1. A parent asks about the human papillomavirus (HPV) vaccine. Which
information will the nurse include in the teaching session?
a. It is recommended
... [Show More] for girls 6 to 9 years old.
b. It is recommended for females ages 11 to 26.
c. It is recommended that booster injections be given.
d. It is recommended to receive four required injections.
ANS: B
The vaccine is safe for girls as young as 9 years old and is recommended for
females ages 11 to 26 if they have not already completed the three required
injections. Booster doses currently are not recommended. The vaccine is most
effective if administered before sexual activity or exposure.
2. A nursing student is providing education to a group of older adults who
are in an independent living retirement village. Which statement made by the
nursing student requires the nurse to intervene?
a. “Avoiding alcohol use will enhance your sexual functioning.”
“You need to tell your partner how you feel about sex and any fears
b. you may have.”
“You do not need to worry about getting a sexually transmitted
c. infection at this point in your life.”
“Using pillows and taking pain medication
if needed before having sexual intercourse
often help alleviate pain and improve
sexual
d. functioning.”
ANS: C
Research indicates many older adults are more sexuality active than
previously thought and engage in high-risk sexual encounters, resulting in a
steady increase HIV and STI rates over the past 12 years. Therefore, the nurse
needs to intervene when the student tells the older adults that they are not at
risk for developing an STI. Avoiding the use of alcohol; using pillows; taking
pain medications before having intercourse if needed; and communicating
thoughts, fears, and feelings about sex all enhance sexual functioning.
3. A nurse is interviewing a woman who uses a diaphragm. Which
information from the patient will require the nurse to follow up?
a. “I have lost 12 pounds on this diet.”
b. “I use the diaphragm to prevent pregnancy.”
c. “I use a contraceptive cream with my diaphragm.”
d. “I know this provides a barrier over the cervical opening.”
ANS: A
The woman needs to be refitted after a significant change in weight (10-pound
gain or loss) or pregnancy. The diaphragm is a round, rubber dome that has a
flexible spring around the edge. It is used with a contraceptive cream or jelly
and is inserted in the vagina so it provides a contraceptive barrier over the
cervical opening.
4. A nurse is conducting a sexual assessment. Which question is appropriate
for the nurse to ask?
a. Have you noticed any changes in the way you feel about yourself?
b. What is your favorite sex position with men and with women?
c. Do you think your partner is attractive?
d. Why do you like men over women?
ANS: A
Asking about any changes in the way you feel about yourself is an
appropriate question to ask during a sexual assessment. Asking about favorite
sex position with men and/or women is inappropriate and invasive. The
assessment needs to focus on the patient, not the partner. Asking “why”
questions is nontherapeutic and is judgmental in this scenario.
5. A 15-year-old patient is concerned because her mother wants her to
receive the human papillomavirus (HPV) vaccination, but the patient is
unsure if she wants it. Which response by the nurse is most therapeutic?
a. Ask the patient what concerns she may have about the vaccination.
b. Inquire about how many sexual partners
she has had in the past year. Remind her
that her mother knows best and that she
should respect her
c. parents’ wishes.
Promote the importance of the vaccine, and recommend that the
d. patient get the vaccine as soon as possible.
ANS: A
The nurse should encourage health promotion behaviors but first must
consider the autonomy of the patient and assess the patient for more data. The
nurse should value the input of the patient in making a decision and assess
what the patient is thinking to address any concerns the patient may have. The
HPV vaccine is a preventative treatment; whether or not the patient is sexually
active (asking about how many sexual partners) does not matter in this case.
The nurse should not make assumptions about a patient’s home life (mother
knows best); instead, the nurse should ask questions while establishing a
therapeutic relationship. Recommending the patient get the vaccine as soon as
possible is in violation of the patient’s rights.
6. A nurse is reviewing a patient’s history. Which priority finding will alert
the nurse to assess the patient for possible sexual dysfunction?
a. Takes vacations out of the country
Takes antianxiety medication
b. Takes exercise classes
c. Takes afternoon naps
ANS: B
Medications that can affect sexual functioning include antihypertensive,
antipsychotics, antidepressants, and antianxiety. Taking vacations out of the
country, exercise classes, and afternoon naps are not as priority for sexual
functioning as medications.
7. A nurse is assessing a child for sexual abuse. Which assessment findings
will the nurse expect?
a. Physical aggression and sleep disturbances
b. Many peers and no drug usage
c. Panic attacks and anorexia
d. Anxiety and depression
ANS: A
Behavioral signs of sexual abuse in a child include physical aggression, sleep
disturbance, poor peer relationships, and substance abuse. Panic attacks,
anorexia, anxiety, and depression are behavioral signs for adults.
8. The nurse is teaching a patient how to use a condom. Which instructions
will the nurse provide?
a. Store in a warm lit space.
b. Use massage oils for lubrication.
c. Rinse and reuse the condom if needed.
d. Hold onto the condom when pulling out.
ANS: D
Teach patients to pull out right after ejaculating and to hold onto the condom
when pulling out. Store condoms in a cool, dry place away from sunlight.
Instruct patient to never reuse a condom or use a damaged condom.
Instruct patient to only use water-based lubricants (e.g., K-Y jelly) to prevent
the condom from breaking; do not use petroleum jelly, massage oils, body
lotions, or cooking oil. [Show Less]