Title: Exam 4 - Principles of Medical versus Surgical Asepsis & Infec
Course: NUR 1008C Transition to Prof Nursing > Section: Module 5

Q: An older couple expresses concern because they are easily fatigued during sexual intercourse and cannot reach climax. The nurse knows that older adults may have changes in sexual functioning. What strategies to increase sexual stamina could the nurse offer? (Select all that apply.)
- Avoid alcohol and tobacco.
- Encourage intimate touching, such as hugging and kissing.
- Eat well-balanced meals, and eliminate excess fats and sugars.
- Plan sexual activity around a time when the couple feels rested.
- Take pain medication before intercourse.
- Use extra lubrication to decrease discomfort.
A: Encourage intimate touching, such as hugging and kissing.; Eat well-balanced meals, and eliminate excess fats and sugars.
If right: Alcohol, tobacco, and certain medications (such as narcotics for pain) may cause drowsiness and fatigue and negatively affect sexual stamina. Eating well-balanced meals can help to increase energy levels. Planning sexual activity when the couple is well rested will help them not get fatigued as quickly. Encouraging intimate touching may help increase libido, but not energy levels. Extra lubrication and taking pain medications may ease the discomfort of sexual intercourse but are not appropriate interventions for a nursing diagnosis of fatigue.
If wrong: Alcohol, tobacco, and certain medications (such as narcotics for pain) may cause drowsiness and fatigue and negatively affect sexual stamina. Eating well-balanced meals can help to increase energy levels. Planning sexual activity when the couple is well rested will help them not get fatigued as quickly. Encouraging intimate touching may help increase libido, but not energy levels. Extra lubrication and taking pain medications may ease the discomfort of sexual intercourse but are not appropriate interventions for a nursing diagnosis of fatigue.

Q: A patient expresses concern that her partner no longer finds her attractive and is considering having a three-way to spice up the relationship. Which response is the best option for the nurse in this situation?
- “Please help me understand how you are feeling about your relationship right now.”
- “If your partner truly loves you, he doesn’t need to have sex with another person.”
- “Nonmonogamous sex is immoral; here is the number for the local church.”
- “Have you considered the consequences of adding a third party to a sexual relationship?”
A: “Please help me understand how you are feeling about your relationship right now.”
If right: The nurse should be nonjudgmental, and asking for clarification of the patient’s feelings will help the nurse better understand the situation. Making assumptions about the patient’s partner is not appropriate. Passing judgment or imposing the nurse’s morals on the patient is unethical. Asking the patient to consider the consequences of a three-way is judgmental and implies that nontraditional sex is inappropriate.
If wrong: The nurse should be nonjudgmental, and asking for clarification of the patient’s feelings will help the nurse better understand the situation. Making assumptions about the patient’s partner is not appropriate. Passing judgment or imposing the nurse’s morals on the patient is unethical. Asking the patient to consider the consequences of a three-way is judgmental and implies that nontraditional sex is inappropriate.

Q: The patient expresses his attraction to the nurse who is caring for him. The patient asks the nurse for her phone number. How should the nurse first attempt to handle the situation?
- Redefine the boundaries of professionalism.
- Give the patient her number, but ask that he call after work hours.
- Give the patient false information to appease him.
- Ask a coworker to take over care for this patient.
A: Redefine the boundaries of professionalism.
If right: The first action the nurse should take is to redefine the boundaries of the nurse-patient relationship. If those attempts fail, the nurse may want to consider consulting her supervisor and discussing whether a different nurse should care for that patient. Giving out personal information or faulty information could be considered unethical.
If wrong: The first action the nurse should take is to redefine the boundaries of the nurse-patient relationship. If those attempts fail, the nurse may want to consider consulting her supervisor and discussing whether a different nurse should care for that patient. Giving out personal information or faulty information could be considered unethical.

Q: A nurse is caring for a patient who expresses a desire to have an elective abortion. The nurse’s religious and ethical values are strongly opposed. How should the nurse best handle the situation?
- Continue to care for the patient, and limit conversation as much as possible.
- Refer the patient to a family planning center or health professional.
- Attempt to educate the patient about the consequences of abortion.
- Inform the patient that because of moral issues, another nurse will have to care for her.
A: Refer the patient to a family planning center or health professional.
If right: The nurse must be aware of personal beliefs and values and is not required to participate in counseling or procedures that compromise those values. However, the patient is entitled to nonjudgmental care and should be referred to someone who can create a trusting environment. The nurse should not care for a patient if the quality of care could be jeopardized. The nurse should not attempt to push personal values onto a patient. The nurse also should not create tension by informing the patient that she does not have the same morals; this could cause the patient to feel guilty or defensive when receiving care from any health care professional.
If wrong: The nurse must be aware of personal beliefs and values and is not required to participate in counseling or procedures that compromise those values. However, the patient is entitled to nonjudgmental care and should be referred to someone who can create a trusting environment. The nurse should not care for a patient if the quality of care could be jeopardized. The nurse should not attempt to push personal values onto a patient. The nurse also should not create tension by informing the patient that she does not have the same morals; this could cause the patient to feel guilty or defensive when receiving care from any health care professional.

Q: A nurse is caring for a 15-year-old who in the past 6 months has had multiple male and female sexual partners. The nurse knows that the therapeutic statement that would be most effective is
- “I know you feel invincible, but STIs and unwanted pregnancy are a real risk. Let’s discuss what you think is the best method for protecting yourself.”
- “Having sexual interaction with both males and females places you at higher risk for STIs. To protect yourself you need to decide which orientation you are.”
- “Your current friends are leading you to make poor choices. You should find new friends to hang out with.”
- “I think it’s best to notify your parents. They know what’s best for you and can help make sure you practice safe sex.”
A: “I know you feel invincible, but STIs and unwanted pregnancy are a real risk. Let’s discuss what you think is the best method for protecting yourself.”
If right: Most young adults feel invincible, and for this reason they participate in risky behaviors. The nurse should acknowledge this feeling to the patient and offer education and alternatives, while giving the patient the autonomy to make his own decisions. The nurse should not force the patient to make a choice of orientation and should not pass judgment on a patient’s sexual orientation or social network; this would make the patient feel defensive and would eliminate the trust in the relationship. Involving parents is not the first line of action; parents should be notified only if the child is in a life or death situation.
If wrong: Most young adults feel invincible, and for this reason they participate in risky behaviors. The nurse should acknowledge this feeling to the patient and offer education and alternatives, while giving the patient the autonomy to make his own decisions. The nurse should not force the patient to make a choice of orientation and should not pass judgment on a patient’s sexual orientation or social network; this would make the patient feel defensive and would eliminate the trust in the relationship. Involving parents is not the first line of action; parents should be notified only if the child is in a life or death situation.

Q: The nurse is caring for a patient who recently had unprotected sex with a partner who has HIV. The nurse informs the patient
- “You should have your blood drawn today to see if you were infected.”
- “If you have the virus, you will have flulike symptoms in 6 months.”
- “Highly active antiretroviral therapy has been shown effective in slowing the disease process.”
- “I will set you up with a support group to help you cope with dying within the next 10 years.”
A: “Highly active antiretroviral therapy has been shown effective in slowing the disease process.”
If right: Highly active retroviral therapy increases the survival time of a person with HIV or AIDS. HIV antibodies will not show up in blood work for 6 weeks to 3 months. The infection stage of HIV lasts for about a month after the virus is contracted; during that time, the patient may experience flulike symptoms. A support group may be beneficial for a patient who contracts HIV; however, it is unknown whether the patient has contracted HIV, and antiretroviral therapy has helped people live beyond the 10 years expected if HIV goes untreated.
If wrong: Highly active retroviral therapy increases the survival time of a person with HIV or AIDS. HIV antibodies will not show up in blood work for 6 weeks to 3 months. The infection stage of HIV lasts for about a month after the virus is contracted; during that time, the patient may experience flulike symptoms. A support group may be beneficial for a patient who contracts HIV; however, it is unknown whether the patient has contracted HIV, and antiretroviral therapy has helped people live beyond the 10 years expected if HIV goes untreated.

Q: Which patient is most in need of a nurse’s referral to adoption services?
- A patient considering abortion for an unwanted pregnancy
- An infertile couple religiously opposed to artificial insemination
- A woman who suffered miscarriage during her first pregnancy
- A couple who has been attempting conception for 3 months
A: An infertile couple religiously opposed to artificial insemination
If right: Adoption is ideal for someone with infertility, especially if infertility treatments are unavailable owing to religious or financial constraints. A patient who wishes to have an elective abortion may be educated about all the possibilities, but the nurse should approach the patient in a nonjudgmental manner and should accept the patient’s decision. When a patient has recently miscarried, the nurse should assess the patient’s feelings about the loss and should address any concerns the patient may have about fertility. Infertility is the inability to conceive after 1 year of unprotected intercourse; therefore, talking about adoption after one miscarriage or after only 3 months of attempting conception would be too soon.
If wrong: Adoption is ideal for someone with infertility, especially if infertility treatments are unavailable owing to religious or financial constraints. A patient who wishes to have an elective abortion may be educated about all the possibilities, but the nurse should approach the patient in a nonjudgmental manner and should accept the patient’s decision. When a patient has recently miscarried, the nurse should assess the patient’s feelings about the loss and should address any concerns the patient may have about fertility. Infertility is the inability to conceive after 1 year of unprotected intercourse; therefore, talking about adoption after one miscarriage or after only 3 months of attempting conception would be too soon.

Q: A woman who has been in a monogamous relationship for the past 6 months presents to clinic with herpes on her labia. The patient is distraught because her partner must have cheated on her. Which response by the nurse is most effective in establishing an open rapport with a patient?
- Share an anecdote.
- Inform the patient that all encounters are confidential.
- Tell the patient that she must be honest about every sexual experience she has had.
- Ask the patient what concerns or fears she has related to the visit.
A: Inform the patient that all encounters are confidential.
If right: If open communication is to be established with the patient, the patient must know that she can trust her health care provider. By telling the patient that all encounters are confidential, the nurse establishes trust. After establishing that trust, the nurse can ask the patient open questions about her fear to further build a relationship. Forcing the patient to confide by sharing every sexual encounter may hinder a trusting relationship.
If wrong: If open communication is to be established with the patient, the patient must know that she can trust her health care provider. By telling the patient that all encounters are confidential, the nurse establishes trust. After establishing that trust, the nurse can ask the patient open questions about her fear to further build a relationship. Forcing the patient to confide by sharing every sexual encounter may hinder a trusting relationship.

Q: A patient admits that he knew for several months that he had an STI but did not report it. The nurse knows that this is because many people with STIs
- Do not acknowledge the importance of STI testing and treatment.
- Are hesitant to admit they contracted an STI.
- Have lifestyles that subject them to repeated exposure.
- Are uncomfortable discussing sexual health issues with a same-sex provider.
A: Are hesitant to admit they contracted an STI.
If right: Many patients feel guilt, embarrassment, and anxiety about contracting an STI; this can cause them to defer care until the problem becomes severe. Although knowledge about the severity of STIs may be insufficient, this should not deter seeking care. Regardless of lifestyle, STIs should be treated immediately to prevent further transmission. The role of the health care provider is to establish a trusting relationship. A person may be open to discussing health promotion behaviors but may still be hesitant to discuss STIs.
If wrong: Many patients feel guilt, embarrassment, and anxiety about contracting an STI; this can cause them to defer care until the problem becomes severe. Although knowledge about the severity of STIs may be insufficient, this should not deter seeking care. Regardless of lifestyle, STIs should be treated immediately to prevent further transmission. The role of the health care provider is to establish a trusting relationship. A person may be open to discussing health promotion behaviors but may still be hesitant to discuss STIs.

Q: The nurse is leading a seminar about menopause and age-related changes. The nurse knows that a patient does not fully understand the changes of aging when the patient says
- “I will no longer ovulate after menopause.”
- “Orgasms are no longer achievable after menopause.”
- “Hormones of sexual regulation such as estrogen decrease with age.”
- “As men age, their ability to sexually perform may decrease.”
A: “Orgasms are no longer achievable after menopause.”
If right: Orgasms are achievable at any age; however, estrogen levels decrease, and this may impede sexual desire. The nurse should ask the patient if she has any questions on action that will assist in healthy sexual patterns. All other statements indicate that the patient does have an understanding of age-related changes.
If wrong: Orgasms are achievable at any age; however, estrogen levels decrease, and this may impede sexual desire. The nurse should ask the patient if she has any questions on action that will assist in healthy sexual patterns. All other statements indicate that the patient does have an understanding of age-related changes.

Q: A patient who had an ostomy placed 1 month ago states that he is feeling depressed and does not want to participate in sexual activities anymore because he is afraid that his partner is not physically attracted to him. Which nursing intervention will be most effective in helping this patient resume sexual activity?
- Reassure the patient that lots of people resume sex the same week the ostomy is placed.
- Inform the patient about a support group for people with ostomies.
- Teach the patient about intimate activities that can be done to incorporate the ostomy.
- Discuss ways to adapt to new body image so the patient will be comfortable in resuming intimacy.
A: Discuss ways to adapt to new body image so the patient will be comfortable in resuming intimacy.
If right: The nurse should address the patient’s need to be comfortable with his own body image; once this is done, the patient can resume sexual activity. Reassuring the patient that others manage to have sexual intercourse with an ostomy may help to decrease anxiety but may have the unintended effect of making the patient feel as though he is abnormal because he has not yet resumed sexual activity. Support groups may be helpful for the patient, but this is not the most effective intervention a nurse can provide. The patient should be discouraged from using the ostomy as an orifice for sexual activity; this can cause infection, trauma, or prolapse to the stoma.
If wrong: The nurse should address the patient’s need to be comfortable with his own body image; once this is done, the patient can resume sexual activity. Reassuring the patient that others manage to have sexual intercourse with an ostomy may help to decrease anxiety but may have the unintended effect of making the patient feel as though he is abnormal because he has not yet resumed sexual activity. Support groups may be helpful for the patient, but this is not the most effective intervention a nurse can provide. The patient should be discouraged from using the ostomy as an orifice for sexual activity; this can cause infection, trauma, or prolapse to the stoma.

Q: An 18-year-old male patient informs the nurse that he isn’t sure if he is homosexual because he is attracted to both genders. The nurse establishes a trusting relationship patient by saying
- “Don’t worry. It’s just a phase you will grow out of.”
- “Those are abnormal impulses. You should seek therapy.”
- “At your age, it is normal to be curious about both genders.”
- “Having questions about sexuality is normal. Have you noticed any changes in the way this makes you feel about yourself?”
A: “At your age, it is normal to be curious about both genders.”
If right: Young adults have questions about sexuality. The patient will feel most comfortable discussing his sexual concerns further if the nurse establishes that it is normal to ask questions about sexuality. The nurse can then discuss in greater detail. Although it is normal for young adults to be curious about sexuality, the nurse should use caution in giving advice on taking sexual action. The nurse should promote safe sex practices. Telling the patient not to worry dismisses his concern. Telling the patient that he is abnormal might offend the patient and prevent him from establishing an open relationship.
If wrong: Young adults have questions about sexuality. The patient will feel most comfortable discussing his sexual concerns further if the nurse establishes that it is normal to ask questions about sexuality. The nurse can then discuss in greater detail. Although it is normal for young adults to be curious about sexuality, the nurse should use caution in giving advice on taking sexual action. The nurse should promote safe sex practices. Telling the patient not to worry dismisses his concern. Telling the patient that he is abnormal might offend the patient and prevent him from establishing an open relationship.

Q: A nurse is caring for a 35-year-old female patient who recently started taking antidepressants after repeated attempts at fertility treatment. The patient tells the nurse, “I feel happier, but my sex drive is gone.” Which nursing diagnosis has the highest priority?
- Sexual dysfunction
- Ineffective coping
- Deficient knowledge about contraception
- Risk for self-directed violence
A: Sexual dysfunction
If right: Antidepressants have adverse effects on sexual desire and response. The nurse should be sure to educate the patient on the potential for these side effects and how to correct for them, for example, using lubricant to ease discomfort. The patient has taken steps toward effective coping by seeking therapy. The patient has not expressed a reason for the nurse to be concerned about contraceptives. The nurse should always assess for concerns about violence in a patient’s life. Although some antidepressants have been related to self-directed violence, this patient states that she is feeling happy.
If wrong: Antidepressants have adverse effects on sexual desire and response. The nurse should be sure to educate the patient on the potential for these side effects and how to correct for them, for example, using lubricant to ease discomfort. The patient has taken steps toward effective coping by seeking therapy. The patient has not expressed a reason for the nurse to be concerned about contraceptives. The nurse should always assess for concerns about violence in a patient’s life. Although some antidepressants have been related to self-directed violence, this patient states that she is feeling happy.

Q: A mother brings her 4-year-old daughter to clinic. She states that she is upset because she has caught her child masturbating. Which response by the nurse is best for calming the mother?
- “Don’t worry. This is normal for a child her age. She will grow out of it.”
- “That is a natural part of development. Your child is exploring and becoming familiar with her body.”
- “Most children have grown out of that phase by now. She might be developmentally delayed.”
- “That is an abnormal behavior for a female child. I’m going to refer you to a specialist.”
A: “That is a natural part of development. Your child is exploring and becoming familiar with her body.”
If right: Embarrassment about sexuality often stems from lack of understanding about what is normal behavior. The best way to alleviate that anxiety is to explain why the behavior occurs. Telling the parent that a child will grow out of it can create more anxiety because the parent will be wondering when the behavior should stop. Sexual development is a continual process that begins in infancy and continues into young adulthood. Both male and females must establish gender identity, and self-exploration is normal for both genders.
If wrong: Embarrassment about sexuality often stems from lack of understanding about what is normal behavior. The best way to alleviate that anxiety is to explain why the behavior occurs. Telling the parent that a child will grow out of it can create more anxiety because the parent will be wondering when the behavior should stop. Sexual development is a continual process that begins in infancy and continues into young adulthood. Both male and females must establish gender identity, and self-exploration is normal for both genders.

Q: A patient who has had several sexual partners in the past month expresses a desire to use a contraceptive. Which contraceptive method should the nurse recommend?
- Spermicide
- Condom
- Diaphragm
- Oral contraceptive
A: Condom
If right: Condoms are both a contraceptive and a barrier against STIs and HIV; proper use will greatly reduce the risk. Spermicides, diaphragms, and oral contraceptives all protect against pregnancy; however, they are not a barrier and do not prevent bodily fluids from coming in contact with the patient during sexual intercourse.
If wrong: Condoms are both a contraceptive and a barrier against STIs and HIV; proper use will greatly reduce the risk. Spermicides, diaphragms, and oral contraceptives all protect against pregnancy; however, they are not a barrier and do not prevent bodily fluids from coming in contact with the patient during sexual intercourse.

Q: A patient asks the nurse what signs and symptoms are associated with chlamydia. How should the nurse respond?
- The first signs that chlamydia presents are frequency and burning upon urination.
- Symptoms of chlamydia usually affect only women.
- Small red blisters appear first and then multiply.
- Dementia results if chlamydia goes untreated too long.
A: The first signs that chlamydia presents are frequency and burning upon urination.
If right: Urinary problems and abnormal discharge are often the first signs of chlamydia. Both men and women can experience these symptoms, although it is known as the silent STI because symptoms may not present for a length of time after the disease is contracted. Small red blisters are associated with genital warts and herpes. Chlamydia does not cause dementia.
If wrong: Urinary problems and abnormal discharge are often the first signs of chlamydia. Both men and women can experience these symptoms, although it is known as the silent STI because symptoms may not present for a length of time after the disease is contracted. Small red blisters are associated with genital warts and herpes. Chlamydia does not cause dementia.

Q: A 15-year-old patient is concerned because her mother wants her to receive the HPV vaccination, but the patient is unsure if she wants it. Which response by the nurse is most therapeutic?
- Ask the patient what concerns she may have about the vaccination.
- Remind her that her mother knows best, and that she should respect her parents’ wishes.
- Ask the patient how many sexual partners she has had in the past year.
- Promote the importance of the vaccine, and recommend that the patient get the vaccine as soon as possible.
A: Ask the patient what concerns she may have about the vaccination.
If right: The nurse should encourage health promotion behaviors but first must consider the autonomy of the patient. The nurse would want to value the input of the patient in making a decision and to address any concerns the patient may have. The HPV vaccine is a preventative treatment, whether or not the patient is sexually active. The nurse should not make assumptions about a patient’s home life; instead, the nurse should ask questions while establishing a therapeutic relationship.
If wrong: The nurse should encourage health promotion behaviors but first must consider the autonomy of the patient. The nurse would want to value the input of the patient in making a decision and to address any concerns the patient may have. The HPV vaccine is a preventative treatment, whether or not the patient is sexually active. The nurse should not make assumptions about a patient’s home life; instead, the nurse should ask questions while establishing a therapeutic relationship.

Q: A male patient with diabetes who is taking medication for erectile dysfunction is experiencing pain and discomfort related to the side effect of priapism. The nurse knows that this patient is at greatest risk for
- Sexual dysfunction related to low self-esteem.
- Impaired circulation due to medication.
- Anxiety related to erectile dysfunction.
- Ineffective coping related to chronic illness.
A: Impaired circulation due to medication.
If right: The most immediate concern for a patient with priapism, a condition caused by lack of circulation to the penis, is that this can cause further health complications. Anxiety, sexual dysfunction, and ineffective coping are all also valid nursing diagnoses but are not a priority for this patient. The diagnosis that causes the most harm to the patient should be addressed first.
If wrong: The most immediate concern for a patient with priapism, a condition caused by lack of circulation to the penis, is that this can cause further health complications. Anxiety, sexual dysfunction, and ineffective coping are all also valid nursing diagnoses but are not a priority for this patient. The diagnosis that causes the most harm to the patient should be addressed first.

Q: A 68-year-old female asks the nurse if a contraceptive is still necessary. What is the best response by the nurse?
- “A barrier such as a condom is recommended if you are unsure whether your sexual partners have been tested for STIs.”
- “No, because you have gone through menopause and can no longer become pregnant.”
- “Let’s discuss this further, what is your current level of sexual activity?”
- “Yes, as long as using a barrier does not decrease sexual performance.”
A: “Let’s discuss this further, what is your current level of sexual activity?”
If right: The nurse should first assess the patient’s risk for contracting an STI. If the patient has been in a monogamous relationship, and both parties are STI free, there is no need for a barrier. However, even though a patient has gone through menopause, there is still risk for an STI. The best way for a nurse to be sensitive to a patient’s needs is to find out more about the patient. Discussing sexual performance in relation to using a barrier method does not answer the patient’s question.
If wrong: The nurse should first assess the patient’s risk for contracting an STI. If the patient has been in a monogamous relationship, and both parties are STI free, there is no need for a barrier. However, even though a patient has gone through menopause, there is still risk for an STI. The best way for a nurse to be sensitive to a patient’s needs is to find out more about the patient. Discussing sexual performance in relation to using a barrier method does not answer the patient’s question.

Q: A mother brings her 12-year-old daughter into a clinic and inquires about getting her an HPV vaccine that day. The nurse informs the mother that the HPV vaccine
- Is safe for children over the age of 5 and lasts 10 years.
- Is recommended only after a female becomes sexually active.
- Will prevent a female from ever getting cervical cancer.
- Requires a three-injection series to be fully effective.
A: Requires a three-injection series to be fully effective.
If right: The HPV vaccine is effective against the four most common types of HPV that can cause cervical cancer. Three injections are required, and booster doses currently are not recommended. It is safe for females older than 9 years of age and is intended for females from 13 to 26 years of age. The vaccine is most effective if administered before sexual activity or exposure.
If wrong: The HPV vaccine is effective against the four most common types of HPV that can cause cervical cancer. Three injections are required, and booster doses currently are not recommended. It is safe for females older than 9 years of age and is intended for females from 13 to 26 years of age. The vaccine is most effective if administered before sexual activity or exposure.