Chapter 54: sexually transmitted infections
Which sexually transmitted infection (STI) is vertically transmitted from the mother to the neonate? Scabies Bacterial vaginosis (BV) Herpes simplex virus 2 (HSV-2) Pediculosis pubis
Herpes simplex virus 2 (HSV-2) - HSV-2 is vertically transmitted from the mother to the neonate. Transmission of HSV-2 requires contact by the infant with the microorganisms in the birth canal. Scabies is a skin disease caused by a mite. BV is not considered an STI. Pediculosis pubis is a parasitic infection. p. 802
A patient diagnosed with gonorrhea has an allergy to penicillin and cephalosporins. What is the safest treatment option for the patient? PO cefixime 400 mg, PO azithromycin 1 gm IM ceftriaxone 250 mg, PO azithromycin 1 gm PO gemifloxacin 320 mg, PO azithromycin 2 gm IM gentamycin 240 mg, PO erythromycin 400 mg
PO gemifloxacin 320 mg, PO azithromycin 2 gm - The patient diagnosed with gonorrhea who is allergic to penicillin and cephalosporins will be treated with PO gemifloxacin 320 mg and azithromycin 2 gm. Gemifloxacin is a fluoroquinolone and azithromycin is a macrolide antibiotic, so they are safe for this patient. Cefixime and ceftriaxone are cephalosporins. Erythromycin is not used in the treatment of gonorrhea. p. 805
Which is the most effective screening tool for early detection of human papillomavirus (HPV) in women? HPV test Visual examination for genital warts Papanicolaou ("Pap") test Rapid plasma reagin (RPR)
Papanicolaou ("Pap") test - The Pap test is a screening tool for early detection of HPV in women. It can detect cervical dysplasia, which can be a precursor to cervical cancer if left untreated. An HPV test is a diagnostic tool that will be used if cervical dysplasia is detected. Visual examination for genital warts is diagnostic of HPV, but not diagnostic of the type of HPV, and it is not an early detector. An RPR is a nontreponemal antibody test for syphilis. p. 807
What statement made by the nurse about erythromycin ointment administration for the newborn is correct? "Erythromycin ointment prevents blindness caused by chlamydia." "Erythromycin ointment prevents blindness caused by syphilis." "Erythromycin ointment can be administered within 2 hours after birth." "The antibiotic administered in labor crosses the placenta, so erythromycin is unnecessary."
"Erythromycin ointment prevents blindness caused by chlamydia." - The statement, "Erythromycin ointment prevents blindness caused by exposure to chlamydia" is correct. It is also used to treat gonorrhea, which can also cause blindness in the newborn. The transmission of syphilis occurs through the placenta from the infected mother to the baby during the pregnancy. Maternal syphilis is treated with penicillin. Erythromycin is administered within the first hour after birth. Antibiotics are not routinely used for laboring patients. If a laboring patient receives antibiotics, the antibiotics cross the placenta but are not effective in preventing blindness that can be caused by chlamydia and gonorrhea.
The nurse is caring for a patient with vulvovaginal candidiasis who has been prescribed miconazole (Monistat). Which instruction will the nurse expect the primary health care provider to give? "Apply 5 g of 2% powder once daily at bedtime for 7 days." "Apply 2 g of 5% vaginal cream once daily at bedtime for 7 days." "Insert a 200-mg vaginal suppository once daily at bedtime for 3 days." "Insert one 100-mg vaginal suppository once daily at bedtime for 3 days."
"Insert a 200-mg vaginal suppository once daily at bedtime for 3 days." - The primary health care provider instructs the nurse to insert one 200-mg suppository in the vagina once daily at bedtime for 3 consecutive days. Suppositories are effective in the treatment of yeast infections such as vulvovaginal candidiasis. Powders are generally used to treat superficial mycoses and dermatophytoses. The nurse should be instructed to apply 5 g of the 2% cream once daily at bedtime for 7 days to treat vulvovaginal candidiasis; 2 g of 5% vaginal cream would not be effective because of inadequate dosing. p. 808
The nurse is caring for a newborn with congenital syphilis. The mother asks, "How did my baby get this?" What is the nurse's best response? "The infection was transmitted when you conceived the baby." "The baby was exposed to the infection when your water broke." "The infection occurred before your baby was born." "The infection occurred when the baby was exposed to your blood."
"The infection occurred before your baby was born." - The nurse's best response is, "The infection occurred before your baby was born." Syphilis is transmitted to the fetus through the placenta and membranes. The infection is not transmitted at conception because the embryo does not adhere to the uterine wall until 5 days after conception. Syphilis is not transmitted after rupture of membranes or upon exposure to maternal blood.
A patient who has been exposed to hepatitis C virus (HCV) asks the nurse, "Now that I have been exposed to this, how can I prevent contracting it?" What is the nurse's best response? "I am going to administer a prophylactic immune globulin." "I am going to administer an immune globulin and a vaccine." "I will give you a vaccination to prevent you from contracting the virus." "There is nothing available to prevent you from contracting HCV after exposure.
"There is nothing available to prevent you from contracting HCV after exposure." - The nurse's best response is, "There is nothing available to prevent you from contracting HCV after exposure." Prophylactic immune globulin is not effective in preventing HCV after exposure and there is no vaccine for HCV.
Which statement by the student nurse about tinidazole (Tindamax) therapy indicates a need for further learning? "Tinidazole is used in the treatment of bacterial vaginosis." "Tinidazole is contraindicated in the first trimester of pregnancy." "Tinidazole should be taken in the morning on an empty stomach." "Tinidazole will cause vomiting in a patient who uses mouthwash."
"Tinidazole should be taken in the morning on an empty stomach." - The nurse asks the patient to take tinidazole (Tindamax) with food to prevent gastrointestinal upset. Tinidazole is an antibacterial drug that can be used in the treatment of bacterial vaginosis. Tinidazole is contraindicated in the first trimester of pregnancy because it is unsafe for the fetus. Tinidazole interacts with alcohol, causing nausea and vomiting. p. 804
A patient in the clinic is diagnosed with Haemophilus ducreyi (chancroid). Which statement will the nurse include in the patient's teaching? "You have a high risk factor for contracting and transmitting human immunodeficiency virus (HIV)." "We can offer you an immunoglobulin to prevent further infection." "You will be getting a vaccine to prevent any further transmission of the virus." "Any partners you have had sex with at least 30 days prior to your symptoms should be treated."
"You have a high risk factor for contracting and transmitting human immunodeficiency virus (HIV)." - Chancroid is a high risk factor for contracting and transmitting human immunodeficiency virus. An immunoglobulin is not effective in a patient with chancroid because it is caused by bacteria. Immediate treatment is necessary to cure the infection, prevent transmission, and resolve the clinical symptoms; a vaccine is not a cure. Any partner with whom sexual contact has occurred 10 days preceding the patient's should be examined and treated.
Which prescription does the nurse obtain from the primary health care provider if the patient with gonorrhea is allergic to cephalosporins? Metronidazole (Flagyl) Ceftriaxone (Rocephin) Azithromycin (Zithromax) + Cefotetan (Cefotan) Azithromycin (Zithromax) + gemifloxacin (Factive)
Azithromycin (Zithromax) + gemifloxacin (Factive) - Azithromycin (Zithromax), an antibacterial drug, in combination with gemifloxacin, a quinolone antibiotic, is an effective treatment regimen if a patient with gonorrhea is allergic to cephalosporins. Cefotetan (Cefotan), a cephalosporin, is effective in the treatment of pelvic inflammatory disease, but would be contraindicated in patients with a cephalosporin allergy. Ceftriaxone (Rocephin) is a cephalosporin and would be contraindicated in patients with a cephalosporin allergy. Metronidazole (Flagyl) is used for the treatment of trichomoniasis, not gonorrhoea. p. 805
Which practices put an individual at an increased risk for contracting sexually transmitted infections (STIs)? Anal intercourse Open-mouth kissing Hand-anal contact Intercourse without a condom Contact with menstrual blood during sexual activity
Anal intercourse Hand-anal contact Intercourse without a condom Contact with menstrual blood during sexual activity - Practices that place an individual at an increased risk for contracting STIs include anal intercourse, hand-anal contact, intercourse without a condom, and contact with menstrual blood during sexual activity. Sexual transmission of pathogens can occur through breaks in the skin and mucosa. Open-mouth kissing does not place an individual at an increased risk for contracting an STIs. p. 801
The cerebral spinal fluid (CSF) analysis in a patient with tertiary syphilis reveals neurosyphilis. What pharmacological treatment does the nurse anticipate will be ordered? Cephalexin Doxycycline Benzathine penicillin G Aqueous crystalline penicillin G
Aqueous crystalline penicillin G - The pharmacological treatment for a neurosyphilis is aqueous crystalline penicillin G.Cephalexin is a cephalosporin and is not used to treat syphilis. Doxycycline is not used to treat the tertiary stage of syphilis. Patients with syphilis but normal CSF should receive benzathine penicillin G.
A woman with a category B pregnancy has large amounts of homogenous, thin, white vaginal discharge. The nurse detects a fishy odor from the discharge. On further assessment, the nurse learns that the patient has a habit of using mouthwash regularly. What would be the ideal course of treatment if the patient is in her first trimester? Clindamycin 300 mg PO bid for 7 days Metronidazole 750 mg tab PO for 7 days Tinidazole 2 g/d for 2 days or 1 g/d for 5 days Clotrimazole 1% cream 5 g intravaginally for 7-14 days
Clindamycin 300 mg PO bid for 7 days - The patient displays the symptoms of bacterial vaginosis. Clindamycin may be used to treat the infection in the patient, because this medication is not contraindicated in the first trimester. Oral intake of metronidazole and tinidazole is prohibited in the first trimester of pregnancy. Moreover, the patient is habituated to mouthwash, which is an alcohol-based product. These medications will be rendered ineffective due to the use of regular mouthwash. Clotrimazole is used to treat vulvovaginal candidiasis. p. 804
A 39-week gestation patient has begun treatment with ciprofloxacin for chancroid. She delivers the baby and plans on breastfeeding. What order from the health care provider is the most appropriate treatment during lactation? Ciprofloxacin PO 500 mg for 3 days Erythromycin PO 500 mg tid for 7 days Ceftriaxone IM 250 mg single dose Trimethoprim-sulfamethoxazole PO 160 mg/800 mg bid for 3 weeks
Erythromycin PO 500 mg tid for 7 days - Erythromycin PO 500 mg tid for 7 days is the safest treatment during lactation. Ciprofloxacin presents a low risk to the fetus during pregnancy with a potential for toxicity during breastfeeding. Ceftriaxone is not recommended for treatment of chancroid during lactation. Trimethoprim-sulfamethoxazole is used for the treatment of Klebsiella infections. p. 803
Which clinical manifestation does the nurse anticipate for a patient with pediculosis pubis? A flu-like syndrome A diffuse rash with crusted-over lesions Generalized pruritus and erythema Extreme pruritus in the affected area
Extreme pruritus in the affected area - Extreme pruritus in the affected area is a clinical manifestation of pediculosis pubis. This is caused by lice moving and laying egg cases. Flu-like syndrome is a symptom in patients with secondary syphilis, HIV, as well as other many other clinical conditions that are not sexually transmitted infections (STIs). A diffuse skin rash with crusted-over lesions may be a clinical finding of the herpes virus or other medical conditions. Generalized pruritus and erythema are not a clinical presentation of pediculosis pubis. p. 807
Which sexually transmitted infections (STIs) can be treated with antibiotics? Gonorrhea Hepatitis C Klebsiella granulomatis Chlamydia trachomatis Molluscum contagiousum
Gonorrhea Klebsiella granulomatis Chlamydia trachomatis
Which are considered contributing factors to the increase in sexually transmitted infections (STIs) in adults over 50 years of age? High divorce rate Low rate of condom use Postmenopausal changes in women Older adults' decreased immune response The availability of drugs for erectile dysfunction
High divorce rate Low rate of condom use Postmenopausal changes in women The availability of drugs for erectile dysfunction - Contributing factors to the increase in STIs in adults over 50 include a high divorce rate, low rate of condom use, postmenopausal changes in women, and the availability of drugs for erectile dysfunction. The high divorce rate has contributed to the increased number of adults dating. The low rate of condom use is due to a lack of need to prevent pregnancy. Postmenopausal changes in women, such as decreased vaginal lubrication, increase the risk for infection. The availability of drugs for erectile dysfunction makes sex more possible for an increased number of older men. Changes in the immune response that occur with age are not a factor in rising STI rates. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night's sleep the night before your exam. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive exam. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best. p. 808
For which patients diagnosed with scabies will the nurse question a prescription of lindane 1%? Infants Elderly Pregnant women Lactating women Children under 12
Infants Pregnant women Lactating women - The use of lindane 1% is not recommended for infants, pregnant women, and lactating women. Lindane crosses the placenta and can be passed on to the infant through the breast milk. The elderly can use lindane 1%. Lindane is not recommended for children under 10. p. 807
A patient comes to the clinic complaining of itching in the vaginal area and is diagnosed as having candidiasis. Which intervention is a priority for this patient? Have the patient soak in a warm bath. Assist the patient with vaginal irrigations. Administer intravenous (IV) erythromycin. Insert a vaginal suppository of miconazole (Monistat) 100 mg.
Insert a vaginal suppository of miconazole (Monistat) 100 mg. - Candidiasis is a fungal infection that is treated with the antifungal agent miconazole (Monistat), among others. The patient should not soak in a bath, and vaginal irrigations and IV erythromycin are not treatments for this disorder. p. 808
What positions are recommended to the patient for insertion of a female condom? Prone Standing Squatting Lying down Placing one foot on a chair
Squatting Lying down Placing one foot on a chair - The recommended positions for insertion of a female condom include squatting, lying down, or placing one foot on a chair. A prone or standing position may not allow proper placement of the condom.
Which factors increase the risk for contracting a sexually transmitted infection (STI)? Substance abuse Sexual assault Imprisonment Mutual monogamy Paid sexual activity
Substance abuse Sexual assault Imprisonment Paid sexual activity - Factors that increase the risk for contracting an STI include substance abuse, sexual assault, imprisonment, and paid sexual activity. Mutual monogamy decreases the risk for contracting an STI. p. 808
In what stage of syphilis do large sores inside the body occur? Latent Tertiary Secondary Primary
Tertiary - During the tertiary stage of syphilis, large sores occur inside the body or on the skin. During the latent stage, the patient is asymptomatic. Rash and mucocutaneous lesions are characteristic of the secondary stage of syphilis. A chancre appears in the primary stage of syphilis at the site where the infection entered the body. p. 805
A patient has been prescribed PO acyclovir 400 mg two times a day for herpes simplex virus 2 (HSV-2). What is the goal of treatment for this prescription? The dosage will eradicate the the viral load. The dosage prescribed is for suppressive therapy. The dosage prescribed is for an initial HSV-2 infection. The severity of recurrent episodes will be reduced when completing treatment.
The dosage prescribed is for suppressive therapy. - Acyclovir 400 mg two times a day for HSV-2 is prescribed for suppressive therapy. The dosage will decrease the viral load but not eradicate it. The dosage for an initial HSV-2 infection is PO acyclovir 400 mg three times daily for 7 to 10 days. The dosage does not reduce the severity in recurrent episodes following drug discontinuation p. 806
The nurse is assessing a female patient who is seeking treatment for trichomoniasis. The patient is prescribed tinidazole (Tindamax) 2 g PO in a single dose. Which assessment finding would indicate a need to cancel the prescription? The patient has chlamydia. The patient is allergic to cephalosporins. The patient is in the first trimester of pregnancy. The patient experiences the Jarisch-Herxheimer reaction.
The patient is in the first trimester of pregnancy. - Tinidazole (Tindamax) therapy, which is used in the treatment of trichomoniasis, is unsafe for the fetus during the first trimester of the pregnancy. Therefore, the nurse should not administer the medication to the patient. The Jarisch-Herxheimer reaction occurs when a patient with syphilis is administered benzathine penicillin G. Tinidazoleis not a cephalosporin. At the same time, cephalosporins are not used in the treatment of trichomoniasis. A patient with trichomoniasis who is taking tinidazole (Tindamax) can be concurrently treated for chlamydia. p. 804
A female patient with nongonococcal urethritis is prescribed doxycycline (Vibramycin). Which assessment finding would be a contraindication for the use of this medication? The patient is pregnant. The patient engages in unprotected sex. The patient experiences pain during intercourse. The patient's partner has nongonococcal urethritis.
The patient is pregnant. - Doxycycline (Vibramycin) is an antibiotic that belongs to the tetracycline class. The use of this drug is unsafe for the fetus and not recommended during pregnancy. Nongonococcal urethritis is a sexually transmitted infection. Therefore, it is likely that the patient either engages in unprotected sex or the patient's partner is infected. A patient with nongonococcal urethritis is likely to experience pain during intercourse. p. 805
What is important for the nurse to understand when caring for a patient receiving episodic treatment for herpes simplex virus 2 (HSV-2)? Treatment should begin in the prodrome phase. Treatment should begin with the onset of the lesion. If a lesion is present, the treatment is still effective. If a lesion is present, suppressive therapy is initiated.
Treatment should begin in the prodrome phase. - Episodic treatment for HSV-2 should begin in the prodrome phase that occurs anywhere from 30 minutes to a couple of days before some outbreaks. Episodic treatment is most effective prior to the onset of the lesion. If a lesion is present, the prescribed medication therapy may be of little benefit. Suppressive therapy is not intended for episodic treatment, but it will help reduce the frequency of genital herpes in patients that have frequent reoccurrences.
The nurse is educating a patient about common vaginal infections and related treatment measures. Which information provided by the nurse is most important? "Monistat, a medication used to treat VVC, is available in different forms." "Metronidazole should never be used during the first trimester of pregnancy." "Creams and suppositories used for treating vulvovaginal candidiasis (VVC) are inserted intravaginally." "All ETOH products must be avoided during treatment and for 3 days after use of oral tinidazole therapy."
"All ETOH products must be avoided during treatment and for 3 days after use of oral tinidazole therapy." - When receiving treatment with oral tinidazole, all ETOH products are contraindicated. Therefore, the nurse should provide teaching for the patient's future reference. Oral metronidazole should never be used during the first trimester of pregnancy. This information, though true, is not going to affect the treatment. Cream and suppositories used for treating VVC are inserted intravaginally. While this information is good to know, it is not imperative to treat the patient. Informing the patient that Monistat is available in different forms is not going to affect the treatment outcome. p. 808
A primary health care provider has prescribed lindane (Kwell) lotion to a patient with scabies. The nurse teaches the patient about the prescribed treatment. Which instruction should the nurse include in the teaching? "Avoid intake of yogurt and cheese while using this medication." "Avoid contact with water for 24 hours after applying this medication." "Vaccinate your pet dog regularly to prevent the spread of the infection." "All of your family members should be examined and treated if necessary."
"All of your family members should be examined and treated if necessary." - Scabies can be transmitted from the patient to other family members by direct physical contact and by shared personal items even before the symptoms appear. Therefore, the patient and his or her family members should be examined and treated if necessary. This helps to prevent transmission and recurrence and eradicates the disease. Unlike monoamine oxidase inhibitors (antidepressant medications), lindane (Kwell) lotion does not interact with foods containing tryptamine, such as cheese and yogurt. Human scabies does not spread by animals. Therefore, regularly vaccinating pet animals may not help to prevent the infection. Most of the lotion gets absorbed immediately and the patient can wash the medicated areas after 8 to 12 hours. p. 807
Which instructions would the nurse give a patient taking oral metronidazole (Flagyl) for bacterial vaginosis? "Avoid alcoholic mouthwash." "Take this medication at night." "Take the medication with food." "Avoid drinking milk with this medication." "The medication may cause depression."
"Avoid alcoholic mouthwash." "Take the medication with food." - Metronidazole (Flagyl) interacts with alcohol, causing nausea and vomiting. Therefore, the nurse should instruct the patient to avoid alcoholic mouthwash. The nurse should instruct the patient to take the medication with food to help prevent gastrointestinal upset. The patient can also take the medication with milk to prevent gastrointestinal upset. The prescribed dose for oral metronidazole (Flagyl) is 250 mg PO tid. If metronidazole gel is prescribed, the gel is applied at bedtime. Metronidazole does not cause depression. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. pp. 802, 804, 808
A patient being treated for bacterial vaginosis (BV) asks the nurse, "Why am I at an increased risk for contracting a sexually transmitted infection (STI)?" Which response by the nurse is correct? "BV causes an imbalance in vaginal bacteria." "BV enhances the growth of the Candida albicans." "BV causes the vaginal secretions to become acidic." "BV kills the lactobacilli and replaces it with aerobic bacteria."
"BV causes an imbalance in vaginal bacteria." - BV can increase a woman's risk of getting an STI due to the imbalance in vaginal bacteria. C. albicans is an opportunistic fungus, not an STI. BV can cause the pH of the vaginal secretions to become alkalotic, not acidic. BV kills the lactobacilli and replaces it with anaerobic, not aerobic, bacteria.
A patient newly diagnosed with hepatitis A (HAV) states, "I have been in a monogamous relationship, and I don't understand how I contracted this." What is the nurse's best response? "Have you been using condoms during sex?" "Do you wash your hands after using the bathroom?" "How many partners have you had in the past year?" "Hepatitis A infection can be contracted in different ways."
"Hepatitis A infection can be contracted in different ways." - The nurse's best response is, "Hepatitis A infection can be contracted in different ways." HAV is primarily transmitted by the fecal-oral route in which the patient ingests food or water contaminated by feces. HAV can also be spread through anal-oral or anal intercourse. Asking the patient about condom use, hand washing, and the number of sexual partners does not answer the patient's question. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 803
A pediatric patient weighing 66 pounds is to receive intravenous (IV) ceftriaxone for treatment of gonorrhea. What is maximum dosage the patient can receive? mg
1500 mg The safe dosage range for a pediatric patient weighing less than 45 kg is 25-50 mg/kg intravenously. The nurse divides 66 lb by 2.2 kg to determine the patient weighs 30 kg. Knowing the maximum dose is 50 mg/kg, the nurse multiplies this number by 30 kg to determine that the maximum dose is 1500 mg for this patient. p. 805
The employee health nurse will administer a hepatitis B immune globulin (HBIG) to a nurse that has sustained a needlestick injury. The nurse has no allergies and weighs 167 lb. How much HBIG will be administered? Record your answer using one decimal place. mL
4.6 mL - The recommended dose of HBIG is 0.06 mL/kg intramuscular (IM) x one dose for postexposure prophylaxis. The nurse divides 167 lb by 2.2 to determine the patient weighs 75.9 kg. The nurse multiplies 0.06 mL by 75.9 kg to determine that 4.6 mL of HBIG will be administered. p. 703
The pediatric infection disease specialist orders intramuscular (IM) benzathine penicillin G for a child diagnosed with syphilis. The patient weighs 24 lb. How many units of benzathine penicillin G will be administered? Record your answer using a whole number. units
545455 units - The recommended dosage for benzathine penicillin G for a child is 50,000 units/kg IM. The nurse divides 24 lb by 2.2 to determine the patient weighs 10.9 kg. The nurse multiplies 10.9 kg by 50,000 units/kg to determine the patient will receive 545,455 units. p. 805
What does the nurse include in the assessment of a pregnant patient with syphilis? Allergy to penicillin History of drug abuse Presence of anaerobes The Jarisch-Herxheimer reaction
Allergy to penicillin - The nurse needs to assess if the patient is allergic to penicillin because benzathine penicillin G is the treatment of choice for syphilis. The Jarisch-Herxheimer reaction most commonly occurs after a patient with syphilis is administered benzathine penicillin G. Therefore, the reaction will not be seen in the patient during the assessment. The nurse need not assess for a history of drug abuse in this case because syphilis is a sexually transmitted infection; it does not occur due to drug abuse. Anaerobes are an indication of pelvic inflammatory disease, not syphilis. pp. 805-806
The nurse is assessing a patient who may have a sexually transmitted infection. What is the first step in the nurse's assessment? Culture vaginal secretions. Ask about medication allergies. Determine if the patient has a fever. Ask the patient about sexual partners.
Ask the patient about sexual partners - Before physical data are gathered, a history is elicited. The term partner is used when discussing sexual activity, rather than value-laden terms such as wife or boyfriend. Include the following questions for all patients, regardless of gender or sexual orientation: "Do you have sex with women?" and "Do you have sex with men?" p. 808
A pregnant patient who has gonorrhea and chlamydia is prescribed ceftriaxone (Rocephin). Which other drug will be included in the patient's prescription? Metronidazole (Flagyl) 2 g PO in a single dose Acyclovir (Zovirax) 400 mg PO tid. for 7-10 days Azithromycin (Zithromax) 1 g PO in a single dose Doxycycline (Vibramycin) 100 mg PO bid for 21 days
Azithromycin (Zithromax) 1 g PO in a single dose - Azithromycin (Zithromax) 1 g PO in a single dose is included in the patient's prescriptions, because it is an antibacterial drug that is used to treat sexually transmitted diseases like gonorrhea and chlamydia. Acyclovir (Zovirax) 400 mg PO tid for 7-10 days is an antiviral drug that is used in the treatment of genital herpes simplex. The primary health care provider prescribes doxycycline (Vibramycin) 100 mg PO bid for 7 days, not for 21 days. Metronidazole (Flagyl) 2 g PO in a single dose is effective for patients with trichomoniasis or for victims of sexual assault. p. 805
What is the most frequent clinical presentation of a Chlamydia trachomatis infection in a newborn who was exposed to the mother's infected cervix during delivery? Pneumonia Acute illness Conjunctivitis Erythema toxicum
Conjunctivitis - Conjunctivitis is the most frequent clinical presentation in a newborn caused by exposure to C. trachomatis in the mother's infected cervix during delivery. C. trachomatis can cause pneumonia in infants between 1 and 3 months old, but it is less common. Gonorrhea presents as an acute illness in the newborn that develops 2 to 5 days after delivery. Erythema toxicum is a common newborn rash that may appear in the newborn and is self-limiting and unrelated to C. trachomatis. p. 805
A 35-week gestation patient is diagnosed with scabies and prescribed PO ivermectin 12,360 mcg to be given now and repeated in 1 week. The patient weighs 136 lb. What is the nurse's priority action? Administer the prescribed medication. Contact the prescriber; the dosage is incorrect. Contact the prescriber; the medication is not used to treat scabies. Contact the prescriber; the medication is not recommended during pregnancy.
Contact the prescriber; the medication is not recommended during pregnancy. - The nurse's priority action is to contact the prescriber; the medication is not recommended during pregnancy. Permethrin or pyrethrins with piperonyl butoxide can be used safely during pregnancy. The dosage calculation is correct. The dosage for ivermectin is 200 mcg/kg. Ivermectin is used to treat scabies.
A patient with vulvar lesions is diagnosed with Molluscum contagiosum. What treatment does the nurse anticipate for the patient? Cryotherapy Oral cimetidine Nothing; the infection is self-limiting Topical therapeutic cream
Cryotherapy - Cryotherapy is used to treat M. contagiosum manifesting as lesions in the genital area. There is a risk for reinfection if all lesions are not eradicated. Treatment with oral cimetidine is recommended as an alternative for small children. M. contagiosum is self-limiting, but treatment is necessary if there are lesions in the genital area. Treatment with a therapeutic cream is reliable as a home therapy for men, not women. p. 804
A patient presenting to the clinic at 20 weeks gestation tests positive for chlamydia. What is the most appropriate treatment option for the patient? Doxycycline PO 100 mg bid for 21 days Ceftriaxone IM 250 mg single dose Ciprofloxacin PO 500 mg bid for 3 days Erythromycin 500 mg qid for 21 days
Erythromycin 500 mg qid for 21 days - The safest treatment for the treatment for a patient who is 20 weeks gestation with chlamydia is erythromycin 500 mg qid for 21 days. Doxycycline should be avoided in the second and third trimesters of pregnancy because of the risk of discoloration of teeth. Ceftriaxone is used to treat chancroid. Ciprofloxacin is used to treat chancroid and Klebsiella granulomatis. p. 803
Which antiviral drug is used to treat herpes simplex virus 2 (HSV-2)? Salicylic acid Azithromycin Ofloxacin Famciclovir
Famciclovir - Famciclovir is used to treat HSV-2. Salicylic acid is used to treat Molluscum contagiosum. Azithromycin is used to treat chancroid. Ofloxacin is an alternative treatment for chlamydia. p. 806
What instructions for comfort are approved for a patient newly diagnosed with the Zika virus? Get plenty of rest. Take acetaminophen for fever. Take aspirin for fever and pain. Drink plenty of fluids. Take ibuprofen for muscle pain.
Get plenty of rest. Take acetaminophen for fever. Drink plenty of fluids. - Patient instructions for comfort includes getting plenty of rest, taking acetaminophen for fever, and drinking plenty of fluids. To reduce the risk of bleeding, aspirin and ibuprofen are contraindicated until dengue fever can be ruled out.
A patient diagnosed with vulvovaginal candidiasis (VVC) is prescribed butoconazole 2% cream. What will the nurse do when reviewing the plan of care with the patient? Inform the patient that any sexual partners should be treated. Inform the patient to abstain from intercourse until treatment is completed. Review the systemic side effects of the medication with the patient. Instruct the patient that local burning and irritation may occur with the use of the medication.
Instruct the patient that local burning and irritation may occur with the use of the medication. - When reviewing the plan of care with the patient, the nurse should inform the patient that the medication prescribed may cause local burning and irritation. Uncomplicated VVC is not acquired through sexual intercourse, so treatment of a sexual partner is not necessary. It is not necessary to abstain from intercourse until treatment is completed. Intercourse does not interfere with the action of the medication, though it may be uncomfortable for the patient. Topical agents usually cause no systemic side effects. The effects that may occur are localized.
The nurse is assessing a patient with symptoms of human papillomavirus (HPV). The patient states that she had a Gardasil vaccination at 11 years of age. Which further assessment data will the nurse obtain? CD4 count Pap test results Allergy to penicillin Tetanus booster vaccination information
Pap test results - The patient has had a Gardasil vaccination for the prevention of cervical cancer caused by HPV. However, because the patient is symptomatic, she will need to undergo routine cancer screening. The nurse will evaluate the Pap test results to determine if the cervical cells are abnormal. Tetanus booster vaccination is not related to HPV. Penicillin is not useful for the treatment of HPV. Therefore, it is not important to assess the patient for penicillin allergy. CD4 counts are useful in assessing HIV infections, not HPV. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation. p. 807
A female patient presenting to the clinic has been exposed to lymphogranuloma venereum (LGV) within the last 30 days. What areas of the body will be examined and tested for chlamydia? Urethra Vagina Cervix Rectum Mouth
Urethra Cervix Rectum - The urethra, cervix, and rectum will be examined and tested for chlamydia in a female patient. A vaginal secretion sample is not used; instead a sample from the cervical area is obtained. The mouth will only be swabbed if oral-genital contact has occurred with the infected partner. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer. p. 803
Which are preventative measures recommended by the Centers for Disease Control and Prevention (CDC) to prevent sexually transmitted infections (STIs)? Using condoms Practicing abstinence Having fewer partners Talking to your partner about STIs Getting tested annually for all STIs
Using condoms Practicing abstinence Having fewer partners Talking to your partner about STIs - The measures recommended by the CDC to prevent STIs include using condoms, practicing abstinence, having fewer partners, and talking to your partner about STIs. The CDC does not endorse getting tested annually for all STIs; rather, there are specific recommendations for each STI depending on patient characteristics and lifestyles. p. 802
What is the recommended therapy for a pregnant woman experiencing recurrent genital herpes? Acyclovir 400 mg three times a day beginning at 24 weeks gestation Valacyclovir PO 500 mg twice a day beginning at 36 weeks gestation Acyclovir 400 mg three times a day beginning at 12 weeks gestation Valacyclovir PO 500 mg twice a day beginning at 40 weeks gestation
Valacyclovir PO 500 mg twice a day beginning at 36 weeks gestation - The recommendation therapy for a pregnant woman experiencing recurrent genital herpes is valacyclovir PO 500 mg twice a day beginning at 36 weeks gestation. The treatment with acyclovir 400 mg three times a day beginning at 24 or 12 weeks gestation is too remote from delivery. Valacyclovir PO 500 mg twice a day beginning at 40 weeks gestation is too late in the pregnancy for the medication to be effective. p. 806
What test is a nontreponemal antibody test that is one of the two types of serological tests used to diagnose syphilis? Nucleic acid amplification (NAA) T. palladium particle agglutination assay (TP-PA) Venereal disease research laboratory (VDRL) Fluorescent treponemal antibody absorption (FTA-ABS)
Venereal disease research laboratory (VDRL) - The VDRL is a nontreponemal antibody test that is one of the two types of serological testing used to diagnose syphilis. NAA is a method for testing gonorrhea. TP-PA and FTA-ABS are tests for antibodies that specifically target T. palladium, the bacteria that cause syphilis. Test-Taking Tip: Be certain to answer every question. You must arrive at one correct or one "best" answer. If you must, "guess" between two alternatives or eliminate the two or three answers you know are wrong first. p. 805
Which condition will be treated with topical drugs from the azole drug classification? Endometriosis Secondary dysmenorrhea Vulvovaginal candidiasis (VVC) Severe premenstrual syndrome (PMS)
Vulvovaginal candidiasis (VVC) - The overgrowth of Candida albicans in the vagina causes VVC. Topical drugs from the azole classification are antifungal agents that help with the treatment of VVC. Selective serotonin reuptake inhibitors (SSRIs) decrease irritability and mood swings that occur during PMS. Aromatase inhibitors, combined hormone contraception (CHC) products, gonadotropin-releasing hormone (Gn-RH) agonists, and progestins are used to treat endometriosis. NSAIDs block pain and are effective for the treatment of secondary dysmenorrhea. p. 808
