Chapter 21. Issues Related to Human Sexuality and Gender Dysphoria Nursing School Test Banks

Chapter 21. Issues Related to Human Sexuality and Gender Dysphoria

Multiple Choice

1. A 52-year-old client states, My husband is upset because I dont enjoy sex as much as I used to. Which priority client data should a nurse initially collect?
1. History of hysterectomy
2. Date of last menstrual cycle
3. Use of birth control methods
4. History of thought disorder

ANS: 2
Rationale: The nurse should assess the clients last menstrual cycle to determine if the client is experiencing the onset of menopause. Menopause usually occurs around the age of 50. The decrease in estrogen can result in multiple symptoms, including a decrease in biological drives and sexual activity.

Cognitive Level: Application
Integrated Process: Assessment

2. In the course of an assessment interview, a female client reveals a history of bisexual orientation. Which action should the nurse initially implement when working with this client?
1. Self-assess personal attitudes toward homosexuality.
2. Review clients possible childhood sexual abuse history.
3. Encourage discussion of aversion to heterosexual relationships.
4. Explore clients family history of homosexuality.

ANS: 1
Rationale: The nurse should initially self-assess personal attitudes toward homosexuality. The nurse must be able to recognize when negative feelings compromise care. Unconditional acceptance of each individual is an essential component of compassionate nursing.

Cognitive Level: Application
Integrated Process: Assessment

3. A widower reports a fear of intimacy because of an inability to achieve and sustain an erection. He has become isolative, has difficulty sleeping, and has lost weight over the past year. Which nursing diagnosis should be a priority for this client?
1. Risk for situational low self-esteem AEB inability to achieve an erection
2. Sexual dysfunction R/T dysfunctional grieving AEB inability to experience orgasm
3. Social isolation R/T low self-esteem AEB refusing to engage in dating activities
4. Disturbed body image R/T penile flaccidity AEB client statements

ANS: 2
Rationale: The nurse should prioritize the nursing diagnosis sexual dysfunction R/T dysfunctional grieving AEB inability to experience orgasm. The nurse should assess the clients mood and level of energy, because depression and fatigue can decrease desire for participation in sexual activity.

Cognitive Level: Analysis
Integrated Process: Diagnosis

4. A nurse is assessing a client diagnosed with pedophilic disorder. What would differentiate this sexual disorder from a sexual dysfunction?
1. Symptoms of sexual dysfunction include inappropriate sexual behaviors, whereas symptoms of a sexual disorder include impairment in normal sexual response.
2. Symptoms of a sexual disorder include inappropriate sexual behaviors, whereas symptoms of sexual dysfunction include impairment in normal sexual response.
3. Sexual dysfunction can be caused by increased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual disorders.
4. Sexual disorders can be caused by decreased levels of circulating androgens, whereas levels of circulating androgens do not affect sexual dysfunction.

ANS: 2
Rationale: The nurse should identify that pedophilic disorder is a sexual disorder in which individuals partake in inappropriate sexual behaviors. Sexual dysfunction involves impairment in normal sexual response. Pedophilic disorder involves having sexual urges, behaviors, or sexually arousing fantasies involving sexual activity with a prepubescent child.

Cognitive Level: Analysis
Integrated Process: Assessment

5. A female client on an inpatient unit enters the common area for visiting hours dressed in a see-through blouse. Which intervention should be a nurses first priority?
1. Discuss with the client the inappropriateness of her attire.
2. Avoid addressing her attention-seeking behavior.
3. Lead the client back to her room and assist her with a change of clothing.
4. Restrict client to room until visiting hours are over.

ANS: 3
Rationale: The most appropriate intervention by the nurse is to lead the client back to her room and assist her with a change of clothing. The client could be exhibiting symptoms of exhibitionistic disorder, which is characterized by urges to expose oneself to unsuspecting strangers.

Cognitive Level: Analysis
Integrated Process: Implementation

6. A nurse is working with a client diagnosed with pedophilic disorder. Which client outcome is appropriate for the nurse to expect during the first week of hospitalization?
1. The client will verbalize an understanding of the importance of follow-up care.
2. The client will implement several relapse-prevention strategies.
3. The client will identify triggers for inappropriate behaviors.
4. The client will attend aversion therapy groups.

ANS: 3
Rationale: During the first week of hospitalization, identifying triggers for inappropriate behaviors is an appropriate outcome for a client diagnosed with pedophilic disorder. Pedophilic disorder involves intense sexual urges, behaviors, or fantasies involving sexual activity with a prepubescent child.

Cognitive Level: Application
Integrated Process: Planning

7. When planning care for a client diagnosed with female sexual interest/arousal disorder, what should a nurse document as an expected outcome of senate focus exercises?
1. To initiate immediate orgasm
2. To reduce anxiety by eliminating physical touch
3. To focus on touching breasts and genitals
4. To reduce goal-oriented demands of intercourse

ANS: 4
Rationale: Female sexual interest/arousal disorder is characterized by a reduced or absent frequency or intensity of interest or pleasure in sexual activity. Senate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy. The expected outcome of senate focus exercises is to reduce goal-oriented demands of intercourse. The reduction in demands reduces performance pressures and anxiety associated with possible failure.

Cognitive Level: Application
Integrated Process: Planning

8. A newly married woman comes to a gynecology clinic reporting anorexia, insomnia, and extreme pain during intercourse that has affected her intimate relationship. What initial intervention should the nurse expect a physician to implement?
1. A thorough physical, including gynecological examination
2. Referral to a sex therapist
3. Assessment of sexual history and previous satisfaction with sexual relationships
4. Referral to the recreational therapist for relaxation therapy

ANS: 1
Rationale: The nurse should expect the physician to implement a thorough physical, including a gynecological examination to assess for any physiological causes of the clients symptoms. If no pathology exists the client may be diagnosed with genito-pelvic pain/penetration disorder. In this disorder, the individual experiences considerable difficulty with vaginal intercourse and attempts at penetration. Pain is felt in the vagina, around the vaginal entrance and clitoris, or deep in the pelvis. There is fear and anxiety associated with anticipation of pain or vaginal penetration. A tensing and tightening of the pelvic floor muscles occurs during attempted vaginal penetration.

Cognitive Level: Application
Integrated Process: Implementation

9. A nurse is instructing a client diagnosed with sexual female sexual interest/arousal disorder. Which symptom and treatment of this disorder should the nurse describe to the client?
1. Avoidance of all genital sexual contact treated by sensate focus exercises
2. Avoidance of all genital sexual contact treated by medicating with tadalafil (Cialis)
3. Anorgasmia treated by vardenafil (Levitra)
4. Anorgasmia treated by systematic desensitization

ANS: 1
Rationale: The nurse should explain to the client that female sexual interest/arousal disorder is characterized by a reduced or absent frequency or intensity of interest or pleasure in sexual activity. Senate focus exercises are highly structured touching activities designed to help overcome performance anxiety and increase comfort with physical intimacy.

Cognitive Level: Application
Integrated Process: Implementation

10. A psychiatric nursing instructor is teaching about the psychological effects of the diagnosis of a sexually transmitted disease (STD). Which student statement indicates that further instruction is needed?
1. STDs carry strong connotations of illicit sex and considerable social stigma.
2. STDs can cause insanity.
3. AIDS can generate hopelessness and helplessness.
4. Antibiotics administered in the early stages can cure all STDs.

ANS: 4
Rationale: The instructor should identify the need for further instruction if a student states that antibiotics can cure all STDs. STDs refer to infections that are contracted primarily through sexual activities or intimate contact. Antibiotics are ineffective in the treatment of the STD human immunodeficiency virus (HIV).

Cognitive Level: Application
Integrated Process: Evaluation

11. A nurse is counseling a client diagnosed with gender dysphoria. What criteria would differentiate this disorder from a transvestic disorder?
1. Clients diagnosed with transvestic disorder are dissatisfied with their gender, whereas clients diagnosed with gender dysphoria are not.
2. Clients diagnosed with gender dysphoria are dissatisfied with their gender, whereas clients diagnosed with transvestic disorder are not.
3. Clients diagnosed with gender dysphoria avoid all forms of sexual intercourse, whereas clients diagnosed with transvestic disorder do not.
4. Clients diagnosed with transvestic disorder avoid all forms of sexual intercourse, whereas clients diagnosed with gender dysphoria do not.

ANS: 2
Rationale: The nurse should identify that clients diagnosed with gender dysphoria are dissatisfied with their gender, whereas clients diagnosed with transvestic disorder experience intense sexual arousal from dressing in the clothes of the opposite gender but are not dissatisfied with their gender. Clients diagnosed with either of these disorders do not avoid all forms of sexual intercourse.

Cognitive Level: Analysis
Integrated Process: Implementation

12. A nurse is assessing a client diagnosed with sexual masochistic disorder. What would differentiate this paraphilic disorder from sexual sadistic disorder?
1. Symptoms of sexual masochistic disorder are chronic acts of humiliation, whereas symptoms of sexual sadistic disorder are acute.
2. Symptoms of sexual sadistic disorder are chronic acts of humiliation, whereas symptoms of sexual masochistic disorder are acute.
3. Masochistic acts can be performed alone, whereas sadistic acts must have a consenting or non-consenting partner.
4. Sadistic acts can be performed alone, whereas mascochistic acts must have a consenting or non-consenting partner.

ANS: 3
Rationale: The identifying feature of sexual masochistic disorder is recurrent and intense sexual arousal when being humiliated, beaten, bound, or otherwise made to suffer. These masochistic activities may be fantasized and may be performed alone (e.g., self-inflicted pain) or with a partner. The identifying feature of sexual sadistic disorder is the recurrent and intense sexual arousal from the physical or psychological suffering of another individual. Both sexual masochistic and sadistic disorders are chronic in nature.

Cognitive Level: Analysis
Integrated Process: Assessment

13. A nurse is assessing a client diagnosed with fetishistic disorder. What would differentiate this paraphilic disorder from frotteuristic disorder?
1. To derive sexual excitement, fetishistic disorder involves the use of nonliving objects, whereas frotteuristic disorder involves touching and rubbing against non-consenting people.
2. To derive sexual excitement, frotteuristic disorder involves the use of nonliving objects, whereas fetishistic disorder involves touching and rubbing against non-consenting people.
3. Clients diagnosed with frotteuristic disorder are heterosexual cross-dressing males, whereas Clients diagnosed with fetishistic disorder are homosexual cross-dressing males.
4. Clients diagnosed with fetishistic disorder are heterosexual cross-dressing males, whereas Clients diagnosed with frotteuristic disorder are homosexual cross-dressing males.

ANS: 1
Rationale: Fetishistic disorder involves recurrent and intense sexual arousal from the use of either nonliving objects or specific nongenital body part(s). Frotteuristic disorder is the recurrent and intense sexual arousal involving touching and rubbing against a non-consenting person. Transvestic disorder involves recurrent and intense sexual arousal from dressing in the clothes of the opposite gender.

Cognitive Level: Analysis
Integrated Process: Assessment

Multiple Response

14. Which of the following characteristics should a nurse identify as normal in the development of human sexuality for an 11-year-old child? (Select all that apply.)
1. The child experiments with masturbation.
2. The child may experience homosexual play.
3. The child shows little interest in the opposite sex.
4. The child shows little concern about physical attractiveness.
5. The child is unlikely to want to undress in front of others.

ANS: 1, 2, 5
Rationale: The nurse should identify that experimenting with masturbation and homosexual play and not wanting to undress in front of others are characteristics that are normal in the development of human sexuality in an 11-year-old child. Interest in the opposite sex usually increases, and children often become self-conscious about their bodies.

Cognitive Level: Application
Integrated Process: Assessment

15. A nursing instructor is teaching about the various categories of paraphilic disorders. Which categories are correctly matched with expected behaviors? (Select all that apply.)
1. Exhibitionistic disorder: Mary models lingerie for a company that specializes in home parties.
2. Voyeuristic disorder: John is arrested for peering in a neighbors bathroom window.
3. Frotteuristic disorder: Peter enjoys subway rush-hour female contact that results in arousal.
4. Pedophilic disorder: George can experience an orgasm by holding and feeling shoes.
5. Fetishistic disorder: Henry masturbates into his wifes silk panties.

ANS: 2, 3, 5
Rationale: Categories of paraphilic disorders include voyeuristic disorder (observing unsuspecting people, who are naked, dressing, or engaged in sexual activity), frotteuristic disorder (touching or rubbing against a non-consenting person), and fetishistic disorder (using nonliving objects in sexual ways). Exhibitionistic disorder is a paraphilic disorder but involves the urge to show ones genitals to unsuspecting strangers. Other categories include sexual masochism disorder, sexual sadism disorder, and transvestic disorder.

Cognitive Level: Analysis
Integrated Process: Implementation

16. A client is diagnosed with erectile disorder. Which of the following medications would address this condition, and what is the therapeutic action of the drug? (Select all that apply.)
1. Phentolamine (Oraverse); increases blood flow to the penis.
2. Apomorphine (Apokyn); acts directly on the dopamine receptors in the brain.
3. Vardenafil (Levitra); blocks the action of phosphodiesterase-5 (PDE5).
4. Goserelin (Zoladex); inhibits the production of gonadotropins.
5. Sildenafil (Viagra); blocks the action of phosphodiesterase-5 (PDE5).

ANS: 1, 2, 3, 5
Rationale: Sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra) have been approved by the FDA for the treatment of erectile disorder. These newer impotence agents block the action of phosphodiesterase-5 (PDE5), an enzyme that breaks down cyclic guanosine monophosphate (cGMP), a compound that is required to produce an erection. Phentolamine has been used in combination with papaverine in an injectable form that increases blood flow to the penis, resulting in an erection. Apomorphine acts directly on the dopamine receptors in the brain. This mode of stimulating dopamine in the brain is thought to enhance the sexual response. Zoladex is a treatment for prostate cancer, not erectile dysfunction.

Cognitive Level: Application
Integrated Process: Evaluation

17. A nurse is planning care for a child diagnosed with gender dysphoria. Which of the following nursing diagnoses could potentially document this clients problems? (Select all that apply.)
1. Low self-esteem R/T rejection by peers
2. Self-care deficit R/T isolative behaviors
3. Disturbed personal identity R/T parenting patterns
4. Impaired social interactions R/T socially unacceptable behaviors
5. Activity intolerance R/T fatigue

ANS: 1, 3, 4
Rationale: Based on the data collected during a nursing assessment, possible nursing diagnoses for the child with gender dysphoria may include the following: Disturbed personal identity related to biological factors or parenting patterns that encourage culturally unacceptable behaviors for assigned gender, impaired social interaction related to socially and culturally unacceptable behaviors, and low self-esteem related to rejection by peers. Self-care deficit and activity intolerance do not address the typical problems of clients diagnosed with gender dysphoria.

Cognitive Level: Analysis
Integrated Process: Diagnosis

Fill-in-the-Blank

18. ___________________________ is the constitution and life of an individual relative to characteristics regarding intimacy.

ANS: Sexuality
Rationale: Sexuality is the constitution and life of an individual relative to characteristics regarding intimacy. It reflects the totality of the person and does not relate exclusively to the sex organs or sexual behavior.

Cognitive Level: Application
Integrated Process: Assessment

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