Chapter 45

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."

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?"

A nurse practitioner is teaching the student about sexual health and is evaluating the student's knowledge of sexual identity. The practitioner knows that the student understands when the student says which of the following?

"Gender role behavior is the behavior a person conveys about being male or female."

A 16-year-old girl tells the nurse that her friend has genital warts and asks the nurse how to make sure that she does not get them. Which of the following should the nurse recommend?

"Get the human papillomavirus vaccine."

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

"How do you feel about yourself as a woman?"

The nurse is providing education about barrier contraceptives. Which statement by the client indicates a need for further education?

"I can leave my diaphragm in for up to 48 hours."

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, leave a small space at the end for semen to collect." "Use a condom with every act of intercourse." "Immediately after ejaculation remove the condom and discard it."

The new community health nurse is learning to care for lesbians, gay males, bisexuals, and transgender (LGBT) individuals. Which statement indicates to the preceptor that the nurse understands the needs of this group?

"Lesbians are less likely to get preventive services for cancer."

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."

epididymis

A long, coiled duct on the outside of the testis in which sperm mature.

Pangender

A person whose gender identity is comprised of all or many gender expressions

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

Antihypertensive medication

A nurse is caring for a 55-year-old male on an orthopedic unit. When the nurse hands the client his morning medication, he grabs her breast and squeezes it. How should the nurse best respond to this situation?

Assertively tell the client that this behavior is not acceptable

The Better Model Acronym

BRING up the topic of sexuality. EXPLAIN that you are concerned with all aspects of patients' lives affected by disease. TELL patients that sexual dysfunction can happen and that you will address their concerns. TIMING is important to address sexuality with each visit. EDUCATE patients about the side effects of their treatments and that side effects may be temporary. RECORD your assessment and interventions in patients' medical records

The forensic nurse is caring for a client who was raped four days ago. Which of the following could the nurse teach the client is an effective contraceptive?

Insertion of a copper intrauterine device (IUD)

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

In the female reproductive system, what corresponds with the male penis?

Clitoris

Patient Outcomes Regarding Sexuality

Define individual sexuality. Establish open patterns of communication with significant others. Develop self-awareness and body awareness. Describe responsible sexual health self-care practices. Practice responsible sexual expression.

Obtaining Sexual Information

Description of the problem Onset and cause of the problem Past attempts at resolution Goals of the patient

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

vas deferens (ductus deferens)

Excretory duct of testis that joins epididymis with ejaculatory duct

Female genitalia

External -Mons pubis -Labia majora and labia minora -Clitoris -Hymen Internal -Ovaries -Fallopian tubes -Uterus -Vagina

The nurse is teaching a class of high school students about sexuality. After class the nurse is approached by Peggy, a 16-year-old female, who eventually discloses to the nurse that she has always had an inner sense that she was a male. The term for this is which of the following?

Gender identity

The nurse prepares to assess a client who is presenting to the infertility clinic for her first appointment. What should the nurse include when obtaining data from the client?

History of an untreated sexually transmitted infection (STI)

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

The nurse is preparing a talk on health issues in the LGBTQ population. Which statistic would the nurse include?

LGBTQ youth are 2 to 3 times more likely to attempt suicide.

General Levels of Sexual History

Level 1: part of the comprehensive health history, obtained by a nurse Level 2: sexual history, obtained by a nurse trained in sexuality Level 3: sexual problem history, obtained by a sex therapist Level 4: psychiatric/psychosocial history, obtained by a psychiatric nurse clinician

Forms of Sexual Expression

Masturbation Sexual intercourse Oral-genital stimulation Abstinence Alternate forms Voyeurism, sadism, masochism, sadomasochism, pedophilia

The nurse is advising an adolescent male about sexual myths that have him concerned. Which statements describe accurate client education regarding these concerns? Select all that apply.

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.

The school nurse is educating a group of 5th and 6th grade girls on menstruation. One girl asks if there is a name for having her first menstrual period. The nurse replies with which of the following terms?

Menarche

A client presents to the clinic seeking the safest contraceptive method to use. The nurse reviews the client's health history and notes that the client is 26 years old, married with no children, and a smoker. Based on the client's history the nurse identifies which methods are the most appropriate for this client? (Select All That Apply)

Norplant System Implanon Depo-Provera

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

On day 14

The nurse prepares to complete an exam on a 25 year old female. The client presents to the community health clinic reporting difficulty with urination. The nurse reviews the chart and sees that the client is originally from Africa. Which does the nurse suspect?

Possible complications from female genital mutilation (FGM) requiring further physical assessment

The nurse is assisting during a physical exam of a client. In regards to the genital exam, what steps does the nurse need to complete? Select all that apply.

Provide privacy. Use careful draping of the client. Use gloves during the exam.

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.

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

STIs are most prevalent among teenagers and young adults.

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.

The nurse is teaching a class about sexuality at a public health clinic. After class the nurse is approached by Cathleen, a 54-year-old female, who eventually discloses to the nurse that she is having a sexual affair with a female partner. The term for an individual's preference for a partner of a particular gender is which of the following?

Sexual orientation

The nurse knows that there are three basic charting methods in predicting ovulation in order to prevent pregnancy. (Select All That Apply)

Temperature method Cervical mucus method Calendar method

folicular phase

That part of the ovarian cycle during which follicles are growing and oocytes maturing. During this phase, the follicle secretes estradiol-17beta, which stimulates growth of the endometrium.

The nurse caring for clients in a physician's office 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 that they may cause anxiety in the child by intolerance of inconsistency of sex-role behavior.

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

The patient may have trichomoniasis.

TURP

Trans-Urethral Removal of the Prostate

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

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

Trichomoniasis

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

transgender

a gender identity or performance that does not fit with cultural norms related to one's assigned sex at birth

prostate gland

a gland surrounding the neck of the bladder in male mammals and releasing prostatic fluid.

transsexual

a person who has changed sexes

sexual orientation

a person's romantic and emotional attraction to another person

vulvodynia

a syndrome of unknown cause that is characterized by chronic burning, pain during sexual intercourse, itching, or stinging irritation of the vulva

Sadomasochism (S&M)

a term used to indicate the linkage of sadism with masochism

bisexual

attracted to both sexes

Heterosexual

attracted to the opposite sex

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

excitement phase.

four phases of sexual response cycle

excitement, plateau, orgasm, resolution

masochism

gratification derived from being hurt or abused

gender nonconformity

individuals expressing behavior and attitudes consistently characteristic of the opposite sex

cisgender

individuals whose gender identity matches his or her biological sex

The nurse is providing education about sexuality to a group of college freshman. One of the terms he discusses is gender identity. Which of the following describes gender identity?

inner sense of being male or female

Gay or lesbian

intimate partners of the same sex living together

gender identity

our sense of being male or female

The nurse is teaching a class about sexuality at a public health clinic. After class the nurse is approached by Cathleen, a 54-year-old female, who eventually discloses to the nurse that, while she is happily married, she feels like a man inside. Cathleen describes this as feeling "trapped" inside her female body. The term for this behavior is which of the following?

transexual

seminal vesicles

two small glands that secrete a fluid rich in sugar that nourishes and helps sperm move

A nurse reads in a client's chart that he or she has gender dysphoria. The nurse determines that the client understands the diagnosis when making what statement?

"People whose biologic sex at birth is contrary to the gender they identify with have gender dysphoria."

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."

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."

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?"

Causes of Menstrual Cycle Irregularities

- Pregnancy or breast-feeding - Eating disorders, extreme weight loss, extreme exercise - Polycystic ovary syndrome (PCOS) - Premature ovarian failure - Pelvic inflammatory disease (PID) - Uterine fibroids

Male Sexual Dysfunction

-Erectile dysfunction -Premature ejaculation -Retarded ejaculation

female sexual dysfunction

-Inhibited sexual desire -Dyspareunia -Vaginismus -Vulvodynia

factors affecting sexuality

-developmental considerations -culture -religion -ethics -lifestyle -health state

Health States Affecting Sexuality

1.Chronic pain 2.Diabetes mellitus 3.Cardiovascular disease 4.Diseases of the joints and mobility 5.Surgery and body image 6.Spinal cord injuries 7.Mental illness 8.Medications

Categories of Patients Requiring Sexual History

1.Patients seeking care for pregnancy, STD, infertility, or contraception 2.Patients experiencing sexual dysfunction 3.Patients whose illness will affect sexual functioning

Cowper's gland

2 small peasized glands located on eachside of uretha that secretes a lubrication fluid

Which example best supports the diagnosis of Sexual Dysfunction: Dyspareunia?

A 50-year-old woman in the process of menopause has pain and burning during intercourse.

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.

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

condom

The clinic nurse is explaining the action of sildenafil (Viagra) to a client. The nurse should assess his medication regimen to determine if he is taking medications that are contraindicated with Viagra. Which of the following medications is contraindicated with Viagra?

nitrates

Four phases of the menstrual cycle

follicular phase, ovulation, luteal phase, menstruation

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

headache

orgasm

one of the phases of the sexual response cycle; characterized by observed muscle contractions all over the body and further increases in breathing, pulse, and blood pressure rates, followed by ejaculation in men and orgasm in women.

dyspareunia

painful sexual intercourse

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

Three layers of the uterus

perimetrium, myometrium, endometrium

biological sex

physical characteristics that define male and female

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.

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.

vaginismus

recurring involuntary muscle spasms in the outer third of the vagina that interfere with sexual intercourse

The nurse should instruct an Islamic female client who is reluctant to undergo pelvic examination from an assigned male health care provider to:`

seek a female health care provider to perform the examination.

sexual identity

self identity biological sex gender identity gender role behavior or expression sexual orientation

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

external male genitalia

testes, scrotum, penis

gender dysphoria

the condition of feeling one's emotional and psychological identity as male or female to be opposite to one's biological sex.

The nurse observes that a client shows signs of depression and often is found crying quietly in her room. Based on what the nurse is aware about violence against women what does the nurse suspect may have occurred with this client?

the patient is a victim of date rape

sadism

the tendency to derive pleasure, especially sexual gratification, from inflicting pain, suffering, or humiliation on others.

The nurse is speaking to a client regarding his sexual history. The client states, "I was born with a penis but I should have had a vagina." The nurse would document the client's gender identity as:

transexual