Exam 6 Sexuality

The nurse is discussing contraception with an adolescent client who asks the nurse: "What if I can't have an orgasm?" What is the nurse's best response?

"A mature sexual relationship does not require a man and woman to achieve simultaneous orgasm." Simultaneous orgasms, or both people attaining orgasm at the same moment, are difficult to achieve. A preoccupation with attaining simultaneous orgasms might disrupt the ultimate intimacy and satisfaction possible during coitus. Multiple orgasms are not abnormal. The size of the penis does not affect whether an orgasm will occur. Having an orgasm is not the only indicator of sexual responsiveness; some individuals may have a pleasurable sexual experience without orgasm.

Which assessment question is most likely to yield data about a female client's sexual identity?

"How do you feel about yourself as a woman?"

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?

Bisexual A bisexual is a person who finds pleasure with both opposite-sex and same-sex partners. Biologic sex is the term used to denote chromosomal sexual development: male (XY) or female (XX), external and internal genitalia, secondary sex characteristics, and hormonal states. Gender role behavior is the behavior a person conveys about being male or female. Sexual orientation refers to the preferred gender of the partner of an individual.

The nurse recommends a barrier method of contraception for a client who is concerned about the side effects of hormonal contraception. Which method might the nurse suggest?

Cervical cap Barrier methods of birth control help in preventing pregnancy by using a device to block sperm from fertilizing an egg. Barrier methods include the cervical cap, condom, diaphragm, and vaginal sponge used in combination with a spermicidal agent. Abstinence means having no sexual intercourse. Norplant is a hormonal method of birth control. Sterilization is a surgical method of birth control.

A client has a history of poorly controlled diabetes. Which health concern will the nurse discuss with the client?

Erectile dysfunction Diabetes is a significant risk factor for erectile dysfunction. The constant elevation of blood sugar in diabetes affects the vascular contraction of male clients. Diabetes does not create an appreciably increased risk of developing sexually transmitted infections, although clients with diabetes have an increased susceptibility to infections of all kinds. Retarded or premature ejaculation is less likely, as these problems do not have a vascular etiology.

A male client, recently diagnosed with diabetes, tells the nurse he is concerned about the effect the condition will have on his ability to participate in sexual activity. Which question by the nurse will be useful to initiate a conversation about the client's concern?

"Can you tell me more about your worries regarding sexual activity?" Asking the client, "Can you tell me more about your worries with sexual activity?" is an open-ended question that allows the client to expand on his stated concern. Asking about the client's partner turns the focus to the partner and does not address the client's immediate concern. Asking the client who gave him this information is a close-ended question and turns the focus away from the client's concern. Erectile dysfunction, or impotence, is a great concern among men with type 2 diabetes; however, this is a close-ended question that does not allow the client to give further details.

A nurse practitioner is teaching the student about sexual health and is evaluating the student's knowledge of sexual identity. The practitioner knows that the student understands when the student says which of the following?

"Gender role behavior is the behavior a person conveys about being male or female." Sexual identity encompasses a person's self-identity, biologic sex, gender identity, gender role behavior or orientation, and sexual orientation or preference. Gender role behavior is the behavior a person conveys about being male or female. Biologic sex is the term used to denote chromosomal sexual development. Gender identity is the inner sense a person has of being male or female. Sexual orientation refers to the preferred gender of a person's partner.

A client presents to the office with concerns of low testosterone and feels it is due to a pituitary gland disorder. Which teaching would the nurse provide to educate this client on how testosterone is produced?

"Gonads are the reproductive organs of the male and are responsible for the production of testosterone and spermatozoa." The testes are the male gonads, which are the reproductive glands that produce male cells (spermatozoa) and testosterone (male hormone). The pituitary gland is the master gland that is responsible for producing the follicle stimulating hormone (FSH) which triggers the production of testosterone so this could very well be a reason for low testosterone. Injury to the testes can be a possible reason for reduced testosterone levels, but this is unusual and is not limited to manifestation through hair loss and weight gain. Seminal fluid, also known as semen, is an organic fluid that may contain spermatozoa. It is secreted by the gonads.

Which assessment question is most likely to yield data about a female client's sexual identity?

"How do you feel about yourself as a woman?" Sexual identity is a broad concept that includes, but supersedes, sexual functioning. However, it is more specific than simply asking about the quality of relationships or if their health allows for a meaningful sex life. Asking an open-ended question about how the client feels about herself as a woman is likely to elicit important insights. Assessing the client's history of STIs does not directly address her sexual identity.

A nurse is collecting a sexual health history from an older adult woman who is postmenopausal. Which client statement requires further education by the nurse?

"I have noticed I have less lubrication with sexual intercourse." After menopause, certain physiologic changes result from decreasing amounts of estrogen. Women experience slower onset of and decreased amounts of lubrication, which could lead to painful intercourse. The clients comment about less lubrication should require follow-up to educate the client on the proper use of lubricants. Women may experience thinning of vaginal and vulvar tissues, genitourinary atrophy, and vasomotor symptoms that may disrupt daytime activities and sleep, resulting in heightened fatigue. The orgasmic phase may become shortened.

A nurse expresses a desire to become culturally competent in the care of females from Africa after a mission trip to the continent. Which statement by the nurse demonstrates an understanding of this population of clients?

"Infibulation is the narrowing of the vaginal opening through the creation of a covering seal." FGM includes procedures that intentionally alter or cause injury to the female genital organs for nonmedical reasons. Complications include increased risk of newborn deaths. It has no health benefits and is nearly always carried out on minors. Infibulation is the narrowing of the vaginal opening through the creation of a covering seal.

A gerontology nurse is discussing sexual dysfunction with an older adult male client. The nurse determines that the education has been effective when the client states:

"Malnutrition may cause impotence." Factors that contribute to sexual dysfunction in the older adult are as follows: use of medications, especially antihypertensive medications; age-related metabolic disorders such as anemia, diabetes, malnutrition, and fatigue (may cause impotence). Sexual intercourse and similar forms of sexual expression are not considered dangerous for anyone able to walk around a room. Erectile dysfunction has treatments such as a penile prosthesis or pharmacologic management.

A nurse reads in a client's chart that he or she has gender dysphoria. The nurse determines that the client understands the diagnosis when making what statement?

"People whose biologic sex at birth is contrary to the gender they identify with have gender dysphoria." People whose biologic sex at birth is contrary to the gender they identify with have gender dysphoria. Heterosexuals experience sexual fulfillment with a person of the opposite sex. People who find pleasure with both opposite-sex and same-sex partners are bisexual. An intersex condition occurs in about 1 in every 2000 babies in which there are contradictions among chromosomal sex, internal organs, and external genital appearance, resulting in ambiguous gender.

The nurse has provided information to a client about oral contraceptives. Which statement by the client would indicate a need for further education?

"Some oral contraceptives protect against STIs." Oral contraceptives need to be taken on a daily basis to prevent breakthrough ovulation. Oral contraceptives do not protect against STIs and clients still need to use STI protection such as condoms. In addition to preventing pregnancy, hormonal contraceptives have many health benefits, including reducing the risk for ovarian cancer and endometrial cancer, reducing symptoms of premenstrual discomforts, decreasing blood loss and anemia, reducing symptoms of endometriosis, and many other benefits.

Which response will the nurse provide to a 13-year-old female client who says to the nurse, "My parents said masturbation is wrong. Is that true?"

"Tell me more about what you know of masturbation." Saying to the client, "Tell me more about what you know of masturbation" allows the client to talk openly and helps the nurse establish rapport with the client. It also gives the nurse an understanding of the client's baseline knowledge. Telling the client, "At least you cannot get pregnant with masturbation" is inappropriate and does not address the client's original concern. Telling the client that masturbation will lead to sexual promiscuity is unfounded and incorrect. Although masturbation is self-stimulation and may be practiced alone, it is inappropriate for the nurse to define wrong vs. right for the client.

While teaching sexual education to a group of high school students, the nurse talks about forms of birth control and when a woman can become pregnant. Which explanation by the nurse about the chance of the woman becoming pregnant is accurate?

"The intrauterine device is a highly effective and reversible contraceptive." The most highly effective and reversible methods of birth control are subdermal implants and two forms of intrauterine devices (IUDs). The most common contraception method worldwide is surgical sterilization. It is responsible for less than one pregnancy per 100 women in a year, but pregnancy is still a possibility. A highly effective but temporary method of contraception is that of the lactation amenorrhea method (LAM) when strict criteria are met (exclusively breastfeeding, no onset of menses, and less than 6 months postpartum). Those methods considered least effective with 18 or more pregnancies per 100 women in a year are all nonhormonal methods of contraception, including withdrawal. The only method guaranteed to prevent pregnancy is abstinence.

A 17-year-old girl tells the nurse she uses tampons and asks how she can cut down on odor during her period. What is the nurse's best response?

"The tampon should be changed frequently." To cut down on odor, and to decrease the risk for toxic shock syndrome, the tampon should be changed frequently, but every hour is too frequent. Nothing should be placed on a tampon prior to insertion as this can cause a serious infection and will not decrease odor. Tampons, if changed frequently, are not dangerous.

The nurse is conducting a sexual history assessment of a 24-year-old female client, who casually remarks she would love to have sex with several actors. What is the best response from the nurse?

"What do you hope to accomplish by doing that?" The nurse should always remain nonjudgmental when assessing a client on any subject. The client will most likely not share the same views as the nurse and that is okay. The nurse should start with open-ended questions to get the conversation started and then progress as the client shares his or her own view points. The other choices would be inappropriate and ineffective in gathering the information needed to provide this client with the best care possible.

An adolescent female client expresses concern to the nurse about her anatomy looking "weird down there." Which response(s) by the nurse is appropriate? Select all that apply.

- "Tell me more about the concerns you have about your body." - "You may want to try using a mirror to better see and understand your anatomy." - "Explain what you mean when you say you look's weird down there.'"

The nurse is teaching a male adolescent how to use a condom. Which teaching points would the nurse include? Select all that apply.

1. "If the condom does not have a nipple receptacle, leave a small space at the end for semen to collect." 2. "Use a condom with every act of intercourse." 3. "Immediately after ejaculation remove the condom and discard it."

The nurse is advising an adolescent male about sexual myths that have him concerned. Which client education accurately describe these concerns? Select all that apply.

1. Masturbation or self-stimulation is a natural and healthy outlet for sexual urges. 2. No male or female should feel pressured into sexual activity at any age. 3. Nocturnal emissions are normal in men of all ages Masturbation or self-stimulation is natural. No one should ever feel pressured into having sex. Nocturnal emissions are normal and occur in about 85% of men. Penis size has no effect on the satisfaction of the sexual experience.

Which example best supports the diagnosis of Sexual Dysfunction: Dyspareunia?

A 50-year-old woman in the process of menopause has pain and burning during intercourse. Dyspareunia refers to pain and burning during intercourse. This is a common cause of sexual dysfunction, especially during menopause. A colostomy, fear of blood pressure elevation, and lack of interest in sex may lead to the nursing diagnosis of Sexual Dysfunction, but not related to dyspareunia.

During a well-check visit of a toddler, the parent mentions that the child is exhibiting sexual behaviors. Which information on growth and development of a toddler will the nurse discuss with the parent?

Acknowledge that masturbation is normal. As children become toddlers, they begin to explore their bodies even more while developing a body image that includes sexual identity. Toddlers may engage in masturbation, and parents should be reassured that this behavior is normal and healthy for development. Playing with friends and exploring their own bodies are normal activities. Children at this stage are curious about body parts and may often ask questions related to such things as where babies come from, breastfeeding, and physical differences between men and women and boys and girls. Body image should be modeled by the parents. Positive body image begins early in life.

The nurse is justified in assessing for sexual dysfunction among male clients who are receiving which of the following?

Antihypertensive medication Antihypertensives are among the drugs implicated in sexual dysfunction. Antihypertensives can decrease forceful blood flow to the penis, making it difficult to achieve an erection. Antibiotics, bronchodilators, and NSAIDs do not typically have this effect.

A female nurse is giving a complete bed bath to a young male client. The nurse notices the client has an erection. Which action will the nurse take?

Continue bathing the client. An erection may occur in response to a full bladder, fantasy, or touch. Exposure of the male client by the nurse may cause an erection during a bed bath. An erection is a normal physiological response and not something the man can voluntarily control. It does not mean the client is attracted to the nurse. By continuing on with the bath the nurse creates a sense of normalcy. There is no need to tell the client's parents about this normal reaction.

In the female reproductive system, what corresponds with the male penis?

Clitoris The clitoris corresponds to the penis in the male in that both organs respond to stimulation that can result in orgasm.

A woman age 49 years 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 client is most likely experiencing?

Dyspareunia Dyspareunia is painful intercourse. Vaginismus is characterized by difficult penetration rather than acute pain during intercourse. Vulvodynia is associated with pain that is not limited to intercourse. Sexually transmitted infections (or STIs) are infections that can be caught or passed on from unprotected sex, or close sexual contact. An STI may or may not be contributing to the woman's problem, though most cases of dyspareunia are unrelated to infections.

A 13-year-old female client comes in for a sports physical for school. During the exam, the client mentions she has a great boyfriend. Which question should the nurse prioritize with this client?

Have you received a human papillomavirus (HPV) vaccination? The FDA recommends the HPV vaccine be given beginning at the age 11 to 12 years to provide immunity prior to the adolescent becoming sexually active. The other questions can also be included in the exam as determined pertinent by the nurse; however, preventing the spread of HPV is the priority.

A nurse is explaining premenstrual syndrome to a female client. The client demonstrates understands when stating what may occur in the premenstrual phase?

Headache

A man 68 years of age comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the client's history, what might the nurse note that contributes to impotence?

History of hypertension Vascular problems cause about half the cases of impotence in men older than 50 years. Use of medications to decrease blood pressure such as diuretics cause erectile dysfunction by decreasing the force of blood flow into the penis. With advancing age the sexual function, libido, and potency decrease, but is not the primary reason for impotence. Past history of infection and lack of exercise does not contribute to impotence.

The nurse is preparing a talk on health issues in the lesbian, gay, bisexual, transgender, queer or questioning (LGBTQ) population. Which statistic would the nurse include?

LGBTQ youth are more likely to attempt suicide. Healthy People 2030 found that LGBTQ youth are more likely to attempt suicide. Lesbians and bisexual females are more likely to be overweight or obese. LGBTQ populations have higher rates of tobacco, alcohol, and other drug use than other populations. Lesbians are less likely to get preventive services for cancer.

During the menstrual cycle, when does ovulation typically take place?

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. On day 1 of a new cycle begins the new menstrual cycle. Menstrual flow might occur every 21 to 35 days or the last two to seven days. Ovulation does not begin when sperm is present. If ovulation and sperm engage, then pregnancy occurs.

During hospitalization for a suicide attempt, the client 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 client informs the nurse that she needs the job but is embarrassed that she performs these favors. The nurse informs the client that this is illegal behavior and is called what?

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 identical situations 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.

Which of the following statements best describes the relationship between biologic sex and gender identity?

Sex is chromosomally determined, while gender is a psychosocial construct. Biologic sex is the term used to denote chromosomal sexual development. Gender identity is the inner sense a person has of being male or female. As such, biologic sex is amenable to medical interventions, but surgery and hormone therapy will not change an individual's inner sense of being male or female. Gender identity is not commonly thought to be chosen or objectively selected during adolescence.

A client is trying to be understanding; however, the client is getting frustrated by the spouse's lack of sexual response. Which factor should the nurse explore to help this physiologically healthy couple create reasonable goals to improve their situation?

Spouse's lack of self-esteem The individual who experiences low self-esteem and self-confidence may experience negative effects in sexual functioning. This may be due to inadequate education; however, it could also be due to past traumatic events. The client's concern can be a good thing as the client tries to help the spouse overcome this barrier. Undiscovered physical factors might be a factor; however low self-esteem is more likely.

The nurse is speaking to a client regarding sexual history. The client states, "I was born with a penis but I should have had a vagina." The nurse would document the client's gender identity as:

TRANSGENDER A transgender man views himself as a woman trapped in a man's body; the reverse is true for a transgender woman. Cross dresser is used to describe a person who dresses like someone of the opposite sex but views oneself according to biological gender. Bisexuals are attracted to both males and females. Gay individuals are attracted to those of the same gender.

A 19-year-old client scheduled for a vaginal exam is visibly upset and cancels the appointment when learning the clinic provider is a man. Which factor should the nurse prioritize when assisting this client?

Taught to avoid exposing herself to strangers Some cultures forbid the woman from exposing herself to a man who is not her spouse. The nurse should ask about cultural practice and alert the health care provider to the situation. The other factors can be explored after the nurse determines the cultural aspect is clarified.

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?

The choice not to start a family. Some people choose a permanent method to prevent pregnancy from ever occurring. Factors that affect a person's choice of a contraceptive method include age, marital status, desire for future pregnancy, religious beliefs, level of education, cost, and ease of use. Permanent contraception offers no protection against sexually transmitted infections.

The nurse is conducting an interview with a client who has a sexual concern. To obtain accurate and complete information from the client, which method will the nurse use to create a comfortable environment to encourage communication?

The nurse should demonstrate ease. The nurse sets the tone or atmosphere for the interview. The nurse's attitudes will greatly affect the client's response to the sexual history, as clients will be more cooperative if they sense the nurse's security and ease during the interview. Privacy is essential for sexual history assessment. Doors should be closed and interruptions should not be allowed during the interview. The nurse should sit close to the client and speak in a quiet, relaxed, objective tone of voice, as well as use eye contact and open body posture. There is no need to hold the client's hand. The nurse should explain to the client that no one will have access to this information unless it is significant to the client's care.

A patient calls the clinic and tells the nurse they have a foamy, greenish, and itchy vaginal discharge. The patient asks the nurse what the significance of this discharge is. What is the best response by the nurse?

The patient may have trichomoniasis. Mucus or white discharge from the vagina is physiologic and normal. Drainage caused by Candida is curd-like and white, while infection with trichomonas is often foamy and green in color. Vaginal dryness causes scant and mucoid drainage that may be blood-tinged. Many people with Chlamydia are asymptomatic without discharge.

A male client comes to the clinic because he thinks that he has syphilis. Which test would the nurse expect the client to have done?

VDRL VDRL is a blood test done to detect syphilis in males and females. HPV is a test done to detect the human papilloma virus. Pap smear is performed on females to evaluate for changes in the cervix. A wet preparation is a sample of vaginal secretions done to detect Candida, Gardnerella and Trichomonas.

The nurse is assessing the sexual health of a female client age 20 years. 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." What would the nurse use when documenting the client's report?

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.

When a man cannot achieve an erection, the phase of the sexual response in which the man is experiencing difficulty is:

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. Therefore, if a man cannot achieve an erection, the difficulty occurs in the excitement phase of the sexual response.

The nurse is providing education about sexuality to a group of college freshmen. Which terms(s) describe a client's sexual orientation? Select all that apply.

heterosexual (straight), gay, lesbian

A nurse is teaching a sex education class to a group of adolescent girls. They ask the nurse about the sexual response cycle in females. Which physiologic response does the nurse tell them is only seen in girls/women?

loss of muscular control during orgasm causing twitching of the arms and legs During the excitement phase, some of the physiologic changes common in both men and women include an increased heart rate and blood pressure. Male and female nipples become hard and erect. In the orgasm phase, women have a loss of muscular control, which causes spastic contractions and twitching of the arms and legs, and men experience involuntary spasmodic contractions only in the penis, epididymis, vas deferens, and rectum. In the resolution phase, men experience a period during which the body does not respond to continued sexual stimulation, called the refractory period.

When a 19-year-old male client tells the nurse that he has never been able to achieve an erection, the nurse recognizes that the client is experiencing:

primary impotence. Primary impotence refers to a man who has never been able to achieve an erection necessary for intercourse; secondary impotence refers to a man who was once successful in attaining and maintaining erections but who has subsequently experienced difficulty. Causes of impotence, whether primary or secondary, can be physiologic, psychological, or both. Certain manifestations may indicate the probability that the problem is secondary to a physiologic or a psychological factor.

The Surgeon General's Call To Action To Promote Sexual Health and Responsible Sexual Behavior was released in 2001. The goal of this document is to:

promote general health and wellness. The Surgeon General's Call to Action To Promote Sexual Health and Responsible Sexual Behavior, was released by the U.S. Office of the Surgeon General. Approaching sexuality issues from a public health perspective, this document emphasizes the challenges to promoting responsible sexual behavior with the goal of promoting general health and wellness in our society.

The nurse should instruct an Islamic female client who is reluctant to undergo pelvic examination from an assigned male health care provider to:

seek a female health care provider to perform the examination. The woman is from a culture or ethnic group whose values influence her feelings about a pelvic examination, particularly one done by a male health care provider.

The nurse is preparing to provide education to a group of high school students on sexually transmitted infection (STI) prevention. The nurse knows that this age group often uses oral-genital stimulation as a way to prevent pregnancy. Which concept should the nurse make sure to convey to the group?

skin-to-skin contact can spread herpes and genital warts

A pregnant teenager did not understand the process of fertilization. The school nurse's best explanation of fertilization is that:

the fertilization process occurs in the outer third of the fallopian tube. Fertilization of one ovum with one spermatozoon normally occurs in the outer third of the fallopian tube. The time period in which the woman can be impregnated is only a few days.

A client that is post-menopausal reports painful intercourse for the last two months. When performing an assessment of the client, what data should the nurse obtain?

the use of antihistamines, tranquilizers, or alcohol The use of antihistamines, tranquilizers, or alcohol and illicit drugs are known to cause painful intercourse (dyspareunia) in some women. The nurse should document the use of any of these and discuss with the client the likely contribution to the problem. The assessment of anatomy and sexual response would be indicated if the client complained of orgasmic dysfunction or vaginismus. The assessment of sexual abuse, rape, or incest is indicated if the client complained of inhibited sexual desire. Communication patterns should be assessed if the client complained of orgasmic dysfunction.