Ch 5-STI- Nursing OB
A nurse is teaching personal hygiene care techniques to a client with genital herpes. Which statement by the client indicates the teaching has been effective?
"I will wear loose cotton underwear." Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions shouldn't be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of hydrogen peroxide and water on lesions isn't recommended.
A nurse is caring for the following clients who have a history of genital herpes infection. Which client is most at risk for an outbreak of genital herpes?
A client who complains of genital pruritus and paresthesia Pruritus and paresthesia as well as redness of the genital area are prodromal symptoms of recurrent herpes infection. These symptoms occur 30 minutes to 48 hours before the lesions appear. Headache and fever are symptoms of viremia associated with the primary infection. Vaginal and urethral discharge is also a local sign of primary infection. Dysuria and lymphadenopathy are local symptoms of primary infection that may also occur with recurrent infection.
Which of the following should a nurse consider when assessing older clients with a sexually transmitted infection (STI)?
Abandon biases that older adults are sexually inactive
A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?
An azole antifungal agent Explanation: The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use, enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.
A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment?
Avoid alcohol The nurse should counsel the client taking metronidazole to avoid alcohol during the treatment because mixing the two causes severe nausea and vomiting. Avoiding extremes of temperature to the genital area is a requirement for clients with genital ulcers, not trichomoniasis. The nurse should instruct the client to avoid sex, regardless of using condoms, until she and her sex partners are cured, that is, when therapy has been completed and both partners are symptom-free. It is not required to increase fluid intake during treatment.
Which of the following instructions should the nurse give to a client with genital herpes to help control the infection?
Avoid sexual contact until sores heal Explanation: The nurse should instruct the client to avoid sexual contact until sores heal completely and new skin forms. Application of antibacterial medication is suggested for wounds in case of lymphedema. Clients with HIV are advised to avoid people with upper respiratory infections. Application of imiquimod cream is suggested for clients infected with human papilloma virus.
A client is receiving ceftriaxone as treatment for gonorrhea. Which of the following would be most important for the nurse to emphasize to the client?
Avoiding alcohol consumption
A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea?
Burning on urination Explanation: Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.
A client with a family history of cervical cancer is to undergo a Pap test. During the client education, what group should the nurse include as at risk for cervical cancer?
Clients who have genital warts The presence of genital warts (condyloma) increases the risk of developing cervical cancer. Women with metrorrhagia or irregular menstrual cycles are at an increased risk of developing breast cancer, not cervical cancer. Clients who have never had a baby or those with a history of fibrocystic breast disease have an increased risk of developing breast cancer, but not cervical cancer.
During unprotected sex, a 17 year-old female high school senior has been exposed to the human papillomavirus (HPV). The school nurse would recognize that the student is at a considerable risk of developing which of the following diagnoses?
Condylomata acuminata HPV is an identified precursor to condylomata acuminate, or genital warts. Herpes, gonorrhea and candidiasis are not likely to result directly from HPV.
Working at the local health clinic, the nurse recognizes that STIs can often result in PID. When a client with a history of repeat STIs presents to the clinic reporting severe abdominal cramping and bleeding, the immediate concern is to ensure the client does not have:
Ectopic pregnancy
A client complaining of genital warts has been diagnosed with human papillomavirus (HPV). The genital warts have been treated, and they have disappeared. Which should the nurse include in the teaching plan when educating the client about the condition?
Even after warts are removed, HPV still remains. The nurse should inform the client that even after warts are removed, HPV still remains and viral shedding will continue. The nurse should instruct the client to avoid applying steroid creams, sprays, or gels to vaginal area. All women over the age of 30 should undergo an HPV test, and women between 9 and 26 years of age should consider HPV vaccination. The use of latex condoms has been associated with a decreased risk, not an increased risk, of cervical cancer.
A client is admitted in the healthcare facility with pelvic inflammatory disease (PID). When reviewing the client's history, which of the following would the nurse identify as a risk factor?
Frequent douching One of the risk factors associated with pelvic inflammatory disease is frequent douching. Women with gestational diabetes are at an increased risk for developing type 2 diabetes later in life. Genetic predisposition and environmental exposure are risk factors associated with breast cancer.
A nurse needs to assess a female client for primary stage herpes simplex virus (HSV) infection. For which symptom related to this condition should the nurse assess?
Genital vesicular lesions Genital herpes simplex is characterized by lesions, frequently located on the vulva, vagina, and perineal areas. Rashes on the face are not symptoms of HSV. Alopecia is one of the symptoms of syphilis, not of primary HSV. Vaginal discharge during the primary stage of herpes is mucopurulent, not yellow-green.
A client comes to the prenatal clinic for her first visit. Which screening would be most appropriate for the nurse to encourage the client to undergo?
HBV Expl: Nurses should encourage women to undergo HBV screening at their first prenatal visit and repeat screening in the last trimester for women with high-risk behaviors to comply with the U.S. Preventive Services Task Force recommendations.
A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata?
Human papilloma virus Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.
A client presents with vulvar itching and diffuse green vaginal discharge. Upon evaluation, she is prescribed metronidazole. What is the paramount nursing intervention in discharge planning?
Instruct the patient not to drink alcohol with this treatment While counseling to abstain from sex for one week is appropriate, the most important intervention is counseling to avoid alcohol during Flagyl treatment. Alcohol consumption while taking Flagyl creates a severe gastrointestinal reaction of nausea, vomiting, and flushing. Flagyl does not have to be taken with milk and further STI testing is indeed recommended with the diagnosis of an STI
Which stage of syphilis occurs when the infected person has no signs or symptoms of syphilis?
Latency Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.
Which instruction should be given to a woman newly diagnosed with genital herpes?
Limit Stress Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it isn't known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Pap test is recommended every year
A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms?
Metronidazole Explanation: The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, enable the protozoan to proliferate. Trichomoniasis responds well to treatment with metronidazole
Which of the following is the most effective treatment for trichominiasis?
Metronidazole (Flagyl) The most effective treatment for trichomoniasis is metronidazole and tinidazole. Penicillin G benzathine is used for syphilis. Doxycycline and Azithromycin are used in the treatment of Chlamydia
A 24 year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis?
Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease The treatment of choice for Trichomonas vaginalis is oral metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment and eradication of the infection is possible with treatment.
Which of the following is the medication of choice for early syphilis?
Penicillin G benzathine Explanation: A single dose of Penicillin G benzathine intramuscular injection is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration. Patients who are allergic to penicillin are usually treated with doxycycline or tetracycline. Rocephin is not the medication of choice for syphilis.
When developing the teaching plan for a client who is HIV positive, which of the following would the nurse include?
Practicing rigid adherence to drug schedule and dosage The nurse should teach the client infected with HIV to strictly adhere to the prescribed drug schedule and dosage. Avoiding caffeine and artificial sweeteners, using transcutaneous electrical nerve stimulation, and having weekly drug instillations of dimethyl sulfoxide into the bladder are suggested for clients with interstitial cystitis.
Pelvic infection is most commonly caused by which of the following?
Sexual transmission Explanation: Pelvic infection is most commonly caused by sexual transmission but can also occur with invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an intrauterine device
An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported?
Syphilis Explanation: The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDS. Genital herpes, hepatitis B, venereal warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law
Which factor in a client's history indicates she's at risk for candidiasis?
Use of corticosteroids Explanation: Small numbers of the fungus Candida albicans are commonly in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Pregnancy, not nulliparity, increases the risk of candidiasis. Candidiasis is rare before menarche and after menopause. The use of hormonal contraceptives, not spermicidal jelly, increases the risk of candidiasis.
Which of the following would alert the nurse to suspect that a client has a yeast infection?
Vulvar burning and itching Explanation: The primary symptom of a yeast infection is burning and itching on the vulva or in the vagina. Acidic vaginal secretions are not the primary symptoms of a yeast infection. Skin changes and lymphadenopathy may occur in the breast and require a follow up for breast exam; however, these are not associated with yeast infections.
A nurse is engaged in primary prevention activities for HPV. The nurse would be most likely involved with which activity?
administering HPV vaccine Primary prevention is aimed at preventing the disease or condition before it occurs, so giving the HPV vaccine would be a primary prevention activity. If the woman does not receive primary prevention with the vaccine, then secondary prevention would focus on education about the importance of receiving regular Pap smears and, for women over age 30, including an HPV test to determine whether the woman has a latent high-risk virus that could lead to precancerous cervical changes.
The nurse is preparing to administer medication therapy to a woman diagnosed with syphilis. The nurse would expect to administer:
penicillin G. Explanation: Penicillin G is the drug of choice for treating syphilis. Miconazole is used to treat candidiasis. Metronidazole is used to treat trichomoniasis. Doxycycline is used to treat chlamydia.
A nurse is conducting a program about genital herpes infection at a community clinic. The nurse determines that additional discussion is needed when the group identifies which activity as a means of transmission?
sharing contaminated needles Herpes simplex virus is transmitted primarily by direct contact with an infected individual who is shedding the virus and may include kissing, sexual contact, and vaginal birth. Sharing contaminated needles is a means of transmitting HIV.
A woman comes to the clinic complaining of intense pruritus and a thick curd-like vaginal discharge. On examination white plaques on observed on the vaginal wall. The nurse suspects which condition?
vulvovaginal candidiasis Pruritus, a thick, curd-like vaginal discharge, and white plaques on the vaginal wall are characteristic of vulvovaginal candidiasis. Trichomoniasis is characterized by a heavy yellow or green or gray frothy or bubbly discharge. Bacterial vaginosis is characterized by a thin white homogeneous vaginal discharge. Chlamydia is usually manifested by a mucopurulent vagina discharge.
During a presentation on sexually transmitted infections (STIs), a participant asks the nurse why STIs occur more often in women. Which of the following would the nurse address as a possible reason?
woman's moist vaginal environment is highly conducive to microbial growth Researchers suggest that STIs occur more often in women than in men, probably because the moist, warm vaginal environment is conducive to microbial growth and because the vagina, as a receptive orifice, is more readily traumatized during sexual activity. The increased risk is not due to women engaging in sexual activity with multiple partners or a genetic predisposition
A nurse is caring for a client with vaginitis. What instructions should the nurse provide to the client to prevent recurrent vaginal infections? Select all that apply
• Avoid using deodorant tampons • Avoid the use of colored toilet tissue. • Wear only cotton panties and ventilated pantyhose.
What is the most common viral infection?
Human papillomavirus (HPV) Explanation: HPV infection is the most common viral infection. Millions of American are infected with HPV, many unaware that they carry the virus.
A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?
A painless genital ulcer that appeared about 3 weeks after unprotected sex A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss. Wartlike papules are indicative of genital warts.
A client is experiencing situational low self-esteem about acquiring a sexually transmitted infection. Which of the following nursing interventions may help foster the client's self-esteem?
Affirm the client's good judgment in seeking treatment Explanation: The nurse should affirm the client's good judgment in seeking treatment. Acknowledging positive action helps increase the client's self-esteem. Explaining the cause of the STI and how to avoid potential consequences or complications dispels inaccurate beliefs and misconceptions and helps the client to acquire realistic information. It does not help the client's self-esteem to be positive. Providing the client with a telephone number for obtaining objective and authoritative information helps the client to ask more questions about an STI and its treatment. Medical follow-up promotes compliance with therapeutic regimen and does not help the client's self-esteem to be positive.
A nurse who is conducting sessions on preventing the spread of sexually transmitted infections (STIs) discovers that there is a very high incidence of hepatitis B in the community. Which measure should the nurse take to ensure the prevention of the disease?
Instruct people to get vaccinated for hepatitis B Explanation: The nurse should instruct all community members to get vaccinated for prevention of hepatitis B. Ensuring that drinking water is disease free and educating people about the risks involved with injecting drugs may help prevent hepatitis A, not hepatitis B. Delaying the start of sexual activity by teenagers may not protect them from hepatitis B in the long run.
A client with vaginitis complains of itching and burning of the perineum. Which suggestion would be most appropriate to relieve the client's symptoms?
Take sitz baths frequently Sitz baths are recommended to relieve the client's itching and burning, as well as relieve swelling of the vulva and perineum. Skin protectants containing zinc oxide promote healing. Using a vinegar (1to 2 tablespoons) and water (1 pint) douche daily may be used to combat the vaginitis when the client is symptomatic. Taking Lactobacillus acidophilus in capsule form or eating yogurt containing active cultures of lactobacilli can help restore normal vaginal microorganisms.
Which woman is at greatest risk for developing cervical cancer?
A client whose high-risk HPV infection persists in genital skin cells Explanation: Women whose high-risk HPV infection persists in genital skin cells are at greatest risk for subsequently developing cervical cancer. Women who lack access to or use of health care, come from lower socioeconomic status, or have a high intake of alcohol and nicotine do not face an increased risk of developing cervical cancer
Copious amounts of frothy, greenish vaginal discharge would be a symptom of which infection?
Trichomoniasis Explanation: The discharge associated with infection caused by Trichomonas organisms is homogenous, greenish gray, watery, and frothy or purulent. The discharge associated with candidiasis is thick, white, and resembles cottage cheese in appearance while that associated with infection due to G. vaginalis is thin and grayish white, with a marked fishy odor. With gonorrhea, vaginal discharge is purulent when present but, in many women, gonorrhea produces no symptoms.
The nurse is caring for clients who have STIs. Which of the following clients is most at risk for becoming infertile due to the infection?
A woman diagnosed with chlamydia Chlamydia trachomatis is the bacterium that is the leading cause of preventable infertility in women and the most common STI in the United States. Chlamydia is transmitted during vaginal, anal, or oral sex, leading to infections in the associated tissues of these areas. Lymphogranuloma venereum (LGV) is an STI that results from the three strains of Chlamydia trachomatis.
A nurse is required to assess a client complaining of unusual vaginal discharge for bacterial vaginosis. For which classic manifestation of this condition should the nurse assess?
Characteristic "stale fish" odor Explanation: Symptoms of bacterial vaginosis include a characteristic "stale fish" odor and thin, white homogeneous vaginal discharge, not heavy yellow discharge. Dysfunctional uterine bleeding is a sign of Chlamydia, not bacterial vaginosis. Erythema in the vulvovaginal area is a symptom of vulvovaginal candidiasis, not bacterial vaginosis.
The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which of the following would the nurse expect to include as the most common STI in the United States?
Chlamydia Explanation: Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. One in five people older than age 12 is infected with the virus that causes genital herpes
Which of the following is the gold standard for HSV diagnosis?
Culture Explanation: The gold standard for HSV diagnosis is a culture of the lesion. Serology may help determine new versus chronic infection when obtained concurrently with positive culture of the lesion. The other diagnostics may be used for diagnosis of skin disorders, but would not be used for HSV.
A nurse working in a community health education program is assigned to educate community members about sexually transmitted infections (STIs). Which nursing strategy should be adopted to prevent the spread of STIs in the community?
Discuss limiting the number of sex partners Explanation: As a nursing strategy to prevent the spread of STIs, the nurse should discuss reducing the number of sex partners to diminish the risk of acquiring STIs. Oral contraceptives are not effective in preventing STIs, and barrier methods (condoms, diaphragms) should be promoted. The nurse should counsel and encourage sex partners of persons with STIs to seek treatment. Maintaining good body hygiene or not sharing personal items with others does not reduce the risk of spreading STIs.
A physician tells a client to return 2 to 3 months after treatment to have a repeat culture done to verify the cure. This order would be appropriate for a woman with which condition?
Gonorrhea Explanation: Gonococcal infections can be completely eliminated by drug therapy. Genital warts aren't curable and are identified by appearance, not culture. Genital herpes isn't curable and is identified by the appearance of the lesions or cytologic studies. The diagnosis of syphilis is done using dark-field microscopy or serologic tests.
A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby?
Instill a prophylactic agent in the eyes of the newborn Explanation: To prevent gonococcal ophthalmia neonatorum in the baby, the nurse should instill a prophylactic agent in the eyes of the newborn. Cephalosporins are administered to the mother during pregnancy to treat gonorrhea but not to prevent infection in the newborn. Performing a cesarean delivery will not prevent gonococcal ophthalmia neonatorum in the newborn. An antiretroviral syrup is administered to the newborn only if the mother is human immunodeficiency virus-positive and will not help prevent gonococcal ophthalmia neonatorum in the baby.
Which of the following would the nurse recommend to a pregnant client with a sexually transmitted infection who is at risk for transmitting the infection?
Participate in early prenatal care The nurse should recommend that a pregnant client with a sexually transmitted infection who is at risk of infection transmission receive early prenatal care because some STIs can be transmitted during childbirth. Patting or blotting the skin dry is helpful in reducing friction and itch-scratch-itch cycle. The nurse should recommend clients infected with carcinogenic viruses to have regular cancer screening examinations to facilitate early diagnosis and optimistic prognosis. Taking tub baths regularly would have no effect on infection transmission.
A nurse is assessing a client diagnosed with bacterial vaginosis. What is a symptom of bacterial vaginosis
Vaginal odor smelling of fish Bacterial vaginosis causes a "stale fish" vaginal odor. Cottage cheese-like discharge is seen in candidiasis and not in bacterial vaginosis, in which the discharge is thin and gray-white. Intense itching of the vulva is associated with candidiasis, not vaginosis. Warts in the vulva and labia are seen in human papillomavirus infection, not in vaginosis.
A client reports genital ulcers and a diagnosis of syphilis. Which nursing interventions should the nurse implement when caring for the client? Select all that apply.
• Have the client urinate in water if urination is painful. • Instruct the client to wash her hands with soap and water after touching lesions. • Instruct the client to wear nonconstricting, comfortable clothes. Explanation: The nurse should instruct the client to wear nonconstricting clothes and to wash her hands with soap and water after touching lesions to avoid autoinoculation. If urination is painful because of the ulcers, instruct the client to urinate in water but to avoid extremes of temperature such as ice packs or hot pads to the genital area. The client should abstain from intercourse during the prodromal period and when lesions are present. The ulcer disappears during the latency period.
