Ch 64 Assessment and Care of Clients with Sexually Transmitted Infections

4. Which sexually transmitted infection (STI) is known as the "silent STI" because 50% of cases are asymptomatic? a. chlamydia b. herpes genitalis virus c. HIV d. syphilis

ANS: A Chlamydia is known as the "silent STI" because 50% of cases are asymptomatic and usually go untreated.

18. To reduce risk of developing cervical cancer, a client who has human papillomavirus (HPV) infection should be advised to avoid: a. smoking b. use of oral contraception c. use of barrier methods of contraception d. use of condoms for future sexual partners

ANS: A Exposure to HPV may predispose them to development of cervical cancer. Due to this increased risk, client teaching should include reduction of other cancer risk factors such as smoking.

6. The nurse should be aware that which sexually transmitted infection (STI) is often seen in combination with chlamydia? a. gonorrhea b. herpes genitalis c. syphilis d. trichomoniasis

ANS: A Gonorrheal infections are seen in combination with chlamydia. Clients at risk should be screened for both STIs.

24. What is the primary route of transmission of hepatitis B? a. sexual contact b. oral-fecal c. blood d. water

ANS: A Hepatitis B is a viral infection transmitted by sexual contact. Symptoms include anorexia, vague abdominal discomfort, nausea, vomiting, fatigue, and jaundice and may progress into chronic liver disease, hepatic cancer, hepatic failure, and death.

8. The nurse caring for a newborn administers silver nitrate or antibiotic solution to prevent an eye infection. This transmission may occur as the baby travels through the birth canal that is infected with: a. gonorrhea b. herpes genitalis c. human immunodeficiency virus (HIV) d. syphilis

ANS: A If a woman is infected with gonorrhea when she gives birth, the infection may be transmitted to the newborn's eyes as the baby travels through the birth canal

9. When a client is diagnosed with gonorrhea, which treatment regime is considered MOST effective? a. a single dose of ciprofloxacin, followed by a 7-day course of oral doxycycline b. a single injection of penicillin G benzathine c. doxycycline 100 mg orally, twice daily for 7 days d. treatment of symptoms only with acyclovir

ANS: A One of the most effective treatments against gonorrhea is a single dose of ciprofloxacin, followed by a 7-day course of oral doxycycline.

1. In addition to the use of nonbarrier methods of birth control, which factor has led to the dramatic increase of sexually transmitted infections (STIs) in the last two decades? a. asymptomatic disease carriers b. careful reporting of STIs c. antibiotic-resistant organisms d. more sex education programs in schools

ANS: A Some of the factors that contribute to the increasing incidence of STIs include increase in casual sexual encounters, particularly with unprotected sex; nonbarrier methods of birth control; existence of asymptomatic disease carriers; unfamiliarity with methods of preventing STIs; increased use of alcohol and illegal drugs, including needle sharing among intravenous drug users and trading sex for drugs; and inadequate reporting of STIs.

11. The destructive, inflammatory changes occurring in the tertiary stage of syphilis involves which organ system? a. multiple b. central nervous c. epidermal d. reproductive

ANS: A Syphilis, a bacterial infection caused by Treponema pallidum, is transmitted through sexual contact or from mother to child. There are four stages of syphilis. Lesions (chancres) appear in the primary stage; the second stage is characterized by a skin rash with low-grade fever, fatigue, headache, sore throat, and lymph node enlargement. If untreated, syphilis becomes latent, and approximately one-third of clients who have secondary-stage disease develop tertiary syphilis, a chronic disabling condition that can affect multiple organs. Neurosyphilis is the final stage. Antibiotics are used in the medical treatment of syphilis.

1. Common diagnostic tests to determine the presence of sexually transmitted infections (STIs) include which of the following? (Select all that apply.) a. antigen for HSV b. Reiter's test c. CT scan d. Western blot e. biopsy f. urine specimen

ANS: A, B, D, F Common diagnostic tests to determine the presence of sexually transmitted infections (STIs) include the following: for blood: ELISA, Western blot, VDRL, RPR, FTA-ABS, Reiter's test, antigen for HSV; for culture: tissue of male urethra, cervix, swab test, Tzanck, NAAT; and for urine: urine specimen, NAAT.

19. What is the preferred treatment of human papillomavirus (HPV) infection? a. topical antibiotics b. cryosurgery c. chemotherapy d. surgical removal under general anesthesia

ANS: B Adolescent or young adult women are at greatest risk; the warts may predispose them to development of cervical cancer. While warts may be surgically removed via cryosurgery, surgery does not cure the condition. A topical solution may be prescribed.

23. For a pregnant client who has trichomoniasis, when will treatment occur? a. mother and baby will be treated after birth b. after the first trimester c. immediately d. once the repeat test is also positive

ANS: B An antiprotozoal medication after the first trimester is the prescribed medical treatment for pregnant women with trichomoniasis.

26. What is the MOST important nursing consideration when collecting information about a client's sexual history? a. recording each of the client's sexual contacts accurately b. noting any recent antibiotic treatment for infections that were not sexually transmitted infections (STIs) c. maintaining a relaxed, nonjudgmental attitude d. recognizing personal attitudes and beliefs regarding persons with STIs

ANS: C Nursing care of clients with STIs includes completing a confidential assessment, including sexual history and symptoms; using a nonjudgmental approach that assists in reducing client anxiety; teaching about the specific STI(s), including mode of transmission, prescribed treatment, and prevention of further infection; and following up regarding sexual partners and their need for treatment.

22. What is the preferred treatment of a client who has trichomoniasis? a. 1 week of Cipro b. 3 days of doxycycline c. up to 1 week of Flagyl d. a single penicillin injection

ANS: C An antiprotozoal medication, up to 1 week of Flagyl, is the prescribed medical treatment.

13. Cytomegalovirus can be misdiagnosed as what illness due to similarity of symptoms? a. AIDS b. herpes genitalis c. mononucleosis d. syphilis

ANS: C Cytomegalovirus is transmitted through contact with bodily fluids and rarely produces significant clinical symptoms. It can be misdiagnosed as mononucleosis because of similarity of symptoms.

14. Transmission of cytomegalovirus to an unborn fetus can result in what condition in the neonate? a. cataracts b. choanal atresia c. mental retardation d. jaundice

ANS: C Cytomegalovirus is transmitted through contact with bodily fluids and rarely produces significant clinical symptoms. Transmission of cytomegalovirus to an unborn fetus can result in mental retardation.

17. Symptoms of infection with human papillomavirus (HPV) include: a. fever, chills, aches, and fatigue b. painful wartlike growths on internal or external genitalia c. painless, soft, fleshy growths appearing in the genital area d. white, cheesy discharge from the vagina

ANS: C Genital warts are caused by HPV and transmitted by sexual contact. These painless warts occur in the urogenital, perineal, or anal areas and may be internal or external. Adolescent or young adult women are at greatest risk; the warts may predispose them to development of cervical cancer. While warts may be surgically removed, surgery does not cure the condition. A topical solution may be prescribed.

15. Client teaching should include that human papillomavirus (HPV) can lead to the formation of: a. chancres b. enlarged inguinal lymph nodes c. genital warts d. herpetic lesions

ANS: C Genital warts are caused by the human papilloma virus and transmitted by sexual contact. These painless warts occur in the urogenital, perineal, or anal areas and may be internal or external. Adolescent or young adult women are at greatest risk; the warts may predispose them to development of cervical cancer.

3. Why do males generally seek health care more readily for symptoms of sexually transmitted infections (STIs)? a. They are more health conscious than women. b. Their symptoms are more severe, and they are more likely to suffer complications. c. Their symptoms are usually more obvious at the onset of the disease. d. The male is more likely to transmit the disease to his partner.

ANS: C Males generally seek health care more readily than females, as their symptoms are usually more obvious at the onset of the disease. Symptoms in females are generally later in developing than those in males.

10. At which stage does syphilis become noninfectious? a. primary b. secondary c. tertiary d. There is no stage at which the disease is not infectious.

ANS: C Syphilis, a bacterial infection caused by Treponema pallidum, is transmitted through sexual contact or from mother to child. There are four stages of syphilis. Lesions (chancres) appear in the primary stage; the second stage is characterized by a skin rash with low-grade fever, fatigue, headache, sore throat, and lymph node enlargement. If untreated, syphilis becomes latent, and approximately one-third of clients who have secondary-stage disease develop tertiary syphilis, a chronic disabling condition. Neurosyphilis is the final stage. Antibiotics are used in the medical treatment of syphilis.

16. Which population group is MOST at risk for developing the human papillomavirus (HPV) infection? a. males between the ages of 17 and 25 years old b. males or females in their early 20s who have had multiple sexual partners c. teenage girls or young women in their 20s d. females in their mid-20s to 30s

ANS: C Teenage girls or young women in their 20s are most at risk for developing HPV infection due to the increase in sexual activity during this period.

20. In addition to sexual contact, client teaching should include that the human immunodeficiency virus (HIV) virus can be transmitted by which mode? a. respiratory b. from baby to mother c. blood d. fecal

ANS: C The HIV virus can be transmitted through sexual contact with an infected person and contact with infected body fluid such as blood, amniotic fluid, vaginal secretions, semen, and any fluid containing blood.

2. When teaching the client about proper condom use, which of the following should the nurse include? (Select all that apply.) a. is just as effective as other birth control methods b. should be discarded after two ejaculations c. disposal includes by holding at the base of the penis after ejaculation d. can be used to prevent oral-genital membrane contact e. store in a cool, dry place away from sunlight f. provides the most protection against sexually transmitted infections (STIs)

ANS: C, D, E Proper condom use includes the following: store in a cool, dry place away from sunlight; aside from abstinence provides the most protection against STIs; can be used to prevent oral-genital membrane contact; disposal includes by holding at the base of the penis after ejaculation; and condom should be discarded after each ejaculation.

25. In addition to prior treatment for sexually transmitted infections (STIs) and sexual orientation, which of the following is a pertinent part of a client history when screening for sexually transmitted diseases? a. year of first sexual intercourse b. racial origin c. attendance at sex education classes d. number of sexual partners over the last 6 months

ANS: D Assessment of the client history should include prior treatment for STIs, sexual orientation, number of sexual partners over the last 6 months, and types of prevention used.

7. What is the MOST common symptom of gonorrheal infection in women? a. grayish-white mucopurulent vaginal discharge b. infertility c. painful sexual intercourse d. yellow or bloody vaginal discharge

ANS: D Many women with gonorrheal infections are symptomatic, but the remainder may have pain or burning on urination, a yellow or bloody vaginal discharge, or both.

12. Which treatment will cure herpes genitalis? a. acyclovir taken orally twice daily for 2 weeks b. an injection of penicillin G benzathine c. doxycycline 100 mg orally, twice daily for 7 days d. none

ANS: D Medical treatment for herpes genitalis includes prevention of transmission and the use of several medications, such as acyclovir and doxycycline. However, there is no cure for herpes genitalis.

5. It is MOST important to remind a pregnant woman being treated for chlamydia to: a. take the prescribed medication with milk b. prepare for treatment of the baby after delivery c. notify her health care provider if symptoms reoccur d. repeat cultures when treatment is complete

ANS: D Pregnant women are treated with erythromycin estolate (Ilosone) or amoxicillin (Amoxil), but they should be cultured again after treatment is completed to confirm the absence of chlamydial infection.

21. Which sexually transmitted disease is caused by a parasitic protozoan and is often seen in combination with gonorrhea? a. chlamydia b. herpes genitalis c. syphilis d. trichomoniasis

ANS: D Trichomoniasis, caused by a protozoa (Trichomonas vaginalis), is transmitted primarily by sexual contact; it occurs frequently with gonorrhea. While some female clients may be asymptomatic, vulval and vaginal pruritus and mucoid vaginal discharge may be present; male clients may have penile discharge and painful urination. An antiprotozoal medication is the prescribed medical treatment.

2. Which statement regarding sexually transmitted infections (STIs) is TRUE? a. Guidelines for reporting STIs are often ignored. b. Statistics on STIs are kept only by individual states. c. Reporting is required for STIs such as herpes and trichomoniasis. d. There is no uniformity in the reporting requirements for STIs.

ANS: D Widespread public education about the causes, methods of transmission, and methods of preventing STIs (including sex education classes in schools and public service ads on television and radio) is considered the most important factor in combatting the continued increase in incidence of STIs. However, there is no uniformity in the reporting requirements for STIs.