Psych Ch. 32 Issues Related to Human Sexuality & Gender Dysphoria

12. The nurse is counseling a client diagnosed with fetishism. Which criteria would differentiate this paraphilic disorder from frotteurism? 1. To derive sexual excitement, fetishism involves the use of nonliving objects, whereas frotteurism involves touching and rubbing against nonconsenting people. 2. To derive sexual excitement, frotteurism involves the use of nonliving objects, whereas fetishism involves touching and rubbing against nonconsenting people. 3. Clients diagnosed with frotteurism are heterosexual cross-dressing males, whereas clients diagnosed with fetishism are homosexual cross-dressing males. 4. Clients diagnosed with fetishism are heterosexual cross-dressing males, whereas clients diagnosed with frotteurism are homosexual cross-dressing males.

12. ANS: 1 Feedback 1 Fetishism involves recurrent and intense sexual arousal from the use of either nonliving objects or specific nongenital body part(s). Frotteurism involves recurrent intense sexual arousal from touching and rubbing against a nonconsenting person. 2 Frotteurism is the recurrent and intense sexual arousal involving touching and rubbing against a nonconsenting person, whereas fetishism involves the use of nonliving objects. 3 Transvestism involves recurrent and intense sexual arousal from dressing in the clothes of the opposite gender. Neither frotteurism nor fetishism involve cross-dressing. 4 Transvestism, not fetishism or frotteurism, involves cross-dressing.

2. During an assessment interview, a female client reveals a history of bisexual orientation. Which action should the nurse initially implement when working with this client? 1. Self-assess personal attitudes toward sexuality. 2. Review client's possible childhood sexual abuse history. 3. Encourage discussion of aversion to heterosexual relationships. 4. Explore client's family history of sexual practices.

ANS: 1 Feedback 1 Personal feelings, attitudes, and values should be clarified and should not interfere with acceptance of the client. The nurse must remain nonjudgmental. Unconditional acceptance of each individual is an essential component of compassionate nursing. 2 Just because the client is bisexual, that does not indicate childhood sexual abuse occurred. 3 The nurse should not assume the bisexual client has an aversion to heterosexual encounters. A diversity of sexual orientations exists among the bisexual population. Some individuals are equally attracted to men and women, whereas others are more attracted to one sex but also accept sexual activity with the other sex. 4 The family's sexual practices are not the focus at this time. The client is the primary focus.

8. A newly married woman comes to a gynecology clinic reporting loss of appetite, difficulty sleeping, and extreme pain during intercourse that has affected her intimate relationship. Which initial intervention should the nurse expect a physician to implement? 1. A thorough physical, including gynecological examination 2. Referral to a sex therapist 3. Assessment of sexual history and previous satisfaction with sexual relationships 4. Referral to the recreational therapist for relaxation therapy

ANS: 1 Feedback 1 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. Pain is felt in the vagina, around the vaginal entrance and clitoris, or deep in the pelvis. There is fear and anxiety associated with anticipation of pain or vaginal penetration. A tensing and tightening of the pelvic floor muscles occurs during attempted vaginal penetration. 2 Referral to a sex therapist is not the first intervention the physician will make. More data is needed before a referral is made. 3 Assessment of sexual history and previous satisfaction with sexual relationships is not the first intervention the physician will make. Assessment of sexual history and satisfaction can occur later. 4 Referral to the recreational therapist for relaxation therapy is not the first intervention the physician would make. More data is needed before a referral is made.

9. The nurse is teaching a client diagnosed with female sexual interest/arousal disorder about symptoms and recommended treatment of this disorder. Which information would the nurse include? 1. Lack of interest in sexual activity treated by sensate focus exercises 2. Lack of interest in sexual activity treated by medicating with tadalafil (Cialis) 3. Anorgasmia treated by vardenafil (Levitra) 4. Anorgasmia treated by systematic desensitization

ANS: 1 Feedback 1 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. Sensate focus exercises are recommended treatment. Sensate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy. 2 Treatment with tadalafil (Cialis) for lack of interest in sexual activity in females is not a recommended treatment. Tadalafil is used to treat erectile dysfunction in men. It is not approved to treat women. 3 Anorgasmia treated by vardenafil (Levitra) is not a recommended treatment of this disorder. Vardenafil is used to treat erectile dysfunction in men. 4 Anorgasmia treated by systematic desensitization is not a typical treatment of this disorder. Systematic desensitization has been used for genito-pelvic pain/penetration disorder.

13. Which characteristics would a nurse identify as "normal" in the development of human sexuality for an 11-year-old child? (Select all that apply.) 1. Experiments with masturbation 2. May experience homosexual play 3. Shows little interest in the opposite sex 4. Has little concern about physical attractiveness 5. Is unlikely to want to undress in front of others

ANS: 1, 2, 5 Feedback 1 The nurse should identify that experimenting with masturbation is normal in the development of human sexuality in an 11-year-old child. 2 The nurse should identify that homosexual play is normal in the development of human sexuality in an 11-year-old child. 3 The nurse should identify that showing little interest in the opposite sex is not normal in the development of human sexuality in an 11-year-old child. Typically, interest in the opposite gender increases. 4 The nurse should identify that showing little concern about physical attractiveness is not normal in the development of human sexuality in an 11-year-old child. Children of this age are very concerned with physical attractiveness. 5 The nurse should identify that not wanting to undress in front of others is normal in the development of human sexuality in an 11-year-old child. Children at this age become self-conscious about their bodies.

16. The nurse is developing a plan of care for a child diagnosed with gender dysphoria. Which nursing diagnoses would be appropriate for this client? (Select all that apply.) 1. Low self-esteem R/T rejection by peers 2. Self-care deficit R/T isolative behaviors 3. Ineffective coping R/T biological factors 4. Impaired social interactions R/T socially unacceptable behaviors 5. Sexual dysfunction R/T depressed mood

ANS: 1, 3, 4 Feedback 1 A nursing diagnosis appropriate for gender dysphoria is low self-esteem related to rejection by peers. These clients may experience rejection by peers and family. 2 While isolative behaviors may occur in some clients with gender dysphoria, self-care deficit does not address the typical problems of these clients. 3 Ineffective coping R/T biological factors is an appropriate nursing diagnosis for a client with gender dysphoria. Some models suggest that an interaction between biological factors and the environment or an indirect interaction between biological factors and individual temperament/personality traits can lead to the acquisition of gender identity. 4 A possible nursing diagnoses for the child with gender dysphoria may include the following: impaired social interaction related to socially unacceptable behaviors. 5 Clients with gender dysphoria do not have problems with sexual dysfunction, the issue is incongruence between their biological/assigned sex and their gender identity.

15. The client has an erectile disorder. Which medications would address this condition? (Select all that apply.) 1. Avanafil (Stendra) 2. Flibanserin (Addyi) 3. Vardenafil (Levitra) 4. Prilocaine/Lidocaine 5. Sildenafil (Viagra)

ANS: 1, 3, 5 Feedback 1 One of the drugs approved by the FDA for the treatment of erectile disorder is avanafil (Stendra). 2 This drug does not treat erectile dysfunction in men. In 2015, the FDA approved the first drug for treatment of hypoactive sexual desire disorder in premenopausal women. This medication, flibanserin (Addyi), is a nonhormonal serotonin agonist and antagonist. 3 Vardenafil (Levitra) was approved by the FDA for the treatment of erectile disorder. This newer impotence agent blocks the action of phosphodiesterase-5 (PDE5), an enzyme that breaks down cyclic guanosine monophosphate (cGMP), a compound that is required to produce an erection. 4 One of the pharmacologic treatment for early ejaculation (not erectile dysfunction) includes desensitizing agents such as lidocaine and prilocaine. 5 Sildenafil (Viagra) blocks the action of phosphodiesterase-5 (PDE5) and is used for erectile disorder.

4. The nurse is teaching about paraphilic disorders. Which criteria would the nurse include to differentiate this sexual disorder from a sexual dysfunction? 1. Symptoms of sexual dysfunction have lasted for at least 6 months, whereas symptoms of a sexual disorder have lasted less than 6 months. 2. Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response. 3. Sexual dysfunction treatment involves decreasing levels of circulating androgens, whereas treatment of sexual disorder involves increasing the level of circulating androgens. 4. Sexual dysfunction can be caused by decreased levels of circulating estrogen, whereas increased levels of circulating estrogen can cause sexual disorders.

ANS: 2 Feedback 1 According to the DSM-5, while sexual dysfunction symptoms must be present for at least 6 months, paraphilia sexual disorders symptoms must be recurrent for over a period of at least 6 months, not less than 6 months. 2 The nurse should identify that paraphilic disorder is a sexual disorder in which individuals partake in inappropriate sexual behaviors, whereas sexual dysfunction is impairment in normal sexual responses. 3 Biological treatment of sexual dysfunction involves increasing (not decreasing) levels of androgens, while paraphilic disorders involves decreasing (not increasing) the levels of circulating androgens. 4 While decreased levels of estrogen can cause sexual dysfunction in women, elevated levels of estrogen do not cause paraphilic disorders.

10. The nurse is caring for a client diagnosed with gender dysphoria. Which criteria would differentiate this disorder from transvestism? 1. Clients diagnosed with transvestism dress in same gender clothing for sexual arousal, whereas clients diagnosed with gender dysphoria dress in opposite gender clothing for sexual arousal. 2. Clients diagnosed with gender dysphoria are dissatisfied with their gender, whereas clients diagnosed with transvestism are not. 3. Clients diagnosed with gender dysphoria avoid most forms of sexual intercourse, whereas clients diagnosed with transvestism do not. 4. Clients diagnosed with transvestism are attracted to the opposite sex, whereas clients diagnosed with gender dysphoria are solely attracted to the same sex.

ANS: 2 Feedback 1 Clients diagnosed with transvestism experience intense sexual arousal from dressing in the clothes of the opposite gender. Clients with gender dysphoria have an incongruence between their biological/assigned sex and their gender identity. 2 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. 3 Clients with gender dysphoria do not avoid most forms of sexual intercourse. These clients have sexual intercourse but they may or may not have same-sex couple relationships. 4 Gender identity does not dictate to whom one is attracted. These clients are not solely attracted to the same sex.

1. The 52-year-old female client states, "My partner is upset because I don't enjoy sex as much as I used to." Which priority client data should the nurse initially collect? 1. History of hysterectomy 2. Date of last menstrual cycle 3. Use of birth control methods 4. Number of sexual partners

ANS: 2 Feedback 1 History of hysterectomy is not assessment data that the nurse should initially collect. 2 The nurse should assess the client's last menstrual cycle to determine if the client is experiencing the onset of menopause. The average age of onset of menopause for the woman is around 52. The decrease in estrogen can result in multiple symptoms, including a decrease in biological drives and sexual activity. 3 Use of birth control methods is not assessment data that the nurse should initially collect. 4 Number of sexual partners is not assessment data that the nurse should initially collect.

3. A widower reports an inability to achieve and sustain an erection. He fears intimacy, has become isolative, has insomnia, and has lost weight over the past year. Which nursing diagnosis should be a priority for this client? 1. Risk for situational low self-esteem R/T lack of intimacy 2. Sexual dysfunction R/T dysfunctional grieving 3. Social isolation R/T low self-esteem 4. Disturbed body image R/T penile flaccidity

ANS: 2 Feedback 1 Risk for situational low self-esteem R/T lack of intimacy is not the priority diagnosis. There is no data to support low self-esteem. 2 The nurse should prioritize the nursing diagnosis sexual dysfunction R/T dysfunctional grieving. The data supports sexual dysfunction (inability to maintain an erection) and dysfunctional grieving (isolative, insomnia, and weight loss). The nurse should assess the client's mood and level of energy, because depression and fatigue can decrease desire for participation in sexual activity. 3 Social isolation R/T low self-esteem is not the priority diagnosis. While the client has become isolative (social isolation), there is not data to support low self-esteem. 4 Disturbed body image R/T penile flaccidity is not the priority diagnosis. While there is data to support penile flaccidity, there is no data to support a disturbed body image.

14. The nursing instructor is educating nursing students about the various categories of paraphilic disorders. Which disorders are correctly matched with expected behaviors? (Select all that apply.) 1. Exhibitionism: Mia models lingerie for a company that specializes in home parties. 2. Voyeurism: Henry is arrested for peering in a neighbor's bathroom window. 3. Frotteurism: William enjoys subway rush-hour female contact that results in arousal. 4. Pedophilia: Jacob can experience an orgasm by holding and feeling shoes. 5. Fetishism: John masturbates into his wife's silk panties.

ANS: 2, 3, 5 Feedback 1 Exhibitionism is a paraphilic disorder but involves the urge to show one's genitals to unsuspecting strangers. Modeling lingerie is not an act of exhibitionism. 2 Categories of paraphilic disorders include voyeurism (observing unsuspecting people, who are naked, disrobing, or engaged in sexual activity). Henry is peering into a neighbor's bathroom window, indicating voyeurism. 3 Categories of paraphilic disorders include frotteurism (touching or rubbing against a non-consenting person). William enjoys subway rush-hour contact with females, a behavior of frotteurism. 4 Pedophilia is categorized as having sexual urges, behaviors, or sexually arousing fantasies involving sexual activity with a prepubescent child. Jacob is not involving children but shoes, indicating a fetish. 5 Categories of paraphilic disorders include fetishism (using nonliving objects in sexual ways). John is using his wife's underwear, a behavior of a fetish.

5. The nurse is caring for a female child with gender dysphoria. Which finding indicates improvement in the child? 1. Ruminates about inability to "fit in" 2. Is able to dress up secretively 3. Asks teachers to be addressed as "him" 4. Plays video games in room

ANS: 3 Feedback 1 Ruminating about situations that are perceived as failures does not indicate improvement. This activity should be discouraged. 2 This does not indicate improvement. Dressing up in secret does not indicate acceptance of self. 3 Asking the teachers to address as "him" indicates improvement in the child. This indicates an acceptance as a worthwhile person regardless of others' responses. 4 Playing video games in room indicates the child is self-imposing social isolation, indicating a lack of improvement.

11. The nurse is counseling a client diagnosed with sexual masochistic disorder. What would differentiate this paraphilic disorder from sexual sadism? 1. Symptoms of sexual masochistic disorder are chronic acts of humiliation, whereas symptoms of sexual sadistic disorder are acute. 2. Symptoms of sexual sadistic disorder are chronic acts of humiliation, whereas symptoms of sexual masochistic disorder are acute. 3. Masochistic acts can be performed alone, whereas sadistic acts must have a consenting or non-consenting partner. 4. Sadistic acts can be performed alone, whereas masochistic acts must have a consenting or nonconsenting partner.

ANS: 3 Feedback 1 Sexual masochism is chronic in nature as is sexual sadism. 2 Both disorders are chronic in nature. 3 The identifying feature of sexual masochistic disorder is 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 intense sexual arousal from the humiliation or harm in another individual. 4 Sadistic acts are performed with a partner. Sexual masochistic disorder acts may be performed alone or with a partner.

6. The nurse is working with a client diagnosed with pedophilic disorder. Which client outcome is appropriate for this client? 1. The client will verbalize comfort with gender identity. 2. The client will develop strategies to prevent exposing genitalia. 3. The client will identify triggers for inappropriate behaviors. 4. The client will attend aversion therapy groups for this fetish.

ANS: 3 Feedback 1 This goal is appropriate for gender dysphoria, not pedophilia. 2 This goal is appropriate for exhibitionism, not pedophilia. 3 Identifying triggers for inappropriate behaviors is an appropriate outcome for a client diagnosed with pedophilic disorder. 4 This goal relates to fetishism, not pedophilia.

7. The nurse is caring for a client diagnosed with female sexual interest/arousal disorder. What should the nurse document as an expected outcome of sensate focus exercises? 1. To initiate immediate orgasm 2. To decrease anxiety by eliminating physical touch 3. To focus on touching breasts and genitals 4. To reduce goal-oriented demands of intercourse

ANS: 4 Feedback 1 The outcome is to reduce performance pressures and demands. Immediate orgasm is not the goal. 2 Sensate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy. 3 The expected outcome does not involve focusing on touching breasts and genitals. Initially, these areas are to be avoided. 4 The expected outcome of sensate focus exercises is to reduce goal-oriented demands of intercourse. The reduction in demands reduces performance pressures and anxiety associated with possible failure and focuses on the sensual side of sexual interaction.