Adaptive Quiz Questions Week 15 NCII

A nurse is assessing a female client with suspected primary syphilis. Which sign of primary syphilis does the nurse expect the client to exhibit? a. Flat wartlike plaques around the vagina and anus b. An indurated painless nodule on the vulva that is draining c. Glistening patches in the mouth covered with a yellow exudate d. A maculopapular rash on the palms of the hands and soles of the feet

B An indurated, draining, painless nodule is the description of a chancre, which is the initial sign of syphilis. Flat wartlike plaques around the vagina and anus are condylomata, which are typical of the secondary stage of syphilis. Glistening patches in the mouth covered with a yellow exudate are typical of the secondary stage of systemic involvement, which occurs from 2 to 4 years after the disappearance of the chancre. A maculopapular rash on the palms and soles is typical of the secondary stage.

1. During a pelvic examination of a 24-year-old woman, the nurse suspects a vaginal infection because of the presence of a white curdlike vaginal discharge. What other finding supports a fungal vaginal infection? a. A foul odor b. An itchy perineum c. An ischemic cervix d. A forgotten tampon

B An itchy perineum usually occurs with candidiasis, a fungal infection; pruritus is the most common symptom. An odorous, frothy greenish discharge occurs with trichomoniasis, a protozoal infestation. Ischemia of the cervix is not associated with candidiasis; candidiasis causes vaginal and cervical inflammation. A forgotten tampon may cause bacterial, not fungal, vaginitis.

A nurse is teaching a client about drug therapy for gonorrhea. Which fact about drug therapy should the nurse emphasize? a. Cures the infection b. Prevents complications c. Controls its transmission d. Reverses pathologic changes

A Ceftriaxone (Rocephin), followed by doxycycline (Vibramycin), is specific for Neisseria gonorrhoeae and eradicates the microorganism; other treatment regimens are available for resistant strains. If the disease progresses before the diagnosis is made, complications such as sterility, heart valve damage, or joint degeneration may occur. Transmission is not controlled; the organism is eliminated. If tubal structures, heart valves, or joints degenerate, the pathologic changes will not be reversed by antibiotic therapy.

The nurse is teaching a sex education course to high school students. What information should the nurse provide regarding the rationale for an increase in gonorrhea prevalence? Select all that apply. a. Symptoms of the disease are vague. b. Screening blood tests are expensive. c. The incubation period is relatively short. d. Causative organisms have become resistant to treatment. e. Diagnostic tests for the causative organism are not yet available.

A, C, D Many clients with gonorrhea are asymptomatic. The incubation period is 3 to 5 days. There is no effective, readily available blood test for gonorrhea. Gonorrhea responds well to treatment, but the Centers for Disease Control and Prevention has received several reports of resistant strains. At times backup secondary medications must be used in order to treat the infection. Urethral/vaginal smears or cultures are specific for the identification of the gonococcal organism.

A nurse is concerned about the public health implications of gonorrhea diagnosed in a 16-year-old adolescent. Which should be of most concern to the nurse? a. Interviewing the client's parents b. Finding the client's sexual contacts c. Instructing the client about birth control measures d. Determining the reasons for the client's promiscuity

B Gonorrhea is a highly contagious disease transmitted through sexual intercourse. The incubation period varies, but symptoms usually occur 2 to 10 days after contact. Early effective treatment prevents complications such as sterility. The parents may be unaware that their child has gonorrhea. Most birth control measures do not protect against the transmission of sexually transmitted infections. Contracting venereal infection is not necessarily indicative of promiscuity.

The clinic nurse is planning care for a client found to have chlamydia. Which treatment should the nurse plan to implement? a. Administration of 250 mg of acyclovir orally in a single dose b. Administration of 1 g of azithromycin orally in a single dose c. Administration of 250 mg of ceftriaxone intramuscularly in a single dose d. Administration of 2.4 million units of benzathine penicillin G intramuscularly in a single dose

B The treatment of choice for chlamydial infection is 1 g of azithromycin orally in a single dose. The one-dose course is preferred because of its ease of completion. Acyclovir may be prescribed in a 7-day course for a genital herpes outbreak. Administering 250 mg of ceftriaxone intramuscularly in a single dose is the drug therapy recommended for gonorrhea. Benzathine penicillin G given intramuscularly as a single 2.4 million unit dose is the treatment for primary, secondary, and early latent syphilis.

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting human immunodeficiency virus (HIV). Which guidance is most appropriate for the nurse to provide? a. Ask her partner to withdraw before ejaculating. b. Make certain their relationship is monogamous. c. Insist that her partner use a condom when having sex. d. Seek counseling about various contraceptive methods.

C A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. Preejaculatory fluid carries HIV in an infected individual, so withdrawing before ejaculation is not effective. Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV positive, the other person is at risk for acquiring HIV. The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from HIV.

A female client who has been sexually active for 5 years is diagnosed with gonorrhea. The client is upset and asks the nurse, "What can I do to keep from getting another infection in the future?" Which statement by the client indicates that the teaching by the nurse was effective? a. "I'll douche after each time I have sex." b. "Having sex is a thing of the past for me." c. "My partner has to use a condom all the time." d. "I'll be using a spermicidal cream from now on."

C Although not 100% effective, a condom is the best protection against gonorrhea in a sexually active person. Douching has no proven protective effect against sexually transmitted infections; excessive douching can alter the natural environment of the vagina and may even promote an ascending infection. Although abstaining from sex is the best way to prevent a sexually transmitted infection, it is not the most realistic response for a sexually active person. Once people become sexually active, they usually remain sexually active. Spermicidal creams do not have a protective effect against sexually transmitted infections; spermicides kill sperm and limit the risk for pregnancy.

A 16-year-old client arrives at the clinic complaining of increased vaginal discharge, intermittent vaginal bleeding, excessive bleeding during menstruation, and pain in the lower abdomen. She relates an active sexual history with multiple partners. Which disease does the nurse suspect the client has? a. Herpes b. Syphilis c. Gonorrhea d. Toxoplasmosis

C The client has signs and symptoms indicative of pelvic inflammatory disease, which is a complication of gonorrhea. Herpes is noted for its painful genital lesions; there are no data to indicate the presence of these lesions. The client does not have the signs and symptoms associated with syphilis or those associated with toxoplasmosis.

Which subjective statement made by the client helps in distinguishing bacterial vaginosis from other vaginal infections? a. "I have painful urination." b. "I have vaginal irritation." c. "I have lower abdominal pain." d. "I have a thin vaginal discharge with a fishy odor."

D Bacterial vaginosis (BV) is manifested by a vaginal discharge characteristic fishy odor, which occurs due to the replacement of hydrogen peroxide producing lactobacillus with anaerobic bacteria. These anaerobes cause an increase in vaginal amines that lead to an alteration of the vaginal pH and cause the odor. Painful urination, vaginal irritations, and lower abdominal pain are common manifestations in other vaginal infections.

In teaching a class about sexually transmitted infections, the nurse discusses manifestations associated with each and effects of delaying treatment. During the discussion, gummas, which are tumors that break and ulcerate, and mental and physical disability are described. Which infection is the nurse describing? a. Chlamydia trachomatis b. Trichomoniasis c. Gonorrhea d. Syphilis

D Gummas are associated with tertiary syphilis. They are tumors of a rubbery consistency that break down and damage the heart and nervous system and skin. The spirochete in late stages can lead to mental and physical disability. Primary syphilis is characterized by chancres. Chlamydia trachomatis is sometimes asymptomatic and often is associated with pelvic inflammatory disease. Redness, itching, and burning are associated with trichomoniasis, as is a frothy, foul-smelling discharge. Gonorrhea may be asymptomatic or associated with a yellow urethral or penile discharge.

A nurse is teaching a group of parents about a developmental expectation that occurs in girls around 10 years of age. What should the nurse identify as the earliest signs of sexual maturity? a. Interest in the opposite sex b. Paying attention to grooming c. The first menstrual period or menarche d. The appearance of axillary and pubic hair

D The hypothalamic-pituitary-gonadal-adrenal mechanism is responsible for the physiologic and structural changes that occur at puberty. In girls, the adrenal glands secrete androgens that are responsible for the appearance of axillary and pubic hair. Interest in the opposite sex is not an indicator of sexual maturity. Paying attention to grooming is not a reliable indicator of sexual maturity. Menarche usually occurs about 2 years after the initial pubescent changes; ovulation usually begins within a year after the first menstrual period.

The waiting area of a health care facility displays a pink triangle. What does this signify? a. The waiting area is for females. b. The waiting area is for pediatric clients. c. The health care facility welcomes transwomen. d. The health care facility welcomes lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients.

D A waiting room in a health care facility marked with a pink triangle indicates that the health care facility is in a safe place for LGBTQ clients, and they can expect respectful and knowledgeable quality care. Other symbols might be used to represent areas that are meant for female and pediatric clients. There are no widely used symbols to designate transwomen-specific health care facilities.

A nurse is caring for a pregnant client who has contracted a trichomonal infection. Which oral drug should the nurse anticipate that the primary healthcare provider will most likely prescribe? a. Penicillin G b. Acyclovir c. Nystatin d. Metronidazole

D Metronidazole is a potent amebicide that is safe in pregnancy. It is effective in eradicating the protozoan Trichomonas vaginalis. Penicillin is administered for its effect on bacterial, not protozoal, infections. Nystatin is an antifungal for infections caused by Candida albicans. Acyclovir is an antiviral drug; therefore it would not be effective in treating protozoal infections such as trichomonas.

A nurse in the clinic is obtaining a health history of a 16-year-old boy with a complaint of a thick urethral discharge. What is the most appropriate nursing action to help confirm a tentative diagnosis of gonorrhea? a. Assessing the temperature for fever b. Collecting a urine sample for a urinalysis c. Drawing blood for a complete blood count d. Obtaining a urethral specimen for a culture

D When the Gonococcus organism is present in the genitourinary tract of a male client, a culture of the urethral exudate provides a definitive diagnosis. Fever is not a specific diagnostic tool, because it occurs with other infections. Although urine may contain Gonococcus organisms, the urine dilutes the concentration; the organisms are more concentrated in the urethral discharge. The Gonococcus organism is in the genitourinary tract, not the blood; a complete blood count will not provide information with which to diagnose gonorrhea.