Chapter 34. Sexual Health My Nursing Test Banks

Chapter 34. Sexual Health

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. Which of the following is the most important information to collect at a womens health examination for a 52-year-old woman?

1)

Age at first sexual encounter

2)

History of PMS

3)

Birth control method used

4)

Date of last menstrual period

ANS: 4

A 52-year-old woman may be experiencing erratic periods of perimenopause. The date of her last menstrual period will help determine her perimenopausal status and guide the discussion of physical, emotional, and sexual changes that commonly occur during a period of declining estrogen production. The nurse will need to determine her menstrual status, which also includes the length and heaviness of flow, the regularity of her cycle, and any change in symptoms associated with menstruation. The nurse will also need to assess for birth control requirements in a heterosexual or bisexual woman.

PTS: 1 DIF: Moderate REF: pp. 1186-1187; application item, not directly stated in text

KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Application

____ 2. An 18-year-old high school senior comes to the local family planning clinic requesting birth control pills. When discussing sexual health with the adolescent girl, your first nursing priority would be to do which of the following?

1)

Urge the teen to practice healthful sexual behaviors.

2)

Inform her about the risk of pregnancy and STIs.

3)

Assess the teens knowledge of sexuality and reproduction.

4)

Provide detailed information about birth control pills.

ANS: 3

You cannot assume that adolescents or young adults have adequate sexual knowledge, and it is difficult for most people to admit a lack of knowledge to a professional. Therefore, when discussing sexual health with a client, the nurse must first assess the clients knowledge and understanding of reproduction and sexuality.

PTS: 1 DIF: Difficult REF: p. 1177

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Analysis

____ 3. Which is the first stage of sexual arousal?

1)

Desire

2)

Excitement

3)

Stimulation

4)

Orgasm

ANS: 1

The sexual response cycle is the sequence of physiological events that occurs when a person becomes sexually aroused. A theorist named Basson identified five stages of physiological events that occur when a person becomes sexually aroused: desire, excitement, plateau, orgasm, and resolution. Desire precedes all other stages of the cycle, but sexual response does not necessarily proceed beyond desire.

PTS:1DIF:ModerateREF:pp. 1178-1179

KEY: Nursing process: N/A | Client need: HPM | Cognitive level: Recall

____ 4. A 65-year-old widow is being given an annual physical exam. She states she has been dating a widowed man for 9 months and that the relationship is fulfilling in most areas. However, she is unable to have sexual relations because she feels she is cheating on her husband, who died 5 years ago. Her partner is very understanding, although her inability to have sexual relations is becoming a strain on their relationship. What is an appropriate nursing diagnosis for this woman?

1)

Sexual Dysfunction related to conflicted sexual orientation

2)

Ineffective Sexuality Patterns related to values conflicts

3)

Ineffective Sexuality Patterns related to impaired relationship with partner

4)

Sexual Dysfunction related to fear of the unknown

ANS: 2

The nursing diagnosis Ineffective Sexuality Patterns is used when the patient expresses concerns about her own sexuality, whereas Sexual Dysfunction is used when there is an actual change in sexual function that the patient views as unsatisfying, unrewarding, or inadequate. In this situation, the patient still views herself as being committed to her deceased husband, causing a conflict in values.

PTS:1DIFifficultREF:p. 1188

KEY: Nursing process: Diagnosis | Client need: PSI | Cognitive level: Analysis

____ 5. You are caring for a 35-year-old man who tells you that he feels distress about being a male, and ever since he was a young child has thought of himself as a female. He describes the isolation he feels and concern about fitting in socially and at work because of these recurrent thoughts. How would you respond to your patient?

1)

Provide information about support groups and other community resources for transsexual people.

2)

Reassure him that he is normal, saying there are more people than we know who feel this way.

3)

Share with him that you personally have had thoughts like this but have coped with these thoughts.

4)

Suggest your patient seek mental healthcare for medication to help him deal with his anxiety.

ANS: 1

Those experiencing a sexual identity disorder, such as transsexualism, typically feel overwhelming cultural disapproval and isolation. The lifelong stresses associated with being transsexual penetrate nearly every aspect of life: medically, socially, and emotionally. Competent and responsive healthcare is essential, and nurses can be an especially valuable source of information and support during a time of isolation and emotional inner conflict. Reassuring the patient he is normal discounts his feelings and conveys insensitivity on the part of the nurse as well as a lack of willingness to listen openly. Genuine support and active listening are important for the transsexual person who is struggling with his gender identity. Interjecting your own experiences trivializes the patients experience. The nurses first action is to offer information rather than imply that the patient has a mental health issue requiring anti-anxiety agents.

PTS:1DIF:ModerateREF:p. 1174

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

____ 6. Based on a nursing diagnosis of Ineffective Sexuality Patterns related to values conflicts, what would be the most effective nursing intervention for a patient?

1)

Educate the patient about sexual orientation and function.

2)

Encourage the patient to discuss relationship problems with her partner.

3)

Advise the patient to discuss her value conflict with a counselor.

4)

Instruct the patient on effective methods to identify fears.

ANS: 3

Effective nursing interventions address the etiology of the identified nursing diagnoses. This patient is experiencing a values conflict. Therefore, interventions must address this concern rather than issues, such as fears and relationship problems. The partner might not be the most suitable person for the patient to talk to because she would be too close to the matter; a counselor is trained to discuss sexuality and values conflicts in a professional and objective manner.

PTS:1DIF:ModerateREF:p. 1189

KEY: Nursing process: Interventions | Client need: Health Promotion | Cognitive level: Application

____ 7. What do shared touching, celibacy, masturbation, and developing intimate relationships have in common? They are all:

1)

Forms of sexuality or sexual orientation.

2)

Cues to use in formulating a nursing diagnosis.

3)

Important in the development of sexual identity.

4)

Forms of sexual expression.

ANS: 4

People express their sexuality and gain satisfaction in many ways. Developing intimate relationships, fantasies and erotic dreams, masturbation, shared touching, oralgenital stimulation, anal stimulation or intercourse, sexual intercourse, and celibacy are all forms of sexual expressioneven a lack of activity is an expression of sexuality.

PTS:1DIF:ModerateREF:pp. 1181-1182

KEY:Nursing process: N/A | Client need: PSI | Cognitive level: Analysis

____ 8. In order to discuss a clients sexual health needs in a comfortable and competent manner, it is most important for a nurse to be able to:

1)

Recognize and set aside personal biases or experiences related to sexuality.

2)

Perform an accurate and comprehensive physical assessment.

3)

Collect an accurate and comprehensive sexual history.

4)

Acquire theoretical knowledge of sexual health concerns.

ANS: 1

In many cultures, people have been socialized to avoid talking openly about sexuality. As a nurse, you will find that you must discuss a variety of issues that are vital for a clients optimal wellness. Some of these discussions may include sexual concerns, dysfunctions, infections, or behaviors. As you reflect on the issues of human sexuality, you will be challenged to confront your own biases related to sexuality and to set those aside as you work with your clients. Although theoretical knowledge is important, you will be able to use it fully only if you can identify and set aside your own biases.

PTS:1DIF:EasyREF:p. 1172

KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Comprehension

____ 9. Which of the following statements by a teenage client would indicate that your teaching about detection of STIs has been effective?

1)

A healthcare provider can tell if you have an STI just by looking at your genitals.

2)

The doctor has to do surgery to biopsy the tissue to find out if a person has an STI.

3)

A healthcare provider can tell if you have an STI by getting a detailed sexual history.

4)

A genital swab culture can be done at the office or clinic to determine if a person has an STI.

ANS: 4

Many STIs have few or no symptoms. To find out if a patient has an STI, you must obtain a swab culture of secretions. For a man, a culture is obtained from the urethra. For a woman, secretions are swabbed near the cervix.

PTS:1DIF:ModerateREF:p. 1183

KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Application

____ 10. When evaluating the treatment plan for a patient with erectile dysfunction (ED), you would deem the treatment successful if the patient made the following statement:

1)

I feel very good about the treatment; I am now comfortable with my sexual orientation.

2)

I am happy with the treatment as I can now maintain an erection through orgasm.

3)

Now I can communicate my sexual needs to my partner without embarrassment.

4)

I now know how to prevent further sexually transmitted infections.

ANS: 2

Men with erectile dysfunction have persistent or recurring inability to achieve or maintain an erection sufficient for satisfactory sexual performance. When the patient is maintaining penile erection through orgasm, this is an indication the interventions were successful. ED is not related to sexual orientation or exposure to STIs. Comfort with communicating about sexual needs is helpful for sexual satisfaction but is not the cause of ED.

PTS:1DIF:ModerateREF:p. 1185

KEY: Nursing process: Evaluation | Client need: PHSI | Cognitive level: Application

____ 11. When providing care for a client with concerns about his sexual orientation, you use the PLISSIT model. You recognize that the first step you must take is to:

1)

Provide information about sexual orientation and common alterations.

2)

Plan time to discuss concerns with the client in a private, comfortable setting.

3)

Permit the client to speak openly by communicating an open, accepting attitude.

4)

Provide referrals to the client so he can identify resources to assist him in the future.

ANS: 3

The PLISSIT model was developed as a guideline for sex therapy. Although basic nursing education does not prepare you to provide sex therapy, the first three PLISSIT steps have been adapted to address sexual knowledge deficits that you are qualified to treat. The first step, P, is to provide permission. Permission means that you communicate an open, accepting attitude so the client feels free to ask questions and express concerns and feelings.

PTS:1DIFifficultREF:p. 1196

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Comprehension

____ 12. A 24-year-old woman comes to the clinic to be evaluated for sexually transmitted infections. She states she has no symptoms, but her boyfriend is complaining of a thin, clear discharge and mild discomfort with urination. His doctor advised him that his partner should be treated because this problem may affect her future fertility. What disorder should be assessed for?

1)

Chlamydia

2)

Trichomoniasis

3)

Genital herpes

4)

Human papillomavirus

ANS: 1

The male partner exhibits symptoms of chlamydia. Women are frequently asymptomatic for chlamydia. As a result, the infection may go untreated and affect future fertility. Trichomoniasis is asymptomatic in men, but women experience a frothy, odorous vaginal discharge. Small blisters on the genitals may be seen with genital herpes. Human papillomavirus produces genital warts.

PTS:1DIFifficultREF:p. 1183

KEY: Nursing process: Assessment | Client need: PHSI | Cognitive level: Analysis

____ 13. When in the reproductive cycle is there marked growth of ovarian material and regrowth of the endometrium, ending with the release of the ovum?

1)

Menstrual phase

2)

Follicular phase

3)

Luteal phase

4)

Fertilization

ANS: 2

The luteal phase occurs after the menstrual phase. At this time, the endometrial lining builds back up after being shed with menstruation. Ovarian follicles mature until the ovum is released. The luteal phase occurs after ovulation. In this phase, if fertilization does not occur, progesterone drops and menses begins again. Fertilization occurs at the time of ovulation at which a sperm joins with the mature egg and the endometrium is ripe to support the embryo.

PTS:1DIF:ModerateREF:p. 1172

KEY:Nursing process: N/A | Client need: PHSI | Cognitive level: Recall

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Normal physiological changes in womens sexual responses that occur with aging include which of the following? Choose all that apply.

1)

Delayed nipple erection

2)

Increased vaginal expansion

3)

Reduced vaginal lubrication

4)

Reduced labial separation and swelling

ANS: 1, 3, 4

As women age, normal physiological responses in sexual behavior include delayed nipple erection, reduced vaginal lubrication, and reduced labial separation and swelling. Vaginal expansion is reduced rather than increased because of decreased estrogen and progesterone levels.

PTS:1DIF:ModerateREF:p. 1179

KEY: Nursing process: Assessment | Client need: HPM | Cognitive level: Analysis

____ 2. A 2-year-old boy has come to the well-child clinic with his mother for a checkup. When the nurse asks his mother if she has any concerns, she says, I dont know why he wont quit touching his privates all the time. I have tried sitting him in a chair, smacking his hand, and telling him no, but he continues to do this. I just dont know how to make him stop. How would you best respond to her concerns? Choose all that apply.

1)

Give him a little time, and hell grow out of it. Hes just too young to understand right now.

2)

How often do you punish him by giving him a time-out or by using physical discipline?

3)

Physical punishment is not the best way to modify a childs behavior.

4)

It isnt unusual for him to fondle his genitals, as this is part of his exploration of his body.

ANS: 2, 3, 4

The first two years of life are highly sensual as infants are nursed, stroked, bathed, and massaged, and they develop their first attachment experience through bonding with the mother. It is not unusual for infants and preschoolers to fondle their genitals and enjoy being nude. This is part of their exploration of their bodies, and parents should not overreact. Although health teaching about normal sexual development of toddlers is important, this mothers comments are a red flag to appropriate discipline. Her exaggerated response using physical reprimands to a 2-year-old child bears further exploration about other potential for physical harm or abuse within the home. The nurse has a responsibility to assess risk to the child for an abusive situation and counsel the mother about alternate methods of dealing with the behavior.

PTS:1DIF:ModerateREF:p. 1175

KEY: Nursing process: Interventions | Client need: HPM | Cognitive level: Application

____ 3. What are common reasons victims of abuse might not report an incident of sexual assault? Choose all that apply.

1)

Fear that her abuser would be angry if she reported it and would hurt her again

2)

Belief that she was to blame for starting a fight with the abuser

3)

Idea that the legal system couldnt prosecute the abuser for the crime

4)

Desire to have the incident behind her, as if it never happened in the first place

ANS: 1, 2, 3, 4

Reasons for not reporting rape include fear of the assailant, fear of consequences to the assailant, knowledge of the low conviction rate for rapists, the desire to avoid a trial, shame and embarrassment, past sexual history, self-blame, and wanting to move on and not face possible consequences involving pregnancy and sexually transmitted infection.

PTS:1DIF:ModerateREF:p. 1184

KEY: Nursing process: Evaluation | Client need: PSI | Cognitive level: Application

____ 4. Which of the following are considered sexual response cycle disorders? Choose all that apply.

1)

Arousal disorder

2)

Date rape

3)

Orgasmic disorder

4)

Low libido

ANS: 1, 3, 4

Low libido, arousal disorder, and orgasmic disorder all affect the sexual response cycle. These disorders affect desire, arousal, excitement, and orgasm. Rape occurs when there is nonconsensual vaginal, anal, or oral penetration. It occurs through force, by the threat of bodily harm, or when the victim is incapable of giving consent. Date rape is forced, unwanted sexual intercourse by an acquaintance when the assault occurs during an agreed-upon social encounter.

PTS:1DIF:EasyREF:pp. 1184-1185

KEY: Nursing process: Diagnosis | Client need: SECE | Cognitive level: Comprehension

____ 5. When caring for a woman who was sexually assaulted, what is your best approach for collecting information surrounding the event? Choose all that apply.

1)

Use a calm, reassuring voice when asking questions of your patient.

2)

Ask only close family members to describe events related to the incident.

3)

Provide privacy by asking questions behind a closed curtain.

4)

Document the details using the patients own words.

ANS: 1, 4

Use a calm, professional approach as you collect sexual data from your patients. This will not only help them to feel more comfortable and confident, but will also yield more honest and complete information. Your patient might have difficulty discussing the events relating to the assault; however, this is a private matter and not a topic to discuss with family members, regardless of the apparent closeness of the relationship. When asking personal questions, provide privacy and be sensitive to your clients cues. A curtain is not secure enough because conversation easily could be overheard. Clear, unambiguous documentation is extremely important because of the criminal nature of sexual crime. Using the patients own words is a way for the nurse to avoid misinterpreting the facts as well as keep from introducing bias or drawing conclusions about the event.

PTS:1DIF:ModerateREF:p. 1184; not directly stated in text

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

____ 6. You are caring for a 32-year-old woman who has been sexually assaulted. What nursing interventions are initially most important for this client?

1)

Help her to communicate effectively with police about the attack.

2)

Obtain permission from your client to test for pregnancy and STIs.

3)

Refer your client to a sexual assault support group.

4)

Promote and model empathy and support for her family members.

ANS: 2, 3

A victim of rape has experienced psychological and physiological trauma. Sexual assault is a risk factor for sexually transmitted infection (STI). Testing for STIs and pregnancy is a necessary component of the physical care of a victim of sexual violence. Referral to a local sexual assault support group is critical when planning care. A sexual assault nurse examiner (SANE), who is a registered nurse, can assist the client through the physical examination, police interview, and disclosure to family members, all of which are important activities.

PTS: 1 DIF: Moderate REF: p. 1184

KEY: Nursing process: Interventions | Client need: PSI | Cognitive level: Application

Completion

Complete each statement.

1.____________________ includes how we perceive ourselves, how we relate to others, and how we express ourselves as sexual beings.

ANS: Sexuality

Definition.

PTS: 1 DIF: Moderate REF: p. 1172

KEY:Nursing process: Interventions | Client need: PSI | Cognitive level: Recall

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