Chapter 29: Sexual Disorders

Which of the following refers to the anatomic and physiologic state of being male or female? A. Biosexual identity B. Sex role identity C. Gender identity D. Sexual orientation

A. Biosexual identity

A client is undergoing treatment of erectile dysfunction using intracavernosal therapy. When educating the client on this therapy, the nurse would include which of the following as a possible complication? Select all that apply. A. Bleeding B. Scarring C. Hypotension D. Priapism E. Chest pain

A. Bleeding B. Scarring C. Priapism

Which of the following would the nurse consider when working with a female client who has problems achieving orgasm? Select all that apply. A. Communication skills B. Restricting sex to "quickies" C. Kegel exercises D. Possible etiologic factors E. Sexual play F. Anxiety-reduction techniques

A. Communication skills E. Sexual play C. Kegel exercises F. Anxiety reduction techniques D. Possible etiologic factors *When caring for patients with female orgasmic disorder, the nurse would include the following: possible etiologic factors, anxiety-reduction techniques, communication skills, sexual preferences, sexual play, Kegel exercises, erotic fantasy, group therapy, and sex therapy.

A psychiatric mental health registered nurse is working with a female client who has just confided that she has a blunted sexual response and almost never achieves orgasm. What actions should this nurse perform? Select all that apply. A. Educate the client about possible resources available to her B. Order a pelvic ultrasound C. Provide cognitive behavioral therapy for the client. D. Provide sex therapy for the client and her partner E. Provide clear information to the client about sexuality

A. Educate the client about possible resources available to her E. Provide clear information to the client about sexuality

A nursing instructor is teaching students about male sexual disorders. The instructor determines that the education was successful when the students identify which of the following as the most common type of male sexual dysfunction? A. Ejaculatory dysfunction B. Fetishism C. Exhibitionism D. Gender dysphoria

A. Ejaculatory dysfunction *Of all the male sexual dysfunctions, ejaculatory dysfunction is one of the most common male sexual disorders and ranges from premature ejaculation (inability to control ejaculation before or shortly after penetration) to delayed ejaculation (delay or absence of ejaculations).

When assessing an individual for sexual dysfunctions, it is most therapeutic for the nurse to do what? A. Frame questions in a way that normalizes a wide range of sexual behaviors and problems, and use terms the client will understand. B. Avoid addressing various lifestyle concerns because this can cause a great deal of discomfort and even shutdown during the interview. C. Use his or her experience as a background for selecting specific questions, and ask questions with which the nurse is most familiar and comfortable. D. Assume that most clients are fairly comfortable with discussing their sexuality, especially if they are married.

A. Frame questions in a way that normalizes a wide range of sexual behaviors and problems, and use terms the client will understand. *It is important to frame questions in a way that will provide safety and comfort to the client in discussing sexuality. The nurse should neither assume that most clients are comfortable with this topic nor avoid discussing any aspect of sexuality.

A nurse is conducting a sexual assessment of a client. Which finding would suggest to the nurse that the client may be experiencing sexual dysfunction? Select all that apply. A. Inappropriately touching another person B. Self-deprecation C. Relaxed appearance when talking about a sexual topic D. Questioning the care provider about his/her sexual relationship E. Statement such as "I have a friend who..."

A. Inappropriately touching another person B. Self-deprecation D. Questioning the care provider about his/her sexual relationship E. Statement such as "I have a friend who..." *Cues and clues to possible sexual dysfunction include sexual humor, ribald remarks, obscene gestures, self-deprecation, genital exposure, inappropriate touching of the care provider or another person, questions pertaining to the sexual relationship of the care provider, statements or questions such as "I have a friend who..." and nervousness related to a sexual topic.

One of the most common nursing diagnoses for clients who are experiencing sexual dysfunction is? A. Ineffective Sexuality Pattern related to desire, arousal, orgasmic, or pain disorder. B. Situational Low Self-esteem related to withdrawal of partner from intimacy. C. Ineffective Family Coping related to difficulty with sexual pleasure. D. Potential for Depressive Illness related to sadness about lack of sexual ability.

A. Ineffective Sexuality Pattern related to desire, arousal, orgasmic, or pain disorder. *The primary problem of ineffective sexuality pattern is caused by a physical dysfunction disrupting satisfying sexual activity.

A nurse is preparing a presentation for a group of nurses about sexuality. Which of the following would the nurse most likely include as being associated with sexuality? Select all that apply. A. Intimacy B. Communication C. Trust D. Pleasure E. Affection

A. Intimacy B. Communication C. Trust D. Pleasure E. Affection

The nursing assessment for a male reporting erectile dysfunction (ED) is properly focused when the nurse assesses for ... A. Preexisting cardiovascular disease B. MDMA abuse C. Type 1 or type 2 diabetes D. Acute or chronic depression

A. Preexisting cardiovascular disease Rationale: ED has been reported to improve significantly with the use of a phosphodiesterase type-5 inhibitor, sildenafil citrate (Viagra). However, there is potential cardiac risk for clients with preexisting cardiovascular disease.

During which phase of the human sexual response cycle does the body return to the unaroused state? A. Resolution B. Plateau C. Orgasm D. Excitement

A. Resolution *Resolution is the gradual return of the organs and body systems to the unaroused state. In the excitement phase, erotic feelings of both genders lead to a penile erection in men, and vaginal lubrication in women. The plateau phase is represented by sexual pleasure and increased muscle tension, heart rate, and blood flow to the genitals. For men, the orgasmic phase is ejaculation of semen; for women, it consists of rhythmic contractions of the vaginal muscles.

A 26-year-old male client has confided in his nurse practitioner that he is rarely able to achieve an erection when he is with a partner. The client has an unremarkable medical history and, upon questioning, attributes his problem to the fact that he was raised in a family where sex was characterized as shameful, dirty, and usually immoral. Which of the following nursing diagnoses should the nurse use in the care of this client? A. Sexual dysfunction related to negative sexual teaching B. Ineffective sexuality patterns related to ineffective sexual teaching C. Sexual dysfunction related to lack of fulfillment D. Ineffective sexuality patterns related to absence of sexual teaching

A. Sexual dysfunction related to negative sexual teaching *The client's erectile dysfunction (sexual dysfunction) is associated with the negative tone of sexual teaching that he received in his family of origin. Teaching was apparently not absent, and lack of fulfillment is the consequence, not the cause, of his problem.

A nurse is reviewing the history of a client diagnosed with a paraphilia. The paraphilia involves the infliction of pain with leather straps or whips. Th en urse interprets this as which paraphilia? A. Sexual sadism B.Sexual masochism C. Rape D. Incest

A. Sexual sadism *Sadism involves the infliction of pain with materials such as leather straps, handcuffs, and whips. Sexual masochism involves the act of being injured, bound, humiliated, or otherwise made to suffer. Rape is the actual penetration of an orifice of a person's body during sexual activity against his or her will. Incest is sexual intercourse between family members who are so closely related as to be legally prohibited from marrying one another because of consanguinity.

A client has been diagnosed with erectile dysfunction. The nurse would expect the client to be placed on which of the following medications? A. Tadalafil B. Sertraline C. Fluoxetine D. Paroxetine

A. Tadalafil *Phosphodiesterase 5 (PDE 5) inhibitors are the treatment of choice for erectile dysfunction. Three PDE 5 inhibitors are approved for erectile dysfunction: sildenafil citrate, vardenafil chloride, and tadalafil. Paroxetine, sertraline, and fluoxetine are selective serotonin reuptake inhibitors (SSRIs), which are not used in the treatment of erectile dysfunction.

The nurse has read in a young adult client's medical record that he sought care related to gender dysphoria. The nurse should recognize what implication of this statement? A. The client identifies more closely with being female than male B. The client has expressed interest in sex reassignment surgery C. The client experiences intense guilt and shame around his sexuality D. The client is more sexually attracted to men than women

A. The client identifies more closely with being female than male *Gender dysphoria denotes an incongruence between a person's experienced/expressed gender and his or her assigned gender. The term does not imply a particular pattern of sexual attraction and the client may or may not be interested in sex reassignment surgery. The client does not necessarily live with guilt and shame.

A middle-aged male client has told the nurse, "Lately, I just don't seem to have any interest in sex, which isn't at all like me." The nurse should focus on what area of assessment when addressing the client's hypoactive sexual desire? A. The client's current medication regimen B. The client's thyroid function C. The client's sleep patterns D. Recent weight gain or weight loss

A. The client's current medication regimen *Male hypoactive sexual desire disorder can result from a variety of factors, but a sudden and uncharacteristic onset should prompt the nurse to assess for medications as a possible cause. Weight changes and sleep changes would be unlikely to be independent causes of the problem. Thyroid problems are a possible contributor, but this would be more likely to be an ongoing problem with a gradual onset.

A 28-year-old woman seeks treatment for sexual dysfunction. She states that she feels aroused and is interested in having intercourse, but that she "clamps down" and her partner cannot achieve penetration. She denies any pain with intercourse. Which of the following would the nurse suspect? A. Vaginismus B. Dyspareunia C. Female sexual interest/arousal disorder D. Female orgasmic disorder

A. Vaginismus *The client is describing vaginismus -- spastic, involuntary constriction of the perineal and outer vaginal muscles fostered by imagined, anticipated, or actual attempts at vaginal penetration. Dyspareunia is a term used to describe the genital pain associated with sexual intercourse which may be caused by vaginismus. Female orgasmic disorder is characterized by the inability of a woman to experience orgasm, or the intensity of the orgasm is markedly reduced at least 75% of the time. Female sexual interest/arousal disorder is the lack of (or significantly reduced) sexual interest/arousal. Women with this disorder rarely initiate sexual activity and are unreceptive of their partner's attempts. They do not experience sexual excitement, which results in personal or interpersonal distress.

A patient approaches the nurse in the clinic waiting room and says, "I want to talk to you about a sexual matter." The nurse can best facilitate the discussion by: a. saying, "Let's go my office." b. responding, "I want to help. Go ahead; I'm listening." c. telling the patient, "Let's schedule another appointment." d. offering to sit in a corner of the waiting room with the patient.

ANS: A A discussion of sexual concerns requires privacy. Suggesting use of office space is preferable to using the waiting room, where others cannot help but overhear sensitive material. The distracters block communication.

A man says, "I enjoy watching women when I am out in public. I like to go to places where I can observe women crossing their legs in hopes of seeing something good." Which statement about this behavior is most accurate? a. It is a sexual disorder. The behavior is socially atypical. It could disrupt relationships and could be insulting to others. b. It is not a sexual disorder. These events occur in public, where those he observes do not have a reasonable expectation of privacy. c. It is not a sexual disorder. Because it occurs in public areas, this behavior does not hurt others or involve intrusion into the personal space of those observed. d. An action is or is not a sexual disorder depending on applicable local laws, so whether this meets the definition of a sexual disorder depends on the location.

ANS: A A sexual disorder is defined as an activity that is socially atypical, has the potential to disrupt significant relationships, and may result in insult or injury to others. The behavior described constitutes a sexual disorder (voyeurism). Although laws vary, an act does not have to be illegal to constitute a sexual disorder. The fact that the behavior occurs in a public setting could have a bearing on whether it is illegal, but not on whether it is considered to be a sexual disorder.

A 10-year-old boy is diagnosed with gender dysphoria. Which assessment finding would the nurse expect? a. Having tea parties with dolls b. A compromised sexual response cycle c. Identifying with boys who are athletic d. Intense urges to watch his parents have sex

ANS: A An individual with gender dysphoria feels at odds with the roles associated with that gender. A child with this diagnosis is likely to engage in play associated with the opposite gender. The other options are not age appropriate or characteristically seen in children with gender dysphoria.

A nurse is anxious about assessing the sexual history of a patient who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the patient's sexual practices? a. "Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern?" b. "Sexual health can reflect a number of medical problems, so I'd like to ask if you have any sexual problems you think we should know about." c. "It's your own business, of course, but it might be helpful for us to have some information about your sexual history. Could you tell me about that, please?" d. "I would appreciate it if you could share your sexual history with me so I can share it with your health care provider. It might be helpful in planning your treatment."

ANS: A Explaining that sexual practices vary helps reduce patient anxiety about the topic by normalizing the full range of sexual practices so that whatever his situation, the patient can feel comfortable sharing it. "It's your business of course..." implies the nurse does not have a valid reason to seek the information and in effect suggests that the patient perhaps should not answer the question. "It might be helpful..." makes the information seem less valid or important for the nurse to pursue and, again, could discourage the patient from responding fully. Asking if the patient has any sexual problems that staff should know about is not unprofessional, but it is a very broad question that may increase a patient's uncertainty about what the nurse wants to hear, thus increasing his anxiety. Defining or giving an example of "sexual problem" would make this inquiry more effective.

*An adult seeks treatment for urges involving sexual contact with children. The adult has not acted on these urges but feels shame. Which finding best indicates that this adult is making progress in treatment? The adult: a. consistently avoids schools and shops at malls only during school hours.* b. indicates sexual drive and enjoyment from sex have decreased. c. reports an active and satisfying sex life with an adult partner. d. volunteers to become a scout troop leader.

ANS: A One strategy for avoiding acting on inappropriate urges is to avoid environments and circumstances that evoke those urges; for a pedophile this would include avoiding all situations that would likely result in contact with children. Pedophilic disorder is persistent; elimination of fantasies about children would be unrealistic. A person who volunteers to lead a scout troop is placing himself/herself around children. A diminished sex drive or a healthy sex life with an appropriate partner does not necessarily reduce the desire for sexual contact with children.

An adult experienced a myocardial infarction six months ago. At a follow-up visit, this adult says, "I haven't had much interest in sex since my heart attack. I finished my rehabilitation program, but having sex strains my heart. I don't know if my heart is strong enough." Which nursing diagnosis applies? a. Deficient knowledge related to faulty perception of health status b. Disturbed self-concept related to required lifestyle changes c. Disturbed body image related to treatment side effects d. Sexual dysfunction related to self-esteem disturbance

ANS: A Patients who have had a myocardial infarction often believe sexual intercourse will cause another heart attack. The patient has completed the rehabilitation, but education is needed regarding sexual activity. These patients should receive information about when sexual activity may begin, positions that conserve energy, and so forth. The scenario does not suggest self-concept or body image disturbance.

A nurse is performing an assessment for a 59-year-old man who has hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment? a. Sexual dysfunction may result from use of prescription medications for management of hypertension. b. Such questions are an indirect way of learning about the patient's medication adherence. c. These questions ease the transition to questions about sexual practices in general. d. Sexual dysfunction can cause stress and contribute to increased blood pressure.

ANS: A Some of the drugs used to treat hypertension can interfere with normal sexual functioning and lead to sexual disorders. Hypertension itself can lead to acquired erectile dysfunction. It would not be appropriate or necessary to use such inquiries as a lead-in to other sexual health topics. Sexual dysfunction, while stressful, does not cause hypertension.

A parent who is very concerned about a 3-year-old son says, "He likes to play with girls' toys. Do you think he is homosexual or mentally ill?" Which response by the nurse most professionally describes the current understanding of gender identity? a. "A child's interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood." b. "It's difficult to say for sure because the research is incomplete so far, but chances are that he will grow up to be a normal adult." c. "The research is incomplete, but many boys play with girls' toys and turn out normal as adults." d. "I am sure that whatever happens, he will be a loving son, and you will be a proud parent."

ANS: A The parent's inquiry is really two questions: (1) whether the child's behavior suggests an increased risk of developing mental illness and (2) what the child's future sexual preference will be. The psychiatric disorder that most directly addresses gender preferences and cross-gender activities is gender identity disorder. Pointing out that cross-gender activities are not necessarily related to gender identity and not likely to be carried into adulthood is supported by current research. Saying the child will grow up to be "normal" implies that to be homosexual is to be abnormal, which reflects a cultural perspective that most professionals would believe to be inappropriate to share in a professional setting. Research provides information about the relationship between cross-gender interests in childhood and adulthood, so a comment that "research is incomplete" is not entirely accurate. Stating that the child is a wonderful boy the father will be proud of, whatever happens, evades the parent's question and suggests that parental bonds should not be affected by gender issues. The nurse has a professional obligation to maintain an objective, therapeutic relationship.

A man who regularly experiences premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my partner." Select the nurse's most therapeutic response. a. "I sense you are feeling frustrated and upset." b. "Tell me more about feeling like a failure." c. "You are too hard on yourself." d. "What do you mean by awful?"

ANS: A Using reflection and empathy promotes trust and conveys concern to the patient. The distracters do not offer empathy, probe, and offer premature reassurance.

A nurse assesses a patient diagnosed with pedophilic disorder. Which findings are most likely? Select all that apply. a. Childhood history of attention deficit hyperactivity disorder (ADHD) b. A poorly managed endocrine disorder c. History of brain injury d. Cognitive distortions e. Grandiosity

ANS: A, C, D Attention deficit hyperactivity disorder (ADHD) in childhood, substance abuse, phobic disorders, and major depression/dysthymia are strongly associated with paraphilic disorders. Errors in thought make it seem acceptable for deviant and destructive sexual behaviors to occur. Patients who have experienced head trauma with damage to the frontal lobe of the brain may display symptoms of promiscuity, poor judgment, inability to recognize triggers that set off sexual desires, and poor impulse control. Endocrine problems are not associated with pedophilic disorder. Self-confidence is lacking; therefore, grandiosity would not be expected.

A woman tells the nurse, "My partner is frustrated with me. I don't have any natural lubrication when we have sex." What type of sexual disorder is evident? a. Genito-Pelvic Pain/Penetration Disorder b. Female Sexual Interest/Arousal Disorder c. Hypoactive Sexual Desire Disorder d. Female Orgasmic Disorder

ANS: B One feature of female sexual interest/arousal disorder relates to inability to maintain physiologic requirements for intercourse. For women, this includes problems with lubrication and swelling. The patient's description does not meet criteria for diagnoses in the distracters.

A respected school coach was arrested after a student reported the coach attempted to have sexual contact. Which nursing action has priority in the period immediately following the coach's arrest? a. Determine the nature and extent of the coach's sexual disorder. b. Assess the coach's potential for suicide or other self-harm. c. Assess the coach's self-perception of problem and needs. d. Determine whether other children were harmed.

ANS: B Pedophiles and other persons with paraphilic disorders can be at increased risk of self-harm associated with the guilt, shame, and anger they feel about their behavior and its effect on their families, victims, and victims' families. They also face considerable losses, such as the end of their careers or the loss of freedom to imprisonment. Thus, safety is the priority issue for assessment. Determining the nature and extent of the patient's disorder and related patient perceptions would be appropriate but not the highest priority for assessment. Investigating whether other victims exist is a matter for law enforcement rather than health care personnel. See relationship to audience response question.

An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which nursing diagnosis is most appropriate for this scenario? a. Defensive coping b. Sexual dysfunction c. Ineffective sexuality pattern d. Disturbed sensory perception, tactile

ANS: B Sexual dysfunction is the most appropriate nursing diagnosis for a patient who is experiencing a problem affecting one or more phases of arousal. This is the primary problem reported by this patient. Ineffective sexuality pattern, since it is due to sexual dysfunction, is secondary to the absence of orgasms. The patient has not indicated she does not become aroused, just that she cannot achieve orgasm. Disturbed sensory perception may be part of the etiology, but the problem is sexual dysfunction. There is no evidence of defensive coping.

A new staff nurse tells the clinical nurse specialist, "I am unsure about my role when patients bring up sexual problems." The clinical nurse specialist should give clarification by saying, "All nurses: a. qualify as sexual counselors. Nurses have knowledge about the biopsychosocial aspects of sexuality throughout the life cycle." b. should be able to screen for sexual dysfunction and give basic information about sexual feelings, behaviors, and myths." c. should defer questions about sex to other health care professionals because of their limited knowledge of sexuality." d. who are interested in sexual dysfunction can provide sex therapy for individuals and couples."

ANS: B The basic education of nurses provides information sufficient to qualify the generalist to assess for sexual dysfunction and perform health teaching. Taking a detailed sexual history and providing sex therapy requires additional training in sex education and counseling. Nurses with basic education are not qualified to be sexual counselors. Additional education is necessary. A registered nurse may provide basic information about sexual function, but complex questions may require referral.

A woman consults the nurse practitioner because she has not achieved orgasm for 2 years, despite having been sexually active. This is an example of: a. Paraphilic Disorder. b. Female Orgasmic Disorder. c. Genito-Pelvic Pain/Penetration Disorder. d. Female Sexual Interest/Arousal Disorder.

ANS: B The persistent inhibition of orgasm is a form of sexual dysfunction called female orgasmic disorder. Genito-pelvic pain/penetration disorder applies to painful intercourse. The patient has not indicated that her interest in sexual activity is diminished, so female sexual interest/arousal disorder does not apply. Paraphilic disorder is not applicable.

A man who reports frequently experiencing premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my partner. Can you help me?" Select the nurse's best response. a. "Have you discussed this problem with your partner?" b. "I can refer you to a practitioner who can help you with this problem." c. "Have you asked your health care provider for prescription medication?" d. "There are several techniques described in this pamphlet that might be helpful."

ANS: B The primary role of the nurse is to perform basic assessment and make appropriate referrals. The other options do not clarify the nurse's role

An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which documentation best indicates the treatment was successful? a. "No complaints related to sexual function; to return next week." b. "Patient reports achieving orgasm last week; seems very happy." c. "Reports satisfaction with sexual encounters; feels partner is supportive." d. "Reports achieving orgasm occasionally; relationship with partner is adequate."

ANS: C Human sexuality, sexual expression, and expectations related to sexuality vary tremendously from person to person and across cultures. Therefore, the best indication of satisfactory treatment is that the patient is satisfied with what has been achieved. In this instance, "Patient reports satisfaction with sexual encounters; feels partner is supportive" best indicates that the patient is satisfied, and both presenting issues are progressing in a positive manner. Achieving orgasm once or occasionally may or may not represent satisfactory progress to the patient. "No complaints" does not necessarily mean that satisfaction exists.

A patient's medical record documents sexual masochism. This patient derives sexual pleasure: a. from inanimate objects. b. by inflicting pain on a partner. c. when sexually humiliated by a partner. d. from touching a non-consenting person.

ANS: C Sexual masochism is sexual pleasure derived from being humiliated, beaten, or otherwise made to suffer. The distracters refer to fetishism, sexual sadism, and frotteurism.

*Which statement about paraphilic disorders is accurate? a. Paraphilic behavior is controllable by willpower, but most persons with these disorders fail to do so. b. Persons with paraphilic disorders rarely experience shame and are not distressed by their acts.* c. Persons with paraphilic disorders prey primarily on female children between the ages of 12 and 15 years. d. Acts of paraphilia are common because persons with the disorders commit the acts repeatedly, but paraphilic disorders are uncommon.

ANS: D Paraphilic disorders are uncommon; however, because persons with these disorders repeatedly enact behaviors associated with their disorders, paraphilic acts are relatively common. The majority of victims of pedophiles are males in early adolescence; those pedophiles who prefer females usually prefer prepubescent children. Some persons with paraphilic disorders experience shame and are at higher risk for suicide due to the stigma, shame, and embarrassment. Biological and psychological drives underlying paraphilic behavior can be very strong and often are not controllable by willpower alone. Persons with paraphilic disorders have difficulty controlling their behavior, even when very motivated to do so.

A man with hypospadias tells the nurse, "Intercourse with my new bride is painful." Which term applies to the patient's complaint? a. Delayed ejaculation b. Erectile dysfunction c. Premature ejaculation d. Genito-pelvic pain/penetration disorder

ANS: D This sexual pain is genito-pelvic pain/penetration disorder and may occur in men or women. The individual feels pain in the genitals during intercourse. Erectile or ejaculation problems are not evident. See relationship to audience response question.

*A patient tells the nurse that his sexual functioning is normal when his wife wears short, red camisole-style nightgowns. He states, "Without the red teddies, I am not interested in sex." The nurse can assess this as consistent with:* a. exhibitionism. b. voyeurism. c. frotteurism. d. fetishism.

ANS: D To be sexually satisfied, a person with a sexual fetish finds it necessary to have some external object present, in fantasy or in reality. Frotteurism involves deriving sexual pleasure from rubbing against others surreptitiously. Exhibitionism is the intentional display of the genitalia in a public place. Voyeurism refers to viewing others in intimate situations.

The male manager of a health club placed a hidden video camera in the women's locker room and recorded several women as they showered and dressed. The disorder most likely represented by this behavior is: a. homosexuality. b. exhibitionism. c. pedophilia. d. voyeurism.

ANS: D Voyeurism is achieving sexual pleasure through the viewing of others in intimate situations, such as undressing, bathing, or having sexual relations. A homosexual individual would be interested in watching members of the same sex, and homosexuality is not typically associated with voyeurism. Exhibitionists are interested in exposing their genitals to others. Pedophiles seek sexual contact with children.

The nursing assessment for a male reporting erectile dysfunction (ED) is properly focused when the nurse assesses for ... Preexisting cardiovascular disease Type 1 or type 2 diabetes Acute or chronic depression Alcohol abuse

Alcohol abuse

A nurse is conducting a social and sexual assessment of a client. Which of the following questions would be most appropriate for the nurse to ask to begin the discussion? A. "How often do you engage in sexual activity?" B. "How would you describe your social life?" C. "Have you ever been sexually assaulted?" D. "Are you heterosexual?"

B. "How would you describe your social life?" *The nurse should begin the assessment with a broad, opening question that addresses the client's social life. Based on the answer, the nurse can then focus on specific aspects. Asking about the frequency of sexual activity assumes that the client is currently sexually active, which may or may not be the case. Asking about sexual orientation would be a question for later in the assessment. However, the nurse should use a broad, general question that allows the client to respond with more than a yes or no. Asking about any sexual assault would need to be addressed much later in the assessment. In this situation, the nurse again, should use a broad, open-ended type question that allows the client to describe the situation and/or feelings, rather than a yes/no answer.

A client has admitted to the nurse that he is sexually aroused by practicing frotteurism. He tells the nurse, "I've never really told anyone before, but it doesn't make me a bad person, does it?" What is the nurse's best response? A. "Ultimately, no one has the moral right to tell you what's right and wrong when you're expressing your sexuality." B. "It doesn't mean that you're a bad person, but it's a serious issue that needs to be addressed." C. "That used to be considered taboo, but we're much more open-minded about sex in our society now." D. "Sexuality is a highly individualized phenomenon and everyone expresses themselves differently."

B. "It doesn't mean that you're a bad person, but it's a serious issue that needs to be addressed."

A nurse is reviewing the medication history of a client diagnosed with erectile dysfunction who is being treated with a PDE5 inhibitor. Which of the following might the nurse note in the client's history? Select all that apply. A. Alprostadil B. Avanafil C. Phentolamine mesylate D. Papaverine hydrochloride E. Vardenafil

B. Avanafil E. Vardenafil *PDE5 inhibitors include sildenafil citrate, vardenafil hydrochloride, tadalafil, and avanafil. Phentolamine and papaverine are smooth muscle relaxants used for intracavernosal pharmacotherapy. Alprostadil is a prostaglandin used in microsuppository form. **REMEMEBER PHIL NEEDS THE "FILS"

During the client interview, the client has implied to the nurse that she never achieves orgasm. What action should the nurse prioritize when following up this statement? A. Tactfully describing the potential benefits of enhancing her sexual function B. Determining whether the client desires a change in sexual activity C. Facilitating a meeting between the client, her partner and the nurse D. Seeking the client's permission to perform a focused genitourinary assessment

B. Determining whether the client desires a change in sexual activity *Prior to providing interventions for a client with a suspected female orgasmic disorder, it is imperative to determine whether the client desires change. This cannot be assumed.

Hypoactive sexual desire disorder can result from which of the following? Select all that apply. A. A high-sodium diet B. Endocrine disease C. Aging D. Stress E. Depression

B. Endocrine disease C. Aging D. Stress E. Depression

While interviewing a male client, he reports that he becomes sexually aroused by rubbing the shoes of his partner and then masturbates while continuing to rub them. The nurse identifies this as which of the following? A. Exhibitionism B. Fetishism C. Frotteurism D. Pedophilia

B. Fetishism *With fetishism, an object such as women's undergarments or foot apparel is used for sexual arousal. The individual usually masturbates while holding, rubbing, or smelling the item or it is worn by a partner during sexual activity. With frotteurism, sexually arousing urges, fantasies, and behaviors occur when touching or rubbing one's genitals against the breasts, genitals, or thighs of a nonconsenting person. With exhibitionism, the behavior involves exposing one's genitals to strangers, with occasional masturbation. With pedophilia, sexual activity occurs with a child usually 13 years of age or younger by an individual at least 16 years of age or 5 years older than the child. Pedophilic acts include fondling, oral sex, and anal or vaginal intercourse with the penis, fingers, or objects, with varying amounts of force.

The diagnostic criteria for erectile dysfunction require that the condition be present for which time frame? A. More than 3 months B. Over 6 months C. About 1 month D. At least 1 year

B. Over 6 months *Although most men experience an occasional lack of erection, intervention is required when there is consistent (more than 6 months) erectile inefficiency during masturbation, intercourse, or upon awakening.

A male client is being treated for premature ejaculation. Which of the following medications would most likely be prescribed for this client? A. Levodopa (Laradopa) B. Paroxetine (Paxil) C. Sildenafil citrate (Viagra) D. Bupropion (Wellbutrin)

B. Paroxetine (Paxil) Paxil is used as a treatment of premature ejaculation or hyperarousal disorder. Laradopa is used to improve sexual response. Viagra is used to treat decreased libido and response-cycle dysfunction. (erectile dysfunction drug) Wellbutrin acts to treat decreased libido and orgasm dysfunction. (male hypoactive sex desire disorder)

A teacher has approached the school nurse because he observed a 7 year-old student touching his genitals in the locker room. What is the nurse's most appropriate response? A. Educate the teacher about the need to empathically address the behavior B. Reassure the teacher that this behavior is not abnormal C. Have the teacher refer the student to the nurse, with the permission of the parents D. Encourage the teacher to initiate education about sexuality with the student

B. Reassure the teacher that this behavior is not abnormal *In most circumstances, a child who touch his or her genitals is not behaving inappropriately or abnormally. A repeated pattern of this behavior may warrant interventions, but an isolated instance does not require additional action.

A client tells the nurse that he is mostly feeling better after a relapse of major depression; however, he is increasingly saddened by a loss of desire to have sex with his wife and the subsequent disconnection in their relationship. A review of the client's history reveals use of an antihypertensive and antidepressant. Which of the following diagnoses will the nurse select to identify the problem the client is experiencing? A. Ineffective Coping B. Sexual Dysfunction C. Disturbed Body Image D. Ineffective Sexual Patterns

B. Sexual Dysfunction *The client's change in sexual functioning is causing distress. The dysfunction may be related to medication side effects. The nurse will set the goal of identifying the cause of the dysfunction. Ineffective coping describes a patient who is not adequately identifying stressors and is choosing an inadequate response. Ineffective Sexual Patterns would be assessed if the client was concerned with personal sexuality. An assessment of Disturbed Body Image would match with a client who has a confused picture of the self.

The mental health nurse shows excellent sexual assessment interviewing skills when ... A. Assuring the client that the conversation is confidential so "you can be open and unafraid about your answers" B. Sharing that the questions are very personal in nature and encourage the client to "let me know if you get uncomfortable with them." C. Asking the very specifically sexual questions only after the therapeutic client-nurse relationship has been well established. D. Being very knowledgeable about the various sexually oriented dysfunctions

B. Sharing that the questions are very personal in nature and encourage the client to "let me know if you get uncomfortable with them." *The mental health nurse shows excellent sexual assessment interviewing skills when stating that the questions she is about to ask are very personal in nature and encourages the client to let her know if "she is uncomfortable with them."

Which of the following reflects an age-related sexual system change in women? Select all that apply. A. Increasing orgasmic force B. Thinning of the vaginal mucosa C. Increased breast response to stimulation D. Decreased orgasmic capacity E. Increasing breast involution

B. Thinning of the vaginal mucosa E. Increasing breast involution *In women, estrogen deficiency during menopause affects the sexual system by causing a gradual thinning of the vaginal mucosa, decreasing the elasticity of muscles and orgasmic force, and increasing breast involution (sagging of breast tissue). Vaginal lubrication decreases, which may cause dyspareunia (pain during intercourse), often requiring the use of a water-soluble lubricant or saliva. Although many women experience little or no change in sexual function, both decreased and increased sexual activity and interest are possible. In some women, more time is required to lubricate the vulvovaginal areas and to strengthen clitoral response. Orgasmic capacity and breast response remain fairly constant in appropriately stimulated women.

A nurse is conducting a sexual assessment of an older male. Which information if reported by the client would the nurse identify as a normal age-related change? A. Spermatogenesis increases B. Testicles enlarge C. Ability to sustain longer erections D. Force of ejaculation increases

C. Ability to sustain longer erections **Older men are capable of sustaining erections much longer with decreased ejaculatory demand, potentially benefiting older women, who require increased time to reach orgasm. The testicles begin to decrease in elasticity and size, ejaculation time increases, and the force of ejaculation decreases. Spermatogenesis decreases, although viable sperm, capable of impregnation, continue to be produced

The nurse is conducting a sexual history of a new client. The nurse understands that which of the following descriptions most accurately describes the concept of gender identity? A. The chromosomal determination of a person's identity as male or female B. An individual's pattern and interpretation of sexual responses C. An individual's subjective view of oneself as being masculine or feminine D. The social manifestations of a person's biological sexual characteristics

C. An individual's subjective view of oneself as being masculine or feminine *The concept of gender identity is described by how one views one's gender as masculine or feminine, socially derived from experiences with the family, friends, and society. Gender identity is not synonymous with biological sex or sexual response.

The nurse is assessing a client with a sexual disorder. During the initial interview, the client relates details about her sexual preferences. The nurse thinks to herself, "This woman is depraved!" How should the nurse address her feelings about the client? A. Reassign the client to another nurse. B. Keep her feelings to herself. C. Discuss her feelings with a colleague. D. Refocus the conversation on more acceptable content.

C. Discuss her feelings with a colleague.

The treatment plan for a client diagnosed with female orgasmic disorder includes interventions that focus on educating the woman about entitlement and about requesting pleasurable sexual stimuli. The nurse interprets this as which of the following? A. Sensate focus B. Counseling C. Facilitative communication D. Couples therapy

C. Facilitative communication *Assertiveness training and facilitative communication are interventions that focus on teaching entitlement to request pleasurable sexual stimuli. Sensate focus is an intervention that focuses on decreasing the pressure to perform and increasing the awareness of pleasurable sensations. Counseling and couples therapy focus on increasing the awareness of personal, social, and relationship issues.

Thomas has complained of recurrent impulses to go to the local mall and touch or rub up against people who are shopping or standing in line. He states that although this is fairly easy to do, he becomes embarrassed as he becomes erect during this activity and occasionally has an ejaculation, which is "very humiliating." From the clinical information above, which of the paraphilias is Thomas suffering from? A. Dyspareunia B. Exhibitionism C. Frotteurism D. Fetishism

C. Frotteurism

A nursing student is reviewing information about sexual maturation. The student demonstrates understanding of the concept when identifying which of the following as a component? Select all that apply. A. Gender B. Orgasm C. Gender role D. Gender identity E. Sexual orientation F. Biosexual identity

C. Gender role D. Gender identity E. Sexual orientation F. Biosexual identity *Sexual maturation encompasses four areas: biosexual identity, gender identity, sex role identity, and sexual orientation. Whereas biosexual identity refers to the anatomic and physiologic state of being male or female, gender identity is the conviction of belonging to a male or female gender. Both biosexual and gender identities result from genetic and intrauterine hormonal influences, not learned behavior. Sex role (or gender role) identity is the outward expression of gender, including behaviors, feelings, and attitudes. Sexual orientation refers to a person's sexual attraction to those of the opposite sex (heterosexual), same sex (homosexual), or both sexes (bisexual).

Which of the following paraphilias might involve the act of using electrical shock to make a person suffer? A. Fetishism B. Pedophilia C. Sexual masochism D. Exhibitionism

C. Sexual masochism *This behavior involves the act of being humiliated, beaten, bound, or made to suffer. Self-induced masochistic acts include use of electric shock, pin sticking, restraints, and mutilation. Partner-induced acts may include bondage; whipping; being urinated or defecated on; and being forced to crawl, bark, or wear diapers. Fetishism is the use of an object such as women's undergarments or foot apparel for sexual arousal. Pedophilia is a sexual activity that occurs with a child, usually 13 years of age or younger, by an individual at least 16 years of age (or 5 years older than the child).

It is most important for the mental health nurse who is providing effective education regarding normal sexual function to ... A. Discuss how normal sexuality is affected by age and health B. Share strategies that help maintaining normal sexual function throughout the lifespan C. Share with the client that normal sexuality can be expressed in a variety of ways D. Identify factors that can affect the expression of normal sexual drives

C. Share with the client that normal sexuality can be expressed in a variety of ways *Client education begins with an explanation of normal sexual response and that variability among individuals with respect to normal sexuality is commonplace; stressing this variation with clients is important.

When describing sexual desire and arousal to a group of nursing students, which of the following would the instructor most likely include? A. Estrogen influences desire in both men and women. B. The sympathetic nervous system controls arousal C. The central nervous system integrates the sex drive. D. The parasympathetic nervous system controls orgasmic discharge.

C. The central nervous system integrates the sex drive. *In healthy adults, the sex drive is integrated through the central nervous system (CNS) with the autonomic nervous system governing extragenital changes (increased respiration and heart rate). The parasympathetic nervous system largely controls arousal, and the sympathetic nervous system largely controls orgasmic discharge. Sexual stimulation brings about a total-body response with dramatic changes seen in the genitals and breasts. Sex hormones, particularly androgen, influence desire in both genders.

A client with a history of erectile dysfunction has just been prescribed tadalafil. What education should the nurse provide to the client? A. The client may develop tolerance to the drug over the course of a few weeks B. The drug enhances the client's erection but increases the risk of premature ejaculation C. The client should seek medical help if his erection lasts longer than a few hours D. The client should avoid grapefruit juice while taking the drug

C. The client should seek medical help if his erection lasts longer than a few hours

A nurse is conducting a seminar for a men's community group on sexual dysfunction. When describing premature ejaculation, which information would the nurse most likely include? A. It is the second most common sexual dysfunction affecting men. B. The majority of men with premature ejaculation seek treatment. C. The underlying cause of premature ejaculation is not known. D. Extensive studies have been done to gain information about premature ejaculation.

C. The underlying cause of premature ejaculation is not known. *The etiology of PE is unknown with little data to support suggested biologic or psychological theories such as anxiety, penile hypersensitivity, and serotonin receptor dysfunction. Based on client self-report, PE is viewed as the most common male sexual dysfunction, with prevalence rates of 20% to 30%. Unlike erectile dysfunction (ED), which has been studied formally and for which most sexual therapy is sought, information on PE has arisen primarily through self-report. It is estimated that about 27% of men seeking treatment report PE as a problem. Most men with PE do not seek treatment.

A 49 year-old client states that she has been experiencing dyspareunia on an increasingly frequent basis. Assessment reveals no organic cause for the problem, so the nurse should recommend: A. Showering or bathing immediately before sexual activity. B. Referral to a sex therapist. C. The use of a water soluble lubricant. D. Limiting sexual activity to once or twice weekly.

C. The use of a water soluble lubricant.

A client is brought to the emergency department by law enforcement after being caught peeping into a neighbor's bedroom while the neighbor and her partner were engaged in sexual activity. The neighbor told law enforcement that this has happened numerous times before. Based on this information, the nurse would suspect which of the following? A. Sexual sadism B. Frotteurism C. Voyeurism D. Fetishism

C. Voyeurism *The nurse would suspect voyeurism, which involves "peeping," for the purpose of sexual excitement, at unsuspecting people who are nude, undressing, or engaged in sexual activity. Sexual sadism involves sexual excitement that occurs when causing physical or psychological suffering to another individual. Frotteurism involves sexually arousing urges, fantasies, and behaviors that occur when touching or rubbing one's genitals against the breasts, genitals, or thighs of a nonconsenting person. With fetishism, an object such as women's undergarments or foot apparel is used for sexual arousal.

A client reports a decrease in vaginal lubrication during sexual intercourse. Which of the following would be appropriate for the nurse to suggest to the client? Select all that apply. A. Petroleum jelly B. Vinegar douche C. Water-soluble lubricant D. Kegel exercises E. Saliva

C. Water-soluble lubricant E. Saliva

A woman comes to the clinic for an annual check up. The client has gained 40 pounds since her last visit 13 months ago. At this time the nurse informs the client that her blood pressure also is much higher since last time. The client denies depression but tells the nurse that she is having trouble with sex. She reports that she previously enjoyed sex and was able to climax, but now can no longer reach orgasm. What would the nurse suspect as the cause for this woman's orgasmic disorder? A. Depression B. Sexual inhibitions C. Grief D. Decreased self-esteem

D. Decreased self-esteem *Poor self-concept can prevent a woman from engaging in sexual relationships and affect her ability to have an orgasm. Because this client gained 40 pounds in one year and now cannot reach orgasm although she once could, the current problem is most likely linked to her weight gain and associated poor self-image.

The mental health nurse shows an understanding of the most common male sexual dysfunctional disorders when asking ... "Do you ejaculate too early?" "Do you feel your partner understands your sexual needs?" "Is intercourse physically painful for you?" "Does your partner ever complain about wanting more sex with you?"

"Do you ejaculate too early?"

An adult client informs the nurse that he often experiences premature ejaculation. When assessing potential causes, what assessment question should the nurse include? "To your knowledge, do your brothers or father face similar issues?" "How many alcoholic drinks do you consume in a typical day?" "Are you circumcised?" "Do you ever experience urinary incontinence?"

"How many alcoholic drinks do you consume in a typical day?" Premature ejaculation is often attributed to drug and alcohol use, with the problem abating when intake is reduced. The issue of alcohol use is more clinically significant than family history. Circumcision and urinary function are not directly relevant to the etiology of premature ejaculation.

The nurse understands that for a client to be diagnosed with erectile dysfunction, the condition must be consistently present for how long? 3 months 9 months 1 month 6 months

6 months

Which characteristic fits the usual profile of an individual diagnosed with pedophilic disorder? a. Homosexual b. Ritualistic behaviors c. Seeks access to children d. Self-confident professional

ANS: C Persons with pedophilic disorder usually place themselves in jobs, activities, or relationships that provide easy access to children. They often become trusted by both parents and children. The other characteristics have no particular relationship to pedophilic disorder.

The nurse is interviewing a client. Which statement would lead the nurse to suspect that the client may be experiencing gender dysphoria? -A woman states, "I guess I've always felt more attracted to women than men, despite being taught this was wrong." -A man states, "I feel like men are to blame for all the violence, crime, and oppression in the world." -A man states, "Looking back, I've always felt like a woman who is trapped in a man's body." -A woman states, "I was never interested in 'girly' pursuits like playing with dolls and playing house."

A man states, "Looking back, I've always felt like a woman who is trapped in a man's body."

Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should: a. develop an understanding of human sexual response. b. assess the patient's sexual functioning and needs. c. acquire knowledge of the patient's sexual roles. d. clarify own personal values about sexuality.

ANS: D Before one can be helpful to patients with sexual dysfunctions or disorders, the nurse must be aware of his or her own feelings and values about sex and sexuality. Nurses must keep their personal beliefs separate from their patient care in order to remain objective, professional, and effective. Nurses must be comfortable with the idea that patients have a right to their own values and must avoid criticism and censure. The other options are indicated as well, but self-awareness must precede them to provide the best care.

While performing an assessment, the nurse says to a patient, "While growing up, most of us heard some half-truths about sexual matters that continue to puzzle us as adults. Do any come to your mind now?" The purpose of this question is to: a. identify areas of sexual dysfunction for treatment. b. determine possible homosexual urges. c. introduce the topic of masturbation. d. identify sexual misinformation.

ANS: D Misinformation about normal sex and sexuality is common. Lack of knowledge may affect an individual's sexual adjustment. Once myths have been identified, the nurse can give information to dispel the myth.

A nurse is reviewing the medical history of a client. Which condition would alert the nurse to the possibility that the client's sexual functioning may be affected? Select all that apply. Diverticulosis Cerebrovascular accident Diabetes Use of antihypertensive drugs Chronic obstructive pulmonary disease

Cerebrovascular accident Diabetes Use of antihypertensive drugs Chronic obstructive pulmonary disease

A woman diagnosed with a sexual arousal disorder asks the nurse, "Why can't I just take the drug men use for erectile dysfunction?" Which response by the nurse would be most appropriate? A. "These drugs are manufactured for men, not women." B. "These medications have not been shown to be effective in women." C. "Women have too many side effects with these medications." D. "Women don't absorb the medication as fully as men do."

B. "These medications have not been shown to be effective in women." Rationale: PDE5 inhibitors are approved for the treatment of erectile dysfunction in men. However, they have not been shown to be efficacious in sexual arousal disorders in women. Side effects and absorption rates are not the underlying reason.

Susan, an RN, is taking care of John, age 22, who had an emergency appendectomy 3 days ago. As she enters John's room at 11 PM, she abruptly stops as she sees that John is masturbating. The most therapeutic nursing intervention is which of the following? A. "John, that will cause your incision to open and is not really appropriate here." B. "Excuse me, John. Let me pull your curtain, and I'll be back later to check on you." C. "John, your behavior is inappropriate and may be disturbing to other clients." D. "Oh, my! I can't believe you're doing that here!"

B. "Excuse me, John. Let me pull your curtain, and I'll be back later to check on you." *Masturbation is a common and healthy sexual activity. By remaining calm and providing privacy, the nurse is acknowledging the client's sexual need.

The nursing student learning about sexual disorders demonstrates understanding when identifying biosexual identity to mean which of the following? A. Conviction of belonging to a male or female gender B. Anatomic physiologic state of being male or female C. A person's sexual attraction to those of the opposite sex D. Outward expression of gender

B. Anatomic physiologic state of being male or female *Biosexual identity refers to the anatomic and physiologic state of being male or female.

An adult male has been caught watching women shower at the gym. This is an example of which type of paraphilia? A. Pedophilia B. Voyeurism C. Exhibitionism D. Fetishism

B. Voyeurism

Which type of paraphilia is characterized by deriving sexual pleasure from looking at unsuspecting people who are naked, undressing, or engaged in sexual activity? A. Frotteurism B. Pedophilia C. Voyeurism D. Bestiality

B. Voyeurism *Voyeurism is the achievement of sexual pleasure by looking at unsuspecting people who are naked, undressing, or engaged in sexual activity. Pedophilia is the use of children for sexual gratification. Frotteursim is sexual contact with inanimate articles for sexual gratification. Bestiality is sexual gratification through contact with animals.

A client with premature ejaculation is prescribed sertraline as part of his treatment. The client asks the nurse how long will it take until he really notices the drug's effect. Which response by the nurse would be most appropriate? A. "You need to take the drug for at least one month to notice the changes." B. "Most people see the effects in about 3 weeks." C. "It usually takes 1 to 2 weeks to be most effective." D. "You should notice a difference after the first dose."

C. "It usually takes 1 to 2 weeks to be most effective."

Nursing students in a psychiatric nursing class are reviewing theories of sexual response. A student correctly identifies the phase described by Masters and Johnson in which erotic feelings cause penile erection in men and vaginal lubrication in women to be ... A. Orgasm phase B. Plateau phase C. Resolution phase D. Excitement phase

D. Excitement phase

When describing the behaviors and fantasies associated with paraphilias, a nurse would most likely identify these as beginning at which time? A. Early young adulthood B. Middle-age C. Adolescence D. Childhood

D. Childhood *Certain behaviors and fantasies associated with paraphilias are said to begin in childhood and become more elaborate and better defined during adolescence and early adulthood.

The human sexual response cycle is divided into four phases. Which of the following is the final phase of the sexual response? A. Orgasm B. Ejaculation C.Excitement D. Resolution

D. Resolution *The final phase of the sexual response is resolution. Excitement is the second phase, and orgasm is the third phase of the sexual response. Ejaculation occurs in the orgasm phase.

When a client endures pain to achieve sexual satisfaction, which of the following paraphilias is occurring? A. Fetishism B. Necrophilia C. Bestiality D. Sexual masochism

D. Sexual masochism

A client is diagnosed with female sexual interest/arousal disorder. Which of the following would the nurse need to keep in mind? The disorder has been widely studied for etiology. Evidence is lacking related to a history of sexual abuse as a factor. Decreased androgen levels during the menstrual cycle may affect arousal. The disorder typically occurs during middle-adulthood.

Decreased androgen levels during the menstrual cycle may affect arousal.

A client couple relates that their sex life has deteriorated over the years. They have had difficult times in their marriage, and the husband seems to desire sex less frequently than does the wife. What is the nurse generalist's role in counseling this couple? Determine the appropriate referral avenue. Provide education. Begin sex therapy. Suggest individual counseling for each first, followed by marital therapy.

Determine the appropriate referral avenue. *Whereas the nurse generalist may be qualified to assess the client's sexual concerns and may be prepared to educate the client regarding normal sexual function, he or she generally is not prepared to provide sex therapy. Areas in which the nurse may provide teaching and counseling include relationship counseling and communication techniques for couples, and referral to specialists in sexual counseling.

Which of the following neurotransmitters is responsible for arousal and ejaculation in men? A. Epinephrine B. Acetylcholine C. Serotonin D. Dopamine

Dopamine *Dopaminergic activity in the central nervous system facilitates arousal and ejaculation in men. The serotonergic system inhibits arousal and ejaculation. Acetylcholine and epinephrine are not involved in these activities.

When a woman who is in a sexual relationship with a partner of another ethnic culture reports "problems with our sex life," the nurse's initial intervention is to determine ... If her partner is willing to attend couples counseling Exactly what form the problems are taking If there are sexual expectations the client finds culturally unacceptable When the relationship began to experience the sexual problems

If there are sexual expectations the client finds culturally unacceptable

An adult client has sought care because of his recent inability to maintain an erection. What lifestyle modifications should the nurse recommend? Select all that apply. Reducing alcohol consumption Losing weight if he is obese Eating a low-fat, high-protein diet Ensuring he gets adequate sleep Exercising on a regular basis

Losing weight if he is obese Reducing alcohol consumption Ensuring he gets adequate sleep Exercising on a regular basis

A nurse is preparing for a presentation on sexual response. When describing the excitement phase, which of the following would the nurse describe as occurring during this phase? Select all that apply. Ejaculation Vaginal lubrication Vaginal muscle contraction Penile erection Erotic feelings

Penile erection Erotic feelings Vaginal lubrication

Which medication classification has been found to be effective in the treatment of premature ejaculation? Selective serotonin reuptake inhibitors (SSRIs) Tricyclics Antipsychotics Monoamine oxidase inhibitors (MAOIs)

Selective serotonin reuptake inhibitors (SSRIs)

A nurse is conducting a psychosocial assessment of a woman suspected of having female orgasmic disorder. Which of the following would be important for the nurse to assess? Select all that apply. Exercise levels Relationship with partner Rest patterns Self-concept Body image

Self-concept Body image Relationship with partner

A client is diagnosed with female orgasmic disorder. Which of the following would the nurse expect to be included in the client's interdisciplinary plan of care? Select all that apply. Squeeze technique Vibrator Sensate focus Facilitative communication Assertiveness training

Sensate focus Facilitative communication Vibrator Assertiveness training

A nurse is reviewing the history of a client diagnosed with a paraphilia. The paraphilia involves the infliction of pain with leather straps or whips. Th en urse interprets this as which paraphilia? Rape Sexual masochism Incest Sexual sadism

Sexual sadism

A group of nursing students is reviewing information about medications used to treat premature ejaculation. The students demonstrate the need for additional study when they identify which of the following as being used? Sildenafil Sertraline Paroxetine Fluoxetine

Sildenafil Sildenafil is used to treat erectile dysfunction. Pharmacotherapy with selective serotonin reuptake inhibitors has been shown to be effective, but their use would be off label. Paroxetine, sertraline, and fluoxetine are commonly used.

When describing gender dysphoria to a group of staff nurses, which information would the nurse leader most likely include? The disorder occurs more frequently in boys than in girls. This disorder often persists into adulthood. The person's assigned gender is expressed. Pharmacologic agents are the mainstay of treatment.

The disorder occurs more frequently in boys than in girls.

A sexual history of a female client reveals that the client has a normal sex drive and reports of orgasm through means other than intercourse. The client also has a history of being raped several years ago. The client reports spasms of the perineal and outer vaginal muscles when vaginal intercourse is attempted. The nurse interprets these findings as suggesting which of the following? A.Priapism B. Vaginismus C. Sexual aversion disorder D. Dyspareunia

Vaginismus