Chapter 34 Sexuality (Perry & Potter)

Sexuality

Part of a person's personality and important for overall health

Sexual health

State of physical, emotional, mental and social well-being in relation to sexuality

Gender roles

Influenced by culture

Gender identity

The first 3 years are crucial for its development

School-age children

Have general questions regarding the physical and emotional aspects of sex

Adolescents

Need accurate information on sexual activity, emotional responses with relationships, sexually transmitted infections, contraception, and pregnancy.

Sexual minority group

Lesbian, gay, bisexual, or transgender

Dyspareunia

painful intercourse

Young adulthood

Intimacy and sexuality are issues for this group

Middle adulthood

Changes in physical appearance lead to concerns about sexual attractiveness

Older adulthood

Factors that determine sexuality activity include present health status, past and present life satisfaction, status of intimate relationships

Contraceptive options [Exam]

Pill, intrauterine device, condoms, diaphragm, tubal ligation, vasectomy

Identify the primary routes of human immunodeficiency virus (HIV) transmission.

a.) Contaminated IV needles
b.) Anal intercourse
c.) Vaginal intercourse
d.) Oral-genital sex
e.) Transfusion of blood products

List the commonly diagnosed STIs

a.) Syphilis
b.) Gonorrhea
c.) Chlamydia
d.) Trichomoniasis
e.) HPV

Identify two sociocultural dimensions of sexuality

a.) Impact of pregnancy and menstruation on sexuality
b.) Discussing sexual issues

Identify three decisional issues regarding sexuality.

a.) Contraception
b.) Abortion
c.) STI prevention

Identify four alterations in sexual health.

a.) Infertility
b.) Sexual abuse
c.) Personal and emotional conflicts
d.) Sexual dysfunction

What factors that may affect sexuality would the nurse assess? (Assessment)

a.) Physical
b.) Functional
c.) Relationship
d.) Lifestyle
e.) Developmental factors
f.) Self-esteem factors

The PLISSIT assessment of sexuality stands for:
(Assessment) [Exam]

Permission, limited information, specific suggestions, intensive therapy

Identify possible nursing diagnoses related to sexual functioning:
(Diagnosis)

a.) Anxiety
b.) Ineffective coping
c.) Interrupted family processes
d.) Deficient knowledge
e.) Sexual dysfunction
f.) Ineffective sexuality patterns
g.) Social isolation
h.) Risk for other-directed violence
i.) Risk for Self-directed violence

The expected outcomes for the nursing diagnosis Sexual Dysfunction Related to Decreased Sexual Drive are:
(Planning)

a.) Consistently use a water-soluble lubricant before sexual intercourse within 1 week
b.) Discuss stressors that contribute to sexual dysfunction with partner within 2 weeks
c.) Identify alternative, satisfying, and acceptable sexual practices for oneself and one's partner within 4 weeks

List the sexual health issues that you would include when educating your patient.
(Implementation)

a.) Contraception
b.) Safe sex practices
c.) Prevention of STIs
d.) Women- regular self breast examinations, mammograms, pap smears
e.) Men- testicular examination

Identify strategies that enhance sexual functioning.
(Implementation)

a.) Avoid alcohol and tobacco
b.) Eat well-balanced meals
c.) Plan sexual activity for times when the couple feels rested
d.) Take pain medication if needed
e.) Use pillows and alternative positioning to enhance comfort
f.) Encourage touch, kissing, hugging, and other tactile stimulation
g.) Communicate your own concerns and fears with your partner

Identify the stressors that may affect a person's sexuality during illness.

Individuals experience major physical changes, the effects of drugs and treatments, emotional stress of a prognosis, concern about future functioning, and separation from others.

Identify the follow-up discussions to determine whether the goals and outcomes were achieved. (Evaluation)

a.) Ask patient questions about risk factors, sexual concerns, and their level of satisfaction
b.) Note behavioral cues

At what developmental stage is it particularly important for children reared in single-parent families to be exposed to same-sex adults?
1.) Infancy
2.) School age
3.) Adolescence
4.) Toddlers and preschool years

4.) Toddlers and preschool years

Which statement about sexual response in older adults is correct?
1.) The resolution phases is slower
2.) The orgasm phase is prolonged
3.) The refractory phase is more rapid
4.) Both genders experience a reduced availability of sex hormones

4.) Both genders experience a reduced availability of sex hormones

The only 100% effective method to avoid contracting a disease through sex is:
1.) Abstinence
2.) Using condoms
3.) Avoiding sex with partners at risk
4.) Knowing the sexual partner's health history

1.) Abstinence

The nurse is providing education on sexually transmitted infections (STIs) to a group of adolescents. The nurse knows that further teaching is needed when one of the adolescents states:
1.) "A vaccine is available to reduce infection from certain types of human papillomavirus."
2.) "I should be screened for a STI after I an with a new partner."
3.) "I know I'm not infected if I don't have any symptoms such as discharge or sores."
4.) "A viral infection such as herpes or human papillomavirus cannot be treated with antibiotics."

3.) "I know I'm not infected if I don't have any symptoms such as discharge or sores."

A 25-year old patient is in the ER and states that she has had a cough and fever for the past 3 days. While performing a physical assessment, the nurse finds several bruises that are in various stages of healing and suspects that the patient possibly is a victim of sexual abuse. Which of the following is the nurse's first action?
1.) Refer the patient to a sexual counselor
2.) Tell the patient about the safe house for women
3.) Ask the patient to describe how she got the bruises
4.) Report the abuse immediately to the proper authorities

2.) Tell the patient about the safe house for women

A 26-year old married woman recently discovered that she is pregnant and is at her first prenatal visit. While assessing the patient, the woman's health nurse practitioner discovers that she has purulent vaginal discharge. The patient states, "It burns when I urinate, and I seem to have to go to the bathroom frequently." Based on these symptoms, the nurse practitioner determines that further follow-up is needed because the patient:
1.) Should be tested for human immunodeficiency virus (HIV)
2.) May have a sexually transmitted infection (STI) such as chlamydia
3.) Is experiencing normal signs of pregnancy
4.) Needs education on proper perineal hygiene

2.) May have a sexually transmitted infection (STI) such as chlamydia

A new graduate nurse is working in a rehab center that specializes in the care of patients with spinal cord injuries (SCIs). The new graduate knows that sexual issues are common with patients with SCIs. Which of the following actions enhances the nurse's comfort in discussing sexual issues with the patients. (Select all that apply)
1.) Clarifying personal values related to sexuality
2.) Role playing discussion of sexual concerns with another nurse
3.) Attending a conference to enhance knowledge about sexuality
4.) Avoiding a discussion of sexual concerns until after completing new nurse orientation

1.) Clarifying personal values related to sexuality
2.) Role playing discussion of sexual concerns with another nurse
3.) Attending a conference to enhance knowledge about sexuality

The nurse is gathering a sexual history from a 68-year old man in a nursing home. It is important for the nurse to keep in mind that:
1.) Older adult are usually not part of a sexual minority group
2.) Older adults sometimes do not reveal intimate details
3.) Older men and women lose their interest in sex
4.) Older adults in nursing homes do not usually participate in sexual activity

2.) Older adults sometimes do not reveal intimate details

Certain cultural groups in the US are disproportionately affected by diseases such as HIV and AIDS. The nurse understands that this is most likely caused by: (Select all that apply)
1.) Expectations about behavior by men or women in the culture
2.) Higher percentages of lesbian, gay, bisexual, or transgender individuals in the culture
3.) Genetic predisposition to the disease in the culture
4.) Communication patterns and language practiced by the culture

1.) Expectations about behavior by men or women in the culture
4.) Communication patterns and language practiced by the culture

Since the majority of STIs have few if any symptoms, it is important for the nurse to:
1.) Encourage regular screenings in all sexually active individuals
2.) Provide information about contraception options
3.) Administer prescribed antibiotics for HPV or genital herpes outbreaks
4.) Ask all patients if they are experiencing any symptoms

1.) Encourage regular screenings in all sexually active individuals

Establishing trust and encouraging disclosure about sexuality are often facilitated if the nurse begins by asking the patient:
1.) How often they have sexual intercourse
2.) To disrobe in preparation for the physical examination
3.) For permission to discuss sexual issues
4.) For specific examples of sexual practices and problems

3.) For permission to discuss sexual issues

A 15-year old girl states that she is having unprotected intercourse with her boyfriend. She asks for more information about birth control methods. The nurse informs the patient that: (Select all that apply)
1.) Condoms or diaphragms must be used with each sexual encounter
2.) Hormonal methods offer little protection against STIs.
3.) Barrier methods off some protection against STIs
4.) Sterilization is an effective option that she should consider

2.) Hormonal methods offer little protection against STIs.
3.) Barrier methods off some protection against STIs

The nurse reviews the health history of a 24-year old woman who indicates that she has had three new sexual partners since her previous exam 2 years ago. The nurse discusses the need for STI screening with the patient even though she denies symptoms or discomfort. The nurse realizes that the most serious complication from untreated STIs in females is:
1.) Genital discharge and dypareunia
2.) Painful menstrual cycles
3.) Infertility and pelvic inflammatory disease
4.) Genital warts

3.) Infertility and pelvic inflammatory disease

The nurse is providing education about condom use at a community clinic for older adults. Which of the following statements demonstrates that the adults understand correct use of condoms? (Select all that apply)
1.) "I can us any kind of lubricant such as lotions or baby oil."
2.) "Before using the condom, I should check the package for damage or expiration."
3.) "I need to use a condom to help reduce the risk of STIs."
4.) "A good place to store condoms is in the bathroom so they don't dry out."

2.) "Before using the condom, I should check the package for damage or expiration."
3.) "I need to use a condom to help reduce the risk of STIs."

Which of the following represents a nonjudgmental approach when gathering a sexual health history?
1.) How do you and your wife/husband feel about intimacy?
2.) Do you have sex with men, women or both?
3.) Are you heterosexual or homosexual?
4.) What is your sexual orientation?

2.) Do you have sex with men, women or both?

A 54-year old male patient who is being seen for an annual physical tells the nurse that he is having difficulty sustaining an erection. The nurse reviews his health history and notes no current health problems except medical treatment for depression. The nurse understands that:
1.) A personal issues such as this is best addressed by the male physician during the examination.
2.) Erectile dysfunction affects most men over the age of 50.
3.) The patient needs to be screened for STIs.
4.) Antidepressant medications may be affecting his sexual functioning.

4.) Antidepressant medications may be affecting his sexual functioning.

The nurse at a community health center is teaching a group of menopausal women about normal changes in the female sexual response that occur with aging. The nurse knows that the information is understood when one of the women states that:
1.) It's normal for me to take longer to reach an orgasm.
2.) I might experience chest pain or shortness of breath during intercourse.
3.) It's normal for me to lose interest in sexual relationships.
4.) I won't need to be concerned about contraception or STIs because of my age.

1.) It's normal for me to take longer to reach an orgasm.

A school nurse is completing a health history on an adolescent female and notices several body piercings and tattoos. The student tells the nurse that she is planning to get more tattoos and piercings over the summer break. The nurse tells the student tattoos and piercings can:
1.) Prevent you from being involves in contact sports.
2.) Only create health problems if they are located in the nipples or genital area.
3.) Increase your risk for infection at the site and in the body.
4.) Be a safe and important way of establishing your personality

3.) Increase your risk for infection at the site and in the body.