2.What would be a successful outcome for this patient?
Following an adjustment to his medications, Mr.
Smith vocalizes an improvement in his sexual func-
tioning.
3.What intellectual, technical, interpersonal, and/or
ethical/legal competencies are most likely to bring
about the desired outcome?
Intellectual: ability to integrate knowledge about
sexual health into nursing care, including the abil-
ity to identify areas of sexual dysfunction for the
patient with a history of diabetes and hypertension
experiencing impotence.
Interpersonal: strong interpersonal skills to
establish trusting relationships and build rapport
with a patient experiencing impotence.
4.What resources might be helpful for Mr. Smith?
Counseling, printed materials on impotence and
corrective measures, information on the effect of
medications on sexual functioning
PATIENT CARE STUDY
1.Objective data are underlined; subjective data are in
boldface.
Anthony Piscatelli, a 6-foot-tall, muscular, healthy
19-year-old college freshman in the School of
Nursing,confides to his nursing advisor that
“everything is great”about college life, with one
exception: “All of a sudden, I find myself
questioning the values I learned at home about
sex and marriage.My Mom was really insistent
that each of her sons should respect women and
that intercourse was something you saved until you
were ready to get married. If she told us once, she
told us a hundred times, that we’d save ourselves,
the girls in our lives, and her and Dad a lot of
heartache if we could just learn to control ourselves
sexually. Problem is that no one here seems to sub-
scribe to this philosophy. I feel like I’m abnormal
in some way to even think like this.There’s a lot
of sexual activity in the dorms, and no one even
thinks you’re serious if you talk about virginity pos-
itively. What do you think? Did my Mom sell me a
bill of goods? Is it true that if you take the proper
precautions, no one gets hurt and everyone has a
good time?” Tony reports that he is a virgin and
that he really misses his close family back home:
“I do get lonely at times and would love to just
cuddle with someone or even give and get a big
hug, but no one seems to understand this.”
2.Nursing Process Worksheet
Health Problem: High risk for altered sexuality patterns
Etiology: Discrepancy between his family’s values
about sex and marriage and those he is discovering
in peer group
Signs and Symptoms:“All of a sudden, I find myself
questioning the values I learned at home about sex
and marriage”; feels like he is “abnormal” in some
way to value virginity; lonely—wants intimacy; “Is
it true that if you take the proper precautions, no
one gets hurt and everyone has a good time?”Expected Outcome:By next meeting, 11/17/11,
patient will report personal satisfaction with the
results of his reevaluation of his beliefs/values con-
cerning sex and marriage.
Nursing Interventions:
a.Assess patient’s knowledge of sexual
development and need for intimacy and belong-
ing, and correct any misinformation.
b.Explore with the patient the source of the
beliefs/values he learned at home and assist in
determining the role he wants these beliefs/val-
ues to play in his life.
c. Compare the options of abstinence and becom-
ing sexually active, and perform related sexual
teaching.
d.Refer to appropriate on-campus sexuality classes,
counseling center, or seminars, as indicated.
Evaluative Statement: 11/17/11: Goal not met.
Patient reports that his confusion has only
deepened and he now feels like “my head is warring
with my body.” Reports sleeping with his girlfriend
but feeling very guilty afterward—now ignores this
girl. Revision: See if he’s willing to talk with a peer
or professional counselor regarding sexual
concerns.—R. LeBon, RN
3.Patient strengths: Healthy; caring family; ability to
voice his concerns; very “likable” person
Personal strengths: Sound knowledge of sexuality;
respect for and appreciation of sexuality;
understanding of developmental challenges of
young adults and self-identity and intimacy needs;
ability to create trusting relationships with young
adults
4.11/17/11: Patient states he is “more confused now”
than when we last met. He yielded to peer pressure
and slept with girlfriend; used condom. While he
“enjoyed this experience,” he has been “wracked
with guilt” ever since. He cannot reconcile this
behavior with what he learned at home and contin-
ues to feel “unsure” of who he wants to be. He defi-
nitely wants some resolution of this conflict and is
interested in speaking with a professional sexuality
counselor. Referral made.—R. LeBon, RNCHAPTER 46
PRACTICING FOR NCLEX
MULTIPLE CHOICE QUESTIONS
1.b 2.d 3.c 4.a 5.b
6.d 7.b 8.a
ALTERNATE-FORMAT QUESTIONS
Multiple Response Questions
1.a, b, e
2.a, b, d
3.d, e
4.b, d, e
5.c, dCopyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins. Study Guide for Fundamentals of Nursing:ANSWER KEY 421
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