Chapter 34: Sexuality

A nurse is caring for a patient with dyspareunia. In which order will the nurse provide care, starting with the first step?

1. Determine which signs and symptoms of dyspareunia the patient has. 4. Develop a nursing diagnosis for the patient. 2. Mutually decide upon goals and objectives for dyspareunia. 5. Use resources to help resolve the problem. 3. Ask the patient if the dyspareunia is improving. The nurse should use the nursing process when caring for patients with sexual dysfunction. Determine signs and symptoms (assessment); develop a nursing diagnosis (diagnosis); mutually decide upon goals (planning); use resources to help resolve the problem (implementation); and ask if the dyspareunia is improving (evaluation).

A nurse is interviewing a woman who uses a diaphragm. Which information from the patient will require the nurse to follow up?

a. "I have lost 12 lb on this diet." The woman needs to be refitted after a significant change in weight (10-lb gain or loss) or pregnancy. The diaphragm is a round, rubber dome that has a flexible spring around the edge. It is used with a contraceptive cream or jelly and is inserted in the vagina, so it provides a contraceptive barrier over the cervical opening.

A nurse is caring for a 15 year old who in the past 6 months has had multiple male and female sexual partners. Which response by the nurse will be most effective?

a. "Sexually transmitted infections and unwanted pregnancy are a real risk. Let's discuss what you think is the best method for protecting yourself." Some adolescents participate in risky behaviors. The nurse should acknowledge this feeling to the patient and offer education and alternatives while giving the patient the autonomy to make his or her own decisions. Adolescents who engage in sexual risk behaviors experience negative health outcomes such as STIs and unintended pregnancy. In addition, the pattern of risk-taking behavior tends to be established and continue throughout life. The nurse should not force the patient to make a choice of orientation and should not pass judgment on a patient's sexual orientation or social network; this would make the patient feel defensive and would eliminate the trust in the relationship. Involving parents is not the first line of action; parents should be notified only if the child is in a life or death situation.

A 15-year-old patient is concerned because her mother wants her to receive the human papillomavirus (HPV) vaccination, but the patient is unsure if she wants it. Which response by the nurse is most therapeutic?

a. Ask the patient what concerns she may have about the vaccination The nurse should encourage health promotion behaviors but first must consider the autonomy of the patient and assess the patient for more data. The nurse should value the input of the patient in making a decision and assess what the patient is thinking to address any concerns the patient may have. The HPV vaccine is a preventative treatment; whether or not the patient is sexually active (asking about how many sexual partners) does not matter in this case. The nurse should not make assumptions about a patient's home life (mother knows best); instead, the nurse should ask questions while establishing a therapeutic relationship. Recommending the patient get the vaccine as soon as possible is in violation of the patient's rights.

A patient who has had several sexual partners in the past month expresses a desire to use a barrier contraceptive that will protect against pregnancy and sexually transmitted infections (STIs). Which contraceptive method should the nurse recommend?

a. Condom Condoms are both a contraceptive and a barrier against sexually transmitted infections (STIs), pregnancy, and human immunodeficiency virus (HIV); proper use will greatly reduce the risk. Spermicides and diaphragms protect against pregnancy; however, they are not a barrier since they do not prevent bodily fluids from coming in contact with the patient during sexual intercourse. Oral contraceptives will only be effective in preventing pregnancy.

A nurse is conducting a sexual assessment. Which question is appropriate for the nurse to ask?

a. Have you noticed any changes in the way you feel about yourself? Asking about any changes in the way you feel about yourself is an appropriate question to ask during a sexual assessment. Asking about favorite sex position with men and/or women is inappropriate and invasive. The assessment needs to focus on the patient, not the partner. Asking "why" questions is nontherapeutic and is judgmental in this scenario.

A nurse is assessing a child for sexual abuse. Which assessment findings will the nurse expect?

a. Physical aggression and sleep disturbances Behavioral signs of sexual abuse in a child include physical aggression, sleep disturbance, poor peer relationships, and substance abuse. Panic attacks, anorexia, anxiety, and depression are behavioral signs for adults.

An older couple expresses concern because they are easily fatigued during sexual intercourse and cannot reach climax. Which strategies to increase sexual stamina will the nurse offer? (Select all that apply.)

a. Plan sexual activity around a time when the couple feels rested. e. Avoid alcohol and tobacco. f. Eat well-balanced meals. Alcohol, tobacco, and certain medications (such as narcotics for pain) may cause drowsiness and fatigue and negatively affect sexual stamina. Eating well-balanced meals can help to increase energy levels. Planning sexual activity when the couple is well rested will help them not get fatigued as quickly. Encouraging intimate touching may help increase libido but not energy levels. Extra lubrication and taking pain medications may ease the discomfort of sexual intercourse but are not appropriate interventions for fatigue.

A nurse is caring for a 35-year-old female patient who recently started taking antidepressants after repeated failed attempts at fertility treatment. The patient tells the nurse, "I feel happier, but my sex drive is gone." Which nursing diagnosis has the highest priority?

a. Sexual dysfunction Antidepressants have adverse effects on sexual desire and response. The nurse should be sure to educate the patient on the potential for these side effects and how to correct for them, for example, using lubricant to ease discomfort. The patient has taken steps toward effective coping by seeking therapy. The patient has not expressed a reason for the nurse to be concerned about contraceptives. The nurse should always assess for concerns about violence in a patient's life. Although some antidepressants have been related to self-directed violence, this patient focus is on becoming pregnant (fertility treatments) but sex drive is gone.

The nurse is leading a seminar about menopause and age-related changes. Which response from a group member indicates the nurse needs to follow up?

b. "Orgasms are no longer achievable after menopause." Believing that orgasms are no long achievable requires follow-up to correct this misconception. Orgasms are achievable at any age; however, it may take longer with aging. All other statements indicate that the patient does have an understanding of age-related changes and needs no follow-up. Both genders experience a reduced availability of sex hormones. The excitement phase prolongs in both men and women. Men often have erections that are less firm and shorter acting.

Which patient is most in need of a nurse's referral to adoption services?

b. An infertile couple religiously opposed to artificial insemination Adoption is an option for someone with infertility, especially if infertility treatments are unavailable owing to religious or financial constraints. A patient who wishes to have an elective abortion may be educated about all the possibilities, but the nurse should approach the patient in a nonjudgmental manner and should accept the patient's decision. When a patient has recently miscarried, the nurse should assess the patient's feelings about the loss and should address any concerns the patient may have about fertility. Infertility is the inability to conceive after 1 year of unprotected intercourse; therefore, talking about adoption after one miscarriage or after only 3 months of attempting conception would be too soon.

A woman who has been in a monogamous relationship for the past 6 months presents to clinic with herpes on her labia. The patient is distraught because her partner must have cheated on her. Which response by the nurse is most effective in establishing an open rapport with a patient?

b. Inform the patient that all encounters are confidential If open communication is to be established with the patient, the patient must know that she can trust health care team members. By telling the patient that all encounters are confidential, the nurse establishes trust. Sharing a story brings the focus to the nurse, inhibiting open rapport. The nurse does not tell the patient what to do, because that should be the patient's decision. Forcing the patient to confide by sharing every sexual encounter may hinder a trusting relationship.

A parent asks about the human papillomavirus (HPV) vaccine. Which information will the nurse include in the teaching session?

b. It is recommended for females ages 11 to 26. The vaccine is safe for girls as young as 9 years old and is recommended for females ages 11 to 26 if they have not already completed the three required injections. Booster doses currently are not recommended. The vaccine is most effective if administered before sexual activity or exposure

A nurse is preparing a community class about sexually transmitted infections. Which primary group will the nurse focus on for this class?

b. Men who have sex with men About 20 million people in the United States are diagnosed with an STI each year, with the highest incidence occurring in men who have sex with men, bisexual men, and youths between the ages of 15 and 24. While bisexual women, youths between the ages of 24 and 27, and pregnant women and their partners are important, they are not the primary groups affected by STIs.

A mother brings her 12-year-old daughter into a clinic and asks about getting a human papillomavirus (HPV) vaccine that day. Which information will the nurse share with the mother and daughter about the HPV vaccine?

b. Protects against cervical cancer. The HPV vaccine is effective against the four most common types of HPVs that can cause cervical cancer. It is not effective against HIV, chlamydia, or pregnancy.

A nurse is caring for a patient who expresses a desire to have an elective abortion. The nurse's religious and ethical values are strongly opposed. How should the nurse best handle the situation?

b. Refer the patient to a family planning center or another health professional. The nurse must be aware of personal beliefs and values and is not required to participate in counseling or procedures that compromise those values. However, the patient is entitled to nonjudgmental care and should be referred to someone who can create a trusting environment. The nurse should not care for a patient if the quality of care could be jeopardized. The nurse should not attempt to push personal values onto a patient. The nurse also should not create tension by informing the patient that he or she does not have the same morals; this could cause the patient to feel guilty or defensive when receiving care from any health care professional.

A nurse is reviewing a patient's history. Which priority finding will alert the nurse to assess the patient for possible sexual dysfunction?

b. Takes an anxiolytic medication. Medications that can affect sexual functioning include antihypertensive, antipsychotics, antidepressants, and antianxiety (anxiolytic). Taking vacations out of the country, exercise classes, and afternoon naps are not as priority for sexual functioning as medications.

A 16-year-old male patient informs the nurse that he isn't sure if he is homosexual because he is attracted to both genders. Which response by the nurse will help establish a trusting relationship?

c. "At your age, it is normal to be curious about both genders." During adolescence, it is not unusual to have questions about sexuality. The patient will feel most comfortable discussing his sexual concerns further if the nurse establishes that it is normal to ask questions about sexuality. The nurse can then discuss in greater detail. Although it is normal for young adults to be curious about sexuality, the nurse should use caution in giving advice on taking sexual action. The nurse should promote safe sex practices. Telling the patient not to worry dismisses his concern. Telling the patient that he is abnormal might offend the patient and prevent him from establishing an open relationship.

The nurse is caring for a patient who recently had unprotected sex with a partner who has been diagnosed with human immunodeficiency virus (HIV). Which response by the nurse concerning initial medical care is best?

c. "Highly active antiretroviral therapy has been shown effective in slowing the disease process." Highly active retroviral therapy increases the survival time of a person with HIV or AIDS. HIV antibodies will not show up in blood work for 6 weeks to 3 months. The infection stage of HIV lasts for about a month after the virus is contracted; during that time, the patient may experience flulike symptoms. A support group may be beneficial for a patient who contracts HIV; however, it is unknown whether the patient has contracted HIV, and antiretroviral therapy has helped people live beyond the 10 years expected if HIV goes untreated.

A nursing student is providing education to a group of older adults who are in an independent living retirement village. Which statement made by the nursing student requires the nurse to intervene?

c. "You do not need to worry about getting a sexually transmitted infection at this point in your life." Research indicates many older adults are more sexuality active than previously thought and engage in high-risk sexual encounters, resulting in a steady increase HIV and STI rates over the past 12 years. Therefore, the nurse needs to intervene when the student tells the older adults that they are not at risk for developing an STI. Avoiding the use of alcohol; using pillows; taking pain medications before having intercourse if needed; and communicating thoughts, fears, and feelings about sex all enhance sexual functioning.

A nurse is using the PLISSIT model when caring for a patient with dyspareunia from diminished vaginal secretions. The nurse suggests using water-soluble lubricants. Which component of PLISSIT is the nurse using?

c. SS The nurse is using the specific suggestions (SS). The PLISSIT model is as follows: Permission to discuss sexuality issues Limited Information related to sexual health problems being experienced Specific Suggestions—only when the nurse is clear about the problem Intensive Therapy—referral to professional with advanced training if necessar

A patient who had a colostomy placed 1 month ago is feeling depressed and does not want to participate in sexual activities anymore. The patient is afraid that the partner does not want sex. The patient is afraid the ostomy is physically unattractive. Which initial nursing intervention will be most effective in helping this patient resume sexual activity?

d. Discuss ways to adapt to new body image so the patient will be comfortable in resuming intimacy. The nurse should first address the patient's need to be comfortable with his or her own body image; once the patient's issues related to body image are resolved, intimacy may follow. Reassuring the patient that others manage to have sexual intercourse with an ostomy may help to decrease anxiety but may have the unintended effect of making the patient feel abnormal because he or she has not yet resumed sexual activity. Support groups may be helpful for the patient, but this is not the most effective initial intervention a nurse can provide; this may be helpful later. The patient is worried about the ostomy; incorporating it into intimate activities is insensitive and can even be damaging to the stoma.

The nurse is teaching a patient how to use a condom. Which instructions will the nurse provide?

d. Hold onto the condom when pulling out. Teach patients to pull out right after ejaculating and to hold onto the condom when pulling out. Store condoms in a cool, dry place away from sunlight. Instruct patient to never reuse a condom or use a damaged condom. Instruct patient to only use water-based lubricants (e.g., K-Y jelly) to prevent the condom from breaking; do not use petroleum jelly, massage oils, body lotions, or cooking oil.