STI practice questions

14. A 23-year-old client comes to a community clinic for an annual Pap smear. Which infection is suspected with an abnormal result of this diagnostic test? 1. Human papillomavirus (HPV) 2. Chlamydia 3. Trichomoniasis 4. Syphilis

ANS: 1 A Pap test does not test directly for HPV, but dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap test is not indicative of chlamydia. An abnormal Pap test is not indicative of trichomoniasis. An abnormal Pap test is not indicative of syphilis.

14. A woman is to receive 2.4 million units of penicillin G benzathine IM to treat syphilis. The medication is available as 1,200,000 units/mL. How many mL should the nurse administer?

ANS: 2 mL desire over have

20. A woman has been diagnosed with pelvic inflammatory disease. Which of the following organisms is the most likely causative agent? 1. Herpesviridae 2. Candida albicans 3. Neisseria gonorrhoeae 4. Treponema pallidum

ANS: 3 Neisseria gonorrhoeae is a common cause of PID. Herpesviridae do not cause PID. Candida albicans does not cause PID. Treponema pallidum does not cause PID.

47. The nurse is assessing clients who are at risk for developing cervical cancer. Which client is at highest risk? 1. Client with a Pap test and an HPV screen positive for type 12 2. Client who is 40 years old and stopped smoking 15 years ago 3. Client who was not sexually active until age 24 4. Client with a Pap test and an HPV screen positive for type 16

ANS: 4 The nurse is aware that HPV types 16 and 18 are high risk and are the most common cause of cervical cancer. A client who tests positive for HPV16 and has an abnormal Pap test is at the highest risk. HPV12 is not a high-risk HPV and is not a precursor to cervical cancer. This client is not at a high risk for developing cervical cancer.

13. A woman is noted to have multiple soft warts on her perineum and rectal areas. The nurse suspects that this client is infected with which of the following sexually transmitted infections? 1. Human papillomavirus (HPV) 2. Human immunodeficiency virus (HIV) 3. Syphilis 4. Trichomoniasis.

ANS: 1 Human papillomavirus (HPV) is characterized by flat warts on the vaginal and rectal surfaces. HIV/AIDS is characterized by nonspecific symptoms like weight loss, dry cough, and fatigue. Primary syphilis is characterized by a nonpainful lesion, called a chancre. Trichomoniasis is characterized by a yellowish green vaginal discharge that usually has a very strong, offensive odor.

29. A man has been diagnosed with a chlamydial infection. The nurse would expect the client to complain of pain at which of the following times? 1. When urinating 2. When ejaculating 3. When the penis becomes erect 4. When the testicles are touched.

ANS: 1 Men infected with Chlamydia often complain of pain on urination. Painful ejaculation is not a common sign of chlamydial infection. Painful erections are not commonly seen when men are infected with Chlamydia. It is not common for men infected with Chlamydia to experience pain when their testes are touched.

18. Which of the following sexually transmitted infections is characterized by a foulsmelling, yellow-green discharge that is often accompanied by vaginal pain and dyspareunia? 1. Syphilis 2. Gonorrhea 3. Trichomoniasis 4. Condylomata acuminata.

ANS: 3 Trichomoniasis is characterized by a yellowish green, foul-smelling discharge. Syphilis is caused by the spirochete, Treponema pallidum. If untreated, syphilis is a three stage illness. The primary symptom is a pain free lesion called a chancre. Gonorrhea, usually symptom free, can even be mistaken for a urinary tract infection. Condylomata are vaginal warts.

26. A female client asks the nurse about treatment for human papilloma viral warts. The nurse's response should be based on which of the following? 1. An antiviral injection cures approximately fifty percent of cases 2. Aggressive treatment is required to cure warts 3. Warts often spread when an attempt is made to remove them surgically 4. Warts often recur a few months after a client is treated.

ANS: 4 It is not uncommon for warts to return a few months after an initial treatment. There are no injections for treating warts. There are gels and creams that can be applied to the warts. Warts usually spontaneously disappear after a period of time. It is a common practice to remove warts surgically.

17. A woman has contracted herpes simplex 2 for the first time. Which of the following signs/symptoms is the client likely to complain of? 1. Flu-like symptoms 2. Metrorrhagia 3. Amenorrhea 4. Abdominal cramping.

ANS: 1 The initial infection of herpes simplex 2 is often symptom free but, if symptoms do occur, the client may complain of flu-like symptoms as well as vesicles at the site of the viral invasion. Metrorrhagia is not associated with herpes simplex 2. Amenorrhea is not associated with herpes simplex 2. Abdominal cramping is not associated with herpes simplex 2

11. A gravid, married client, 24 weeks' gestation, is found to have bacterial vaginosis. Her health care practitioner has ordered metronidazole (Flagyl) to treat the problem. Which of the following educational information is important for the nurse to provide the woman at this time? 1. The woman must be careful to observe for signs of preterm labor 2. The woman must advise her partner to seek therapy as soon as possible 3. The main side effect of the medicine is a copious vaginal discharge 4. A repeat culture should be taken two weeks after completing the therapy

ANS: 1 Clients with bacterial vaginosis are high risk for preterm labor. Male partners rarely need treatment. Female partners, in lesbian relationships, may, however, need to be treated. Bacterial vaginosis is characterized by a discharge that is often foul-smelling. The discharge is not related to the therapy. An initial, diagnostic microscopic and culture assessment is done. It is not required that a repeat test be done 2 weeks later.

27. A triage nurse answers a telephone call from the male partner of a woman who was recently diagnosed with cervical cancer. The man is requesting to be tested for human papillomavirus (HPV). The nurse's response should be based on which of the following? 1. There is currently no approved test to detect HPV in men 2. A viral culture of the penis and rectum is used to detect HPV in men 3. A Pap smear of the meatus of the penis is used to detect HPV in men 4. There is no need for a test because men do not become infected with HPV.

ANS: 1 The CDC has not approved any tests to detect HPV in men.

22. A woman has been diagnosed with primary syphilis. Which of the following physical findings would the nurse expect to see? 1. Cluster of vesicles 2. Pain-free lesion 3. Macular rash 4. Foul-smelling discharge.

ANS: 2 A pain-free lesion, called a chancre, is consistent with a diagnosis of primary syphilis. A reddish brown rash is seen with stage 2 syphilis. A cluster of vesicles is consistent with a diagnosis of herpes, not primary syphilis. A macular rash is not seen with primary syphilis. A reddish brown rash is seen with stage 2 syphilis. A foul-smelling discharge is not seen with primary syphilis. It is seen with trichomoniasis.

24. After a sex education class, the school nurse overhears an adolescent woman discussing safe sex practices. Which of the following comments by the young woman indicates that teaching about infection control was effective? 1. "I don't have to worry about getting infected if I have oral sex." 2. "Teen women are most high risk for sexually transmitted infections (STI)." 3. "The best thing to do if I have sex a lot is to use spermicide each and every time." 4. "Boys get human immunodeficiency virus (HIV) easier than girls do."

ANS: 2 The mucous membranes of the female and of the teenager are more permeable to STIs than are the mucous membranes of adults and of men. This is a fallacy. Both men and women can become infected from oral sex. The best thing a sexually active man or woman can do is to use a condom—male or female—during intercourse. The only way absolutely to stay disease free is to become celibate. Females are more susceptible to disease than are males

52. A nurse educator is teaching a class to nursing students about the incidence of sexually transmitted infections (STIs) and their impact on public health. Which is the most commonly reported STI in the United States? 1. Syphilis 2. Gonorrhea 3. Chlamydia 4. Genital herpes

ANS: 3 Chlamydia is the most commonly reported and fastest spreading bacterial STI in the United States, with 1,401,906 cases reported in 2013. The incidence of syphilis increased by 10% from 2012 to 2013 but still remains below the reported rate of chlamydia. Gonorrhea is the second most frequently reported communicable infection in the United States. Nursing considerations focus on educating individuals on the clinical signs and symptoms of HSV-2, as most infected individuals have not received a diagnosis.

10. A client with genital warts asks the nurse about what to expect with the infection. Which statement is most appropriate? 1. "You might have to try several different medications before finding one that works." 2. "Once you take the prescribed medication, you will be cured of the infection." 3. "Even though you don't experience symptoms, you can still spread the infection." 4. "You can expect additional outbreaks, each of which will be longer than the first."

ANS: 3 Most individuals with HPV never develop symptoms. Genital warts respond well to treatment with client applied topical antiviral medications. Genital warts are controllable but not curable. Subsequent episodes usually are shorter and less intense.

25. An asymptomatic woman is being treated for HIV infection at the women's health clinic. Which of the following comments by the woman shows that she understands her care? 1. "If I get pregnant, my baby will be HIV positive." 2. "I should have my viral load and antibody levels checked every day." 3. "Since my partner and I are both HIV positive, we use a condom." 4. "To be safe, my partner and I only engage in oral sex."

ANS: 3 She and her partner should use condoms during sexual intercourse. When clients with HIV receive therapy during pregnancy and labor and delivery and their babies receive oral therapy after delivery, the transmission rate of HIV is almost zero. The viral load and CD4 counts should be monitored regularly but they need not be assessed daily. Even though the transmission of HIV via oral sex is likely much lower than from genital or rectal intercourse, it is still a dangerous practice.

19. The nurse is educating a group of adolescent women regarding sexually transmitted infections. The nurse knows that learning was achieved when a group member states that the most common sign/symptom of sexually transmitted infections is which of the following? 1. Menstrual cramping 2. Heavy menstrual periods 3. Flu-like symptoms 4. Lack of signs or symptoms

ANS: 4 Most commonly, women experience no signs or symptoms when they have contracted a sexually transmitted infection. Menstrual cramping is not usually related to sexually transmitted infections. Heavy menstrual periods are not usually related to a sexually transmitted infection. Flu-like symptoms are not usually related to sexually transmitted infections.

16. A woman, seen in the emergency department, is diagnosed with pelvic inflammatory disease (PID). Before discharge, the nurse should provide the woman with health teaching regarding which of the following? 1. Endometriosis 2. Menopause 3. Ovarian hyperstimulation 4. Sexually transmitted infections.

ANS: 4 PID usually occurs as a result of an ascending sexually transmitted infection. PID is not related to endometriosis. PID is not related to menopause. PID is not related to ovarian hyperplasia.

23. A woman has been diagnosed with syphilis. Which of the following nursing interventions is appropriate? 1. Council the woman about how to live with a chronic infection 2. Question the woman regarding symptoms of other sexually transmitted infections 3. Assist the primary health care practitioner with cryotherapy procedures 4. Educate the woman regarding the safe disposal of menstrual pads.

ANS: 2 Any time someone is infected with one STI, it is recommended that he or she be assessed for other STIs. Syphilis is treatable. The treatment of choice is penicillin. Cryotherapy is not performed on clients with syphilis. This is an inappropriate response.

90. The woman with the lowest risk for sexually transmitted pelvic inflammatory disease is one who uses which of the following? 1. Oral contraceptives 2. A barrier method of contraception 3. An intrauterine device for contraception 4. A birth control patch

ANS: 2 Preventive measures include abstinence and consistent use of barrier methods of birth control (e.g., condoms, diaphragms, and vaginal spermicides). Current data on use of oral contraception and risk of lower- and upper-genital-tract infection and sequelae are inconsistent. Women who use IUDs are probably at increased risk of pelvic inflammatory disease (PID) that may not be STI-related. The hormones in the patch are the same hormones as in the birth control pill—estrogen and progestin—and are not effective in preventing PID.

8. The parent of a newborn angrily asks the nurse, "Why would the doctor want to give my baby the vaccination for hepatitis B. It's a sexually transmitted disease, you know!" Which of the following is the best response by the nurse? 1. "The hepatitis B vaccine is given to all babies. It is given because many babies get infected from their mothers during pregnancy." 2. "It is important for your baby to get the vaccine in the hospital because the shot may not be available when your child gets older." 3. "Hepatitis B can be a life-threatening infection that is contracted by contact with blood as well as sexually." 4. "Most parents want to protect their children from as many serious diseases as possible. Hepatitis B is one of those diseases."

ANS: 3 Hepatitis B is a very serious disease that can be transmitted sexually or via contact with blood and blood products. The vaccine is given in infancy to prevent future infections. This response implies that the mother in the scenario is not interested in protecting her child. That is very unlikely. Vaccines are not administered to prevent vertical transmission, but rather to prevent contracting the virus in the future. If a pregnant woman is hepatitis B positive, her baby would receive the hepatitis B immune globulin (HBIG), in addition to the vaccine, within 12 hours of delivery. This protocol minimizes the incidence of vertical transmission. Vaccines are not administered simply because they are available.

12. A nonpregnant young woman has been diagnosed with bacterial vaginosis (BV). The nurse questions the woman regarding her sexual history, including her frequency of intercourse, how many sexual partners she has, and her use of contraceptives. What is the rationale for the nurse's questions? 1. Clients with BV can infect their sexual partners 2. The nurse is required by law to ask the questions 3. Clients with BV can become infected with HIV and other sexually transmitted infections more easily than uninfected women 4. The laboratory needs a full client history in order to know for which organisms and antibiotic sensitivities it should test.

ANS: 3 The change in normal flora increases the woman's susceptibility to other organisms. Unless the partner is female, the transmission to partners is low. There is no law that requires the nurse to ask these questions. There is no need to provide the laboratory with this information.

28. A client, who is sexually active, is asking the nurse about the vaccine that is given to prevent human papillomavirus (HPV). Which of the following should be included in the counseling session? 1. Gardasil® is not recommended for women who are already sexually active 2. Gardasil® protects recipients from all strains of the virus 3. The most common side effect from the vaccine is pain at the injection site 4. Anyone who is allergic to eggs is advised against receiving the vaccine

ANS: 3 There are very few side effects experienced by those who receive the vaccine. The vaccine can be administered to women as young as 9 and up to age 26, whether sexually active or not. The vaccine does not protect against viruses that can cause about 30% of the cancers and about 10% of the warts.

2. A 19-year-old client with multiple sex partners is being counseled about the hepatitis B vaccination. During the counseling sessions, which of the following should the nurse advise the client to receive? 1. The hepatitis B immune globulin before receiving the vaccine 2. A vaccine booster every 10 years 3. The complete series of three intramuscular injections 4. The vaccine as soon as she becomes 21

ANS: 3 To be immunized against hepatitis B, a three-injection vaccine series is administered. The current recommendation by the Centers for Disease Control and Prevention (CDC) is that the hepatitis B vaccine series be administered during the neonatal period. For those who have not received the vaccine in infancy, it can be administered at any age. The second and third shots are administered 1 month and 6 months after the first, respectively. The immune globulin is not administered before giving the vaccine. The vaccine is administered in a series of 3 injections. There are no booster shots being administered at this time. The vaccine can be administered at any age.

21. The public health nurse calls a woman and states, "I am afraid that I have some disturbing news. A man who has been treated for gonorrhea by the health department has told them that he had intercourse with you. It is very important that you seek medical attention." The woman replies, "There is no reason for me to go to the doctor! I feel fine!" Which of the following replies by the nurse is appropriate at this time? 1. "I am sure that you are upset by the disturbing news, but there is no reason to be angry with me." 2. "I am sorry. We must have received the wrong information." 3. "That certainly could be the case. Women often report no symptoms." 4. "All right, but please tell me your contacts because it is possible for you to pass the disease on even if you have no symptoms."

ANS: 3 Women often have no symptoms when infected with gonorrhea. Instead of reprimanding the client, the nurse should acknowledge how difficult it is to hear the news and continue the discussion. The nurse must pursue the discussion since women often have no symptoms when infected with gonorrhea. The nurse must pursue the discussion since women often have no symptoms when infected with gonorrhea.

1. The nurse in a pediatric clinic is caring for a 9-year-old girl who has been diagnosed with gonorrhea. Which of the following actions is appropriate for the nurse to take? 1. Notify the physician so the child can be admitted to the hospital 2. Discuss with the girl the need to stop future sexual encounters 3. Question the mother about her daughter's menstrual history 4. Report the girl's medical findings to child protective services.

ANS: 4 . This child must be reported to child protective services. Any time a sexually transmitted disease is discovered in a minor, the nurse has the legal obligation to report the finding to a child protection agency. In addition, if required by law, the health department should also be notified in order to track and follow up on sexually transmitted infections. The child need not be admitted to the hospital. This assumes that the child has control over the sexual encounter. It is likely that this child is a victim of sexual abuse. The child's menstrual history is irrelevant. It is possible that she has yet to reach menarche.