Question 1

A man with hypospadias tells the nurse, "Intercourse with my new bride is painful." Which term applies to the patient's complaint?

Accepted Answer

Dyspareunia is persistent genital pain 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.

Question 2

Which statement about paraphilic disorders is accurate?

Accepted Answer

Paraphilic disorders are uncommon; however, because people with these disorders repeatedly enact behaviours 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 people 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 behaviour can be very strong and often are not controllable by willpower alone. People with paraphilic disorders have difficulty controlling their behaviour, even when very motivated to do so.

Question 3

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 which of the following?

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 4

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?

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, does not cause hypertension.

Question 5

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?

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. Ineffective sexuality pattern, since it is due to sexual dysfunction, is secondary to the absence of orgasms and is indicated by expressions of concern regarding one's own sexuality. The patient has not indicated not becoming aroused, just the inability to achieve orgasm. Disturbed sensory perception may be part of the etiology, but the problem is sexual dysfunction. There is no evidence of defensive coping.

Question 6

Which nursing action should occur first regarding a patient who has a problem of sexual dysfunction or sexual disorder?

Accepted Answer

Before a nurse 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.

Question 7

The male manager of a health club placed a hidden video camera in the women's locker room and recorded several women as they showered and dressed. The disorder most likely represented by this behaviour is which of the following?

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 8

A patient's medical record documents sexual masochism. This patient derives sexual pleasure in which of the following ways?

Accepted Answer

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

Question 9

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 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, the patient can feel comfortable sharing it. "It's 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 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 10

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 which of the following?

Accepted Answer

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.

Question 11

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

Accepted Answer

People 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.

Question 12

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?

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. 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 in a person with pedophilic disorder.

Question 13

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 behaviour 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 behaviour described constitutes a sexual disorder (voyeurism). Many of the people involved in nonstandard sexual practices find no need for therapy because their sexual activities are carried out with a consenting adult partner, and they are neither illegal nor physically or emotionally harmful to either partner. If, however, the person is experiencing relationship difficulties, wishes to change the sexual behaviours, becomes involved in illegal activity, or is physically or emotionally harming others or being harmed, therapy is indicated.

Question 14

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 coach's arrest?

Accepted Answer

Pedophiles and other people with paraphilic disorders can be at increased risk of self-harm associated with the guilt, shame, and anger they feel about their behaviour 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 due 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 providers. See relationship to audience response question.

Question 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?

Accepted Answer

The parent's inquiry is really two questions: (1) whether the child's behaviour 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" 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 parent'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 16

An adult experienced a myocardial infarction 6 months ago. At a follow-up visit, he says, "I haven't had much interest in sex since my heart attack. I finished my rehabilitation program, but having sex strains my heart. I don't know if my heart is strong enough." Which nursing diagnosis applies?

Accepted Answer

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.

Question 17

A woman tells the nurse, "My partner is frustrated with me. I don't have any natural lubrication when we have sex." What type of sexual disorder is evident?

Accepted Answer

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

Question 18

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?

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 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 the person is satisfied.

Question 19

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?" What is the purpose of this question?

Accepted Answer

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

Question 20

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 which of the following?

Accepted Answer

The basic education of nurses provides information sufficient to qualify the generalist to take a sexual history, assess for sexual dysfunction, and perform health teaching. A registered nurse may provide basic information about sexual function, but complex questions may require referral.

Quiz 22: Sexual Dysfunction, Gender Dysphoria, and Paraphilias