CH 28: Infections

Normal pH of vagina

4-4.5

Bartholin cysts

A fluid-filled swelling (cyst)

The nurse is caring for clients who have STIs. Which client is most at risk for becoming infertile due to the infection? A) a woman diagnosed with trichomoniasis B) a woman diagnosed with chlamydia C) a woman diagnosed with syphilis D) a woman diagnosed with herpes simplex virus

B) a woman diagnosed with chlamydia Chlamydia trachomatis is the bacterium that is the leading cause of preventable infertility in women and the most common STI in the United States. Chlamydia is transmitted during vaginal, anal, or oral sex, leading to infections in the associated tissues of these areas. Lymphogranuloma venereum (LGV) is an STI that results from the three strains of Chlamydia trachomatis.

medication treatment for trichomoniasis

metronidazole

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? A) It produces its own natural antibiotics. B) It maintains an alkaline pH of 7 to 8, which destroys invading bacteria. C) Normal vaginal flora act as phagocytes of invading bacteria. D) Normal vaginal pH is acidic (4 to 5), which protects from infection.

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

What is the gold standard for HSV diagnosis?

culture

What is the medication of choice for early syphilis?

penicillin G benzathine

condylomata

warty growths indicative of the human papillomavirus

A woman comes to the clinic reporting vaginal discharge. The nurse suspects trichomoniasis based on which symptoms? Select all that apply. A) urinary frequency B) yellow/green discharge C) joint pain D) blister-like lesions E) muscle aches

A) urinary frequency B) yellow/green discharge

A woman comes into the health clinic complaining of thick, cottage cheese-like vaginal discharge, with white patches on her labia that worsens before her menses. She complains of intense pruritus and dyspareunia. The health care provider would order which preparation for treatment? A) Fluconazole B) Tetracycline C) Clindamycin D) Acyclovir

A) Fluconazole Treatment of candidiasis includes miconazole cream or suppository, clotrimazole tablet or cream, terconazole cream or intravaginal suppository, or fluconazole oral tablet. Most of these medications are used intravaginally in the form of a cream, tablet, or suppositories for 3 to 7 days. If fluconazole is prescribed, a 150-mg oral tablet is taken as a single dose. The other medications would not be appropriate.

When developing a program for STI prevention, which action would need to be done first? A) educating on how to promote sexual health B) getting individuals to change their behaviors C) increasing the availability of resources D) interfering with the mode of transmission

A) educating on how to promote sexual health The key to successful treatment and prevention of STIs is education to promote sexual health. Behavior changes, increasing the availability of resources, and interfering with modes of transmission are important, but all of these require education.

When preparing a teaching plan for a female adolescent with a sexually transmitted infection (STI), the nurse plans to address the fact that the adolescent is at increased risk for cervical cancer. Which STI would the adolescent most likely have? A) genital warts B) genital herpes C) syphilis D) chlamydia

A) genital warts Genital warts or condylomata acuminata is caused by the human papilloma virus (HPV), which places the adolescent at increased risk for cervical cancer. An increased risk for cervical cancer is not associated with genital herpes. An increased risk for cervical cancer is not associated with syphilis. An increased risk for cervical cancer is not associated with chlamydia.

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect which finding once the microorganism disseminates throughout the body? A) painful joints B) sore throat C) intermenstrual bleeding D) painful urination

A) painful joints The client with an anal gonorrheal infection experiences symptoms of gonorrhea where the microorganism has invaded the rectum. After the microorganism disseminates throughout the body, the client may manifest a skin rash, fever, and painful joints. Other symptoms such as infections of the urinary tract or vagina, sore throat, intermenstrual bleeding due to cervicitis, and painful urination are associated with the organism's invasion of those structures, depending on the nature of the sexual contact.

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 means of exposure? A) sexual intercourse B) sharing needles for IV drug use C) perinatal transmission D) blood transfusion

A) sexual intercourse HIV infections are increasing in adolescents and young adults aged 13 to 24 years predominantly trasmitted by sexual intercourse. Approximately 25% of cases of STIs reported in the United States each year are among teenagers. More than 2 million adolescents between the ages of 10 and 19 are living with HIV, and many do not receive the care and support they need to stay in good health. This is particularly significant because the risk of HIV transmission increases substantially if either partner is infected with an STI. Sharing of needles, perinatal transmission, and blood transfusions are less often means of transmission in adolescents.

A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection? A) viral culture of vesicular fluid B) Papinicolaou smear C) IgG/IgM antibody testing D) treponemal testing

A) viral culture of vesicular fluid Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicles. The IgG/IgM antibody testing is frequently done for screening purposes. Papanicolaou (Pap) smears are an insensitive and nonspecific diagnostic test for HSV and should not be relied on for diagnosis. Treponemal testing is used to diagnose syphylis.

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? A) antibiotic therapy B) menstruation C) douching D) use of feminine hygiene sprays

B) Menstruation 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 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis? A) Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy. B) Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease. C) Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection. D) Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.

B) Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease The treatment of choice for Trichomonas vaginalis is oral metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment and eradication of the infection is possible with treatment.

A nurse at a local community clinic is developing a program to address STI prevention. What 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

B) recommending screening for symptomatic individuals 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.

When developing a teaching plan for a community group about HIV infection, which group would the nurse identify being most vulnerable for HIV infection? A) Native American/First Nations people B) heterosexual women C) new health care workers D) Asian immigrants

B)heterosexual women The number of women with HIV infection and AIDS has been increasing steadily worldwide. Today, women account for one in four (25%) new HIV infections in the United States. Women of color have been especially hard hit and represent the majority of women living with the disease and newly infected ones. African American women suffer disproportionately from the HIV/AIDS epidemic, as they acquire new HIV infections at nearly 15 times the rate of white women. New health care workers and Asian immigrants are not among those considered at high risk

The nurse is reviewing medication orders for a pregnant patient diagnosed with a urinary tract infection. Which medication order should the nurse question for this patient? A) Ampicillin B) Amoxicillin C) Tetracycline D) Cephalosporin

C) Tetracycline Amoxicillin, ampicillin, and cephalosporins are effective against most organisms causing UTIs and are safe antibiotics during pregnancy. Tetracyclines are contraindicated during pregnancy because they cause retardation of bone growth and staining of the fetal teeth.

A 40-year-old woman with gray, runny vaginal discharge that has a foul, fishy odor has been told that she most likely has vaginosis. What most likely contributed to her present condition? A) unprotected sex with a new partner who is a carrier of the relevant bacteria B) autoinoculation from a cold sore, wart, or oral fungal infection C) a sharp reduction in the number of lactobacilli in the client's vaginal flora D) proliferation of sexually-transmitted protozoa

C) a sharp reduction in the number of lactobacilli in the client's vaginal flora Vaginosis is a disorder characterized by a shift in the vaginal flora from one dominated by hydrogen peroxide-producing lactobacillus to one with greatly reduced numbers of lactobacillus species and an overgrowth of other organisms. Autoinoculation or sexual transmission of bacteria or protozoa is unlikely to contribute.

Assessment of a female client reveals a thick, white vaginal discharge. The client 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.

C) candidiasis. 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.

A primary care provider tells a client to return 2 to 3 months after treatment to have a repeat culture done to verify the cure. This prescription would be appropriate for a woman with which condition? A) genital warts B) genital herpes C) gonorrhea D) syphilis

C) gonorrhea Gonococcal infections can be completely eliminated by drug therapy. Genital warts are not curable and are identified by appearance, not culture. Genital herpes is not curable and is identified by the appearance of the lesions or cytologic studies. The diagnosis of syphilis is done using dark-field microscopy or serologic tests.

A 23-year-old sexually active woman tells the nurse practitioner that she is worried because she has been having abnormal vaginal bleeding, dysuria, and weird vaginal discharge. What sexually transmitted infection would the nurse suspect? A) chlamydia B) syphilis C) gonorrhea D) HSV

C) gonorrhea Typical symptoms in women infected with gonorrhea include abnormal vaginal discharge, dysuria, cervicitis, abnormal vaginal bleeding, Bartholin's abscess, and PID.

Which factor in a client's history indicates she is at risk for candidiasis? A) nulliparity B) menopause C) use of corticosteroids D) use of spermicidal jelly

C) use of corticosteroids 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 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the client from infecting others in the future. Which statement by the client demonstrates understanding of his health problem? A) "Either me or a partner could end up with an eye infection from chlamydia that could make us blind." B) "Even though I couldn't end up sterile, a woman that I give it to certainly could." C) "Each of the 3 stages of the disease seems to be worse than the previous one." D) "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it."

D) "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it." Seventy-five percent of women with chlamydial infections are asymptomatic. Blindness is a rare complication in adults who live in industrialized countries, and both men and women can become sterile from the effects. Syphilis, not chlamydial infections, has a course of three distinct stages.

A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment? A) Avoid extremes of temperature to the genital area. B) Use condoms during sex. C) Increase fluid intake. D) Avoid alcohol.

D) Avoid alcohol. The nurse should counsel the client taking metronidazole to avoid alcohol during the treatment because mixing the two causes severe nausea and vomiting. Avoiding extremes of temperature to the genital area is a requirement for clients with genital ulcers, not trichomoniasis. The nurse should instruct the client to avoid sex, regardless of using condoms, until she and her sex partners are cured, that is, when therapy has been completed and both partners are symptom-free. It is not required to increase fluid intake during treatment.

A client with primary syphilis is allergic to penicillin. The nurse would expect the primary care provider to prescribe which agent? A) acyclovir B) ceftriaxone C) podophyllum resin D) doxycycline

D) doxycycline 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.

A nurse is caring for clients who have a history of genital herpes infection. The client most at risk for an outbreak of genital herpes is the client who reports: A) headache and fever. B) vaginal and urethral discharge. C) dysuria and lymphadenopathy. D) genital pruritus and paresthesia.

D) genital pruritus and paresthesia. Pruritus and paresthesia as well as redness of the genital area are prodromal symptoms of recurrent herpes infection. These symptoms occur 30 minutes to 48 hours before the lesions appear. Headache and fever are symptoms of viremia associated with the primary infection. Vaginal and urethral discharge is also a local sign of primary infection. Dysuria and lymphadenopathy are local symptoms of primary infection that may also occur with recurrent infection.

Which medications are appropriate to treat vaginal candidiasis?

miconazole fluconazole