Sexual Health Chapter 32

Question 1

Identify the major structures of the female reproductive system.

Answer 1

Answer:
Major structures of the female reproductive system are as follows:
●   Pair of ovaries and fallopian tubes
●   Uterus
●   Vagina
●   External genital tissues

Question 2

Summarize the three phases of the menstrual cycle.

Answer 2

Answer:
The three phases of the menstrual cycle are menstrual, follicular, and luteal.
● The menstrual phase is associated with the shedding of the endometrial lining of the uterus and the development of several ovarian follicles.
● The follicular phase is associated with growth of ovarian follicles and regrowth of the endometrium of the uterus.
● In the luteal phase, the ruptured follicle begins to secrete progesterone, which further stimulates growth of the endometrium. If fertilization occurs, the endometrium is ready to support an embryo. If fertilization does not occur, the progesterone level drops and menses begin.

Question 3

Identify the major structures of the male reproductive system.

Answer 3

Answer:
Major structures of the male reproductive system are as follows:
● Testes, which produce sperm
● A series of ducts, including the epididymis, ductus deferens, ejaculatory duct, and urethra, that transport the sperm and semen
● Glands, including the seminal vesicles, prostate, and bulbourethral glands, that add secretions that mix with the sperm to produce semen

Question 4

How is gender determined?

Answer 4

Answer:
Gender is determined by the chromosomes provided by the ovum and sperm at the moment of conception. The female contributes the X chromosome. The male contributes either an X or a Y chromosome.
● An XX grouping produces a female offspring.
● An XY grouping produces a male offspring.

Question 5

Distinguish gender, gender role, and gender identity.

Answer 5

Answer:
Gender, gender role, and gender identity are distinguished as follows:
● Gender indicates the biological sex status.
● Gender roles are the expressions of gender that are congruent with the expectations of our culture.
● Gender identity is how we perceive ourselves, as male or female.

Question 6

What is androgyny?

Answer 6

Answer:
The word androgyny is a combination of the Greek words for male, “andro,” and for female, “gyn.” It is the recognition that each of us has skills and behaviors that may be classified as either masculine or feminine.

Question 7

What are the majority and minority sexual orientations in our culture?

Answer 7

Answer:
In our culture, the majority and minority sexual orientations are as follows:
● Majority. Heterosexuality is thought to be the dominant sexual orientation.
● Minority. Homosexuality and bisexuality are minority sexual orientations.

Question 8

What is meant by transgender?

Answer 8

Answer:
Transgender (or “differently gendered”) is a broad term encompassing all manners of crossing gender barriers. That is, a person’s gender identity is different from the person’s apparent biological sex. For example, some people think of themselves as female even though they have male genitalia. Longitudinal studies have shown that there are varied sexual orientation outcomes for transgender persons (Zucker, 2000): They may be heterosexual, homosexual, or bisexual as adults. Transgender persons may be transsexual, intersexed, or cross-dressers.

Question 9

Why is it important to consider sexuality throughout the lifecycle?

Answer 9

Answer:
It is important to consider sexuality throughout the lifecycle because we are sexual beings from birth to death. Expression of our sexuality evolves through the life span.

Question 10

What are the two major contributing factors to adolescents’ heightened sexual interest and activity?

Answer 10

Answer:
Adolescents’ heightened sexual interest and activity are due to these two major contributing factors:
● Hormonal changes accompanying puberty
● Cultural emphasis on sex

Question 11

What aspects of human sexuality are associated with young and middle adulthood?

Answer 11

Answer:
Young and middle adulthood are associated with the following aspects of sexuality:
●   Definition of sexual identity
●   Resolution of issues related to sexual orientation
●   Establishing a life partnership
●   Parenting
●   “Emptying the nest”
●   Menopause
●   Emergence of chronic disease

Question 12

What challenges to sexuality may be found in the aging adult?

Answer 12

Answer:
Aging adults experience the following challenges to sexuality:
● Loss of health
● Loss of partner
● Loss of privacy
● Physical changes, such as loss of vaginal lubrication in women and difficulty maintaining an erection in men

Question 13

What sexual knowledge would you expect an adult male with children to have?

Answer 13

Answer:
You cannot make assumptions that an adult male with children has knowledge about sexuality or reproduction. You will need to assess his knowledge base.

Question 14

What sexual knowledge would you expect a nursing student to have?

Answer 14

Answer:
A nursing student should be prepared to address clients’ concerns about sexuality and therefore should have a broad knowledge base on sexuality.

Question 15

Identify four factors associated with physical illness that may affect sexuality or sexual functioning.

Answer 15

Answer:
Answers may include any four of the following factors associated with chronic illness that may affect sexuality:
●   Activity intolerance
●   Limitations of mobility
●   Pain
●   Attitudes toward disability
●   Self-esteem changes

Question 16

What determines our sexual attitudes?

Answer 16

Answer:
Our sexual attitudes are determined by the integration of culture, religion, lifestyle, education, and health status into our own personal values.

Question 17

Identify the phase (of the sexual response cycle) described.

● This phase is reached if there is ongoing stimulation. This stage may be achieved, lost, and regained several times without the occurrence of orgasm.

Answer 17

Answer:

Plateau phase

Question 18

Identify the phase (of the sexual response cycle) described.

This stage occurs in the mind and may be communicated between potential sexual partners either verbally or through body language.

Answer 18

Answer:

Desire phase

Question 19

Identify the phase (of the sexual response cycle) described.

● This phase is associated with the release of sexual tension.

Answer 19

Answer:

Orgasm phase

Question 20

What are aspects of an intimate relationship?

Answer 20

Answer:
The following are aspects of an intimate relationship:
●   Trust
●   Openness
●   Mutual respect
●   Caring
●   Commitment
●   Protection
●   Honesty
●   Devotion
The relationship may or may not include sexual activity.

Question 21

Identify solitary types of sexual expression and those that may be conducted with a partner.

Answer 21

Answer:
The following types of sexual expression are solitary or conducted with a partner.
● Solitary sexual expressions may include fantasies, erotic dreams, or masturbation. Some individuals choose to be celibate.
● With a partner, sexual expressions may include mutual masturbation/shared touching, oral–genital stimulation, anal stimulation/anal intercourse, or coitus.

Question 22

Identify three methods to decrease the transmission of STIs.

Answer 22

Answer:
Any three of the following methods decrease the transmission of STIs:
● Celibacy
● Participation in a committed, mutually monogamous relationship
● Limiting the number of partners
● Use of latex barriers (e.g., condoms)
● Use of dental dams for cunnilingus
● Avoiding high-risk behaviors, such as poor sexual choices as a result of drugs and alcohol
● Having regular checkups for STIs
● Complying with any prescribed treatment
● Accepting personal responsibility for actions

Question 23

What are physical and emotional symptoms of premenstrual syndrome (PMS)?

Answer 23

Answer:
Premenstrual syndrome may include the following symptoms:
● Physical symptoms are headaches, constipation, breast tenderness, weight gain, and swelling.
● Emotional symptoms are depression, anxiety, irritability, tension, and an inability to concentrate.

Question 24

Identify three forms of sexual victimization.

Answer 24

Answer:
The three forms of sexual victimization are as follows:
●   Sexual abuse
●   Sexual harassment
●   Rape

Question 25

In which phases of the sexual response cycle can sexual dysfunction occur?

Answer 25

Answer:
During the sexual response cycle, sexual dysfunction can occur during these phases:
●   Arousal
●   Excitement
●   Orgasm

Question 26

What techniques can you use to increase comfort and communication during a sexual history assessment?

Answer 26

Answer:
A variety of answers are possible, including the following techniques:
● Make provisions for a private setting
● Be unhurried
● Avoid communication stoppers
● Be sensitive to verbal and nonverbal cues that indicate concerns

Question 27

Dyspareunia

Answer 27

Painful intercourse

Question 28

Exhibitionism

Answer 28

Exposing genitals to unsuspecting person

Question 29

Libido

Answer 29

Also known as desire

Question 30

Menarche

Answer 30

Beginning of menstruation

Question 31

Hermaphrodite

Answer 31

Born with ambiguous sex organs

Question 32

A male clinical instructor tells a female nursing student that she will definitely pass her clinical rotation if she agrees to go on a date with him. This is an example of which of the following?
A.  Date rape
B.  Negative intimate relationship
C.  Sexual harassment
D.  Sexual masochism

Answer 32

Answer:
C. Sexual harassment

Response:
The instructor is implying that the nursing student must accept unwanted sexual advances in return for a passing grade, a form of “quid pro quo” sexual harassment.

Question 33

Mrs. Blankenship is a 52-year-old woman who has come to the clinic for her “well woman” check. She states to the nurse, “I think I’m beginning menopause.” The nurse’s best response would be which of the following?
A. “Oh, it will be so wonderful for you not to be bothered by your monthly menses anymore.”
B. “What are your feelings about that?”
C. “You will need to start taking hormone replacement therapy now.”
D. “Menopause is a normal occurrence, and you don’t need to worry about it at all.”

Answer 33

Answer:
B. “What are your feelings about that?”

Rationale:
Response B is an open-ended statement that will enable the nurse to gather further data about the patient’s concerns. Responses A and D subject the patient to the nurse’s beliefs and values about issues related to sexual health. It is up the patient, in collaboration with the physician, to determine whether hormone replacement therapy is appropriate.

Question 34

Mr. Caruthers and Mrs. Duncan are older adults, widowed, and live in separate rooms in an assisted living facility. The nurse aide reports to the nurse that she has just seen the couple kissing and holding hands. The nurse aide then begins to laugh. A correct nursing action would be which of the following?
A. Instruct the nurse aide that older adults still experience sexual pleasure.
B. Call the administrator and inform her of the couple’s action.
C. Tell the nurse aide to confront the couple and tell them to act their age.
D. Laugh with the nurse aide, and tell her that nothing will happen anyway because the couple is old.

Answer 34

Answer:
A. Instruct the nurse aide that older adults still experience sexual pleasure.

Rationale:
Other responses are not appropriate. The administrator would have no say in the couple’s actions. Telling the couple to act their age is disrespectful of their sexual health needs, and it is known that many older adults still participate in and enjoy sexual activity. Response D shows a lack of knowledge as well as lack of respect.

Question 35

When a newborn baby is identified as being a boy, we are noting the baby’s
A.  gender role.
B.  gender identity.
C.  gender.
D.  gender choice.

Answer 35

Answer:

C. gender.

Question 36

When a patient is giving his sexual history to the nurse, he states that he has a same-sex partner. The nurse’s best response would be which of the following?
A. “I have some material that will help you to overcome your condition.”
B. “Tell me about your partner.”
C. “I can put you in touch with a wonderful psychiatrist.”
D. “It will be better for you if you do not share that information with the rest of the staff.”

Answer 36

Answer:
B. “Tell me about your partner.”

Rationale:
Other responses are inappropriate. Homosexuality is not a “condition”; it is a person’s sexual orientation. Being gay is not a psychiatric disease. Telling the patient not to tell anyone is disrespectful to the patient’s sexual identity.

Question 37

he nursing diagnosis Ineffective Sexuality Patterns can be used when describing vaginismus.

Answer 37

Answer:
False

Rationale:
The correct diagnosis would be Sexual Dysfunction.

Question 38

An important issue about sexually transmitted infections is that many patients are asymptomatic.

Answer 38

Answer:
True

Rationale:
This fact often leads to delayed treatment and spread of the infection.

Question 39

After having surgery for benign prostatic hypertrophy, a male patient will always experience impotence.

Answer 39

Answer:
False

Rationale:
This will depend on the type surgery done. Impotence is not an expected outcome.

Question 40

Shared touch can be a way to maintain celibacy.

Answer 40

Answer:
False

Rationale:
Technically, the term celibacy means refraining from all sexual activity. Although persons who are celibate certainly “touch” others, the intent would not be to achieve sexual gratification.

Question 41

You are caring for a healthy 28-year-old man with a fractured tibia (bone in the lower leg). The patient has asked you to place his penis in the urinal and hold it while he voids. You should:

1) assist the patient as he has requested.
2) immediately leave the room.
3) tell him his behavior is inappropriate.
4) report him to your supervisor.

Answer 41

Answer:
3) tell him his behavior is inappropriate.

Rationale:
The patient’s request is unnecessary and should be considered a request for sexual stimulation. If you believe a client is demonstrating inappropriate sexual behaviors, immediately tell the client that his behavior is inappropriate. If this is unsuccessful, you may need to inform your supervisor or request a change in assignment.

Question 42

Which topic is most important to include when educating all clients about sexuality?

1) Contraception
2) Sexually transmitted infections (STIs)
3) Sexual orientation
4) Sexual identity

Answer 42

Answer:
2) Sexually transmitted infections (STIs)

Rationale:
STIs are among the most common infectious diseases in the United States today. More than 20 different STIs have been identified, and they affect millions of men and women in this country each year. In 2000, the Centers for Disease Control and Prevention (CDC) estimated 18.9 million new cases were reported. Educating on prevention is absolutely critical.

Question 43

NANDA has two nursing diagnoses for describing sexual problems: Ineffective Sexuality Patterns and Sexual Dysfunction. How would you determine which diagnosis to use on a client?

1) Use Ineffective Sexuality Patterns when the patient expresses concern about the ability to achieve his perceived sex role.
2) Use Ineffective Sexuality Patterns when the patient is seeking confirmation of desirability.
3) Use Sexual dysfunction when the patient is experiencing values conflicts in the area of sexuality.
4) Use Sexual Dysfunction when the patient expresses dissatisfaction with an actual change in sexual functioning (e.g., difficulty maintaining an erection).

Answer 43

Answer:
4) Use Sexual Dysfunction when the patient expresses dissatisfaction with an actual change in sexual functioning (e.g., difficulty maintaining an erection).

Rationale:
There is much overlap between these two NANDA diagnoses; however, Sexual Dysfunction is the more specific diagnosis for physiological and performance problems.

Question 44

What is the term for a person who feels a personal identity as the opposite gender for which he or she was born?

1) Transvestite
2) Intersexual
3) Homosexual
4) Transsexual

Answer 44

Answer:
4) Transsexual

Rationale:
Transgendered (or “differently gendered”) is a broad term used to describe people whose gender identity differs in some way from their apparent biological gender. A transsexual is a person who identifies his or her own self image as the opposite gender of birth. This is also referred to as a gender identity disorder. Intersexed people are born with ambiguous sexual organs. For example, the person may have female internal organs (ovaries, a uterus), but an external penis. An older term for this is hermaphrodite. A homosexual person is one whose focus of sexual attraction is those of the same gender. A cross-dresser (or transvestite) is a person who occasionally or frequently wears the clothing characteristic of the opposite sex, particularly the undergarments, as a form of sexual expression.

Question 45

Which of the following is a DSM category of sexual deviation that a client might require mental health care?

1) Homosexuality
2) Voyeurism
3) Bisexuality
4) Transgenderism

Answer 45

Answer:
2) Voyeurism

Rationale:
The Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2000) describes eight categories of sexual deviation or paraphilias: exhibitionism, fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestic fetishism, and voyeurism. Homosexuality and bisexuality are forms of sexual orientation. A transgendered person is someone with a gender identification issue.

Question 46

A 17-year-old woman with Down syndrome is brought to the emergency department by her parents after an incident of sexual assault by her uncle. What would you do when providing care to her after the incident? Select all that apply.

1) Document pregnancy status with a urine or blood sample.
2) Advise parents to have her tested for STIs 1 week after the incident.
3) Administer the hepatitis B and HPV vaccines, as ordered.
4) Refer the victim to a sexual assault center for further information and counseling.

Answer 46

Answer:

1) Document pregnancy status with a urine or blood sample.
3) Administer the hepatitis B and HPV vaccines, as ordered.

Rationale:
The risk for sexually transmitted infections (STIs) is extremely high in cases of sexual assault. Not only should prophylactic treatment be given for STIs, such as gonorrhea or chlamydia, but you might also administer vaccines to prevent hepatitis B and human papillomavirus (HPV), as prescribed and according to your agency’s policy. If there is a significant risk for HIV, prophylaxis may be prescribed within 72 hours of exposure. The victim should receive follow-up care 1 week after the event to assess for healing of injuries and presence of sexually transmitted infection. Female adolescents who have experienced a sexual assault should be offered emergency contraception, even if vaginal penetration cannot be determined with certainty. At the time of the evaluation, pregnancy status should be documented with either a blood or urine sample. Because of the long-term psychologic and emotional consequences of sexual assault, victims most often benefit from counseling. Consider referring the victim to a sexual assault center for support, counseling, and additional information.