Chapter 35 Sexuality EAQ

The nurse is counseling a couple on contraceptive methods. Which nonprescription method should the nurse recommend? 1 Condom 2 Diaphragm 3 Vaginal ring 4 Subdermal implant 5 Transdermal skin patch

1 Condoms are nonprescription methods of contraception. A condom prevents entry of sperm into the vagina. It is made of a thin rubber sheath and fits over the penis. A diaphragm is a barrier with spermicide to be used in females; it must be fitted by a gynecologist and so requires a prescription. Vaginal contraceptive rings, subdermal implants, and transdermal skin patches are hormonal methods of contraception and require a health provider's prescription.

Decreased levels of which hormone may result in painful sexual intercourse? 1 Estrogen 2 Testosterone 3 Growth hormone 4 Follicle-stimulating hormone (FSH)

1 Decreased estrogen levels result in decreased vaginal lubrication and vaginal tissue thinning. These changes can result in painful sexual intercourse. Testosterone, growth hormone, and follicle-stimulating hormone (FSH) do not affect the vaginal tissues and do not cause painful intercourse when their levels decrease. Testosterone is responsible for sexual growth and development in males. Growth hormone is responsible for overall growth and development in an individual. FSH promotes sexual growth in females.

The nurse is providing a sex education session to a group of grade-school students. Which aspect of sexual education should the nurse include in the teaching? Select all that apply. 1 Body changes 2 Menstruation 3 Sexually transmitted infections 4 Contraception 5 Sexual relationships

1 Menstruation is the periodic discharge of blood from the uterus through the vagina. Due to lack of information about menstruation, grade-school children may view it as a dreadful disease. Therefore, the nurse should teach or encourage parents or teachers to educate children about menstruation. School-age children have questions about changes in their bodies and emotions, and they need accurate information about these changes. Body changes are more evident in adolescents due to hormonal changes that influence their health. Adolescents who are sexually active may also have several sexual partners. They may seek sexual relationships to achieve the goals of intimacy and pleasure. Therefore, the nurse should teach adolescents (not grade-school children) about body changes, contraception, sexually transmitted infections, and sexual relationships.

Which priority nursing intervention should be included in the plan of care based on the fact that the majority of sexually transmitted infections (STIs) have few if any symptoms? 1 Encourage regular screenings in all sexually active individuals. 2 Provide information about contraception options. 3 Administer prescribed antibiotics for human papillomavirus (HPV) or genital herpes outbreaks. 4 Ask all patients if they are experiencing any symptoms.

1 One of the challenges in reducing the incidence of sexually transmitted infections (STIs) is that most STIs have few symptoms in males or females. Asymptomatic STIs can be diagnosed during a physical examination with appropriate laboratory tests. Screening after each new sex partner is the most effective method to detect and manage STIs. Human papillomavirus (HPV) and herpes are viral infections and cannot be treated with antibiotics.

The nurse is assessing a couple who have been unable to conceive a child for some time. Which questions should the nurse ask the couple to determine whether they should be diagnosed as infertile? Select all that apply. 1 "What is the duration of having unprotected sex?" 2 "Do you experience a sense of failure?" 3 "Do you feel that your body is defective?" 4 "Do you enjoy having sexual intercourse?" 5 "Do you live in a city or suburban area?"

1, 2, 3 Patients are diagnosed as infertile if they are unable to conceive after having 1 year of unprotected sexual intercourse. The patients may experience a feeling of failure and may even think that their bodies are defective. Infertility does not depend on seeking pleasure from sexual intercourse and enjoying the activity. The location of a residence does not affect fertility.

The nurse is teaching a patient how to use a condom. Which statement by the nurse about using a condom is appropriate? Select all that apply. 1 The air should be squeezed out of the condom. 2 The condom should be applied when the penis is hard. 3 The condom should be unrolled to the base of the penis. 4 The condom should be pulled out during ejaculation. 5 Massage oils should be used for lubrication.

1, 2, 3 The air in the condom should be squeezed out. It should be put on as soon as the penis becomes hard and before making any contact with vagina, anus, or mouth. It should be unrolled to the base of the penis to prevent any leakage. The condom should be pulled out after ejaculation and not during ejaculation; pulling it out during ejaculation may cause the semen to pass into the partner. Only water-based lubricants should be used with a condom. Massage oils should not be used, because they may contribute to the condom breaking.

The nurse is reviewing the sexual and physical examination data of a patient diagnosed with sexual dysfunction. Which signs and symptoms might the nurse anticipate finding in the assessment data? Select all that apply. 1 Dyspareunia 2 Erectile dysfunction 3 Uncontrolled hypertension 4 Depression and guilt 5 Foul-smelling genitals

1, 2, 3, 4 Sexual dysfunction is the inability to accomplish sexual desires. It can be due to many reasons. Dyspareunia is pain occurring with sexual intercourse that may lead to decreased sexual desire. Erectile dysfunction that prevents erection required for satisfactory copulation may also lead to decreased desire. Sexual dysfunction may also be related to various psychological factors, including anxiety, depression, and guilt. Uncontrolled hypertension is a risk factor for sexual dysfunction. Foul-smelling genitals call into question cleanliness or suggest the presence of infection.

A new graduate nurse is working in a rehabilitation center that specializes in the care of patients with spinal cord injuries (SCIs). The new graduate knows that sexual issues are common among patients with SCIs. Which actions can enhance the nurse's comfort in discussing sexual issues with patients? Select all that apply. 1 Clarifying personal values related to sexuality 2 Role playing discussion of sexual concerns with another nurse 3 Attending a conference to enhance knowledge about sexuality 4 Avoiding a discussion of sexual concerns until after completing new nurse orientation 5 Asking a nurse who is experienced in caring for patients with SCIs about common sexual concerns

1, 2, 3, 5 Nurses often avoid discussing sexual issues with patients because they are uncomfortable, lack knowledge, or have personal values in conflict with the patients' values. Nurses who have difficulty addressing sexual issues need to seek education and experiences to increase knowledge and explore their personal values.

A middle-aged patient is diagnosed with erectile dysfunction. Which associated conditions might the nurse find in the patient? Select all that apply. 1 Diabetes 2 Hypertension 3 Anorexia 4 Hyperlipidemia 5 Hyperthyroidism

1, 2, 4 Diabetes mellitus, hypertension, and hyperlipidemia are risk factors associated with erectile dysfunction. Obesity, not anorexia, is a risk factor for erectile dysfunction. Hypothyroidism, not hyperthyroidism, is associated with erectile dysfunction.

The nurse is communicating with a gay patient. Which statements hold true for this patient group? Select all that apply. 1 They belong to a sexual minority. 2 They do not readily seek preventive care. 3 They are comfortable revealing their sexual orientation. 4 They are concerned about discrimination. 5 They are more prone to getting sexually transmitted diseases

1, 2, 4 Gay patients belong to a sexual minority group often described as lesbian, gay, bisexual, or transgender (LGBT). Current evidence indicates that they experience decreased access to health care and do not readily seek preventive care (Lim et al., 2014; Williamson, 2010), and may limit access to health care due to the fear of discrimination. Although a lot of advancements and modernization has happened, somehow the sexual minority group is not yet well accepted, and hence many of them are not comfortable revealing their sexual orientation. Sexually transmitted diseases can occur in any sexually active person irrespective of the category they belong to.

A 50-year-old male patient comes for a follow-up visit a few months after a myocardial infarction. The nurse plans to interview the patient to assess his sexual health. What precautions should the nurse take when assessing the patient's sexuality? Select all that apply. 1 Ensure that the patient is comfortable discussing the issue. 2 Ensure that the patient has privacy. Close the door or curtains of the room. 3 Avoid talking to the patient. Hand him a questionnaire and ask him to complete it. 4 Ask open-ended questions, such as how the patient's health problem has affected his sexual activity. 5 Include the family members in the discussion to get more information.

1, 2, 4 When assessing a patient's sexuality, it is extremely important that the patient is comfortable discussing it. The nurse should maintain privacy by closing the doors and curtains of the room. Asking open-ended question gives the patient the opportunity to explore his situation completely. It is an incorrect nursing practice to avoid discussion with the patient and just handing him a questionnaire. Family members should not be included in the discussion, because that may be an invasion of the patient's privacy.

When conducting a comprehensive sexual history assessment, which questions should the nurse include? Select all that apply. 1 "To how many babies have you given birth?" 2 "Do you know about contraception?" 3 "Have you had a urinary tract infection?" 4 "How many sexual partners have you ever had?" 5 "Have you undergone a surgical removal of a kidney?"

1, 2, 4 While assessing a patient's sexual history, the nurse should ask about the number of children and the means of contraception. A comprehensive sexual assessment also gathers information about the number of sexual partners the patient has had in the past. Questions regarding urinary tract infection or surgical removal of a kidney do not provide information about the sexual history and hence are not included in the assessment.

A woman wishes to use hormonal contraceptives. How do they work? Select all that apply. 1 They cause thinning of the lining of the uterus. 2 They prevent ovulation. 3 They reduce sperm motility. 4 They act as a spermicidal barrier. 5 They thicken the cervical mucus

1, 2, 5 Hormonal contraceptives work by thinning the uterus so that the fertilized ovum does not get implanted. They also prevent ovulation and thicken the cervical mucus, preventing sperm cells from ascending into the uterus. Hormonal contraceptives do not affect the motility of sperm and do not have any spermicidal effect. Spermicidal creams and jellies kill sperm cells before they enter the uterus.

The nurse is educating a couple about the human immunodeficiency virus (HIV). Which statements by the nurse about HIV are appropriate? Select all that apply. 1 It is a blood-borne pathogen. 2 It spreads through oral-genital sex. 3 It is not found in bodily fluids. 4 It causes ectopic pregnancy. 5 Its risk can be reduced by the use of condoms.

1, 2, 5 Human immunodeficiency virus (HIV) is primarily a blood-borne pathogen. It spreads through vaginal and anal intercourse and through oral-genital sex. The use of condoms reduces the incidence of HIV infection, whereas unprotected sex increases the risk of HIV transmission. Bodily fluids contain HIV, and any exchange of body fluids can result in HIV transmission. Unlike chlamydia, HIV infection is not known to cause ectopic pregnancy.

A couple wishes to prevent conception using natural contraceptive methods based on the menstrual cycle. Which factors indicate the fertile period? Select all that apply. 1 Rhythm of the menstrual cycle 2 Cervical mucus 3 Urinary frequency 4 Breast tenderness 5 Basal body temperature

1, 2, 5 The factors that indicate the fertile period of the menstrual cycle are the regularity of the menstrual cycle, consistency of the cervical mucus, and changes in basal body temperature. The regularity of the menstrual cycle can be affected by many factors, including illness and emotional stressors. Cervical mucus changes in color and consistency throughout the menstrual cycle and can be used to estimate the fertile period. Basal body temperature usually increases during the ovulation period. Urinary frequency and breast tenderness do not provide information about the fertile period. An increase in urinary frequency is associated with urinary tract infections and sexually transmitted infections. Breast tenderness occurs during the first trimester of pregnancy, and it can be a symptom of premenstrual syndrome or fibrocystic breast disease.

The nurse is conducting a sexual assessment of an adolescent. Which should the nurse keep in mind when interacting with this age group? Select all that apply. 1 Use simple language. 2 Check for signs of physical injuries. 3 Keep the findings private and confidential. 4 Use a closed and positive approach. 5 Inform patients that answering questions is normal

1, 2, 5 When interacting with an adolescent about sexuality, use simple and understandable language. The physical examination should involve checking for any signs of injuries to assess for abuse. The patient may be hesitant to interact and hence should be informed that answering such questions is normal. The findings should be shared with the parent or guardian when dealing with a minor. The nurse's approach should be open and positive, because a closed approach may make the patient uncomfortable while responding.

The nurse is evaluating the sexual assessment data of a patient. The nurse finds that the patient has various self-concept issues that are affecting sexual health. Which statements by the patient would indicate such self-concept issues? Select all that apply. 1 "I am not attractive." 2 "I am a chain smoker." 3 "I can't accomplish my sexual desires." 4 "The disease has made me very weak." 5 "Overwork leaves me sleepless at nights."

1, 3, 4 A patient's sexuality is affected by various factors, including self-concept issues related to identity, body image, and self-esteem. A sense of looking ugly may cause a person to feel undesirable. Disease conditions may lead to poor body image and weakness, which may cause dejection and the feeling that one cannot accomplish sexual desires. Being a chain smoker or getting insufficient sleep are lifestyle factors that may affect sexuality but are not self-concept issues.

A patient with heart disease asks the nurse if medications for heart disease can cause erectile dysfunction. Which drugs can cause erectile dysfunction? Select all that apply. 1 Illicit drugs 2 Antidiabetics 3 Diuretic agents 4 Antiplatelet drugs 5 Antihypertensives

1, 3, 5 Drugs that have been associated with erectile dysfunction include illicit drugs, diuretic agents, and antihypertensive medications. Antidiabetics and antiplatelet drugs are not associated with erectile dysfunction. Antidiabetic and antiplatelet drugs are associated with minor side effects such as nausea, diarrhea, and itchy skin.

A couple approaches the nurse for advice about nonprescription contraceptive methods. Which methods should the nurse mention to the couple? Select all that apply. 1 Abstinence 2 Skin patches 3 Vaginal rings 4 Condoms and spermicides 5 Timing of coitus

1, 4, 5 Nonprescription contraceptive options for couples include abstinence from sexual intercourse, condoms and spermicidal jellies, and timing intercourse with the woman's ovulation cycle. Skin patches and vaginal rings contain hormonal substances that require a health care provider's prescription for use.

The nurse is discussing sexual issues with a patient. Which statements hold true about sexuality? Select all that apply. 1 It is influenced by personal beliefs. 2 It is not affected by medications in use. 3 It is influenced by the place where one lives. 4 Pregnancy may affect sexual interest. 5 It may be affected by chronic respiratory disease. 6 Ethnicity plays a role in shaping sexual values.

1, 4, 5, 6 Sexuality is influenced by various factors. An individual's sexuality may be affected by personal beliefs and notions of sexual health. Pregnancy leads to fluctuation in sexual desire due to the hormonal and bodily changes that occur. In addition, presence of disease conditions may shift the focus and energy of the patient towards healing, thus affecting sexuality. The sociocultural environment of a person always influences conduct. The rules and norms of society often determine acceptable and nonacceptable behavior within the culture, thus affecting sexuality. Sexuality is affected by the medications in use. The global location of a person has not been found to affect sexuality.

The nurse is caring for an infertile couple and learns that the couple is suffering from chlamydia. Which statement by the nurse about chlamydia is appropriate? Select all that apply. 1 It affects the genitourinary tract. 2 There is no cure for this disorder. 3 It does not cause ectopic pregnancy. 4 The rectum is resistant to chlamydia infection. 5 It may cause infection of the eyes and lungs in newborns.

1, 5 Chlamydia infection affects the genitourinary system and causes conjunctivitis and pneumonia in newborns. Chlamydia can be cured with antibiotics. Chlamydia infection may cause pelvic inflammatory disease (PID), infertility, and ectopic pregnancy. Chlamydia also infects the rectum.

The nurse is educating a couple about sexually transmitted infections. Which sexual infections cannot be cured? Select all that apply. 1 Herpes 2 Syphilis 3 Chlamydia 4 Gonorrhea 5 Human papillomavirus infection

1, 5 Sexually transmitted infections that cannot be cured include herpes and human papillomavirus. Syphilis, chlamydia, and gonorrhea are sexually transmitted infections caused by bacteria; they can be cured by antibiotics. Syphilis is caused by the bacteria Treponema pallidum. Chlamydia is caused by the bacteria Chlamydia trachomatis. Gonorrhea is caused by the bacteria Neisseria gonorrhoeae.

Which question represents a nonjudgmental approach when gathering a sexual health history? 1 "How do you and your wife/husband feel about intimacy?" 2 "Do you have sex with men, women, or both?" 3 "Are you heterosexual or homosexual?" 4 "What is your sexual orientation?

2 A nonjudgmental attitude facilitates trust and open communication between the nurse and patient. Using terms such as partner versus wife or husband allows patients to identify their sexual preference. The terms gay, lesbian, bisexual, or transgender are preferred over the terms heterosexual or homosexual and are more specific in reference to sexual practices.

Which nursing action takes priority when working with a patient who opts for an abortion? 1 Explain that abortion means killing a life. 2 Clarify the nurse's own personal values. 3 Convince the patient that abortion is a crime. 4 Criticize the patient for the decision.

2 Before nurses can be helpful to patients opting for an abortion, they must be aware of and comfortable with their own feelings and values. The nurse should not provide wrong and biased information to the patient to influence the decision. As a corollary, nurses must be comfortable with the idea that patients have a right to their own values. Nurses must also avoid criticism and censure.

A woman has been diagnosed with infertility. The nurse finds that the patient has multiple sexual partners and suspects a correlation between the patient's infertility and her promiscuous lifestyle. Which could have caused infertility in this patient? 1 Human immunodeficiency virus (HIV) 2 Chlamydia 3 Herpes simplex 4 Human papillomavirus

2 Chlamydia trachomatis infection, if left untreated, may cause infertility, pelvic inflammatory disease, and ectopic pregnancy. Most chlamydia infections are not treated because they do not cause any symptoms in women. Human immunodeficiency virus (HIV) usually does not cause infertility. Herpes causes painful genital lesions but does not cause infertility. Human papillomavirus causes warts and cervical and anogenital malignancies.

While caring for a pregnant patient who is in the first trimester of pregnancy, the nurse discusses sexual activity during pregnancy with the patient. During which trimester are pregnant women most likely to experience increased libido? 1 First trimester 2 Second trimester 3 Third trimester 4 It is unaffected during pregnancy

2 During the second trimester of pregnancy, patients are most likely to experience an increased libido due to an increased blood supply to the pelvic area to nourish the placenta. In the first trimester, there is usually a decrease in libido due to nausea and vomiting. In the third trimester, a comfortable position for sex is difficult. Therefore, sexual desire is usually not equal during all trimesters of pregnancy.

The nurse is gathering a sexual history from a 68-year-old man in a nursing home. Which is important for the nurse to keep in mind? 1 Older adults are usually not part of a sexual minority group. 2 Older adults sometimes do not reveal intimate details. 3 Older men and women lose interest in sex. 4 Older adults in nursing homes do not usually participate in sexual activity.

2 Older adults are sometimes hesitant to reveal information relating to sexual issues because they are embarrassed. It is important that the nurse include a sexual history as a routine aspect of assessment to communicate that sexual activity is normal. Studies have shown an increase in sexual dysfunction with aging but no decrease in sexual activity or interest.

The nurse finds that a 12-year-old girl displays physical aggression, excessive masturbation, poor school performance, and poor peer relationships. Which other findings observed in the girl indicate a history of being sexually abused? Select all that apply. 1 Difficulty eating 2 Difficulty walking or sitting 3 Unusual odor in the genital area 4 Vomiting or abdominal tenderness 5 Fractures of the face, nose, and arms

2, 3 Physical aggression, excessive masturbation, poor school performance, and poor peer relationships are behavioral symptoms of sexual abuse. Symptoms such as difficulty walking or sitting and an unusual odor in the genital area often indicate sexual abuse. Therefore, the nurse should confirm the history of sexual abuse during assessment. Difficulty eating occurs due to anorexia, which is a common finding in adults. Vomiting or abdominal tenderness and fractures of the face, nose, and arms are physical signs that often indicate sexual abuse in adults.

A 15-year-old girl states that she is having unprotected intercourse with her boyfriend. She asks for more information about birth control methods. Which information should the nurse include in patient education? Select all that apply. 1 Condoms or diaphragms are the most effective methods. 2 Hormonal methods offer little protection against sexually transmitted infections (STIs). 3 Barrier methods offer some protection against STIs. 4 Sterilization is an effective option that the patient should consider. 5 The rhythm method is effective for preventing pregnancy.

2, 3 The most effective methods are longer-acting methods, such as an intrauterine device (IUD) or hormonal injection, which are not associated with the sexual act itself. Sterilization is the most effective method besides abstinence but would not be a good option for a young woman, because it is not easily reversible. Hormonal methods do not provide any barrier against sexually transmitted infections (STIs), whereas barrier methods may help reduce the risk. The rhythm method would not be an effective method of birth control for a 15-year-old girl. Couples who use this method need to understand the reproductive cycle of the woman's body and the subtle signs and signals that her body gives during the cycle. To prevent pregnancy, couples abstain from sexual intercourse during designated fertile periods.

A patient presents with decreased libido, depression, and ineffective coping. Which nursing interventions would be helpful for the patient? Select all that apply. 1 Assess for influence of cultural beliefs. 2 Assess the causes of ineffective coping. 3 Help the patient to set realistic goals. 4 Encourage the patient to express feelings. 5 Explain to the patient about the use of condoms.

2, 3, 4 Assessment of the cause of ineffective coping will help the nurse to understand the patient's problems and plan the treatment accordingly. Helping the patient to set realistic goals would help increase the patient's confidence and prevent frustration. Encouraging the patient to express feelings will provide greater insight into the problem. Assessing the influence of cultural beliefs is helpful regarding social isolation. Explaining to the patient about the use of condoms would not help increase libido or enhance coping.

A patient presents with ineffective sexual functioning. Which strategies should the nurse suggest to enhance sexual functioning in the patient? 1 Discourage the use of pain medications. 2 Discourage the use of alcohol and tobacco. 3 Encourage touching and kissing. 4 Discourage the use of pillows during sex. 5 Communicate concerns and fears with the partner.

2, 3, 5 Alcohol and tobacco may decrease sexual functioning and should be discouraged. Touching, kissing, and tactile stimulation are forms of intimacy and should be encouraged. Communicating concerns and fears with the partner and health care provider help in better understanding the problem. Pain medication may be promoted before intercourse in the patient who has chronic pain that could affect intercourse.

A couple approaches the nurse for advice on contraception. Which method suggested by the nurse does not require a health care provider's prescription? 1 Hormonal injection 2 Subdermal implant 3 Condom 4 Intrauterine device

3

How can a nurse establish trust and encourage patient disclosure about sexuality? 1 Ask how often the patient has sexual intercourse. 2 Ask the patient to disrobe in preparation for the physical assessment. 3 Request permission to discuss sexual issues. 4 Request specific examples of sexual practices and problems

3 According to the PLISSIT assessment of sexuality, the nurse should first ask for permission to discuss sexual issues with the patient, followed by open-ended questions to determine the patient's concerns.

A 50-year-old woman complains of dyspareunia. Which is a possible cause of dyspareunia in the patient? 1 Diminished sexual desire 2 Diabetes and hypertension 3 Diminished vaginal lubrication 4 Increased vaginal elasticity

3 Dyspareunia is painful sexual intercourse. In perimenopausal women, estrogen secretion decreases and leads to diminished vaginal lubrication and elasticity. These changes may cause dyspareunia. Diminished sexual desire could be due to low estrogen but does not lead to dyspareunia. Diabetes and hypertension do not cause dyspareunia.

A 50-year-old male patient comes for a follow-up visit a few months after a myocardial infarction. The nurse plans to interview the patient to assess his sexual health. During assessment, the patient expresses that he is not able to perform well sexually. Which explanation should the nurse give to the patient? 1 The patient's sexuality is affected by his age and is absolutely normal. 2 The patient must undergo surgery and extensive medication therapy to get back to normal. 3 Sexuality can be affected by ailments such as myocardial infarction, but the patient should return to normal soon. 4 Sexuality can be affected by ailments such as myocardial infarction, and the damage is permanent.

3 Sexuality may be altered by disease states such as myocardial infarction, unstable angina, diabetes, and spinal cord injury. Medications such as antihypertensives also alter sexual function. These alterations are usually temporary and resolve with time. Because the patient is only 50 years old, his decline in sexual activity is not related to age alone. The patient doesn't need to undergo surgery or medication therapy; he should return to normal without them.

The nurse reviews the health history of a 24-year-old woman who indicates that she has had three new sexual partners since her previous examination 2 years ago. The nurse discusses the need for screening for sexually transmitted infection (STI) even though the patient denies symptoms or discomfort. Which is the most serious complication from untreated STIs in females? 1 Genital discharge and dyspareunia 2 Painful menstrual cycles 3 Infertility and pelvic inflammatory disease 4 Genital warts

3 Sexually transmitted infections (STIs) can certainly cause discharge, discomfort, and genital warts; however, the most serious complications from untreated bacterial STIs are damage to the reproductive organs and increased risks of pelvic inflammatory disease, ectopic pregnancy, and infertility.

A patient has opted for a diaphragm as a mode of contraception. Which advice should the nurse provide to the patient? Select all that apply. 1 It should be used along with an intrauterine device (IUD). 2 It should be used along with condoms. 3 It should be refitted after pregnancy. 4 It should be used with a contraceptive cream. 5 It should be refitted after a significant change in weight.

3, 4, 5 Diaphragms require refitting after pregnancy and after a significant change in the patient's weight (more than a 10-lb gain or loss). Diaphragms are always used with contraceptive creams (spermicides) to ensure their effectiveness. An intrauterine device (IUD) is placed inside the uterus for its contraceptive effects. A patient using an IUD need not use a diaphragm. Although not necessary for contraception when using a diaphragm with spermicide, condoms can be used with a diaphragm and spermicide to decrease transmission of sexually transmitted infections.

A female patient is advised to use a diaphragm for contraception. The nurse understands that any weight change necessitates a resizing of the diaphragm. How much change in weight would be significant? 1 Loss or gain of 4 lbs 2 Loss or gain of 6 lbs 3 Loss or gain of 8 lbs 4 Loss or gain of 10 lbs

4 A diaphragm is a round, rubber dome that is fitted into the cervical opening to provide contraception. It must be used with a contraceptive cream or jelly. It must be refitted if the patient has a weight gain or loss of 10 lbs. Weight changes of 4, 6, or 8 lbs have no adverse effect on the placement of the diaphragm and thus do not require the patient to be refitted.

A couple does not desire to have any more children. Which contraceptive method should the nurse suggest to the couple? 1 Skin patch 2 Abstinence 3 Intrauterine device 4 Vasectomy

4 Because the couple does not wish to have any more children, it is advisable for the couple to opt for permanent contraception. Vasectomy is usually a permanent sterilization procedure for men and involves tying and cutting of the vas deferens. Skin patches and intrauterine devices are not as effective and do not offer permanent contraception. Abstinence from sex is difficult to maintain for most couples.

A patient has been diagnosed with cervical cancer. The patient is a commercial sex worker. Which infection could be responsible for this malignancy? 1 Chlamydia infection 2 Gonorrhea infection 3 Herpes simplex infection 4 Papillomavirus infection

4 Human papillomavirus causes cervical cancer in women and anogenital cancers and warts in both men and women. Chlamydia trachomatis infection does not cause malignancies but can cause urinary and pelvic symptoms. Neisseria gonorrhoeae infection causes urethritis and does not lead to any malignancy. Herpes simplex causes recurrent genital lesions.

A 54-year-old male patient who is being seen for an annual physical tells the nurse that he is having difficulty sustaining an erection. The nurse reviews his health history and notes no current health problems except medical treatment for depression. What should the nurse understand about this? 1 A personal issue such as this is best addressed by a male physician during the examination. 2 Erectile dysfunction affects most men over the age of 50. 3 The patient needs to be screened for sexually transmitted infections (STIs). 4 Antidepressant medication may be affecting the patient's sexual functioning.

4 Many drugs can affect sexual function. Antidepressants can alter sexual functioning by blocking neurotransmitters. The decision to screen a patient should be based on health history, assessment, and sexual practices.