Chapter 52 - Sexually Transmitted Infections

19. The nurse in the outpatient clinic notes that the following patients have not received the human papillomavirus (HPV) vaccine. Which patients should the nurse plan to teach about benefits of the vaccine? (Select all that apply) a. A 24-yr-old male patient who has a history of genital warts. b. A 20-yr-old male patient who has had one male sexual partner. c. A 38-yr-old female patient who has never been sexually active. d. A 20-yr-old female patient who has a newly diagnosed Chlamydia infection. e. A 30-yr-old female patient whose sexual partner has a history of genital warts.

Answer: A, B, D Rationale: The HPV vaccines are recommended for male and female patients between ages 9 through 26 years. There are several types of HPV. Ideally, the vaccines are administered before patients are sexually active, but they offer benefit even to those who already have HPV infection because the vaccines protect against HPV types not already acquired.

17. A 39-yr-old patient with a history of IV drug use is seen at a community clinic. The patient reports difficulty walking, stating, "I don't know where my feet are." Diagnostic screening reveals positive rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) test results. Based on the patient history, what will the nurse assess? (Select all that apply.) a. Heart sounds. b. Genitalia for lesions. c. Joints for swelling and inflammation. d. Mental state for judgment and orientation. e. Skin and mucous membranes for gummas.

Answer: A, D, E Rationale: The patient's clinical manifestations and laboratory tests are consistent with tertiary syphilis. Valvular insufficiency, gummas, and changes in mentation are other clinical manifestations of this stage.

18. Which topics will the nurse include when preparing to teach a patient with recurrent genital herpes simplex? (Select all that apply.) a. Infected areas should be kept moist to speed healing. b. Sitz baths may be used to relieve discomfort caused by the lesions. c. Consistent use of antiviral medications can cure genital herpes infection. d. Recurrent genital herpes episodes usually are shorter than the first episode. e. The virus can infect sexual partners even when you do not have symptoms.

Answer: B, D, E Rationale: Patients are taught that shedding of the virus and infection of sexual partners can occur even in asymptomatic periods, recurrent episodes resolve more quickly, and sitz baths can be used to relieve pain caused by the lesions. Antiviral medications decrease the number of outbreaks but do not cure herpes simplex infections. Infected areas may be kept dry if this decreases pain and itching.

10. A 19-yr-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not sought treatment until now because "the warts are so disgusting." Which patient problem is consistent with these data? a. Anxiety. b. Difficulty coping. c. Lack of knowledge. d. Disturbed body image.

Answer: Disturbed body image. Rationale: The patient's statement that her lesions are disgusting suggests that disturbed body image is the major concern. There is no evidence to indicate anxiety, difficulty coping, or lack of knowledge about mode of transmission.

12. A female patient is diagnosed with Chlamydia during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says which of the following? a. "My partner will need to take antibiotics at the same time I do." b. "Go ahead and give me the antibiotic injection, so I will be cured." c. "I will use condoms during sex until I finish taking all the antibiotics." d. "I do not plan on having children, so treating the infection is not important."

Answer: a. "My partner will need to take antibiotics at the same time I do." Rationale: Sex partners should be treated simultaneously to prevent reinfection. Chlamydia is treated with oral antibiotics. Abstinence from sexual intercourse is recommended for 7 days after treatment. Condoms should be recommended during all sexual contacts to prevent infection. Chronic pelvic pain, as well as infertility, can result from untreated Chlamydia

15. Which patient will the nurse plan on teaching about the Gardasil-9 vaccine? a. A 24-yr-old female patient who has not been sexually active. b. A 34-yr-old female patient who has multiple sexual partners. c. A 22-yr-old female patient who is pregnant for the first time. d. A 34-yr-old female patient who is in a monogamous relationship.

Answer: a. A 24-yr-old female patient who has not been sexually active. Rationale: Gardasil-9 is recommended for female patients ages 9 through 26 years, preferably those who have never been sexually active. It is not recommended for women during pregnancy or for older women.

4. A patient who has had blood drawn for an insurance screening has a positive Rapid Plasma Reagin (RPR) test. Which action should the nurse take first? a. Ask the patient about past treatment for syphilis. b. Explain the need for blood and spinal fluid cultures. c. Schedule fluorescent treponemal antibody absorption (FTA-Abs) testing. d. Assess for the presence of chancres, flulike symptoms, or a rash on the trunk.

Answer: a. Ask the patient about past treatment for syphilis. Rationale: When antibody testing is positive for syphilis, the antibodies remain present for an indefinite period even after successful treatment, so the nurse should inquire about previous treatment before doing other assessments or testing. Culture, FTA-Abs testing, and assessment for symptoms may be appropriate based on whether the patient has been previously treated for syphilis.

2. A 20-yr-old female patient who is being seen in the family medicine clinic for an annual physical examination reports being sexually active. What topic should the nurse plan to teach the patient? a. Testing for Chlamydia infection. b. Immunization for herpes simplex. c. Infertility associated with the human papillomavirus (HPV). d. The relationship between the herpes virus and cervical cancer.

Answer: a. Testing for Chlamydia infection. Rationale: The Centers for Disease Control and Prevention recommends testing for Chlamydia for all sexually active women younger than age 25 years. HPV infection does not cause infertility. There is no vaccine available for herpes simplex, and herpes simplex infection does not cause cervical cancer.

14. A patient who is diagnosed with Chlamydia tells the nurse that she is very angry because her husband is her only sexual partner. Which response should the nurse make first? a. "You may need professional counseling to help resolve your anger." b. "It is understandable that you feel angry about contracting an infection." c. "Your feelings are justified, and you should share them with your husband." d. "It is important that both you and your husband be treated for the infection."

Answer: b. "It is understandable that you feel angry about contracting an infection." Rationale: This response expresses the nurse's acceptance of the patient's feelings and encourages further discussion and problem solving. The patient may need professional counseling, but more assessment of the patient is needed before making this judgment. The nurse should also assess further before suggesting that the patient share her feelings with the husband because problems such as abuse might be present in the relationship. Although it is important that both partners be treated, the patient's anger suggests that the feelings need to be acknowledged first.

8. Which infection reported in the health history of a female patient will the nurse identify as a risk factor for infertility? a. Treponema pallidum. b. Neisseria gonorrhoeae. c. Condyloma acuminatum. d. Herpes simplex virus type 2.

Answer: b. Neisseria gonorrhoeae. Rationale: Complications of gonorrhea include scarring of the fallopian tubes, which can lead to tubal pregnancies and infertility. Syphilis, genital warts, and genital herpes do not lead to problems with conceiving, although transmission to the fetus (syphilis) or newborn (genital warts or genital herpes) is a concern.

6. A patient admitted with chest pain is found to have positive rapid plasma reagin (RPR) and fluorescent treponemal antibody absorption (FTA-Abs) tests, rashes on the palms and the soles of the feet, and moist papules in the anal and vulvar area. Which action will the nurse include in the plan of care? a. Assess for arterial aneurysms. b. Wear gloves for patient contact. c. Place the patient in a private room. d. Apply antibiotic ointment to the perineum.

Answer: b. Wear gloves for patient contact. Rationale: Exudate from any lesions with syphilis is highly contagious. Systemic antibiotics, rather than local treatment of lesions, are used to treat syphilis. The patient does not require a private room because the disease is spread through contact with the lesions. This patient has clinical manifestations of secondary syphilis and does not need to be monitored for manifestations of tertiary syphilis.

16. After the nurse has taught a patient with a newly diagnosed sexually transmitted infection (STI) about expedited partner therapy, which patient statement indicates that the teaching has been effective? a. "I will tell my partner that it is important to be examined at the clinic." b. "I will have my partner take the antibiotics if any STI symptoms occur." c. "I will make sure that my partner takes all of the prescribed medication." d. "I will have my partner use a condom until I have finished the antibiotics."

Answer: c. "I will make sure that my partner takes all of the prescribed medication." Rationale: With expedited partner therapy, the patient is given a prescription or medications for the partner. The partner does not need to be evaluated by the health care provider but is presumed to be infected and should be treated concurrently with the patient. Use of a condom will not treat the presumed STI in the partner.

7. Which statement by a patient indicates that the nurse's teaching about management of primary genital herpes has been effective? a. "I will use acyclovir ointment on the area to relieve the discomfort." b. "I will use condoms for intercourse until the medication is all gone." c. "I will take the oral acyclovir (Zovirax) every 8 hours for the next week." d. "I will need to take all of the medication to be sure the infection is cured."

Answer: c. "I will take the oral acyclovir (Zovirax) every 8 hours for the next week." Rationale: The treatment regimen for primary genital herpes infections includes acyclovir 400 mg 3 times daily for 7 to 10 days. The patient is taught to abstain from intercourse until the lesions are gone. Condoms should be used even when the patient is asymptomatic. Acyclovir ointment is not effective in treating lesions or reducing pain. Herpes infection is chronic and recurrent.

11. When a 31-yr-old male patient returns to the clinic for follow-up after treatment for gonococcal urethritis, a purulent urethral discharge is still present. Which question will the nurse ask to identify a possible cause of recurrent infection? a. "Did you take the prescribed antibiotic for a week?" b. "Did you drink at least 3 quarts of fluids every day?" c. "Were your sexual partners treated with antibiotics?" d. "Do you wash your hands after using the bathroom?"

Answer: c. "Were your sexual partners treated with antibiotics?" Rationale: A common reason for recurrence of symptoms is reinfection because infected partners have not been simultaneously treated. Because gonorrhea is treated with one dose of antibiotic, antibiotic therapy for a week is not needed. An adequate fluid intake is important, but a low fluid intake is not a likely cause for failed treatment. Poor hygiene may cause complications such as ocular trachoma but will not cause a failure of treatment.

9. A patient is diagnosed with primary syphilis during her eighth week of pregnancy. What information should the nurse discuss with the patient? a. Likelihood of a stillbirth. b. Plans for cesarean section. c. Intramuscular injection of penicillin. d. Antibiotic eyedrops for the newborn.

Answer: c. Intramuscular injection of penicillin. Rationale: A single injection of penicillin is recommended to treat primary syphilis. This will treat the mother and prevent transmission of the disease to the fetus. Instillation of erythromycin into the eyes of the newborn is used to prevent gonorrheal eye infections. C-section is used to prevent the transmission of herpes to the newborn. Although stillbirth can occur if the fetus is infected with syphilis, treatment before the 10th week of gestation will eliminate in utero transmission to the fetus.

3. A patient with gonorrhea is treated with a single IM dose of ceftriaxone and is given a prescription for azithromycin (Zithromax) 1000 mg x 1 dose. What rationale should the nurse provide to the patient for this combination? a. Prevent reinfection during treatment. b. Treat any coexisting syphilis infection. c. Provides coverage for possible chlamydia infection. d. Provides coverage for possible trichomonas infection.

Answer: c. Provides coverage for possible chlamydia infection. Rationale: Because there is a high incidence of co-infection with gonorrhea and Chlamydia, patients are usually treated for both. The other explanations about the purpose of the antibiotic combination are not accurate.

1. A male patient who has a profuse, purulent urethral discharge with painful urination is seen at the clinic. Which information should the nurse obtain as a basis for planning focused care? a. Sexual orientation. b. Immunization history. c. Recent sexual contacts. d. Contraceptive preference.

Answer: c. Recent sexual contacts. Rationale: Information about sexual contacts is needed to help establish whether the patient has been exposed to a sexually transmitted infection and because sexual contacts also will need treatment. The other information is not pertinent in determining the plan of care for the patient's current symptoms.

5. A male patient who has been diagnosed with gonococcal urethritis tells the nurse he had recent sexual contact with a woman but says she did not appear to have any disease. What information should the nurse explain to the patient? a. Women develop subclinical cases of gonorrhea that are not true gonorrheal infections. b. Women do not develop gonorrhea infections but can serve as carriers to spread the disease to men. c. Women may not be aware they have gonorrhea because they often do not have symptoms of infection. d. When gonorrhea infections occur in women, the disease affects only the ovaries and not the genital organs.

Answer: c. Women may not be aware they have gonorrhea because they often do not have symptoms of infection. Rationale: Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked. The disease may affect both the genitals and the other reproductive organs and cause complications such as pelvic inflammatory disease. Women who can transmit the disease have active infections, not subclinical cases or carrier status.

13. A patient in the sexually transmitted infection (STI) clinic tells the nurse that she is concerned she may have been exposed to gonorrhea. How will the nurse plan to determine whether the patient has gonorrhea? a. Interview the patient about symptoms of gonorrhea. b. Take a sample of cervical discharge for Gram staining. c. Draw a blood specimen for rapid plasma reagin (RPR) testing. d. Obtain secretions for a nucleic acid amplification test (NAAT).

Answer: d. d. Obtain secretions for a nucleic acid amplification test (NAAT). Rationale: NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms may not be helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble N. gonorrhoeae. RPR testing is used to detect syphilis.