Chapter 30 - Sexual Disorders

A pedophile tells the nurse, "I feel so guilty and shameful over molesting a child. My family will be so disgusted with me. I could save them from embarrassment if I were gone." What is the nurse's priority action?

Further assess the patient's suicidality. Patients who describe guilt, shame, and the idea that others would be better off without them are suicide risks. The nurse should further assess the patient's comments, document, report the data, and consider the need for suicide precautions

A 10-year-old boy is diagnosed with gender identity disorder. Which assessment finding would the nurse expect?

Having tea parties with dolls An individual with gender identity disorder feels trapped in the body of the "wrong" gender and 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.

A nurse assesses a patient recently diagnosed with pedophilia. Which findings are most likely? Select all that apply.

History of childhood sexual abuse Limbic system abnormalities An endocrine disorder

Which characteristic fits the profile of an individual who is a pedophile?

Seeks access to children It is known that pedophiles usually place themselves in jobs, activities, or relationships that provide easy access to children. They often become trusted by both parents and children.

A client is diagnosed with erectile disorder. Which of the following medications would address this condition, and what is the therapeutic action of the drug? (Select all that apply.)

Phentolamine (Oraverse); increases blood flow to the penis. Apomorphine (Apokyn); acts directly on the dopamine receptors in the brain. Vardenafil (Levitra); blocks the action of phosphodiesterase-5 (PDE5). Sildenafil (Viagra); blocks the action of phosphodiesterase-5 (PDE5).

While volunteering at a homeless shelter, a nurse observes a known pedophile leaving the restroom with a small child. Select the nurse's priority action.

Report the observation to authorities by the child abuse hotline. In every state, nurses are mandated reporters of child abuse. The nurse is obligated legally and morally to report the incident so that proper authorities can follow up.

A psychiatric nursing instructor is teaching about the psychological effects of the diagnosis of a sexually transmitted disease (STD). Which student statement indicates that further instruction is needed?

"Antibiotics administered in the early stages can cure all STDs." Rationale: The instructor should identify the need for further instruction if a student states that antibiotics can cure all STDs. STDs refer to infections that are contracted primarily through sexual activities or intimate contact. Antibiotics are ineffective in the treatment of the STD human immunodeficiency virus (HIV).

A man experiencing premature ejaculation tells the nurse, "I feel like such a failure. It's so awful for both me and my wife. Can you help me?" Select the nurse's best response.

"I can refer you to a practitioner who can help you with this problem." 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.

A nurse cares for a man diagnosed with pedophilia. Leuprolide (Lupron Depot) was prescribed. One month later, which statement by the patient indicates that the medication is having a therapeutic effect?

"My sexual desire has practically disappeared." Leuprolide is an antiandrogen. When testosterone is reduced, sexual desire is decreased. The statement that sexual desire has "practically disappeared" suggests that the medication is having the desired effect. The distracters are unrelated to the desired effect of this drug.

The clinic nurse sees a new patient with vague sexual complaints. Select the best question for the nurse to help the patient express these concerns more clearly.

"What are your concerns and feelings about your sexuality?" Individuals with sexual concerns may need help and support to express the problem. Approaching the subject directly is most appropriate. The patient is not concerned with the problems of other patients or the nurse's level of comfort.

A school nurse uses a participative approach to teach about safety to a group of third graders. Which questions should the nurse pose to the students? Select all that apply.

"What would you do if a stranger told you to get in his or her car because your parents were hurt?" "If you were playing on the Internet, and someone invited you into a private chat room, what would you do?"

A newly married woman comes to a gynecology clinic reporting anorexia, insomnia, and extreme pain during intercourse that has affected her intimate relationship. What initial intervention should the nurse expect a physician to implement?

A thorough physical, including gynecological examination Rationale: The nurse should expect the physician to implement a thorough physical, including a gynecological examination to assess for any physiological causes of the client's symptoms. If no pathology exists the client may be diagnosed with genito-pelvic pain/penetration disorder. In this disorder, the individual experiences considerable difficulty with vaginal intercourse and attempts at penetration.

A nurse is instructing a client diagnosed with sexual female sexual interest/arousal disorder. Which symptom and treatment of this disorder should the nurse describe to the client?

Avoidance of all genital sexual contact treated by sensate focus exercises Rationale: The nurse should explain to the client that female sexual interest/arousal disorder is characterized by a reduced or absent frequency or intensity of interest or pleasure in sexual activity. Senate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy.

Studies indicate that which child has the highest risk for being sexually victimized?

Boy, age 13 According to a study by John Jay College, the majority of victims of sexual misconduct were boys age 11 to 17.

A nurse is counseling a client diagnosed with gender dysphoria. What criteria would differentiate this disorder from a transvestic disorder?

Clients diagnosed with gender dysphoria are dissatisfied with their gender, whereas clients diagnosed with transvestic disorder are not. Rationale: The nurse should identify that clients diagnosed with gender dysphoria are dissatisfied with their gender, whereas clients diagnosed with transvestic disorder experience intense sexual arousal from dressing in the clothes of the opposite gender but are not dissatisfied with their gender. Clients diagnosed with either of these disorders do not avoid all forms of sexual intercourse.

A senator develops a sexual relationship with a 20-year-old receptionist. Which adjective most likely applies to this relationship?

Coercive Relationships between powerful and less powerful persons usually have a coercive element. They are not illegal unless the less powerful person is a minor. The relationship may be harmonious and consensual in the minds of the involved parties.

A 52-year-old client states, "My husband is upset because I don't enjoy sex as much as I used to." Which priority client data should a nurse initially collect?

Date of last menstrual cycle Rationale: The nurse should assess the client's last menstrual cycle to determine if the client is experiencing the onset of menopause. Menopause usually occurs around the age of 50. The decrease in estrogen can result in multiple symptoms, including a decrease in biological drives and sexual activity.

An adult has felt much tension since losing a home by foreclosure. This person goes to a park, feeds the birds, and then impulsively exposes himself/herself to a group of parents and children. Which term applies to this behavior?

Exhibitionism Exhibitionism is obtaining sexual pleasure from exposing one's genitalia to unsuspecting strangers. Voyeurism refers to obtaining sexual pleasure from observing people who are naked. Dyspareunia refers to painful intercourse. Sexual masochism refers to deriving sexual pleasure from being humiliated, beaten, or otherwise made to suffer.

A female client on an inpatient unit enters the common area for visiting hours dressed in a see-through blouse. Which intervention should be a nurse's first priority?

Lead the client back to her room and assist her with a change of clothing. Rationale: The most appropriate intervention by the nurse is to lead the client back to her room and assist her with a change of clothing. The client could be exhibiting symptoms of exhibitionistic disorder, which is characterized by urges to expose oneself to unsuspecting strangers.

A nurse is planning care for a child diagnosed with gender dysphoria. Which of the following nursing diagnoses could potentially document this client's problems? (Select all that apply.)

Low self-esteem R/T rejection by peers Disturbed personal identity R/T parenting patterns Impaired social interactions R/T socially unacceptable behaviors

A nurse is assessing a client diagnosed with sexual masochistic disorder. What would differentiate this paraphilic disorder from sexual sadistic disorder?

Masochistic acts can be performed alone, whereas sadistic acts must have a consenting or non-consenting partner. Rationale: The identifying feature of sexual masochistic disorder is recurrent and intense sexual arousal when being humiliated, beaten, bound, or otherwise made to suffer. These masochistic activities may be fantasized and may be performed alone (e.g., self-inflicted pain) or with a partner. The identifying feature of sexual sadistic disorder is the recurrent and intense sexual arousal from the physical or psychological suffering of another individual. Both sexual masochistic and sadistic disorders are chronic in nature.

A nurse cares for a patient demonstrating paraphilia. The nurse expects the health care provider may prescribe which type of medication to reduce paraphilic behaviors?

Selective serotonin reuptake inhibitor (SSRI) SSRIs are reported to have a positive effect on paraphilia. The other medications are not indicated for this disorder.

In the course of an assessment interview, a female client reveals a history of bisexual orientation. Which action should the nurse initially implement when working with this client?

Self-assess personal attitudes toward homosexuality. Rationale: The nurse should initially self-assess personal attitudes toward homosexuality. The nurse must be able to recognize when negative feelings compromise care. Unconditional acceptance of each individual is an essential component of compassionate nursing.

A widower reports a fear of intimacy because of an inability to achieve and sustain an erection. He has become isolative, has difficulty sleeping, and has lost weight over the past year. Which nursing diagnosis should be a priority for this client?

Sexual dysfunction R/T dysfunctional grieving AEB inability to experience orgasm Rationale: The nurse should prioritize the nursing diagnosis sexual dysfunction R/T dysfunctional grieving AEB inability to experience orgasm. The nurse should assess the client's mood and level of energy, because depression and fatigue can decrease desire for participation in sexual activity.

___________________________ is the constitution and life of an individual relative to characteristics regarding intimacy.

Sexuality Rationale: Sexuality is the constitution and life of an individual relative to characteristics regarding intimacy. It reflects the totality of the person and does not relate exclusively to the sex organs or sexual behavior.

An adult has felt much tension since losing a home by foreclosure. This person goes to a park, feeds the birds, and then impulsively exposes himself/herself to a group of parents and children. Which intervention would have the greatest benefit for this person?

Stress management Because the individual demonstrated the exhibitionistic behavior during a period of increased stress, providing stress management would be beneficial. The other interventions may be acceptable but would not have the relevance that stress management would have.

A nurse is assessing a client diagnosed with pedophilic disorder. What would differentiate this sexual disorder from a sexual dysfunction?

Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response. Rationale: The nurse should identify that pedophilic disorder is a sexual disorder in which individuals partake in inappropriate sexual behaviors. Sexual dysfunction involves impairment in normal sexual response. Pedophilic disorder involves having sexual urges, behaviors, or sexually arousing fantasies involving sexual activity with a prepubescent child.

The clinic nurse sees a patient with a long-standing diagnosis of pedophilia who was recently arrested and released on bail. Which perspective about pedophilia would the nurse expect from this patient?

The belief that the child was given valuable knowledge and pleasure. Individuals with pedophilia frequently do not believe that their behavior is harmful to the child. Instead, they point to having provided teaching and pleasure for the child. The other options are not characteristic of the thinking of the pedophile.

Which of the following characteristics should a nurse identify as "normal" in the development of human sexuality for an 11-year-old child? (Select all that apply.)

The child experiments with masturbation. The child may experience homosexual play. The child is unlikely to want to undress in front of others.

A nurse is working with a client diagnosed with pedophilic disorder. Which client outcome is appropriate for the nurse to expect during the first week of hospitalization?

The client will identify triggers for inappropriate behaviors. Rationale: During the first week of hospitalization, identifying triggers for inappropriate behaviors is an appropriate outcome for a client diagnosed with pedophilic disorder. Pedophilic disorder involves intense sexual urges, behaviors, or fantasies involving sexual activity with a prepubescent child.

A nurse is assessing a client diagnosed with fetishistic disorder. What would differentiate this paraphilic disorder from frotteuristic disorder?

To derive sexual excitement, fetishistic disorder involves the use of nonliving objects, whereas frotteuristic disorder involves touching and rubbing against non-consenting people. Rationale: Fetishistic disorder involves recurrent and intense sexual arousal from the use of either nonliving objects or specific nongenital body part(s). Frotteuristic disorder is the recurrent and intense sexual arousal involving touching and rubbing against a non-consenting person. Transvestic disorder involves recurrent and intense sexual arousal from dressing in the clothes of the opposite gender.

When planning care for a client diagnosed with female sexual interest/arousal disorder, what should a nurse document as an expected outcome of senate focus exercises?

To reduce goal-oriented demands of intercourse Rationale: Female sexual interest/arousal disorder is characterized by a reduced or absent frequency or intensity of interest or pleasure in sexual activity. Senate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy. The expected outcome of senate focus exercises is to reduce goal-oriented demands of intercourse. The reduction in demands reduces performance pressures and anxiety associated with possible failure.

A nursing instructor is teaching about the various categories of paraphilic disorders. Which categories are correctly matched with expected behaviors? (Select all that apply.)

Voyeuristic disorder: John is arrested for peering in a neighbor's bathroom window. Frotteuristic disorder: Peter enjoys subway rush-hour female contact that results in arousal. Fetishistic disorder: Henry masturbates into his wife's silk panties.

A man tells the nurse, "I have trouble maintaining an erection." This comment indicates:

a sexual erectile disorder. In sexual erectile disorders, the individual cannot maintain the physiologic requirements for sexual intercourse. The patient's statement does not provide data to suggest one of the other options.

Paraphilia is defined as:

an intense sexual urge with an abnormal focus. Paraphilias are conditions in which the sexual instinct is expressed in ways that are socially prohibited or unacceptable or are biologically undesirable. The distracters characterize other sexual behaviors.

Contemporary cultural rejection of certain sexual behaviors is determined primarily based on sexual acts:

involving coercion rather than consent. Sexual acts that are forced on another are considered both morally and legally unacceptable. The other options are used less often as evaluation criteria.

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:

saying, "Let's go to my office." 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. Offering to schedule an appointment blocks communication.

Prior to working with patients regarding sexual concerns, a prerequisite for providing nonjudgmental care is:

sexual self-awareness. Only when a nurse has accepted his or her own feelings and values related to sexuality can he or she provide fully nonjudgmental care to a patient. If the nurse is uncomfortable, the patient might misinterpret discomfort as disapproval.

A patient's medical record documents sexual masochism. This patient derives sexual pleasure:

when sexually humiliated by a partner. Sexual masochism is sexual pleasure derived from being humiliated, beaten, or otherwise made to suffer. The distracters refer to fetishism, sexual sadism, and frotteurism.