CH. 45 PREP U

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

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

Which sexually transmitted infection has the following characteristics: thin, foamy, greenish vaginal discharge that causes itching of the vulva and vagina?

- Trichomoniasis Explanation: Trichomoniasis is characterized by thin, foamy, greenish vaginal discharge that causes itching of the vulva and vagina; it is often asymptomatic in males. Nonspecific vaginitis is characterized by foul-smelling, thin, grayish-white vaginal discharge. Herpes simplex virus type 1 and 2 are characterized by lesions.

During a routine physical exam, a male client informs the nurse that he frequently participates in anal intercourse with his new girlfriend. The nurse discusses this practice with the client by informing him that:

- condoms are recommended for anal intercourse. Explanation: Condoms are recommended for anal and vaginal intercourse to prevent sexually transmitted diseases. Information should be talked about including that care should be used to avoid injury to the delicate rectal mucosa, and lubrication is necessary for comfort.

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

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

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

If the condom does not have a nipple receptacle end, a small space should be left at the end of condom to collect the semen in order to provide a pocket to collect semen and prevent breakage. A condom should be used with every act of intercourse to help prevent STI transmission and pregnancy. Immediately after ejaculation, the penis and condom should be removed from the vagina by holding onto the base of the condom. This prevents spillage of semen into the vagina. The condom should be rolled onto the penis as soon as it becomes erect; this protects against sperm from secretions from Cowper's glands. Spermicide can be used with condoms to increase contraception properties. Condoms can never be used a second time.

The nurse is in the process of assessing a 24-year-old female client's sexual history. After reviewing the nurse's current notes, which additional information should the nurse prioritize for this client's assessment? Select all that apply.

There is various data that should be included in a sexual assessment. - Asking about future plans concerning pregnancies, any sexual problems, feeling safe with her sexual partner, and history of Papanicolaou tests are all pertinent question which should be asked. It would not be appropriate to ask for her opinion on abortions.

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

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

How would the nurse respond to a female client who says, "I do not think I have ever experienced an orgasm. Is that normal?

- "A normal sexual response for women may include multiple plateaus without an orgasm as a result." Explanation: Although studies have found only one response pattern in men, studies found variability in the patterns of sexual response among women. An intimacy-based circular model emphasized the multifactorial nature of the female sexual response, which encompasses: - emotional intimacy - sexual stimuli - psychological factors - relationship satisfaction. Some women experience a plateau phase with several peaks without actually experiencing orgasm. Others experience a definite orgasm; still others experience multiple orgasms.

A male client presents to the clinic with reports of erectile dysfunction. Which statement by the nurse will assist in identifying the potential cause of the erectile dysfunction?

- "Do you take any medications such as antihypertensives, antidepressants, or illicit drugs?" Explanation: Common causes of impotence (which may be physiologic or psychological) include various illnesses, treatments for these illnesses, and personal anxieties. Antihypertensive medication and antidepressant medications are a leading cause of impotence in male clients and it is possible to switch medications to help the client with this problem.

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

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

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

- "How do you feel about yourself as a woman?" Explanation: Sexual identity is a broad concept that includes, but supersedes, sexual functioning. However, it is more specific than simply asking about the quality of relationships or if their health allows for a meaningful sex life. Asking an open-ended question about how the client feels about herself as a woman is likely to elicit important insights.

A nurse is conducting a health history on a 45-year-old client. The nurse is preparing to address the client's sexual history. Which statement by the nurse would be most appropriate at this time?

- "I am going to ask you some questions about your sexual health." Explanation: Because of the sensitivity of the questions involved with a sexual history, it is helpful to start this section of the interview with a transitional statement, such as, "I am going to ask you some questions about your sexual health." This question focuses the client on the topic and demonstrates the nurse's comfort with the topic. The statement regarding the need to determine if the client is at risk of sexually transmitted infections may frighten the client and does not allow for good communication regarding this sensitive topic. The statements about the client being sexually active or engaging in safer sexual behaviors indicate assumptions on the part of the nurse and are judgmental.

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

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

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

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

The nurse assessing an adolescent's need for further information regarding sexual health should ask which question?

- "What questions or concerns do you have about your sexual health?" Explanation: An open-ended, nonthreatening question related to the client's need for further information should be included while obtaining a sexual history. "Are you involved in an intimate relationship at this time?" and "Have you ever been diagnosed with a sexually transmitted disease? "are closed ended questions requiring a yes or no response. Asking how many sexual partners, while open ended, is threatening and assumes that the adolescent has had multiple partners

A young adult woman comes to the clinic for an evaluation. During the visit, the client asks the nurse, "I have heard about the morning after pill that you take in case you have unprotected sex. What do I need to know?" Which education will the nurse provide to the client?

- "It is important to take the pill within 72 hours of having unprotected sex." Explanation: Emergency contraception, often called the "morning after pill," is designed to reduce the risk of pregnancy after unprotected sexual intercourse. Emergency contraception is provided in two ways. Increased doses of specific oral contraceptive pills can reduce the risk of pregnancy when taken up to 120 hours after unprotected intercourse (ideally within 72 hours). Most are up to 89% effective when taken within 72 hours of unprotected sex. They are less effective as time passes. Another method of emergency contraception is insertion of a copper IUD within 5 to 7 days after unprotected intercourse. Planned Parenthood (2017) reports that anyone can obtain Plan B One-Step over the counter without a prescription at a drugstore or family planning clinic. All other brands of emergency contraception require a prescription from a clinician for those aged 16 or younger. The morning after pill would work for regular and irregular menstrual cycles.

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

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

A sex therapist is educating nurses on methods of sexual stimulation that people use to gain satisfaction. The therapist determines that the nurses understand when what comment is made?

- "One form of sexual stimulation is hugging." Explanation: The methods by which people gain satisfaction through sexual stimulation are varied. Forms of sexual stimulation include kissing, hugging, stroking, squeezing, breast stimulation, manual stimulation of the genitals, oral-genital stimulation, and anal stimulation. Fetishism, more often practiced by males, is sexual arousal with the aid of an inanimate object. Clitoral stimulation is difficult to achieve in the missionary position. Voyeurism is the achievement of sexual arousal by looking at the body of someone other than one's sexual partner.

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

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

A female client has recently had surgery for cervical cancer and asks the nurse about other ways she can have sex with her husband. Which of the following statements by the nurse is most accurate?

- "Stimulation of the genitals by the mouth and tongue may be used to reach orgasm." Explanation: Stimulation of the genitals by the mouth and tongue may be used as a way to reach orgasm. Abstinence is not having sex and would not meet the couple's needs. Anal intercourse, commonly practiced by gay men, is also used by heterosexual couples. Fellatio is stimulation of the male genitals; cunnilingus is stimulation of the female genitals.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

A nurse is conducting a healthy living workshop with a group of female college students. Which information will the nurse include in the teaching plan about condoms?

- Condoms can protect the client from pregnancy. Explanation: Condoms should be used during every sexual encounter to provide significant (but imperfect) protection against both pregnancy and sexually transmitted infections. Condoms are worn by male and female partners. Condoms are 98% effective in preventing pregnancy. Condoms should never be reused.

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

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

A woman age 49 years has sought care from her primary care provider because of "intimacy problems." Upon questioning, the woman reveals that she is experiencing sexual desire, but that intercourse causes her significant pain. In the absence of sexual activity, the woman states that she does not have any significant vaginal discomfort. What would the clinician recognize that this client is most likely experiencing?

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

The nurse is preparing to counsel a couple on their sexual relationship. The nurse prepares for the session by reviewing the sexual response cycle. The nurse recalls the order of the four phases of the cycle. Place the phases in correct order as they occur. Use all options.

- Excitement - Plateau - Orgasm - Resolution Explanation: The sexual response cycle is physiologic response made up of four phases. During the first phase, excitement, is initiated by erotic stimulation and arousal. The second phase, the plateau phase, intensity is greater than that of excitement but not enough to begin orgasm. Desire and arousal continue to build and intensify. This phase varies from a few minutes to 15 to 20 minutes. During the third phase, orgasm, the climax and sexual explosion of the tension that has been building over the preceding phases occurs. The fourth and final phase, resolution, is characterized by a return to the level of body functioning present before the excitement phase.

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

- Headache Explanation: Premenstruation is characterized by the appearance of one or more of the following symptoms several days before the onset of menstruation: (1) emotional symptoms such as depression, irritability, anxiety, changes in sleep habits, changes in sexual desire, poor concentration, crying, anger, and social withdrawal (2) physical symptoms such as appetite changes, breast tenderness, bloating and weight gain, aches and pains, swelling, acne, gastrointestinal issues, and fatigue. Blurred vision may be an ominous sign that is unrelated to premenstrual syndrome.

The nurse is advising an adolescent male about sexual myths that have him concerned. Which client education accurately describe these concerns? Select all that apply. - A larger penis allows for a more satisfying sexual experience. - Nocturnal emissions indicate the existence of a sexual disorder. - Nocturnal emissions are signs of a sexually transmitted infection. - Masturbation or self-stimulation is a natural and healthy outlet for sexual urges. - No male or female should feel pressured into sexual activity at any age. - Nocturnal emissions are normal in men of all ages.

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

The nurse is preparing a 15-year-old adolescent for the first gynecological examination to evaluate heavy menstruation. Which intervention by the nurse will help the client feel less anxious during the gynecological examination?

- Offer to remain with the client during the examination. Explanation: An adolescent experiencing the first gynecological examination can have anxiety, as the client may not know what to expect. Offering to remain with the client during the examination would help the client feel less anxious. Providing privacy while donning the gown is not addressing anxiety that may occur during the gynecological examination. Showing and explaining the examination instruments may heighten the client's anxiety. Telling the client that the nurse will leave once the assessment begins may cause anxiety if the client is not familiar with the health care provider.

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

- On day 14 Explanation: Ovulation generally occurs on day 14 when the mature ovum ruptures from the follicle and the surface of the ovary and is swept into the fallopian tube. From day 15 to day 28, the phase in the ovaries is called the luteal phase. On day 1 of a new cycle begins the new menstrual cycle. Menstrual flow might occur every 21 to 35 days or the last two to seven days.

Which statement(s) describes sexual dysfunction in males or females? Select all that apply. - Premature ejaculation is a condition in which a man consistently reaches ejaculation or orgasm before or soon after entering the vagina. - Retarded ejaculation refers to the man's inability to ejaculate into the vagina or delayed intravaginal ejaculation. - Dyspareunia is painful intercourse. - Vulvodynia is a chronic vulvar discomfort or pain characterized by burning, stinging, irritation, or rawness of the female genitalia that interferes with sexual activity. - Inhibited sexual desire refers to the inability of a woman to reach orgasm.

- Premature ejaculation is a condition in which a man consistently reaches ejaculation or orgasm before or soon after entering the vagina. - Retarded ejaculation refers to the man's inability to ejaculate into the vagina or delayed intravaginal ejaculation. - Dyspareunia is painful intercourse. - Vulvodynia is a chronic vulvar discomfort or pain characterized by burning, stinging, irritation, or rawness of the female genitalia that interferes with sexual activity. Sexual dysfunction in males includes: - premature ejaculation (which is usually not caused by a physical problem) - retarded ejaculation (ejaculatory incompetence; has similar causes as impotence) - Vulvodynia (unknown cause or treatment) is a female sexual dysfunction. - Dyspareunia is painful intercourse - Inhibited sexual desire consists of an inhibition in sexual arousal so that congestion and vaginal lubrication are absent or minimal.

During hospitalization for a suicide attempt, the client informs the nurse that she does not want to return to work because her boss expects sexual favors each week before he gives her a paycheck. The client informs the nurse that she needs the job but is embarrassed that she performs these favors. The nurse informs the client that this is illegal behavior and is called what?

- Quid pro quo harassment. Explanation: Quid pro quo means that something is given or withheld in exchange for something else. It generally occurs when a person in a position of authority offers either direct or indirect reward or punishment based on the granting of sexual favors. Environmental harassment and hostile environment harassment are identical situations and occur when workplace behaviors of a sexual nature create a hostile, intimidating environment that interferes with a person's work performance. Fetishism is sexual arousal with the aid of an inanimate object not generally associated with sexual activity.

A school nurse is providing a class on sexually transmitted infections (STIs). Which statement is correct regarding STIs?

- STIs are most prevalent among adolescents and young adults. Explanation: STIs are most prevalent among adolescents and young adults, and nearly two- thirds of all STIs occur in people younger than 25 years of age. The incidence of STIs is increasing due to multiple sex partners and sexual activity at a younger age. STIs affect men and women of all backgrounds and economic levels. Not all signs and symptoms of STI's are obvious such as HIV/AIDS.

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

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

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

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

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

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

The nurse takes into consideration developmental stage when assessing sexuality. Which is an example of a developmentally appropriate intervention?

- The nurse teaches parents of a 4-year-old child that they may cause anxiety in the child by intolerance of inconsistency of sex-role behavior. Explanation: The process of human development affects the psychosocial, emotional, and biologic aspects of life, which in turn affect a person's sexuality. The child from 4 to 6 years of age becomes increasingly aware of the sexual self, demonstrated by enjoyment in exploring body parts of self and playmates, and engaging in masturbation. Parents may cause anxiety in the child by intolerance of inconsistency of sex-role behavior. The nurse should teach the parents of an 18-month-old infant to not discourage self-manipulation of genitals. Parents should allow toddlers to designate their own readiness for toilet training because strict measures may lead to compulsive behaviors later. Same-sex preference for relationships is not related to heterosexual or homosexual tendencies in the school-age child.

A client visits a community clinic reporting a foul-smelling vaginal discharge that is thin, foamy, and green in color; itching of vulva and vagina; and burning on urination. Which STI would the nurse suspect?

- Trichomonas vaginalis Explanation: Trichomonas vaginalis is characterized by foul-smelling vaginal discharge that is thin, foamy, and green in color; itching of vulva and vagina; and burning on urination. Fatigue, diarrhea, weight loss, enlarged lymph nodes, fever, anorexia, and night sweats are common with AIDS. Vaginal discharge, burning on urination, urinary frequency, dysuria, and urethral soreness is common with Chlamydia trachomatis. Neisseria gonorrhoeae may be symptom free, or may present in males with purulent penile discharge, dysuria, and frequency of urination; women typically present with dysuria, abnormal menses, vaginal discharge, or pelvic inflammatory disease.

The nurse should inform a young female client that the barrier method providing the best protection against sexually transmitted infections (STIs) is:

- condoms. Explanation: Condoms provide effective (though imperfect) protection against STIs. Spermicides, diaphragms, and cervical caps do not provide effective protection against STIs.

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

- excitement phase. Explanation: The excitement phase is characterized by rapid erection of the penis with tensing and thickening of the scrotal skin and elevation of the scrotal sac. Therefore, if a man cannot achieve an erection, the difficulty occurs in the excitement phase of the sexual response.

During the orgasmic phase of the sexual response, the woman may experience:

- hypertension. Explanation: The orgasm in the woman produces contractions, and the woman experiences an increased respiratory rate, heart rate, and blood pressure.

When the mother of a 2-year-old tells the pediatric nurse that the child masturbates, the nurse informs the mother that the child:

- is exhibiting normal behavior. Explanation: Toddlers may engage in masturbation, and parents should be assured that this behavior is normal and healthy for development.

During the plateau phase of the sexual response, the man may experience:

- nipple erection. Explanation: In the plateau phase, the man may experience nipple reaction; a sex flush, characterized by a maculopapular rash over the epigastric area, may appear during the latter part of this phase.

The nurse is caring for a client diagnosed with vaginismus. When reviewing the client's history, what would the nurse would expect to find?

- past history of a rape Explanation: Vaginismus usually results from psychological problems, namely fear of penetration due to a negative association such as rape, sexual abuse, or fear of sexual intercourse.

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

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

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

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

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

- skin-to-skin contact can spread herpes and genital warts Explanation: Some STIs spread through oral-genital sex, anal sex, or even intimate skin-to-skin contact without actual penetration (genital warts and herpes can be spread this way). Therefore, only avoiding all types of intimate genital contact can prevent these STIs. The use of a barrier method reduces the risk of STIs but should not be conveyed as "safe." HIV is contracted through direct contact with infected bodily secretions not through the use of public restrooms. While reducing sexual partners does reduce the risk of infection it only takes one exposure to contract a STI. The concept that should be conveyed is the risk that any skin-to-skin contact can spread herpes and genital warts.

The nurse is assessing the sexual health of a female client age 20 years. During the interview, the client says, "I feel that my vaginal opening constricts whenever I am about to have intercourse. I seem to have no control over it." What would the nurse use when documenting the client's report?

Vaginismus Explanation: The client is experiencing an involuntary contraction of the muscles surrounding the vaginal orifice; this should be documented as vaginismus. Dyspareunia is painful intercourse. Difficulty achieving orgasm is documented as orgasmic dysfunction. Abstention from sexual intercourse is documented as celibacy.