Chapter 20: Sexual Dysfunctions, Gender Dysphoria, and Paraphilias My Nursing Test Banks

Chapter 20: Sexual Dysfunctions, Gender Dysphoria, and Paraphilias

MULTIPLE CHOICE

1. A new staff nurse tells the clinical nurse specialist, I am unsure about my role when patients bring up sexual problems. The clinical nurse specialist should give clarification by saying, All nurses:

a.

qualify as sexual counselors. Nurses have knowledge about the biopsychosocial aspects of sexuality throughout the life cycle.

b.

should be able to screen for sexual dysfunction and give basic information about sexual feelings, behaviors, and myths.

c.

should defer questions about sex to other health care professionals because of their limited knowledge of sexuality.

d.

who are interested in sexual dysfunction can provide sex therapy for individuals and couples.

ANS: B

The basic education of nurses provides information sufficient to qualify the generalist to assess for sexual dysfunction and perform health teaching. Taking a detailed sexual history and providing sex therapy requires additional training in sex education and counseling. Nurses with basic education are not qualified to be sexual counselors. Additional education is necessary. A registered nurse may provide basic information about sexual function, but complex questions may require referral.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 380-381 | Page 385 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

2. A nurse is performing an assessment for a 59-year-old man who has hypertension. What is the rationale for including questions about prescribed medications and their effects on sexual function in the assessment?

a.

Sexual dysfunction may result from use of prescription medications for management of hypertension.

b.

Such questions are an indirect way of learning about the patients medication adherence.

c.

These questions ease the transition to questions about sexual practices in general.

d.

Sexual dysfunction can cause stress and contribute to increased blood pressure.

ANS: A

Some of the drugs used to treat hypertension can interfere with normal sexual functioning and lead to sexual disorders. Hypertension itself can lead to acquired erectile dysfunction. It would not be appropriate or necessary to use such inquiries as a lead-in to other sexual health topics. Sexual dysfunction, while stressful, does not cause hypertension.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 385 (Table 20-1) | Page 387 (Table 20-3) 388-389

TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

3. An adult experienced a myocardial infarction six months ago. At a follow-up visit, this adult says, I havent had much interest in sex since my heart attack. I finished my rehabilitation program, but having sex strains my heart. I dont know if my heart is strong enough. Which nursing diagnosis applies?

a.

Deficient knowledge related to faulty perception of health status

b.

Disturbed self-concept related to required lifestyle changes

c.

Disturbed body image related to treatment side effects

d.

Sexual dysfunction related to self-esteem disturbance

ANS: A

Patients who have had a myocardial infarction often believe sexual intercourse will cause another heart attack. The patient has completed the rehabilitation, but education is needed regarding sexual activity. These patients should receive information about when sexual activity may begin, positions that conserve energy, and so forth. The scenario does not suggest self-concept or body image disturbance.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 382 | Page 388 TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Health Promotion and Maintenance

4. Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder? The nurse should:

a.

develop an understanding of human sexual response.

b.

assess the patients sexual functioning and needs.

c.

acquire knowledge of the patients sexual roles.

d.

clarify own personal values about sexuality.

ANS: D

Before one can be helpful to patients with sexual dysfunctions or disorders, the nurse must be aware of his or her own feelings and values about sex and sexuality. Nurses must keep their personal beliefs separate from their patient care in order to remain objective, professional, and effective. Nurses must be comfortable with the idea that patients have a right to their own values and must avoid criticism and censure. The other options are indicated as well, but self-awareness must precede them to provide the best care.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 380-381 | Page 385-386 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

5. A patient tells the nurse that his sexual functioning is normal when his wife wears short, red camisole-style nightgowns. He states, Without the red teddies, I am not interested in sex. The nurse can assess this as consistent with:

a.

exhibitionism.

c.

frotteurism.

b.

voyeurism.

d.

fetishism.

ANS: D

To be sexually satisfied, a person with a sexual fetish finds it necessary to have some external object present, in fantasy or in reality. Frotteurism involves deriving sexual pleasure from rubbing against others surreptitiously.Exhibitionism is the intentional display of the genitalia in a public place. Voyeurism refers to viewing others in intimate situations.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 392-393 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

6. While performing an assessment, the nurse says to a patient, While growing up, most of us heard some half-truths about sexual matters that continue to puzzle us as adults. Do any come to your mind now? The purpose of this question is to:

a.

identify areas of sexual dysfunction for treatment.

b.

determine possible homosexual urges.

c.

introduce the topic of masturbation.

d.

identify sexual misinformation.

ANS: D

Misinformation about normal sex and sexuality is common. Lack of knowledge may affect an individuals sexual adjustment. Once myths have been identified, the nurse can give information to dispel the myth.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 387 (Table 20-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

7. A woman tells the nurse, My partner is frustrated with me. I dont have any natural lubrication when we have sex. What type of sexual disorder is evident?

a.

Genito-Pelvic Pain/Penetration Disorder

b.

Female Sexual Interest/Arousal Disorder

c.

Hypoactive Sexual Desire Disorder

d.

Female Orgasmic Disorder

ANS: B

One feature of female sexual interest/arousal disorder relates to inability to maintain physiologic requirements for intercourse. For women, this includes problems with lubrication and swelling. The patients description does not meet criteria for diagnoses in the distracters.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 382-383 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

8. The male manager of a health club placed a hidden video camera in the womens locker room and recorded several women as they showered and dressed. The disorder most likely represented by this behavior is:

a.

homosexuality.

c.

pedophilia.

b.

exhibitionism.

d.

voyeurism.

ANS: D

Voyeurism is achieving sexual pleasure through the viewing of others in intimate situations, such as undressing, bathing, or having sexual relations. A homosexual individual would be interested in watching members of the same sex, and homosexuality is not typically associated with voyeurism. Exhibitionists are interested in exposing their genitals to others. Pedophiles seek sexual contact with children.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 393-394 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

9. A woman consults the nurse practitioner because she has not achieved orgasm for 2 years, despite having been sexually active. This is an example of:

a.

Paraphilic Disorder.

b.

Female Orgasmic Disorder.

c.

Genito-Pelvic Pain/Penetration Disorder.

d.

Female Sexual Interest/Arousal Disorder.

ANS: B

The persistent inhibition of orgasm is a form of sexual dysfunction called female orgasmic disorder. Genito-pelvic pain/penetration disorder applies to painful intercourse. The patient has not indicated that her interest in sexual activity is diminished, so female sexual interest/arousal disorder does not apply. Paraphilic disorder is not applicable.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 383-384 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

10. An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which nursing diagnosis is most appropriate for this scenario?

a.

Defensive coping

c.

Ineffective sexuality pattern

b.

Sexual dysfunction

d.

Disturbed sensory perception, tactile

ANS: B

Sexual dysfunction is the most appropriate nursing diagnosis for a patient who is experiencing a problem affecting one or more phases of arousal. This is the primary problem reported by this patient. Ineffective sexuality pattern, since it is due to sexual dysfunction, is secondary to the absence of orgasms. The patient has not indicated she does not become aroused, just that she cannot achieve orgasm. Disturbed sensory perception may be part of the etiology, but the problem is sexual dysfunction. There is no evidence of defensive coping.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 382 | Page 385 (Table 20-1) | Page 388-389 (Table 20-4)

TOP: Nursing Process: Diagnosis/Analysis

MSC: Client Needs: Psychosocial Integrity

11. An adult consulted a nurse practitioner because of an inability to achieve orgasm for 2 years, despite having been sexually active. This adult was frustrated and expressed concerns about the relationship with the sexual partner. Which documentation best indicates the treatment was successful?

a.

No complaints related to sexual function; to return next week.

b.

Patient reports achieving orgasm last week; seems very happy.

c.

Reports satisfaction with sexual encounters; feels partner is supportive.

d.

Reports achieving orgasm occasionally; relationship with partner is adequate.

ANS: C

Human sexuality, sexual expression, and expectations related to sexuality vary tremendously from person to person and across cultures. Therefore, the best indication of satisfactory treatment is that the patient is satisfied with what has been achieved. In this instance, Patient reports satisfaction with sexual encounters; feels partner is supportive best indicates that the patient is satisfied, and both presenting issues are progressing in a positive manner. Achieving orgasm once or occasionally may or may not represent satisfactory progress to the patient. No complaints does not necessarily mean that satisfaction exists.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 390-391 TOP: Nursing Process: Evaluation

MSC: Client Needs: Psychosocial Integrity

12. Which characteristic fits the usual profile of an individual diagnosed with pedophilic disorder?

a.

Homosexual

c.

Seeks access to children

b.

Ritualistic behaviors

d.

Self-confident professional

ANS: C

Persons with pedophilic disorder usually place themselves in jobs, activities, or relationships that provide easy access to children. They often become trusted by both parents and children. The other characteristics have no particular relationship to pedophilic disorder.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 392 (Box 20-3) | Page 393-394

TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

13. A nurse is anxious about assessing the sexual history of a patient who is considerably older than the nurse is. Which statement would be most appropriate for obtaining information about the patients sexual practices?

a.

Some people are not sexually active, others have a partner, and some have several partners. What has been your pattern?

b.

Sexual health can reflect a number of medical problems, so Id like to ask if you have any sexual problems you think we should know about.

c.

Its your own business, of course, but it might be helpful for us to have some information about your sexual history. Could you tell me about that, please?

d.

I would appreciate it if you could share your sexual history with me so I can share it with your health care provider. It might be helpful in planning your treatment.

ANS: A

Explaining that sexual practices vary helps reduce patient anxiety about the topic by normalizing the full range of sexual practices so that whatever his situation, the patient can feel comfortable sharing it. Its your business of course implies the nurse does not have a valid reason to seek the information and in effect suggests that the patient perhaps should not answer the question. It might be helpful makes the information seem less valid or important for the nurse to pursue and, again, could discourage the patient from responding fully. Asking if the patient has any sexual problems that staff should know about is not unprofessional, but it is a very broad question that may increase a patients uncertainty about what the nurse wants to hear, thus increasing his anxiety. Defining or giving an example of sexual problem would make this inquiry more effective.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 385-387 (Table 20-2) TOP: Nursing Process: Assessment

MSC: Client Needs: Health Promotion and Maintenance

14. A man says, I enjoy watching women when I am out in public. I like to go to places where I can observe women crossing their legs in hopes of seeing something good. Which statement about this behavior is most accurate?

a.

It is a sexual disorder. The behavior is socially atypical. It could disrupt relationships and could be insulting to others.

b.

It is not a sexual disorder. These events occur in public, where those he observes do not have a reasonable expectation of privacy.

c.

It is not a sexual disorder. Because it occurs in public areas, this behavior does not hurt others or involve intrusion into the personal space of those observed.

d.

An action is or is not a sexual disorder depending on applicable local laws, so whether this meets the definition of a sexual disorder depends on the location.

ANS: A

A sexual disorder is defined as an activity that is socially atypical, has the potential to disrupt significant relationships, and may result in insult or injury to others. The behavior described constitutes a sexual disorder (voyeurism). Although laws vary, an act does not have to be illegal to constitute a sexual disorder. The fact that the behavior occurs in a public setting could have a bearing on whether it is illegal, but not on whether it is considered to be a sexual disorder.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 381-382 | Page 393-394 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

15. A parent who is very concerned about a 3-year-old son says, He likes to play with girls toys. Do you think he is homosexual or mentally ill? Which response by the nurse most professionally describes the current understanding of gender identity?

a.

A childs interest in the activities of the opposite gender is not unusual or related to sexuality. Most children do not carry cross-gender interests into adulthood.

b.

Its difficult to say for sure because the research is incomplete so far, but chances are that he will grow up to be a normal adult.

c.

The research is incomplete, but many boys play with girls toys and turn out normal as adults.

d.

I am sure that whatever happens, he will be a loving son, and you will be a proud parent.

ANS: A

The parents inquiry is really two questions: (1) whether the childs behavior suggests an increased risk of developing mental illness and (2) what the childs future sexual preference will be. The psychiatric disorder that most directly addresses gender preferences and cross-gender activities is gender identity disorder. Pointing out that cross-gender activities are not necessarily related to gender identity and not likely to be carried into adulthood is supported by current research. Saying the child will grow up to be normal implies that to be homosexual is to be abnormal, which reflects a cultural perspective that most professionals would believe to be inappropriate to share in a professional setting. Research provides information about the relationship between cross-gender interests in childhood and adulthood, so a comment that research is incomplete is not entirely accurate. Stating that the child is a wonderful boy the father will be proud of, whatever happens, evades the parents question and suggests that parental bonds should not be affected by gender issues. The nurse has a professional obligation to maintain an objective, therapeutic relationship.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 397 TOP: Nursing Process: Implementation

MSC: Client Needs: Health Promotion and Maintenance

16. Which statement about paraphilic disorders is accurate?

a.

Paraphilic behavior is controllable by willpower, but most persons with these disorders fail to do so.

b.

Persons with paraphilic disorders rarely experience shame and are not distressed by their acts.

c.

Persons with paraphilic disorders prey primarily on female children between the ages of 12 and 15 years.

d.

Acts of paraphilia are common because persons with the disorders commit the acts repeatedly, but paraphilic disorders are uncommon.

ANS: D

Paraphilic disorders are uncommon; however, because persons with these disorders repeatedly enact behaviors associated with their disorders, paraphilic acts are relatively common. The majority of victims of pedophiles are males in early adolescence; those pedophiles who prefer females usually prefer prepubescent children. Some persons with paraphilic disorders experience shame and are at higher risk for suicide due to the stigma, shame, and embarrassment. Biological and psychological drives underlying paraphilic behavior can be very strong and often are not controllable by willpower alone. Persons with paraphilic disorders have difficulty controlling their behavior, even when very motivated to do so.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 394 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

17. A respected school coach was arrested after a student reported the coach attempted to have sexual contact. Which nursing action has priority in the period immediately following the coachs arrest?

a.

Determine the nature and extent of the coachs sexual disorder.

b.

Assess the coachs potential for suicide or other self-harm.

c.

Assess the coachs self-perception of problem and needs.

d.

Determine whether other children were harmed.

ANS: B

Pedophiles and other persons with paraphilic disorders can be at increased risk of self-harm associated with the guilt, shame, and anger they feel about their behavior and its effect on their families, victims, and victims families. They also face considerable losses, such as the end of their careers or the loss of freedom to imprisonment. Thus, safety is the priority issue for assessment. Determining the nature and extent of the patients disorder and related patient perceptions would be appropriate but not the highest priority for assessment. Investigating whether other victims exist is a matter for law enforcement rather than health care personnel. See relationship to audience response question.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Page 395-396 (Table 20-6) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

18. An adult seeks treatment for urges involving sexual contact with children. The adult has not acted on these urges but feels shame. Which finding best indicates that this adult is making progress in treatment? The adult:

a.

consistently avoids schools and shops at malls only during school hours.

b.

indicates sexual drive and enjoyment from sex have decreased.

c.

reports an active and satisfying sex life with an adult partner.

d.

volunteers to become a scout troop leader.

ANS: A

One strategy for avoiding acting on inappropriate urges is to avoid environments and circumstances that evoke those urges; for a pedophile this would include avoiding all situations that would likely result in contact with children. Pedophilic disorder is persistent; elimination of fantasies about children would be unrealistic. A person who volunteers to lead a scout troop is placing himself/herself around children. A diminished sex drive or a healthy sex life with an appropriate partner does not necessarily reduce the desire for sexual contact with children.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 396 (Table 20-6) | Page 392 (Box 20-3) | Page 397-398

TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

19. A patients medical record documents sexual masochism. This patient derives sexual pleasure:

a.

from inanimate objects.

b.

by inflicting pain on a partner.

c.

when sexually humiliated by a partner.

d.

from touching a non-consenting person.

ANS: C

Sexual masochism is sexual pleasure derived from being humiliated, beaten, or otherwise made to suffer. The distracters refer to fetishism, sexual sadism, and frotteurism.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 397-398 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

20. A man with hypospadias tells the nurse, Intercourse with my new bride is painful. Which term applies to the patients complaint?

a.

Delayed ejaculation

b.

Erectile dysfunction

c.

Premature ejaculation

d.

Genito-pelvic pain/penetration disorder

ANS: D

This sexual pain is genito-pelvic pain/penetration disorder and may occur in men or women. The individual feels pain in the genitals during intercourse. Erectile or ejaculation problems are not evident. See relationship to audience response question.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 382-384 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity

21. A man who regularly experiences premature ejaculation tells the nurse, I feel like such a failure. Its so awful for both me and my partner. Select the nurses most therapeutic response.

a.

I sense you are feeling frustrated and upset.

b.

Tell me more about feeling like a failure.

c.

You are too hard on yourself.

d.

What do you mean by awful?

ANS: A

Using reflection and empathy promotes trust and conveys concern to the patient. The distracters do not offer empathy, probe, and offer premature reassurance.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 381-382 | Page 387 (Table 20-2) | Page 392 | Page 393-394

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

22. A man who reports frequently experiencing premature ejaculation tells the nurse, I feel like such a failure. Its so awful for both me and my partner. Can you help me? Select the nurses best response.

a.

Have you discussed this problem with your partner?

b.

I can refer you to a practitioner who can help you with this problem.

c.

Have you asked your health care provider for prescription medication?

d.

There are several techniques described in this pamphlet that might be helpful.

ANS: B

The primary role of the nurse is to perform basic assessment and make appropriate referrals. The other options do not clarify the nurses role.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 387 (Table 20-2) | Page 388-389

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment

23. A 10-year-old boy is diagnosed with gender dysphoria. Which assessment finding would the nurse expect?

a.

Having tea parties with dolls

b.

A compromised sexual response cycle

c.

Identifying with boys who are athletic

d.

Intense urges to watch his parents have sex

ANS: A

An individual with gender dysphoria feels at odds with the roles associated with that gender. A child with this diagnosis is likely to engage in play associated with the opposite gender. The other options are not age appropriate or characteristically seen in children with gender dysphoria.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 391 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

24. A patient approaches the nurse in the clinic waiting room and says, I want to talk to you about a sexual matter. The nurse can best facilitate the discussion by:

a.

saying, Lets go my office.

b.

responding, I want to help. Go ahead; Im listening.

c.

telling the patient, Lets schedule another appointment.

d.

offering to sit in a corner of the waiting room with the patient.

ANS: A

A discussion of sexual concerns requires privacy. Suggesting use of office space is preferable to using the waiting room, where others cannot help but overhear sensitive material. The distracters block communication.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Page 381-382 | Page 387 (Table 20-2) | Page 392 | Page 393-394

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

MULTIPLE RESPONSE

1. A nurse assesses a patient diagnosed with pedophilic disorder. Which findings are most likely? Select all that apply.

a.

Childhood history of attention deficit hyperactivity disorder (ADHD)

b.

A poorly managed endocrine disorder

c.

History of brain injury

d.

Cognitive distortions

e.

Grandiosity

ANS: A, C, D

Attention deficit hyperactivity disorder (ADHD) in childhood, substance abuse, phobic disorders, and major depression/dysthymia are strongly associated with paraphilic disorders. Errors in thought make it seem acceptable for deviant and destructive sexual behaviors to occur. Patients who have experienced head trauma with damage to the frontal lobe of the brain may display symptoms of promiscuity, poor judgment, inability to recognize triggers that set off sexual desires, and poor impulse control. Endocrine problems are not associated with pedophilic disorder. Self-confidence is lacking; therefore, grandiosity would not be expected.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 393-394 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

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