Chapter 28: Infections

A client is diagnosed with trichomoniasis infection. The nurse prepares to teach the client about which medication?

Correct response: metronidazole Explanation: Oral metronidazole or tinidazole are used to treat trichomoniasis. Penicillin G may be used to treat syphilis. Miconazole and fluconazole are used to treat candidiasis.

Which instruction should the nurse give to a client with genital herpes to help control the infection?

Correct response: Avoid sexual contact until sores heal. Explanation: The nurse should instruct the client to avoid sexual contact until sores heal completely and new skin forms. Application of antibacterial medication is suggested for wounds in case of lymphedema. Clients with HIV are advised to avoid people with upper respiratory infections. Application of imiquimod cream is suggested for clients infected with human papillomavirus.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment?

Correct response: genital herpes Explanation: Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

The nurse explains to a client diagnosed with trichomoniasis that the disease is caused by the parasitic protozoan Trichomonas vaginalis. What would the nurse say is a factor that triggers growth of trichomoniasis?

Correct response: irritation of vaginal walls Explanation: Factors that trigger growth of trichomoniasis include irritation of vaginal walls, pregnancy, sexual activity, trauma to the vaginal walls, systemic illness, menstruation, and emotional upsets.

Which stage or period of syphilis occurs when the infected person has no signs or symptoms of syphilis?

Correct response: latency Explanation: A period of latency occurs when the infected person has no signs or symptoms of syphilis. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.

Which factor in a client's history indicates she is at risk for candidiasis?

Correct response: use of corticosteroids Explanation: Small numbers of the fungus Candida albicans are commonly in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Pregnancy, not nulliparity, increases the risk of candidiasis. Candidiasis is rare before menarche and after menopause. The use of hormonal contraceptives, not spermicidal jelly, increases the risk of candidiasis.

A young couple are disappointed that they are not yet pregnant and are seeking assistance at the health clinic. After assessing their medical history, the nurse discovers the female has a history of several episodes of PID. The nurse predicts this may be a source of the infertility related to which factor?

Correct response: It interferes with the transport of ova due to tubal scarring. Explanation: Pelvic inflammatory disease results in scarring and adhesions of the tubes, leading to poor transport of ova. PID does not affect hormone metabolism, nor does it affect the production of cervical mucus. Antibodies are present only in a few cases and are unrelated to PID.

The vagina is at risk for infection because of its location and because it opens to the outside of the body. What is a protective mechanism of the vagina to keep it from becoming infected?

Correct response: Normal vaginal pH is acidic (4 to 5), which protects from infection. Explanation: Normally, the vagina maintains an acidic pH of 4 to 5, which protects the vagina from infection.

During a routine physical examination, the client is noted to have a Bartholin cyst abscess. The nurse recognizes the need to obtain testing to rule out:

Correct response: STI. Explanation: Cultures of the purulent abscess fluid and of the cervix should be obtained for Neisseria gonorrhoeae and Chlamydia trachomatis to rule out sexually transmitted infection. A careful history should include questions concerning the woman's sexual practices and protective measures used. Cancer, fungal infection, or UTI is not associated with a Bartholin cyst.

A nurse practitioner is seeing a client at the local clinic and the client complains of vaginal itching and irritation. The nurse practitioner rules out an active infection and asks the client about her hygiene practices. What practices would be recognized as contributory to the complaint? Select all that apply.

Correct response: Use of tampons with deodorant Douching after intercourse History of an upper respiratory tract infection that was treated with antibiotics Explanation: Vaginal itching and irritation usually results from a change in the pH of the vagina. Examples of substances that alter the pH are deodorant tampons and sanitary pads, douches, and antibiotics. Not showering daily or using a shower gel does not cause vaginal irritation and itching.

Which medication is used to suppress viral load of the HSV-2 infection?

Correct response: acyclovir Explanation: The antiviral agents acyclovir, valacyclovir, and famciclovir are recommended to suppress the viral load and decrease recurrence and shedding. Metronidazole and clindamycin are not used for this action.

The nurse cares for a client recently diagnosed with syphilis who has no known drug allergies. Which medication will the nurse expect the health care provider to prescribe?

Correct response: benzathine penicillin G Explanation: Current guidelines recommend benzathine penicillin G injection (long-acting penicillin) as the preferred treatment for syphilis. If the client is allergic to penicillin, other medications (e.g., doxycycline, tetracycline, or ceftriaxone) may be used; however, data to support the use of these medications to treat syphilis are limited. Metronidazole is the treatment for trichomoniasis, and miconazole is the treatment for candidiasis.

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea?

Correct response: burning on urination Explanation: Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which most common bacterial STI in the United States would the nurse expect to include?

Correct response: chlamydia Explanation: Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. Genital herpes is a viral STI. One in five people older than age 12, however, is infected with the virus that causes genital herpes.

A client with primary syphilis is allergic to penicillin. The nurse would expect the primary care provider to prescribe which agent?

Correct response: doxycycline Explanation: Clients who are allergic to penicillin are given doxycycline or erythromycin. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

Clients who have had PID are prone to which complication?

Correct response: ectopic pregnancy Explanation: All clients who have had PID need to be informed of the signs and symptoms of ectopic pregnancy because they are prone to this complication. An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus.

Working at the local health clinic, the nurse recognizes that STIs can often result in pelvic inflammatory disease. When a client with a history of repeat STIs presents to the clinic reporting severe abdominal cramping and bleeding, the immediate concern is to ensure the client does not have:

Correct response: ectopic pregnancy. Explanation: Every day, more than one million people are newly infected with STIs that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition. STIs may contribute to cervical cancer, infertility, ectopic pregnancy, chronic pelvic pain, and death.

A 24-year-old female client reports various issues. She admits to having unprotected sexual intercourse. Which findings would indicate possible pelvic inflammatory disease (PID)? Select all that apply.

Correct response: lower abdominal tenderness adnexal tenderness cervical motion tenderness Explanation: Minimal criteria of PID as established by the CDC include lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness.

A woman is diagnosed with a vaginal infection. After teaching the client about measures to reduce her risk, the nurse determines that the client needs additional teaching when she states which factor as increasing her risk?

Correct response: menstruation Explanation: The vagina has an acidic environment, which protects it against ascending infections. Antibiotic therapy, douching, perineal hygiene sprays, and deodorants upset the acid balance within the vaginal environment and can predispose women to infections. Menstruation is not considered a risk factor.

A nurse is assessing a client diagnosed with bacterial vaginosis. What is a symptom of bacterial vaginosis?

Correct response: vaginal odor smelling of fish Explanation: Bacterial vaginosis causes a "stale fish" vaginal odor. Cottage cheese-like discharge is seen in candidiasis and not in bacterial vaginosis, in which the discharge is thin and gray-white. Intense itching of the vulva is associated with candidiasis, not vaginosis. Warts in the vulva and labia are seen in human papillomavirus infection, not in vaginosis.