Module 19 Sexuality: Nursing: A Concept-Based Approach To Learning, 2e (Pearson)

Nursing: A Concept-Based Approach to Learning, 2e (Pearson)
Module 19 Sexuality
The Concept of Sexuality
1) A 58-year-old female client is concerned that intercourse with her spouse has become
increasingly painful. What should the nurse explain about the changes in this client's body?
A) Cervical mucus is thicker after menopause.
B) Estrogen levels increase after menopause.
C) Sexual desire diminishes after menopause.
D) Vaginal lubrication decreases after menopause.
Answer: D
Explanation: A) Older women remain capable of multiple orgasms and may, in fact, experience
an increase in sexual desire after menopause. Vaginal lubrication and elasticity decrease with
menopause and decreased estrogen, and phases of the sexual response cycle may take longer to
occur. The client's concerns are not related to cervical mucus.
B) Older women remain capable of multiple orgasms and may, in fact, experience an increase in
sexual desire after menopause. Vaginal lubrication and elasticity decrease with menopause and
decreased estrogen, and phases of the sexual response cycle may take longer to occur. The
client's concerns are not related to cervical mucus.
C) Older women remain capable of multiple orgasms and may, in fact, experience an increase in
D) Older women remain capable of multiple orgasms and may, in fact, experience an increase in
Page Ref: 1343-1344
Cognitive Level: Applying
Client Need: Health Promotion and Maintenance
Nursing Process: Implementation
Learning Outcome: 1. Summarize the physiology of the reproductive system related to
sexuality.
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2) A female client tells the nurse about having difficulty with sexual relations because of a recent
weight gain. Which interventions should the nurse include when planning this client's care?
A) Sexual self-concept
B) Gender identity
C) Body image
D) Gender-role behavior
Answer: C
Explanation: A) Body image is constantly changing. How people feel about their bodies is
related to sexuality. People who have a poor body image may respond negatively to sexual
arousal. This is what the client is experiencing. Sexual self-concept determines with whom one
will have sex, the gender and kinds of people one is attracted to, and the values about when,
where, with whom, and how one expresses sexuality. Gender identity is one's self-image as male
or female. Gender-role behavior is the outward expression of a person's sense of maleness or
femaleness as well as the expression of what is perceived as gender-appropriate behavior.
B) Body image is constantly changing. How people feel about their bodies is related to sexuality.
People who have a poor body image may respond negatively to sexual arousal. This is what the
client is experiencing. Sexual self-concept determines with whom one will have sex, the gender
and kinds of people one is attracted to, and the values about when, where, with whom, and how
one expresses sexuality. Gender identity is one's self-image as male or female. Gender-role
behavior is the outward expression of a person's sense of maleness or femaleness as well as the
expression of what is perceived as gender-appropriate behavior.
C) Body image is constantly changing. How people feel about their bodies is related to sexuality.
D) Body image is constantly changing. How people feel about their bodies is related to sexuality.
Page Ref: 1345
Nursing Process: Planning
Learning Outcome: 2. Examine the relationship between sexuality and other concepts/systems.
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3) A female client tells the nurse about having no interest in sex since it has become painful.
Which intervention(s) would be appropriate to help the client with this problem?
Select all that apply.
A) Ask when the last Pap smear was performed.
B) Discuss the need to be screened for sexually transmitted infections.
C) Instruct on the use of artificial lubrication.
D) Encourage the client to discuss with the healthcare provider because there are medications to
help with this problem.
E) Suggest antibiotics to treat the pain.
Answer: C, D
Explanation: A) The client is describing a sexual arousal disorder, a subjective lack of sexual
excitement that is linked with a lack of lubrication in the female. Interventions to help with this
problem include using artificial lubrication and discussing medication options with the
healthcare provider. Antibiotics, screening for sexually transmitted infections, and the last Pap
smear would be interventions to address a sexual pain disorder, which involves pain that occurs
during or immediately after intercourse.
B) The client is describing a sexual arousal disorder, a subjective lack of sexual excitement that
is linked with a lack of lubrication in the female. Interventions to help with this problem include
using artificial lubrication and discussing medication options with the healthcare provider.
Antibiotics, screening for sexually transmitted infections, and the last Pap smear would be
interventions to address a sexual pain disorder, which involves pain that occurs during or
immediately after intercourse.
C) The client is describing a sexual arousal disorder, a subjective lack of sexual excitement that
D) The client is describing a sexual arousal disorder, a subjective lack of sexual excitement that
E) The client is describing a sexual arousal disorder, a subjective lack of sexual excitement that
Page Ref: 1343-1344, 1349
Learning Outcome: 3. Identify commonly occurring alterations in sexuality and their related
treatments.
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4) During a physical assessment, a client tells the nurse that his penis "hurts" when the shaft is
touched. What should the nurse suspect is occurring with this client?
A) Urethral stricture
B) Acute orchitis
C) Inflammatory disease
D) Acute epididymitis
Answer: A
Explanation: A) Normally, palpation of the penis should not cause tenderness. The client's
complaint of pain could indicate a urethral stricture. Redness or lesions on the penis could
indicate inflammatory disease. Acute epididymis and acute orchitis are associated with a tender
scrotum.
B) Normally, palpation of the penis should not cause tenderness. The client's complaint of pain
could indicate a urethral stricture. Redness or lesions on the penis could indicate inflammatory
disease. Acute epididymis and acute orchitis are associated with a tender scrotum.
C) Normally, palpation of the penis should not cause tenderness. The client's complaint of pain
D) Normally, palpation of the penis should not cause tenderness. The client's complaint of pain
Page Ref: 1357
Cognitive Level: Analyzing
Client Need: Physiological Integrity
Nursing Process: Assessment
Learning Outcome: 4. Differentiate common assessment procedures used to examine sexual
health across the life span.
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5) A female client complains of having a "strange discharge" from the vagina and "stinging"
when voiding urine. Which diagnostic test(s) would be useful to aid in the diagnosis of this
client's disorder?
A) Biopsy
B) Urinalysis
C) Complete blood count
D) Serum hormone levels
E) Papanicolaou smear
Answer: B, E
Explanation: A) The client is complaining of a strange discharge from her vagina. A
Papanicolaou smear would be the most helpful in diagnosing the cause of that symptom. The
client is also complaining of stinging with urination. A urinalysis would be helpful to rule out a
urinary tract infection as the cause for the urinary pain. The other diagnostic tests may or may
not help diagnose this client's health problem.
B) The client is complaining of a strange discharge from her vagina. A Papanicolaou smear
would be the most helpful in diagnosing the cause of that symptom. The client is also
complaining of stinging with urination. A urinalysis would be helpful to rule out a urinary tract
infection as the cause for the urinary pain. The other diagnostic tests may or may not help
diagnose this client's health problem.
C) The client is complaining of a strange discharge from her vagina. A Papanicolaou smear
D) The client is complaining of a strange discharge from her vagina. A Papanicolaou smear
E) The client is complaining of a strange discharge from her vagina. A Papanicolaou smear
Page Ref: 1362
Learning Outcome: 5. Describe diagnostic and laboratory tests to determine the individual's
reproductive system status.
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6) During a sexual history, a female client tells the nurse that because she is in a committed
relationship, sexual relations are more satisfying and frequent. What should the nurse realize the
client is describing?
A) Emptiness
B) A lack of intimacy
C) The feeling of connectedness
D) Disconnection
Answer: C
Explanation: A) Fulfillment of sexuality depends on the ability to relate to a partner in an
intimate and mutually pleasing manner that is compatible with one's values and chosen lifestyle.
Lack of intimacy is related to satisfaction problems. If one has sex with a stranger, the body may
function well, but there is often a sense of something missing after the sexual experience.
Making love to one person while feeling more attracted to or in love with another person can
result in feelings of emptiness or disconnection. Even couples in a committed relationship may
complain of lack of intimacy. Dissatisfaction issues include lack of romance, love, tenderness,
and nurturance.
B) Fulfillment of sexuality depends on the ability to relate to a partner in an intimate and
mutually pleasing manner that is compatible with one's values and chosen lifestyle. Lack of
intimacy is related to satisfaction problems. If one has sex with a stranger, the body may function
well, but there is often a sense of something missing after the sexual experience. Making love to
one person while feeling more attracted to or in love with another person can result in feelings of
emptiness or disconnection. Even couples in a committed relationship may complain of lack of
intimacy. Dissatisfaction issues include lack of romance, love, tenderness, and nurturance.
C) Fulfillment of sexuality depends on the ability to relate to a partner in an intimate and
D) Fulfillment of sexuality depends on the ability to relate to a partner in an intimate and
Page Ref: 1343, 1351
Client Need: Psychosocial Integrity
Learning Outcome: 6. Explain management of sexual health and prevention of alterations in
sexuality.
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7) An older client tells the nurse that he still has erections and wants to have sex with his wife,
but she does not have the same interest as he does. What should the nurse do to assist this client?
A) Explain that women lose interest in sex as part of the aging process.
B) Suggest that he wait awhile and the urge to have sex will pass.
C) Ask what he has been doing to fulfill himself sexually.
D) Encourage the client to ask his wife to discuss the lack of interest with her physician.
Answer: D
Explanation: A) The nurse's role with this client is counseling for sexual dysfunction. The nurse
should encourage the client to ask his wife to discuss the lack of interest with her physician as a
starting point. The other choices are inappropriate and should not be provided to the client.
B) The nurse's role with this client is counseling for sexual dysfunction. The nurse should
encourage the client to ask his wife to discuss the lack of interest with her physician as a starting
point. The other choices are inappropriate and should not be provided to the client.
C) The nurse's role with this client is counseling for sexual dysfunction. The nurse should
D) The nurse's role with this client is counseling for sexual dysfunction. The nurse should
Page Ref: 1343-1344
Learning Outcome: 7. Demonstrate the nursing process in providing culturally competent and
caring interventions across the life span for individuals with common alterations in sexuality.
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8) A female client is prescribed an androgen medication to treat an estrogen-sensitive type of
breast cancer. What should the nurse instruct this client about the medication?
A) There is an increased risk of multiple births.
B) Secondary male sex characteristics may develop.
C) Monitor weight weekly.
D) Report calf pain or dyspnea.
E) It must be taken with food.
Answer: B, C
Explanation: A) Androgen hormone replacements may be used to treat estrogen-dependent
cancers. The nurse should instruct the client of the risk of developing secondary male sex
characteristics when taking this medication. This medication also affects body weight so the
nurse should instruct the client to monitor body weight weekly. Increased risk of multiple births
is associated with female infertility medications. Reporting calf pain or dyspnea is associated
with estrogen hormone replacement therapy. This medication does not need to be taken with
food.
B) Androgen hormone replacements may be used to treat estrogen-dependent cancers. The nurse
should instruct the client of the risk of developing secondary male sex characteristics when
taking this medication. This medication also affects body weight so the nurse should instruct the
client to monitor body weight weekly. Increased risk of multiple births is associated with female
infertility medications. Reporting calf pain or dyspnea is associated with estrogen hormone
replacement therapy. This medication does not need to be taken with food.
C) Androgen hormone replacements may be used to treat estrogen-dependent cancers. The nurse
D) Androgen hormone replacements may be used to treat estrogen-dependent cancers. The nurse
E) Androgen hormone replacements may be used to treat estrogen-dependent cancers. The nurse
Page Ref: 1364
Learning Outcome: 8. Compare and contrast common independent and collaborative
interventions for clients with alterations in sexuality.
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Exemplar 19.1 Erectile Dysfunction
1) During a health history, the nurse learns that a client has a recent onset of impotence. Which
question will help identify a potential cause of this manifestation?
A) "Does this occur often?"
B) "For what diseases and disorders have you been treated?"
C) "Are you on any medications?"
D) "How does your partner feel about this problem?"
Answer: B
Explanation: A) A client's health history can provide clues to the underlying cause of impotence.
The question "for what diseases and disorders have you been treated" would provide the nurse
with information as to possible causes for the recent onset of the disorder. Asking the client if the
impotence occurs often will not help identify the cause of the problem. Asking the client how the
partner feels about the problem also will not help identify a possible cause. The question "are
you on any medication?" would be beneficial to ask; however, it should be an open-ended
question and not a closed-ended question as identified. The nurse should ask the client to "list
any medications" instead of asking "are you on any medication?" which could be answered with
a yes or no.
B) A client's health history can provide clues to the underlying cause of impotence. The question
"for what diseases and disorders have you been treated" would provide the nurse with
information as to possible causes for the recent onset of the disorder. Asking the client if the
a yes or no.
C) A client's health history can provide clues to the underlying cause of impotence. The question
a yes or no.
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D) A client's health history can provide clues to the underlying cause of impotence. The question
a yes or no.
Page Ref: 1353
Learning Outcome: 1. Describe the pathophysiology, etiology, clinical manifestations, and
direct and indirect causes of erectile dysfunction.
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2) The nurse is conducting a health history with a client with erectile dysfunction. Which
finding(s) could provide a possible cause for the client's problem?
A) Blood pressure of 118/68 mmHg
B) Treatment for type 2 diabetes mellitus for 7 years
C) Body mass index (BMI) of 24.5
D) Alcohol intake of 4 to 6 beers each day
E) Plays golf twice a week
Answer: B, D
Explanation: A) The risk factors for erectile dysfunction are numerous. They include advancing
age, diseases such as heart disease and diabetes, trauma, and the use of prescription or illicit
drugs. Excessive use of alcohol can also result in erectile dysfunction. Recreational sports, a
body mass index within normal limits, and a normal blood pressure would not provide a possible
cause for the client's recent experience with the disorder.
B) The risk factors for erectile dysfunction are numerous. They include advancing age, diseases
such as heart disease and diabetes, trauma, and the use of prescription or illicit drugs. Excessive
use of alcohol can also result in erectile dysfunction. Recreational sports, a body mass index
within normal limits, and a normal blood pressure would not provide a possible cause for the
client's recent experience with the disorder.
C) The risk factors for erectile dysfunction are numerous. They include advancing age, diseases
D) The risk factors for erectile dysfunction are numerous. They include advancing age, diseases
E) The risk factors for erectile dysfunction are numerous. They include advancing age, diseases
Page Ref: 1367
Learning Outcome: 2. Identify risk factors associated with erectile dysfunction.
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3) A client is concerned about becoming impotent because of the inability to sustain an erection
and a history of a sexually transmitted infection as a young adult. What is the nurse's best
response to this client's concerns?
A) An occasional incident like this is normal and common, and there is no reason to be
concerned.
B) Sexually transmitted infections may result in sexual problems in adults.
C) Erectile dysfunction is the correct term for the inability to achieve or sustain an erection.
D) The medical diagnosis of erectile dysfunction is not made until the man has erection
difficulties in 25% or more of his interactions.
Answer: A
Explanation: A) This client is concerned about his masculinity and sexual abilities. The correct
answer at this point is to tell him that it is common and normal for men to experience occasional
erectile difficulties. The other options are also true, but they do not serve to alleviate the client's
concerns. If the client continues to have difficulties achieving or sustaining an erection, further
investigation should take place. Simply correcting the client's use of medical terminology does
not address his concerns.
B) This client is concerned about his masculinity and sexual abilities. The correct answer at this
point is to tell him that it is common and normal for men to experience occasional erectile
difficulties. The other options are also true, but they do not serve to alleviate the client's
C) This client is concerned about his masculinity and sexual abilities. The correct answer at this
D) This client is concerned about his masculinity and sexual abilities. The correct answer at this
Page Ref: 1367
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care
across the life span for individuals with erectile dysfunction.
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4) A male client tells the nurse that he has no idea why his wife wants to stay married to him
because he has not been able to "perform" sexually since his prostate surgery. Which diagnosis
would be appropriate for this client?
A) Ineffective Coping
B) Situational Low Self-Esteem
C) Hormonal Imbalance
D) Sexual Dysfunction
Answer: B
Explanation: A) The client is viewing himself as less than a man and is concerned with his wife
wanting to remain married to him. Situational Low Self-Esteem is the most appropriate nursing
diagnosis for the client at this time. Sexual dysfunction is associated with anxiety concerning the
cause of the dysfunction, which is not the case for the client. The client may or may not be
experiencing ineffective coping. Hormonal imbalance is not a nursing diagnosis.
B) The client is viewing himself as less than a man and is concerned with his wife wanting to
remain married to him. Situational Low Self-Esteem is the most appropriate nursing diagnosis
for the client at this time. Sexual dysfunction is associated with anxiety concerning the cause of
the dysfunction, which is not the case for the client. The client may or may not be experiencing
ineffective coping. Hormonal imbalance is not a nursing diagnosis.
C) The client is viewing himself as less than a man and is concerned with his wife wanting to
D) The client is viewing himself as less than a man and is concerned with his wife wanting to
Page Ref: 1369
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for an individual with
erectile dysfunction.
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5) The nurse is planning care for a client with erectile dysfunction. What should the nurse
include in this client's plan of care?
A) Names of psychologists with experience in treating the disorder
B) Information on medications for treatment
C) Types of devices and surgeries available to help with the disorder
D) Reason for disorder as being side effect of prescribed medication
E) Information on exact cause
Answer: B, C
Explanation: A) When planning the care of a client with erectile dysfunction, the nurse should
include information on medications for treatment and types of devices and surgeries available to
help with the disorder. Because an exact cause may be difficult to determine for the client, this
would not be appropriate for the nurse to include in the client's plan of care. Explaining the
reason for the disorder as being a side effect of prescribed medication could cause the client to
discontinue medication necessary to treat other health disorders and should not be done. The
nurse should not provide the names of psychologists who treat the disorder.
B) When planning the care of a client with erectile dysfunction, the nurse should include
information on medications for treatment and types of devices and surgeries available to help
with the disorder. Because an exact cause may be difficult to determine for the client, this would
not be appropriate for the nurse to include in the client's plan of care. Explaining the reason for
the disorder as being a side effect of prescribed medication could cause the client to discontinue
medication necessary to treat other health disorders and should not be done. The nurse should not
provide the names of psychologists who treat the disorder.
C) When planning the care of a client with erectile dysfunction, the nurse should include
D) When planning the care of a client with erectile dysfunction, the nurse should include
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E) When planning the care of a client with erectile dysfunction, the nurse should include
Page Ref: 1368-1369
Learning Outcome: 6. Plan evidence-based care for an individual with erectile dysfunction and
his family in collaboration with other members of the healthcare team.
6) The nurse is instructing a client about the medication sildenafil (Viagra). Which client
statement indicates teaching has been effective?
A) "Viagra should be taken with food."
B) "I can take Viagra anywhere from 1 to 6 hours before sex."
C) "I can take only one pill in a 24-hour period."
D) "Grapefruit juice will decrease the effects of Viagra."
Answer: C
Explanation: A) Taking only one pill in a 24-hour period is the recommended dosing for
sildenafil (Viagra). Grapefruit juice can lead to increased, not decreased, levels of sildenafil.
Sildenafil should be taken on an empty stomach, not with food. The optimum time for
administration is 1 hour before sex, but it can be taken up to 4 hours before sex.
B) Taking only one pill in a 24-hour period is the recommended dosing for sildenafil (Viagra).
Grapefruit juice can lead to increased, not decreased, levels of sildenafil. Sildenafil should be
taken on an empty stomach, not with food. The optimum time for administration is 1 hour before
sex, but it can be taken up to 4 hours before sex.
C) Taking only one pill in a 24-hour period is the recommended dosing for sildenafil (Viagra).
D) Taking only one pill in a 24-hour period is the recommended dosing for sildenafil (Viagra).
Page Ref: 1368
Nursing Process: Evaluation
Learning Outcome: 7. Evaluate expected outcomes for an individual with erectile dysfunction.
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7) The nurse is caring for a client with erectile dysfunction (ED). Which medication should the
nurse anticipate being prescribed for this client?
A) Sildenafil (Viagra)
B) Methylphenidate (Ritalin)
C) Vardenafil (Levitra)
D) Buspirone (BuSpar)
E) Tadalafil (Cialis)
Answer: A, C, E
Explanation: A) Sildenafil (Viagra) works to relax the smooth muscles in the penis, allowing
increased blood flow to the penis resulting in an erection. Vardenafil (Levitra) works to relax the
smooth muscles in the penis, allowing increased blood flow to the penis resulting in an erection.
Tadalafil (Cialis) works to relax the smooth muscles in the penis, allowing increased blood flow
to the penis resulting in an erection. Buspirone (Buspar) is an antianxiety agent and is not
effective for erectile dysfunction (ED). Methylphenidate (Ritalin) is a mild central nervous
system stimulant and is not effective for ED.
B) Sildenafil (Viagra) works to relax the smooth muscles in the penis, allowing increased blood
flow to the penis resulting in an erection. Vardenafil (Levitra) works to relax the smooth muscles
in the penis, allowing increased blood flow to the penis resulting in an erection. Tadalafil (Cialis)
works to relax the smooth muscles in the penis, allowing increased blood flow to the penis
resulting in an erection. Buspirone (Buspar) is an antianxiety agent and is not effective for
erectile dysfunction (ED). Methylphenidate (Ritalin) is a mild central nervous system stimulant
and is not effective for ED.
C) Sildenafil (Viagra) works to relax the smooth muscles in the penis, allowing increased blood
D) Sildenafil (Viagra) works to relax the smooth muscles in the penis, allowing increased blood
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E) Sildenafil (Viagra) works to relax the smooth muscles in the penis, allowing increased blood
Page Ref: 1368
Learning Outcome: 5. Summarize therapies used by interdisciplinary teams in the collaborative
care of an individual with erectile dysfunction.
8) A client asks for a prescription for tadalafil (Cialis). What would be important for the nurse
know prior to planning interventions for this client?
A) "Do you have diabetes mellitus?"
B) "Do you take blood pressure medication?"
C) "Do you have any sexually transmitted infections?"
D) "Do you use nitroglycerine?"
Answer: D
Explanation: A) Combining tadalafil (Cialis) with nitroglycerine can lead to serious
hypotension. Taking blood pressure medication is not a contraindication to the use of tadalafil
(Cialis). Having diabetes mellitus is not a contraindication to the use of tadalafil (Cialis). Having
a sexually transmitted infection is not a contraindication to the use of tadalafil (Cialis).
B) Combining tadalafil (Cialis) with nitroglycerine can lead to serious hypotension. Taking
blood pressure medication is not a contraindication to the use of tadalafil (Cialis). Having
diabetes mellitus is not a contraindication to the use of tadalafil (Cialis). Having a sexually
transmitted infection is not a contraindication to the use of tadalafil (Cialis).
C) Combining tadalafil (Cialis) with nitroglycerine can lead to serious hypotension. Taking
D) Combining tadalafil (Cialis) with nitroglycerine can lead to serious hypotension. Taking
Page Ref: 1368
Learning Outcome: 6. Plan evidence-based care for an individual with erectile dysfunction and
his family in collaboration with other members of the healthcare team.
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9) A nurse is caring for a client who is prescribed a selective phosphodiesterase type 5 inhibitor
for the treatment of erectile dysfunction. The nurse should include which statement when
educating the client regarding this medication?
A) "You should take this medication about 30 minutes before sexual activity."
B) "The action of this medication will last up to 36 hours."
C) "This medication will enhance erections with or without sexual stimulation."
D) "This medication should not be taken more than twice daily."
Answer: B
Explanation: A) Sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra), tadalafil (Cialis),
and avanafil (Stendra) are all selective phosphodiesterase type 5 inhibitors used in the treatment
of erectile dysfunction. The nurse should tell the client that the action of this medication will last
up to 36 hours. The client should take the medication an hour prior to sexual activity, not 30
minutes. This medication will enhance erections only with sexual stimulation and should not be
taken more than once daily.
B) Sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra), tadalafil (Cialis), and avanafil
(Stendra) are all selective phosphodiesterase type 5 inhibitors used in the treatment of erectile
dysfunction. The nurse should tell the client that the action of this medication will last up to 36
hours. The client should take the medication an hour prior to sexual activity, not 30 minutes.
This medication will enhance erections only with sexual stimulation and should not be taken
more than once daily.
C) Sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra), tadalafil (Cialis), and avanafil
D) Sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra), tadalafil (Cialis), and avanafil
Page Ref: 1368
care of an individual with erectile dysfunction.
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10) A nurse is treating a client with diabetes mellitus who complains of erectile dysfunction
(ED). Which hormonal cause contributes to ED?
A) Increased prolactin levels
B) Decreased aldosterone levels
C) Decreased circulating catecholamines
D) Decreased thyroid-stimulating hormone
Answer: D
Explanation: A) Hormonal causes of ED include decreased testosterone, decreased prolactin,
and alterations in thyroid function. A decrease in thyroid-stimulating hormone (TSH) would be a
cause of this disorder. All other choices are incorrect.
B) Hormonal causes of ED include decreased testosterone, decreased prolactin, and alterations in
thyroid function. A decrease in thyroid-stimulating hormone (TSH) would be a cause of this
disorder. All other choices are incorrect.
C) Hormonal causes of ED include decreased testosterone, decreased prolactin, and alterations in
D) Hormonal causes of ED include decreased testosterone, decreased prolactin, and alterations in
Page Ref: 1367
direct and indirect causes of erectile dysfunction.
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Exemplar 19.2 Family Planning
1) A nurse instructor is teaching a group of student nurses regarding problems of infertility and
genetic inheritance of disease. Which statement made by the nurse indicates that teaching has
been effective?
A) "A person's genotype is the observable expression of the traits."
B) "The total genetic makeup of an individual is referred to as the phenotype."
C) "In an autosomal recessive inherited disorder, the individual must have two abnormal genes to
be affected."
D) "An individual is said to have an autosomal dominant inherited disorder if the disease trait is
homozygous."
Answer: C
Explanation: A) In an autosomal recessive inherited disorder, the individual must have two
abnormal genes to be affected. A person's phenotype is the observable expression of traits, and
the total genetic makeup of an individual is referred to as genotype. An individual is said to have
an autosomal dominant inherited disorder if the disease trait is heterozygous–that is, the
abnormal gene overshadows the normal gene of the pair to produce the trait.
B) In an autosomal recessive inherited disorder, the individual must have two abnormal genes to
be affected. A person's phenotype is the observable expression of traits, and the total genetic
makeup of an individual is referred to as genotype. An individual is said to have an autosomal
dominant inherited disorder if the disease trait is heterozygous–that is, the abnormal gene
overshadows the normal gene of the pair to produce the trait.
C) In an autosomal recessive inherited disorder, the individual must have two abnormal genes to
D) In an autosomal recessive inherited disorder, the individual must have two abnormal genes to
Page Ref: 1376-1377
direct and indirect causes of infertility.
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2) A nurse who is working at an obstetrics clinic is caring for a client who desires more
information regarding fertility awareness-based contraceptive methods. Which statement made
by the nurse provides the client with correct information?
A) "Maximum fertility for the woman occurs approximately 2 days before ovulation and
decreases rapidly the day after."
B) "The calendar rhythm method is based on the assumption that ovulation tends to occur about
7 days before the start of the next menstrual period."
C) "To use the calendar rhythm method, the woman must record her menstrual cycles for 6
months to identify the shortest and longest cycles."
D) "The calendar method is the most reliable of the fertility awareness methods."
Answer: C
Explanation: A) Fertility awareness-based methods, also known as natural family planning, are
based on an understanding of the changes that occur throughout a woman's ovulatory cycle.
Maximum fertility for the woman occurs approximately 6 days before ovulation and decreases
rapidly the day after. The calendar rhythm method, also called the standard days method, is
based on the assumption that ovulation tends to occur about 14 days before the start of the next
menstrual period. To use this method, the woman must record her menstrual cycles for 6 months
to identify the shortest and longest cycles. The calendar method is the least reliable of the
fertility awareness methods.
B) Fertility awareness-based methods, also known as natural family planning, are based on an
understanding of the changes that occur throughout a woman's ovulatory cycle. Maximum
fertility for the woman occurs approximately 6 days before ovulation and decreases rapidly the
day after. The calendar rhythm method, also called the standard days method, is based on the
assumption that ovulation tends to occur about 14 days before the start of the next menstrual
period. To use this method, the woman must record her menstrual cycles for 6 months to identify
the shortest and longest cycles. The calendar method is the least reliable of the fertility awareness
methods.
C) Fertility awareness-based methods, also known as natural family planning, are based on an
methods.
21
D) Fertility awareness-based methods, also known as natural family planning, are based on an
methods.
Page Ref: 1378
Learning Outcome: 6. Plan evidence-based care for an individual or couple who seek family
planning, preconception counseling or infertility assistance.
22
3) A female client tells the nurse about wanting to wait to start a family even though the spouse
has been "hinting" about it for some time. What is the best response by the nurse?
A) "Maybe you should babysit a friend's child for a while to see if you really want children."
B) "You and your spouse need to discuss the decision to start a family."
C) "If you don't want to start a family then you don't have to."
D) "What would you do if you became pregnant now?"
Answer: B
Explanation: A) Making the decision to have children is the first step a couple makes in the
process of conception. Sometimes one individual wishes to have a child but the other does not. In
these situations, an open discussion is essential to reach a mutually acceptable decision. Telling
the client that she does not need to start a family if she doesn't want to does not address the issue
of the spouse hinting about starting a family. Asking what the client would do if she became
pregnant now does not address the client's desire to wait to start a family. Suggesting the client
babysit a friend's child would be a strategy to help a person decide if he or she wants to have a
family but does not address the client and spouse's current issue.
B) Making the decision to have children is the first step a couple makes in the process of
conception. Sometimes one individual wishes to have a child but the other does not. In these
situations, an open discussion is essential to reach a mutually acceptable decision. Telling the
client that she does not need to start a family if she doesn't want to does not address the issue of
the spouse hinting about starting a family. Asking what the client would do if she became
C) Making the decision to have children is the first step a couple makes in the process of
D) Making the decision to have children is the first step a couple makes in the process of
Page Ref: 1371-1372
Learning Outcome: 1. Describe decisions to be made by couples prior to beginning
preconception counseling.
23
4) A female client tells the nurse that she does not want to have children because there is a
history of Down syndrome in the family. What should the nurse respond to this client?
A) "That is a common genetic defect caused by an extra chromosome."
B) "Babies born with Down syndrome do not live very long."
C) "It is probably best to not give birth to a baby with birth defects."
D) "Down syndrome only occurs in the babies of women who are over the age of 40."
Answer: A
Explanation: A) Down syndrome is the most common trisomy abnormality seen in children. It is
the product of the union of a normal egg or sperm with an egg or sperm that has an extra
chromosome. This syndrome can occur at any time in a childbearing client of any age. Although
children born with Down syndrome have a variety of physical ailments, advances in medical
science have extended their life expectancy. The nurse should not provide an opinion about
giving birth to a baby with birth defects.
B) Down syndrome is the most common trisomy abnormality seen in children. It is the product
of the union of a normal egg or sperm with an egg or sperm that has an extra chromosome. This
syndrome can occur at any time in a childbearing client of any age. Although children born with
Down syndrome have a variety of physical ailments, advances in medical science have extended
their life expectancy. The nurse should not provide an opinion about giving birth to a baby with
birth defects.
C) Down syndrome is the most common trisomy abnormality seen in children. It is the product
birth defects.
D) Down syndrome is the most common trisomy abnormality seen in children. It is the product
birth defects.
Page Ref: 1374
Learning Outcome: 2. Identify factors associated with family planning, infertility, and
preconception counseling.
24
5) During an evaluation for infertility, a male client is asked to provide a sperm sample. What
information from the client's health history could impact the client's sperm?
A) Activity level
B) Smoking
C) Use of over-the-counter analgesics
D) Mumps after adolescence
E) Number of siblings
Answer: B, C, D
Explanation: A) The quality and effectiveness of sperm is affected by smoking history, use of
over-the-counter pain medications, and experiencing mumps after adolescence. Activity level
and number of siblings are not criteria to evaluate the quality and effectiveness of sperm.
B) The quality and effectiveness of sperm is affected by smoking history, use of over-the-counter
pain medications, and experiencing mumps after adolescence. Activity level and number of
siblings are not criteria to evaluate the quality and effectiveness of sperm.
C) The quality and effectiveness of sperm is affected by smoking history, use of over-the-counter
D) The quality and effectiveness of sperm is affected by smoking history, use of over-the-
counter pain medications, and experiencing mumps after adolescence. Activity level and number
of siblings are not criteria to evaluate the quality and effectiveness of sperm.
E) The quality and effectiveness of sperm is affected by smoking history, use of over-the-counter
Page Ref: 1373
direct and indirect causes of infertility.
25
6) During a health history, the nurse learns that a female client has been trying to conceive for 2
years and does not understand why she cannot become pregnant. For which causes of infertility
should the nurse assess in this client?
A) Amount of alcohol consumed each day
B) Dietary eating pattern
C) Amount of exercise
D) Employment status
E) History of sexually transmitted infections
Answer: A, B, C, E
Explanation: A) Risk factors for female infertility include excess alcohol consumption, poor
diet, athletic training, or being infected with a sexually transmitted infection. Employment status
is not a risk factor for female infertility.
B) Risk factors for female infertility include excess alcohol consumption, poor diet, athletic
training, or being infected with a sexually transmitted infection. Employment status is not a risk
factor for female infertility.
C) Risk factors for female infertility include excess alcohol consumption, poor diet, athletic
D) Risk factors for female infertility include excess alcohol consumption, poor diet, athletic
E) Risk factors for female infertility include excess alcohol consumption, poor diet, athletic
Page Ref: 1372-1373
Learning Outcome: 4. Identify risk factors and prevention methods associated with infertility.
26
7) A client is prescribed an oral contraceptive with estrogen and progesterone. What should the
nurse instruct the client about this contraceptive?
A) An increase in appetite and weight gain is caused by the estrogen.
B) Headaches and nausea are caused by the progesterone.
C) Breast tenderness occurs because of the estrogen.
D) An increase in blood pressure is caused by the progesterone.
E) Acne and oily skin can occur because of the progesterone.
Answer: C, E
Explanation: A) There are possible side effects when taking oral contraceptives that contain both
estrogen and progesterone. Headaches and nausea are caused by the estrogen. Breast tenderness
occurs because of the estrogen. Acne and oily skin can occur because of the progesterone. An
increase in appetite and weight gain is caused by the progesterone. An increase in blood pressure
is caused by the estrogen.
B) There are possible side effects when taking oral contraceptives that contain both estrogen and
progesterone. Headaches and nausea are caused by the estrogen. Breast tenderness occurs
because of the estrogen. Acne and oily skin can occur because of the progesterone. An increase
in appetite and weight gain is caused by the progesterone. An increase in blood pressure is
caused by the estrogen.
C) There are possible side effects when taking oral contraceptives that contain both estrogen and
D) There are possible side effects when taking oral contraceptives that contain both estrogen and
E) There are possible side effects when taking oral contraceptives that contain both estrogen and
Page Ref: 1383-1384
care of an individual or couple seeking help with family planning, preconception counseling, or
infertility.
27
8) The nurse is teaching a client with infertility about the medication clomiphene (Clomid).
Which client statement indicates that teaching has been effective?
A) "This medication stimulates gonadotropin-releasing hormone."
B) "This medication stimulates follicle-stimulating hormone (FSH)."
C) "This medication stimulates luteinizing hormone (LH)."
D) "This medication increases my estrogen levels so I can ovulate."
Answer: C
Explanation: A) Clomiphene (Clomid) stimulates LH, resulting in the maturation of more
ovarian follicles than would normally occur. Clomiphene (Clomid) does not increase estrogen
levels or stimulate FSH and gonadotropin-releasing hormone.
B) Clomiphene (Clomid) stimulates LH, resulting in the maturation of more ovarian follicles
than would normally occur. Clomiphene (Clomid) does not increase estrogen levels or stimulate
FSH and gonadotropin-releasing hormone.
C) Clomiphene (Clomid) stimulates LH, resulting in the maturation of more ovarian follicles
D) Clomiphene (Clomid) stimulates LH, resulting in the maturation of more ovarian follicles
Page Ref: 1365, 1387
Learning Outcome: 7. Evaluate expected outcomes for the individual or couple seeking family
planning, preconception counseling, or infertility assistance.
28
9) A client plans to use oral contraceptives for birth control. Which client behavior would cause
the nurse the most concern?
A) The client has several sexual partners.
B) The client is being treated for bipolar disorder.
C) The client smokes one-half pack of cigarettes a day.
D) The client drinks two glasses of wine a day.
Answer: C
Explanation: A) Cigarette smoking while taking oral contraceptives increases the client's risk for
a thrombolytic disorder. Drinking two glasses of wine a day is not a contraindication to the use
of oral contraceptives. Having several sexual partners or being treated for bipolar disorder is not
a contraindication to the use of oral contraceptives.
B) Cigarette smoking while taking oral contraceptives increases the client's risk for a
thrombolytic disorder. Drinking two glasses of wine a day is not a contraindication to the use of
oral contraceptives. Having several sexual partners or being treated for bipolar disorder is not a
contraindication to the use of oral contraceptives.
C) Cigarette smoking while taking oral contraceptives increases the client's risk for a
D) Cigarette smoking while taking oral contraceptives increases the client's risk for a
Page Ref: 1383-1384
Learning Outcome: 6. Plan evidence-based care for an individual or couple who seek family
29
10) A client wants to use the vaginal sponge as a method of contraception. Which statement or
statements indicate that the client needs further instruction?
A) "I need to leave it in no longer than 6 hours."
B) "I need to use a lubricant prior to insertion."
C) "I can insert the sponge no longer than 24 hours prior to having intercourse."
D) "I need to add spermicidal cream prior to intercourse."
E) "I need to moisten it with water prior to use."
Answer: A, B, D
Explanation: A) A lubricant is not needed, as the sponge is moistened with water prior to
insertion. Spermicidal cream is not needed, because it is already in the sponge. To activate the
spermicide in the vaginal sponge, it must be moistened thoroughly with water. The sponge can
be inserted and remain in place for 24 hours.
B) A lubricant is not needed, as the sponge is moistened with water prior to insertion.
Spermicidal cream is not needed, because it is already in the sponge. To activate the spermicide
in the vaginal sponge, it must be moistened thoroughly with water. The sponge can be inserted
and remain in place for 24 hours.
C) A lubricant is not needed, as the sponge is moistened with water prior to insertion.
D) A lubricant is not needed, as the sponge is moistened with water prior to insertion.
E) A lubricant is not needed, as the sponge is moistened with water prior to insertion.
Page Ref: 1382
Learning Outcome: 7. Evaluate expected outcomes for the individual or couple seeking family
30
Exemplar 19.3 Menopause
1) A nurse is caring for a client who is perimenopausal who states that she has recently had
frequent bacterial vaginal infections. The nurse understands that the reason this has occurred is
likely due to which of the following?
A) Decreased vaginal pH
B) Increased vaginal pH
C) Increased estrogen level
D) Decreased vasomotor stability
Answer: B
Explanation: A) In the perimenopausal client, the vaginal pH increases, predisposing the client
to bacterial vaginal infections. In perimenopause, estrogen levels decrease, not increase.
Decreased vasomotor stability leads to hot flashes, not vaginal bacterial infections.
B) In the perimenopausal client, the vaginal pH increases, predisposing the client to bacterial
vaginal infections. In perimenopause, estrogen levels decrease, not increase. Decreased
vasomotor stability leads to hot flashes, not vaginal bacterial infections.
C) In the perimenopausal client, the vaginal pH increases, predisposing the client to bacterial
D) In the perimenopausal client, the vaginal pH increases, predisposing the client to bacterial
Page Ref: 1394-1395
Learning Outcome: 1. Describe the physiology, etiology, and clinical manifestations of
menopause.
31
2) A nursing working in an outpatient women's health clinic is caring for a client in menopause.
When discussing hormone replacement therapy (HRT) with the client, the nurse should include
which statement?
A) "Most healthy, recently menopausal women should not use HRT for relief of hot flashes and
vaginal dryness."
B) "HRT is the least effective treatment of menopausal hot flashes and vaginal dryness."
C) "If vaginal dryness and painful intercourse are the only symptoms, then low-dose vaginal
estrogen is preferred."
D) "The risk of blood clots in the legs or lungs is further increased by using transdermal patches,
gels, or sprays."
Answer: C
Explanation: A) If vaginal dryness and dyspareunia (painful intercourse) are the only symptoms,
then low-dose vaginal estrogen is preferred. Most healthy, recently menopausal women may use
HRT for relief of hot flashes and vaginal dryness. Risks for blood clots in the legs and lungs are
increased with HRT, but occurrence is rare in women age 50-59. The risk is further lowered by
using low-dose estrogen pills or transdermal patches, gels, or sprays.
B) If vaginal dryness and dyspareunia (painful intercourse) are the only symptoms, then low-
dose vaginal estrogen is preferred. Most healthy, recently menopausal women may use HRT for
relief of hot flashes and vaginal dryness. Risks for blood clots in the legs and lungs are increased
with HRT, but occurrence is rare in women age 50-59. The risk is further lowered by using low-
dose estrogen pills or transdermal patches, gels, or sprays.
C) If vaginal dryness and dyspareunia (painful intercourse) are the only symptoms, then low-
D) If vaginal dryness and dyspareunia (painful intercourse) are the only symptoms, then low-
Page Ref: 1395-1396
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care for
menopausal individuals.
32
3) A female client asks what causes the symptoms of menopause. On which hormonal function
should the nurse focus when responding to this client's question?
A) Increased estrogen levels
B) Increased progesterone levels
C) Estrone as the major hormone
D) Increased luteinizing hormone levels
Answer: C
Explanation: A) As ovarian function decreases, the production of estrogen decreases and is
replaced by estrone as the major ovarian estrogen. Estrone is produced in small amounts and has
only about one-tenth the biological activity of estradiol. With decreased ovarian function, the
second ovarian hormone, progesterone, which is produced during the luteal phase of the
menstrual cycle, also is markedly reduced.
B) As ovarian function decreases, the production of estrogen decreases and is replaced by
estrone as the major ovarian estrogen. Estrone is produced in small amounts and has only about
one-tenth the biological activity of estradiol. With decreased ovarian function, the second
ovarian hormone, progesterone, which is produced during the luteal phase of the menstrual cycle,
also is markedly reduced.
C) As ovarian function decreases, the production of estrogen decreases and is replaced by
D) As ovarian function decreases, the production of estrogen decreases and is replaced by
Page Ref: 1394
Learning Outcome: 1. Describe the pathophysiology, etiology, and clinical manifestations of
menopause.
33
4) A client with a history of breast cancer who is entering menopause is seeking information
about how to manage hot flashes. What information can be provided to the client?
A) Soy and black cohosh can be used to manage the hot flashes associated with menopause.
B) The client should be advised that she will have to wait until menopause has finished for the
hot flashes to cease.
C) Estrogen is the only reliable method of treatment for hot flashes.
D) Olive oil and black cohosh are effective in the management of hot flashes.
Answer: A
Explanation: A) The hot flashes can be successfully managed with soy and black cohosh.
Estrogen is not the only reliable method of treatment for hot flashes. Olive oil is not used to
manage hot flashes. Advising the client to wait is inappropriate.
B) The hot flashes can be successfully managed with soy and black cohosh. Estrogen is not the
only reliable method of treatment for hot flashes. Olive oil is not used to manage hot flashes.
Advising the client to wait is inappropriate.
C) The hot flashes can be successfully managed with soy and black cohosh. Estrogen is not the
D) The hot flashes can be successfully managed with soy and black cohosh. Estrogen is not the
Page Ref: 1397
Learning Outcome: 2. Identify risk factors associated with menopause.
34
5) The nurse is assessing a postmenopausal client. Which client statement should indicate further
assessment by the nurse?
A) "I use water-soluble lubricant to treat my vaginal dryness."
B) "For some reason, I have more sexual desire than ever."
C) "Sex certainly takes longer than it used to, but I'm getting used to that."
D) "I am so glad that I don't need to worry about sex anymore."
Answer: D
Explanation: A) The nurse would further assess the client who made the statement, "I am so
glad that I don't need to worry about sex anymore." This statement is unclear. Does it mean that
the client is glad not to have to engage in sex anymore, or does it mean that she will not have to
worry about getting pregnant anymore? The other statements reflect normal changes associated
with aging and healthy responses to those changes.
B) The nurse would further assess the client who made the statement, "I am so glad that I don't
need to worry about sex anymore." This statement is unclear. Does it mean that the client is glad
not to have to engage in sex anymore, or does it mean that she will not have to worry about
getting pregnant anymore? The other statements reflect normal changes associated with aging
and healthy responses to those changes.
C) The nurse would further assess the client who made the statement, "I am so glad that I don't
D) The nurse would further assess the client who made the statement, "I am so glad that I don't
Page Ref: 1397-1398
Learning Outcome: 3. Illustrate the nursing process in providing culturally competent care for
menopausal individuals.
35
6) A premenopausal client tells the nurse that she is not looking forward to menopause because it
means her life is over. Which nursing diagnosis would be appropriate for the client at this time?
A) Ineffective Sexuality Pattern
B) Deficient Knowledge
C) Situational Low Self-Esteem
D) Disturbed Body Image
Answer: C
Explanation: A) The client believes that once menopause is reached, her life is over. The most
appropriate nursing diagnosis for the client at this time would be Situational Low Self-Esteem
because the client could have inadequate coping skills to aid with the aging process. There is no
information to support the diagnosis of Ineffective Sexuality Pattern. The client may or may not
have deficient knowledge or a disturbed body image.
B) The client believes that once menopause is reached, her life is over. The most appropriate
nursing diagnosis for the client at this time would be Situational Low Self-Esteem because the
client could have inadequate coping skills to aid with the aging process. There is no information
to support the diagnosis of Ineffective Sexuality Pattern. The client may or may not have
deficient knowledge or a disturbed body image.
C) The client believes that once menopause is reached, her life is over. The most appropriate
D) The client believes that once menopause is reached, her life is over. The most appropriate
Page Ref: 1397
Learning Outcome: 4. Formulate priority nursing diagnoses appropriate for a woman
transitioning into menopause.
36
7) A client approaching menopause is interested in oral hormone replacement therapy to manage
the symptoms. Which should the nurse include in this client's teaching plans?
A) Hormone replacement therapy is linked to higher rates of deep vein thrombosis and colorectal
cancer.
B) Estrogen is cardio-protective for women.
C) Hormone replacement therapy is useful for women who are at an increased risk for the
development of osteoporosis.
D) Hormone replacement therapy is associated with a reduced incidence of breast cancer and
pulmonary embolism.
Answer: C
Explanation: A) Osteoporosis is associated with the reduction of estrogen. Hormone
replacement therapy is encouraged for those women who are at an increased risk for the
development of this disease. Estrogen was once thought to be cardio-protective for women, but
newer studies refute these claims. There is an increased risk for breast cancer and pulmonary
embolism for those women who are taking hormone replacement therapy. Although the rates of
deep vein thrombosis are increased, the rates of colorectal cancer are reduced in those taking
hormone replacement therapy.
B) Osteoporosis is associated with the reduction of estrogen. Hormone replacement therapy is
encouraged for those women who are at an increased risk for the development of this disease.
Estrogen was once thought to be cardio-protective for women, but newer studies refute these
claims. There is an increased risk for breast cancer and pulmonary embolism for those women
who are taking hormone replacement therapy. Although the rates of deep vein thrombosis are
increased, the rates of colorectal cancer are reduced in those taking hormone replacement
therapy.
C) Osteoporosis is associated with the reduction of estrogen. Hormone replacement therapy is
therapy.
D) Osteoporosis is associated with the reduction of estrogen. Hormone replacement therapy is
therapy.
Page Ref: 1395-1396
Learning Outcome: 5. Plan evidence-based care for the individual entering menopause and her
family in collaboration with other members of the healthcare team.
37
8) The nurse is evaluating care provided to a client experiencing menopause. Which observation
indicates that the client is successfully managing menopausal symptoms?
A) Weight loss of 5 pounds in 4 months after starting an exercise program at the local gym
B) Client's stated desire to stay at home and limit social activities
C) Weight gain of 10 pounds in 3 months
D) Client's stated loss of interest in recreational activities
Answer: A
Explanation: A) Evidence of successful outcomes for a client with menopause include:
demonstrating a positive sense of self as evidenced by stable weight; participation in a regular
exercise program; ability to manage stress; verbalizing feelings related to changes that have
occurred; and describing strategies for maintaining health. A weight loss of 5 pounds in 4 months
after starting an exercise program is evidence of successful management of menopause. The
other observations are not evidence of successful management of menopause.
B) Evidence of successful outcomes for a client with menopause include: demonstrating a
positive sense of self as evidenced by stable weight; participation in a regular exercise program;
ability to manage stress; verbalizing feelings related to changes that have occurred; and
describing strategies for maintaining health. A weight loss of 5 pounds in 4 months after starting
an exercise program is evidence of successful management of menopause. The other
observations are not evidence of successful management of menopause.
C) Evidence of successful outcomes for a client with menopause include: demonstrating a
D) Evidence of successful outcomes for a client with menopause include: demonstrating a
Page Ref: 1398
Learning Outcome: 7. Evaluate expected outcomes for the individual experiencing menopause.
38
9) A client experiencing menopause voices an interest in using alternative and complementary
therapies to manage symptoms. What initial response by the nurse is indicated?
A) "What types of therapies are of interest to you?"
B) "Those seldom work."
C) "Have you discussed this with your physician?"
D) "Many women report success with these measures."
Answer: A
Explanation: A) Alternative and complementary therapies are used by many women to manage
the manifestations associated with menopause. The nurse has a responsibility to collect data from
the client. The nurse will need to determine which types of therapies are of interest to the client.
The success of these remedies varies by user. It is inappropriate for the nurse to meet the client's
request with negativity. Clients using alternative therapies are asked to report them to their
physicians. This is not, however, the initial step for this scenario.
B) Alternative and complementary therapies are used by many women to manage the
manifestations associated with menopause. The nurse has a responsibility to collect data from the
client. The nurse will need to determine which types of therapies are of interest to the client. The
success of these remedies varies by user. It is inappropriate for the nurse to meet the client's
C) Alternative and complementary therapies are used by many women to manage the
D) Alternative and complementary therapies are used by many women to manage the
Page Ref: 1396-1397
39
10) A client who is postmenopausal confides in the nurse about pain experienced during
intercourse. What should the nurse instruct the client to do?
A) Use vaginal lubricants during intercourse.
B) Avoid intercourse.
C) Tolerate this problem because it is a normal part of aging.
D) Decrease the frequency of intercourse to decrease the pain.
Answer: A
Explanation: A) It is not uncommon for a postmenopausal female to report painful intercourse
that is related to a decrease in vaginal lubrication. Vaginal lubricants can be very effective in
reducing the pain experienced during intercourse. Although this is a normal change of aging,
clients do not have to tolerate the discomfort. Avoidance and decreasing frequency of intercourse
would not resolve the problem for the client. It is stereotypical to assume the client would have
less of a desire for intercourse at an older age.
B) It is not uncommon for a postmenopausal female to report painful intercourse that is related to
a decrease in vaginal lubrication. Vaginal lubricants can be very effective in reducing the pain
experienced during intercourse. Although this is a normal change of aging, clients do not have to
tolerate the discomfort. Avoidance and decreasing frequency of intercourse would not resolve
the problem for the client. It is stereotypical to assume the client would have less of a desire for
intercourse at an older age.
C) It is not uncommon for a postmenopausal female to report painful intercourse that is related to
D) It is not uncommon for a postmenopausal female to report painful intercourse that is related to
Page Ref: 1398
40
Exemplar 19.4 Menstrual Dysfunction
1) A nurse is caring for a client who complains of pain with menstruation. What is true regarding
the etiology and pathophysiology of this condition?
A) Primary dysmenorrhea is caused by decreased levels of prostaglandins, causing the
contractions of the uterus to increase in strength.
B) Primary dysmenorrhea begins within the first 3 or 4 menstrual periods after menarche and
will occur with each ovulatory cycle during the teens and 20s of a woman's life.
C) Secondary dysmenorrhea is more common than primary dysmenorrhea.
D) Primary dysmenorrhea causes include endometriosis, tumors, cysts, pelvic adhesions, pelvic
inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adneomyosis.
Answer: B
Explanation: A) Pain associated with menses, called dysmenorrhea, is one of the most common
menstrual dysfunctions. Primary dysmenorrhea is very common among women with normal
menstrual function and is more common than secondary dysmenorrhea. Primary dysmenorrhea is
caused by the release of prostaglandins that cause the contractions of the uterus needed to expel
menstrual fluid and tissue. Primary dysmenorrheal begins within the first 3 or 4 menstrual
periods after menarche and will occur with each ovulatory cycle during the teens and 20s of a
woman's life. Secondary dysmenorrhea is related to pathology or diseases that affect the uterus
and pelvic area. Causes of secondary dysmenorrhea include endometriosis, tumors, cysts, pelvic
adhesions, pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and
adneomyosis.
B) Pain associated with menses, called dysmenorrhea, is one of the most common menstrual
dysfunctions. Primary dysmenorrhea is very common among women with normal menstrual
function and is more common than secondary dysmenorrhea. Primary dysmenorrhea is caused by
the release of prostaglandins that cause the contractions of the uterus needed to expel menstrual
fluid and tissue. Primary dysmenorrheal begins within the first 3 or 4 menstrual periods after
menarche and will occur with each ovulatory cycle during the teens and 20s of a woman's life.
Secondary dysmenorrhea is related to pathology or diseases that affect the uterus and pelvic area.
Causes of secondary dysmenorrhea include endometriosis, tumors, cysts, pelvic adhesions,
pelvic inflammatory disease, infections, cervical stenosis, uterine leiomyomas, and adneomyosis.
C) Pain associated with menses, called dysmenorrhea, is one of the most common menstrual
41
D) Pain associated with menses, called dysmenorrhea, is one of the most common menstrual
Page Ref: 1399-1400
direct and indirect causes of menstrual dysfunction.
42
2) The nurse suspects a 20-year-old client is experiencing primary dysmenorrhea. Which did the
nurse assess in this client?
A) Bleeding between menstrual periods
B) Headache
C) Fatigue
D) Diarrhea
E) Scant menses
Answer: B, C, D
Explanation: A) Manifestations of primary dysmenorrhea include headache, diarrhea, and
fatigue in addition to vomiting, breast tenderness, and pain radiating to the lower back and
thighs. Scant menses is a symptom of a hormone imbalance. Bleeding between menstrual periods
is a characteristic of metrorrhagia.
B) Manifestations of primary dysmenorrhea include headache, diarrhea, and fatigue in addition
to vomiting, breast tenderness, and pain radiating to the lower back and thighs. Scant menses is a
symptom of a hormone imbalance. Bleeding between menstrual periods is a characteristic of
metrorrhagia.
C) Manifestations of primary dysmenorrhea include headache, diarrhea, and fatigue in addition
metrorrhagia.
D) Manifestations of primary dysmenorrhea include headache, diarrhea, and fatigue in addition
metrorrhagia.
E) Manifestations of primary dysmenorrhea include headache, diarrhea, and fatigue in addition
metrorrhagia.
Page Ref: 1399-1400
direct and indirect causes of menstrual dysfunction.
43
3) The nurse identifies that a client is at risk for dysfunctional uterine bleeding. What did the
A) High level of stress
B) Weight gain of 20 lbs. in 2 months
C) Uses birth control pills for contraception
D) Has a history of peptic ulcer disease
E) Limits intake of high-fat foods
Answer: A, B, C
Explanation: A) A number of factors may predispose a woman to dysfunctional uterine
bleeding. These factors include stress, extreme weight changes, and use of oral contraceptive
agents. Dysfunctional uterine bleeding is usually related to hormonal imbalances and not
associated with peptic ulcer disease or low-fat diets.
B) A number of factors may predispose a woman to dysfunctional uterine bleeding. These
factors include stress, extreme weight changes, and use of oral contraceptive agents.
Dysfunctional uterine bleeding is usually related to hormonal imbalances and not associated with
peptic ulcer disease or low-fat diets.
C) A number of factors may predispose a woman to dysfunctional uterine bleeding. These
D) A number of factors may predispose a woman to dysfunctional uterine bleeding. These
E) A number of factors may predispose a woman to dysfunctional uterine bleeding. These factors
include stress, extreme weight changes, and use of oral contraceptive agents. Dysfunctional
uterine bleeding is usually related to hormonal imbalances and not associated with peptic ulcer
disease or low-fat diets.
Page Ref: 1401
Learning Outcome: 2. Identify risk factors associated with menstrual dysfunction.
44
4) A young adolescent client is concerned about experiencing severe cramps with menstruation.
What should the nurse respond to this client?
A) "This is not normal but is something that can be treated."
B) "You have cramps because you started your periods too early."
C) "Cramps are seen in those who just start having periods and will become less severe as you
get older."
D) "You need to see a gynecologist for a pelvic examination."
Answer: C
Explanation: A) Primary dysmenorrhea occurs without specific pelvic pathology and is most
often seen in girls who have just begun menstruating, becoming less severe after the mid-20s.
The client does not need to see a gynecologist for a pelvic examination. Cramps are normal in
the age range. The client is an early adolescent, which is not too early to start having periods.
B) Primary dysmenorrhea occurs without specific pelvic pathology and is most often seen in
girls who have just begun menstruating, becoming less severe after the mid-20s. The client does
not need to see a gynecologist for a pelvic examination. Cramps are normal in the age range. The
client is an early adolescent, which is not too early to start having periods.
C) Primary dysmenorrhea occurs without specific pelvic pathology and is most often seen in
D) Primary dysmenorrhea occurs without specific pelvic pathology and is most often seen in
Page Ref: 1399
across the life span for individuals with menstrual dysfunction.
45
5) The nurse has identified the diagnosis of Ineffective Coping for a client with severe
premenstrual syndrome. What should be included in this client's plan of care?
A) Encourage frequent rest periods.
B) Suggest 4 ounces of wine each day.
C) Encourage exercise and relaxation techniques.
D) Instruct to avoid contraception during menstruation if engaging in sexual intercourse.
Answer: C
Explanation: A) Interventions to aid with ineffective coping for a client with severe
premenstrual syndrome include encouraging exercise and relaxation techniques and avoiding
alcohol intake. The client should not be encouraged to have 4 ounces of wine each day. The
client should be instructed to use contraception if engaging in sexual intercourse during
menstruation because ovulation and pregnancy can occur. Frequent rest periods would be
beneficial for a client with dysfunctional uterine bleeding.
B) Interventions to aid with ineffective coping for a client with severe premenstrual syndrome
include encouraging exercise and relaxation techniques and avoiding alcohol intake. The client
should not be encouraged to have 4 ounces of wine each day. The client should be instructed to
use contraception if engaging in sexual intercourse during menstruation because ovulation and
pregnancy can occur. Frequent rest periods would be beneficial for a client with dysfunctional
uterine bleeding.
C) Interventions to aid with ineffective coping for a client with severe premenstrual syndrome
uterine bleeding.
D) Interventions to aid with ineffective coping for a client with severe premenstrual syndrome
uterine bleeding.
Page Ref: 1404
menstrual dysfunction.
46
6) The nurse is developing strategies for the relief of menstrual cramping to teach a group of
young women. What should be the focus of these strategies?
A) Minimization of menstrual flow
B) Avoidance of uterine contraction
C) Increase of blood flow to the uterine muscle
D) Decrease in estrogen production
Answer: C
Explanation: A) Menstrual cramping is a result of the muscle ischemia that occurs when the
client experiences powerful uterine contractions. Increase of blood flow to the uterine muscle
through rest, some exercises, application of heat to the abdomen, and presence of milder uterine
contractions (such as those associated with orgasm) can decrease pain and cramping. There is no
connection between the actual amount of flow and pain. Estrogen production should follow
normal patterns and should not be altered.
B) Menstrual cramping is a result of the muscle ischemia that occurs when the client experiences
powerful uterine contractions. Increase of blood flow to the uterine muscle through rest, some
exercises, application of heat to the abdomen, and presence of milder uterine contractions (such
as those associated with orgasm) can decrease pain and cramping. There is no connection
between the actual amount of flow and pain. Estrogen production should follow normal patterns
and should not be altered.
C) Menstrual cramping is a result of the muscle ischemia that occurs when the client experiences
D) Menstrual cramping is a result of the muscle ischemia that occurs when the client experiences
Page Ref: 1342-1343
Learning Outcome: 6. Plan evidence-based care for an individual with menstrual dysfunction
and her family in collaboration with other members of the healthcare team.
47
7) The nurse instructs a client on ways to reduce premenstrual difficulty. Which client statement
indicates the instruction was beneficial?
A) The client states the need to increase dietary sugar intake to promote energy.
B) The client states that guided imagery does not help with the symptoms.
C) The client states the need to increase intake of simple carbohydrates.
D) The client states that reducing caffeine intake will help.
Answer: D
Explanation: A) The client stating that a reduction in caffeine intake will help is evidence that
instruction was beneficial. The other client statements would indicate the need for additional
instruction because guided imagery can be used to reduce stress and promote relaxation, and
simple carbohydrates and sugars should be reduced.
B) The client stating that a reduction in caffeine intake will help is evidence that instruction was
beneficial. The other client statements would indicate the need for additional instruction because
guided imagery can be used to reduce stress and promote relaxation, and simple carbohydrates
and sugars should be reduced.
C) The client stating that a reduction in caffeine intake will help is evidence that instruction was
D) The client stating that a reduction in caffeine intake will help is evidence that instruction was
Page Ref: 1403
Learning Outcome: 7. Evaluate expected outcomes for an individual with menstrual
dysfunction.
48
8) A high school student asks the school nurse what can be done for menstrual cramps. What
should the nurse recommend to this student who is experiencing primary dysmenorrhea?
A) Increase caffeine intake.
B) Use a heating pad.
C) Try black cohosh.
D) Engage in regular exercise.
E) Avoid vitamin supplements.
Answer: B, C, D
Explanation: A) Regular aerobic activity helps to decrease dysmenorrhea symptoms. Caffeine
should be restricted to reduce irritability. Black cohosh helps reduce manifestations in some
clients. Vitamin supplements should not be avoided and may be needed to help control
symptoms. A heating pad helps reduce abdominal cramping and pain.
B) Regular aerobic activity helps to decrease dysmenorrhea symptoms. Caffeine should be
restricted to reduce irritability. Black cohosh helps reduce manifestations in some clients.
Vitamin supplements should not be avoided and may be needed to help control symptoms. A
heating pad helps reduce abdominal cramping and pain.
C) Regular aerobic activity helps to decrease dysmenorrhea symptoms. Caffeine should be
D) Regular aerobic activity helps to decrease dysmenorrhea symptoms. Caffeine should be
E) Regular aerobic activity helps to decrease dysmenorrhea symptoms. Caffeine should be
Page Ref: 1403
care of an individual with menstrual dysfunction.
49
9) The nurse is caring for a client recovering from a total hysterectomy. What should the nurse
include when instructing this client prior to discharge?
A) The importance of douching after intercourse for at least 6 weeks
B) Why bed rest is indicated for at least a month after the surgery
C) The risks and benefits of hormone replacement therapy
D) The importance of returning to normal activities of daily living as soon as possible
Answer: C
Explanation: A) If the ovaries have been removed with a hysterectomy, the nurse should provide
information on the risks and benefits of hormone replacement therapy because the client is
immediately thrust into menopause. The client should restrict physical activity for 4 to 6 weeks
after the surgery. Bed rest is not indicated when recovering from this surgery. Douching and
sexual intercourse should be avoided for at least 4 to 6 weeks after the surgery.
B) If the ovaries have been removed with a hysterectomy, the nurse should provide information
on the risks and benefits of hormone replacement therapy because the client is immediately
thrust into menopause. The client should restrict physical activity for 4 to 6 weeks after the
surgery. Bed rest is not indicated when recovering from this surgery. Douching and sexual
intercourse should be avoided for at least 4 to 6 weeks after the surgery.
C) If the ovaries have been removed with a hysterectomy, the nurse should provide information
D) If the ovaries have been removed with a hysterectomy, the nurse should provide information
Page Ref: 1403
Learning Outcome: 6. Plan evidence-based care for an individual with menstrual dysfunction
and her family in collaboration with other members of the healthcare team.
50
Exemplar 19.5 Responsible Sexual Behavior
1) The nurse teaches families about recognizing signs of dating violence in their teenage
children. Which participant statement indicates that teaching about safe sexual practices has been
effective?
A) "Our son has a new girlfriend."
B) "Our daughter has come home with the odor of alcohol on her breath."
C) "We taught our children about dating violence when they were 6 years old."
D) "We noticed our daughter seems very happy lately."
Answer: B
Explanation: A) When teaching parents to suspect unsafe sexual practices in teens, the nurse
emphasizes that the children should be monitored for substance abuse as a new behavior. This
does not necessarily mean there is dating violence, but it can be a sign if this is a new behavior.
The daughter experiencing dating violence is more apt to show signs of depression and possible
suicidal behavior. If a child has a new boyfriend or girlfriend, the parents are taught to meet the
child's friends; it is not a sign of dating violence for the child to have a new girlfriend. Six-year-
olds are too young for a discussion regarding dating violence.
B) When teaching parents to suspect unsafe sexual practices in teens, the nurse emphasizes that
the children should be monitored for substance abuse as a new behavior. This does not
necessarily mean there is dating violence, but it can be a sign if this is a new behavior. The
daughter experiencing dating violence is more apt to show signs of depression and possible
C) When teaching parents to suspect unsafe sexual practices in teens, the nurse emphasizes that
D) When teaching parents to suspect unsafe sexual practices in teens, the nurse emphasizes that
Page Ref: 1406-1407
Client Need: Safe and Effective Care Environment
Learning Outcome: 1. Describe responsible sexual behavior.
51
2) A college student is being treated for Chlamydia. What should the nurse teach this student to
decrease the risk of transmitting another sexually transmitted infection?
A) Unprotected sex is acceptable if you know the partner well.
B) Latex condoms should be used for all sexual activity.
C) Birth control pills will help to decrease the risk of pregnancy and STDs.
D) Condoms should be used with petroleum jelly.
Answer: B
Explanation: A) Latex condoms should be used for all sexual activity to decrease the risk of
contracting a sexually transmitted infection. Although birth control pills can decrease the risk of
pregnancy, they do not protect against the transmission of sexually transmitted infections.
Petroleum jelly can damage a condom, defeating its purpose for safe sex. Unprotected sex should
only be considered when both partners have been tested for HIV and the relationship is mutually
monogamous.
B) Latex condoms should be used for all sexual activity to decrease the risk of contracting a
sexually transmitted infection. Although birth control pills can decrease the risk of pregnancy,
they do not protect against the transmission of sexually transmitted infections. Petroleum jelly
can damage a condom, defeating its purpose for safe sex. Unprotected sex should only be
considered when both partners have been tested for HIV and the relationship is mutually
monogamous.
C) Latex condoms should be used for all sexual activity to decrease the risk of contracting a
monogamous.
D) Latex condoms should be used for all sexual activity to decrease the risk of contracting a
monogamous.
Page Ref: 1406-1407
Client Need: Safe and Effective Care Environment
Learning Outcome: 2. Demonstrate client teaching to reduce the risk of sexually transmitted
infections.
52
3) A community health nurse is educating a group of teenage clients regarding the prevention of
date violence and rape. Which statement will the nurse include in teaching?
A) "Caucasian girls report dating violence more commonly than Hispanic or African American
girls."
B) "Girls who report dating violence are less likely to report other at-risk behaviors, such as
using illegal substances."
C) "Although previous violence in a teenage male is a problem, it is not associated with an
increased risk of dating violence."
D) "A decreased use of birth control is associated with an increased risk of dating violence and
rape."
Answer: D
Explanation: A) A decreased use of birth control is associated with an increased risk of dating
violence and rape. African American girls report dating violence more commonly than Hispanic
or Caucasian girls. Girls who report dating violence are more likely to report other at-risk
behaviors, such as using illegal substances. Previous violence is associated with an increased risk
of dating violence.
B) A decreased use of birth control is associated with an increased risk of dating violence and
rape. African American girls report dating violence more commonly than Hispanic or Caucasian
girls. Girls who report dating violence are more likely to report other at-risk behaviors, such as
using illegal substances. Previous violence is associated with an increased risk of dating
violence.
C) A decreased use of birth control is associated with an increased risk of dating violence and
violence.
D) A decreased use of birth control is associated with an increased risk of dating violence and
violence.
Page Ref: 1406-1407
Learning Outcome: 2. Demonstrate client teaching to reduce the risk of sexually transmitted
infections.
53
Exemplar 19.6 Sexually Transmitted Infections
1) During an assessment, the nurse suspects a client is experiencing genital herpes. What did the
A) Low blood pressure
B) Headache
C) Fever
D) Back pain
E) Vaginal discharge
Answer: B, C, D, E
Explanation: A) Manifestations of genital herpes include headache, fever, vaginal discharge, and
back pain. Low blood pressure is not a manifestation of genital herpes.
B) Manifestations of genital herpes include headache, fever, vaginal discharge, and back pain.
Low blood pressure is not a manifestation of genital herpes.
C) Manifestations of genital herpes include headache, fever, vaginal discharge, and back pain.
D) Manifestations of genital herpes include headache, fever, vaginal discharge, and back pain.
E) Manifestations of genital herpes include headache, fever, vaginal discharge, and back pain.
Page Ref: 1410
direct and indirect causes of sexually transmitted infection (STI).
54
2) A client reports an open area on the penis. Which question will help the nurse with data
collection?
A) "Do you think you have a disease?"
B) "Have you had sexual intercourse recently?"
C) "Are you promiscuous?"
D) "When did you initially notice this open area?"
Answer: D
Explanation: A) It will be important to record the onset of the open area. The remaining
questions are closed, and will not elicit much information. Asking the client about promiscuity is
judgmental. Determining the date of the last episode of sexual intercourse might be indicated
later if a disease is diagnosed.
B) It will be important to record the onset of the open area. The remaining questions are closed,
and will not elicit much information. Asking the client about promiscuity is judgmental.
Determining the date of the last episode of sexual intercourse might be indicated later if a disease
is diagnosed.
C) It will be important to record the onset of the open area. The remaining questions are closed,
is diagnosed.
D) It will be important to record the onset of the open area. The remaining questions are closed,
is diagnosed.
Page Ref: 1414-1415
Learning Outcome: 2. Identify risk factors and prevention factors associated with STIs.
55
3) A client is experiencing dysuria, urinary frequency, and vaginal discharge. For which sexually
transmitted infection(s) should the nurse prepare the client for testing?
A) Syphilis
B) Vaginitis
C) Chlamydia
D) Trichomoniasis
E) Gonorrhea
Answer: C, E
Explanation: A) Chlamydia invades the same target organs as gonorrhea, which include the
cervix and male urethra, and creates the manifestations of dysuria, urinary frequency, and
discharge. The other sexually transmitted infections target other organs.
B) Chlamydia invades the same target organs as gonorrhea, which include the cervix and male
urethra, and creates the manifestations of dysuria, urinary frequency, and discharge. The other
sexually transmitted infections target other organs.
C) Chlamydia invades the same target organs as gonorrhea, which include the cervix and male
D) Chlamydia invades the same target organs as gonorrhea, which include the cervix and male
E) Chlamydia invades the same target organs as gonorrhea, which include the cervix and male
Page Ref: 1412-1413
across the life span for individuals with STIs.
56
4) A client diagnosed with a sexually transmitted infection reports having "no idea" how the
illness was contracted. Which nursing diagnosis would be appropriate for the client at this time?
A) Anxiety
B) Knowledge Deficit
C) Ineffective Coping
D) Sexual Dysfunction
Answer: B
Explanation: A) The client having no idea how the illness was contracted indicates a deficit in
knowledge regarding the transmission of sexually transmitted infections. There is not enough
information to determine if the client has sexual dysfunction, ineffective coping, or anxiety.
B) The client having no idea how the illness was contracted indicates a deficit in knowledge
regarding the transmission of sexually transmitted infections. There is not enough information to
determine if the client has sexual dysfunction, ineffective coping, or anxiety.
C) The client having no idea how the illness was contracted indicates a deficit in knowledge
D) The client having no idea how the illness was contracted indicates a deficit in knowledge
Page Ref: 1415
an STI.
57
5) The nurse is planning care for a client with a history of sexually transmitted infections. What
should be included in this plan of care?
A) Instruction to limit sexual contact until recovered from illness
B) Plan for the client to contact sexual partners regarding the diagnosis
C) Need to increase fluids and rest
D) Importance of adequate nutrition
Answer: B
Explanation: A) The client has a history of sexually transmitted infections. The nurse should
discuss with the client a plan for sexual partners to be contacted regarding the diagnosis. The
need to increase fluids, rest, and nutrition are important, but not as important as the client
contacting sexual partners regarding the diagnosis. The nurse should instruct the client to avoid,
not just limit, sexual contact until recovered from the illness.
B) The client has a history of sexually transmitted infections. The nurse should discuss with the
client a plan for sexual partners to be contacted regarding the diagnosis. The need to increase
fluids, rest, and nutrition are important, but not as important as the client contacting sexual
partners regarding the diagnosis. The nurse should instruct the client to avoid, not just limit,
sexual contact until recovered from the illness.
C) The client has a history of sexually transmitted infections. The nurse should discuss with the
D) The client has a history of sexually transmitted infections. The nurse should discuss with the
Page Ref: 1415
Learning Outcome: 6. Plan evidence-based care for an individual with an STI and his or her
58
6) The nurse instructs a married couple on the importance of treatment for a chlamydia infection.
Which statement or statements indicate that teaching was effective?
A) "He could get an infection in the tube that carries the urine out."
B) "She could have severe vaginal itching."
C) "It could cause us to develop rashes."
D) "She could develop a worse infection of the uterus and tubes."
E) "She could become pregnant."
Answer: A, D
Explanation: A) Chlamydia is a major cause of nongonococcal urethritis (NGU) in men.
Chlamydia cervicitis can ascend and become pelvic inflammatory disease, or infection of the
uterus, fallopian tubes, and sometimes ovaries. Chlamydia does not cause a woman to become
pregnant. Chlamydia does not cause vaginal itching. Chlamydia does not cause a rash.
B) Chlamydia is a major cause of nongonococcal urethritis (NGU) in men. Chlamydia cervicitis
can ascend and become pelvic inflammatory disease, or infection of the uterus, fallopian tubes,
and sometimes ovaries. Chlamydia does not cause a woman to become pregnant. Chlamydia
does not cause vaginal itching. Chlamydia does not cause a rash.
C) Chlamydia is a major cause of nongonococcal urethritis (NGU) in men. Chlamydia cervicitis
D) Chlamydia is a major cause of nongonococcal urethritis (NGU) in men. Chlamydia cervicitis
E) Chlamydia is a major cause of nongonococcal urethritis (NGU) in men. Chlamydia cervicitis
Page Ref: 1412
Learning Outcome: 7. Evaluate expected outcomes for an individual with an STI.
59
7) A client with syphilis is allergic to penicillin. Which medication would the client need to be
prescribed to treat the infection?
A) Doxycycline
B) Amoxicillin
C) Tetracycline
D) Gentamicin
E) Erythromycin
Answer: A, C
Explanation: A) Clients allergic to penicillin are given oral doses of doxycycline or tetracycline
for 14 days for the treatment of syphilis. Gentamicin, amoxicillin, and erythromycin are not
prescribed for the treatment of syphilis.
B) Clients allergic to penicillin are given oral doses of doxycycline or tetracycline for 14 days for
the treatment of syphilis. Gentamicin, amoxicillin, and erythromycin are not prescribed for the
treatment of syphilis.
C) Clients allergic to penicillin are given oral doses of doxycycline or tetracycline for 14 days for
D) Clients allergic to penicillin are given oral doses of doxycycline or tetracycline for 14 days
for the treatment of syphilis. Gentamicin, amoxicillin, and erythromycin are not prescribed for
the treatment of syphilis.
E) Clients allergic to penicillin are given oral doses of doxycycline or tetracycline for 14 days for
Page Ref: 1414
care of an individual with an STI.
60
8) The nurse is planning care to address pain in the client with genital herpes. Which intervention
would be appropriate for this client?
A) Increase the intake of cranberry juice.
B) Clean lesions 2 or 3 times a day with warm water and soap.
C) Dry lesions with a hair dryer turned to the hot setting.
D) Wear tight cotton clothing.
Answer: B
Explanation: A) Measures to reduce the discomfort of herpes lesions include cleansing the
lesions two or three times a day with warm water and soap. Lesions should be dried using a hair
dryer turned to a cool setting. It is important to wear loose cotton clothing that will not trap
moisture. Fluids that increase urine acidity such as cranberry juice should be avoided.
B) Measures to reduce the discomfort of herpes lesions include cleansing the lesions two or three
times a day with warm water and soap. Lesions should be dried using a hair dryer turned to a
cool setting. It is important to wear loose cotton clothing that will not trap moisture. Fluids that
increase urine acidity such as cranberry juice should be avoided.
C) Measures to reduce the discomfort of herpes lesions include cleansing the lesions two or three
D) Measures to reduce the discomfort of herpes lesions include cleansing the lesions two or three
Page Ref: 1415
Learning Outcome: 6. Plan evidence-based care for an individual with an STI and his or her
61
9) A public health nurse is educating a group of adults regarding sexually transmitted infections.
Which is an appropriate statement by the nurse?
A) "Males have higher rates of gonorrhea and Chlamydia, whereas women have higher rates of
syphilis."
B) "Men are disproportionately affected by STIs compared to women and infants."
C) "Women often experience few early manifestations of the infection, delaying diagnosis and
treatment."
D) "The incidence of STIs is highest among young Caucasian females."
Answer: C
Explanation: A) Women often experience few early manifestations of sexually transmitted
infection, delaying diagnosis and treatment. Women have higher rates of gonorrhea and
Chlamydia, whereas men, especially men who have sex with men, have higher rates of syphilis.
Women and infants are disproportionately affected by STIs. The incidence of STIs is highest
among people of color.
B) Women often experience few early manifestations of sexually transmitted infection, delaying
diagnosis and treatment. Women have higher rates of gonorrhea and Chlamydia, whereas men,
especially men who have sex with men, have higher rates of syphilis. Women and infants are
disproportionately affected by STIs. The incidence of STIs is highest among people of color.
C) Women often experience few early manifestations of sexually transmitted infection, delaying
D) Women often experience few early manifestations of sexually transmitted infection, delaying
Page Ref: 1408
across the life span for individuals with STIs.
62

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