Lippincott NCLEX Review - STD's

A sexually active male client has burning on urination and a milky discharge from the urethral meatus. Documentation on the client's chart should include which of the following information? Select all that apply. 1. History of unprotected sex (sex without a condom). 2. Length of time since symptoms presented. 3. History of fever or chills. 4. Presence of any enlarged lymph nodes on examination. 5. Names and phone numbers of all sexual contacts. 6. Allergies to any medications.

1, 2, 3, 4, 6. The client is suspected of having a sexually transmitted infection. Therefore, the client's sexual history, assessment, and examination must be documented, including symptoms (such as fever, chills, and enlarged glands) and their onset and duration. Allergies are critical to document for every client, but are especially noteworthy in this case because antibiotics will be prescribed. If a sexually transmitted infection is confirmed, sexual contacts need to be treated. To protect privacy, the names and phone numbers should never be placed in the chart. The public health department will also assist in obtaining information and treating known sexual contacts.

An 18-year-old female is to have a pelvic exam. Which of the following responses by the nurse would be best when the client says that she is nervous about the upcoming pelvic examination? 1. "Can you tell me more about how you're feeling?" 2. "You're not alone. Most women feel uncomfortable about this examination." 3. "Do not worry about Dr. Smith. He's a specialist in female problems." 4. "We'll do everything we can to avoid embarrassing you."

1. Asking the client to describe her nervousness gives her the opportunity to express her concerns. It also allows the nurse to understand her better and gives the nurse a base to respond to the client's stated fears, questions, or need for further information. Responses that make assumptions about the source of the concern or offer reinforcement are not supportive and block successful communication.

The primary reason that a herpes simplex virus (HSV) infection is a serious concern to a client with human immunodeficiency virus (HIV) infection is that it: 1. Is an acquired immunodeficiency virus (AIDS)-defining illness. 2. Is curable only after 1 year of antiviral therapy. 3. Leads to cervical cancer. 4. Causes severe electrolyte imbalances.

1. HSV infection is one of a group of disorders that, when diagnosed in the presence of HIV infection, are considered to be diagnostic for AIDS. Other AIDSdefining illnesses include Kaposi's sarcoma; cytomegalovirus of the liver, spleen, or lymph nodes; and Pneumocystis carinii pneumonia. HSV infection is not curable and does not cause severe electrolyte imbalances. Human papillomavirus can lead to cervical cancer.

Which of the following groups has experienced the greatest rise in the incidence of sexually transmitted diseases (STDs) over the past two decades? 1. Teenagers. 2. Divorced people. 3. Young married couples. 4. Older adults.

1. Statistics reveal that the incidence of STDs is rising more rapidly among teenagers than among any other age group. Many reasons have been given for this trend, including a change in societal mores and increasing sexual activity among teenagers. During this developmental stage, teenagers may engage in high-risk sexual behaviors because they often are living in the present and feel that it won't happen to them.

What is most important for the nurse to teach a client newly diagnosed with genital herpes? 1. Use condoms at all times during sexual intercourse. 2. A urologist should be seen only when lesions occur. 3. Oral sex is permissible without a barrier. 4. Determine if your partner has received a vaccine against herpes.

1. The client should be taught to abstain from sexual intercourse while lesions are present. Condoms should be used at all times as the virus can be shed without lesions present. Multiple partners would promote the spread of genital herpes. There is no vaccine available to prevent genital herpes. Although periodic examinations should be advised, a urologist does not necessarily need to be seen when lesions occur.

The nurse is interviewing a client with newly diagnosed syphilis. In order to prevent the spread of the disease, the nurse should focus the interview by: 1. Motivating the client to undergo treatment. 2. Obtaining a list of the client's sexual contacts. 3. Increasing the client's knowledge of the disease. 4. Reassuring the client that records are confidential.

2. An important aspect of controlling the spread of sexually transmitted diseases (STDs) is obtaining a list of the sexual contacts of an infected client. These contacts, in turn, should be encouraged to obtain immediate care. Many people with STDs are reluctant to reveal their sexual contacts, which makes controlling STDs difficult. Increasing clients' knowledge of the disease and reassuring clients that their records are confidential can motivate them to seek treatment, which does help to control the spread of the disease, but it is not as critical as information about the client's sexual contacts.

Benzathine penicillin G, 2.4 million units IM, is prescribed as treatment for an adult client with primary syphilis. The nurse should administer the injection in the: 1. Deltoid. 2. Upper outer quadrant of the buttock. 3. Quadriceps lateralis of the thigh. 4. Midlateral aspect of the thigh.

2. Because of the large dose, the upper outer quadrant of the buttocks is the recommended site. The deltoid and the quadriceps lateralis of the thigh are not large enough for the recommended dose. In infants and small children, the midlateral aspect of the thigh may be preferred.

The nurse assesses the mouth and oral cavity of a client with human immunodeficiency virus (HIV) infection because the most common opportunistic infection initially presents as: 1. Herpes simplex virus (HSV) lesions on the lips. 2. Oral candidiasis. 3. Cytomegalovirus (CMV) infection. 4. Aphthae on the gingiva.

2. The most common opportunistic infection in HIV infection initially presents as oral candidiasis, or thrush. The client with HIV should always have an oral assessment. HSV and CMV are opportunistic infections that present later in acquired immunodeficiency syndrome. Aphthous stomatitis, or recurrent canker sores, is not an opportunistic infection, although the sores are thought to occur more often when the client is under stress.

Women who have human papillomavirus (HPV) are at risk for development of: 1. Sterility. 2. Cervical cancer. 3. Uterine fibroid tumors. 4. Irregular menses.

2. Women who have HPV are much more likely to develop cervical cancer than women who have never had the disease. Cervical cancer is now considered a sexually transmitted disease. Regular examinations, including Papanicolaou tests, are recommended to detect and treat cervical cancer at an early stage. Girls and women as well as boys and men (around ages 9 to 26 depending on the vaccine) should receive a vaccine to prevent HPV. HPV does not cause sterility, uterine fibroid tumors, or irregular menses.

The nurse is administering Didanosine (Videx) to a client with HIV. Before administering this medication, the nurse should check which lab test results? Select all that apply. 1. Elevated serum creatinine. 2. Elevated blood urea nitrogen (BUN). 3. Elevated aspartate aminotransferase (AST). 4. Elevated alanine aminotransferase (ALT). 5. Elevated serum amylase.

3, 4, 5. The nurse should withhold the medication and notify the physician immediately if the client develops manifestations of pancreatitis or hepatic failure including nausea and vomiting, severe abdominal pain, elevated bilirubin, or elevated serum enzymes (eg, amylase, AST, ALT). If both BUN and creatinine are elevated, the client may have kidney disease.

The nurse is caring for a client from Southeast Asia who has HIV-AIDS. The client does not speak or comprehend the English language. The nurse should? 1. Contact the hospital's chaplain. 2. Do an Internet search for the Joint United Nations Programme on HIV/AIDS. 3. Utilize language-appropriate interpreters. 4. Ask a family member to obtain informed consent.

3. Interpreters are essential in enabling the nurses' communications to be understood accurately. The chaplain may not know the client's language. The Joint United Nations Programme on HIV/AIDS has the number of reported cases of AIDS. It is not necessary for the family member to obtain informed consent.

The typical chancre of syphilis appears as: 1. A grouping of small, tender pimples. 2. An elevated wart. 3. A painless, moist ulcer. 4. An itching, crusted area.

3. The chancre of syphilis is characteristically a painless, moist ulcer. The serous discharge is very infectious. Because the chancre is usually painless and disappears, the client may not be aware of it or may not seek care. The chancre does not appear as pimples or warts, and does not itch, thus making diagnosis difficult.

A client with human immunodeficiency virus (HIV) infection is taking zidovudine (AZT). The expected outcome of AZT is to: 1. Destroy the virus. 2. Enhance the body's antibody production. 3. Slow replication of the virus. 4. Neutralize toxins produced by the virus.

3. Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus.

A female client with gonorrhea informs the nurse that she has had sexual intercourse with her boyfriend and asks the nurse, "Would he have any symptoms?" The nurse responds that in men the symptoms of gonorrhea include: 1. Impotence. 2. Scrotal swelling. 3. Urine retention. 4. Dysuria.

4. Dysuria and a mucopurulent urethral discharge characterize gonorrhea in men. Gonococcal symptoms are so painful and bothersome for men that they usually seek treatment with the onset of symptoms. Impotence, scrotal swelling, and urine retention are not associated with gonorrhea.

In educating a client about human immunodeficiency virus (HIV), the nurse should take into account the fact that the most effective method known to control the spread of HIV infection is: 1. Premarital serologic screening. 2. Prophylactic treatment of exposed people. 3. Laboratory screening of pregnant women. 4. Ongoing sex education about preventive behaviors.

4. Education to prevent behaviors that cause HIV transmission is the primary method of controlling HIV infection. Behaviors that place people at risk for HIV infection include unprotected sexual intercourse and sharing of needles for IV drug injection. Educating clients about using condoms during sexual relations is a priority in controlling HIV transmission.

A nurse is planning care for a 25-year-old female client who has just been diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse, "How could this have happened?" The nurse responds to the question based on the most frequent mode of HIV transmission, which is: 1. Hugging an HIV-positive sexual partner without using barrier precautions. 2. Inhaling cocaine. 3. Sharing food utensils with an HIV-positive person without proper cleaning of the utensils. 4. Having sexual intercourse with an HIV-positive person without using a condom.

4. HIV infection is transmitted through blood and body fluids, particularly vaginal and seminal fluids. A blood transfusion is one way the disease can be contracted. Other modes of transmission are sexual intercourse with an infected partner and sharing IV needles with an infected person. Women now have the highest rate of newly diagnosed HIV infection. Many of these women have contracted HIV from unprotected sex with male partners. HIV cannot be transmitted by hugging, inhaling cocaine, or sharing utensils.

When educating a female client with gonorrhea, the nurse should emphasize that for women gonorrhea: 1. Is often marked by symptoms of dysuria or vaginal bleeding. 2. Does not lead to serious complications. 3. Can be treated but not cured. 4. May not cause symptoms until serious complications occur.

4. Many women do not seek treatment because they are unaware that they have gonorrhea. They may be symptom-free or have only very mild symptoms until the disease progresses to pelvic inflammatory disease. Dysuria and vaginal bleeding are not present in gonorrhea. Gonorrhea can lead to very serious complications. It can be cured with the proper treatment.

A male client with human immunodeficiency virus (HIV) infection becomes depressed and tells the nurse: "I have nothing worth living for now." Which of the following statements would be the best response by the nurse? 1. "You are a young person and have a great deal to live for." 2. "You should not be too depressed; we are close to finding a cure for AIDS." 3. "You are right; it is very depressing to have HIV." 4. "Tell me more about how you are feeling about being HIV positive."

4. The nurse should respond with a statement that allows the client to express his thoughts and feelings. After sharing feelings about their diagnosis, clients will need information, support, and community resources. Statements of encouragement or agreement do not provide an opportunity for the client to express himself.