Sexual Health

Question 13. Which classification of medications can cause decreased vaginal lubrication? 1. Antihistamines 2. Anticonvulsants 3. Antidepressants 4. Antihypertensives

1 Rationales Option 1: Antihistamines cause decreased vaginal lubrication. Option 2: Anticonvulsants do not affect vaginal lubrication. They can decrease libido and delay orgasms. Option 3: Antidepressants can decrease libido and delay orgasms. They do not decrease vaginal lubrication. Option 4: Antihypertensives can cause erectile dysfunction. They do not cause vaginal dryness. [Page reference: 1239]

Question 25. An older female client is in for her yearly examination, and when asked about any changes, she states she has been experiencing pain during intercourse. How should the nurse respond to this statement? 1. Explain that vaginal dryness is common in older women and using a water-soluble lubricant can help with any discomfort. 2. Explain that older women often experience fewer orgasms with weaker intensity leading to vaginal dryness. 3. Offer to have the client evaluated by a psychologist for sexual dysfunction. 4. Assess the client for health and suggest hormonal therapy to address the physiological issue of vaginal dryness.

1 Rationales Option 1: As women age, hormonal changes cause vaginal dryness that can lead to painful intercourse. By offering an explanation with a solution, the nurse has addressed this issue professionally. Option 2: Aging women may experience fewer, intense orgasms that are not directly attributed to vaginal dryness; however, this is only addressing a portion of the problem. Option 3: A psychologist may be needed in certain situations; however, this is a typical aging issue in females, which the nurse should address holistically. Option 4: Hormonal therapy may or may not be necessary, and the physician should address this issue with the client if deemed necessary. [Page reference: 1237]

Question 6. Which best defines ethnocentrism related to sexual health? 1. Ethnocentrism is a belief that one's sexual beliefs are the norm for all cultures. 2. Ethnocentrism is a belief that sexual relations should wait until after marriage. 3. Ethnocentrism is a belief that one's sexuality depends on the view of others. 4. Ethnocentrism is a belief that involves one's sexual identity.

1 Rationales Option 1: Many people believe that what they view as normal sexual activity is the same for all cultures. This is ethnocentrism. Option 2: In the past, the norm was to wait until after marriage to engage in sexual activity. This is not ethnocentrism. Option 3: Ethnocentrism is not the belief that one's sexuality depends on the views of others. health. Option 4: Gender identity, not ethnocentrism, involves a person's sexual identity. [Page reference: 1237]

Question 42. A 52-year-old client comes to the outpatient clinic complaining of a throbbing headache over the past 3 days. The client has tried several over-the-counter (OTC) medications with no relief. When checked, the blood pressure reads 220/110. When you ask whether the client has ever been treated for high blood pressure, the client replies, "Yes, but I quit taking it because it affected my sex life." What would be an appropriate response by the nurse? 1. Apply a holistic approach to assessment and formulating strategies to address sexual concerns. 2. Explain to the client there are medications that can help with any sexual dysfunction he or she may be experiencing. 3. Offer to refer the client to a counselor who specializes in aging adults and sexual dysfunction. 4. Assess the client, obtain subjective data including current lab results, and create a nursing plan that will address the immediate need for intervention of hypertension.

1 Rationales Option 1: By assessing the entire situation of the client, such as how hypertension itself can cause erectile dysfunction along with self-image and identity issues of the aging adult the nurse, can help create a plan that will address the sexual concerns of the client. Option 2: Offering medications is only addressing a small portion of the issue and may or may not be appropriate given the level of hypertension. Option 3: Counseling may or may not be an appropriate strategy, but it will only address a small component of the issue with a hypertensive client experiencing sexual dysfunction. Option 4: Addressing the malignant hypertension is crucial and vital; however, the nurse cannot forget about the client not taking their medications and the reason. [Page reference: 1231-1232]

Question 34. An older female client states she regularly douches, especially after sexual intercourse. What information should the nurse provide this client regarding douching? 1. Douching removes normal bacteria that cleans the vaginal cavity and protects against infection. 2. Douching is essentially useless as a method of contraception. 3. Clients should only douche when they smell an unpleasant odor. 4. Clients should only douche directly after their menstrual cycles to remove any residual blood and tissue.

1 Rationales Option 1: Douching is associated with significant risks, including removal of beneficial bacteria that acts to cleanse the vagina and protect it against infection. Option 2: While douching is not suggested for contraception, a more professional tone should be used to educate the client regarding using douching for this reason. Option 3: Some odors are normal at certain times of the menstrual cycle, and douching should not be used to address this. Option 4: Douching is not recommended for any reason and should not be encouraged at any time. [Page reference: 1253]

Question 27. A post tubal ligation client is experiencing cramping, lower abdominal pain, and back and upper thigh pain, with headache, vomiting, and diarrhea. What should the nurse assess this client for? 1. Dysmenorrhea 2. Premenstrual syndrome (PMS) 3. Premenstrual dysphoric disorder (PMDD) 4. Human papilloma virus (HPV)

1 Rationales Option 1: Dysmenorrhea is painful menstruation caused by strong uterine contractions that lead to ischemia of the uterus and manifests as severe cramping and lower abdominal pain as well as other symptoms. Option 2: PMS is characterized by physical and emotional changes occurring 3 to 14 days before the onset of the woman's menstrual period. Option 3: PMDD is a more severe form of menstrual cycle dysfunction where women may become severely depressed for a week or more prior to menses. Option 4: HPV is a sexually transmitted disease that is often asymptomatic and found on routine pap smears. [Page reference: 1244]

Question 39. A 37-year-old male client complains of nausea, vomiting, loss of appetite, abdominal pain, fatigue with muscle and joint pain. Upon assessment, the nurse notices yellowing of the eyes and skin and darkened urine. When questioned, the client states he has had multiple male sexual partners over the course of the past several years. What do these symptoms possibly indicate? 1. Hepatitis B 2. Hepatitis C 3. AIDS 4. HIV

1 Rationales Option 1: Hepatitis B is a common sexually transmitted disease that can be prevented through vaccination. Option 2: Hepatitis C manifests as bleeding and bruising easily, itchy skin, swelling in legs, weight loss, and confusion. Option 3: AIDS is an immunodeficiency syndrome caused by an attack on the immune system, causing a deficiency in T-cell production and does not typically manifest with yellowing of the eyes and skin. Option 4: HIV is manifested in the early stages as flu-like symptoms and may remain asymptomatic for many years. [Page reference: 1245]

Question 29. How can a new nurse overcome uncomfortable feelings of discussing sexuality with clients? 1. Include sexuality as a routine part of the nursing assessment. 2. Have another more experienced nurse conduct the nursing assessment until a professional comfort level is achieved. 3. Seek professional counseling from a senior nurse to determine how to approach clients' sexuality. 4. Address sexuality in a comprehensive manner with detailed questioning.

1 Rationales Option 1: Including sexuality in the routine nursing assessment reinforces the concept that sexuality is an integral part of life and can be looked at as a teaching opportunity for the client. Option 2: The only way to overcome discomfort in such a situation is to continue to engage in professional conversations with clients until a more comfortable level is achieved. Option 3: Seeking advice from senior nursing staff can help with methods on approaching the topic; however, to become more comfortable, the topic should be discussed with each client. Option 4: Using a standard form helps maintain consistency and professionalism as well as utilizes brief, direct questions. However, the nurse will need to be aware of a client's verbal and nonverbal cues to identify and explore relevant issues that may not be on the form. [Page reference: 1258]

Question 30. A client is making sexual comments toward the nurse and attempts to touch the nurse inappropriately while they are administering an IV. What would the appropriate response be for the nurse? 1. Be direct and tell the client to not touch him or her, refocusing the client on the treatment and what procedure is being done. 2. Push the client's hand away and alert him or her that security will be called if this does not stop. 3. Make light of the situation and leave the room immediately. 4. Use a louder, firm voice to tell the client this is inappropriate and disrespectful and the nurse expects him or her to stop right away.

1 Rationales Option 1: It is always best to be firm and direct with clients and clearly state what is expected from them. Option 2: Pushing the client's hand away and threatening to call security may only make the situation worse. Option 3: Making light of the situation does not address the issue with the client, who may continue advances if it is not addressed directly. Option 4: Raising the voice and getting angry with clients is not a professional or appropriate manner in which to handle a client. [Page reference: 1255]

Question 35. What might an appropriate goal be for a client with a nursing diagnosis of Sexual Dysfunction and Ineffective Sexuality Patterns? 1. Communicate sexual needs and preferences to the partner. 2. Refer to counseling for altered sexual functioning. 3. Include the partner in discussions if the client wishes. 4. Describes techniques for preventing STIs.

1 Rationales Option 1: Stating an outcome directly related to the nursing diagnosis addresses the issue and sets a realistic goal for the client. Option 2: Referral to counseling is an intervention, not an outcome or goal. Option 3: Including a partner in discussion is a component of the nurse's teaching plan. Option 4: Describing techniques for preventing STIs is a goal, but it is not appropriate for sexual dysfunction or ineffective sexuality patterns. [Page reference: 1250]

Question 23. Which sexually transmitted infection (STI) causes a chancre to form at the initial site of contact? 1. Syphilis 2. Gonorrhea 3. Chlamydia 4. Genital warts

1 Rationales Option 1: Syphilis causes a chancre to form at the initial site of contact. Option 2: Gonorrhea causes purulent discharge from the penis or cervix but does not cause chancres to form. Option 3: Chlamydia causes clear drainage from the penis and is often asymptomatic in females. Chlamydia does not cause chancres to form. Option 4: Genital warts cause warts, not chancres, to form. [Page reference: 1245]

Question 43. A mother is concerned about her child who is biologically male but prefers to dress as a girl and wants to be called Stephanie instead of Steven. What does the DSM-5 refer to this as? 1. Gender dysphoria 2. Gender identity disorder 3. Intersexed 4. Bisexual

1 Rationales Option 1: The DSM-5 has replaced the previous terminology of gender identity disorder to gender dysphoria and now emphasizes that gender nonconformity is not a mental disorder. Option 2: Gender identity disorder is the previous term used to describe an individual who forms a gender identity that is not the same as the biological gender. Option 3: An intersexed person is born with ambiguous sexual organs. Option 4: A bisexual person is sexually and emotionally attracted to both males and females. [Page reference: 1234]

Question 36. What might an appropriate nursing diagnosis be for a client who has recently undergone removal of a testicle and is concerned his wife will not be sexually attracted to him any longer? 1. Disturbed Body Image related to change in appearance secondary to orchiectomy 2. Fear related to altered body image and appearance 3. Chronic Low Self-Esteem related to disturbed body image 4. Sexual dysfunction related to change in sexual role

1 Rationales Option 1: The client has expressed concern that his wife will not see him the same way, so his body imaged has been altered due to his orchiectomy. Option 2: Fear as a nursing diagnosis should address what the fear is related to, and altered body image and appearance is not typically a reason to be afraid. Option 3: Disturbed body image is a nursing diagnosis itself and should be addressed in conjunction with chronic low self-esteem. Option 4: Change in sexual role is a nursing diagnosis itself and a contributor to the sexual dysfunction, so they should each be addressed. [Page reference: 1251]

Question 33. A newly married young woman is concerned that her husband still expects to be sexually active while she is menstruating. How should the nurse address this concern? 1. Explain that it is not dangerous to engage in sexual activity during menses and why. 2. Offer suggestions on varying positions and techniques to make the experience more comfortable during menses. 3. Provide a brochure on how to adjust to being a newlywed. 4. Advise the client to take ibuprofen prior to sexual activity, as this will help reduce some of the discomfort she may experience.

1 Rationales Option 1: The client may need to be educated on the physiological aspect of menstruation, and let her know the blood is from the uterus, not the vaginal cavity, so it is not dangerous to have sex during this time. Option 2: Offering suggestions on positions and techniques may be too embarrassing and personal for a client who is young and not fully aware of her sexual being. Option 3: Providing information on topics that address newly married couples may be appropriate, but this does not address the question directly with the client. Option 4: Taking ibuprofen has benefits when menstruating, but this does not address the client's immediate concern. [Page reference: 1253]

Question 24. A single mother is concerned that her 2-year-old child is preoccupied with his genitals. What can the nurse say to help educate this mother on how children develop their sexuality? 1. It is not unusual for children this age to explore their bodies and enjoy being nude. 2. Children this age are typically comparing their genitals to those of others, and so this behavior will pass. 3. It is not unusual for children this age to masturbate and explore their sexuality. 4. A child at this age starts to identify with the same-sex parent and take on those identity roles, so it is important to introduce a male figure in the child's life.

1 Rationales Option 1: The first 2 years of life are highly sensual, as they form attachments, and therefore touching their genitals is not unusual at this stage. Option 2: During the toddler stage, children become curious as to how their body parts compare to others, but exploration of genitalia is normal at the 1- to 2-year-old stage. Option 3: Around age 5, children start to mimic adults by holding hands, acting as if they are getting married. Option 4: Preschool children, not 2-year-olds, will begin to identify with the same-sex parent and has mostly same-sex friends. [Page reference: 1235]

Question 12. The nurse is discussing condom use with a teenage male client. What action made by the client requires correction by the nurse? 1. Storing a condom in the wallet 2. Using a new condom each time 3. Squeezing out air in the tip of the condom 4. Placing the condom on before sexual contact

1 Rationales Option 1: The nurse should correct the client and instruct him to not store condoms in the wallet. The wallet is in the back pocket and the body heat can cause the condom to degrade. Option 2: A client should use a new condom each time the client has sexual intercourse. Option 3: The client should squeeze out the air in the tip of the condom and leave some room for the ejaculate. This is correct and does not require correction. Option 4: It is correct for the client to place the condom on the penis prior to touching the vagina, mouth, or anus. This ensures no contact with body fluids. [Page reference: 1264]

Question 28. Which describes the sexual response stage of desire? 1. Occurs in the mind and is communicated verbally or through body language; is expressed as libido 2. The body's physical response including increased heart rate, myotonia, and vasocongestion 3. Continued increases in pulse, respiratory rate, blood pressure, and muscle tension 4. Heart rate, respiratory rate, and blood pressure reach peak, and loss of voluntary muscle tone

1 Rationales Option 1: This describes the sexual response stage of desire. Option 2: This describes the sexual response stage of excitement. Option 3: This describes the sexual response stage of plateau. Option 4: This describes the sexual response stage of orgasm. [Page reference: 1240]

Question 3. The nurse is preparing a presentation to adolescents regarding sexual activity. What information should the nurse include in the presentation? Select all that apply. 1. Oral sex still carries risks of disease. 2. Over two-thirds of adolescents have sex by age 19. 3. Teenage pregnancies have increased in recent years. 4. Many adolescents today practice serial monogamy. 5. Schools should be the primary source of sexual education.

1,2 Rationales Option 1: Many teenagers participate in oral intercourse because they believe it carries no risks of disease. Option 2: Over two-thirds of adolescents report having sexual intercourse by the age of 19. Option 3: In spite of the increase in teenage sexual activity, there has been a decrease in teenage pregnancies. Option 4: Actually, more younger adults, not teenagers, practice serial monogamy. Option 5: Sexual education should be started in the home, with supplemental education in the schools. [Page reference: 1236]

Question 2. The parents of a toddler ask the nurse about appropriate developmental behavior. Which actions would the nurse instruct the parents as normal? Select all that apply. 1. Walking around nude 2. Touching their genitals 3. Practicing getting married 4. Asking where babies come from 5. Understanding gender roles and identity

1,2 Rationales Option 1: The nurse should inform the parent that it is normal for toddlers to run around without clothes on. Option 2: It is common for toddlers to play with and touch their genitals. It is a way for them to learn about their bodies. Option 3: Children may pretend and play getting married, but this does not happen in toddlerhood. Option 4: Preschool-aged children, not toddlers, commonly ask where babies come from. Option 5: School-age children through puberty begin to understand gender roles. This does not happen in toddlers. [Page reference: 1235]

Question 17. Which sexually transmitted infections must be reported to the Centers for Disease Control and Prevention (CDC) according to federal law? Select all that apply. 1. Chlamydia trachomatis 2. Gonorrhea 3. Syphilis 4. Herpes 5. Genital warts

1,2,3 Rationales Option 1: According to federal law, chlamydia must be reported to the CDC. Option 2: Gonorrhea must be reported to the CDC according to federal law. Option 3: Syphilis is a sexually transmitted infection that must be reported to the CDC according to federal law. Option 4: Herpes is a viral sexually transmitted infection that does not need to be reported to the CDC. Option 5: Genital warts do not need to be reported to the CDC. [Page reference: 1243]

Question 26. A client with cardiovascular disease has a prescription for nitroglycerin. He is complaining of erectile dysfunction and is requesting the physician give him medication to help. What medication(s) should not be suggested for this client? Select all that apply. 1. Sildenafil (Viagra) 2. Vardenafil (Levitra) 3. Tadalafil (Cialis) 4. Testosterone (AndroGel) 5. Edex injection

1,2,3 Rationales Option 1: Sildenafil is contraindicated in clients receiving nitrate therapy due to its vasodilation effect. Option 2: Vardenafil is contraindicated in clients receiving nitrate therapy such as nitroglycerin due to the vasodilation effect on the cardiovascular system. Option 3: Tadalafil is a vasodilator and due to its effect on the body, it is contraindicated in clients who have been prescribed nitrate drugs. Option 4: Testosterone in the form of AndroGel is indicated for the replacement of testosterone in adult males due to a deficiency or absence of the male hormone and is a safe replacement for cardiovascular clients. Option 5: Injections into the penis are viable options for those suffering from erectile dysfunction and are on nitrate therapy. [Page reference: 1239]

Question 5. The nurse educator is instructing a group of nurses who work in a nursing home regarding sexual activity and problems for the geriatric population. What information should the nurse include in the presentation? Select all that apply. 1. Lack of privacy 2. Lack of a partner 3. Erectile dysfunction 4. Increased vaginal lubrication 5. Decreased male sexual desire

1,2,3 Rationales Option 1: Some older adults may not have privacy for sexual intimacy due to living with adult children or in a nursing home. Option 2: Older adults may experience obstacles for sexual expression including lack of a partner due to spousal death. Option 3: Many older men report erectile dysfunction due to comorbidities such as hypertension and diabetes mellitus. Option 4: Women who are older will report a decrease in vaginal lubrication, which leads to painful intercourse. Option 5: More women than men experience a decrease in sexual desire due to postmenopausal hormone changes. [Page reference: 1248]

Question 11. A client asks the nurse about herbal and natural remedies for the symptoms of perimenopause. What information should the nurse provide? Select all that apply. 1. Eat foods that contain soy. 2. Take red clover or black cohosh. 3. Drink 8 to 10 glasses of water daily. 4. Exercise 2 to 3 days per week. 5. Use prescription vaginal estrogen cream.

1,2,3 Rationales Option 1: Soy products contain phytoestrogens that convert to weaker estrogens during digestion. This can lessen the symptoms of perimenopause. Option 2: Red clover or black cohosh can help with the symptoms of perimenopause. Option 3: Drinking plenty of water can counteract the effect of low estrogen levels. Option 4: The client should be taught to exercise daily. This helps maintain bone strength that is lost during menopause. Option 5: The client wants information regarding natural and complementary ways to deal with the effects of perimenopause. Therefore, the nurse would not recommend prescription vaginal estrogen cream. [Page reference: 1254]

Question 21. What information should the school nurse instruct a group of children regarding stranger danger? Select all that apply. 1. Do not get in a car with a stranger. 2. Never disclose personal information on the Internet. 3. Inform an adult if someone touches you. 4. It is acceptable to receive gifts from strangers. 5. Allow unlimited time on the Internet.

1,2,3 Rationales Option 1: The nurse should teach children to never get in a car with strangers. Option 2: Personal information should not be shared on the Internet, as pedophiles can use this to make contact with the children. Option 3: The nurse would instruct the children to notify an adult if someone attempts to touch the child in a private area. Option 4: The nurse should instruct the children that they should never accept gifts from strangers. Option 5: The child should have supervised, limited time on the Internet and social media. [Page reference: 1253]

Question 46. An older female client is concerned that both she and her husband have decreased libido, and when they do engage in sexual practices, it is not as pleasurable as it was. She doesn't understand why, as they both are healthy and "not that old yet." What information should be explained to this client regarding the physiological changes in sexual function with the aging adult? Select all that apply. 1. Women experience a loss in vaginal muscle tone. 2. Men experience a delay and less-firm erection during the excitement phase. 3. Women may have vaginal dryness. 4. Men may need more stimulation during the excitement phase. 5. Men experience longer ejaculatory phases with longer contractions.

1,2,3,4 Rationales Option 1: Decreased muscle tone results in less stimulation during intercourse. Option 2: Due to circulatory issues in the aging male, some men experience a longer time to become excited and have a less-firm erection. Option 3: Due to decreased natural vaginal lubrication caused by decreased hormones, vaginal dryness may make intercourse more painful. Option 4: Men may take longer in the excitement phase, causing delayed erection or plateau. Option 5: Aging men typically experience shorter ejaculatory phases with shorter contractions. [Page reference: 1237]

Question 32. A 32-year-old male client is complaining about erectile dysfunction and inability to achieve orgasm that has recently become an issue. Upon questioning, he states this recently occurred and he once was easily aroused and sexually active. What should the nurse also assess this client for that could be a contributor? Select all that apply. 1. Opioid drug use such as hydrocodone 2. Use of stimulants such as cocaine 3. Excessive alcohol use or abuse 4. Prescription medications such as antidepressants and anticonvulsants 5. Any use of antihistamines or decongestants

1,2,3,4 Rationales Option 1: Opioid drug use, found in pain medication, can cause erectile dysfunction. Option 2: Stimulants such as cocaine and methamphetamines can initially cause an enhanced aroused state, but with prolonged use they can result in erectile dysfunction and delayed orgasm. Option 3: Alcohol use, in limited amounts, can initially cause an enhanced state of arousal, but with prolonged use it can result in erectile dysfunction and delayed orgasm. Option 4: Antidepressants, anti-anxiety medications, and anticonvulsant medications can cause erectile dysfunction and altered ability to achieve orgasm. Option 5: Antihistamine use can decrease libido but typically does not cause erectile dysfunction or inability to achieve orgasm. [Page reference: 1239]

Question 45. A school nurse has been asked to address a class on healthy sexual practices and will be discussing the dos and don'ts of condom usage. What information should be included? Select all that apply. 1. Keep condoms out of the sun. 2. Check the expiration date of the condom and packaging. 3. Don't use lotions or oils with condoms. 4. Don't store condoms in your wallet. 5. Use only latex condoms.

1,2,3,4 Rationales Option 1: Treat condoms gently and keep them out of direct sunlight, as it can cause them to dry out and become brittle. Option 2: Expired or old condoms can become dry and brittle and be ineffective. Option 3: Using water-based lubricants can be effective, but lotions and oils can cause condoms to break. Option 4: Condoms are sensitive to long exposure to heat so don't store condoms in the wallet or another place where body heat can break down the latex. Option 5: Latex condoms should be used only if both individuals do not have a latex allergy in which case a polyurethane condom should be used. [Page reference: 1264]

Question 8. The nurse is preparing to discuss sexual health with a new client. What should the nurse remember to incorporate into the discussion? Select all that apply. 1. Provide privacy. 2. Sit face to face. 3. Allow others to sit in on the interview. 4. Refrain from outside interruptions. 5. Request that the client remain calm.

1,2,4 Rationales Option 1: The nurse should make sure the interview is conducted in a private room to maintain confidentiality. Option 2: The nurse should sit at the same level as the client and not stand over him or her, as that might make the client feel inferior to the nurse. Option 3: The nurse should only have the client present, especially for the initial interview. Option 4: The nurse should ask others to take phone calls and refrain from interruptions. This makes the client feel important and the client has the nurse's full attention. Option 5: The nurse should be prepared for a wide gamut of emotions from tears to outbursts when discussing a client's sexual life. [Page reference: 1247]

Question 4. The nurse is working with a client going through perimenopause, or the time prior to menopause. Which physiological changes should the nurse instruct the client to expect? Select all that apply. 1. Hot flashes 2. Mood swings 3. Increased sleep 4. Painful intercourse 5. Increased sexual desire

1,2,4 Rationales Option 1: Due to changes in estrogen and progesterone levels, the nurse would instruct the client to expect hot flashes. Option 2: The nurse would instruct the client that mood swings can occur due to hormone level changes. Option 3: The client would experience sleep disturbances and not have enough sleep. Option 4: Intercourse may become more painful as the vaginal secretions decrease and the vaginal wall thins. The nurse should instruct the client regarding this and ways to treat it. Option 5: A woman in perimenopause would experience a decrease in sexual desire. [Page reference: 1248]

Question 38. A sexually active teen states she doesn't have an STI because she has no signs or symptoms. What asymptomatic STIs should the nurse offer education on to this client? Select all that apply. 1. Chlamydia 2. Gonorrhea 3. Trichomoniasis 4. Genital herpes 5. HIV

1,2,4,5 Rationales Option 1: Chlamydia is the most common STI and is typically asymptomatic in females. Option 2: Gonorrhea may be asymptomatic, especially for females in the early stage. Option 3: In females, trichomoniasis presents as cheesy, frothy, irritating, and odorous vaginal discharge; however, in males it is typically asymptomatic. Option 4: Genital herpes may be asymptomatic in both males and females. Option 5: HIV may be asymptomatic during the initial stage or may appear as flu-like symptoms. [Page reference: 1244-1246]

Question 14. An adolescent male presents to the clinic with urinary burning and a thick yellowish discharge and tests positive for gonorrhea. Which is the most important information for the nurse to share with the client? Select all that apply. 1. Take the full course of antibiotics. 2. Inform all sexual partners about the infection. 3. Have sexual partners use oral contraception. 4. Avoid sharing needles, which causes reinfection. 5. Refrain from sexual intercourse until the infection is resolved.

1,2,5 Rationales Option 1: The client needs to be informed to take all the antibiotics and not stop when feeling better. Option 2: The client must inform all sexual partners about having gonorrhea so they may be treated. Option 3: Barrier contraception, not oral contraception, works to prevent sexually transmitted diseases. Option 4: Gonorrhea is not transmitted through blood, only through sexual relations. The client should avoid sharing needles to prevent hepatitis and human immunodeficiency virus. Option 5: The nurse instructs the client to refrain from sexual intercourse until the infection is resolved to prevent reinfection. [Page reference: 1244]

Question 19. A nurse is performing research on sexual assault and notices many rapes go unreported. Which factors lead to this occurring? Select all that apply. 1. Fear of being embarrassed or ashamed 2. Rape occurred by an unknown assailant 3. Client is afraid of retribution by the rapist 4. Rape happening during drug or alcohol use 5. The high conviction rates of sexual offenders

1,3,4 Rationales Option 1: Many clients do not report the rape because they are embarrassed or ashamed it occurred. Option 2: Whether a person is raped by a known or unknown person does not affect the reporting rates. Option 3: A client may choose to not report the rape because he or she is afraid of the rapist finding the victim and repeating the act or causing further harm. Option 4: Rapes that go unreported include ones that happened while one or both parties were using drugs or alcohol. Option 5: The client may not report the rape due to the low, not high, conviction rate of sexual offenders. [Page reference: 1247]

Question 18. A client is discussing her menstrual cycle with the nurse and reports pain during menstruation. Which interventions should the nurse instruct the client to perform to alleviate the dysmenorrhea? Select all that apply. 1. Bedrest 2. Exercise 3. Black cohosh 4. Heat application 5. Nonsteroidal anti-inflammatory medications

1,4,5 Rationales Option 1: The nurse can instruct the client to lie down and rest to alleviate the dysmenorrhea. Option 2: Exercise may help with overall health, but it does not relieve menstrual pain. Option 3: Black cohosh helps the symptoms of perimenopause but does not relieve the pain of dysmenorrhea. Option 4: Applying heat to the back and lower abdomen can help relieve the pain of dysmenorrhea. Option 5: Nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen can help decrease uterine inflammation that causes dysmenorrhea. [Page reference: 1244]

Question 10. Which questions should the nurse ask a 25-year-old female client regarding cancer risk and screening? Select all that apply. 1. "When was your last Pap smear?" 2. "When did you obtain your last mammogram?" 3. "Have you ever been pregnant before?" 4. "Have you received the HPV vaccination?" 5. "Do you perform monthly self-breast exams?"

1,4,5 Rationales Option 1: The nurse should ask the client when her last Pap smear was obtained. This helps determine the client's health and if she obtains regular check-ups. Option 2: The client is 25 years old and would not be obtaining mammograms. This does not begin until age 40. Option 3: The nurse would ask about previous pregnancies when inquiring about the client's childbearing history, not cancer risk. Option 4: The nurse would ask if the client has received the HPV vaccination to determine cervical cancer risk. Option 5: The nurse would ask the client if she performs routine monthly self-breast examinations. This helps the nurse determine how in tune the client is to cancer prevention. [Page reference: 1249]

Question 22. At what age should a woman with an average risk of breast cancer have her first mammogram? 1. 40 2. 45 3. 50 4. 55

2 Rationales Option 1: At age 40, the client should discuss with the health-care provider when to have the first mammogram. Option 2: Women should have their first mammogram at age 45. Option 3: A 50-year-old female should have been screening with annual mammograms for a while. Option 4: A woman who is age 55 or over can have mammograms every other year. [Page reference: 1254]

Question 31. Which describes features of a contraceptive sponge? 1. Intercourse only when a woman is thought to be in the infertile phase of her menstrual cycle 2. Inexpensive; can be inserted into the vagina up to 24 hours before intercourse 3. Highly effective for preventing pregnancy; can be left in place for weeks to months 4. Highly effective for preventing pregnancy; injection lasts for 3 months

2 Rationales Option 1: This describes fertility awareness methods of avoiding or achieving pregnancy. Option 2: This describes the contraceptive sponge. Option 3: This describes a vaginal ring. Option 4: This describes Depo-Provera injections. [Page reference: 1255]

Question 9. What should the nurse ask a female client about during an interview regarding sexual health? Select all that apply. 1. Marital status 2. Age of menarche 3. Current occupation 4. Use of contraception 5. If the client is sexually active 6. History of sexually transmitted infections

2,4,5,6 Rationales Option 1: The nurse does not need to know the marital status of the client. The nurse should discuss the client having a sexual partner and not assume the client is married or single. Option 2: The nurse should ask the client about her reproductive history including age of menarche. Option 3: The occupation of the client is unneeded information during the sexual interview. Option 4: The nurse should ask the client regarding the use of contraception. Option 5: The nurse should know if the client is sexually active, as this could open a new line of questions to ask. Option 6: The nurse should know if the client has had any sexually transmitted infections. This would cue the nurse to ask about contraception. [Page reference: 1250]

Question 40. The nurse is performing a sexual history for a client who presents to the clinic for a physical. The client informs the nurse that while she presents as and identifies as a woman, she is biologically male. Which term would the nurse enter into the medical record? 1. Bisexual 2. Intersexed 3. Transgender 4. Heterosexual

3 Rationales Option 1: Bisexuality is being attracted to both sexes. The client in the given scenario identifies as female, and does not discuss attraction to both sexes. Option 2: A client who is intersexed is born with ambiguous sex organs. This client is not intersexed. Option 3: The client is transgender as she is biologically male, but identifies as a woman. Option 4: A heterosexual is a person of one gender having attraction to the opposite gender. [Page reference: 1234-1235]

Question 16. The nurse is educating a group of adolescents on ways to prevent sexually transmitted infections (STIs). Which statement made by a member of the group indicates an understanding of the information given? 1. "It is not possible to get an STI from oral sex." 2. "I should have my partner start taking the pill." 3. "I should use a latex, lubricated condom during sex." 4. "I have taken antibiotics before for an STI. I am protected from getting another STI."

3 Rationales Option 1: STIs can be transmitted through oral, anal, and vaginal intercourse. Option 2: While oral contraception prevents pregnancy, it does not protect from STIs. Option 3: The client stating that he or she should use a latex, lubricated condom during sex is accurate, and this indicates an understanding of the information provided. Option 4: Many STIs such as gonorrhea and chlamydia are caused by bacteria for which there is not immunity. It is possible to contract such STIs again. [Page reference: 1243]

Question 7. A male nurse enters the room of a female client, introduces himself, and informs the client he is the client's nurse today. The client asks for a female nurse due to her culture and religion. What should the nurse do next? 1. Inform the client he is the only nurse available for the shift. 2. Ask the client what aspects of having a male nurse disturbs her. 3. Speak with the nurse manager to change client assignments for the day. 4. Ask the client if it would be acceptable to have both a male and female nurse.

3 Rationales Option 1: The nurse would not inform the client that he is the only nurse, as there would be more nurses available. Option 2: The nurse would not question the client's religious and cultural beliefs, as this could insult the client. Option 3: As the client has asked for a female nurse due to cultural and religious beliefs, the nurse should honor this request and speak to the nurse manager about changing assignments. Option 4: It would not be acceptable for the male nurse to perform any client care due to religious and cultural preferences. [Page reference: 1237]

Question 37. Which STI symptoms describe gonorrhea? 1. Occur 1 to 2 weeks after infection: thin, clear urethral discharge; mild discomfort with urination 2. Cheesy, frothy, irritating, and odorous vaginal discharge 3. Thick white or yellowish urethral discharge, burning, and frequent/painful urination 4. Cauliflower-like appearance

3 Rationales Option 1: These symptoms describe chlamydia. Option 2: These symptoms describe trichomoniasis. Option 3: These symptoms describe gonorrhea. Option 4: These symptoms describe human papilloma virus. [Page reference: 1244]

Question 20. Which disorder involves ejaculate entering the bladder instead of being released through the urethral opening? 1. Dyspareunia 2. Erectile dysfunction 3. Premature ejaculation 4. Retrograde ejaculation

4 Rationales Option 1: Dyspareunia is painful intercourse for a female. This does not involve ejaculation. Option 2: Erectile dysfunction occurs when a client is unable to maintain an erection. This does not cause ejaculate to enter the bladder. Option 3: Premature ejaculation is when the man ejaculates within a short period of penetration. Option 4: Retrograde ejaculation happens frequently in clients with spinal cord injuries. It involves semen being released into the bladder instead of through the urethral opening. [Page reference: 1248]

Question 44. While working with a couple experiencing sexual problems within their relationship, the nurse uses the PLISSIT model of treatment. What would be an appropriate (P) permission recommendation for the nurse? 1. Each client gives the other permission to experiment with their sexual fantasies. 2. Concise information about treatment options is offered. 3. Specific interventions that promote optimal sexual functioning are planned. 4. Approval is provided for the clients regarding sexual thoughts and fantasies between consenting adults.

4 Rationales Option 1: Having each client give the other permission is a specific suggestion that is another component of the PLISSIT model. Option 2: Keeping information limited, or concise, is another component (L) of the PLISSIT model. Option 3: Specific interventions can fall under specific suggestions or interventions in the PLISSIT model. Option 4: Offering permission for the clients to engage in sexual thoughts and fantasies allows the clients to trust the nurse, and they are more apt to answer open-ended questions during the assessment. [Page reference: 1254-1255]

Question 15. The nurse is working with a group of clients who report erectile dysfunction and are interested in treatment with sildenafil (Viagra). In which client would this treatment be contraindicated? 1. 45-year-old client with asthma 2. 30-year-old client with psoriasis 3. 75-year-old client with osteoarthritis 4. 60-year-old client with unstable angina

4 Rationales Option 1: Sildenafil (Viagra) is not contraindicated for a client with asthma. This drug does not interact with the treatment for asthma. Option 2: Sildenafil (Viagra) is not contraindicated in a client with psoriasis, as this drug does not affect the skin. Option 3: An elderly client with osteoarthritis and no other comorbidities would be able to take sildenafil (Viagra). Option 4: A client with unstable angina is usually prescribed nitrates for vasodilation. Sildenafil (Viagra) is contraindicated for clients taking nitrates. [Page reference: 1239]

Question 41. Place in order the stages of sexual response cycle. 1-Orgasm 2-Plateau 3-Resolution 4-Excitement

4,2,1,3 Correct Correct Feedback Sexual arousal begins with excitement, which is the body's physical response to desire. It starts with increased heart rate, blood pressure, and respirations. Women develop vaginal lubrication and swelling of the breasts, clitoris, and labia; men develop an erection. The second stage is the plateau stage. This occurs if excitement continues. In the plateau stage for the woman, the clitoris retracts, Bartholin's glands lubricate, and the vagina narrows. For men, the ridge of the glans penis becomes more prominent and a couple of drops of pre-ejaculate are released. In the orgasmic stage, the male ejaculates and the female feels warmth as rhythmic contractions occur in the vagina, uterus, and pelvic floor. The last stage is the resolution stage. The man experiences a refractory period where an erection cannot occur for a period of time. The woman can experience another plateau and orgasm or can enter the resolution stage. [Page reference: 1239-1242]

Question 1. Place in order the phases of the menstrual cycle. 1-Luteal phase 2-Ovulatory phase 3-Follicular phase 4-Menstrual phase

4,3,2,1 Correct Correct Feedback In the menstrual phase, the uterus sheds the endometrial lining and several ovarian follicles develop. The follicular phase begins with the first day of menstrual bleeding and ends with ovulation about 13 to 14 days later. The ovulatory phase is next and last from 16 to 36 hours. After ovulation, the endometrium thickens in the luteal phase. This occurs to support a pregnancy. [Page reference: 1233]