Chapter 35 Patients with STIs

The nurse is caring for a client who has just been diagnosed with chlamydia and is very upset. The client says, "I don't understand this. The person I had sex with did not have any symptoms at all. How could I have known?" What is the best response by the nurse to this client? "It is very hard to see signs of infection in the heat of passion." "Many people with chlamydia won't have symptoms for up to 3 weeks after being infected." "I think you realize that if you had used some form of a barrier protection such as a condom, it would have helped prevent this situation." "It is really important that you know the sexual history of every potential lover. It may be uncomfortable but it will prevent the situation you are dealing with right now."

"Many people with chlamydia won't have symptoms for up to 3 weeks after being infected."

An adolescent informs the school nurse that she is afraid of contracting an STI but her boyfriend does not want to use condoms. What is the best response by the nurse? "You are too young to be having sex at all." "If he won't use a condom, then he doesn't care about you." "The use of condoms is one of the best ways to reduce the risk of acquiring an STI." "I can understand your concern and you should bring him here so that I can talk with him about STIs."

"The use of condoms is one of the best ways to reduce the risk of acquiring an STI."

The nurse is providing education about treatment for syphilis to a client who has a confirmed infection. The client states, "Penicillin causes me to have raised, red bumps all over my body. Will I have to take it again?" How should the nurse respond? "You can be treated with an alternative antibiotic called doxycycline." "There are many alternatives to taking antibiotics to treat syphilis." "Ceftriaxone is an antibiotic that is also effective in the treatment of this infection." "Topical application of an immune response modifier can be used instead."

"You can be treated with an alternative antibiotic called doxycycline."

A client with a trichomoniasis infection is prescribed metronidazole. Which teaching will the nurse provide to the client about this medication? Report to the health care provider any metallic taste. Avoid all alcohol for 24 hours after taking the medication. This medication prevents future trichomoniasis infections. Abstain from sexual activity for a month after taking the medication.

Avoid all alcohol for 24 hours after taking the medication.

Which of the following describes microorganisms present without host interference or interaction? Colonization Infection Infectious disease Reservoir

Colonization

A nurse is teaching a group of college-aged men about the risks of Chlamydia trachomatis and Neisseria gonorrhoeae. A participant has implied that men do not need to be particularly concerned about these diseases since the health consequences for men are comparatively minor. The nurse counters that men may in fact become infertile because these diseases can cause: Priapism Epididymitis Incarcerated hernias Hydrocele

Epididymitis

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention? Rashes on the palms of the hands and soles of the feet Cauliflower-like warts on the penis Painful red papules on the shaft of the penis Foul-smelling discharge from the penis

Foul-smelling discharge from the penis

A nurse practitioner who works for Planned Parenthood is responsible for health education seminars. During these presentations, the nurse always discusses the symptoms of the most common STI among young, sexually active people. This is: Candidiasis. Human papillomavirus. Endocervicitis. Salpingitis.

Human papillomavirus.

The nurse has been teaching a client with genital herpes how to care for the lesions. Which of the following statements by the client indicates that she needs additional instruction? "I'll use a sitz bath to decrease the inflammation of the sores." "I'll wear occlusive underwear to prevent transmission of the virus." "I can wash the lesions gently with soap and pat them dry with a towel." "It's important that I drink plenty of fluids."

I'll wear occlusive underwear to prevent transmission of the virus." The client should wear loose cotton underwear to promote cleanliness and dryness in the genital area. Sitz baths can promote cleanliness and decrease inflammation in the area. Lesions may be cleaned gently with soap and patted dry carefully with a towel; the client should avoid touching the lesions and then touching any other part of the body. Drinking plenty of fluids is advised to decrease dysuria, which accompanies genital herpes.

The nurse is caring for a client with genital herpes experiencing a reoccurrence. Which nursing diagnosis would be the priority? Knowledge Deficit Powerlessness Anxiety Impaired Skin Integrity

Impaired Skin Integrity

A patient presents with vulvar itching and diffuse green vaginal discharge. Upon evaluation, she is prescribed metronidazole (Flagyl). What is the paramount nursing intervention in discharge planning? Instruct the patient not to drink alcohol with this treatment. Counsel the patient to refrain from sex for 1 week. Advise the patient to take medication with a glass of milk. Reassure the patient further sexually transmitted infection (STI) testing is not indicated.

Instruct the patient not to drink alcohol with this treatment.

The nurse recognizes the client is in which stage of syphilis when the client has no signs or symptoms of syphilis? Primary Latency Secondary Tertiary

Latency

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

Latency

Which of the following is the most effective treatment for trichomoniasis? Metronidazole (Flagyl) Penicillin G benzathine Doxycycline (Adoxa) Azithromycin (Zithromax)

Metronidazole (Flagyl)

A patient has been admitted to a medical unit with respiratory symptoms that are characteristic of tuberculosis. When transporting the patient to radiology for a chest x-ray, the nurse has applied a mask that covers the patient's nose and mouth. This action addresses which component of the chain of infection? Causative organism Mode of exit Portal of entry Susceptible host

Mode of exit

Which of the following is the medication of choice for early syphilis? Penicillin G benzathine Doxycycline Tetracycline Rocephin

Penicillin G benzathine

The nurse has received several laboratory studies back at the clinic. Which of these results should be reported to the local health department? Wound infection with MRSA Positive influenza Positive gonorrhea Positive mononucleosis

Positive gonorrhea

The nurse is working in the labor and delivery suite when a client with active herpes simplex virus type 2 (HSV-2) appears in active labor. Which adjustment in the plan of care will the nurse prepare for? Administer an intravenous antibiotic to the mom while in labor. Complete a full assessment of the newborn on delivery. Prepare for a cesarean section. Place an antibacterial ointment on the mother's lesions.

Prepare for a cesarean section.

A patient comes to the clinic with complaints of a painless sore on her lip 2 weeks after she had oral sex with her boyfriend. The nurse observes a chancre on the lips and the physician orders testing for syphilis. If results are positive, what is the likely stage the patient is in? Primary Secondary Latency Tertiary

Primary

The nurse is caring for a male patient with gonorrhea. The patient asks how he can reduce his risk of contracting another sexually transmitted infection (STI). The nurse should instruct the patient to: Ask all potential sexual partners if they have a sexually transmitted disease. Wear a condom every time he has intercourse. Consider intercourse to be risk-free if his partner has no visible discharge, lesions, or rashes. Expect to limit the number of sexual partners to fewer than five over his lifetime.

Wear a condom every time he has intercourse.

A gynecologist told a patient that she had chlamydia. The nurse expected the health care provider to prescribe a single dose of which of the following medications? Tetracycline Amoxicillin Penicillin with benzathine Zithromax

Zithromax

A client is being tested for gonorrhea. Based on the nurse's understanding of this STI, the nurse would anticipate that the client will also be tested for: syphilis chlamydia HPV Herpes simplex 2

chlamydia

A nurse is reading a journal article about STIs and risk factors. The nurse demonstrates understanding of the article by identifying which factor as increasing the risk? Select all that apply. age over 30 years monogamous relationship engagement in sex at an early age multiple sex partners use of illicit drugs

engagement in sex at an early age multiple sex partners use of illicit drugs

The nurse is presenting a community lecture about STIs, and emphasizes that some STIs are easily cured with early and adequate treatment. Which is not among these easily treated diseases? genital herpes chlamydia gonorrhea syphilis

genital herpes Chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes is not.

A nurse is teaching a group of young adults about STIs. As part of the teaching session, the nurse emphasizes the need for practicing safe sex. The nurse is addressing which component of the chain of infection? causative organism mode of transmission mode of exit susceptible host

mode of transmission

The nurse educator, who is teaching a class on sexually transmitted infections, recognizes that teaching has been effective when students indicate which statement is true about the difference between colonization and infection? "Colonization and infection are interchangeable terms used to describe a bacterial invasion." "Colonization becomes infection when the host and organism interact." "Colonization results in symptoms such as redness and swelling, infection results in fever." "Both colonization and infection require treatment with different antibiotics."

"Colonization becomes infection when the host and organism interact."

A 20-year-old male client comes to the clinic for an evaluation. During the visit, the client mentions that he wants to make sure that he is using condoms properly. When reviewing the steps, which client statement would warrant additional instruction? "I should put the condom on my penis before it becomes erect." "I unroll the condom all the way on to my penis." "I'll hold the condom on before I pull out." "I will put on a new condom if I want to have sex again."

"I should put the condom on my penis before it becomes erect."

The nurse is seeing a client who came into the sexual health clinic after discovering condylomata along her labia. The client states, "This makes no sense, I don't even know who I got this from and I have been so careful!" What is the nurse's best response? "If you make a list of your sexual partners over the past month you should be able to narrow down the person who is the source of your infection." "If a condom was used during all sexual contacts, it is unlikely the warts that you have were caused by the human papillomavirus (HPV)." "It sounds like you are feeling angry. Let's talk more about human papillomavirus (HPV) and strategies to stay healthy while you are being treated." "You are high risk simply because you are sexually active with more than one partner. Do you know how many partners all your partners have had?"

"It sounds like you are feeling angry. Let's talk more about human papillomavirus (HPV) and strategies to stay healthy while you are being treated."

The nurse is caring for a group of clients at a public health clinic. Which sexually transmitted disease would the nurse focus the client education on curative goals? Chlamydia HIV HPV Genital herpes

Chlamydia Chlamydia is the most common and fast spreading bacteria. Because it is a bacteria, with proper treatment, chlamydia is able to be cured. Sexually transmitted diseases that are viruses, such as HIV, HPV, and herpes, can lay dormant in the body thus being difficult to treat.

In which group is it most important for the client to understand the importance of an annual Papanicolaou test? Clients with a history of recurrent candidiasis Clients with a pregnancy before age 20 Clients infected with the human papillomavirus (HPV) Clients with a long history of hormonal contraceptive use

Clients infected with the human papillomavirus (HPV)

Patients who have had pelvic inflammatory disease (PID) are prone to which of the following complications? Ectopic pregnancy Bacteremia Thrombophlebitis Inguinal lymphadenopathy

Ectopic pregnancy

A nursing midwife delivered a baby whose mother had a sexually transmitted disease. The nurse knows that of the six sexually transmitted diseases, only two can be transmitted via the perinatal route. What are those two diseases? Chlamydia and Gonorrhea Herpes simplex and syphilis Trichomoniasis and syphilis Human papillomavirus and Chlamydia

Herpes simplex and syphilis

The nurse is seeing a client in the community health clinic who reports finding "sores" in the mouth. On assessment, the nurse notes the lesions appear flat, flesh colored and papillary. What should the nurse do next? Inform the client that the lesion in the mouth is consistent with a human papillomavirus (HPV) infection Obtain a health history that includes inquiring about sexual health practices Provide the client with information about having a colposcopy Suggest serology testing for herpes simplex virus (HSV)

Obtain a health history that includes inquiring about sexual health practices The most common strains of HPV, 6 and 11, usually cause condylomata (genital warts) on the female and male genitalia and can be found in the mouth. Often these lesions are visible, flesh-colored, flat, verrucous, or papillary. The nurse should first obtain a further health history including sexual health practices that would help determine if further investigation for HPV is needed. Because the client has only told the nurse about the lesions and no other symptoms at this point, the informing the client that the lesion is consistent with the HPV infection would be premature. Further assessment and diagnostic testing is warranted. A colposcopy is a diagnostic biopsy performed on females to check for any cellular changes or dysplasia (changes in cervical cells). Lesions associated HSV and HPV are unique in characteristics. HSV lesions are painful and, although the nurse may be correct in suggested blood work for HSV, it is important that a complete health history with sexual health practices be discussed to ensure accurate assessment of the client's needs.

A young male patient of a free clinic has been diagnosed with gonorrhea and has begun treatment. The nurse at the clinic is providing the man with relevant health education and has emphasized the importance of using condoms. The man replies, "I can't stand using condoms because I can't feel anything if I use one. I'll have to think about that." The nurse should consequently identify which of the following nursing diagnoses? Anxiety related to diagnosis with an sexually transmitted infection (STI) Ineffective coping related to necessary health promotion measures Risk for infection transmission related to lack of STI prevention measures Deficient knowledge about the disease and risk for spread of infection

Risk for infection transmission related to lack of STI prevention measures This patient's ambivalence about important protective measures is suggestive of a risk for infection transmission. There is no indication that he lacks knowledge or is experiencing anxiety or ineffective coping.

Pelvic infection is most commonly caused by which of the following? Sexual transmission Surgical abortion Hysteroscopy Insertion of intrauterine device

Sexual transmission

The nurse is assessing a client who reports stiff joints and alopecia. While taking the client's health history, the client reports having multiple sexual partners in the past 6 months and finding a lesion on her labia about 1 month before today's appointment. What should the nurse anticipate based on the signs and symptoms presented? The client will require treatment for the secondary stage of syphilis. Treatment planning for a chlamydial infection is needed. Pelvic inflammatory disease is the likely cause of the hair loss. The client will require a colposcopy to confirm any diagnosis.

The client will require treatment for the secondary stage of syphilis. In the secondary stage of syphilis, generalized signs of infection may include lymphadenopathy (abnormal enlargement of lymph nodes), arthritis, meningitis (inflammation of the pia mater, arachnoid, and the subarachnoid space), hair loss, fever, malaise, and weight loss. Hair loss and arthritis are not common symptoms associated with a chlamydial infection or pelvic inflammatory disease. The information collected in the health history confirms that the client has moved past the primary stage of the infection. A colposcopy is a diagnostic procedure carried out to determine if there have been any changes in cervical cells (dysplasia). Given the client's reported health history, secondary syphilis should be further investigated first.

A female patient has just been diagnosed with condylomata acuminata (genital warts). What information is appropriate to tell this patient? This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually. The most common treatment is metronidazole (Flagyl), which should eradicate the problem within 7 to 10 days. The potential for transmission to her sexual partner will be eliminated if condoms are used every time they have sexual intercourse. The human papillomavirus (HPV), which causes condylomata acuminata, can't be transmitted during oral sex.

This condition puts her at a higher risk for cervical cancer; therefore, she should have a Papanicolaou (Pap) test annually.

A female patient tells the nurse that she thinks she has a vaginal infection because she has noted inflammation of her vulva and a yellow-green discharge. The nurse recognizes that the clinical manifestations described are typical of what vaginal infections? Trichomonas vaginalis Candidiasis Gardnerella Chlamydial infection

Trichomonas vaginalis

How often should women diagnosed with human papillomavirus (HPV) have Pap smears? Yearly Every 6 months Every 2 years Every 3 years

Yearly Women with HPV should have annual Pap smears because of the potential of HPV to cause dysplasia.