Chapter 67: Coordinating Care for Patients With Sexually Transmitted Infection

Which patient is at greatest risk for developing chlamydia trachomatis infection? 1) 16-year-old, sexually active, using no contraceptive 2) 22-year-old mother of two, developed dyspareunia 3) 35-year-old woman on oral contraceptives 4) 48-year-old woman with hot flashes and night sweats

1 Teens have the highest incidence of sexually transmitted infections, especially chlamydia. A patient not using contraceptives is not using condoms, which decrease the risk of contracting an STI.

An adolescent patient worriedly shows the nurse a wart located on her vulva. Based on this data which diagnosis does the nurse suspect? 1) Condyloma 2) Genital herpes 3) Chancre 4) Secondary syphilis

1 Warty lesions on the labia and within the vestibule are known as condyloma acuminatum, caused by human papillomavirus (HPV) infection.

Which patient should the nurse anticipate a prescription for ceftriaxone (Rocephin) IM and doxycycline (Vibramycin) orally? 1) A pregnant patient with gonorrhea and a yeast infection 2) A nonpregnant patient with gonorrhea and chlamydia 3) A pregnant patient with syphilis 4) A nonpregnant patient with chlamydia and trichomoniasis

2 This combined treatment provides dual treatment for gonorrhea and chlamydia because the two infections frequently occur together.

A gray vaginal discharge with an unpleasant fishy or musty odor is likely to be a symptom of which infection? 1) Candidiasis 2) Trichomonas 3) Gonorrhea 4) Chlamydia

2 Trichomonas often manifests by a vaginal discharge that is gray or white, thin, homogenous, with a malodorous, unpleasant fishy or musty odor.

During a physical assessment, the nurse notes vesicles. Which disease process is associated with this clinical manifestation? 1) Secondary syphilis 2) Herpes simplex virus 3) Hyperthyroidism 4) Gonorrhea

2 Vesicles are a clinical manifestation associated with herpes simplex virus.

During an assessment, the nurse suspects a patient is experiencing genital herpes. Which clinical manifestations cause the nurse to come to this conclusion? Select all that apply. 1) Low blood pressure 2) Headache 3) Fever 4) Back pain 5) Vaginal discharge

2345 Manifestations of genital herpes include headache, fever, vaginal discharge, and back pain.

Which is not a warning sign of a sexually transmitted infection (STI)? 1) Penile discharge 2) Penile lesion 3) Testicular mass 4) Dysuria

3 A testicular mass is not a clinical manifestation associated with an STI. A testicular mass may be benign or malignant.

A patient is experiencing dysuria, urinary frequency, and vaginal discharge. For which sexually transmitted infection should the nurse prepare the patient for testing? 1) Syphilis 2) Vaginitis 3) Chlamydia 4) Trichomoniasis

3 Chlamydia invades the same target organs as gonorrhea, which include the cervix and male urethra, and creates the manifestations of dysuria, urinary frequency, and discharge.

The nurse is providing care to a patient who will have the uterus removed due to uterine cancer. Which term should the nurse use when educating the patient about this procedure? 1) Ablation 2) Excision 3) Hysterectomy 4) Chemotherapy

3 Hysterectomy is the removal of the uterus.

After a 5% acetic acid wash is applied to the cervix, the cervix blanches white. Based on this data, which conclusion by the nurse is appropriate? 1) Bacterial vaginosis 2) Monilial vaginitis 3) HPV 4) Cervical cancer

3 Rapid acetowhitening or blanching may indicate presence of HPV, causative agent of genital warts.

When conducting a physical examination, the nurse notes that the patient has a systemic rash. Which sexually transmitted infection may be the cause for this clinical manifestation? 1) Herpes simplex virus 2) Gonorrhea 3) Secondary syphilis 4) Chlamydia

3 Secondary syphilis often manifests with a systemic rash.

Which diagnostic test should the nurse question when prescribed for a patient diagnosed with pelvic inflammatory disease (PID)? 1) CBC (complete blood count) with differential 2) Vaginal culture for Neisseria gonorrhoeae 3) Throat culture for Streptococcus A 4) Nucleic acid amplification test (NAAT)

3 Streptococcus of the throat is not associated with PID.

Which clinical manifestation noted during the physical examination is a prodromal sign for genital herpes? 1) Dysuria 2) Muscle pain 3) Abnormal sensation 4) Swollen lymph nodes

3 Tingling or an abnormal sensation prior to presence of the vesicle or ulcer is a prodromal sign for genital herpes.

A public health nurse is educating a group of adults regarding sexually transmitted infections. Which is an appropriate statement by the nurse? 1) "Males have higher rates of gonorrhea and chlamydia, whereas women have higher rates of syphilis." 2) "Men are disproportionately affected by STIs compared to women and infants." 3) "Women often experience few early manifestations of the infection, delaying diagnosis and treatment." 4) "The incidence of STIs is highest among young Caucasian females."

3 Women often experience few early manifestations of sexually transmitted infection, delaying diagnosis and treatment.

The nurse is providing care to a patient who will receive toxic medication via intravenous infusion to treat cancer. Which term should the nurse use when educating the patient about this procedure? 1) Ablation 2) Excision 3) Hysterectomy 4) Chemotherapy

4 Chemotherapy includes chemicals that have toxic effects used to kill cancer cells.

A patient reports an open area on the penis. Which question will help the nurse with data collection? 1) "Do you think you have a disease?" 2) "Have you had sexual intercourse recently?" 3) "Are you promiscuous?" 4) "When did you initially notice this open area?"

4 It will be important to record the onset of the open area.

The nurse recognizes which patient is at the greatest risk for C trachomatis? A. An 18-year-old single female B. A 45-year-old married female C. A 60-year-old single female D. A 30-year-old married male

Answer: A Rationale: Single, sexually active females and males under the age of 25 are at increased risk for Chlamydia and gonorrhea more than other age groups.

What is a key point the nurse must make to patients who are diagnosed with genital herpes? A. Transmission of genital herpes is possible even when symptoms are not evident. B. Transmission of genital herpes is possible only during symptomatic episodes. C. Transmission of genital herpes is not possible when the patient is taking the prescribed medications. D. Transmission of genital herpes is possible only during the first outbreak.

Answer: A Rationale: Transmission is possible even if taking medications to treat herpes and when asymptomatic, not just during the first outbreak or symptomatic episodes.

The nurse provides recommendations for which healthy lifestyle changes for Keisha? (Select all that apply.) A. Avoid sexual intercourse while under the influence of drugs or alcohol. B. Limit the number of sexual partners. C. Utilize condoms if engaging in sexual activity. D. Seek out a Web site to become properly informed about STIs. E. Abstain from sexual intercourse.

Answer: A, B, C, and D Rationale: All the above are healthy lifestyle changes. Abstinence is not necessary; safe sex is.

Which statements by Keisha indicate that teaching has been effective? (Select all that apply.) A. "I know I should eat well and limit sexual activity for a while." B. "I can expect my symptoms to improve within 3 days." C. "There is no point in telling my boyfriend; I can't give him PID!" D. "I should call my provider if I experience a fever, increased abdominal pain, vaginal discharge, nausea, and vomiting." E. "Because I was prescribed doxycycline, I know I should avoid prolonged exposure to sunlight."

Answer: A, B, D, and E Rationale: The nurse should explain that the patient should be on pelvic rest (no intercourse or sports activities) for at least 2 weeks while on treatment. Patients should demonstrate clinical improvement within 3 days after the initiation of therapy. Sex partners should be aware of the risk of exposure to an STI. Increased abdominal pain, vaginal discharge, or nausea and vomiting may indicate that prescribed medication is not effective. Doxycycline may cause photosensitivity (make skin sensitive to sunlight).

What are symptoms of secondary syphilis? (Select all that apply.) A. Maculopapular rash B. Chancre C. Alopecia D. Decreased mental function E. Joint paint

Answer: A, C, and E Rationale: Secondary syphilis symptoms include a maculopapular rash that may develop on the palms, soles, buttocks, and upper thighs. Other symptoms may include fever or malaise, alopecia, joint pain, and headaches. Chancre is a sign of primary syphilis. Neurosyphilis may result in decreased mental functioning.

1. What is the most effective screening tool for cervical cancer? A. DNA testing B. Papanicolaou test C. Ultrasound D. X-ray

Answer: B Rationale: Pap test is the most-effective screening tool for cervical cancer. Ultrasound, x-rays, and DNA testing do not screen for cervical cancer.

The nurse recognizes which of the following statements are true about PID? (Select all that apply.) A. Pelvic inflammatory disease is an acute infection that routinely descends from the upper genital tract to the cervix or vagina. B. If the patient is diagnosed with PID and is pregnant, inpatient admission should be considered. C. Symptoms such as lower abdominal pain and elevated blood pressure are specific criteria for PID. D. Laparoscopy is the only definitive test to diagnosis PID. E. Tubo-ovarian abscess is a severe complication of PID.

Answer: B and E Rationale: PID is an acute infection that ascends the upper genital tract. It does not descend. A provider will consider inpatient hospitalization with diagnoses of PID and pregnancy. Other situations/conditions that would warrant consideration are: poor response/ tolerance of oral antibiotics, HIV, differential diagnoses such as tubo-ovarian abscess, appendicitis, or ectopic pregnancy. Elevated blood pressure is not a specific criterion to PID. Specific manifestations include: lower abdominal pain, uterine tenderness, adnexal tenderness, and cervical motion tenderness. PID can be detected by transvaginal ultrasound, MRI, endometrial biopsy and laparoscopy. These procedures are helpful in conjunction with clinical manifestations of PID. Tubo-ovarian abscess with rupture can lead to peritonitis or sepsis and is considered a surgical emergency.

Complications of gonorrhea can lead to which clinical manifestations? (Select all that apply.) A. Maculopapular rash B. Ectopic pregnancy C. Infertility D. PID E. Urinary incontinence

Answer: B, C, and D Rationale: Complications of gonorrhea include PID, which can cause ectopic pregnancy and infertility.

The nurse understands which of the following are correct about syphilis? (Select all that apply.) A. A chancre is a common symptom in tertiary syphilis. B. Neurosyphilis invades the CNS and may occur at any stage of syphilis. C. The most infectious stages of syphilis are the primary and secondary stages. D. Latent infections are detected primarily by visual inspection. E. Penicillin G is the preferred treatment for all stages of syphilis.

Answer: B, C, and E Rationale: A chancre is a common symptom in primary syphilis. Latent infections are detected by serology.

The nurse recognizes which statements are true when discussing gonorrhea? (Select all that apply.) A. Gonococci are viruses caused by N gonorrhoeae. B. Concomitant infection with Chlamydia can occur; therefore, test for both. C. Gonorrhea remains localized to an expectant mother; therefore, there is very low risk of vertical transmission to the infant. D. The NAAT is effective in detection of genitourinary infection of N gonorrhoeae. E. A hallmark symptom in males with gonorrhea is copious purulent urethral discharge.

Answer: B, D, and E Rationale: Gonococcal organisms are bacterial in nature, not viral. The risk of concomitant infection of gonorrhea and Chlamydia is common (50%). Infants are exposed to cervical exudates at birth are therefore at high risk for infection of being delivered vaginally to a mother who is diagnosed with untreated gonorrhea. NAAT has sensitivities to 99% and therefore is effective for detecting infection. The hallmark sign for gonorrhea in males is gonococcal urethritis as evidenced by copious purulent urethral discharge.

Keisha is prescribed metronidazole (Flagyl) as part of the medications she needs to take after discharge. When addressing this medication, what should the nurse explain? A. "This medication should be taken only on an empty stomach." B. "This medication should be refrigerated." C. "When you take this medication, alcohol should be avoided." D. "When you start feeling better, this medication can be discontinued."

Answer: C Rationale: Consuming alcohol with metronidazole places the individual at risk for severe nausea and vomiting. A) Incorrect. Metronidazole can be taken with food or milk to avoid stomach upset. B) Incorrect. Metronidazole should be storedat room temperature and not in direct sunlight. D) Incorrect. Not taking the entire prescribed medication regime may cause re-infection.

Pelvic inflammatory disease can cause an abscess and/or scar the fallopian tubes, which may block fertilization or interrupt the progression of an egg and lead to which condition? A. Ovarian torsion B. Ovarian cyst C. Ectopic pregnancy D. Fallopian cancer

Answer: C Rationale: Ectopic pregnancy. Scarring of a fallopian tube may cause a fertilized egg to implant in the fallopian tube anywhere outside the womb. A (ovarian torsion or twisting of ovary), B, and D are not the re- sult of pelvic abscesses or scarring of fallopian tubes.

Keisha is diagnosed with PID. If left untreated, what complication is she at risk for developing? A. Uterine prolapse B. Polycystic ovary syndrome C. Infertility D. Endometriosis

Answer: C Rationale: Pelvic inflammation can lead to scarring in the uterus, fallopian tubes, and pelvic cavity. Scar tissue may block or interrupt the normal movement of eggs into the uterus and thus block fertilization by sperm.

Which statement is correct when providing discharge instructions to a patient with genital herpes? A. Genital herpes is an infection that is always symptomatic. B. Genital herpes is a low contagious infection. C. Genital herpes is an infection that can be cured by antivirals. D. A person can transmit HSV to others without displaying any symptoms.

Answer: D Rationale: Genital herpes is an infection that can be asymptomatic. Genital herpes is a highly contagious infection. Condoms may not stop the transmission of herpes. Genital herpes cannot be cured. Antivirals may lesson symptoms.

Keisha is diagnosed with chlamydia during her recent examination. The nurse is aware that this infection can transcend the upper genital tract and lead to which clinical manifestation if untreated? A. Leg/calf tenderness, adnexal tenderness, pelvic tenderness B. Heavy menses, abdominal pain, fatigue C. Elevated C-reactive protein, positive rapid plasma regain (RPR), elevated erythrocyte sedimentation rate (ESR) D. Uterine tenderness, abdominal pain, cervical motion tenderness

Answer: D Rationale: Uterine tenderness, abdominal pain, and cervical motional tenderness are all clinical manifestations of PID. Gonorrhea can be a causative pathogen of PID.

Which of the following is correct relative to the male reproductive system? A. The majority of the male reproductive system is located on the inside of the body. B. The scrotum is a loose pouch-like sac that functions as a temperature regulator for the testes. C. The prostate gland which is located below the bladder surrounding the urethra, functions to store and secrete urine. D. The vas deferens contains ducts that connect the left and right epididymis to the refractory ducts in order to transport sperm.

B

Case Study

On completion of Keisha's physical assessment and radiology test, the provider diagnoses her with PID. She is given an intramuscular shot of ceftriaxone and sent home with a prescription for oral doxycycline and metronidazole to be taken for 14 days. Keisha's nurse educates her about the medications and information on steps to make positive lifestyle changes related to drinking, smoking, and unhealthy sexual practices. Keisha is asked to return within 3 days to check the status of symptoms and to obtain the results of her test. Keisha returns in 3 days as requested. She states that she is feeling much better, which is confirmed by a clinical examination by her provider. All results are negative except for chlamydia. Keisha is informed the chlamydia can be treated with doxycycline, so no additional antibiotics are necessary. Keisha is very interested in making some lifestyle changes because the diagnosis of PID has really scared her. Thenurse provides Keisha with community resources,the number to the local health department, and informative Web sites to assist her in making these healthy modifications. She is asked to return in 3 to 6 months to be retested for at-risk STIs.

A young adult patient reports penile discharge and dysuria for three days. Which is the most likely cause of the patient's clinical manifestations? 1) Sexually transmitted infection 2) Orchitis 3) Spermatocele 4) All of the above

1 A penile discharge is often an indication of an STI (especially gonorrhea and chlamydia).

The nurse is providing care to a patient who will have abnormal cervical tissue removed via cryosurgery. Which term should the nurse use when educating the patient about this procedure? 1) Ablation 2) Excision 3) Hysterectomy 4) Chemotherapy

1 Ablation is the process of burning or freezing in order to remove abnormal cervical tissue. Most common procedures are cryosurgery and laser ablation.

The health-care provider prescribes metronidazole (Flagyl) for a woman diagnosed with trichomoniasis. Which statement should the nurse include in the discharge instructions for this patient? 1) "Both partners must be treated with the medication." 2) "Alcohol does not need to be avoided while taking this medication." 3) "It will turn your urine orange." 4) "This medication could produce drowsiness."

1 Both partners should be treated with the medication.

A patient with syphilis is allergic to penicillin. Based on this data, which medication does the nurse anticipate as appropriate for this patient? 1) Doxycycline 2) Amoxicillin 3) Gentamicin 4) Erythromycin

1 Patients allergic to penicillin are given oral doses of doxycycline or tetracycline for 14 days for the treatment of syphilis.

The nurse instructs a married couple on the importance of treatment for a chlamydia infection. Which statements indicate that teaching was effective? Select all that apply. 1) "He could get an infection in the tube that carries the urine out." 2) "She could have severe vaginal itching." 3) "It could cause us to develop rashes." 4) "She could develop a worse infection of the uterus and tubes." 5) "She could become pregnant."

14 Chlamydia is a major cause of nongonococcal urethritis (NGU) in men. Treatment for chlamydia does not cause vaginal itching. Untreated syphilis, not chlamydia, can cause a rash. Chlamydia cervicitis can ascend and become pelvic inflammatory disease or infection of the uterus, fallopian tubes, and sometimes ovaries. Chlamydia can contribute to infertility.

Which is not considered a risk factor for male patients in terms of contracting a sexually transmitted infection (STI)? 1) Multiple sexual partners 2) Smoking 3) Intravenous (IV) drug use 4) Unprotected sex

2 Although smoking poses health risks, it is not a risk factor for STIs.

The nurse is providing care to a patient who will have advanced cervical lesions removed via cold knife conization. Which term should the nurse use when educating the patient about this procedure? 1) Ablation 2) Excision 3) Hysterectomy 4) Chemotherapy

2 Excision is the process of resecting or removing tissue. Most commonly done procedure with advanced cervical lesions is cold knife conization (CKC).

The nurse is planning care to address pain in the patient with genital herpes. Which intervention would be appropriate for this patient? 1) Increase the intake of cranberry juice 2) Clean lesions two or three times a day with warm water and soap 3) Dry lesions with a hair dryer turned to the hot setting 4) Wear tight cotton clothing

2 Measures to reduce the discomfort of herpes lesions include cleansing the lesions two or three times a day with warm water and soap.

The nurse is planning care for a patient with a history of sexually transmitted infections. What should be included in this plan of care? 1) Instruction to limit sexual contact until recovered from illness 2) Plan for the patient to contact sexual partners regarding the diagnosis 3) Need to increase fluids and rest 4) Importance of adequate nutrition

2 The patient has a history of sexually transmitted infections. The nurse should discuss with the patient a plan for sexual partners to be contacted regarding the diagnosis.

A patient diagnosed with a sexually transmitted infection reports having "no idea" how the illness was contracted. Which nursing diagnosis would be appropriate for the patient at this time? 1) Anxiety 2) Knowledge Deficit 3) Ineffective Coping 4) Sexual Dysfunction

2 The patient having no idea how the illness was contracted indicates a deficit in knowledge regarding the transmission of sexually transmitted infections.

Which is a clinical manifestation associated with neurosyphilis? 1) Systemic rash 2) Vesicles 3) Penile discharge 4) Psychosis

4 Psychosis is a clinical manifestation associated with neurosyphilis.

The nurse recognizes that the virus responsible for cervical cancer is called: A. Cytomegalovirus B. Herpes simplex virus C. Human parvovirus D. Human papillomavirus

Answer: D Rationale: Human papillomavirus is the virus responsible for cervical cancer.

The rounded area of the uterus that is superior to the opening of the uterine tubes is called the: A. Fimbria B. Ovary C. Fundus D. Bladder

C

The passage that extends from the cervix of the uterus to the opening of the external genitalia is called the: A. Introitus B. Clitorus C. Vestibule D. Vagina

D