chapter 56 caring for clients with sexually transmitted infections

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? A) Chlamydia B) HIV C) HPV D) Genital herpes

Ans: A Feedback: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.

Which nursing instruction is most helpful to prevent autoinoculation of a sexually transmitted disease? A) Pat lesions instead of scratching. B) Use different sections of a towel to dry areas with lesions. C) Perform thorough handwashing. D) Do not share personal items with others.

Ans: C Feedback:Autoinoculation means to "self-infect." The nurse is most helpful to stress that handwashing helps prevent the spread of infection to others and also to other parts of one's own body. Patting lesions can still spread the infection. The client should use a different towel to clean noninfected parts of the body. Sharing personal items spreads the infection to others.

A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate? A) "Use a condom during sexual activity if the infection becomes active again." B) "If the infection has healed, you probably don't have to use a condom." C) "Inform all potential sexual partners about the infection, even if it is inactive." D) "Refrain from all sexual activity until you don't have another outbreak for a year."

Ans: C Feedback:The nurse should advise the client to inform all potential sexual partners of the HSV infection even if it is in an inactive state. The nurse should also advise the client to use a condom during sexual activity even if the disease is dormant and to avoid sexual contact if the infection is active. Condoms do not protect skin and mucous membranes left exposed.

During a sexual history, the client states that she has had multiple sex partners. Which statement by the nurse is most correct? A) "You are putting yourself at risk when you have multiple sex partners." B) "The chance of acquiring a sexually transmitted disease increases with multiple sex partners." C) "It is hard to find a good partner these days." D) "What do you do to prevent sexually transmitted infections?"

Ans: D Feedback:The nurse is most correct to obtain the client's feedback in a nonjudgmental way to open communication. When communication is open, the nurse has the best potential to provide nursing instruction and emphasize key points. Being judgmental or introducing the nurse's opinion does not promote therapeutic communication.

The nurse is working at a public health clinic. Which symptoms does the nurse anticipate prior to assessing a client with secondary syphilis? A) A chancre on the genitals B) Fever, sore throat, lymph node enlargement C) Urethral drainage, dysuria D) Dementia, central nervous system involvement

Ans: B Feedback:The nurse is correct to anticipate symptoms of a fever, sore throat, and lymph node enlargement. Other symptoms include malaise, rash, and headache. A chancre is a painless ulcer that occurs in the primary stage. Urethral drainage occurs in other sexually transmitted infections such as chlamydia. The client in the tertiary stage of syphilis experiences dementia and central nervous system involvement.

The nurse is reviewing the chart of a client newly diagnosed with syphilis. Which question is most important to ask next? A) Have you had sexual relations with anyone? B) Are you allergic to penicillin? C) When did you first notice symptoms? D) Are you having any pain?

Ans: B Feedback: The nurse's first question focuses on the treatment needed, which is the dose of penicillin. The other questions are valid questions, which can be asked later.

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect to find which of the following once the microorganism disseminates throughout the body? A) Painful joints B) Sore throat C) Intermenstrual bleeding D) Painful urination

Ans: A Feedback: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.

Which of the following nursing instructions is most important for the nurse to emphasize to the client with a new HSV-2 diagnosis? A) You must inform all sexual partners. B) Keep lesions dry with alcohol or peroxide. C) Wear loose underwear to promote air circulation. D) Use a condom during sexual activity.

Ans: A Feedback: The spread of the infection could quickly multiple if the client's sexual partners are infected and continue to spread the virus to others; thus, it is most important to emphasize that all sexual partners must be informed. All of the other options are correct but not most important.

The client states a history of lymphogranuloma venereum diagnosed 6 months ago. When completing the head-to-toe assessment, which area should be a focus? A) Mental status B) Lesions on the genitals C) Lymph nodes of the genital area D) Lower extremities for edema

Ans: C Feedback: Lymphogranuloma venereum is caused by the C. trachomatis bacteria and is characterized by an erosion or papule and enlargement of adjacent lymph nodes, which can become necrotic. A focused assessment is completed noting the genital lymph nodes. The other options are completed during a head-to-toe assessment.

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent? A) Acyclovir B) Ceftriaxone C) Podophyllum resin D) Tetracycline

Ans: D Feedback: Clients who are allergic to penicillin are given a 14-day regimen of tetracycline or doxycycline. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

Which of the following should a nurse consider when assessing older clients with a sexually transmitted infection (STI)? A) Abandon biases that older adults are sexually inactive. B) Older clients, because of their maturity, are rarely embarrassed to talk about this. C) Older clients know the ways to prevent STIs. D) Older clients who are sexually active have less risk for STIs than other age groups.

Ans: A Feedback: Nurses should abandon biases that older adults are sexually inactive. Therefore, when taking a health history, nurses should include questions about sexuality and behaviors that put them at risk for STIs. Older clients who are sexually active have the same risks of acquiring an STI as other age groups. Older adults who are not in monogamous relationships may not understand ways that are appropriate for preventing STIs. Some older adults with an STI are embarrassed and may not seek medical attention. Careful assessment is necessary to help the older adult receive medical treatment as quickly as possible.

The nurse is caring for a female diagnosed with a sexually transmitted infection (STI). The client states that her sister also has an STI. Which instruction, by the nurse, provides the rationale for females obtaining infections more frequently than males? A) The vagina is more conducive to microbial growth. B) Menstrual flow provides a medium for growth. C) Females have a more difficult time with hygiene. D) Hormones alter the pH of the reproductive tract.

Ans: A Feedback:The nurse is most correct to state that the vagina provides a more conducive environment due to the warm and moist nature. The vagina is also a receptive orifice where the bacteria are deposited. Menstrual flow is cleansing to the area as debris is removed from the tract. It is the nature of the vagina that causes the difficulty with hygiene. Females clean externally on a regular basis. Hormones fluctuate during the menstrual cycle but do not impact the pH of the body.

The nurse is counseling a client who has been diagnosed with two sexually transmitted infections. The client is shocked and states not knowing how this has happened. Which of the following statements is most appropriate by the nurse? A) "Your partner could have been asymptomatic at that time." B) "You should have asked your partner if they have any infections." C) "Sexually transmitted infections have obvious signs of their presence." D) "Your partner should have told you of a previous infection."

Ans: A Feedback:The nurse is most correct to support the client and provide information on how the infection could have been spread. It is true that the client's partner could have been asymptomatic during their sexual contact. The nurse should not be judgmental or accusing in nature as in the other responses.

The nurse is instructing a health class on the proper use of a condom. Place the steps of applying a condom in the proper order. Use all options. A) Obtain an erection. B) Check the expiration date of the condom. C)Unroll the condom over the penis leaving a 1/2 -inch space at the top. D) Dispose of the used condom. E) Roll the condom up to the tip of the penis pinching the top.

Ans: A, B, C, D, E Feedback: The correct method to put on a condom is to begin by making sure that the condom is not passed the expiration date. The male obtains an erection and unrolls the condom over the penis, leaving a 1/2 -inch space at the top of the condom for the semen. After orgasm, roll the condom up to the tip of the penis pinch the top where the semen is contained. Dispose of the used condom.

Which type of sexually transmitted disease is the nurse most accurate to highlight in the client's history as it remains dormant in the body and can reoccur at any time? A) Chlamydia B) Herpes infection C) Gonorrhea D) Syphilis

Ans: B Feedback: The nurse is most accurate to highlight the herpes infection as the virus can remain dormant in the ganglia of the nerves. Symptoms are usually more severe with the initial outbreak. Subsequent episodes are usually shorter and less intense. The other infections are important to note in the history.

A client with genital warts is receiving treatment with a local application of trichloroacetic acid. Which client statement indicates adequate understanding of the procedure? A) "One or two treatments should get rid of the warts." B) "I'm temporarily not contagious once the warts are destroyed." C) "Once the warts are gone, then I know I'm cured." D) "My partner doesn't need to be treated."

Ans: B Feedback: Genital warts when treated chemically will most likely be eradicated after three to six cycles of treatment. Eradication does not mean the condition is cured; the person is temporarily noncontagious once the warts are destroyed. All sexual contacts of the client need to be examined and treated.

The nurse has just obtained a newborn for admission and assessment in the newborn nursery. Which of the following nursing actions is done as a result of potential contamination of the neonate when descending down the birth canal? A) Assessing the mouth for thrush B) Instilling erythromycin ointment in the eyes C) Providing an injection of vitamin K D) Completing hearing screening

Ans: B Feedback: The nurse instills erythromycin ointment into the newborn's eyes immediately after birth. The ointment is an antibiotic given prophylactically to prevent the occurrence of blindness in newborns born to a mother with a sexually transmitted infection such as gonorrhea, ophthalmia neonatorum due to Neisseria gonorrhoeae, and chlamydia trachomatis from the Chlamydia bacteria.

The nurse is completing a community education via a pamphlet on sexually transmitted diseases. Which key point would the nurse place in bold letters? A) Common age-groups for clients with sexually transmitted diseases are in their late teens and 20s. B) Many people are asymptomatic and show no symptoms contributing to the spread of the disease. C) Some sexually transmitted diseases can cause infertility caused by scarring of reproductive organs. D) Some sexually transmitted diseases can be transmitted to newborns through the birth canal.

Ans: B Feedback: The nurse is most correct to place information regarding prevention of sexually transmitted diseases in bold letters. The information that many people are asymptomatic and show no symptoms is an important point to stress. Common age-groups are an interesting fact. Repercussions of the disease are also important to highlight; however, prevention is most important.

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata? A) Herpes virus B) Human papilloma virus C) Treponema pallidum D) Haemophilus ducreyi bacillus

Ans: B Feedback:Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.

The nurse is instructing an adolescent female on potential vaccinations available. Which vaccination would the nurse state that decreases the risk of cervical cancer? A) Hepatitis B B) Human papilloma viral (HPV) C) Herpes zoster D) Meningococcal

Ans: B Feedback:Human papilloma viral (HPV) infection is the most commonly transmitted sexual disease in the United States. A strain of this infection can cause cervical cancer. An HPV vaccine is available to both females and males. For females, the vaccine decreases the risk of cervical cancer and genital warts. For males, the vaccine decreases the risk of genital warts and anal cancers. Hepatitis B vaccine protects against a liver disease. Herpes zoster is the vaccine for shingles. The meningococcal vaccine protects against several diseases including meningitis.

When evaluating the therapeutic outcome of medication therapy for a client with a recurrent sexually transmitted disease, which client statement best confirms medication use? A) "I take my medication per physician's order." B) "I seem to have less breakouts with fewer symptoms." C) "I am able to take the medication with food to prevent nausea." D) "I feel that things are going better in my life."

Ans: B Feedback:The best evidence confirming a therapeutic outcome of medication use is the client's statement of having less symptom breakouts and fewer symptoms. This indicates that the medication is being effective to contain the disease. It is good that the client administers the medications per physician's order and is able to tolerate the medication with food. Although it is a positive statement that things are going better in the client's life, it does not necessarily mean that the effect stems from the medication therapy.

The nurse is addressing a multidisciplinary panel stating the need for continued education on sexually transmitted infections (STI). One of the points is the fact that the statistics of infection are underreported. Which of the following is the main cause that statistics are underreported? A) Clients do not often seek treatment for STIs. B) Only certain STIs are reported to the Centers for Disease Control and Prevention. C) Poor communication is offered between the physician offices and reporting agency. D) Reporting physicians are afraid of being sued for a breach in confidentiality.

Ans: B Feedback:The nurse is most correct to state that only certain sexually transmitted infections are mandated to be reported to the Centers for Disease Control and Prevention, thus providing incomplete data. Most clients with an infection report for treatment to a physician's office, clinic, or emergency department. Although communication between government agencies and local offices can always be improved, mandated reporting is specific to the information needed. There is no breach in confidentiality.

The nurse is discussing information regarding the human papilloma viral (HPV) infection. Which statement, made by the client, requires clarification? A) "HPV transmission may occur when the client is asymptomatic." B) "HPV is spread during sexual intercourse." C) "HPV may be spread to a newborn at the time of delivery." D) "HPV can be spread by autoinoculation."

Ans: B Feedback: The nurse is correct to clarify that sexual penetration is not necessary to transmit HPV; the warts can also be spread by autoinoculation. The other options are correct statements that need no clarification.

The nurse is providing education to the client newly diagnosed with three different types of sexually transmitted infections. Which of the following does the nurse identify to the client as the most common sexually transmitted infection? A) Genital warts B) Chlamydia C) Gonorrhea D) Syphilis

Ans: B Feedback: The nurse is most correct to state that chlamydia is the most common and fastest spreading bacterial sexually transmitted infection. The number of new cases in 2010 totaled 1.3 million.

The experienced nurse is assisting the novice nurse in caring for a client with a newly acquired sexually transmitted infection. Which of the following infections does the experienced nurse stress to report to the Centers for Disease Control (CDC)? Select all that apply. A) Venereal warts B) Chlamydia C) Hepatitis B D) Syphilis E) HIV F) Gonorrhea

Ans: B, D, E, F Feedback:Reporting new sexually transmitted infections (STIs) to the CDC is the responsibility of either the healthcare provider or the testing laboratory. Chlamydia, syphilis, HIV, and gonorrhea are all reportable infections. Venereal warts and hepatitis B are not reportable.

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported? A) Genital herpes B) Hepatitis B C) Syphilis D) Condylomata acuminata

Ans: C Feedback: The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDs. Genital herpes, hepatitis B, venereal warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law.

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? A) Administer an intravenous antibiotic to the mom while in labor. B) Complete a full assessment of the newborn on delivery. C) Prepare for a cesarean section. D) Place an antibacterial ointment on the mother's lesions.

Ans: C Feedback: The nurse is most accurate to prepare for a cesarean section because the mother has an active lesion and does not want to transmit the virus to the newborn. Antibiotic therapy, at this time, does not prevent the transmission of the infection. A full assessment is always completed on the newborn and is not an adjustment in the plan of care. Antibacterial ointment is not placed on the mother's lesions.

The nurse is providing discharge instructions to a female client following inpatient therapy for a gonorrhea infection. The client is being discharged on doxycycline (Vibramycin) for 7 days. Which nursing instruction is essential for a therapeutic outcome? A) Obtain a pulse prior to administering medication. B) Use an alternate form of birth control. C) Complete all prescribed medication. D) Take medication on an empty stomach.

Ans: C Feedback: The prescribed discharge medication is an antibiotic; thus, the therapeutic outcome would be to have no further infection. The nurse is most correct to instruct to complete all doses or the infection could return. Vibramycin does not have a cardiac side effect; thus, the client does not need to obtain a pulse prior to administration. It is correct to instruct the client to use an alternate form of birth control and take on an empty stomach (if tolerated); however, that instruction does not determine the therapeutic outcome.

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age? A) 35 B) 32 C) 24 D) 18

Ans: C Feedback:The CDC (2010) recommends annual screening for chlamydia in all sexually active women younger than 24 years of age and in women with new or multiple sexual partners.

The nurse is instructing a client on proper procedures to protect herself from sexually transmitted infections (STIs). Which statement, made by the client, needs clarification? A) "If I use barrier protection, it will protect me from STIs." B) "You cannot always know everything about a person." C) "I consider myself protected because I am on birth control pills." D) "I refrain from sexual contact or use protection to keep myself safe."

Ans: C Feedback:The nurse is most correct to clarify that although birth control pills are effective at preventing pregnancy, they do not prevent against exposure to STIs. The other statements have no inaccurate content as can be determined at this time.

The nurse is instructing an adolescent on ways to prevent sexually transmitted infections (STIs). When evaluating the options, which is best when the client states being sexually active? A) Having one sexual partner B) Abstinence C) Use a latex condom with a spermicide. D) Urinating after sexual intercourse

Ans: C Feedback:The nurse is most correct to instruct the sexually active client on the proper use of a latex condom. A latex condom with nonoxynol-9 is best to be used when having oral, vaginal, or anal intercourse. Having one sexual partner does not mean that the partner does not have a sexually transmitted infection. The client states being sexually active; thus, abstinence is not an option. Urinating after intercourse reduces the risk of an STI; however, providing a barrier between the partners is a better option.

The nurse is caring for a client in the tertiary stage of a syphilis infection. Which assessment finding is anticipated? A) The client has ulcers in the genital region. B) The client has arthritis symptoms making ambulation difficult. C) The client has dementia and cannot care for himself or herself. D) The client complains of a headache and sore throat.

Ans: C Feedback: The client in the tertiary stage of a syphilis infection is expected to have central nervous system complications including dementia. In the primary stage, a chancre appears on the genitals. In the secondary stage, a fever, malaise, rash, headache, and sore throat is anticipated. There are no musculoskeletal symptoms associated with syphilis.

When describing sexually transmitted infections and testing, the nurse explains that a client is typically tested for chlamydia, gonorrhea, and syphilis at the same time for which reason? A) The symptoms of these diseases are the same, and culture tests alone can determine the disease that has infected the client. B) The infecting bacterium in all cases is the same, and therefore, clients have concurrent infections. C) The infections spread through the same medium, and therefore, clients have concurrent infections. D) It is not unusual for clients to have concurrent infections with more than one

Ans: D .Feedback:It is common practice to test clients for chlamydia, gonorrhea, and syphilis because it is not unusual for clients to have concurrent infections with more than one STI. For chlamydia, the causative microorganism is a bacterium named Chlamydia trachomatis. For gonorrhea, the infection is caused by a bacterium named Neisseria gonorrhoeae. The spirochete Treponema pallidum is the causative microorganism of syphilis. The symptoms of these conditions are not identical. The causative microorganisms do not spread through the same medium.

A client with syphilis did not receive treatment and has now progressed into the tertiary stage of the disorder. Which of the following would the nurse expect the client to exhibit? A) Ulcerated chancre, aortic valve insufficiency, lymphadenopathy B) Fever, malaise, sore throat C) Papular lesion, rash, headache D) Tabes dorsalis, ataxia, and Charcot's joints

Ans: D Feedback:The client with late or tertiary syphilis is noninfectious because the microorganism has invaded the central nervous system (CNS) as well as other organs of the body. Symptoms of tertiary syphilis include tabes dorsalis (a degenerative condition of the CNS that results in loss of peripheral reflexes and of vibratory and position senses), ataxia, and neuropathic joint disease, also called Charcot's joints. Symptoms of secondary syphilis include fever, malaise, rash, headache, sore throat, and lymph node enlargement. Ulcerated chancre occurs in the primary stage.

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

Ans: D Feedback:The priority nursing diagnosis focuses on the Impaired Skin Integrity. Interventions would include nursing instruction on the care of the skin to prevent further infection to self and others. The nurse would also focus on the management of the disease. Because this is a reoccurrence, Knowledge Deficit is not a priority. Psychosocial nursing diagnoses are not a priority at this time unless other data suggests.

Which of the following types of condoms is appropriate only if the client is in a long-standing relationship? A) Latex condom B) Lubricated condom C) Ribbed condom D) Natural membrane condom

Ans: D Feedback:Using a natural membrane condom is only appropriate when the client is in a long-standing relationship. The natural membrane condom acts as a barrier preventing sperm from encountering the female reproductive tract, but it allows viruses to pass through the membrane. A latex condom is appropriate unless an individual is allergic to latex. A lubricated or ribbed condom is related to sexual pleasure.