Question 1

A 55-year-old patient is recuperating from a myocardial infarction.At a follow-up visit to his physician's office,he tells the nurse practitioner,"I haven't had much interest in sex since my heart attack.My wife is wondering if something's wrong with me.The truth is,I know having sex puts a strain on my heart,and I don't know if my heart is strong enough." The nursing diagnosis for this patient would be:

Accepted Answer

Patients who have had a myocardial infarction often believe sexual intercourse will cause another heart attack.These patients should receive information about when sexual activity may begin,positions that conserve energy,and so forth.The scenario does not suggest self-esteem disturbance.The scenario describes sexual dysfunction rather than disturbed body image.

Question 2

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

Accepted Answer

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,is not generally considered to cause hypertension.

Question 3

A woman consulted the nurse practitioner because she had not been able to have an orgasm,despite having been sexually active for 2 years.She was very frustrated and felt it was harming the relationship with her spouse.Which nursing process evaluation of an identified patient outcome would best indicate that treatment has been successful?

Accepted Answer

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 spouse is supportive" best indicates that the patient herself 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,and "offers no complaints" does not necessarily mean that satisfaction exists.

Question 4

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:

Accepted Answer

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.

Question 5

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 _______________:

Accepted Answer

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.Options A and D: Nurses with basic education are not qualified to be sexual counselors.Additional education is necessary.Option C: Basic information about sexual function may be provided by the registered nurse.Complex questions may require referral.

Question 6

The nursing action that takes priority when working with a patient who has a problem of sexual dysfunction or disorder is:

Accepted Answer

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.As a corollary,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.All of the other options are indicated as well,but self-awareness must precede them to achieve the best possible patient care.

Question 7

Which of these statements about erectile dysfunction is accurate?

Accepted Answer

Erectile dysfunction (impotence)has many causes,including medical conditions,medications,and psychiatric disorders such as anxiety and depression.It is unusual in young men,and when it occurs,the cause is usually psychological rather than physical.Although the marketing of medications for the disorder might suggest otherwise,acquired erectile dysfunction affects only 10% to 20% of all men.Treatment is primarily by oral or injected medications,but counseling would be the most appropriate intervention when emotional problems such as depression and anxiety are principal causes of the disorder.

Question 8

A woman consults the nurse practitioner because she has not been able to have an orgasm,despite having been sexually active for 2 years.She is very frustrated and feels it is harming the relationship with her spouse.Which nursing diagnosis would be most appropriate for this presentation?

Accepted Answer

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.Relational impairment and Ineffective sexuality pattern,since they are due to sexual dysfunction,are secondary to the anorgasmia.The patient has not indicated she does not become aroused,just that she cannot achieve orgasm.

Question 9

A 25-year-old patient tells the nurse he is living a miserable existence.All his life,he states,he has thought,felt,and acted like a woman while living in the body of a man.He has lived as a female and dressed in feminine attire for more than a year.He has decided to change jobs so as not to compromise the new identity and now wishes to "take the next step" with surgery.The first patient request the physician will likely address is:

Accepted Answer

Psychotherapy to help anticipate and deal with the psychological issues and adjustments involved in gender reassignment would be undertaken before hormonal therapy and sexual reassignment surgery.Although privacy concerns exist,owing to the unusual nature and possible social stigma associated with gender reassignment,altering medical records would be unethical and an unlikely request.The scenario suggests that the patient prefers life as a woman and would probably not seek to increase his masculinity.

Question 10

While performing a nursing assessment,the nurse says to a patient,"While growing up,most of us have 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:

Accepted Answer

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

Question 11

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

Accepted Answer

The persistent inhibition of orgasm is a form of sexual dysfunction called anorgasmia.Dyspareunia is painful intercourse.The patient has not indicated that her interest in sexual activity is diminished,so diminished desire and low libido do not apply.

Question 12

A man is admitted to an inpatient mental health unit after arrest for attempting sexual contact with a minor.Which medication would the nurse most expect to be prescribed? Select all that apply.

Accepted Answer

The pharmacological treatment of pedophilia involves the use of hormonal agents that suppress sexual drive and interest,such as antiandrogen agents (medroxyprogesterone,cyproterone)or SSRI antidepressants.Monoamine oxidase inhibitors and antipsychotic and antianxiety drugs are not typically indicated for these disorders.

Question 13

Which statement about paraphilias is accurate?

Accepted Answer

Paraphilias are uncommon disorders;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.Persons with paraphilias can often experience shame and are at higher risk for suicide due to the stigma,shame,and embarrassment associated with the disorders.Biological and psychological drives underlying paraphilic behavior can be very strong and often are not controllable by willpower alone.Persons with paraphilias have great difficulty controlling their behavior,even when very desirous and motivated to do so.

Question 14

A young father is very concerned because his 4-year-old son "enjoys playing girls' games more than with boys' toys." He wants to know if his son is gay or mentally ill.Which response most professionally describes our current understanding of gender identity?

Accepted Answer

The father's inquiry is really two questions: (1)whether the child's behavior suggests an increased risk of developing mental illness and (2)what the child's 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" or "fine" 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 does provide information about the relationship between cross-gender interests in childhood versus 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 father's 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.

Question 15

A new nurse is doing her first admission assessment and is anxious about asking a patient who is considerably older than her for his sexual history.Which statement would be most appropriate for obtaining information about the patient's sexual practices?

Accepted Answer

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,he need not feel uncomfortable about revealing it."It's your business,of course," implies that you do not have a valid reason to seek the information and in effect suggests that the patient perhaps should not answer the question."You never can tell,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 patient's 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.

Question 16

The male manager of a health club has been discovered to have placed a hidden video camera in the women's locker room and has taped several women as they showered and dressed.The disorder most likely represented by this behavior is:

Accepted Answer

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.

Question 17

A respected school coach is arrested after a student reports that he attempted to have sexual contact with him.Which issue would be the priority for assessment in the period immediately following the coach's arrest?

Accepted Answer

Pedophiles and other persons with paraphilias 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 patient's 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.

Question 18

A man seeks treatment for urges involving sexual contact with children.He has not acted on these urges and is ashamed of them.Which of the following outcomes would indicate that the patient is making progress in his treatment?

Accepted Answer

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.Pedophilia is a persistent disorder,and elimination of fantasies about children would be unrealistic;a patient reporting that the fantasies had ceased might not be fully self-aware or honest.A diminished sex drive or a healthy sex life with an appropriate partner does not necessarily reduce the desire for sexual contact with children.

Question 19

A man confesses that he enjoys watching women when he is out in public.Further exploration reveals that he goes to settings where he can observe women crossing their legs in hopes of "seeing something good." Which statement about this behavior is most accurate?

Accepted Answer

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 (called 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.

Quiz 21: Sexual Dysfunction and Sexual Disorders