Chapter 34 (Potter & Perry) Sexuality

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:

A. "A vaccine is available to reduce infection from certain types of human papillomavirus."
B. "I should be screened for an STI after I am with a new partner."
C. "I know I' m not infected if I don't have any symptoms such as discharge or sores."
D. "A viral infection such as herpes or human papillomavirus cannot be treated with antibiotics."

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


Many STIs have few symptoms and are often detected during routine screening. The risk of infection is higher in people who are under the age of 25 and who have multiple sex partners. Viral infections cannot be cured with antibiotics, but medication is available to suppress outbreaks. Bacterial infections can be treated with antibiotics, but the infection can recur with new exposure.

A 25-year-old patient is in the emergency department 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?

A. Refer the patient to a sexual counselor
B. Tell the patient about the safe house for women
C. Ask the patient to describe how she got the bruises
D. Report the abuse immediately to the proper authorities

B. Tell the patient about the safe house for women


The first action is to educate the patient about available resources in the community to help her develop an escape plan. Reporting the abuse to authorities may put her at increased risk for violence but is legally required.

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:

A. Should be tested for human immunodeficiency virus (HIV).
B. May have a sexually transmitted infection (STI) such as chlamydia.
C. Is experiencing normal signs of pregnancy.
D. Needs education on proper perineal hygiene.

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


Chlamydia does not cause symptoms in about 75% of women; thus they are often unaware that they have an STI. It often causes genitourinary track infections in men and women. Serious complications can result from untreated STIs in pregnancy such as preterm labor and rupture of membranes and premature delivery of the newborn. Purulent discharge indicates infection and is not an expected finding in pregnancy or from poor hygiene practices.

A new graduate nurse is working in a rehabilitation center that specializes in the care of patients with spinal cord injuries (SCIs). The new graduate knows that sexual issues are common among patients with SCIs. Which of the following actions enhances the nurse's comfort in discussing sexual issues with the patients? (Select all that apply)

A. Clarifying personal values related to sexuality
B. Role playing discussion of sexual concerns with another nurse
C. Attending a conference to enhance knowledge about sexuality
D. Avoiding a discussion of sexual concerns until after completing new nurse orientation

A. Clarifying personal values related to sexuality
B. Role playing discussion of sexual concerns with another nurse
C. Attending a conference to enhance knowledge about sexuality


Nurses often avoid discussing sexual issues with patients because they are uncomfortable, lack knowledge, or have personal values in conflict with the patients. Nurses who have difficulty addressing sexual issues need to seek education and experiences to increase knowledge and explore their personal values

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:

A. Older adults are usually not part of a sexual minority group.
B. Older adults sometimes do not reveal intimate details.
C. Older men and women lose their interest in sex.
D. Older adults in nursing homes do not usually participate in sexual activity.

B. Older adults sometimes do not reveal intimate details.


Older adults are sometimes hesitant to reveal information relating to sexual issues because they are embarrassed. Sexual health is sometimes not addressed by the nurse, but it is important to include a sexual history as a routine aspect of assessment to communicate that sexual activity is normal. Studies have shown an increase in sexual dysfunction with aging but no decrease in sexual activity or interest.

Certain cultural groups in the United States are disproportionately affected by diseases such as human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS). The nurse understands that this is most likely caused by:
(Select all that apply)

A. Expectations about behavior by men or women in the culture.
B. Higher percentages of lesbian, gay, bisexual, or transgender individuals in the culture.
C. Genetic predisposition to the disease in the culture
D. Communication patterns and language practiced by the culture.

A. Expectations about behavior by men or women in the culture.
D. Communication patterns and language practiced by the culture.


Cultural factors such as gender, education, socioeconomic status, religion, language, and values influence the use of the health care system. Populations that are at increased risk for HIV are people who are intravenous drug users, those with hemophilia, and those who practice unprotected sex. Genetic factors often increase risk for certain health problems such as cardiovascular disease or cancers but do not usually increase the risk for HIV since it is a viral infection and not a genetic disease.

Since the majority of sexually transmitted infections (STIs) have few if any symptoms, it is important for the nurse to:

A. Encourage regular screenings in all sexually active individuals.
B. Provide information about contraception options.
C. Administer prescribed antibiotics for human papillomavirus (HPV) or genital herpes outbreaks.
D. Ask all patients if they are experiencing any symptoms.

A. Encourage regular screenings in all sexually active individuals.


One of the challenges in reducing the incidence of STIs is that most STIs have few symptoms in males or females. Asymptomatic STIs can be diagnosed during a physical examination with appropriate laboratory tests. Screening after each new sex partner is the most effective method to detect and manage STIs. HPV and herpes are viral infections and cannot be treated with antibiotics.

Establishing trust and encouraging disclosure about sexuality are often facilitated if the nurse begins by asking the patient:

A. How often he or she has sexual intercourse.
B. To disrobe in preparation for the physical assessment.
C. For permission to discuss sexual issues.
D. For specific examples of sexual practices and problems.

C. For permission to discuss sexual issues.


According to the PLISSIT assessment of sexuality (see Box 34-4), the nurse should first ask for Permission to discuss sexual issues with the patient, followed by open-ended questions to determine the patient's concerns.

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)

A. Condoms or diaphragms must be used with each sexual encounter.
B. Hormonal methods offer little protection against sexually transmitted infections (STIs).
C. Barrier methods offer some protection against STIs.
D. Sterilization is an effective option that she should consider.

B. Hormonal methods offer little protection against sexually transmitted infections (STIs).
C. Barrier methods offer some protection against STIs.


The most effective methods are longer-acting methods (such as an intrauterine device (IUD) or hormonal injection), which are not associated with the sexual act itself. Sterilization is the most effective method besides abstinence but would not be a good option for a young woman since it is not easily reversible. Hormonal methods do not provide any barrier against STIs, whereas barrier methods may help reduce the risk

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 examination 2 years ago. The nurse discusses the need for sexually transmitted infection (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:

A. Genital discharge and dyspareunia.
B. Painful menstrual cycles.
C. Infertility and pelvic inflammatory disease.
D. Genital warts.

C. Infertility and pelvic inflammatory disease.


STIs can certainly cause discharge, discomfort, and genital warts; however, the most serious complications from untreated bacterial STIs are damage to the reproductive organs and increase in the risk of pelvic inflammatory disease, ectopic pregnancy, and infertility.

The nurse is providing education about condom use at a community clinic for older adults. Which of following statements demonstrates that the adults understand correct use of condoms?
(Select all that apply)

A. "I can use any kind of lubricant such as lotions or baby oil."
B. "Before using the condom, I should check the package for damage or expiration."
C. "I need to use a condom to help reduce the risk of sexually transmitted infections."
D. "A good place to store condoms is in the bathroom so they don't dry out."

B. "Before using the condom, I should check the package for damage or expiration."
C. "I need to use a condom to help reduce the risk of sexually transmitted infections."


Older adults sometimes are not familiar with condom use and storage. Teach them to use water-based lubricants because oil-based products contribute to breakage of latex condoms. Condoms need to be stored in a cool, dry location away from sunlight

Which of the following represents a nonjudgmental approach when gathering a sexual health history?

A. How do you and your wife/husband feel about intimacy?
B. Do you have sex with men, women, or both?
C. Are you heterosexual or homosexual?
D. What is your sexual orientation?

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


A nonjudgmental attitude facilitates trust and open communication between the nurse and patient. Using terms such as partner versus wife or husband allows the patient to identify his or her sexual preference. The terms gay, lesbian, bisexual, or transgender are preferred over the terms heterosexual or homosexual and are more specific in reference to sexual practices.

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:

A. A personal issue such as this is best addressed by the male physician during the examination.
B. Erectile dysfunction affects most men over the age of 50.
C. The patient needs to be screened for sexually transmitted infections (STIs).
D. Antidepressant medication may be affecting his sexual functioning.

D. Antidepressant medication may be affecting his sexual functioning.


Many drugs can affect sexual function. Antidepressants can alter sexual functioning by blocking neurotransmitters. The decision to screen the patient is based on his health history, assessment, and sexual practices.

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:

A. It's normal for me to take longer to reach an orgasm.
B. I might experience chest pain or shortness of breath during intercourse.
C. It's normal for me to lose interest in sexual relationships.
D. I won't need to be concerned about contraception or sexually transmitted infections because of my age.

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


Normal changes in the female sexual response include a decrease in sex hormone levels, decrease in vaginal lubrication, longer time to reach orgasm, and longer refractory times. Many factors such as chronic illness, medications, stress, or loss of partner can influence the older adult's sexual activity. Older adults may not be as comfortable using barrier methods such as condoms and therefore are at increased risk for sexually transmitted infections.

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 piercing and tattoos can:

A. Prevent you from being involved in contact sports.
B. Only create health problems if they are located in the nipples or genital area.
C. Increase your risk for infection at the site and in the body.
D. Be a safe and important way of establishing your personality.

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


Studies have shown that adolescents with multiple tattoos and piercings are more likely to engage in high-risk behaviors such as drug use and sex with multiple partners. Piercings and tattoos in any location can increase the risk for localized and systemic infection.