Chapter 43: Sexuality

The nurse is teaching a male adolescent how to use a condom. Which teaching points would the nurse include? (Select all that apply.) a) "Use a condom with every act of intercourse." b) "Roll the condom onto the penis before it becomes erect." c) "If the condom does not have a nipple receptacle, leave a small space at the end for semen to collect." d) "Immediately after ejaculation remove the condom and discard it." e) "Do not use a spermicide with the condom." f) "If using a lambskin condom, the condom may be reused a second time."

a) "Use a condom with every act of intercourse." c) "If the condom does not have a nipple receptacle, leave a small space at the end for semen to collect." d) "Immediately after ejaculation remove the condom and discard it."

The nurse is teaching a class about sexuality at a public health clinic. After class the nurse is approached by Cathleen, a 54-year-old female, who eventually discloses to the nurse that, while she is happily married, she feels like a man inside. Cathleen describes this as feeling "trapped" inside her female body. The term for this behavior is which of the following? a) Transsexual b) Gender role behavior c) Bisexual d) Transvestite

a) Transsexual

The nurse is assessing the sexual health of a 20-year-old female client. During the interview, the client says, "I feel that my vaginal opening constricts whenever I am about to have intercourse. I seem to have no control over it." Which of the following would the nurse use when documenting the client's complaint? a) Vaginismus b) Dyspareunia c) Orgasmic dysfunction d) Celibacy

a) Vaginismus * The client is experiencing an involuntary contraction of the muscles surrounding the vaginal orifice; this should be documented as vaginismus. Dyspareunia is painful intercourse. Difficulty achieving orgasm is documented as orgasmic dysfunction. Abstention from sexual intercourse is documented as celibacy.

The nurse assessing an adolescent's need for further information should ask which of the following questions? a) What questions or concerns do you have about your sexual health? b) Have you ever been diagnosed with a sexually transmitted disease? c) How many sexual partners have you had? d) Are you involved in an intimate relationship at this time?

a) What questions or concerns do you have about your sexual health?

A gerontology nurse is discussing sexual dysfunction with an elderly male client. The nurse sees that learning has occurred when the client states which of the following? a) "Erectile dysfunction, caused by diabetes, has no treatment." b) "Malnutrition may cause impotence." c) "Antihypertensive medication will not affect sexual function." d) "I need to be able to walk a mile in order for sexual intercourse to not be dangerous."

b) "Malnutrition may cause impotence." *Factors that contribute to sexual dysfunction in the older adult are as follows: use of medications, especially antihypertensives; age-related metabolic disorders such as anemia, diabetes, malnutrition, and fatigue may cause impotence

A female client has recently had surgery for cervical cancer and asks the nurse about other ways she can have sex with her husband. Which of the following statements by the nurse is most accurate? a) "Complete abstinence would satisfy your sexual needs." b) "Stimulation of the genitals by the mouth and tongue may be used to reach orgasm." c) "Fellatio is stimulation of the female genitals." d) "Anal intercourse is not practiced by heterosexuals."

b) "Stimulation of the genitals by the mouth and tongue may be used to reach orgasm."

The nurse is teaching a class about sexuality at a public health clinic. After class the nurse is approached by John, a 22-year-old male, who eventually discloses to the nurse that, while he enjoys having sex with his girlfriend, he also has experienced pleasurable sex with males. The term for this behavior is which of the following? a) Biologic sex b) Bisexual c) Gender role behavior d) Sexual orientation

b) Bisexual

When a man cannot achieve an erection, the phase of the sexual response in which the man is experiencing difficulty is the a) Obligatory phase b) Excitement phase c) Orgasmic phase d) Refractory phase

b) Excitement phase * The excitement phase is characterized by rapid erection of the penis with tensing and thickening of the scrotal skin and elevation of the scrotal sac.

A 60-year-old female client with a history of osteoarthritis in her hip confides to the nurse that "intercourse hurts my hip." Which of the following would be the best option for the nurse to suggest? a) Using vaginal lubrication b) Exploring alternate positions for intercourse c) Taking a narcotic prior to intercourse d) Practicing Kegel exercises

b) Exploring alternate positions for intercourse

The nurse is preparing a talk on health issues in the LGBT population. Which statistics would the nurse include? a) Lesbians are more likely to get preventive services for cancer. b) LGBT youth are 2 to 3 times more likely to attempt suicide. c) Lesbians and bisexual females are more likely to be underweight or anorexic. d) LGBT populations have lower rates of tobacco, alcohol, and other drug use.

b) LGBT youth are 2 to 3 times more likely to attempt suicide. *Healthy People 2020 found that LGBT youth are 2 to 3 times more likely to attempt suicide. Lesbians and bisexual females are more likely to be overweight or obese. LGBT populations have higher rates of tobacco, alcohol, and other drug use than other populations. Lesbians are more likely to get preventive services for cancer.

The nurse working at a family planning clinic evaluates a client's risk for complications from oral contraceptives. Which of the following places the client at highest risk? a) History of diabetes b) Smokes 1 pack cigarettes per week c) Drinks 1 glass of wine daily d) Age less than 35

b) Smokes 1 pack cigarettes per week * Complications for oral contraceptives include an increased incidence of blood clots, heart attacks, and stroke, especially in women who smoke.

The nurse is teaching patients how to avoid contracting an STI. What would the nurse include as a teaching point? a) Douche immediately following sexual intercourse. b) Use a hormonal method of contraception if sexually active. c) Avoid having intercourse during menstruation. d) Practice coitus interruptus if a condom is not available.

c) Avoid having intercourse during menstruation. *Patients should avoid having sex during menstruation. HIV-infected women are probably more infectious, and HIV-uninfected women are probably more susceptible to becoming infected during that time. Douching immediately after intercourse will not prevent STIs and is harmful to the normal flora of the reproductive tract. Coitus interruptus and hormonal contraception are birth control measures and will not prevent the transmission of STIs.

The nurse prepares to complete an exam on a 25 year old female. The client presents to the community health clinic with complaints of difficulty with urination. The nurse reviews the chart and sees that the client is originally from Africa. The nurse suspects which of the following? a) Complications from an untreated sexually transmitted infection (STI) b) A diagnosis of interstitial cystitis c) Complications from female genital mutilation (FGM) d) An acute urinary tract infection (UTI)

c) Complications from female genital mutilation (FGM) *Female genital mutilation (FGM) includes procedures that intentionally alter or cause injury to the female genital organs for non-medical reasons. It is a procedure that has no health benefits for girls and women and can cause severe bleeding, problems urinating, and later cysts, infections, infertility as well as complications in childbirth and increased risk of newborn deaths. The nurse may rule out UTI via urinalysis however, the nurse would want to rule out the presence of FGM in order to make sure the client receives appropriate long-term care. Nothing in the data provides the nurse with an indication of an untreated STI or interstitial cystitis.

A 49-year-old woman has sought care from her primary care provider because of "intimacy problems." Upon questioning, the woman reveals that she is experiencing sexual desire, but that intercourse causes her significant pain. In the absence of sexual activity, the woman states that she does not have any significant vaginal discomfort. What would the clinician recognize that this patient is most likely experiencing? a) Vaginismus b) A sexually transmitted infection (STI) c) Dyspareunia d) Vulvodynia

c) Dyspareunia *Dyspareunia is painful intercourse. Vaginismus is characterized by difficult penetration rather than acute pain during intercourse, and vulvodynia is associated with pain that is not limited to intercourse. An STI may or may not be contributing to the woman's problem, though most cases of dyspareunia are unrelated to infections.

The forensic nurse is caring for a client who was raped four days ago. Which of the following could the nurse teach the client is an effective contraceptive? a) Depo-Provera injection b) Use of the Norplant system c) Insertion of a copper intrauterine device (IUD) d) Transdermal contraceptive patch

c) Insertion of a copper intrauterine device (IUD) * Emergency contraception is provided in two ways: increased doses of oral contractptive pills (usually within 72 hours) or insertion of a copper IUD within 5-7 days after unprotected intercourse. The other options are used for routine contraception.

The nurse is advising an adolescent male about sexual myths that have him concerned. Which statements describe accurate patient teaching regarding these concerns? (Select all that apply.) a) Nocturnal emissions indicate the existence of a sexual disorder. b) A larger penis allows for a more satisfying sexual experience. c) No male or female should feel pressured into sexual activity at any age. d) Nocturnal emissions are normal in men of all ages. e) Nocturnal emissions are signs of a sexually transmitted disease. f) Masturbation or self-stimulation is a natural and healthy outlet for sexual urges.

c) No male or female should feel pressured into sexual activity at any age. d) Nocturnal emissions are normal in men of all ages. f) Masturbation or self-stimulation is a natural and healthy outlet for sexual urges.

The community health nurse is aware that many factors influence a client's decision for contraception. Which of the following is the most likely reason a client would select permanent contraception? a) To reduce the risk of sexually transmitted diseases. b) Religious beliefs which prevent reproduction. c) The choice not to start a family. d) The desire to have multiple sex partners.

c) The choice not to start a family.

During hospitalization for a suicide attempt, the patient informs the nurse that she does not want to return to work because her boss expects sexual favors each week before he gives her a paycheck. The patient informs the nurse that she needs the job but is embarrassed that she performs these favors. The nurse informs the patient that this is illegal behavior and is called: a) environmental harassment. b) fetishism. c) quid pro quo harassment. d) hostile environment harassment.

c) quid pro quo harassment. *Quid pro quo means that something is given or withheld in exchange for something else. It generally occurs when a person in a position of authority offers either direct or indirect reward or punishment based on the granting of sexual favors. Environmental harassment and hostile environment harassment are the same situation and occur when workplace behaviors of a sexual nature create a hostile, intimidating environment that interferes with a person's work performance. Fetishism is sexual arousal with the aid of an inanimate object not generally associated with sexual activity.

The nurse notices that the patient shows signs of depression and often is found crying quietly in her room. Based on what the nurse recalls about violence against women the nurse suspects the following? a) the patient has recently suffered a personal loss b) the patient is a victim of sexual harrassment c) the patient is a victim of date rape d) the patient has anxiety related to being in the hospital

c) the patient is a victim of date rape * Victims of sexual assault are 3 times more likely to suffer from depression, 6 times more likely to suffer from posttraumatic stress disorder, 13 times more likely to abuse alcohol, 26 times more likely to abuse drugs, and 4 times more likely to contemplate suicide. Clearly, nurses need to be alert to evidence of sexual abuse while taking the history and conducting physical examinations. Neither anxiety or suffering a personal loss are factors related to violence against women. Harassment is any annoying or distressing comment or conduct that is known or should be known to be unwelcome.

The nurse is providing education about sexuality to a group of college freshman. One of the terms he discusses is gender identity. Which of the following describes gender identity? a) Behavior conveyed about being male or female b) Preferred gender of the partner of an individual c) Desire to wear the clothes of the opposite sex d) Inner sense of being male or female

d) Inner sense of being male or female

During the menstrual cycle, when does ovulation typically take place? a) On day 1 of a new cycle b) From days 15 to 28 c) When sperm is present d) On day 14

d) On day 14 *Ovulation generally occurs on day 14 when the mature ovum ruptures from the follicle and the surface of the ovary and is swept into the fallopian tube. From day 15 to day 28, the phase in the ovaries is called the luteal phase.

Which sexually transmitted infection has the following characteristics: thin, foamy, greenish vaginal discharge that causes itching of the vulva and vagina? a) Herpes simplex 1 b) Herpes simplex 2 c) Nonspecific vaginitis d) Trichomoniasis

d) Trichomoniasis *Trichomoniasis is characterized by thin, foamy, greenish vaginal discharge that causes itching of the vulva and vagina; it is often asymptomatic in males. Nonspecific vaginitis is characterized by foul-smelling, thin, grayish-white vaginal discharge. Herpes simplex virus type 1 and 2 are characterized by lesions