioidentical hormones D. Soy and ginseng E. Hormone replacement therapy Rationale: Menopausal symptoms can be treated with medications or the use of alternative and complementary therapies. Medications include hormone replacement therapy and selective serotonin reuptake inhibitors (SSRIs) and other antidepressants, and selective estrogen receptor modulators (SERMs). Alternative and complementary therapies include bioidentical hormones, acupuncture, biofeedback, massage, meditation, yoga, soy, and ginseng. Muscle relaxers are not used to treat manifestations of menopause.
A client experiencing perimenopausal symptoms asks what can be done to help control the symptoms. Which intervention should the nurse recommend? (Select all that apply.) A. Dressing in layers B. Increasing caffeine intake C. Avoiding sexual intercourse D. Engaging in regular exercise E. Drinking cool liquids
A. Dressing in layers D. Engaging in regular exercise E. Drinking cool liquids Rationale: Exercise can help manage the anxiety and mood swings associated with perimenopause. Dressing in loose layers of clothing that can be added or removed will increase comfort during hot flashes. Drinking cool liquids can help with hot flashes. Caffeine is not identified as having an impact on menopausal symptoms. Sexual intercourse does not have to be avoided during perimenopause, but lubricants may be used to decrease discomfort from vaginal dryness.
The nurse prepares teaching material for a client experiencing menopause. Which health promotion intervention should the nurse discuss with the client? (Select all that apply.) A. Eating more estrogenic food, such as brown rice, sweet potatoes, carrots, apples, corn, green beans, and tofu B. Using water-soluble gels to increase vaginal lubrication C. Wearing fitted clothing D. Avoiding alcohol and cigarette use E. Undergoing hormone replacement therapy (HRT) as soon as possible
A. Eating more estrogenic food, such as brown rice, sweet potatoes, carrots, apples, corn, green beans, and tofu B. Using water-soluble gels to increase vaginal lubrication D. Avoiding alcohol and cigarette use Rationale: Health promotion interventions for menopause include teaching the client about the use of water-soluble gels that increase vaginal lubrication and other ways to help her continue or resume a mutually satisfying sexual relationship with her partner. Eating foods that are mildly estrogenic, such as brown rice, sweet potatoes, carrots, apples, corn, green beans, and tofu, may also improve vaginal dryness. Avoiding alcohol and tobacco use is beneficial as well. The nurse should teach the client about dressing in loose layers, not in fitted clothing. The nurse should teach the client about the risks and the benefits of HRT but emphasize that not every woman needs or wants it.
A middle-aged female client experiencing symptoms of menopause has increased follicle-stimulating hormone and luteinizing hormone levels. Which intervention should the nurse initiate? (Select all that apply.) A. Encouraging discussion of how menopausal symptoms are affecting sexual functioning B. Providing information about medications that might be prescribed to help with menopausal symptoms C. Asking open-ended questions about the client's body image D. Explaining physiologic manifestations of menopause E. Instructing the client to avoid over-the-counter vaginal lubricants
A. Encouraging discussion of how menopausal symptoms are affecting sexual functioning B. Providing information about medications that might be prescribed to help with menopausal symptoms C. Asking open-ended questions about the client's body image D. Explaining physiologic manifestations of menopause Rationale: The client is experiencing menopause and may have problems understanding the natural female aging process, sexual dysfunction, low self-esteem, or disturbed body image. Interventions to help the client with these problems include explaining the physiologic manifestations of menopause, providing information about medications that might be prescribed to help with menopausal symptoms, encouraging discussion of how menopausal symptoms are affecting sexual functioning, and instructing the client to use vaginal lubricants if experiencing decreased lubrication. Asking open-ended questions will further explore the client's thoughts and feelings about body image in a therapeutic manner.
The nurse examines a middle-aged female client following a hysterectomy. The nurse knows this gynecologic procedure can cause physical and psychologic changes. Which condition may these changes lead to in the client? A. Female orgasmic disorder B. Sexual interest/arousal disorder C. Vaginismus D. Genito-pelvic pain/penetration disorder
A. Female orgasmic disorder Rationale: Certain gynecologic surgeries, especially hysterectomy and oophorectomy, can cause physical and psychologic changes that make orgasm difficult. Vaginismus is commonly associated with genito-pelvic pain/penetration disorders. Gynecologic surgical procedures have not been linked to sexual interest/arousal disorder or genito-pelvic pain/penetration disorder.
The nurse interviews a middle-aged client experiencing menopause. Which option should the nurse discuss to help with the symptoms? (Select all that apply.) A. Hormone replacement therapy B. Calcium intake of 500 mg a day C. Nonpharmacologic methods of relief D. Sexual abstinence E. Lifestyle changes
A. Hormone replacement therapy C. Nonpharmacologic methods of relief E. Lifestyle changes Rationale: Many physiologic effects of menopause are amenable to either hormone replacement therapy (HRT) or nonpharmacologic methods of relief, such as lifestyle changes, so these options should be discussed. The recommended daily calcium intake for women over age 50 is 1200 mg to help prevent osteoporosis. Menopause does not require abstaining from sexual contact.
A client asks about the symptoms of menopause during a wellness visit. Which vasomotor manifestation of menopause should the nurse describe? (Select all that apply.) A. Hot flashes B. Night sweats C. Decreased body hair D. Palpitations E. Dizziness
A. Hot flashes B. Night sweats D. Palpitations E. Dizziness Rationale: The manifestations of menopause affect many body systems, including the vasomotor system. Vasomotor manifestations include hot flashes, palpitations, dizziness, headaches, insomnia, and night sweats. Decreased body hair is an integumentary, not vasomotor, manifestation of menopause. Menopausal clients have integumentary manifestations that include decreased body hair, decreased skin elasticity, and decreased subcutaneous tissue
The nurse is caring for a client who was diagnosed with erectile dysfunction (ED) several months ago. The client has poor visual acuity and experiences a tremor in his left hand. Which treatment choice for ED is not likely to meet the client's needs? A. Injectable medications B. Mechanical devices C. Oral medications D. Penile implant
A. Injectable medications Rationale: Oral medications, injectable medications, mechanical devices, and penile implants are all interventions for ED. Of these, injectable medications are often not an acceptable treatment for clients. A client with a hand tremor and poor vision would not be a good candidate for self-injections. Many clients report dissatisfaction with them because of difficulty in self-injecting, pain, lack of spontaneity, and cost.
A client experiencing menopause is concerned about a loss in height. Which change should the nurse explain as being responsible for this finding? A. Menopause can lead to osteoporosis, which in turn can lead to fractures and kyphosis. B. Menopause leads to hormone changes that affect muscle strength in the body. C. Menopause leads to bone changes that can cause scoliosis. D. Menopause can lead to poor nutrition and decreased bone density.
A. Menopause can lead to osteoporosis, which in turn can lead to fractures and kyphosis. Rationale: Long-term estrogen deprivation results in an imbalance in bone remodeling and osteoporosis, leading to fractures and kyphosis. Scoliosis is curvature of the spine. Poor nutrition can affect how a woman responds to menopause, but menopause does not cause poor nutrition. Muscle weakness is not associated with menopause.
Which women are most likely to report decreased desire accompanied by personal distress? A. Middle-aged women B. Postmenopausal women C. Pregnant women D. Young women
A. Middle-aged women Rationale: Women of all ages may be affected by female sexual interest/arousal disorder, although middle-aged women are most likely to report decreased desire accompanied by personal distress. It is likely that older women actually have lower levels of desire but are either less troubled by it or less likely to report it. Young women and pregnant women are less affected by sexual interest/arousal disorder.
A client with a history of bone fractures is experiencing severe hot flashes from menopause. Which medication should the nurse anticipate being prescribed for this client? A. Selective estrogen receptor modulator (SERM) B. Monoamine oxidase inhibitor (MAOI) C. Selective serotonin reuptake inhibitor (SSRI) D. Serotonin-norepinephrine reuptake inhibitor (SNRI)
A. Selective estrogen receptor modulator (SERM) Rationale: A SERM combined with conjugated estrogen is used to treat hot flashes and reduce risk of bone fractures. Recent research also suggests that SSRIs and SNRIs are effective in relieving hot flashes and night sweats, but they do not reduce the risk of bone fracture. MAOIs are a class of antidepressants.
The nurse is explaining that lifestyle choices often can be both a risk factor for and a cause of erectile dysfunction (ED). Which lifestyle choices cause ED? A. Smoking, alcohol use, being overweight B. Stress, anxiety, low self-esteem C. Injury to the penis, chronic obstructive pulmonary disease (COPD), diabetes mellitus D. Low level of testosterone, hypothyroidism
A. Smoking, alcohol use, being overweight Rationale: Smoking, alcohol use, being overweight, and not exercising are examples of lifestyle choices. Stress, anxiety, and low self-esteem are examples of psychological causes. Injury to the penis, COPD, and diabetes mellitus are examples of vascular causes. Low levels of testosterone and thyroid alterations are examples of endocrine causes.
The nurse is assessing a client experiencing menopause. Which findings should the nurse expect in this client? (Select all that apply.) A. Thinning hair B. Cold intolerance C. Headaches D. Hot flashes E. Vaginal dryness
A. Thinning hair C. Headaches D. Hot flashes E. Vaginal dryness Rationale: The physical manifestations of menopause are thought to be related to diminishing estrogen. This accounts for the hot flashes, vaginal dryness, thinning hair, and headaches. Women experiencing menopause do not typically experience cold intolerance.
While performing a physical exam on a female client, the nurse finds the client has a malformation of the genital tract as well as hypertonicity of the muscles in the pelvic floor. Which condition may result from these physical findings? A. Vaginismus B. Sexual interest/arousal disorder C. Female orgasmic disorder D. Genito-pelvic pain/penetration disorder
A. Vaginismus Rationale: Vaginismus tends to be primary rather than secondary. Potential physical causes of primary vaginismus include malformations of the genital tract, as well as hypertonicity and/or poor control of the muscles in the pelvic floor. Vaginismus may be involved with genito-pelvic pain/penetration disorder, but these physical findings do not necessarily cause genito-pelvic pain/penetration disorder. These physical findings are not associated with female orgasmic disorder or sexual interest/arousal disorder.
A client experiencing menopause is being counseled about bone health and exercise. Which exercise should be recommended for bone health? A. Walking B. Cycling C. Stretching D. Swimming
A. Walking Rationale: Walking is the best method of maintaining bone health for a client in menopause. Weight-bearing exercise reduces the rate of bone loss, helps maintain optimum weight, and reduces cardiovascular risk. Swimming, cycling, and stretching are not weight-bearing exercises.
A client in menopause is experiencing sexual issues. Which information should the nurse provide to the client? A. Water-based gels are helpful for vaginal lubrication. B. Oil-based lubricants can make sexual activity more enjoyable. C. Foreplay is not needed after menopause. D. Dietary changes are not needed during menopause due to hormone changes.
A. Water-based gels are helpful for vaginal lubrication. Rationale: Water-soluble gels are helpful for vaginal lubrication in the client experiencing symptoms of menopause. Increased foreplay might be needed in menopause to allow more time for vaginal lubrication. Oil-based lubricants are not recommended. Dietary changes can be used to help with vaginal dryness and weight gain associated with menopause.
A client is trying to prevent complications of menopause such as osteoporosis and cardiovascular problems. Which intervention should the nurse suggest as most beneficial? A. Weight-bearing exercise reduces the rate of bone loss and reduces cardiovascular risk. B. Take 900 mg of calcium daily to prevent osteoporosis. C. Hormone replacement therapy is essential for avoiding the complications of menopause. D. Black cohosh can reduce cardiovascular risk during menopause.
A. Weight-bearing exercise reduces the rate of bone loss and reduces cardiovascular risk. Rationale: The nurse should emphasize the importance of weight-bearing exercise, which reduces the rate of bone loss, helps maintain optimum weight, and reduces cardiovascular risk. The recommended daily calcium intake for women over age 50 is 1200 mg to help prevent osteoporosis. While there are benefits to undergoing HRT, osteoporosis and cardiovascular problems are still possible. Researchers studying black cohosh, which is often used to treat hot flashes and other symptoms (not cardiovascular problems), have concluded that evidence for its effectiveness is lacking and further research is needed
During a health history, the nurse learns that a client has a recent onset of impotence. Which question will help identify a potential cause of this manifestation? A) "Does this occur often?" B) "For what diseases and disorders have you been treated?" C) "Are you on any medications?" D) "How does your partner feel about this problem?"
B) "For what diseases and disorders have you been treated?" Rationale: A client's health history can provide clues to the underlying cause of impotence. The question "for what diseases and disorders have you been treated" would provide the nurse with information as to possible causes for the recent onset of the disorder. Asking the client if the impotence occurs often will not help identify the cause of the problem. Asking the client how the partner feels about the problem also will not help identify a possible cause. The question "are you on any medication?" would be beneficial to ask; however, it should be an open-ended question and not a closed-ended question as identified. The nurse should ask the client to "list any medications" instead of asking "are you on any medication?" which could be answered with a yes or no.
A nurse is caring for a client who is prescribed a selective phosphodiesterase type 5 inhibitor for the treatment of erectile dysfunction. The nurse should include which statement when educating the client regarding this medication? A) "You should take this medication about 30 minutes before sexual activity." B) "The action of this medication will last up to 36 hours." C) "This medication will enhance erections with or without sexual stimulation." D) "This medication should not be taken more than twice daily."
B) "The action of this medication will last up to 36 hours." Rationale: Sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra), tadalafil (Cialis), and avanafil (Stendra) are all selective phosphodiesterase type 5 inhibitors used in the treatment of erectile dysfunction. The nurse should tell the client that the action of this medication will last up to 36 hours. The client should take the medication an hour prior to sexual activity, not 30 minutes. This medication will enhance erections only with sexual stimulation and should not be taken more than once daily.
The nurse suspects a 20-year-old client is experiencing primary dysmenorrhea. Which did the nurse assess in this client? Select all that apply. A) Bleeding between menstrual periods B) Headache C) Fatigue D) Diarrhea E) Scant menses
B) Headache C) Fatigue D) Diarrhea Rationale: Manifestations of primary dysmenorrhea include headache, diarrhea, and fatigue in addition to vomiting, breast tenderness, and pain radiating to the lower back and thighs. Scant menses is a symptom of a hormone imbalance. Bleeding between menstrual periods is a characteristic of metrorrhagia.
nurse is caring for a client who is perimenopausal who states that she has recently had frequent bacterial vaginal infections. The nurse understands that the reason this has occurred is likely due to which of the following? A) Decreased vaginal pH B) Increased vaginal pH C) Increased estrogen level D) Decreased vasomotor stability
B) Increased vaginal pH Rationale: In the perimenopausal client, the vaginal pH increases, predisposing the client to bacterial vaginal infections. In perimenopause, estrogen levels decrease, not increase. Decreased vasomotor stability leads to hot flashes, not vaginal bacterial infections.
The nurse is planning care for a client with erectile dysfunction. What should the nurse include in this client's plan of care? Select all that apply. A) Names of psychologists with experience in treating the disorder B) Information on medications for treatment C) Types of devices and surgeries available to help with the disorder D) Reason for disorder as being side effect of prescribed medication E) Information on exact cause
B) Information on medications for treatment C) Types of devices and surgeries available to help with the disorder Rationale: When planning the care of a client with erectile dysfunction, the nurse should include information on medications for treatment and types of devices and surgeries available to help with the disorder. Because an exact cause may be difficult to determine for the client, this would not be appropriate for the nurse to include in the client's plan of care. Explaining the reason for the disorder as being a side effect of prescribed medication could cause the client to discontinue medication necessary to treat other health disorders and should not be done. The nurse should not provide the names of psychologists who treat the disorder.
A nurse is caring for a client who complains of pain with menstruation. What is true regarding the etiology and pathophysiology of this condition? A) Primary dysmenorrhea is caused by decreased levels of prostaglandins, causing the contractions of the uterus to increase in strength. B) Primary dysmenorrhea begins within the first 3 or 4 menstrual periods after menarche and will occur with each ovulatory cycle during the teens and 20s of a woman's life. C) Secondary dysmenorrhea is more common than primary dysmenorrhea. D) Primary dysmenorrhea causes include endometriosis, tumors, cysts, pelvic adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adneomyosis.
B) Primary dysmenorrhea begins within the first 3 or 4 menstrual periods after menarche and will occur with each ovulatory cycle during the teens and 20s of a woman's life. Rationale: Pain associated with menses, called dysmenorrhea, is one of the most common menstrual dysfunctions. Primary dysmenorrhea is very common among women with normal menstrual function and is more common than secondary dysmenorrhea. Primary dysmenorrhea is caused by the release of prostaglandins that cause the contractions of the uterus needed to expel menstrual fluid and tissue. Primary dysmenorrheal begins within the first 3 or 4 menstrual periods after menarche and will occur with each ovulatory cycle during the teens and 20s of a woman's life. Secondary dysmenorrhea is related to pathology or diseases that affect the uterus and pelvic area. Causes of secondary dysmenorrhea include endometriosis, tumors, cysts, pelvic adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adneomyosis.
A female client is prescribed an androgen medication to treat an estrogen-sensitive type of breast cancer. What should the nurse instruct this client about the medication? Select all that apply. A) There is an increased risk of multiple births. B) Secondary male sex characteristics may develop. C) Monitor weight weekly. D) Report calf pain or dyspnea. E) It must be taken with food.
B) Secondary male sex characteristics may develop. C) Monitor weight weekly. Rationale: Androgen hormone replacements may be used to treat estrogen-dependent cancers. The nurse should instruct the client of the risk of developing secondary male sex characteristics when taking this medication. This medication also affects body weight so the nurse should instruct the client to monitor body weight weekly. Increased risk of multiple births is associated with female infertility medications. Reporting calf pain or dyspnea is associated with estrogen hormone replacement therapy. This medication does not need to be taken with food.
A male client tells the nurse that he has no idea why his wife wants to stay married to him because he has not been able to "perform" sexually since his prostate surgery. Which diagnosis would be appropriate for this client? A) Ineffective Coping B) Situational Low Self-Esteem C) Hormonal Imbalance D) Sexual Dysfunction
B) Situational Low Self-Esteem Rationale: The client is viewing himself as less than a man and is concerned with his wife wanting to remain married to him. Situational Low Self-Esteem is the most appropriate nursing diagnosis for the client at this time. Sexual dysfunction is associated with anxiety concerning the cause of the dysfunction, which is not the case for the client. The client may or may not be experiencing ineffective coping. Hormonal imbalance is not a nursing diagnosis.
The nurse is conducting a health history with a client with erectile dysfunction. Which finding(s) could provide a possible cause for the client's problem? Select all that apply. A) Blood pressure of 118/68 mmHg B) Treatment for type 2 diabetes mellitus for 7 years C) Body mass index (BMI) of 24.5 D) Alcohol intake of 4 to 6 beers each day E) Plays golf twice a week
B) Treatment for type 2 diabetes mellitus for 7 years D) Alcohol intake of 4 to 6 beers each day Rationale: The risk factors for erectile dysfunction are numerous. They include advancing age, diseases such as heart disease and diabetes, trauma, and the use of prescription or illicit drugs. Excessive use of alcohol can also result in erectile dysfunction. Recreational sports, a body mass index within normal limits, and a normal blood pressure would not provide a possible cause for the client's recent experience with the disorder.
A female client complains of having a "strange discharge" from the vagina and "stinging" when voiding urine. Which diagnostic test(s) would be useful to aid in the diagnosis of this client's disorder? Select all that apply. A) Biopsy B) Urinalysis C) Complete blood count D) Serum hormone levels E) Papanicolaou smear
B) Urinalysis E) Pap smear Rationale: The client is complaining of a strange discharge from her vagina. A Papanicolaou smear would be the most helpful in diagnosing the cause of that symptom. The client is also complaining of stinging with urination. A urinalysis would be helpful to rule out a urinary tract infection as the cause for the urinary pain. The other diagnostic tests may or may not help diagnose this client's health problem.
A high school student asks the school nurse what can be done for menstrual cramps. What should the nurse recommend to this student who is experiencing primary dysmenorrhea? Select all that apply. A) Increase caffeine intake. B) Use a heating pad. C) Try black cohosh. D) Engage in regular exercise. E) Avoid vitamin supplements.
B) Use a heating pad. C) Try black cohosh. D) Engage in regular exercise. Rationale: Regular aerobic activity helps to decrease dysmenorrhea symptoms. Caffeine should be restricted to reduce irritability. Black cohosh helps reduce manifestations in some clients. Vitamin supplements should not be avoided and may be needed to help control symptoms. A heating pad helps reduce abdominal cramping and pain.
A postpartum client presents with sexual dysfunction that has worsened with time. The nurse should teach this client about the factors that can cause reductions in desire and vaginal lubrication, leading to dyspareunia. Which factor may be responsible for this condition? A. Anxiety B. Breastfeeding C. Delivery-related damage to the vulva D. Fatigue
B. Breastfeeding Rationale: Decreased androgen and estrogen levels and increased prolactin levels (especially in breastfeeding women) cause reductions in desire and vaginal lubrication, leading to dyspareunia. Fatigue and anxiety can contribute to low desire and difficulty reaching orgasm, but not dyspareunia. Delivery-related damage to the vulva, perineum, and pelvic floor can cause dyspareunia, but will not cause reduction in desire and vaginal lubrication.
A client has chosen to use topical hormone applications to treat erectile dysfunction. Which advice should the nurse give this client? A. Never apply the medication more than once in a 24-hour period. B. Ensure women and children do not touch the medication. C. Only apply the medication as needed. D. Wash hands thoroughly after application of the medication.
B. Ensure women and children do not touch the medication Rationale: While washing hands thoroughly after application, only applying as needed, and only applying once in a 24-hour period may be beneficial, men who use topical hormone applications must take precautions to ensure women and children do not come into contact with testosterone-containing gels or creams because this can be harmful to their health.
A female client was raised in a society in which women have few sexual rights and are subject to practices such as forced matrimony, child marriage, and polygamy. The nurse understands that women who grew up in sexually repressive environments are at an increased risk for some disorders. Which disorder would be most expected? A. Female orgasmic disorder B. Genito-pelvic pain/penetration disorder C. Vaginismus D. Sexual interest/arousal disorder
B. Genito-pelvic pain/penetration disorder Rationale: Women who grew up in sexually repressive environments are at increased risk for genito-pelvic pain/penetration disorder, and the condition is more common in societies where women have few sexual rights and are subject to practices such as forced matrimony, child marriage, and polygamy. This type of environment is not associated with female orgasmic disorder or sexual interest/arousal disorder. Vaginismus may accompany this disorder.
A male client has chosen to wear a transdermal patch for hormone replacement to boost libido. While the client is undergoing this therapy, the nurse advises the client regarding monitoring of certain biochemical factors. Which factor should be monitored? A. Red blood cells B. Liver enzymes C. White blood cells D. Prostate-specific antigen (PSA)
B. Liver enzymes Rationale: Hormone replacements may be administered via injection, transdermal patch, or topical gel. Although such therapy can boost a man's libido and sperm count, it comes with potential side effects including acne, weight gain, hyperglycemia, priapism, renal stones, and jaundice. Thus, men who receive hormone therapy require regular monitoring of their liver enzymes, blood glucose, and serum electrolytes. Red blood cells, white blood cells, and prostate-specific antigen (PSA) are not affected by hormone replacement therapy.
The nurse is caring for a male client being discharged from the hospital with a nitroglycerin prescription for chest pain. The client states that he takes sildenafil citrate (Viagra) for erectile dysfunction (ED), knowing that this is no longer safe. The client is unwilling to try injectable medication and is not a candidate for surgical intervention. Which treatment option for ED would be appropriate for the nurse to include in the discharge instructions? A. Biofeedback device B. Mechanical device C. Topical cream D. Acupuncture
B. Mechanical Device Rationale: If a client is unable to take oral medications, unwilling to try injectable medications, and not a candidate for surgery, a mechanical device such as a vacuum constriction device (VCD) may be prescribed. This device draws blood into the penis via a vacuum, where it is trapped by a constricting O-ring at the base of the penis. The device is removed for intercourse, with the O-ring left in place to maintain the erection. Topical creams, acupuncture, and biofeedback devices are not evidence-based treatments for ED.
Which nursing diagnosis should the nurse consider when planning care for a client experiencing menopause? (Select all that apply.) A. Constipation B. Self-Esteem, Situational Low C. Knowledge, Deficient D. Sexuality Pattern, Ineffective E. Body Image, Disturbed
B. Self-Esteem, Situational Low C. Knowledge, Deficient D. Sexuality Pattern, Ineffective E. Body Image, Disturbed
The nurse is teaching a client about treatment options for erectile dysfunction (ED). Which explanation regarding pharmacologic treatment is the most appropriate? A. The medications dilate blood vessels all over the body except in the penis, to achieve an erection. B. The medications help achieve an erection during sexual stimulation by relaxing the smooth muscle of the penis and increasing blood flow. C. The medications constrict blood flow to other parts of the body in order to shunt it to the penis during sexual stimulation. D. The medications allow one to relax enough to reduce the psychological stress of ED in order to achieve an erection.
B. The medications help achieve an erection during sexual stimulation by relaxing the smooth muscle of the penis and increasing blood flow Rationale: Oral medications enhance erections in the presence of sexual stimulation. They increase the effects of nitrous oxide to relax smooth muscle in the penis and increase blood flow during sexual stimulation.
The healthcare provider of a 64-year-old client newly diagnosed with ED has ordered sildenafil citrate (Viagra) upon discharge. Which information should be included in the discharge instructions for this client? A. The effects of this drug can last up to 36 hours. B. This drug should not be taken more than once a day. C. This drug can be taken in conjunction with alpha-adrenergic blockers. D. This drug can be taken with nitroglycerin sublingual tablets.
B. This drug should not be taken more than once a day Rationale: Oral medications such as a Viagra, Levitra (vardenafil hydrochloride), Cialis (tadalafil), and Stendra (avanafil) should be taken no more than once a day and should not be used by men who are taking nitrate-based drugs or alpha-adrenergic blockers. The duration of effects of these drugs does need to be included in the discharge instructions for this client, but Viagra's duration is not 36 hours.
A client experiencing menopause does not want to take any prescribed medications for the symptoms. Which alternative or complementary therapy should the nurse review with the client? (Select all that apply.) A. Hormone replacement therapy B. Yoga C. Bioidentical hormones D. Soy and ginseng E. Massage
B. Yoga C. Bioidentical hormones D. Soy and ginseng E. Massage Rationale: Soy, ginseng, yoga, bioidentical hormones, and massage are all considered alternative or complementary therapies to manage menopausal symptoms. Hormone replacement therapy is not considered an alternative or complementary therapy.
A young adolescent client is concerned about experiencing severe cramps with menstruation. What should the nurse respond to this client? A) "This is not normal but is something that can be treated." B) "You have cramps because you started your periods too early." C) "Cramps are seen in those who just start having periods and will become less severe as you get older." D) "You need to see a gynecologist for a pelvic examination."
C) "Cramps are seen in those who just start having periods and will become less severe as you get older." Rationale: Primary dysmenorrhea occurs without specific pelvic pathology and is most often seen in girls who have just begun menstruating, becoming less severe after the mid-20s. The client does not need to see a gynecologist for a pelvic examination. Cramps are normal in the age range. The client is an early adolescent, which is not too early to start having periods.
The nurse is instructing a client about the medication sildenafil (Viagra). Which client statement indicates teaching has been effective? A) "Viagra should be taken with food." B) "I can take Viagra anywhere from 1 to 6 hours before sex." C) "I can take only one pill in a 24-hour period." D) "Grapefruit juice will decrease the effects of Viagra."
C) "I can take only one pill in a 24-hour period." Rationale: Taking only one pill in a 24-hour period is the recommended dosing for sildenafil (Viagra). Grapefruit juice can lead to increased, not decreased, levels of sildenafil. Sildenafil should be taken on an empty stomach, not with food. The optimum time for administration is 1 hour before sex, but it can be taken up to 4 hours before sex.
A nursing working in an outpatient women's health clinic is caring for a client in menopause. When discussing hormone replacement therapy (HRT) with the client, the nurse should include which statement? A) "Most healthy, recently menopausal women should not use HRT for relief of hot flashes and vaginal dryness." B) "HRT is the least effective treatment of menopausal hot flashes and vaginal dryness." C) "If vaginal dryness and painful intercourse are the only symptoms, then low-dose vaginal estrogen is preferred." D) "The risk of blood clots in the legs or lungs is further increased by using transdermal patches, gels, or sprays."
C) "If vaginal dryness and painful intercourse are the only symptoms, then low-dose vaginal estrogen is preferred." Rationale: If vaginal dryness and dyspareunia (painful intercourse) are the only symptoms, then low-dose vaginal estrogen is preferred. Most healthy, recently menopausal women may use HRT for relief of hot flashes and vaginal dryness. Risks for blood clots in the legs and lungs are increased with HRT, but occurrence is rare in women age 50-59. The risk is further lowered by using low-dose estrogen pills or transdermal patches, gels, or sprays.
A female client tells the nurse about having difficulty with sexual relations because of a recent weight gain. Which interventions should the nurse include when planning this client's care? A) Sexual self-concept B) Gender identity C) Body image D) Gender-role behavior
C) Body image Rationale: Body image is constantly changing. How people feel about their bodies is related to sexuality. People who have a poor body image may respond negatively to sexual arousal. This is what the client is experiencing. Sexual self-concept determines with whom one will have sex, the gender and kinds of people one is attracted to, and the values about when, where, with whom, and how one expresses sexuality. Gender identity is one's self-image as male or female. Gender-role behavior is the outward expression of a person's sense of maleness or femaleness as well as the expression of what is perceived as gender-appropriate behavior.
The nurse has identified the diagnosis of Ineffective Coping for a client with severe premenstrual syndrome. What should be included in this client's plan of care? A) Encourage frequent rest periods. B) Suggest 4 ounces of wine each day. C) Encourage exercise and relaxation techniques. D) Instruct to avoid contraception during menstruation if engaging in sexual intercourse.
C) Encourage exercise and relaxation techniques. Rationale: Interventions to aid with ineffective coping for a client with severe premenstrual syndrome include encouraging exercise and relaxation techniques and avoiding alcohol intake. The client should not be encouraged to have 4 ounces of wine each day. The client should be instructed to use contraception if engaging in sexual intercourse during menstruation because ovulation and pregnancy can occur. Frequent rest periods would be beneficial for a client with dysfunctional uterine bleeding.
A female client asks what causes the symptoms of menopause. On which hormonal function should the nurse focus when responding to this client's question? A) Increased estrogen levels B) Increased progesterone levels C) Estrone as the major hormone D) Increased luteinizing hormone levels
C) Estrone as the major hormone Rationale: As ovarian function decreases, the production of estrogen decreases and is replaced by estrone as the major ovarian estrogen. Estrone is produced in small amounts and has only about one-tenth the biological activity of estradiol. With decreased ovarian function, the second ovarian hormone, progesterone, which is produced during the luteal phase of the menstrual cycle, also is markedly reduced.
A client approaching menopause is interested in oral hormone replacement therapy to manage the symptoms. Which should the nurse include in this client's teaching plans? A) Hormone replacement therapy is linked to higher rates of deep vein thrombosis and colorectal cancer. B) Estrogen is cardio-protective for women. C) Hormone replacement therapy is useful for women who are at an increased risk for the development of osteoporosis. D) Hormone replacement therapy is associated with a reduced incidence of breast cancer and pulmonary embolism.
C) Hormone replacement therapy is useful for women who are at an increased risk for the development of osteoporosis. Rationale: Osteoporosis is associated with the reduction of estrogen. Hormone replacement therapy is encouraged for those women who are at an increased risk for the development of this disease. Estrogen was once thought to be cardio-protective for women, but newer studies refute these claims. There is an increased risk for breast cancer and pulmonary embolism for those women who are taking hormone replacement therapy. Although the rates of deep vein thrombosis are increased, the rates of colorectal cancer are reduced in those taking hormone replacement therapy.
The nurse is developing strategies for the relief of menstrual cramping to teach a group of young women. What should be the focus of these strategies? A) Minimization of menstrual flow B) Avoidance of uterine contraction C) Increase of blood flow to the uterine muscle D) Decrease in estrogen production
C) Increase of blood flow to the uterine muscle Rationale: Menstrual cramping is a result of the muscle ischemia that occurs when the client experiences powerful uterine contractions. Increase of blood flow to the uterine muscle through rest, some exercises, application of heat to the abdomen, and presence of milder uterine contractions (such as those associated with orgasm) can decrease pain and cramping. There is no connection between the actual amount of flow and pain. Estrogen production should follow normal patterns and should not be altered.
A female client tells the nurse about having no interest in sex since it has become painful. Which intervention(s) would be appropriate to help the client with this problem? Select all that apply. A) Ask when the last Pap smear was performed. B) Discuss the need to be screened for sexually transmitted infections. C) Instruct on the use of artificial lubrication. D) Encourage the client to discuss with the healthcare provider because there are medications to help with this problem. E) Suggest antibiotics to treat the pain.
C) Instruct on the use of artificial lubrication. D) Encourage the client to discuss with the healthcare provider because there are medications to help with this problem. Rationale: The client is describing a sexual arousal disorder, a subjective lack of sexual excitement that is linked with a lack of lubrication in the female. Interventions to help with this problem include using artificial lubrication and discussing medication options with the healthcare provider. Antibiotics, screening for sexually transmitted infections, and the last Pap smear would be interventions to address a sexual pain disorder, which involves pain that occurs during or immediately after intercourse.
A premenopausal client tells the nurse that she is not looking forward to menopause because it means her life is over. Which nursing diagnosis would be appropriate for the client at this time? A) Ineffective Sexuality Pattern B) Deficient Knowledge C) Situational Low Self-Esteem D) Disturbed Body Image
C) Situational Low Self-Esteem Rationale: The client believes that once menopause is reached, her life is over. The most appropriate nursing diagnosis for the client at this time would be Situational Low Self-Esteem because the client could have inadequate coping skills to aid with the aging process. There is no information to support the diagnosis of Ineffective Sexuality Pattern. The client may or may not have deficient knowledge or a disturbed body image.
During a sexual history, a female client tells the nurse that because she is in a committed relationship, sexual relations are more satisfying and frequent. What should the nurse realize the client is describing? A) Emptiness B) A lack of intimacy C) The feeling of connectedness D) Disconnection
C) The feeling of connectedness Rationale: Fulfillment of sexuality depends on the ability to relate to a partner in an intimate and mutually pleasing manner that is compatible with one's values and chosen lifestyle. Lack of intimacy is related to satisfaction problems. If one has sex with a stranger, the body may function well, but there is often a sense of something missing after the sexual experience. Making love to one person while feeling more attracted to or in love with another person can result in feelings of emptiness or disconnection. Even couples in a committed relationship may complain of lack of intimacy. Dissatisfaction issues include lack of romance, love, tenderness, and nurturance.
The nurse is caring for a client recovering from a total hysterectomy. What should the nurse include when instructing this client prior to discharge? A) The importance of douching after intercourse for at least 6 weeks B) Why bed rest is indicated for at least a month after the surgery C) The risks and benefits of hormone replacement therapy D) The importance of returning to normal activities of daily living as soon as possible
C) The risks and benefits of hormone replacement therapy Rationale: If the ovaries have been removed with a hysterectomy, the nurse should provide information on the risks and benefits of hormone replacement therapy because the client is immediately thrust into menopause. The client should restrict physical activity for 4 to 6 weeks after the surgery. Bed rest is not indicated when recovering from this surgery. Douching and sexual intercourse should be avoided for at least 4 to 6 weeks after the surgery.
While performing a sexual history, the nurse learns that a client experiences vaginal discomfort during intercourse. Which intervention should the nurse recommend to the client? (Select all that apply.) A. Discuss having a hysterectomy with the healthcare provider. B. Apply ice packs to the perineum before having intercourse. C. Have testing for sexually transmitted infections. D. Use topical lidocaine before having intercourse. E. Take a warm bath before having intercourse.
C. Have testing for sexually transmitted infections. D. Use topical lidocaine before having intercourse. Rationale: Suggestions to help with a sexual pain disorder include having testing for sexually transmitted infections and applying topical lidocaine. A warm bath before intercourse is not an intervention to reduce pain with intercourse. Ice packs applied to the perineum would be appropriate for priapism. A hysterectomy is an appropriate intervention for menstrual dysfunction.
The nurse is preparing to examine a client who is experiencing menopause. Which information should the nurse obtain when performing a health history? (Select all that apply.) A. Posture B. Vital signs C. Menstrual history D. Sleep pattern E. Medications
C. Menstrual history D. Sleep pattern E. Medications Rationale: When performing a health history on a client experiencing menopause, the nurse should obtain information about the client's menstrual history, medications, and sleep pattern. Posture and vital signs are assessments that the nurse will include when completing the physical examination.
An older adult client presents with alterations in ejaculation after initiating medical treatment for hypertension. Which form of sexual dysfunction is the client likely suffering? A. Retrograde ejaculation B. Primary delayed ejaculation C. Secondary delayed ejaculation D. Premature ejaculation
C. Secondary ejaculation Rationale: Secondary delayed ejaculation is more commonly linked to physical causes, including use of certain medications (opioids, antihypertensives, and antidepressants) and various diseases, injuries, and procedures that affect nerve function in the pelvic region. Premature ejaculation is linked to a number of biological and psychologic causes. Primary premature ejaculation is frequently related to psychologic issues of events that occurred during childhood or adolescence. Secondary premature ejaculation is more likely linked to biological contributors such as thyroid dysfunction and prostate disease. Retrograde ejaculation nearly always occurs due to muscle and nerve damage from surgery. Primary delayed ejaculation seems most often related to psychologic factors.
The nurse is caring for a client with diabetes mellitus who is newly diagnosed with erectile dysfunction (ED). The client asks how diabetes caused the ED. Which rationale is the basis of the nurse's response? A. The psychological stress of having a chronic disease brought on the ED. B. The medications the client is on for diabetes mellitus is a cause of ED. C. Vascular and nerve damage associated with diabetes mellitus contributes to ED. D. ED is a normal part of aging that happens to all men at some point.
C. Vascular and nerve damage associated with diabetes mellitus contributes to ED Rationale: Both vascular and nerve damage related to diabetes mellitus may affect sexual arousal and orgasm, contributing to ED. Medications prescribed for diabetes mellitus are not known to increase the risk of ED. Although psychological stress may be a cause of ED, a diagnosis of diabetes mellitus is not itself a risk factor. ED is not a normal part of aging, although there may be some age-related changes, such as decreased testosterone levels, that happen to men.
A client asks for a prescription for tadalafil (Cialis). What would be important for the nurse know prior to planning interventions for this client? A) "Do you have diabetes mellitus?" B) "Do you take blood pressure medication?" C) "Do you have any sexually transmitted infections?" D) "Do you use nitroglycerine?"
D) "Do you use nitroglycerine?" Rationale: Combining tadalafil (Cialis) with nitroglycerine can lead to serious hypotension. Taking blood pressure medication is not a contraindication to the use of tadalafil (Cialis). Having diabetes mellitus is not a contraindication to the use of tadalafil (Cialis). Having a sexually transmitted infection is not a contraindication to the use of tadalafil (Cialis).
The nurse is assessing a postmenopausal client. Which client statement should indicate further assessment by the nurse? A) "I use water-soluble lubricant to treat my vaginal dryness." B) "For some reason, I have more sexual desire than ever." C) "Sex certainly takes longer than it used to, but I'm getting used to that." D) "I am so glad that I don't need to worry about sex anymore."
D) "I am so glad that I don't need to worry about sex anymore." Rationale: The nurse would further assess the client who made the statement, "I am so glad that I don't need to worry about sex anymore." This statement is unclear. Does it mean that the client is glad not to have to engage in sex anymore, or does it mean that she will not have to worry about getting pregnant anymore? The other statements reflect normal changes associated with aging and healthy responses to those changes.
A nurse is treating a client with diabetes mellitus who complains of erectile dysfunction (ED). Which hormonal cause contributes to ED? A) Increased prolactin levels B) Decreased aldosterone levels C) Decreased circulating catecholamines D) Decreased thyroid-stimulating hormone
D) Decreased thyroid-stimulating hormone Rationale: Hormonal causes of ED include decreased testosterone, decreased prolactin, and alterations in thyroid function. A decrease in thyroid-stimulating hormone (TSH) would be a cause of this disorder. All other choices are incorrect.
An older client tells the nurse that he still has erections and wants to have sex with his wife, but she does not have the same interest as he does. What should the nurse do to assist this client? A) Explain that women lose interest in sex as part of the aging process. B) Suggest that he wait awhile and the urge to have sex will pass. C) Ask what he has been doing to fulfill himself sexually. D) Encourage the client to ask his wife to discuss the lack of interest with her physician.
D) Encourage the client to ask his wife to discuss the lack of interest with her physician. Rationale: The nurse's role with this client is counseling for sexual dysfunction. The nurse should encourage the client to ask his wife to discuss the lack of interest with her physician as a starting point. The other choices are inappropriate and should not be provided to the client.
The nurse instructs a client on ways to reduce premenstrual difficulty. Which client statement indicates the instruction was beneficial? A) The client states the need to increase dietary sugar intake to promote energy. B) The client states that guided imagery does not help with the symptoms. C) The client states the need to increase intake of simple carbohydrates. D) The client states that reducing caffeine intake will help.
D) The client states that reducing caffeine intake will help. Rationale: The client stating that a reduction in caffeine intake will help is evidence that instruction was beneficial. The other client statements would indicate the need for additional instruction because guided imagery can be used to reduce stress and promote relaxation, and simple carbohydrates and sugars should be reduced.
A 58-year-old female client is concerned that intercourse with her spouse has become increasingly painful. What should the nurse explain about the changes in this client's body? A) Cervical mucus is thicker after menopause. B) Estrogen levels increase after menopause. C) Sexual desire diminishes after menopause. D) Vaginal lubrication decreases after menopause.
D) Vaginal lubrication decreases after menopause. Rationale: Older women remain capable of multiple orgasms and may, in fact, experience an increase in sexual desire after menopause. Vaginal lubrication and elasticity decrease with menopause and decreased estrogen, and phases of the sexual response cycle may take longer to occur. The client's concerns are not related to cervical mucus.
An older adult client seeks medical attention for vaginal bacterial infections. Which change in the client should the nurse consider as an explanation for the infections? A. Night sweats can lead to more bacteria. B. Thickened vaginal tissues tear more easily. C. Increased vaginal lubrication can result in more bacteria being harbored in the vagina. D. As vaginal pH rises, bacterial infections can become more common.
D. As vaginal pH rises, bacterial infections can become more common. Rationale: Vaginal pH rises after menopause, predisposing women to bacterial infections. Night sweats do not increase vaginal infections. Vaginal tissue atrophies, not thickens. Vaginal lubrication decreases.
A client is experiencing the menopausal symptom of vaginal dryness. Which medication should the nurse anticipate being prescribed for this client? A. Psychotropic B. Bisphosphonate C. Vitamin D supplement D. Estrogen preparation
D. Estrogen preparation Rationale: Vaginal dryness can be treated with low-dose vaginal estrogen. Psychotropic medications are used to treat mental health disorders. Bisphosphonates are medications for osteoporosis. Vitamin D supplements are used to help increase calcium absorption.
The nurse is teaching a female client diagnosed with sexual interest/arousal disorder regarding increased risk of developing another disorder. Which other disorder should the nurse include in the teaching? A. Genito-pelvic pain/penetration disorder B. Vaginismus C. Hormonal imbalance D. Female orgasmic disorder
D. Female orgasmic disorder Rationale: Women who have deficiencies in arousal and/or desire are at increased risk for orgasmic disorder. Deficiencies of arousal/desire are not precursors to vaginismus, hormonal imbalance, or genito-pelvic pain/penetration disorder.
The nurse is caring for a client who presents with an exacerbation of hypertension. The nurse learns that the client recently stopped taking blood pressure medication. The client states that the medication made him "have problems in the bedroom." Which cause resulted in this client's erectile dysfunction (ED)? A. Psychological B. Endocrine C. Lifestyle choices D. Iatrogenic
D. Iatrogenic Rationale: Iatrogenic causes of ED are side effects of medication and surgical procedures. Lifestyle choices that contribute to ED are smoking, alcohol use, overweight, and not exercising. Psychological causes of ED include stress, anxiety, guilt, depression, and low self-esteem. Endocrine causes are low levels of testosterone and altered thyroid function.
A client is experiencing signs of menopause. Which change in hormone level should the nurse use to confirm the client's health status? A. Increased estradiol (E2) B. Increased androstenedione C. Increased progesterone D. Increased luteinizing hormone (LH)
D. Increased luteinizing hormone (LH) Rationale: During the menopausal period, ovarian production of estradiol (E2) decreases. With decreased ovarian function, progesterone production is also markedly reduced. Levels of the hormone androstenedione also decrease during menopause. Luteinizing hormone and follicle-stimulating hormone (FSH) levels increase during menopause. Estradiol controls the amount of FSH and LH released by the pituitary gland via a negative feedback system; when estradiol production decreases, this feedback system ceases to function.
A male client with erectile dysfunction (ED) is considering surgery to correct the problem. Which surgical procedure is the preferred option for clients with this condition? A. Venous or arterial procedures B. Ligation of the vas deferens C. Draining of spermatic cord D. Prosthetic device implant
D. Prosthetic device implant Rationale: Venous or arterial procedures are generally not successful; often, the result is only temporary because the underlying cause of vascular insufficiency is not corrected. Thus, implantation of a penile prosthesis is usually the preferred option. Draining of the spermatic cord is not a surgery to correct erectile dysfunction. Ligation of the vas deferens is a vasectomy.
A postmenopausal woman presents with low desire, reduced arousal, and orgasmic difficulties. Which medication, although not FDA-approved for female use, is often prescribed off-label to address these issues is postmenopausal women? A. Estrogen B. Flibanserin C. Bupropion D. Testosterone
D. Testosterone Rationale: Although not FDA approved for female use, testosterone is often prescribed off-label to address low desire, reduced arousal, and orgasmic difficulties in postmenopausal women. Estrogen is FDA approved for clients with low desire, low arousal, and sexual pain. Bupropion is frequently prescribed for premenopausal women. Flibanserin is the only FDA-approved medication specifically aimed at the treatment of low desire in women; however, it is not frequently prescribed due to a combination of high cost, low effectiveness, potentially dangerous interactions with alcohol, and the small number of physicians who are certified to prescribe the drug.
The nurse is caring for a client newly diagnosed with erectile dysfunction (ED). Which item is appropriate for the nurse to include in the assessment process? (Select all that apply.) A. Client's socioeconomic status B. Client's risk factors for ED C. Client's current list of medications D. Client's cultural background E. Client's history of surgical procedures
B. Client's risk factors for ED C. Client's current list of medications D. Client's cultural background E. Client's history of surgical procedures Rationale: When a client seeks care for sexual dysfunction, during the initial interview, the nurse must find out as much as possible about the client's problem. This includes performing a complete physical examination that considers a range of contributing factors such as cardiovascular disease, endocrine abnormalities, nerve diseases, and problems with bowel and bladder functions. Throughout the assessment, the nurse should also ask the client about contributing factors that may not be apparent during the physical exam. This includes questions about medications, social habits, surgical history, activity level, reproductive history, relationship status, cultural background, and overall psychologic health. The client's socioeconomic status is not of primary importance in the assessment.
The nurse reviews with a client recovering from an oophorectomy the reason why symptoms of menopause are occurring. Which client statement should indicate to the nurse that teaching was effective? A. "Surgical menopause is usually less abrupt and should subside quickly once the body adjusts." B. "Removal of my fallopian tubes has started surgical menopause, and the symptoms start quickly." C. "Removal of my ovaries has caused an abrupt onset of menopause, and the symptoms can be severe." D. "Since my uterus has been removed, the symptoms of menopause have started."
C. "Removal of my ovaries has caused an abrupt onset of menopause, and the symptoms can be severe." Rationale: Surgical menopause is caused by removal of the ovaries, known as oophorectomy. Unlike medical menopause, onset of surgical menopause is abrupt and the symptoms may be severe. Removal of the uterus and fallopian tubes does not cause surgical menopause.
