Chapter 45: Sexuality

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.

A client has a history of poorly controlled diabetes. Which health concern will the nurse discuss with the client?

Erectile dysfunction Explanation: Diabetes is a significant risk factor for erectile dysfunction. The constant elevation of blood sugar in diabetes affects the vascular contraction of male clients. Diabetes does not create an appreciably increased risk of developing sexually transmitted infections, although clients with diabetes have an increased susceptibility to infections of all kinds. Retarded or premature ejaculation is less likely, as these problems do not have a vascular etiology.

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.

The nurse is caring for a client, 29 years of age, who is admitted with chronic pain secondary to rheumatoid arthritis. The client confides in the nurse about a desire to be able to have sex with the spouse but it just "hurts too much." Which information will the nurse discuss with the client about how to manage chronic pain during sexual intimacy?

Use modified positions. Explanation: The desire for human warmth and contact does not cease because of pain. Altered or modified positions for coitus are sometimes necessary and discussing these with clients can be an important part of implementing the nursing process. The nurse should not discourage the client from wanting to enjoy sex but should explore ways to help the client.

A female client tells the nurse that vaginal intercourse with her partner is not as exciting as it used to be. Which of the following could the nurse teach her?

Use of Kegel exercises Explanation: Some women who practice Kegel exercises, which promote good vaginal tone, have found their sexual satisfaction is improved. The BETTER model is a tool used in conducting sexual assessments. Voyeurism and masturbation are techniques of self-stimulation that would not involve the client's partner

A female client presents with a report of pain and burning in the area of the vulva during intercourse. How will the nurse document the clients report of symptoms?

vulvodynia Explanation: Vulvodynia produces symptoms of burning and pain in areas of the vulva. Vaginismus is involuntary contraction of the muscles surrounding the vaginal orifice so that penetration may be impossible and very painful. Dyspareunia is painful intercourse at the vaginal opening or upon deep thrusting.

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; and (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 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) Explanation: Emergency contraception is provided in two ways: increased doses of oral contraceptive pills (usually within 72 hours) or insertion of a copper IUD within 5-7 days after unprotected intercourse. The other options are used for routine contraception.

The community health nurse is aware that many factors influence a client's decision for contraception. Which of the following is the most likely reason a client would select permanent contraception?

The choice not to start a family. Explanation: Some people choose a permanent method to prevent pregnancy from ever occurring. Factors that affect a person's choice of a contraceptive method include age, marital status, desire for future pregnancy, religious beliefs, level of education, cost, and ease of use. Permanent contraception offers no protection against sexually transmitted infections.

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.

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." Explanation: 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.

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 antihypertensive medications; age-related metabolic disorders such as anemia, diabetes, malnutrition, and 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 a penile prosthesis or pharmacologic management.

A teenage female client tells the nurse that she is having intercourse with her boyfriend. The client asks the nurse about methods to prevent pregnancy. Which statement by the nurse would be most accurate?

"Many unintended pregnancies result from the use of less effective methods of contraception." Explanation: Unintended pregnancy remains a significant women's health issue in the United States. Many unintended pregnancies result from the use of less effective methods of contraception, such as condoms, spermicide, or barrier methods. Continuous abstinence involves not having sex with a partner at all. In periodic abstinence, women chart their periods of fertility and abstain from vaginal intercourse during these periods. Barrier methods include the vaginal sponge used in combination with a spermicidal agent. Coitus interruptus, the withdrawal of the penis from the vagina before ejaculation, does not prevent all pregnancies. Pre-ejaculate can contain enough sperm to cause a pregnancy, and pre-ejaculate or semen may spill onto the vulva.

An adolescent female client expresses concern to the nurse about her anatomy looking "weird down there." Which response(s) by the nurse is appropriate? Select all that apply.

"Tell me more about the concerns you have about your body." "You may want to try using a mirror to better see and understand your anatomy." "Explain what you mean when you say you look's weird down there.'" Explanation: Sexuality is the degree to which a person exhibits and experiences maleness or femaleness physically, emotionally, and mentally. Exploring and understanding the body and its anatomy are essential in assisting men and women to achieve healthy sexual relationships. The use of a mirror to examine oneself is one way to begin this process. Saying something like "Tell me more..." or "Explain what you mean..." are clarifying, open-ended statements that allow the client to expand on her thoughts and concerns. Telling a client that "everyone" feels this way is dismissive and does not address the client, but the rest of the population. Telling the client she will look different soon may not be true and is misleading to the client

A middle-aged male client is in the clinic for a routine blood pressure check. During the health history, the client mentions to the nurse about being concerned that the spouse is "unhappy with their love life." Which question is best for the nurse to ask?

"What makes you think your spouse is unhappy? What has happened?" Explanation: It is often difficult for clients to discuss their sexuality. Any mention from the client should be discussed further to help discover if there are any early symptoms of a more serious condition such as undiagnosed cancer. It may also help uncover a situation which can be easily addressed such as erectile dysfunction. When the nurse uses therapeutic communication techniques (open-ended questions), the nurse demonstrates acceptance and concern for the client's perceived health need.

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 the cervical cap, condom, diaphragm, and 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 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 advising an adolescent male about sexual myths that have him concerned. Which client education accurately describe 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. Explanation: 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 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 Explanation: The first menstrual period, called menarche, is experienced at about 12 years of age. Menstruation is often referred to as a woman's "period" or "menses." Menopause is the cessation of a woman's menstrual activity. In the ovaries, in a typical 28-day cycle, the phase from day 4 to 14 is called the follicular phase.

The nurse is assessing a 37-year-old female client who suddenly starts crying when asked about sexual function. The client explains she really loves her spouse but has become afraid of having sex because it hurts so much. Which factor(s) should the nurse further explore to determine a potential cause for this clients situation? Select all that apply.

Previous trauma Estrogen levels Vaginal infection Fear of pain Explanation: Genito-pelvic pain penetration disorder (GPPD) includes a continuum of pain from superficial vaginal pain to pain with deep penetration. Fear of pain with penetration is a key emotional element necessary for diagnosis. Various causes have been recognized such as sexual violence and low estrogen levels that can result in lower levels of vaginal lubricant. Vaginal infection is also a potential cause. The involuntary contraction of vaginal muscles was once believed to be a contributing factor but research has proven this is not true.

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. Explanation: STIs are most prevalent among teenagers 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.

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.

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.

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 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." Explanation: The diaphragm stays in for 8 hours after intercourse; the FemCap can stay for 48 hours. Diaphragms and cervical caps are washable and reusable. Female condoms can be inserted up to 8 hours before intercourse to avoid interrupting sexual activity. Male condoms can be made of latex, polyurethane or natural membranes. Male latex condoms when used correctly are an effective means of contraceptive and very effective at preventing transmission of STIs.

A nurse is counseling a couple who expressed that they are having difficulty conceiving. What could the nurse consider as a cause?

Changing developmental stage Explanation: Changing developmental stages, such as menopause, can interfere with a couple's normal sexual expression. Masturbation, and "petting" or simple stroking as part of foreplay do not affect a couple being able to conceive. Having sex during ovulation would increase the likelihood of the client becoming pregnant.

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

Clitoris Explanation: The clitoris corresponds to the penis in the male in that both organs respond to stimulation that can result in orgasm.

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.

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. Ovulation does not begin when sperm is present. If ovulation and sperm engage, then pregnancy occurs.

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.

The nurse is conducting an assessment on a 42-year-old female client. The client admits to having unprotected sex with multiple individuals over the years. Based on the data collected during the assessment, which disorder should the nurse suspect this client has?

Syphilis Explanation: This client presents with a high risk for a sexually transmitted infection. The rash, swollen lymph nosed, alopecia, malaise and elevated temperature are classic symptoms of secondary syphilis. Chlamydia has no symptoms and must be detected on routine exams. Gonorrhea often presents with burning on urination, pain during intercourse and penile discharge in men. HSV may first present as a cold sore and after going away may present again as a lesion in the genital area.

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. It is not necessary to teach the client that anal intercourse should be avoided.

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.

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

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 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.

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, and 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.

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.

"Are you planning a pregnancy in the future?" "Do you have any sexual problems?" "Do you feel safe with your sexual partner?" "Have you had any abnormal Papanicolaou tests?" Explanation: 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, recently diagnosed with diabetes, tells the nurse he is concerned about the effect the condition will have on his ability to participate in sexual activity. Which question by the nurse will be useful to initiate a conversation about the client's concern?

"Can you tell me more about your worries regarding sexual activity?" Explanation: Asking the client, "Can you tell me more about your worries with sexual activity?" is an open-ended question that allows the client to expand on his stated concern. Asking about the client's partner turns the focus to the partner and does not address the client's immediate concern. Asking the client who gave him this information is a close-ended question and turns the focus away from the client's concern. Erectile dysfunction, or impotence, is a great concern among men with type 2 diabetes; however, this is a close-ended question that does not allow the client to give further details.

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." Explanation: Sexual identity encompasses a person's self-identity, biologic sex, gender identity, gender role behavior or orientation, and sexual orientation or preference. Gender role behavior is the behavior a person conveys about being male or female. 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. Sexual orientation refers to the preferred gender of a person's partner.

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." Explanation: Human papillomavirus (HPV) is a DNA virus also called genital warts and is a sexually transmitted infection (STI). A vaccine is now available to prevent this disease. Male partners with HPV may or may not have lesions. Women should avoid douching to prevent STIs, as they remove normal protective bacteria in the vagina and increases the risk of getting some STIs. The Norplant system is a contraceptive method and does not prevent STIs.

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.

While conducting a sexual history, the nurse asks a client about protection from sexually transmitted infections (STIs). Which question would be most appropriate for the nurse to ask?

"Have you had any sexually transmitted infections and if so, which ones?" Explanation: When asking about STI protection, a question such as "Have you had any sexually transmitted infections and if so, which ones?" provides the nurse with important information about STIs and behavioral risk. Erectile dysfunction is not an indicator of STIs or risk factors. How the client feels about expressing themselves sexually is more of a determining factor of sexual self-esteem. Asking the client if he finds sex satisfying provides information about sexual functioning, not STI protection.

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. Assessing the client's history of STIs does not directly address her sexual identity.

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 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 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." Explanation: People whose biologic sex at birth is contrary to the gender they identify with have gender dysphoria. Heterosexuals experience sexual fulfillment with a person of the opposite sex. People who find pleasure with both opposite-sex and same-sex partners are bisexual. An intersex condition occurs in about 1 in every 2000 babies in which there are contradictions among chromosomal sex, internal organs, and external genital appearance, resulting in ambiguous gender.

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.

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.

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. Each individual will determine which method of contraception is the best method to personally use. Condoms should never be reused.

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. The classic sexual response cycle outlined by Masters and Johnson (1966) is linear in nature and has four phases: excitement, plateau, orgasm, and resolution

The female reproductive system is made up of both external and internal organs. Which are external organs in this system? Select all that apply.

Mons pubis Labia majora Clitoris Skene glands Explanation: The mons pubis, labia majora, clitoris, and Skene glands are external organs. The ovaries are internal organs.

A client tells the nurse that she and her husband have selected periodic abstinence as their choice of contraception. Which is the best method for the nurse to recommend to monitor fertility?

Symptothermal method Explanation: The best approach to monitoring fertility is a combination of all three methods (temperature, cervical mucus, and calendar), called the symptothermal method.

Traditionally, the male sexual response is thought to be broken up into three phases. Which occurrence is part of the plateau phase?

The circumference of the penis thickens at the coronal ridge and a few drops of fluid appear at the urethral meatus. Explanation: During the plateau phase, the circumference of the penis thickens at the coronal ridge. The size of the testes also increase by 50% and a few drops of fluid appear at the urethral meatus.

The nurse is performing an assessment for a client that has human immunodeficiency virus (HIV). What data obtained by the nurse indicate that the client may have developed acquired immunodeficiency syndrome (AIDS)? Select all that apply.

The client reports fatigue. The client is having several episodes of diarrhea in a day. The client reports the incidence of nightly sweating. Lymph nodes are enlarged in the inguinal area and axillary area. Explanation: Clients that are HIV-positive may remain healthy for many years. When the CD4 count drops, the client is at risk for the development of diseases and cancers that a healthy person is normally able to resist. The development of fatigue, diarrhea, weight loss, enlarged lymph nodes, fever, anorexia, and night sweats indicate that the client may now be in the stage of AIDS.

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.

A nurse is teaching a sex education class to a group of adolescent girls. They ask the nurse about the sexual response cycle in females. Which physiologic response does the nurse tell them is only seen in girls/women?

loss of muscular control during orgasm causing twitching of the arms and legs Explanation: During the excitement phase, some of the physiologic changes common in both men and women include an increased heart rate and blood pressure. Male and female nipples become hard and erect. In the orgasm phase, women have a loss of muscular control, which causes spastic contractions and twitching of the arms and legs, and men experience involuntary spasmodic contractions only in the penis, epididymis, vas deferens, and rectum. In the resolution phase, men experience a period during which the body does not respond to continued sexual stimulation, called the refractory period.

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 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, including reducing the risk for ovarian cancer and endometrial cancer, reducing symptoms of premenstrual discomforts, decreasing blood loss and anemia, reducing symptoms of endometriosis, and many other benefits.