Chapter 21: Sexuality, Sex and Gender Identity

Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition

MULTIPLE CHOICE

1. The mother of a 3-month-old male infant tells the primary care pediatric nurse practitioner
that she occasionally notices he has a penile erection just after nursing. What will the nurse
practitioner tell the mother?
a. Infants should be prevented from masturbating.
b. The infant is conscious of the pleasure associated with nursing.
c. This is a form of infantile priapism.
d. This is a normal, reflexive behavior at this age.
ANS: D
Newborn infants are reflexive beings, and sexual reflexes, which are present prenatally, are
easily stimulated. A penile erection may occur while nursing. Infants explore with their hands
and may touch their own genitalia for pleasure and for the purpose of soothing, and this is
normal. A penile erection at this young age is reflexive and not conscious and intentional. It is
not a form of priapism.

2. The primary care pediatric nurse practitioner is performing a well child examination on a 3-
year-old. The child’s parent reports that the child has recently begun masturbating. What will
the nurse practitioner counsel this parent?
a. To allow the behavior whenever it occurs, since it is normal
b. To discuss sexuality with the child
c. To explore whether the child is being abused
d. To teach the child about privacy and hand hygiene
ANS: D
Masturbation is normal at this age and children do this because it is pleasurable. Parents
should be taught to discuss privacy and hygiene with the child and to encourage the child to
limit the activity to a private place. At this age, the behavior is not associated with sexual
fantasies, so a discussion of sexuality is not warranted. Masturbation at this age is common
and is not usually an indication of abuse.

3. The parent of an 8-year-old child tells the primary care pediatric nurse practitioner that the
child has begun to ask questions about why a schoolmate has “2 daddies” and wonders how to
talk to the child about this. What will the nurse practitioner recommend?
a. Beginning a discussion about different types of sexual relationships and same-sex
partners
b. Discussing the issue with the child in terms of the parent’s religious values and
norms
c. Explaining that not all families are the same and what is most important is that
they love and care for their children
d. Telling the child that some adult relationships are complicated and will be
understood when the child is older
ANS: C
 School age is a good time for parents to reinforce the notion that there is diversity in families
within which parents and adults love and care for their children. It is not necessary to be
explicit but to establish a good history of communication and to explain complex issues to
children at a level of the child’s understanding. In this way, the child will know that parents
are accessible and open to discussion of complex and/or puzzling issues.

4. The primary care pediatric nurse practitioner is performing a well child exam on an 8-year-old
girl and notes the presence of breast buds. What will the nurse practitioner include when
initiating anticipatory guidance for this patient?
a. A discussion about the risks of pregnancy and sexually transmitted diseases
b. Information about sexual maturity and menstrual periods
c. Material about the human papillomavirus vaccine
d. Sexual orientation and the nature of sexual relationships
ANS: B
Since this child is 8 years old, it is early to discuss sexual behavior and reproduction given the
level of the child’s cognition and understanding. However, with these early changes in
telearche marking the onset of puberty, it is wise to discuss menstruation in an age-appropriate
manner before it occurs so that the child can be prepared. Since this child is showing signs of
early puberty, this information can be included in anticipatory guidance.

5. The primary care pediatric nurse practitioner is counseling the parents of a 13-year-old female
who has Down syndrome about sexual maturation. What will the nurse practitioner tell these
parents?
a. It is important to discuss and support healthy sexuality.
b. Providing too much information about sexuality may be confusing given the
child’s cognitive level of understanding.
c. Suppressing periods with contraceptives will lessen their daughter’s distress.
d. They should give her information about periods but not about sexuality.
ANS: A
Persons with disabilities have the same desires to make decisions and foster fulfilling
relationships with others as other people have. Unless healthy sexuality is taught and
supported, unhealthy and abusive sexuality is more likely to occur. Parents should give
information when it is desired and delivered in a manner appropriate to the child’s level of
understanding. Suppressing periods only ignores the issue but does not change the increased
feelings that accompany puberty.

6. During a well child examination, a 15-year-old female tells the primary care pediatric nurse
practitioner that some of her friends have begun having sex. She has a boyfriend but denies
engaging in sex with him. What will the nurse practitioner do initially?
a. Ask her for her definitions of “sex.”
b. Discuss the risks of sexually transmitted diseases.
c. Find out if she is considering sexual relations.
d. Give her information about contraception.
ANS: A
Many adolescents do not equate oral or anal intercourse with sex, so it is important to find out
how this patient defines sex. The other options also may be considered depending on the
situation, however, clarity about the words used in the discussion are most important initially
for the nurse practitioner to focus the subsequent conversation appropriately.
7. During a well child examination of a 6-year-old girl, the primary care pediatric nurse
practitioner notes that the child becomes embarrassed and resists taking off her underwear for
the exam. What should the nurse practitioner infer from this observation?
a. The child has been sexually molested.
b. The child is feeling violated by the examiner.
c. The parent is exhibiting regressive behavior.
d. This is a normal reaction in a child of this age.
ANS: D
Young school-age children can be extremely modest and embarrassed and resist taking off
their clothes for an examiner. Since this is normal, it does not indicate a history of sexual
abuse unless other signs are present. Older school-age children more commonly feel violated
during an exam, not younger children. This response of increased modesty is age-appropriate
and not regressive.

8. The primary care pediatric nurse practitioner is providing anticipatory guidance to the parent
of a school-age boy. The parent expresses concerns that the child prefers to play with dolls, is
worried that the child will be a homosexual, and asks what can be done to prevent this from
happening. What will the nurse practitioner tell this parent?
a. Homosexual identity formation cannot be predicted by early childhood behavior.
b. Masculinizing boys from an early age helps to determine heterosexual orientation.
c. Sexual orientation identification begins late in adolescence and not in childhood.
d. The development of sexual orientation is generally a multifaceted process.
ANS: D
The etiology and age of preferred sexual orientation is unknown, and the sequential
developmental signs are debated. The development of sexual orientation is most likely
multifaceted and cannot be predicted by one phenomenon, such as playing with dolls alone.
Early childhood behavior can predict homosexual orientation as girls may feel “unfeminine”
and boys may exhibit feminine tendencies. It is clear that psychosocial components and
parenting do not cause or prevent homosexuality.