Ch. 44: Sexuality PrepU
A client tells a nurse that her menstrual cycle has become irregular. Which of the following does the nurse consider as a cause of the irregularity? Select all that apply. a) Anorexia nervosa b) Oral contraception taken every day year round c) Primary ovarian insufficiency d) Infection of the reproductive organs e) Diabetes
• Infection of the reproductive organs • Anorexia nervosa • Primary ovarian insufficiency • Oral contraception taken every day year round Explanation: Menstrual cycle irregularities can have many different causes, including pregnancy or breast feeding, eating disorders (anorexia nervosa), polycystic ovary syndrome, premature ovarian failure (also known as primary ovarian insufficiency), pelvic inflammatory disease (infection of the reproductive organs), and, uterine fibroids. Diabetes does not cause irregular menstrual periods.
The nurse is discussing contraception with an adolescent patient who asks the nurse: "What if I can't have an orgasm?" What is the nurse's best response? a) "A mature sexual relationship does not require a man and woman to achieve simultaneous orgasm." b) "The ability to achieve orgasm is the only indicator of a person's sexual responsiveness." c) "The larger the penis, the greater the potential for achieving orgasm." d) "Women who have multiple orgasms are promiscuous."
"A mature sexual relationship does not require a man and woman to achieve simultaneous orgasm." Explanation: Simultaneous orgasms, or both people attaining orgasm at the same moment, are difficult to achieve. A preoccupation with attaining simultaneous orgasms might disrupt the ultimate intimacy and satisfaction possible during coitus. Multiple orgasms are not abnormal. The size of the penis does not affect whether an orgasm will occur. Having an orgasm is not the only indicator of sexual responsiveness; some individuals may have a pleasurable sexual experience without orgasm.
A nurse practitioner is teaching the student about sexual health and is evaluating the student's knowledge of sexual identity. The practitioner knows that the student understands when the student says which of the following? a) "Biologic sex is the inner sense a person has of being male or female." b) "Gender role behavior is the behavior a person conveys about being male or female." c) "Gender identity refers to the preferred gender of a person's partner." d) "Sexual orientation is the term used to denote chromosomal sexual development."
"Gender role behavior is the behavior a person conveys about being male or female." Explanation: Sexual identity encompasses a person's self-identity, biologic sex, gender identity, gender role behavior or orientation, and sexual orientation or preference. Gender role behavior is the behavior a person conveys about being male or female. Biologic sex is the term used to denote chromosomal sexual development. Gender identity is the inner sense a person has of being male or female. Sexual orientation refers to the preferred gender of a person's partner.
A 16-year-old girl tells the nurse that her friend has genital warts and asks the nurse how to make sure that she does not get them. Which of the following should the nurse recommend? a) "Have the Norplant system implanted in your arm." b) "Douching will help to prevent them." c) "Get the human papillomavirus vaccine." d) "If your male partner doesn't have genital warts, you will not get them."
"Get the human papillomavirus vaccine." Explanation: Human papillomavirus (HPV) is a DNA virus also called genital warts and is a sexually transmitted infection (STI). A vaccine is now available to prevent this disease. Male partners with HPV may or may not have lesions. Women should avoid douching to prevent STIs, as they remove normal protective bacteria in the vagina and increases the risk of getting some STIs. The Norplant system is a contracteptive method and does not prevent STIs.
Which assessment question is most likely to yield clinically meaningful data about a female client's sexual identity? a) "How do you feel about yourself as a woman?" b) "Do you find that your health allows you to enjoy a meaningful sex life?" c) "Are you satisfied with the quality of your relationships right now?" d) "Have you ever had any sexually transmitted infections in the past?"
"How do you feel about yourself as a woman?" Explanation: Sexual identity is a broad concept that includes, but supersedes, sexual functioning. However, it is more specific than simply asking about the quality of relationships. Asking an open-ended question about how the client feels about herself as a woman is likely to elicit important insights. Assessing the client's history of STIs does not directly address her sexual identity.
A gerontology nurse is discussing sexual dysfunction with an older adult male client. The nurse determines that the education has been effective when the client states: a) "I need to be able to walk a mile in order for sexual intercourse to not be dangerous." b) "Malnutrition may cause impotence." c) "Erectile dysfunction, caused by diabetes, has no treatment." d) "Antihypertensive medication will not affect sexual function."
"Malnutrition may cause impotence." Explanation: Factors that contribute to sexual dysfunction in the older adult are as follows: use of medications, especially antihypertensive medications; age-related metabolic disorders such as anemia, diabetes, malnutrition, and fatigue (may cause impotence). Sexual intercourse and similar forms of sexual expression are not considered dangerous for anyone able to walk around a room. Erectile dysfunction has treatments such as a penile prosthesis or pharmacologic management.
A female client has recently had surgery for cervical cancer and asks the nurse about other ways she can have sex with her husband. Which of the following statements by the nurse is most accurate? a) "Complete abstinence would satisfy your sexual needs." b) "Stimulation of the genitals by the mouth and tongue may be used to reach orgasm." c) "Fellatio is stimulation of the female genitals." d) "Anal intercourse is not practiced by heterosexuals."
"Stimulation of the genitals by the mouth and tongue may be used to reach orgasm." Explanation: Stimulation of the genitals by the mouth and tongue may be used as a way to reach orgasm. Abstinence is not having sex and would not meet the couple's needs. Anal intercourse, commonly practiced by gay men, is also used by heterosexual couples. Fellatio is stimulation of the male genitals; cunnilingus is stimulation of the female genitals.
The nurse assessing an adolescent's need for further information should ask which of the following questions? a) "What questions or concerns do you have about your sexual health?" b) "How many sexual partners have you had?" c) "Have you ever been diagnosed with a sexually transmitted disease?" d) "Are you involved in an intimate relationship at this time?"
"What questions or concerns do you have about your sexual health?" Explanation: An open-ended, nonthreatening question related to the patient's need for further information should be included while obtaining a sexual history
Which example best supports the diagnosis of Sexual Dysfunction: Dyspareunia? a) A 39-year-old alcoholic woman is no longer interested in having sex with her partner. b) A 50-year-old woman with a history of stroke is afraid to have sex with her partner for fear it will elevate her blood pressure. c) A client with a colostomy believes she cannot have a sexual relationship with her husband because he will be repulsed by her stoma. d) A 50-year-old woman in the process of menopause has pain and burning during intercourse.
A 50-year-old woman in the process of menopause has pain and burning during intercourse. Explanation: Dyspareunia refers to pain and burning during intercourse. This is a common cause of sexual dysfunction, especially during menopause. A colostomy, fear of blood pressure elevation, and lack of interest in sex may lead to the nursing diagnosis of Sexual Dysfunction, but not related to dyspareunia.
The nurse is justified in assessing for sexual dysfunction among male clients who are receiving which of the following? a) Non-steroidal anti-inflammatory drugs (NSAIDs) b) Bronchodilators c) Antihypertensive medication d) Antibiotics
Antihypertensive medication Explanation: Antihypertensives are among the drugs implicated in sexual dysfunction. Antibiotics, bronchodilators, and NSAIDs do not typically have this effect.
The nurse recommends a barrier method of contraception for a client who is concerned about the side effects of hormonal contraception. Which method might the nurse suggest? a) Abstinence b) Sterilization c) Cervical cap d) Norplant system
Cervical cap Explanation: Barrier methods of birth control help in preventing pregnancy by using a device to block sperm from fertilizing an egg. Barrier methods include the cervical cap, condom, diaphragm, and vaginal sponge used in combination with a spermicidal agent. Abstinence means having no sexual intercourse. Norplant is a hormonal method of birth control. Sterilization is a surgical method of birth control.
A nurse is teaching a female client about the sexual response cycle. The nurse determines that the education was successful when the client identifies which female structure as comparable to the male penis? a) Skene glands b) Mons pubis c) Clitoris d) Ovaries
Clitoris Explanation: The clitoris corresponds to the penis in the male in that both organs contain erectile tissue and respond to stimulation that can result in orgasm. Skene or paraurethral glands lie inside of, and on, the posterior of the urethra. The Skene and the Bartholin glands produce a small amount of lubricant. The mons pubis is a pad of fatty tissue over the bony prominence called the symphysis pubis. The ovaries contain the female sex cells and female hormones.
A woman age 49 years has sought care from her primary care provider because of "intimacy problems." Upon questioning, the woman reveals that she is experiencing sexual desire, but that intercourse causes her significant pain. In the absence of sexual activity, the woman states that she does not have any significant vaginal discomfort. What would the clinician recognize that this client is most likely experiencing? a) A sexually transmitted infection (STI) b) Dyspareunia c) Vaginismus d) Vulvodynia
Dyspareunia Explanation: Dyspareunia is painful intercourse. Vaginismus is characterized by difficult penetration rather than acute pain during intercourse, and vulvodynia is associated with pain that is not limited to intercourse. An STI may or may not be contributing to the woman's problem, though most cases of dyspareunia are unrelated to infections.
What is associated with the resolution phase of the male sexual response cycle? a) The ability to begin the excitement phase again b) Increased blood flow to the penis c) Feelings of relaxation and fulfillment d) Intense physical pleasure
Feelings of relaxation and fulfillment Explanation: The resolution phase of the sexual response cycle is associated with feelings of relaxation, fatigue, and fulfillment. The most intense pleasure of a physical nature takes place during orgasm, and the male experiences a refractory period during which he is incapable of sexual response. Blood flow to the penis returns to normal levels during the resolution phase.
The forensic nurse is caring for a client who was raped four days ago. Which of the following could the nurse teach the client is an effective contraceptive? a) Depo-Provera injection b) Insertion of a copper intrauterine device (IUD) c) Transdermal contraceptive patch d) Use of the Norplant system
Insertion of a copper intrauterine device (IUD) Explanation: Emergency contraception is provided in two ways: increased doses of oral contractptive pills (usually within 72 hours) or insertion of a copper IUD within 5-7 days after unprotected intercourse. The other options are used for routine contraception
The nurse is preparing a talk on health issues in the LGBT population. Which statistics would the nurse include? a) Lesbians are more likely to get preventive services for cancer. b) LGBT youth are 2 to 3 times more likely to attempt suicide. c) LGBT populations have lower rates of tobacco, alcohol, and other drug use. d) Lesbians and bisexual females are more likely to be underweight or anorexic.
LGBT youth are 2 to 3 times more likely to attempt suicide. Explanation: Healthy People 2020 found that LGBT youth are 2 to 3 times more likely to attempt suicide. Lesbians and bisexual females are more likely to be overweight or obese. LGBT populations have higher rates of tobacco, alcohol, and other drug use than other populations. Lesbians are more likely to get preventive services for cancer
The school nurse is educating a group of 5th and 6th grade girls on menstruation. One girl asks if there is a name for having her first menstrual period. The nurse replies with which of the following terms? a) Menses b) Menopause c) Menarche d) Follicular phase
Menarche Explanation: The first menstrual period, called menarche, is experienced at about 12 years of age. Menstruation is often referred to as a woman's "period" or "menses." Menopause is the cessation of a woman's menstrual activity. In the ovaries, in a typical 28-day cycle, the phase from day 4 to 14 is called the follicular phase.
During the menstrual cycle, when does ovulation typically take place? a) On day 14 b) From days 15 to 28 c) When sperm is present d) On day 1 of a new cycle
On day 14 Explanation: Ovulation generally occurs on day 14 when the mature ovum ruptures from the follicle and the surface of the ovary and is swept into the fallopian tube. From day 15 to day 28, the phase in the ovaries is called the luteal phase.
A nurse is educating a male client about testicular self-examination. The nurse would encourage the client to perform the exam at which frequency? a) Once a week b) Once every 3 months c) Once every 6 months d) Once a month
Once a month Explanation: Testicular self-examination should be performed once a month.
A school nurse is providing a class on sexually transmitted infections (STIs). Which statement is correct regarding STIs? a) STIs disproportionately affect people with a lower socioeconomic status and education. b) The incidence of STIs is decreasing due to limited sex partners. c) STIs are most prevalent among teenagers and young adults. d) The signs and symptoms of an STI are obvious.
STIs are most prevalent among teenagers and young adults. Explanation: STIs are most prevalent among teenagers and young adults, and nearly two- thirds of all STIs occur in people younger than 25 years of age. The incidence of STIs is increasing due to multiple sex partners and sexual activity at a younger age. STIs affect men and women of all backgrounds and economic levels
The nurse is teaching a class about sexuality at a public health clinic. After class the nurse is approached by Cathleen, a 54-year-old female, who eventually discloses to the nurse that she is having a sexual affair with a female partner. The term for an individual's preference for a partner of a particular gender is which of the following? a) Sexual orientation b) Transvestite c) Transsexual d) Gender role behavior
Sexual orientation Explanation: Sexual orientation refers to the preferred gender of the partner of an individual. A transvestite is an individual who desires to take on the role or wear the clothes of the opposite sex. Gender role behavior is the behavior a person conveys about being male or female. A transsexual is a person of a certain biologic gender who has the feelings of the opposite sex.
The nurse working at a family planning clinic evaluates a client's risk for complications from oral contraceptives. Which of the following places the client at highest risk? a) Drinks 1 glass of wine daily b) Age less than 35 c) History of diabetes d) Smokes 1 pack cigerettes per week
Smokes 1 pack cigerettes per week Explanation: Complications for oral contraceptives include an increased incidence of blood clots, heart attacks, and stroke, especially in women who smoke.
A female client tells the nurse that she and her husband have selected periodic abstinence as their choice of contraception. Which of the following is the best method for the nurse to recommend to predict ovulation? a) Symptothermal method b) Calendar method c) Temperature method d) Cervical mucus method
Symptothermal method Explanation: The best approach to monitoring fertility is a combination of all three methods (temperature, cervical mucus, and calendar), called the symptothermal method.
The community health nurse is aware that many factors influence a client's decision for contraception. Which of the following is the most likely reason a client would select permanent contraception? a) To reduce the risk of sexually transmitted diseases. b) The desire to have multiple sex partners. c) The choice not to start a family. d) Religious beliefs which prevent reproduction.
The choice not to start a family. Explanation: Some people choose a permanent method to prevent pregnancy from ever occurring. Factors that affect a person's choice of a contraceptive method include age, marital status, desire for future pregnancy, religious beliefs, level of education, cost, and ease of use. Permanent contraception offers no protection against sexually transmitted infections.
In which of these situations does the nursing action NOT advocate for patient sexual needs? a) The nurse refers to the patient as Mr., Mrs., Miss, or Ms., according to the patient's preference. b) The nurse ensures the patient wears a hospital gown to protect personal clothing. c) The nurse anticipates potentially shaming situations for the patient. d) The nurse interfaces with the physician to obtain information for the patient.
The nurse ensures the patient wears a hospital gown to protect personal clothing. Explanation: Patient's should be given the option to wear their own sleepwear to promote sexual identity rather than hospital gowns. The nurse can anticipate potentially shaming situations by informing the patient about embarrassing procedures and that is not unusual for patients to be embarrassed in these situations. The nurse can be the patient's spokesperson when obtaining information from the physician. Referring to patients by their title shows respect to the patient.
Which sexually transmitted infection has the following characteristics: thin, foamy, greenish vaginal discharge that causes itching of the vulva and vagina? a) Herpes simplex 1 b) Nonspecific vaginitis c) Trichomoniasis d) Herpes simplex 2
Trichomoniasis Explanation: Trichomoniasis is characterized by thin, foamy, greenish vaginal discharge that causes itching of the vulva and vagina; it is often asymptomatic in males. Nonspecific vaginitis is characterized by foul-smelling, thin, grayish-white vaginal discharge. Herpes simplex virus type 1 and 2 are characterized by lesions
A male client comes to the clinic because he thinks that he has syphilis. Which test would the nurse expect the client to have done? a) HPV b) VDRL c) Pap smear d) Wet preparation
VDRL Explanation: VDRL is a blood test done to detect syphilis in males and females. HPV is a test done to detect the human papilloma virus. Pap smear is performed on females to evaluate for changes in the cervix. A wet preparation is a sample of vaginal secretions done to detect Candida, Gardnerella and Trichomona
The nurse is assessing the sexual health of a female client age 20 years. During the interview, the client says, "I feel that my vaginal opening constricts whenever I am about to have intercourse. I seem to have no control over it." What would the nurse use when documenting the client's report? a) Orgasmic dysfunction b) Vaginismus c) Celibacy d) Dyspareunia
Vaginismus Explanation: The client is experiencing an involuntary contraction of the muscles surrounding the vaginal orifice; this should be documented as vaginismus. Dyspareunia is painful intercourse. Difficulty achieving orgasm is documented as orgasmic dysfunction. Abstention from sexual intercourse is documented as celibacy.
When a man cannot achieve an erection, the phase of the sexual response in which the man is experiencing difficulty is: a) orgasmic phase. b) obligatory phase. c) excitement phase. d) refractory phase.
excitement phase. Explanation: The excitement phase is characterized by rapid erection of the penis with tensing and thickening of the scrotal skin and elevation of the scrotal sac.
The nurse is providing education about sexuality to a group of college freshman. One of the terms he discusses is gender identity. Which of the following describes gender identity? a) behavior conveyed about being male or female b) inner sense of being male or female c) desire to wear the clothes of the opposite sex d) preferred gender of the partner of an individual
inner sense of being male or female Explanation: Gender identity is the inner sense a person has of being male or female. Gender role behavior is the behavior a person conveys about being male or female. Sexual orientation refers to the preferred gender of the partner of an individual. A transvestite is an individual who desires to take on the role (or wear the clothes) of the opposite sex
The term that is used to describe the female client who states that she's a man trapped in a women's body is: a) homosexual. b) bisexual. c) heterosexual. d) transsexual.
transsexual. Explanation: A transsexual woman views herself as a man trapped in woman's body. Some people are heterosexual, attracted sexually to members of the opposite gender. Others are bisexual, attracted to both men and women sexually. Others are homosexual, attracted sexually to members of the same gender.
The nurse is teaching a male adolescent how to use a condom. Which teaching points would the nurse include? (Select all that apply.) a) "Roll the condom onto the penis before it becomes erect." b) "Do not use a spermicide with the condom." c) "Use a condom with every act of intercourse." d) "If using a lambskin condom, the condom may be reused a second time." e) "If the condom does not have a nipple receptacle, leave a small space at the end for semen to collect." f) "Immediately after ejaculation remove the condom and discard it."
• "Use a condom with every act of intercourse." • "If the condom does not have a nipple receptacle, leave a small space at the end for semen to collect." • "Immediately after ejaculation remove the condom and discard it." Explanation: If the condom does not have a nipple receptacle end, a small space should be left at the end of condom to collect the semen in order to provide a pocket to collect semen and prevent breakage. A condom should be used with every act of intercourse to help prevent STI transmission and pregnancy. Immediately after ejaculation, the penis and condom should be removed from the vagina by holding onto the base of the condom. This prevents spillage of semen into the vagina. The condom should be rolled onto the penis as soon as it becomes erect; this protects against sperm from secretions from Cowper's glands. Spermicide can be used with condoms to increase contraception properties. Condoms can never be used a second time
The nurse is advising an adolescent male about sexual myths that have him concerned. Which statements describe accurate client education regarding these concerns? Select all that apply. a) No male or female should feel pressured into sexual activity at any age. b) A larger penis allows for a more satisfying sexual experience. c) Nocturnal emissions are normal in men of all ages. d) Masturbation or self-stimulation is a natural and healthy outlet for sexual urges. e) Nocturnal emissions are signs of a sexually transmitted infection. f) Nocturnal emissions indicate the existence of a sexual disorder.
• No male or female should feel pressured into sexual activity at any age. • Nocturnal emissions are normal in men of all ages. • Masturbation or self-stimulation is a natural and healthy outlet for sexual urges. Explanation: Masturbation or self-stimulation is natural. No one should ever feel pressured into having sex. Nocturnal emissions are normal and occur in about 85% of men. Penis size has no effect on the satisfaction of the sexual experience
