Chapter 53 - Sexually Transmitted Infections (VOICE)

Which infection, reported in the health history of a woman who is having difficulty conceiving, will the nurse identify as a risk factor for infertility? a. N. gonorrhoeae

ANS: A Complications of gonorrhea include scarring of the fallopian tubes, which can lead to tubal pregnancies and infertility.

Which patient will the nurse plan on teaching about the Gardasil vaccine? a. A 24-year-old female who has not been sexually active

ANS: A Gardasil is recommended for females ages 9 through 26, preferably those who have never been sexually active.

A 46-year-old man who has had blood drawn for an insurance screening has a positive Venereal Disease Research Laboratory (VDRL) test. Which action should the nurse take next? a. Ask the patient about past treatment for syphilis.

ANS: A Once antibody testing is positive for syphilis, the antibodies remain present for an indefinite period of time even after successful treatment, so the nurse should inquire about previous treatment before doing other assessments or testing. Culture, FAT-Abs testing, and assessment for symptoms may be appropriate, based on whether the patient has been previously treated for syphilis

A 29-year-old female patient is diagnosed with Chlamydia during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says which of the following? a. "My partner will need to take antibiotics at the same time I do."

ANS: A Sex partners should be treated simultaneously to prevent reinfection. Chlamydia is treated with oral antibiotics.

A 20-year-old woman who is being seen in the family medicine clinic for an annual physical exam reports being sexually active. The nurse will plan to teach the patient about a. testing for Chlamydia infection.

ANS: A Testing for Chlamydia is recommended for all sexually active females under age 25 by the Centers for Disease Control and Prevention.

A 19-year-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not sought treatment until now because "the warts are so disgusting." Which nursing diagnosis is most appropriate? a. Disturbed body image related to feelings about the genital warts

ANS: A The patient's statement that her lesions are disgusting suggests that disturbed body image is the major concern.

The nurse in the outpatient clinic notes that the following patients have not received the human papillomavirus (HPV) vaccine. Which patients should the nurse plan to teach about benefits of the vaccine (select all that apply)? a. 24-year-old man who has a history of genital warts b. 18-year-old man who has had one male sexual partner d. 20-year-old woman who has a newly diagnosed Chlamydia infection

ANS: A, B, D The HPV vaccines are recommended for male and female patients between ages 9 through 26. Ideally, the vaccines are administered before patients are sexually active, but they offer benefit even to those who already have HPV infection

A 39-year-old patient with a history of IV drug use. The patient reports difficulty walking, stating "I don't know where my feet are." Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-Abs) tests. what will the nurse assess (select all that apply)? a. Heart sounds d. Mental state for judgment and orientation e. Skin and mucous membranes for gummas

ANS: A, D, E The patient's clinical manifestations and laboratory tests are consistent with tertiary syphilis. Valvular insufficiency, gummas, and changes in mentation are other clinical manifestations of this stage

A 22-year-old patient with gonorrhea is treated with a single IM dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100 mg bid for 7 days. The nurse explains to the patient that this combination of antibiotics is prescribed to b. treat any coexisting chlamydial infection.

ANS: B Because there is a high incidence of co-infection with gonorrhea and chlamydia, patients are usually treated for both.

A patient admitted with chest pain is also found to have positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-Abs) tests, rashes on the palms and the soles of the feet, and moist papules in the anal and vulvar area. Which action will the nurse include in the plan of care? b. Wear gloves for patient contact.

ANS: B Exudate from any lesions with syphilis is highly contagious. Systemic antibiotics, rather than local treatment of lesions, are used to treat syphilis. T

A 48-year-old male patient who has been diagnosed with gonococcal urethritis tells the nurse he had recent sexual contact with a woman but says she did not appear to have any disease. In responding to the patient, the nurse explains that b. women may not be aware they have gonorrhea because they often do not have symptoms of infection.

ANS: B Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked.

A 32-year-old woman who is diagnosed with Chlamydia tells the nurse that she is very angry because her husband is her only sexual partner. Which response should the nurse make first? b. "It is understandable that you are angry with your husband right now."

ANS: B This response expresses the nurse's acceptance of the patient's feelings and encourages further discussion and problem solving.

Which topics will the nurse include when preparing to teach a patient with recurrent genital herpes simplex (select all that apply)? b. Sitz baths may be used to relieve discomfort caused by the lesions. d. Recurrent genital herpes episodes usually are shorter than the first episode. e. The virus can infect sexual partners even when you do not have symptoms of infection.

ANS: B, D, E Patients are taught that shedding of the virus and infection of sexual partners can occur even in asymptomatic periods, that recurrent episodes resolve more quickly, and that sitz baths can be used to relieve pain caused by the lesions.

When a 31-year-old male patient returns to the clinic for follow-up after treatment for gonococcal urethritis, a purulent urethral discharge is still present. When trying to determine the reason for the recurrent infection, which question is most appropriate for the nurse to ask the patient? c. "Were your sexual partners treated with antibiotics?"

ANS: C A common reason for recurrence of symptoms is reinfection because infected partners have not been simultaneously treated.

A woman is diagnosed with primary syphilis during her eighth week of pregnancy. The nurse will plan to teach the patient about the c. intramuscular injection of penicillin. d. antibiotic eye drops for the newborn.

ANS: C A single injection of penicillin is recommended to treat primary syphilis. This will treat the mother and prevent transmission of the disease to the fetus.

Which statement by a 24-year-old patient indicates that the nurse's teaching about management of primary genital herpes has been effective? a. "I will use acyclovir ointment on the area to relieve the pain." c. "I will take the acyclovir (Zovirax) every 8 hours for the next week."

ANS: C The treatment regimen for primary genital herpes infections includes acyclovir 400 mg 3 times daily for 7 to 10 days.

After the nurse has taught a patient with a newly diagnosed sexually transmitted infection about expedited partner therapy, which patient statement indicates that the teaching has been effective? c. "I will make sure that my partner takes all of the prescribed medication."

ANS: C With expedited partner therapy, the patient is given a prescription or medications for the partner.

A 32-year-old man who has a profuse, purulent urethral discharge with painful urination is seen at the clinic. Which information will be most important for the nurse to obtain? d. Recent sexual contacts

ANS: D Information about sexual contacts is needed to help establish whether the patient has been exposed to a sexually transmitted infection (STI) and because sexual contacts also will need treatment.

A 55-year-old woman in the sexually transmitted infection (STI) clinic tells the nurse that she is concerned she may have been exposed to gonorrhea by her partner. To determine whether the patient has gonorrhea, the nurse will plan to d. obtain secretions for a nucleic acid amplification test (NAAT).

ANS: D NAAT has a high sensitivity (similar to a culture) for gonorrhea.