Chapter 34 Sexuality

The nurse is providing community education about how the sexual response changes with age. Which statement made by one of the adults indicates the need for further information? 1. "Health problems such as diabetes, chronic obstructive pulmonary disease, and hypertension have little effect on sexual functioning and desire." 2. "It usually takes longer for both sexes to reach an orgasm." 3. "Most of the normal changes in function are related to alteration in circulation and hormone levels." 4. "Many medications can interfere with sexual function."

1. "Health problems such as diabetes, chronic obstructive pulmonary disease, and hypertension have little effect on sexual functioning and desire."

The nurse is interviewing a client who is concerned about the possibility of contracting the human immunodeficiency virus (HIV) from unprotected sex with a known IV drug user. The nurse knows that if the client is infected: 1. The client's life expectancy is 3 to 5 years 2. There are no effective treatment modalities 3. Symptoms of the disease will be assessable within the first month post exposure 4. Blood work will confirm the diagnosis 6 weeks to 3 months after the initial exposure

ANS: 4 The primary infection stage lasts for about a month after contracting the virus. During this time, the person often experiences flu-like symptoms. Then, the person enters the clinical latency phase; at this time, the person has no symptoms of infection. HIV antibodies appear in the blood about 6 weeks to 3 months following infection. If left untreated, people who are infected with HIV will live about 10 years. The last stage, acquired immunodeficiency syndrome (AIDS), occurs when the person begins to show symptoms of the disease. Highly active antiretroviral therapy (HAART) has greatly increased the survival time of persons who live with HIV/AIDS

A 16-year-old female tells the school nurse that she doesn't need the human papillomavirus (HPV) vaccine since her partner always uses condoms. The best response by the nurse to this statement is: 1. "Latex condoms are the most effective way to eliminate the risk of HPV transmission." 2. "Your parents may not want you to receive the HPV vaccine since it has been shown to increase sexual risk taking and sexual activity." 3. "The HPV 9-valent vaccine is recommended for males and females even if they use condoms because it targets the specific viruses that cause cancer and genital warts." 4. "You are past the recommended age to receive the vaccine."

3. "The HPV 9-valent vaccine is recommended for males and females even if they use condoms because it targets the specific viruses that cause cancer and genital warts."

A nurse who recently graduated from nursing school is providing discharge instructions to a patient who suffered a myocardial infarction (MI). The nurse knows that sexual issues are common after an MI but feels uncomfortable bringing up this topic. What is the best way for the nurse to handle this situation? (Select all that apply.) 1. Instruct the patient to discuss any sexual concerns with his or her partner after discharge. 2. Avoid discussing the topic unless the patient brings it up. 3. Ask a more experienced nurse to cover this with the patient and learn from the example. 4. Plan to attend conferences or training soon on how to discuss such issues. 5. Encourage the patient to discuss any personal concerns with the cardiologist.

3. Ask a more experienced nurse to cover this with the patient and learn from the example. 4. Plan to attend conferences or training soon on how to discuss such issues.

The diaphragm is a barrier method of contraception in which a dome-shaped rubber device is placed in the vagina before sexual activity to prevent semen from coming into contact with the cervix. A. True B. False

A. True Rationale: The diaphragm is a barrier method of contraception in which a dome-shaped rubber device is placed in the vagina before sexual activity to prevent semen from coming into contact with the cervix.

Teenagers tend to engage in risky sexual behavior primarily because they: 1. Feel invincible 2. Lack factual information 3. Emulate poor social models 4. Possess immature decision-making skills

ANS: 1 Adolescents tend to think they are invincible and do not expect 'bad things' to happen to them. While the other options can be factors in some teens' decisions to engage in unprotected sex, the age-group generally lacks the insight that they are not invincible and that they will suffer the consequences of poor decision making

The nurse is providing education on sexually transmitted infections (STIs) to a group of older adults. The nurse knows that further teaching is needed when the participants make which statements? (Select all that apply.) 1. "I don't need to use condoms since there is no risk for pregnancy." 2. "I should be screened for an STI each time I'm with a new partner." 3. "I know I'm not infected because I don't have discharge or sores." 4. "I was tested for STIs last year, so I know I'm not infected." 5. "The infection rate in older adults is low because most are not sexually active."

1. "I don't need to use condoms since there is no risk for pregnancy." 3. "I know I'm not infected because I don't have discharge or sores." 4. "I was tested for STIs last year, so I know I'm not infected." 5. "The infection rate in older adults is low because most are not sexually active."

An adolescent who is pregnant for the first time is at her initial prenatal visit. The women's health nurse practitioner (WHNP) informs the patient that she will be screening her for sexually transmitted infections (STIs). The patient replies, "I know I don't have an STI because I don't have any symptoms." Which responses by the WHNP would be appropriate? (Select all that apply.) 1. "Untreated STIs can cause serious complications in pregnancy, so we routinely screen pregnant women." 2. "Bacterial STIs don't usually cause symptoms, or you could have an asymptomatic viral STI." 3. "Chlamydia screening is recommended for all sexually active women up to age 25 even if asymptomatic." 4. "People between the ages of 15 and 24 are often asymptomatic and have the highest incidence of STIs." 5. "There is no need to screen for infection since you aren't having any problems or symptoms."

1. "Untreated STIs can cause serious complications in pregnancy, so we routinely screen pregnant women." 3. "Chlamydia screening is recommended for all sexually active women up to age 25 even if asymptomatic." 4. "People between the ages of 15 and 24 are often asymptomatic and have the highest incidence of STIs."

The school nurse is counseling an adolescent male who is returning to school after attempting suicide. He denies substance abuse and has no history of treatment for depression. He says he has no friends or family who understand him. Critical thinking encourages the nurse to consider all possibilities, including which of the following? (Select all that apply.) 1. Adolescents often explore their sexual identity and expose themselves to complications such as sexually transmitted infections (STIs) or unplanned pregnancy. 2. Peer approval and acceptance are not important in this age-group. 3. Lesbian, gay, bisexual, and transgender (LGBTQ+) youth often experience stress from identification with a sexual minority group. 4. Knowledge about normal changes associated with puberty and sexuality can decrease stress and anxiety. 5. Adolescence is a time of emotional stability and self-acceptance.

1. Adolescents often explore their sexual identity and expose themselves to complications such as sexually transmitted infections (STIs) or unplanned pregnancy. 3. Lesbian, gay, bisexual, and transgender (LGBTQ+) youth often experience stress from identification with a sexual minority group. 4. Knowledge about normal changes associated with puberty and sexuality can decrease stress and anxiety.

The nurse is gathering a sexual health history on a patient being admitted to the hospital for surgery. Which question demonstrates a nonjudgmental attitude? 1. Can you tell me your sexual orientation? 2. How do you and your wife feel about intimacy? 3. Do you have sex with men, women, or both? 4. Do you have sexual intercourse at your age?

1. Can you tell me your sexual orientation?

The nurse reviews the health history of a 48-year-old man and notes that he was started on medications for elevated blood pressure and depression at his last annual physical. He tells the nurse that over the past 6 months he is having difficulty sustaining an erection. The nurse understands that: (Select all that apply.) 1. Nurses are not expected to discuss sexual issues with male patients and the physician should address this. 2. Sexual function can be affected by some medications. 3. Sexually transmitted infections (STIs) can cause complications such as erectile dysfunction and screening should be done. 4. Some men with health issues experience erectile dysfunction. 5. Medications used to treat hypertension and depression seldom interfere with sexual function.

2. Sexual function can be affected by some medications. 4. Some men with health issues experience erectile dysfunction.

The nurse is gathering a history from a 72-year-old male patient being admitted to a nursing home. The patient requests a private room. The nurse understands that: 1. The patient cannot be sexually active since he is moving into a nursing home. 2. The patient may be requesting a private room to facilitate an intimate relationship with his partner. 3. There is no need to take a sexual history since most older adults are uncomfortable discussing intimate details of their lives. 4. Older adults in nursing homes usually do not participate in sexual activity.

2. The patient may be requesting a private room to facilitate an intimate relationship with his partner.

A 53-year-old female being treated for breast cancer tells the nurse that she has no interest in sex since her surgery 2 months ago. The nurse is aware that: (Select all that apply.) 1. Sexual issues are expected in a woman this age. 2. Women experience sexual dysfunction more frequently than men. 3. Hypoactive sexual desire disorder (HSDD) occurs in women over 65 years of age. 4. Medical conditions such as cancer often contribute to HSDD. 5. Disturbances in self-concept affect sexual functioning.

2.Women experience sexual dysfunction more frequently than men. 4. Medical conditions such as cancer often contribute to HSDD. 5. Disturbances in self-concept affect sexual functioning.

Which of the following statements made by a client concerning birth control requires immediate correction by the nurse? 1. "My partner is responsible for our birth control; he uses a condom." 2. "I've gained some weight so I should have my diaphragm refitted." 3. "My husband is reluctant to have a vasectomy since it is permanent." 4. "I prefer the cervical cap since I can leave it in for a longer period of time."

ANS: 1 Barrier methods include over-the-counter spermicidal products and condoms. Spermicidal products (e.g., creams, jellies, foams, and sponges) are put into the vagina before intercourse to create a spermicidal barrier between the uterus and ejaculated sperm. A condom is a thin rubber sheath that fits over the penis to prevent entrance of sperm into the vagina. Vaginal spermicides and condoms are most effective when instructions are carefully followed; their combined use is more effective in preventing pregnancy than the use of either one alone. While a vasectomy may be reversed, it is verydifficult and results cannot be guaranteed. The remaining options are correct

To increase the tone and sensation of the pelvic floor for a female client, the nurse teaches: 1. Kegel exercises 2. Vaginal dilation 3. Stop-start techniques 4. Sensate focus exercises

ANS: 1 Kegel exercises increase the tone and sensation of the pelvic floor (pubococcygeus muscle) for the female client. Vaginal dilation will not increase the tone and sensation of the pelvic floor. Stopping urination may help identify proper muscle contraction, but oncethe muscle is identified, Kegel exercises should not be repeated during urination. Stopping urination midstream may create a backflow of urine into the bladder, predisposing a person to infection. Sensate focus exercises do not increase muscle tone

The most common reason for clients with sexually transmitted diseases (STDs) to remain untreated is: 1. Embarrassment and guilt 2. Inability to access health care services 3. Lack of knowledge concerning signs and symptoms 4. Insufficient respect for the seriousness of the disease

ANS: 1 People often do not seek treatment because they are embarrassed to discuss sexual symptoms or concerns. They are also often hesitant to talk about their sexual behavior if they believe that it is not "normal." Any sexual behavior that embarrasses the client often hinders the detection of an STD. While the remaining options may be factors for some individuals, they are not the most common reason for failure to seek treatment

The nurse is counseling a woman who has multiple sexual partners and has recently been diagnosed with the human papillomavirus (HPV). The importance of regularly scheduled Pap smears is discussed primarily because: 1. This woman has a high risk for cervical cancer 2. Her sexual practices also put her at risk for HIV 3. This woman's age puts her at risk for uterine cancer 4. Regular screening results in improved client outcomes

ANS: 1 Researchers estimate that 80% to 90% of cervical cancer cases are linked to HPV infection. It is true that regular screenings do improve client outcomes; the purpose of thePap smear is directly related to cervical cancer. HPV does not increase the risk of uterine cancer nor would it be detected by a Pap smear. While having multiple sexual partners does increase the risk of contracting HIV, it would not be diagnosed with a Pap smear

The nurse knows that studies of sexuality in older adults have shown: 1. To be inconsistent in their overall findings 2. That this population is reluctant to discuss their sexual practices 3. That there is a decline of sexual interest and behavior among older adults 4. That older adults retain an interest in sexual function and are sexually active

ANS: 1 Studies of sexuality in older adults are limited and inconsistent in their findings. Many studies suggest that older adults retain an interest in sexual function and are sexually active while other studies conclude that there is a decline of sexual interest and behavior among older adults

The nurse is aware that sexuality is part of growth and development. The preschooler's interest in gender sexuality is characterized by an interest in: 1. Exploring his or her own genitalia 2. Learning how and why his or her anatomy differs from other children 3. Playing and developing friendships with children of the opposite sex 4. Spending most of his or her time with the parent of the opposite sex

ANS: 1 The first step of gender identity development occurs as the child becomes aware of the differences of the sexes and perceives that he or she is male or female. This is characterized by an interest in his or her genitalia. Learning how and why his or her anatomy differs from other children would require a higher level of cognitive ability. Children of this age-group primarily focus on their parents and family, not other children. According to Freud, the preschool child identifies with the parent of the same sex and develops a complementary relationship with the parent of the opposite sex. The preschool child does not spend most of his or her time with the parent of the opposite sex

A 58-year-old woman asks the nurse what she can do to promote healthy physical sexual relations. Based on the client's age, the nurse responds by saying: 1. "Using a water-based lubricant may be helpful." 2. "Reducing the frequency of intercourse may help you." 3. "I will refer you to a sexual therapist to better assist you." 4. "Continue what you've been doing. Nothing should have changed."

ANS: 1 The perimenopausal and menopausal woman may have diminished vaginal lubrication as a result of decreased levels of estrogen, thus using a water-based lubricant may help. Decreasing the frequency of intercourse would not promote healthy sexual relations. If a nurse is uncomfortable discussing sexual issues with a client, then he or she should get another nurse who is comfortable to talk with the client. A sex therapist is not necessary in this situation. Sex therapists address more complex sexual issues. There are some physical changes with aging that may affect sexuality. The client should be educated on the expected changes and how to best address them

The nurse realizes that a woman who has experienced a voluntary abortion will be most likely to experience a sense of: 1. Loss and sadness 2. Remorse and regret 3. Relief and confidence 4. Peace and contentment

ANS: 1 When a woman chooses abortion as a way of dealing with an unwanted pregnancy, the woman, and often her partner, experiences a sense of loss, grief, and/or guilt. While individuals may experience those emotions identified in the other options, the most universal feelings are of loss, grief, sadness, and guilt

Which of the following sexually transmitted diseases (STDs) are considered curable with antibiotic treatment? (Select all that apply.) 1. Syphilis 2. Gonorrhea 3. Chlamydia 4. Genital warts 5. Genital herpes 6. Pelvic inflammatory disease (PID)

ANS: 1, 2, 3, 6 Gonorrhea, chlamydia, syphilis, and pelvic inflammatory disease (PID) are caused by bacteria and are usually curable with antibiotics. All clients need to understand that antibiotics need to be taken for the full course of treatment. Genital herpes and genital warts are viral and are not curable

In order to therapeutically counsel clients regarding issues related to sexuality, a nurse should have knowledge on which of the following topics? (Select all that apply.) 1. Abortion 2. Birth control 3. Sexual techniques 4. Sexual orientation 5. Sexual development 6. Sexually transmitted diseases (STD)

ANS: 1, 2, 4, 5, 6 Nurses help clients achieve sexual health by having a sound scientific knowledge base regarding sexuality. A basic understanding of sexual development, sexual orientation, contraception, abortion, and sexually transmitted diseases (STDs) is necessary. A sex therapist would be better suited to discuss sexual techniques with a client

Which of the following conditions should the nurse discuss as possible outcomes of untreated chlamydia with a client newly diagnosed with the disease? (Select all that apply.) 1. Infertility 2. Uterine cancer 3. Ectopic pregnancy 4. Neonatal complications 5. Pelvic inflammatory disease (PID) 6. Human immunodeficiency virus (HIV)

ANS: 1, 3, 4, 5 If it is not treated, chlamydia can cause PID, ectopic pregnancy, infertility, and neonatal complications. Either uterine cancer or HIV is directly connected to chlamydia

The nurse who is discussing safe sex with a group of teenage students must realize that safe sex practice includes: (Select all that apply.) 1. Having sex with only partners you know well 2. Willingness to resist peer pressure to have sex 3. Insisting upon the use of barrier protective devices 4. An understanding that the goal is to prevent the spread of STDs 5. Openly discussing a history of STDs (sexually transmitted diseases) 6. Not making the decision to be sexually active while using drugs or alcohol

ANS: 1, 3, 4, 5, 6 "Safe sex" is a term that describes responsible sexual behavior aimed at preventing the spread of STDs, including HIV/AIDS. Responsible sexual behavior includes knowing one's sexual partner, being able to openly discuss sexual and drug-use history with the partner, not allowing drugs or alcohol to influence decision making, and using protective devices.

When discussing sexually transmitted diseases (STDs) with a group of college students, the nurse identifies which of the following as the more common signs and symptoms? (Select all that apply.) 1. Fever 2. Joint pain 3. Genital rash 4. Anal discharge 5. Genital lesions 6. Painful urination

ANS: 1, 4, 5, 6 Common symptoms of an STD include discharge from the vagina, penis, or anus; pain during sex or when urinating; blisters or sores in the genital area; and fever. The remaining options are not typical signs or symptoms of STDs

The nurse has completed an assessment on an adult male client and finds that he is having difficulty having an erection and has less interest in sex. The nurse notes that the client has recently started taking an antihypertensive medication. A nursing diagnosis of sexual dysfunction related to side effects of antihypertensive is identified by the nurse. An appropriate outcome for this client is: 1. Client will avoid taking medication before intercourse 2. Client will relate renewed interest in sex within 1 month 3. Client will be interviewed by a sexual therapist immediately 4. Client will seek out other satisfying substitute activities or hobbies

ANS: 2 An appropriate expected outcome for the nursing diagnosis of sexual dysfunction related to side effects of antihypertensive would be client will relate renewed interest in sex within 1 month. An appropriate goal would be client will express satisfaction with sexual relationship with wife within 1 month. The client should not avoid taking his antihypertensive medication before intercourse, but should be taught that there are other blood pressure medications available that can maintain blood pressure control and that do not negatively affect sexual function. He can then discuss this with his physician. Being interviewed by a therapist is not an appropriate expected outcome. Seeing a sexual therapist immediately is not necessary and may only intensify his concern. Seeking out substitute activities or hobbies is not an appropriate expected outcome. It does not address or resolve the problem

A school nurse is responsible for teaching adolescents about sexually transmitted diseases (STDs). When discussing chlamydia, the nurse instructs the students that it is: 1. A viral infection that cannot be cured 2. Treated with a full course of antibiotics 3. Contracted via blood-borne exchange 4. Prevented with the use of spermicidals

ANS: 2 Diseases that are caused by bacteria and that can usually be cured with antibiotics include gonorrhea, chlamydia, syphilis, and pelvic inflammatory disease. All clients need to understand that antibiotics need to be taken for the full course of treatment. Chlamydia is caused by bacteria that can be treated, not a virus. Sexually transmitted diseases, such as chlamydia, are transmitted from infected individuals to partners during intimate sexual contact. It is not contracted via blood-borne exchange, but rather through body fluids. Chlamydia is not prevented with the use of spermicidals

Which of the following statements best reflects the nurse's understanding regarding strong personal feelings against voluntary abortions? 1. "It would be difficult, but I would try to care for the client in a professional manner." 2. "I chose not to work in areas that would require me to deal with the issue of abortion." 3. "I will need to separate my personal values in a manner so as to not appear to be judgmental." 4. "I would just ask another registered nurse to care for the client who is recovering from an abortion."

ANS: 2 Nurses are entitled to their personal views and should not be forced to participate in counseling or procedures contrary to beliefs and values. It is essential to choose specialties or places of employment where personal values are not compromised and the care of a client in need of health care is not jeopardized. The other options represent impractical or unrealistic solutions to the dilemma

The nurse is putting together a presentation on the prevention of sexual abuse. She should incorporate which of the following? 1. Abusers fit into easily identified, classic profiles. 2. Intensity is generally increased during pregnancies. 3. Sexual abuse is found primarily in lower socioeconomic groups. 4. Most of the incidents occur with strangers or unknown assailants

ANS: 2 Sexual abuse may begin, continue, or even intensify during pregnancy. The abuser may not fit any classic description. Sexual abuse crosses all gender, socioeconomic, age, and ethnic groups. Most often sexual abuse is at the hands of a former intimate partner or family member

The nurse knows that when a society or culture supports sexual abstinence outside of marriage, it avoids providing sex education to its children because it is believed that to do so would: 1. Erode traditional family values 2. Promote premarital sexual activity 3. Be too emotionally traumatic for both parent and child 4. Put the child at an increased risk for disease and pregnancy

ANS: 2 When a culture supports a belief in abstinence until marriage, there is usually a belief thatteaching children about sex will promote sexual activity. While the other options may represent beliefs held by the culture as well, its primary concern appears to be sexual activity

A client is concerned that she and her husband, now that they have a baby in the house, will be unable to maintain a healthy sexual relationship. To assist these clients, it would be most helpful for the nurse to know: 1. If they share parenting beliefs 2. How long they have been married 3. How comfortable they are in communicating their feelings to each other 4. The level of knowledge they have regarding healthy sexual relationships

ANS: 3 In response to identified concerns, the nurse may initiate discussion. Knowing of the comfort level in communicating their feelings provides an open dialogue enabling the client to talk freely with the nurse to address the concerns. To assist the clients in their situational change, the nurse needs to explore communication and sexual patterns of the couple. Having similar parenting beliefs will have less impact on their sexual relationship. To assist the couple in adjusting to the change of becoming a family, the nurse needs to explore communication patterns of the couple. How long they have been married would be less significant. The level of knowledge they have regarding healthy sexual relationships would not be as impacting on their sexual relationship as would their ability to discuss their feelings with one another

The nurse is teaching sexuality to a group of senior adults. Which of the following comments by a participant reflects that he or she has an understanding of the changes in sexuality that occur with aging? 1. "So, sexual intercourse will be more painful for my wife, and we should have sex less frequently?" 2. "We have recently seen the need to begin using a lubricant. That's because we make love less often." 3. "My orgasms seem to not last as long, but my husband and I are probably more satisfied now than when we were younger." 4. "I understand that it is natural not to have such an interest in sex anymore. People our age shouldn't still have those feeling."

ANS: 3 Orgasms may not last as long in the older adult as a result of aging. Older adults may feel more sexually satisfied because they no longer have to be concerned with contraception and are not experiencing the pressures of raising children and working. Decreased levels of estrogen may lead to diminished vaginal lubrication and decreased vaginal elasticity, making intercourse more painful. The couple should not be advised to have sex less frequently, but rather to use a vaginal lubricant and allow more time for caressing. The need to use a lubricant is not due to having sex less often, but is due to decreasing levels of estrogen in the woman. Saying that people of a certain age shouldn't still have sexual feelings is not a true statement. Sexual feelings in older adulthood are normal. Sexuality and continued interest in sex throughout late life generally reflect life patterns.

The nurse is discussing the physical changes that occur during puberty with a group of 11- to 12-year-olds. The most therapeutic statement the nurse could make directed toward minimizing their anxiety would be: 1. "You'll be fine. Everyone survives puberty." 2. "Don't worry because everyone goes through the changes." 3. "Don't be afraid to talk about the changes with an adult; we all know about puberty." 4. "Puberty is a normal stage of development. Remember, it's simply a part of growing up."

ANS: 3 School-age children generally have questions regarding the physical and emotional aspects of sex. They need accurate information from home and school about changes in their bodies and emotions during this period and what to expect as they move into puberty. Knowledge about normal emotional and physical changes associated with puberty will decrease anxiety as these changes begin to happen. It is of little value to tell the child that all will be fine since that tends to send a message that you are minimizing their concerns and so is a barrier to communication. Keeping the responses short and in terms the child will understand is best.

Which of the following interview questions asked by the nurse is best directed at assessing a common symptom of chlamydia? 1. "Do you have any sores on your genitals (privates)?" 2. "Remember that a fever can be a sign of this sexually transmitted disease (STD)." 3. "Have you been experiencing any problems with urinating (making your water)?" 4. "If you notice a red rash on your perineal area (between your legs) notify your doctor."

ANS: 3 Symptoms in women include dysuria, urinary frequency, and purulent vaginal discharge. In men, it usually infects the urethra and causes dysuria and urethral discharge. The remaining options suggest symptoms/signs that are not commonly associated with chlamydia

Sexual experimentation is common among adolescents and should primarily be: 1. Discouraged 2. Encouraged 3. Accepted as normal adolescent behavior 4. Viewed as a means of determining sexual orientation

ANS: 4 Adolescence is often a time when individuals explore their primary sexual orientation. Although the behavior should not be discouraged or encouraged, in order to avoid undo stress on the adolescent, the experimentation should be viewed as an acceptable way to determine sexual orientation

Which of the following statements best educates the client regarding the transmission of sexually transmitted diseases (STDs)? 1. "Always have protected sex, and you will be safe." 2. "Be careful to avoid coming into contact with a partner's semen or vaginal secretions." 3. "STDs are spread from person to person by coming into contact with their sperm or vaginal secretions." 4. "STDs can be transmitted through any open sore that comes into contact with a partner's semen or vaginal secretions."

ANS: 4 Any contact with another person's body fluids or an open lesion on the skin, anus, or genitalia can transmit an STD. The remaining options do not provide complete information of the possible means of transmitting STDs.

The nurse is discussing various sexual issues with a group of military personnel who have experienced spinal cord injuries. Which of the following statements best addresses the issue of alternative methods of personal sexual gratification? 1. "People do whatever works best for them and their partner." 2. "You don't need anyone else to approve how you engage in sex." 3. "Sex practices are private and need only to be discussed with your sexual partner." 4. "Any form of stimulation that is mutually agreed upon and satisfying is acceptable sexual practice."

ANS: 4 As sexually active adults develop intimate relationships, they learn techniques of stimulation that are satisfying to both themselves and their sexual partners. Some adults need permission or affirmation that alternative ways of sexual expression other than penile-vaginal intercourse are normal. While the other options prove acceptance, they are not as sensitive in their wording or address the issue as completely.

The middle adult couple is most likely to experience a change in their sexual intimacy when: 1. The changes of normal aging occur 2. One or both retire from the work force 3. Chronic illness affects sexual performance 4. The children no longer reside full time in the home

ANS: 4 Children leaving home usually creates a change in intimate relationships. This results in either a time of renewed intimacy between partners or a time when formerly intimate partners realize that they no longer care for each other or have common interests. While changes of aging and chronic illness can affect performance and retirement usually requires an adjustment in expectations and attitudes, these options do not appear to have the same degree of impact on intimacy as does the "empty nest."

The nurse, after completion of an assessment in the medical clinic of a client, the nurse documents that the client has dyspareunia based on the client's experience of: 1. Delay or absence of an orgasm 2. Deficient or absent sexual desire 3. Involuntary constriction of the vagina 4. Recurrent genital pain during intercourse

ANS: 4 Dyspareunia is recurrent or persistent genital pain in either a male or a female before, during, or after sexual intercourse that is not associated with vaginismus or with lack of lubrication. Orgasmic disorder is the recurrent delay in, or absence of, orgasm following normal sexual excitement. Hypoactive sexual desire disorder is the persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity. Vaginismus is an involuntary constriction of the outer one third of the vagina that prevents penile insertion and intercourse

An adolescent female student, who is sexually active, visits the office of the school nurse. Which of the following statements best reflects her understanding of the effective use of contraception devices? 1. "My boyfriend is able to withdraw before ejaculation, and that prevents me from getting pregnant." 2. "I take my temperature every morning; when it goes down for at least two days, we have unprotected sex." 3. "We always use 'foam' before each time that we have sex and as you can see I haven't gotten pregnant yet." 4. "We have decided that I should have a diaphragm inserted and to use contraceptive cream with each intercourse.

ANS: 4 In order to be an effective contraceptive method, the diaphragm should be used with a contraceptive cream or jelly. The client is verbalizing understanding. Any act of unprotected intercourse can result in pregnancy. The boyfriend withdrawing prior to ejaculation is not an effective contraceptive method. Any act of unprotected intercourse can result in pregnancy. This statement is not demonstrating understanding of the basal body temperature method of contraception. Using spermicidal foam alone is not recommended. The client should use a condom and foam to be more effective in preventing pregnancy

A client is scheduled for cardiac surgery. The nurse is conducting a sexual history and is told that he is nervous about resuming sexual activities. The nurse uses therapeutic communication with the client when responding: 1. "You can have sexual intercourse after your surgery, but there are serious risks." 2. "Your partner will be nervous about resuming sexual activities, but that is only normal." 3. "Don't worry. In about 2 months you will be able to return to your normal sexual patterns." 4. "You are expressing a very normal concern, Perhaps we could discuss your feelings further."

ANS: 4 Open communication and positive self-esteem, such as explaining that their concern is very normal and offering to discuss further are essential factors in effectively resolving concerns. Telling the client that there are serious risks may only worry the client more. Stating that the client's partner will be nervous about resuming sexual activities does not focus on the client and, therefore, does not encourage the client to express his concerns. Telling the client not to worry is nontherapeutic. At this point, not even knowing the outcome of the surgery, the nurse should not predict resumption of sexual activity for the client. Furthermore, this response does not encourage the client to communicate his feelings

While working with a male client and administering medications, the female nurse is approached sexually. The nurse should: 1. Have a male nurse assume care for this client 2. Immediately report the incident to the client's physician 3. Tell the client that his behavior is offensive and leave the room 4. Review and define the limits of a professional relationship for the client

ANS: 4 The nurse should convey a message of acceptance of the client, but not the inappropriate behavior. Reviewing and defining the professional relationship with the client can accomplish this. Matching the gender of the health care worker with the gender of the client may be beneficial when dealing with assessment of sexual needs or sex education. However, in this instance, the client needs to be informed that inappropriate sexual behavior is unacceptable. To turn the client's care over to a male nurse would not resolve the problem, and would convey a message of dislike and lack of acceptance of the client. Reporting the incident immediately to the client's physician would not be the nurse's best action. The client needs to be made aware of the problem in order to discontinue such behavior. Telling the client his behavior is offensive and then leaving the room is not therapeutic. The client needs to be reminded of the professional relationship he shares with the nurse

The most common characteristics shared by individuals most likely to contract a sexually transmitted disease (STD) are that they: (Select all that apply.) 1. Use illegal drugs 2. Possess poor reading skills 3. Are economically deprived 4. Have multiple sexual partners 5. Have ineffective immune systems 6. Frequently engage in unprotected sex

ANS: 4, 6 People most likely to be infected share one key characteristic: unprotected sex with multiple partners. Additionally, social factors such as poverty, low literacy, discrimination, use of illegal drugs (e.g., crack cocaine, meth), incarceration, sexual abuse, and racial segregation contribute to racial disparities in rates of STDs

A nurse is teaching parents about normal developmental aspects of sexuality in their children. Which statements from parents would warrant further teaching? Select all that apply. a) "When my 2-year-old son touches his genitals, I push his hand away and tell him 'No'." b) "I should wean my infant by 4 months and encourage him to use a sippy cup." c) "I should explain sexuality to my 9-year-old in a factual manner when she asks me questions about her body." d) "I should explain about body changes to my 11-year-old prior to them happening to alleviate her fears." e) "I should teach my 10-year-old about contraception and ways to avoid sexually transmitted diseases." f) "I should allow my teenager to establish her own beliefs and moral value system by not sharing my own beliefs."

a, b, e, f. Self-manipulation of genitals is normal behavior; parents should avoid telling a child this as "bad." Parents should avoid early weaning of infants to prevent oral deprivation. Parents should explain contraception and STIs to their adolescent children; it would be premature to do so for a 10-year-old. Parents should share their beliefs and moral system with their children. Parents should also give their children the desired information about sexuality in a clear, factual form and give them information about body changes before they experience them, to alleviate fears.

A nurse is performing sexual assessments of male patients in a long-term care facility. Which patients would the nurse flag as having an increased risk for erectile dysfunction? Select all that apply. a) A 72-year-old man with a history of diabetes b) A 78-year-old man who has a new partner c) A 75-year-old man who has Parkinson's disease d) An 80-year-old man who is an alcoholic e) An 85-year-old man who takes antihypertensive medication f) A 76-year-old man who smokes tobacco`

a, d, e. Risk factors for erectile dysfunction include history of diabetes, spinal cord trauma, cardiovascular disease, surgical procedure, alcoholism, and use of antihypertensives, antidepressants, or illicit drugs. Having a new partner may be a risk factor for premature ejaculation, and a history of Parkinson's disease may predispose the patient to delayed ejaculation. Smoking is not a risk factor for impotence.

A nurse is providing health checkups for patients in a clinic located in a predominately LGBT community. Which health disparities should the nurse keep in mind related to this population? Select all that apply. a) LGBT youth are four times more likely to attempt suicide. b) LGBT youth are more likely to be homeless. c) Lesbians are less likely to get preventive services for cancer. d) Lesbians and bisexual females are more likely to be underweight. e) Transgender people have a high prevalence of HIV and sexually transmitted infections. f) LGBT populations have the lowest rates of tobacco, alcohol, and other drug use in the country.

b, c, e. LGBT youth are more likely to be homeless. Lesbians are less likely to get preventive services for cancer. Transgender people have a high prevalence of HIV and sexually transmitted infections. LGBT youth are two to three times more likely to attempt suicide. Lesbians and bisexual females are more likely to be overweight or obese. LGBT populations have the highest rates of tobacco, alcohol, and other drug use in the country. These health issues are partly thought to be the effects of chronic stress resulting from stigmatization.

A nurse is assessing a patient who is visiting her gynecologist. The patient tells the nurse that she has been having a vaginal discharge that "smells bad and is green and foamy." She also complains of burning upon urination and dyspareunia. What sexually transmitted infection would the nurse suspect? a) Human papillomavirus (HPV) b) Syphilis c) Trichomoniasis d) Herpes simplex virus

c. Trichomoniasis causes a foul-smelling vaginal discharge that is thin, foamy, and green in color, and also causes itching of the vulva and vagina, burning on urination, and dyspareunia. HPV causes a profuse watery vaginal discharge, dyspareunia, intense pruritus, and vulvar irritation. Syphilis causes a single painless genital lesion 10 days to 3 months after exposure and generalized skin rash, enlarged lymph nodes, and fever that may appear 2 to 4 weeks after appearance of primary lesion and may last for several years. Herpes presents as single or multiple painful vesicles that rupture and form ulcer-like lesions, which form scabs as they heal.

A patient tells the nurse counselor that he can only get sexual pleasure by looking at the body of a person other than his wife from a distance. How would the nurse document this data? a) Masochism b) Pedophilia c) Voyeurism d) Sadism`

c. Voyeurism is the achievement of sexual arousal by looking at the body of someone other than a person's own sexual partner. Masochism refers to gaining sexual pleasure from the humiliation of being abused. Pedophilia is a term used to describe the practice of adults gaining sexual fulfillment by performing sexual acts with children. Sadism refers to the practice of gaining sexual pleasure while inflicting abuse on another person.

Which assessment question would be most appropriate for a patient who is experiencing dyspareunia? a) "Do you currently have a new partner?" b) "Have you been diagnosed with a neurologic disorder?" c) "Do you take antihypertensive medication?" d) "Do you use antihistamines?"

d. Factors contributing to dyspareunia include diabetes; hormonal imbalances; vaginal, cervical, or rectal disorders; antihistamine, alcohol, tranquilizer, or illicit drug use; and cosmetic or chemical irritants to genitals.