46Fundamentals of Nursing: The Art & Science of Person Centered Care, 10th Edition; Taylor, Lynn, Bartlett. Chapter 46 Sexuality

A nurse is teaching parents about expected developmental aspects of sexuality in children. Which statements from parents indicate further teaching is needed? Select all that apply.

“When my 2-year-old son touches his genitals, I push his hand away and tell him ‘No’.”

“I should wean my infant by 4 months and encourage him to use a sippy cup.”

“I should explain sexuality to my 9-year-old in a factual manner when they ask questions about their body.”

“I should explain about body changes to my 11-year-old prior to them happening to alleviate their fears.”

“I should teach my 10-year-old about contraception and ways to avoid sexually transmitted diseases.”

“I should allow my teenager to establish their own beliefs and moral value system rather than sharing my own beliefs.”

a, b, c, e, f.

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

A nurse is counseling an older couple regarding sexuality. Which statement from the couple should the nurse address?

“We’re at the age when we should consider stopping sexual activity.”

“We need more time for sexual stimulation than we used to.”

“If we are unable to have sex, we can still have an intimate relationship.”

“If we change our position, we can still have sex and be more comfortable.”

a. Sexual activity need not be hindered by age, and couples who have been consistently sexually active throughout their lives may continue their intimate relationship for as long as they desire. Nurses should teach couples that adaptation to bodily changes is possible with use of comfortable positions for intercourse and increased time for stimulation as well as teach alternatives to coitus, such as caressing, hugging, and stroking, when coitus is impossible because of illness or disability.

A nurse in a urology practice performs sexual health assessments of male older adults. Which patients would the nurse identify as having an increased risk for erectile dysfunction? Select all that apply.

Patient with a history of diabetes

Patient with a new partner

Patient with Parkinson disease

Patient with alcoholism

Patient taking antihypertensive medication

Patient who is a tobacco smoker

a, d, e.

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

A school nurse is providing sex education classes for adolescents. Which statement would the nurse include when describing normal sexual functioning?

“People are born with a certain amount of sexual drive, which can be depleted in later years.”

“If you want to be a great athlete, sexual abstinence is necessary during training.”

“A nocturnal emission (wet dream), is an indicator of a sexual disorder.”

“It is natural for women to have as strong a desire for sex and enjoy it as much as men.”

d. Physiologic studies indicate that, in some respects, the female’s sex drive is not only as strong but may be even stronger than that of the male. The more consistently sexually active a person is, the longer the activity continues into the later years of life. Physiologically, the achievement of orgasm is rarely more demanding than most activities encountered in daily life; there is no scientific evidence that sex “weakens” a person. Erotic dreams that culminate in orgasms are normal common physiologic phenomena in at least 85% of men.

During a checkup in a pediatric office, the mother of a school-aged boy tells the nurse that she is worried because she has occasionally found him masturbating. She asks the nurse how she should handle this “problem.” How would the nurse best respond to this mother’s concern?

“Children should be taught not to masturbate because most people believe self-stimulation is wrong.”

“Masturbation is a means of learning what a person prefers sexually; overreacting can lead the child to believe sex is bad or dirty.”

“There are serious health risks associated with frequent masturbation, and the practice should be discouraged in children.”

“Children who masturbate demonstrate sexual dysfunction and should be seen by a child psychologist.”

b. Masturbation is a technique of sexual expression in which a person practices self-stimulation. It is a way for people to learn what they prefer during stimulation and what feels good. People masturbate regardless of sex, age, or marital status. Negative reaction or overreaction by parents to a child’s masturbating can lead to a belief that the genitals and sex are bad or dirty, causing guilt or a feeling they are wrong. People may not masturbate due to guilt about it or believe self-stimulation is wrong. It is important to let patients know masturbation is not “dirty” and will not lead to blindness or insanity.

A patient who developed a pulmonary embolism (blood clot in the lung) after using oral contraceptives asks the nurse what she should do if she can no longer use “the pill.” The nurse suggests which mechanical barrier for birth control?

Diaphragm

Transdermal contraceptive patch

Depo-Provera

Evra patch

a. The diaphragm is the only barrier method of contraception listed; all the other methods are hormonal.

A 17-year-old college student calls the emergency department (ED) and tells the nurse they were raped by a professor. They want to come to the ED, but only if the nurse promises their parents will not be contacted. What should be the nurse’s first priority?

Getting the patient into a safe environment and mobilizing support for them

Encouraging the student to disclose the name of the professor

Ensuring the student is assessed for pregnancy, STIs, and other complications

Convincing the student to tell their parents to receive their support

a. While the remaining options may be indicated, the priority is to ensure the safety of the woman and to get her the support she needs at this moment.

A nurse is teaching patients about contraception methods. Which statement by a patient indicates a need for further teaching?

“Depo-Provera is not effective against sexually transmitted infections, but contraceptive protection is immediate if I get the injection on the first day of my period.”

“The hormonal contraceptive, NuvaRing, protects against pregnancy by suppressing ovulation, thickening cervical mucus, and preventing implantation of the fertilized eggs.”

“Abstinence is an effective method of contraception and may be used as a periodic or continuous strategy to prevent pregnancy and STIs.”

“Withdrawal is an effective method of birth control that reduces risk for STIs.”

d. Withdrawal offers no protection against sexually transmitted infections. An injection of depot medroxyprogesterone acetate (DMPA) can prevent pregnancy for 12 weeks, is 99.7% effective, and provides contraception immediately if administered on the first day of the female’s period. The NuvaRing works by inhibiting ovulation in much the same way as oral contraceptives. Used appropriately, the vaginal ring is 99.3% effective in protecting against pregnancy. Abstinence is the most effective form of birth control, preventing pregnancy and STIs 100% of the time when practiced consistently and appropriately.

A nurse in a gynecology practice is assessing a patient reporting vaginal discharge that “smells bad and is green and foamy.” She also reports burning upon urination and dyspareunia. The nurse suggests the patient and partner will need treatment for which STI?

Human papillomavirus (HPV)

Syphilis

Trichomoniasis

Herpes simplex virus

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

A school nurse is providing information for parents of teenagers regarding the human papillomavirus (HPV) and the recommended HPV vaccination. What teaching point would the nurse include?

“HPV causes genital warts and cervical and other cancers.”

“HPV causes a single painless genital lesion and can lead to sterility.”

“Fifty percent of females between ages 14 and 19 years are infected with HPV.”

“The HPV vaccination is only recommended for the female population.”

a. HPV causes genital warts and cervical and other cancers. It manifests as pale, soft, papillary lesions found around the internal and external genitalia, perianal and rectal areas of the body. One in four young females between ages 14 and 19 years is infected with at least one of the most common STIs, which include the human papillomavirus (HPV). The HPV vaccination is recommended for males and females.

Students enrolled in a sexuality course are discussing people who achieve sexual arousal by looking at the body of someone other than a sexual partner. How would the students correctly name this behavior?

Masochism

Pedophilia

Voyeurism

Sadism

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

An 18-year-old presents at a women's health care clinic seeking oral contraceptives before having heterosexual intercourse for the first time. She tells the nurse she doesn't know what to expect. What accurate statements by the nurse would be helpful? Select all that apply.

"During the excitement phase, your breasts swell and the nipples invert."

"Lubrication of the vagina seeps outside of the body making stimulation more pleasurable by decreasing friction."

"Your clitoris enlarges and emerges slightly from the clitoral hood."

"The first obvious sign of arousal in your partner is an erection of the penis caused by increased blood flow."

"The man's scrotum noticeably elevates, thickens, and enlarges."

"The skin of the penis and scrotum become pale in color."

b, c, d, e.

It is appropriate to provide education about sexuality and sexual responses. The nurse could teach that during the excitement phase, the female breasts swell and the nipples become erect and hard to the touch. Lubrication of the vagina seeps along the vulvar creases decreasing friction and making stimulation of the genitals more pleasurable. The upper two thirds of the vagina enlarge and expand. The clitoris enlarges and emerges slightly from the clitoral hood. The labia also enlarge and separate and turn a deep rosy-red with arousal. The first obvious sign of arousal in the male is an erection of the penis caused by increased pelvic congestion of blood. The scrotum noticeably elevates, thickens, and enlarges. The skin of the penis and scrotum turns a deep reddish purple in response to congestion and arousal. Male nipples may also harden and become erect. The nurse should also discuss contraception, preventing STIs, and the patient’s right to say no if she chooses.

A nurse working in a gynecology practice screens patients for menstrual irregularities. Which patients would a nurse identify are at risk for menstrual cycle irregularities? Select all that apply.

Breastfeeding mother

Adolescent with anorexia

Individual abstaining from sexual intercourse

Patient diagnosed with pelvic inflammatory disease

Patient obsessed with exercising

Patient with a spinal cord injury

a, b, d, e.

Causes of menstrual cycle irregularities include pregnancy or breastfeeding, eating disorders, extreme weight loss, excessive exercising, and pelvic inflammatory disease, as well as many other causes. Abstaining from sex and spinal cord injuries are not causes of menstrual irregularities.

A nurse in a gynecology clinic is obtaining a health history on a patient reporting pain during sexual activity. Which assessment question would be most appropriate for a patient who is experiencing dyspareunia?

“Do you currently have a new partner?”

“Have you been diagnosed with a neurologic disorder?”

“Do you take antihypertensive medication?”

“Do you regularly use antihistamines?”

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

A nurse is providing health care for patients in a clinic located in a predominately LGBTQIA+ community. Which health disparities should the nurse keep in mind when planning care for this population? Select all that apply.

LGBTQIA+ youth are more likely to attempt suicide.

LGBTQIA+ youth are more likely to be homeless.

Lesbians are less likely to get preventive services for cancer.

Lesbians and bisexual females are more likely to be underweight.

Transgender people have a high prevalence of HIV and sexually transmitted infections.

LGBTQIA+ populations have low rates of tobacco, alcohol, and other drug use.

a, b, c, e.

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

Nurses in the emergency department (ED) have received education on identification of victims of human trafficking. Which patients would the ED nurse identify may be at risk? Select all that apply.

Those who work in hotels, nail salons, or home-cleaning services

Those who perform agricultural or ranch work

Those who show evidence of being controlled physically or psychologically

Those accompanied by someone who encourages them to share their own information

Those who produce identification documents (ID or passport)

Those who show the loss of the sense of time or space or not do know what city or state they are in

a, b, c, e, f.

Victims of human trafficking can be any age. The nurse observes for those engaging in sex work, agricultural, or ranch work; working in hotels, massage parlors, nail salons, or home-cleaning services; performing domestic labor (cleaning, childcare, eldercare, etc.); working in restaurants, bars, or cantinas; and begging, street peddling, or door-to-door sales. Victims of human trafficking may exhibit evidence of being controlled either physically or psychologically, an inability to leave home or their place of work, or an inability to speak for themselves or share their own information. Information is provided by someone accompanying the individual, and they do not have control of their own identification documents (ID or passport). They have few or no personal possessions, may owe a large debt that they are unable to pay off, and may demonstrate loss of sense of time or whereabouts.

A parent brings their preteen daughter to the pediatric office for an annual checkup. The parent asks when they should tell the child about menses. What information will the nurse provide?

“You can discuss this when you are ready.”

“It isn’t necessary to discuss menstruation until age 13.”

“Most preteens have heard about menses from their friends. There is no rush.”

“Menses begins between ages 10 and 13 years, so now is a good time.”

d. Puberty begins for most girls with development of secondary sex characteristics, and menarche begins at about age 12 years but may occur anywhere between ages 8 and 17 years. Information regarding body changes is needed to alleviate fears and should be given to the child before puberty begins. The focus should be on the daughter’s needs, not the parent’s need.