25QW/exp Chapter 5: Sexually Transmitted Infections
After teaching a group of adolescents about HIV, the nurse asks them to identify the major means by which adolescents are exposed to the virus. The nurse determines that the teaching was successful when the group identifies which of the following? A) Sexual intercourse B) Sharing needles for IV drug use C) Perinatal transmission D) Blood transfusion
Ans: A Feedback: Nurses can play a key role in preventing and controlling HIV infection by promoting risk-reduction counseling and offering routine HIV testing to adolescents. Most sexually active youth do not feel that they are at risk of contracting HIV and have never been tested. Obtaining a sexual history and creating an atmosphere that promotes nonjudgmental risk counseling is a key component of the adolescent visit. In light of increasing numbers of people with HIV/AIDS and missed opportunities for HIV testing, the CDC recommends universal and routine HIV testing for all clients seen in health care settings who are 13 to 64 years of age. Sharing contaminated needles, perinatal transmission, and blood transfusions are not associated with adolescents and HIV.
After teaching a class on sexually transmitted infections, the instructor determines that the teaching was successful when the class identifies which statement as true? A) STIs can affect anyone if exposed to the infectious organism. B) STIs have been addressed more on a global scale. C) Clients readily view the diagnosis of STI openly. D) Most individuals with STIs are over the age of 30.
Ans: A Feedback: STIs know no gender, class, racial, ethnic, or social barriers—all individuals are vulnerable if exposed to the infectious organism. The problem of STIs has still not been tackled adequately on a global scale, and until this is done, numbers worldwide will continue to increase. Given the high value some cultures place on virginity and fidelity, a diagnosis of an STI can be devastating to the woman and her family. Even to suggest a test for STIs can appear inappropriate or offensive. An estimated two thirds of all STIs occur among persons under the age of 25.
client with trichomoniasis is to receive metronidazole (Flagyl). The nurse instructs the client to avoid which of the following while taking this drug? A) Alcohol B) Nicotine C) Chocolate D) Caffeine
Ans: A Feedback: The client should be instructed to avoid consuming alcohol when taking metronidazole because severe nausea and vomiting could occur. There is no need to avoid nicotine, chocolate, or caffeine when taking metronidazole.
A woman who is HIV-positive is receiving HAART and is having difficulty with compliance. To promote adherence, which of the following areas would be most important to assess initially? A) The woman's beliefs and education B) The woman's financial situation and insurance C) The woman's activity level and nutrition D) The woman's family and living arrangements
Ans: A Feedback: The most important area to assess initially would be the client's beliefs and knowledge about the disease and its treatment. A common barrier is a lack of understanding about the link between drug resistance and nonadherence. Once this area is assessed, the nurse can assess for other barriers, such as finances and insurance, nutrition and activity level, and family issues, including living arrangements (for example, the woman may be afraid that her HIV status would be revealed if others see her taking medication).
A woman comes to the clinic complaining of a vaginal discharge. The nurse suspects trichomoniasis based on which of the following? (Select all that apply.) A) Urinary frequency B) Yellow/green discharge C) Joint pain D) Blister-like lesions E) Muscle aches
Ans: A, B Feedback: Manifestations of trichomoniasis include a yellow/green or gray frothy or bubbly discharge, dysuria, urinary frequency, and irritation or itching of the genital area. Joint pain suggesting arthritis is associated with gonorrhea. Blister-like lesions and muscle aches would suggest genital herpes.
A nurse is preparing a presentation for a group of women at the clinic who have been diagnosed with genital herpes. Which of the following would the nurse expect to include as a possible precipitating factor for a recurrent outbreak? (Select all that apply.) A) Exposure to ultraviolet light B) Exercise C) Use of corticosteroids D) Emotional stress E) Sexual intercourse.
Ans: A, C, D, E Feedback: Recurrent genital herpes outbreaks are triggered by precipitating factors such as emotional stress, menses, ultraviolet light exposure, illness, surgery, fatigue, genital trauma, immunosuppression such as from drugs like corticosteroids, and sexual intercourse, but more than half of recurrences occur without a precipitating cause.
When developing a teaching plan for a community group about HIV infection, which group would the nurse identify as an emerging risk group for HIV infection? A) Native Americans B) Heterosexual women C) New health care workers D) Asian immigrants
Ans: B Feedback: According to statistics, more than 90% of all HIV infections have resulted from heterosexual intercourse, making heterosexual women particularly vulnerable due to substantial mucosal exposure to seminal fluids. HIV disproportionately affects African American and Hispanic women, but together they represent less than 25% of all U.S. women. New health care workers and Asian immigrants account for only a very small number of HIV-positive cases.
A group of students are reviewing information about STIs. The students demonstrate understanding of the information when they identify which of the following as the most common bacterial STI in the United States? A) Gonorrhea B) Chlamydia C) Syphilis D) Candidiasis
Ans: B Feedback: According to the CDC, chlamydia is the most common bacterial STI in the United States. Gonorrhea and syphilis are bacterial infections but not the most common ones. Candidiasis is a fungal infection.
A nurse is teaching a woman with genital ulcers how to care for them. Which statement by the client indicates a need for additional teaching? A) "I need to wash my hands after touching any of the ulcers." B) "I need to abstain from intercourse primarily when the lesions are present." C) "I should avoid applying ice or heat to my genital area." D) "I can try lukewarm sitz baths to help ease the discomfort."
Ans: B Feedback: For genital ulcers, the client needs to abstain from intercourse during the prodromal period and when lesions are present. The client should wash her hands after touching the lesions to avoid inoculation and avoid extremes of temperature such as ice packs or hot pads to the genital area. Comfort measures such as lukewarm sitz baths can be helpful.
A nurse is assessing a client for possible risk factors for chlamydia and gonorrhea. Which of the following would the nurse identify? A) Asian American ethnicity B) Age under 25 years C) Married D) Consistent use of barrier contraception
Ans: B Feedback: High-risk groups for chlamydia and gonorrhea include single women, women younger than 25 years, African American women, women with a history of STIs, those with new or multiple sex partners, those with inconsistent use of barrier contraception, and women living in communities with high infection rates.
Which findings would the nurse expect to find in a client with bacterial vaginosis? A) Vaginal pH of 3 B) Fish-like odor of discharge C) Yellowish-green discharge D) Cervical bleeding on contact
Ans: B Feedback: Manifestations of bacterial vaginosis include a thin, white homogenous vaginal discharge with a characteristic stale fish odor, vaginal pH greater than 4.5, and clue cells on wet-mount examination. A yellowish-green discharge with cervical bleeding on contact would be characteristic of trichomoniasis.
A nurse at a local community clinic is developing a program to address STI prevention. Which of the following would the nurse least likely include in the program? A) Outlining safer sexual behavior B) Recommending screening for symptomatic individuals C) Promoting the use of barrier contraceptives D) Offering education about STI transmission
Ans: B Feedback: Strategies to prevent STIs include providing basic information about STI transmission, outlining safer sexual behaviors, screening asymptomatic persons with STIs, and promoting the use of barrier contraceptives.
A mother brings her 12-year-old daughter in for well-visit checkup. During the visit, the nurse is discussing the use of prophylactic HPV vaccine for the daughter. The mother agrees and the daughter receives her first dose. The nurse schedules the daughter for the next dose, which would be given at which time? A) In 1 month B) In 2 months C) In 3 months D) In 4 months
Ans: B Feedback: The HPV vaccine is administered intramuscularly in three separate 0.5-mL doses. The first dose may be given to any individual 9 to 26 years old prior to infection with HPV. The second dose is administered 2 months after the first, and the third dose is given 6 months after the initial dose.
When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)? A) Hive-like rash for the past 2 days B) Five different sexual partners C) Weight gain of 5 lbs in 1 year D) Clear vaginal discharge
Ans: B Feedback: The number of sexual partners is a risk factor for the development of STIs. A rash could be related to numerous underlying conditions. A weight gain of 5 lbs in one year is not a factor increasing one's risk for STIs. A change in the color of vaginal discharge such as yellow, milky, or curd-like, not clear, would suggest an STI.
A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through the: A) Amniotic fluid B) Placenta C) Birth canal D) Breast milk
Ans: B Feedback: The syphilis spirochete can cross the placenta at any time during pregnancy. It is not transmitted via amniotic fluid, passage through the birth canal, or breast milk.
A client is diagnosed with pelvic inflammatory disease (PID). When reviewing the client's medical record, which of the following would the nurse expect to find? (Select all that apply.) A) Oral temperature of 100.4 degrees F B) Dysmenorrhea C) Dysuria D) Lower abdominal tenderness E) Discomfort with cervical motion F) Multiparity
Ans: B, C, D, E Feedback: History and physical examination findings of PID include dysmenorrhea, dysuria, lower abdominal tenderness, and cervical motion tenderness. Typically the client has a fever above 101 degrees F and is nulliparous.
Assessment of a female client reveals a thick, white vaginal discharge. She also reports intense itching and dyspareunia. Based on these findings, the nurse would suspect that the client has: A) Trichomoniasis B) Bacterial vaginosis C) Candidiasis D) Genital herpes simplex
Ans: C Feedback: A thick, white vaginal discharge accompanied by intense itching and dyspareunia suggest vulvovaginal candidiasis. Trichomoniasis is characterized by a heavy yellow, green, or gray frothy or bubbly discharge. Bacterial vaginosis is manifested by a thin, white homogenous vaginal discharge with a characteristic stale fish-like odor. Genital herpes simplex involves genital ulcers.
The nurse encourages a female client with human papillomavirus (HPV) to receive continued follow-up care because she is at risk for: A) Infertility B) Dyspareunia C) Cervical cancer D) Dysmenorrhea
Ans: C Feedback: Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer. Therefore, the client needs continued follow-up for Pap smears. HPV is not associated with an increased risk for infertility, dyspareunia, or dysmenorrhea.
A client with genital herpes simplex infection asks the nurse, "Will I ever be cured of this infection?" Which response by the nurse would be most appropriate? A) "There is a new vaccine available that prevents the infection from returning." B) "All you need is a dose of penicillin and the infection will be gone." C) "There is no cure, but drug therapy helps to reduce symptoms and recurrences." D) "Once you have the infection, you develop an immunity to it."
Ans: C Feedback: Genital herpes is a lifelong viral infection. No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. A vaccine is available for HPV infection but not genital herpes. Penicillin is used to treat syphilis. No immunity develops after a genital herpes infection.
After teaching a class on preventing pelvic inflammatory disease, the instructor determines that the teaching was successful when the class identifies which of the following as an effective method? A) HIV B) HSV C) HPV D) HAV E) HBV
Ans: C Feedback: Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. However, the only vaccines currently available are for prevention of HAV, HBV, and HPV infection.
A group of nursing students are reviewing information about vaccines used to prevent STIs. The students would expect to find information about which of the following? (Select all that apply). A) HIV B) HSV C) HPV D) HAV E) HBV
Ans: C, D, E Feedback: Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. However, the only vaccines currently available are for prevention of HAV, HBV, and HPV infection.
Which instructions would the nurse include when teaching a woman with pediculosis pubis? A) "Take the antibiotic until you feel better." B) "Wash your bed linens in bleach and cold water." C) "Your partner doesn't need treatment at this time." D) "Remove the nits with a fine-toothed comb."
Ans: D Feedback: The nurse should instruct the client to remove the nits from the hair using a fine-toothed comb. Permethrin cream and lindane shampoo, not antibiotics, are used as treatment. Bedding and clothing should be washed in hot water to decontaminate it. Sexual partners should be treated also, as well as family members who live in close contact with the infected person.
A woman gives birth to a healthy newborn. As part of the newborn's care, the nurse instills erythromycin ophthalmic ointment as a preventive measure related to which STI? A) Genital herpes B) Hepatitis B C) Syphilis D) Gonorrhea
Ans: D Feedback: To prevent gonococcal ophthalmia neonatorum, erythromycin or tetracycline ophthalmic ointment is instilled into the eyes of all newborns. This action is required by law in most states. The ointment is not used to prevent conditions related to genital herpes, hepatitis B, or syphilis.
The nurse reviews the CD4 cell count of a client who is HIV-positive. A result less than which of the following would indicate to the nurse that the client has AIDS? A) 1,000 cells/mm3 B) 700 cells/mm3 C) 450 cells/mm3 D) 200 cells/mm3
Ans: D Feedback: When the CD4 T-cell count reaches 200 or less, the person has reached the stage of AIDS according to the CDC. A CD4 T-cell count between 450 and 1,200 is considered normal.
The nurse is developing a plan of care for a client who is receiving highly active antiretroviral therapy (HAART) for treatment of HIV. The goal of this therapy is to: A) Promote the progression of disease B) Intervene in late-stage AIDS C) Improve survival rates D) Conduct additional drug research
Ans: C Feedback: The use of HAART aims to improve the prognosis of HIV/AIDS. Dramatic advances with antiretroviral medication have turned a disease that used to be a death sentence into a chronic, manageable one for individuals who live in countries where antiretroviral therapy is available. Drug therapy does not promote the progression of the disease. It is started at the time of the first infection, not in late-stage AIDS. Treatment advances have been based on research, but drug therapy is not prescribed to conduct additional research.
