Human Sexuality

1. A nurse is discussing sexual arousal during a preadolescent boys' sex education class. Which of the following should the nurse base her reply on when a boy asks, "What exactly happens when my body gets aroused, anyway?" 1. The vas deferens thickens & expands. 2. The sympathetic nerves of the penis are stimulated. 3. The corpora of the penis become engorged. 4. The prepuce of the penis elongates.

1. CORRECT ANSWER 3. When arousal occurs, the penile blood vessels become engorged & an erection is achieved. The vas deferens is the internal structure through which the semen passes from the testes to the urethra. Its shape is unaffected by sexual arousal. The parasympathetic nerves are stimulated during sexual arousal, not the sympathetic nerves. The prepuce, or foreskin, does not increase in length during arousal. It is unlikely that the nurse would use some of the terminology included in the responses when speaking with the boys. For example, she might replace the term "prepuce" with the word "foreskin." Do not choose the incorrect response simply because you do not understand or disagree with the terminology in the response. Note that the responses are not direct quotes since they are not surrounded by quotation marks & the stem states, "Which of the following should the nurse base her reply on?"

10. It is day 17 of a woman's menstrual cycle. She is complaining of breast tenderness & pain in her lower left quadrant. The woman states that her cycle is usually 31 days long. Which of the following is an appropriate reply by the nurse? 1. "You are probably ovulating." 2. "Your hormone levels should be checked." 3. "You will probably menstruate early." 4. "Your breast changes are a worrisome sign."

10. CORRECT ANSWER 1. This statement is true. Breast tenderness & mittelschmerz often occur at the time of ovulation. 2. Breast tenderness & mittelschmerz are symptoms of ovulation, not of abnormal hormonal levels. Menstruation occurs approximately 14 days after ovulation. The breast changes are normal & often are felt by women at the time of ovulation. There are two hints to the answer in this question. First, the woman has a 31-day cycle & it is day 17. It is, therefore, 14 days before the woman usually menstruates. Women usually ovulate 14 days before their menstrual periods begin. The one-sided lower quadrant pain is also a clue. Women often feel a twinge, called mittelschmerz, near the site of the ovary at the time of ovulation.

11. A man asks the nurse where his sperm are produced. On the diagram, please place an "X" on the site of spermatogenesis.

11. CORRECT ANSWER The test-taker should place an "X" on the testes. Be familiar with the anatomy & physiology of both the male & female reproductive systems. Spermatogenesis occurs in the testes, which is where the "X" should be placed. When the vas deferens is ligated during a vasectomy, the sperm are no longer able to migrate from the testes to the female reproductive tract, & the man becomes sterile.

12. The nurse is teaching a class on reproduction. When asked about the development of the ova, the nurse would include which of the following? 1. Meiotic divisions begin during puberty. 2. At the end of meiosis, four ova are created. 3. Each ovum contains the diploid number of chromosomes. 4. Like sperm, ova have the ability to propel themselves.

12. CORRECT ANSWER 1. This answer is correct. Meiosis I occurs during puberty. At the completion of oogenesis only 1 ovum is created. At thecompletion of spermatogenesis, 4 sperm are created. Each ovum contains the haploid number of chromosomes. Sperm have flagella that propel them through the woman's reproductive system. Ova, however, do not have the ability to propel themselves, but rather are propelled externally by the cilia in the fallopian tubes. Be familiar with the fact that meiosis begins during puberty & that the ova age during the following years. This is the likely reason why women who attempt to become pregnant after 35 years of age have an increased incidence of infertility as well as an increased probability of becoming pregnant with a Down syndrome fetus.

13. A client complaining of secondary amenorrhea is seeking care from her gynecologist. Which of the following may have contributed to her problem? 1. Athletic activities. 2. Vaccination history. 3. Pet ownership. 4. Genetic history.

13. CORRECT ANSWER 1. If the young woman exercises excessively—for example, as a competitive gymnast or runner—her body fat index will be so low she will become amenorrheic. Vaccination history has not been shown to be related to secondary amenorrhea. Pet ownership has not been shown to be related to secondary amenorrhea. Genetic history has not been shown to be related to secondary amenorrhea. Be able to deduce what is meant by secondary amenorrhea. The prefix "a" means "not" & the remainder of the word refers to the menses. A problem that is labeled "primary" is one that occurs initially. A secondary problem occurs later. A client with primary amenorrhea, therefore, is a young woman who has never had a period. A client with secondary amenorrhea is a young woman who did have periods, but whose periods have stopped. The most common cause of secondary amenorrhea is pregnancy, but a low body fat index, such as can result from excessive or very strenuous exercises, can also lead to amenorrhea.

14. What is the function of the arrowed region on the drawing at right? 1. It produces a fluid that nourishes the sperm. 2. It secretes a fluid that neutralizes the acidic environment of the vagina. 3. It is the reservoir where sperm mature. 4. It contracts during ejaculation forcing the sperm & fluid out of the

14. CORRECT ANSWER 3. The marked organ is the epididymis, which is the reservoir where sperm mature. The seminal vesicles, which are not marked in the diagram, produce a fluid that nourishes the sperm. The prostate gland, which is not marled in the diagram, secretes a fluid that neutralizes the acidic environment of the vagina. The pubococcygeal muscles are not marked in the diagram. These muscles & others contract during ejaculation, forcing the sperm & fluid out of the urethra.

15. A couple is seeking infertility counseling. During the history, it is noted that the man is a cancer survivor, drinks one beer every night with dinner, & takes a sauna every day after work. Which of the following is an appropriate response by the nurse? 1. It is unlikely that any of these factors is impacting his fertility. 2. Daily alcohol consumption could be causing his infertility problems. 3. Sperm may be malformed when exposed to the heat of the sauna. 4. Cancer survivors have the same fertility rates as healthy males. urethra.

15. CORRECT ANSWER 3. The high temperature of the sauna could alter the number & morphology of the sperm. Exposing the testes to the heat of the sauna can alter the normal morphology of the sperm. Alcohol consumed in excessive amounts can alter spermatogenesis, but one beer per day has not been shown to be a problem. Chemotherapy has been shown to affect the ability of males to create sperm. Do not to be fooled by quantities & numbers when they are included in the stem or answer options. The stem states that the male consumes one beer each evening. That quantity has not been shown to affect fertility.

2. A woman, whose menstrual cycle is 35 days long, states that she often has a slight pain on one side of her lower abdomen on day 21 of her cycle. She wonders whether or not she has ovarian cancer. What is the nurse's best response? 1. "Women often feel a slight twinge when ovulation occurs." 2. "Ovarian cancer is a possibility & you should seek medical attention as soon as possible." 3. "Ovarian cancer is unlikely because the pain is not a constant pain." 4. "It is more likely that such pain indicates an ovarian cyst because pain is more common with that problem."

2. CORRECT ANSWER 1. This statement is true & the discomfort, at the location of the ovary where ovulation occurs, is called mittelschmerz. Ovulation usually occurs 14 days before the first day of the menses. The history given by the woman is not indicative of ovarian cancer. The timing of the pain is more significant than the type of pain. The timing of the pain is more significant than the type of pain. Although the stem includes the fact that the woman is concerned about ovarian cancer, this question is actually testing about ovulation. Try not to be confused by extraneous information included in a stem.

3. A nurse is explaining to a client about monthly hormonal changes. Starting with Day 1 of the menstrual cycle, please place the following four hormones in the chronological order in which they elevate during the menstrual cycle. 1. Follicle-stimulating hormone. 2. Gonadotropin-releasing hormone. 3. Luteinizing hormone. 4. Progesterone.

3. CORRECT ANSWER 2, 1, 3, 4 Gonadotropin-releasing hormone stimulates the production of follicle-stimulating hormone (FSH) & luteinizing hormone (LH). FSH rises first & LH follows. After ovulation, progesterone rises. In order to remember the hormones of the female menstrual cycle, it is important to know definitions, especially of prefixes & suffixes. Gonadotropin is a hormone that stimulates the gonads—that is, the ovaries or the testes. Follicle-stimulating hormone stimulates the follicle, or ovum sac, to mature, while luteinizing hormone stimulates the release of the ovum from the ovary & heralds the luteal phase of the menstrual cycle (when the corpus luteum is functioning). Finally, progesterone becomes elevated.

4. A 54-year-old client calls her health care practitioner complaining of frequency & burning when she urinates. Which of the following factors that occurred within the preceding 3 days likely contributed to this client's problem? 1. She had intercourse with her partner. 2. She returned from a trip abroad. 3. She stopped taking hormone replacement therapy. 4. She started a weight-lifting exercise program.

4. CORRECT ANSWER 1. The fact that the client had intercourse in the last 3 days likely led to the symptoms she is reporting, which are symptoms of a urinary tract infection (UTI). Returning from a recent trip abroad is not likely related to the symptoms the client is reporting, which are symptoms of a UTI. Stopping hormone replacement therapy (HRT) is unlikely related to the symptoms reported by the client. It is unlikely that starting a weight-lifting program is related to the symptoms of a UTI that the client is reporting. The urinary meatus is often manipulated during foreplay & rubbed against during intercourse. To prevent a UTI, women are encouraged to urinate immediately after having intercourse to flush any bacteria from the urethral opening.

5. A woman's temperature has just risen 0.4°F & will remain elevated during the remainder of her cycle. She expects to menstruate in about 2 weeks. Which of the following hormones is responsible for the change? 1. Estrogen. 2. Progesterone. 3. Luteinizing hormone (LH). 4. Follicle-stimulating hormone (FSH).

5. CORRECT ANSWER 2. Progesterone elevation occurs after ovulation & spikes at about 5-6 days after ovulation. Progesterone is thermogenic—that is, heat producing. Progesterone is the reason why women's temperatures are elevated following ovulation. . Estrogen begins to elevate before ovulation. It is not responsible for the temperature elevation. LH spikes at the time of ovulation. FSH promotes the maturation of the ovum. This question asks to explain a temperature rise that occurs 2 weeks prior to menstruation. It is essential to know that ovulation usually takes place approximately 14 days before the onset of the menses. That eliminates estrogen & FSH since the temperature would have been elevated much earlier in the cycle if those hormones were responsible. LH spikes & then drops at the time of ovulation; that hormone, too, can be eliminated as a possible answer. The only hormone that becomes elevated during the latter part of the menstrual cycle is progesterone.

6. A woman is menstruating. If hormonal studies were to be done at this time, which of the following hormonal levels would the nurse expect to see? 1. Both estrogen & progesterone are high. 2. Estrogen is high & progesterone is low. 3. Estrogen is low & progesterone is high. 4. Both estrogen & progesterone are low.

6. CORRECT ANSWER 4. When the ovum is not fertilized, both estrogen & progesterone levels drop. The hormonal drop is followed by menstruation. When the ovum is not fertilized, both estrogen & progesterone levels drop. The drop in hormones is followed by menstruation. When the ovum is not fertilized, both estrogen & progesterone levels drop. The drop in hormones is followed by menstruation. When the ovum is not fertilized, both estrogen & progesterone levels drop. The drop in hormones is followed by menstruation. Menstruation begins the menstrual cycle. Since pregnancy has not occurred, the nurse can deduce that the hormones of pregnancy need not remain elevated. An educated guess, therefore, would be option 4, that both estrogen & progesterone are low.

7. A nurse teaches a woman who wishes to become pregnant that if she assesses for spinnbarkeit she will be able closely to predict her time of ovulation. Which technique should the client be taught in order to assess for spinnbarkeit? 1. Take her temperature each morning before rising. 2. Carefully feel her breasts for glandular development. 3. Monitor her nipples for signs of tingling & sensitivity. 4. Assess her vaginal discharge for elasticity & slipperiness.

7. CORRECT ANSWER 4. Spinnbarkeit is defined as the "thread" that is created when the vaginal discharge is slippery & elastic at the time of ovulation. The changes are in response to high estrogen levels. The woman inserts her index & middle fingers into her vagina & touches her cervix. After removing her fingers, she separates her fingers & "spins a thread" between her fingers. When she is not in her fertile period, the mucus is thick & gluey. The temperature does elevate after ovulation, but the elevation is not defined as spinnbarkeit. The breasts do become sensitive & some women do palpate tender nodules in the breasts at the time of ovulation, but those changes are not spinnbarkeit. The nipples may tingle & become sensitive. It is important to be familiar with self-help techniques to assist clients to understand their bodies. Spinnbarkeit is a German term that literally means the ability to create a thread.

8. In analyzing the need for teaching regarding sexual health in a client who is sexually active, which of the following questions is the most important for a nurse to ask? 1. "How old are your children?" 2. "Did you have intercourse last evening?" 3. "With whom do you have intercourse?" 4. "Do you use vaginal lubricant?"

8. CORRECT ANSWER 3. This question is the most important for the nurse to ask. The nurse is trying to learn whether or not the client is having intercourse with more than one partner and/or whether the client has intercourse with men, women, or both. The ages of a client's children may be important, but it is not the most important information for the nurse to ask about. Whether or not the client had intercourse the preceding night is important, but it is not the most important information for the nurse to ask about. Whether or not the client uses vaginal lubricant is important, but it is not the most important information for the nurse to ask about. Clients who engage in sex with multiple sex partners are high risk for infection & pregnancy. Women who have intercourse with same-sex partners are high risk for some sexually transmitted infections (STIs), especially bacterial vaginosis. & because there is no risk of pregnancy, women in lesbian relationships may be less likely to protect themselves from infection.

9. When a nurse is teaching a woman about her menstrual cycle she mentions that which of the following is the most important change that happens during the follicular phase of the menstrual cycle? 1. Maturation of the graafian follicle. 2. Multiplication of the fimbriae. 3.Secretionofhumanchorionicgonadotropin. 4.Proliferationoftheendometrium.

9. CORRECT ANSWER 1. FSH is elevated during the follicular phase & the Graafian follicle matures. The fimbriae are located at the ends of the fallopian tubes. They do not multiply in number. The hormone hCG is not produced during the menstrual cycle. It is produced by the fertilized egg in early pregnancy. Endometrial proliferation occurs during the secretory phase of the menstrual cycle. Always try to find a clue in the stem for the answer to the question. In this question, choose "the most important change that happens during the follicular phase." In general, things are named logically, & this case is no different. The follicular phase is the period of the menstrual cycle when the follicle matures.