Question 1

The nurse is caring for a patient who has had opioid use disorder for several years and now presents with a sexual dysfunction. For which clinical manifestations will the nurse assess the patient? Select all that apply.

Accepted Answer

1. Alcohol, opioids, and sedatives are among the many substances that can contribute to sexual dysfunction, either during use or associated with withdrawal from the substance. The most commonly reported sexual problems are difficulty with orgasm or ejaculation. While the other manifestations may occur in this type of sexual dysfunction, these are not the most common types of clinical manifestations associated with substance use or abuse.
2. Alcohol, opioids, and sedatives are among the many substances that can contribute to sexual dysfunction, either during use or associated with withdrawal from the substance. The most commonly reported sexual problems are difficulty with orgasm or ejaculation. While the other manifestations may occur in this type of sexual dysfunction, these are not the most common types of clinical manifestations associated with substance use or abuse.

Question 2

The nurse is caring for a female patient with female orgasmic disorder. The nurse explains that a number of factors are involved in the development of the disorder. Which factors will the nurse discuss as being associated with female orgasmic disorder? Select all that apply.

Accepted Answer

1. Many factors may contribute to female orgasmic disorder. These include hostility toward the partner, fear of becoming pregnant, fear of vaginal damage, and fear of losing control. A fear of sex itself generally contributes to female arousal disorder, not female orgasmic disorder.
2. Many factors may contribute to female orgasmic disorder. These include hostility toward the partner, fear of becoming pregnant, fear of vaginal damage, and fear of losing control. A fear of sex itself generally contributes to female arousal disorder, not female orgasmic disorder.
4. Many factors may contribute to female orgasmic disorder. These include hostility toward the partner, fear of becoming pregnant, fear of vaginal damage, and fear of losing control. A fear of sex itself generally contributes to female arousal disorder, not female orgasmic disorder.
5. Many factors may contribute to female orgasmic disorder. These include hostility toward the partner, fear of becoming pregnant, fear of vaginal damage, and fear of losing control. A fear of sex itself generally contributes to female arousal disorder, not female orgasmic disorder.

Question 3

The nurse is caring for a patient with a sexual dysfunction and is referring to the DSM-5 as guide of reference. What subtype of sexual dysfunction does the DSM-5 refer to as occurring regardless of partner, situation, or type of stimulation?

Accepted Answer

4. According to the DSM-5, a sexual dysfunction that occurs regardless of partner, situation, or type of stimulation is considered generalized. A situational sexual dysfunction occurs only in specific circumstances or with a specific partner. A lifelong sexual dysfunction occurs from the beginning of sexual experiences. An acquired sexual dysfunction develops after normal sexual experiences began.

Question 4

The nurse is caring for a patient with female sexual arousal disorder. The nurse understands that psychological as well as biological factors contribute to the etiology of this disorder. Which does the nurse recognize as a contributing factor to the development of female sexual arousal disorder?

Accepted Answer

3. Female sexual arousal disorder is characterized by the complete lack of interest in sexual activity. Psychological as well as biological factors contribute to the etiology of this disorder. Low serum testosterone is a biological etiological factor for the development of this disorder. Estrogen levels are not linked to this disorder. Decreased, not increased, serum dopamine may be an etiological factor. Testosterone is an androgen hormone and a decrease, not increase, in androgen levels may contribute to the development of this disorder.

Question 5

The nursing instructor is teaching a group of nursing students about the stages of the sexual response cycle. Which stage is the instructor describing when teaching about the release of the neurotransmitters acetylcholine, dopamine, and nitric oxide?

Accepted Answer

1. Excitement (arousal) is a vascular phenomenon involving the parasympathetic (cholinergic) nervous system. It results in erection, clitoral engorgement, genital and breast swelling, and lubrication caused by the neurotransmitters acetylcholine, dopamine, and nitric oxide. Plateau, orgasm, and resolution do not involve the release of the neurotransmitters acetylcholine, dopamine, and nitric oxide.

Question 6

The nurse is researching the genetic link to sexual dysfunction and sexual disorders. Which sexual dysfunction syndromes or disorders does the nurse learn are directly related to chromosomal inheritance? Select all that apply.

Accepted Answer

1. Turner syndrome and Kleinfelter syndrome are directly related to chromosomal inheritance. With these syndromes, an incorrect combination of chromosomes occurs, leading to abnormalities in sexual development. Gender dysphoria is a feeling of distress that arises when individuals experience psychosocial incongruence between their assigned gender and the gender with which they more clearly identify. Chromosomal inheritance is not implicated in paraphilic disorder. Intersex condition is caused by hormonal dysfunction during fetal development, not a chromosomal inheritance.
3. Turner syndrome and Kleinfelter syndrome are directly related to chromosomal inheritance. With these syndromes, an incorrect combination of chromosomes occurs, leading to abnormalities in sexual development. Gender dysphoria is a feeling of distress that arises when individuals experience psychosocial incongruence between their assigned gender and the gender with which they more clearly identify. Chromosomal inheritance is not implicated in paraphilic disorder. Intersex condition is caused by hormonal dysfunction during fetal development, not a chromosomal inheritance.

Question 7

The student nurse is learning about the stages of the sexual response cycle in order to care for patients with sexual disorders. The student will learn that the primary physiology of excitement or arousal involves which system?

Accepted Answer

2. According to the sexual response cycle, excitement or arousal is a vascular phenomenon involving the parasympathetic nervous system. The sympathetic, renin-angiotensin-aldosterone, and peripheral nervous systems are not involved in the primary physiology of excitement or arousal.

Question 8

The student nurse is learning about the impact of biological, psychological, social, cultural, and spiritual domains on sexual development and dysfunctions. According to the attachment theory, which alternative form of attachment, linked to sexual identity, may occur if parental attachment is compromised? Select all that apply.

Accepted Answer

1. In the 1950s, John Bowlby described attachment theory to explain the degree to which an infant can rely on his or her parents, particularly the mother, to meet needs for security. Attachment theory may be used as a lens through which to examine the development of sexual identity and behaviors. Bowlby observed that a distressed infant who is securely attached to the caregiver will turn to the caregiver for solace. If the infant has been deprived in some significant way from developing a secure attachment to the caregiver, however, another attachment style may develop. One is a pattern called preoccupied attachment, in which the infant has a high desire for intimacy but is fearful of being abandoned. The infant may show clingy behaviors and, if threatened by the potential loss of the caregiver, may react with anger, jealousy, and panic. Fearful attachment results in high levels of anxiety and avoidance of dependency on the caregiver. The dismissive attachment style results in a child who withdraws from others and relies on himself or herself. The child with dismissive attachment would see intimacy as a sign of weakness. Authoritarian and permissive refer to styles of parenting, not attachment patterns.
3. In the 1950s, John Bowlby described attachment theory to explain the degree to which an infant can rely on his or her parents, particularly the mother, to meet needs for security. Attachment theory may be used as a lens through which to examine the development of sexual identity and behaviors. Bowlby observed that a distressed infant who is securely attached to the caregiver will turn to the caregiver for solace. If the infant has been deprived in some significant way from developing a secure attachment to the caregiver, however, another attachment style may develop. One is a pattern called preoccupied attachment, in which the infant has a high desire for intimacy but is fearful of being abandoned. The infant may show clingy behaviors and, if threatened by the potential loss of the caregiver, may react with anger, jealousy, and panic. Fearful attachment results in high levels of anxiety and avoidance of dependency on the caregiver. The dismissive attachment style results in a child who withdraws from others and relies on himself or herself. The child with dismissive attachment would see intimacy as a sign of weakness. Authoritarian and permissive refer to styles of parenting, not attachment patterns.
5. In the 1950s, John Bowlby described attachment theory to explain the degree to which an infant can rely on his or her parents, particularly the mother, to meet needs for security. Attachment theory may be used as a lens through which to examine the development of sexual identity and behaviors. Bowlby observed that a distressed infant who is securely attached to the caregiver will turn to the caregiver for solace. If the infant has been deprived in some significant way from developing a secure attachment to the caregiver, however, another attachment style may develop. One is a pattern called preoccupied attachment, in which the infant has a high desire for intimacy but is fearful of being abandoned. The infant may show clingy behaviors and, if threatened by the potential loss of the caregiver, may react with anger, jealousy, and panic. Fearful attachment results in high levels of anxiety and avoidance of dependency on the caregiver. The dismissive attachment style results in a child who withdraws from others and relies on himself or herself. The child with dismissive attachment would see intimacy as a sign of weakness. Authoritarian and permissive refer to styles of parenting, not attachment patterns.

Question 9

The nurse is caring for a female patient with a suspected sexual dysfunction. In order for the health care provider to diagnose this condition, which must be true of the symptoms? Select all that apply.

Accepted Answer

2. In general, a sexual dysfunction may be diagnosed if it frequently, though not necessarily always, prevents the desired participation in sexual activity; has been present for at least 6 months; and is not caused by some other mental, behavioral, or medical condition.
4. In general, a sexual dysfunction may be diagnosed if it frequently, though not necessarily always, prevents the desired participation in sexual activity; has been present for at least 6 months; and is not caused by some other mental, behavioral, or medical condition.
5. In general, a sexual dysfunction may be diagnosed if it frequently, though not necessarily always, prevents the desired participation in sexual activity; has been present for at least 6 months; and is not caused by some other mental, behavioral, or medical condition.

Question 10

The nurse is caring for a patient with gender dysphoria who is in the process of gender reassignment. The patient tells the nurse, "Why does this process take so long? I'm tired of living like the opposite sex." What is the nurse's best response?

Accepted Answer

2. Sexual reassignment is purposefully a protracted process, by design allowing the patient to make a social transition to the opposite gender, living and working full time in the social role for a period of time, generally 2 or more years, before any hormonal or surgical procedure begins. This social transition usually requires a name change and a change in work status. The rationale is that reversible changes should successfully precede irreversible changes. While self reflection is always encouraged, the protracted process of gender reassignment is not to determine whether or not the patient is serious about the procedure. The protracted timeframe is also not to allow the health care provider time to decide whether the patient is a good candidate for the procedure; this occurs in the first phase of the process and does not encompass the entirety of the process. The patient does not make a physical transition until after the completion of the surgical procedure.

Question 11

The psychiatric-mental health nurse preparing to provide patient education to a patient with a sexual dysfunction. Which information about orgasm will the nurse include in the session?

Accepted Answer

2. Orgasm is mediated by norepinephrine, produced by the sympathetic nervous system. While dopamine, epinephrine, and nitric oxide are involved in orgasm, these are not the mediating agents.

Question 12

According to the Masters and Johnson model, which best describes the pattern of the human sexual response cycle?

Accepted Answer

1. The Masters and Johnson model proposed that sexual response is linear, and that desire always precedes arousal, and arousal is followed by orgasm and resolution. According to this model, the order of these stages of response does not vary.

Question 13

The nurse is assessing a female patient who complains of pain during intercourse. The nurse will review the patient history for which factors that may contribute to genitopelvic pain/penetration disorder? Select all that apply.

Accepted Answer

4. Contributing factors to genitopelvic pain/penetration disorder include latex allergy, endometriosis, urinary tract infections, and vaginal infections. Chronic stress is associated with female sexual interest/arousal disorder.

Question 14

The nurse is caring for a male patient with hypothyroidism who complains of sexual dysfunction. What sexual disorder is most likely in this patient? Select all that apply.

Accepted Answer

4. Thyroid disease may contribute to premature ejaculation and male hypoactive sexual desire disorder. While the other answer choices are male sexual disorders, these are not caused by thyroid disease.
5. Thyroid disease may contribute to premature ejaculation and male hypoactive sexual desire disorder. While the other answer choices are male sexual disorders, these are not caused by thyroid disease.

Question 15

Which intervention is most appropriate for the nurse to offer when helping a patient with gender dysphoria?

Accepted Answer

1. Promoting comfort with the chosen gender role are an appropriate intervention. Discouraging genital reassignment surgery and avoiding patient discussions of hormonal treatment are not helpful and may impede the therapeutic relationship. Encouraging the patient to live as his or her assigned gender is not an effective intervention for gender dysphoria.

Question 16

The nurse is caring for a patient who has been diagnosed with gender dysphoria. The patient desires sexual reassignment surgery. What does the nurse recognize as the first phase of this type of treatment?

Accepted Answer

2. The first phase of gender reassignment surgery is the diagnostic testing phase. As a first step, many clinics require that the individual be recommended as a candidate for surgery by at least two mental health providers who are trained and experienced in transgender issues. Hormonal therapy is the second phase of the gender reassignment surgical process. Nutritional therapy and therapeutic testing are not separate phases of the gender reassignment surgical process.

Question 17

The nurse is caring for a patient who has been diagnosed with a sexual disorder. When discussing the role hormones play in sexuality, what information will the nurse provide regarding oxytocin?

Accepted Answer

3. Oxytocin is a hormone secreted by the posterior pituitary gland. Oxytocin promotes grooming, arousal, and orgasmic activity. Estrogen regulates the menstrual cycle and causes the mammary glands to prepare for milk production. Testosterone is responsible for the sex drive in both sexes.

Question 18

The nurse is caring for a 55-year-old male patient with Parkinson disease who is being treated for a sexual disorder. Which sexual disorder is most likely in this patient?

Accepted Answer

1. Delayed ejaculation is characterized by a marked delay in ejaculation and or marked infrequency or absence of ejaculation despite the presence of adequate sexual stimulation and the desire to ejaculate. The patient with Parkinson disease is most likely to suffer from this disorder due to damage to peripheral sensory nerves. While the other answer choices represent male sexual disorders, the frequency of occurrence of these disorders is not increased in patients with Parkinson disease.

Question 19

The nurse is caring for a patient with gender dysphoria who underwent gender reassignment surgery 14 months ago. The patient tells the nurse that she regrets her decision of having the surgery. What is the most common reason individuals feel regret after gender reassignment surgery?

Accepted Answer

2. More often than not, individuals who regret gender reassignment surgery failed to go through a social transition of living as a member of the opposite gender for a significant period of time (as long as 2 years) prior to undergoing surgery. These individuals may have acknowledged the social implications of living as a member of the opposite gender; however, these individuals may not have spent sufficient time making the social transition. Failure to comply with pharmacologic or hormonal therapy are not associated with regretting the surgical procedure. A patient who fails to undergo the required pre-surgical diagnostic testing does not undergo the procedure.

Question 20

The nurse at a pediatric clinic is assessing a 14-year-old male patient. The patient and his parents are concerned that he has not started puberty. The nurse anticipates the need to provide patient education about which disorder or condition?

Accepted Answer

3. Disorders of sexual development, sometimes referred to as intersex conditions, are a group of conditions resulting from hormonal errors during fetal development in which internal genitalia differ from external genitalia. In some cases, these are not discovered until adolescence, when the patient fails to achieve puberty. Gender dysphoria is distress associated with psychosocial incongruence between an individual's assigned gender and the gender with which the individual identifies. Priapism is a prolonged erection lasting more than 4 hours. Erectile dysfunction is a sexual dysfunction that may be acquired after a period of adequate functioning or that may occur as a lifelong inability to obtain or maintain an erection.

Quiz 19: Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders