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17. A respected school coach was arrested after a student reported the coach attempted to have sexual contact. Which nursing action has priority in the period immediately following the coach’s arrest?

a. Determine the nature and extent of the coach’s sexual disorder.

b. Assess the coach’s potential for suicide or other self-harm.

c. Assess the coach’s self-perception of problem and needs.

d. Determine whether other children were harmed.

ANS: B

Pedophiles and other persons with paraphilic disorders can be at increased risk of self-harm associated with the guilt, shame, and anger they feel about their behavior and its effect on their families, victims, and victims’ families. They also face considerable losses, such as the end of their careers or the loss of freedom to imprisonment. Thus, safety is the priority issue for assessment. Determining the nature and extent of the patient’s disorder and related patient perceptions would be appropriate but not the highest priority for assessment. Investigating whether other victims exist is a matter for law enforcement rather than health care personnel. See relationship to audience response question.

PTS: 1 DIF: Cognitive Level: Analyze (Analysis)

REF: Pages 20-41, 45, 63 (Table 20-6) TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

18. An adult seeks treatment for urges involving sexual contact with children. The adult has not acted on these urges but feels shame. Which finding best indicates that this adult is making progress in treatment? The adult a. consistently avoids schools and shops at malls only during school hours. b. indicates sexual drive and enjoyment from sex have decreased. c. reports an active and satisfying sex life with an adult partner. d. volunteers to become a scout troop leader.

ANS: A

One strategy for avoiding acting on inappropriate urges is to avoid environments and circumstances that evoke those urges; for a pedophile this would include avoiding all situations that would likely result in contact with children. Pedophilic disorder is persistent; elimination of fantasies about children would be unrealistic. A person who volunteers to lead a scout troop is placing himself/herself around children. A diminished sex drive or a healthy sex life with an appropriate partner does not necessarily reduce the desire for sexual contact with children.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 20-42, 43, 63 (Table 20-6), 68 (Box 20-3)

MSC: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

19. A patient’s medical record documents sexual masochism. This patient derives sexual pleasure a. from inanimate objects. b. by inflicting pain on a partner. c. when sexually humiliated by a partner. d. from touching a nonconsenting person.

ANS: C

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

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Page 20-36

TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity a. Delayed ejaculation b. Erectile dysfunction c. Premature ejaculation d. Genito-pelvic pain/penetration disorder

20. A man with hypospadias tells the nurse, “Intercourse with my new bride is painful.” Which term applies to the patient’s complaint?

ANS: D

This sexual pain is genito-pelvic pain/penetration disorder and may occur in men or women. The individual feels pain in the genitals during intercourse. Erectile or ejaculation problems are not evident. See relationship to audience response question.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 20-12, 13 TOP: Nursing Process: Assessment

MSC: Client Needs: Physiological Integrity a. “I sense you are feeling frustrated and upset.” b. “Tell me more about feeling like a failure.” c. “You are too hard on yourself.” d. “What do you mean by awful?”

21. A man who regularly experiences premature ejaculation tells the nurse, “I feel like such a failure. It’s so awful for both me and my partner.” Select the nurse’s most therapeutic response.

ANS: A

Using reflection and empathy promotes trust and conveys concern to the patient. The distracters do not offer empathy, probe, and offer premature reassurance.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 20-16, 20, 24, 55 (Table 20-2)

TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity a. “Have you discussed this problem with your partner?” b. “I can refer you to a practitioner who can help you with this problem.” c. “Have you asked your health care provider for prescription medication?” d. “There are several techniques described in this pamphlet that might be helpful.”

22. A man who reports frequently experiencing premature ejaculation tells the nurse, “I feel like such a failure. It’s so awful for both me and my partner. Can you help me?” Select the nurse’s best response.

ANS: B

The primary role of the nurse is to perform basic assessment and make appropriate referrals. The other options do not clarify the nurse’s role.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 20-16, 20, 24, 55 (Table 20-2)

TOP: Nursing Process: Implementation MSC: Client Needs: Safe, Effective Care Environment a. Having tea parties with dolls b. A compromised sexual response cycle c. Identifying with boys who are athletic d. Intense urges to watch his parents have sex

23. A 10-year-old boy is diagnosed with gender dysphoria. Which assessment finding would the nurse expect?

ANS: A

An individual with gender dysphoria feels at odds with the roles associated with that gender. A child with this diagnosis is likely to engage in play associated with the opposite gender. The other options are not age appropriate or characteristically seen in children with gender dysphoria.

PTS: 1 DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 20-25 to 28 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity

24. A patient approaches the nurse in the clinic waiting room and says, “I want to talk to you about a sexual matter.” The nurse can best facilitate the discussion by a. saying, “Let’s go my office.” b. responding, “I want to help. Go ahead; I’m listening.” c. telling the patient, “Let’s schedule another appointment.” d. offering to sit in a corner of the waiting room with the patient.

ANS: A

A discussion of sexual concerns requires privacy. Suggesting use of office space is preferable to using the waiting room, where others cannot help but overhear sensitive material. The distracters block communication.

PTS: 1 DIF: Cognitive Level: Apply (Application)

REF: Pages 20-16, 18, 55 (Table 20-2) TOP: Nursing Process: Implementation

MSC: Client Needs: Psychosocial Integrity

Multiple Response

1. A nurse assesses a patient diagnosed with a paraphilic disorder. Which findings are most likely? (Select all that apply.)

a. Childhood history of attention deficit hyperactivity disorder (ADHD) b. A poorly managed endocrine disorder c. History of brain injury d. Cognitive distortions e. Grandiosity

ANS: A, C, D

ADHD in childhood, substance abuse, phobic disorders, and major depressive disorder/dysthymia are strongly associated with paraphilic disorders. Errors in thought make it seem acceptable for deviant and destructive sexual behaviors to occur. Patients who have experienced head trauma with damage to the frontal lobe of the brain may display symptoms of promiscuity, poor judgment, inability to recognize triggers that set off sexual desires, and poor impulse control. Endocrine problems are not associated with pedophilic disorder. Self-confidence is lacking; therefore, grandiosity would not be expected.

PTS: 1

DIF: Cognitive Level: Understand (Comprehension)

REF: Pages 20-38, 39 TOP: Nursing Process: Assessment

MSC: Client Needs: Psychosocial Integrity