NU371 Week 8 PrepU: Sexually Transmitted Infections (STIs)

Primary genital herpes is a sexually transmitted infection (STI) caused by either the herpes simplex virus type 1 or type 2. What are the initial symptoms of primary genital herpes infections? Select all that apply. Genital pain Eczema-like lesions Small pustules Itching Chancres

Genital pain Small pustules Itching o The initial symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Chancres and eczema-like lesions are not indicative of genital herpes.

A client develops Reiter's syndrome. Which symptoms will the nurse assess? Select all that apply. · Pneumonia · Conjunctivitis · Cardiovascular pain · Pain in the joints

· Conjunctivitis · Pain in the joints o Untreated chlamydia can develop into Reiter's syndrome, which presents with urethritis and conjunctivitis and arthritis of the knees, sacroiliac, and vertebral joints. Cardiovascular pain and pneumonia are not presenting symptoms of this condition.

A woman seen in the emergency department is diagnosed with primary syphilis. What finding is most likely? · chancres at the vaginal site · vaginal bleeding · vesicles on the labia · foul-smelling discharge

· chancres at the vaginal site o Syphilis is divided into four stages: primary, secondary, latency, and tertiary. Primary syphilis is characterized by a chancre at the site of bacterial entry. Foul-smelling discharge would not be noted. Vesicles on the labia are not associated with syphilis. Bleeding from the vagina could be normal menses and does not correlate with syphilis.

It is important to test anyone who has had sex with an individual tests positive for gonorrhea within how many days of the diagnosis? 60 days 365 days 180 days 90 days

60 days o All sex partners within 60 days prior to discovery of the infection should be contacted, tested, and treated.

For a woman, what is the most serious long-term outcome of an infection resulting from exposure to the N. gonorrhoeae bacteria? Dysuria Sterility Postcoital bleeding Bartholin gland abscesses

Sterility o There may be infections of the uterus and development of acute or chronic infection of the fallopian tubes (i.e., salpingitis), with ultimate scarring and sterility. The other options are less serious in nature.

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis? one or more flat, wartlike papules in the genital area that are sensitive to touch copper-colored macules on the palms and soles that appeared after a brief fever a painless genital ulcer that appeared about 3 weeks after unprotected sex patchy hair loss and red, broken skin involving the scalp, eyebrows, and beard areas

a painless genital ulcer that appeared about 3 weeks after unprotected sex o A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss. Wartlike papules are indicative of genital warts.

Pelvic infection is most commonly caused by: induced abortion (medical abortion). insertion of intrauterine device. hysteroscopy. sexual transmission.

sexual transmission. o Pelvic infection is most commonly caused by sexual transmission but can also occur with invasive procedures such as endometrial biopsy, induced abortion (medical abortion), hysteroscopy, or insertion of an intrauterine device.

A nurse in the sexual health clinic is assessing a male adolescent client, who has sex with men, for sexually transmitted infection (STI) risk factors. Which factor would the nurse identify as presenting the highest risk for STIs? the number of sexual partners sexual orientation of the client risky sexual behaviors the age of the client

the age of the client o Adolescents tend to think they are invincible and deny the risks of their behavior. This risky behavior exposes them to STIs. Adolescents frequently have unprotected intercourse and they engage in partnerships of limited duration. The other options are all risk factors, but just the fact the client is an adolescent places the client more at risk for a STI, because adolescents will engage in risky sexual behaviors with a larger number of sexual partners without considering risks. The client's sexual orientation should not place the client at risk if precautions are taken.

A client is receiving ceftriaxone as treatment for gonorrhea. What would be most important for the nurse to emphasize to the client? · Take the drug on an empty stomach. · Report signs of an oral yeast infection. · Use a sunscreen when outside. · Avoid alcohol consumption.

· Avoid alcohol consumption. o If alcohol is ingested when taking ceftriaxone, the client can experience a disulfiram-like reaction. Therefore the nurse would need to emphasize avoiding alcohol consumption. Taking the drug on an empty stomach may be appropriate but not the most important consideration. Using a sunscreen would be appropriate if the client was receiving doxycycline or tetracycline. Reporting the appearance of an oral yeast infection would be appropriate for a client receiving tetracycline.

What statements are true concerning genital warts? Select all that apply · It resolves on it's own without treatment. · It is not a treatable condition. · It is most common in those with multiple sexual partners. · It is a rare condition. · It is prevalent in those under 25.

· It resolves on it's own without treatment. · It is most common in those with multiple sexual partners. · It is prevalent in those under 25. o Genital warts are a common condition occurring in up to 20 million Americans. It is prevalent in those under 24 and in those with multiple sexual partners. It is treatable; however, it resolves spontaneously without treatment within 2 years.

What is the most common viral infection? · trichomoniasis · chlamydia · human papillomavirus (HPV) · gonorrhea

· human papillomavirus (HPV) o HPV infection is the most common viral infection. Millions of Americans are infected with HPV, many unaware that they carry the virus.

Which medications are appropriate to treat vaginal candidiasis? Select all that apply. · gentamicin · fluconazole · azithromycin · penicillin G benzathine · miconazole

· fluconazole · miconazole o Therapeutic management for vaginal candidiasis includes miconazole, clotrimazole, terconazole, and fluconazole. The other choices are antibiotics and are not effective treatment for a fungal infection such as vaginal candidiasis.

A client asks how his condition, Condylomata acuminata, is caused. What is the nurse's bestresponse? · "A bacteria caused your condition." · "A parasite is the cause of this condition." · "Human papillomavirus (HPV) is the cause of your condition." · "The cause of this is unknown."

· "Human papillomavirus (HPV) is the cause of your condition." o HPV is the cause of C. acuminata or genital warts.

The nurse cares for a client recently diagnosed with syphilis who has no known drug allergies. Which medication will the nurse expect the health care provider to prescribe? · doxycycline · benzathine penicillin G · miconazole · metronidazole

· benzathine penicillin G o Current guidelines recommend benzathine penicillin G injection (long-acting penicillin) as the preferred treatment for syphilis. If the client is allergic to penicillin, other medications (e.g., doxycycline, tetracycline, or ceftriaxone) may be used; however, data to support the use of these medications to treat syphilis are limited. Metronidazole is the treatment for trichomoniasis, and miconazole is the treatment for candidiasis.

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) o HPV causes genital warts, which are associated with an increased incidence of cervical cancer. Recurrent candidiasis, pregnancy before age 20, and use of hormonal contraceptives don't increase the risk of cervical cancer.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which most common bacterial STI in the United States would the nurse expect to include? · syphilis · gonorrhea · genital herpes · Chlamydia

· Chlamydia o Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. Genital herpes is a viral STI. One in five people older than age 12, however, is infected with the virus that causes genital herpes.

The nurse administers erythromycin ophthalmic ointment to a newborn. If noted hours after administration, which finding will the nurse report to the health care provider? · The newborn has small hives on the back. · The newborn is noted to blink and rub the eyes occasionally. · The father states he is allergic to penicillin. · The newborn has mild redness in both eyes.

· The newborn has small hives on the back. o Erythromycin is a prophylactic agent instilled into the eyes of all newborns to prevent gonococcal ophthalmia neonatorum. After administering the eye ointment, the nurse would assess the newborn for signs of an allergic reaction which include hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing or swallowing; or swelling of the mouth, face, lips, tongue, or throat. Mild redness is a common side effect and does not require reporting. Blinking and rubbing of the eye could be related to blurred vision or changes in vision the newborn is experiencing. The father being allergic to penicillin is not cause to report an already administered medication. The father being allergic does not indicate the newborn is also allergic to a medication. The newborn would be monitored more closely when given penicillin drugs.

Trichomoniasis, being a STI, can cause a number of complications. It is a risk factor for which complication in both the male and female population? · Blockage of tubes and ducts · HIV transmission · Atypical pelvic inflammatory disease · Ovarian and testicular cysts

· HIV transmission o Trichomoniasis can cause a number of complications. It is a risk factor for HIV transmission and infectivity in both men and women. In women, it increases the risk of tubal infertility and atypical pelvic inflammatory disease, and it is associated with adverse outcomes such as premature birth in pregnant women.

A sexually active female presents to the clinic with white copious vaginal discharge, itch, swelling, and dysuria. The nurse anticipates the client will be treated for the overgrowth of which organism? · Escherichia coli · Lactobacillus acidophilus · Candida albicans · Neisseria gonorrhoeae

· Candida albicans o Candida albicans is the most commonly identified organism in vaginal yeast infections. Women with vulvovaginal candidiasis commonly complain of vulvovaginal pruritus accompanied by irritation, erythema, swelling, dysuria, and dyspareunia. The characteristic discharge, when present, is usually thick, white, and odorless.

In assessing a client, the nurse notes a grayish discharge from the vaginal area accompanied by a foul odor. What is the nurse's best action? Applying an antifungal cream Asking about other symptoms Encouraging better hygiene Flushing the area with an antibiotic wash

Asking about other symptoms o Bacterial vaginosis is accompanied by a grayish white discharge with a foul odor. The nurse should ask about other symptoms (such as redness, itching, and burning) before implementing any interventions. Antibiotic "washing" is not an acceptable intervention. Antifungal creams are not used for bacteria.

Which event is associated with the primary stage of syphilis? Development of gummas Palmar rash Development of central nervous system lesions Genital chancres

Genital chancres o Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

An HIV-positive client who is on antiretroviral therapy reports anorexia, nausea, and vomiting. Which suggestion should the nurse offer the client to cope with this condition? · Limit number of meals to three a day. · Constantly drink fluids while eating. · Eat dry crackers after meals. · Use high-protein supplements.

· Use high-protein supplements. o The nurse should instruct the client to use high-protein supplements to provide quick and easy protein and calories. The nurse should also instruct the client to eat dry crackers upon arising, not after every meal, and to eat six small meals a day, not three. Drinking fluids constantly while eating is not recommended. The nurse should instruct the client to separate the intake of food and fluids.

The nurse is caring for a male client diagnosed with gonorrhea and chlamydia. Which health care provider order will the nurse question? · acyclovir 400 mg orally BID · notification of all recent sexual partners · rapid serum HIV test · avoidance of sexual activity until treatment is complete

· acyclovir 400 mg orally BID o The nurse would question an order for acyclovir because this is an anti-viral medication used to treat genital herpes. Clients with gonorrhea and chlamydia are treated with antibiotics such as levofloxacin, erythromycin, azithromycin, or tetracycline. The client should notify recent sexual partners to allow them to be tested and treated as needed. The client would be informed to avoid sexual activity until the treatment is complete and to use condoms once sexual activity resumes to prevent future infections. It is recommended for clients with sexually transmitted infections (STIs) be tested for other STIs because risk factors for contracting an STI include a history of STIs.

The nurse explains to a client diagnosed with trichomoniasis that the disease is caused by the parasitic protozoan Trichomonas vaginalis. What would the nurse say is a factor that triggers growth of trichomoniasis? spontaneous abortion (miscarriage) trauma to the bladder being postmenopausal irritation of vaginal walls

irritation of vaginal walls o Factors that trigger growth of trichomoniasis include irritation of vaginal walls, pregnancy, sexual activity, trauma to the vaginal walls, systemic illness, menstruation, and emotional upsets.

A client presents with copious, frothy, malodorous green/yellow vaginal discharge. A diagnosis of Trichomoniasis is made. The client tells the nurse that she has not been sexually active and is concerned. Select the possible modes of transmission. Select all that apply. · Hot tubs · Fomites · Respiratory droplets · Drinking glasses · Sexual contact · Swimming pools

· Hot tubs · Fomites · Sexual contact · Swimming pools o Although the infection is commonly transmitted by sexual contact, it can occur via fomites and the organism has been shown to survive in swimming pools and hot tubs. Drinking glasses and droplets are not modes of transmission.

A community health nurse is conducting an educational session at a local community center on sexually transmitted infections (STIs). The nurse considers the session successful when participants identify which statement as correct? "At least antibiotics will cure a sexually transmitted infection." "Gonorrhea and syphilis are infections seen only in men." "Human papillomavirus is the cause of essentially all cases of cervical cancer." "STIs can't be transmitted through oral sexual intercourse."

"Human papillomavirus is the cause of essentially all cases of cervical cancer." o Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer, which is the fourth most common cancer in women in the United States. Up to 95% of cervical squamous cell carcinomas and nearly all preinvasive cervical neoplasms are caused by the HPV. Antibiotics will only cure those STIs caused by bacterial infections. A viral STI infection is a lifetime infection. Gonorrhea and syphilis affect both men and women. Sexually transmitted infections are infections of the reproductive tract caused by microorganisms transmitted through oral sexual intercourse.

Which client is at highest risk of developing trichomoniasis? A client newly diagnosed with diabetes mellitus type 2 A client who is sexually active A client who completed a 10-day course of antibiotic therapy for a urinary tract infection A client who is taking 10 different medications

A client who is sexually active o A reported risk factor for trichomoniasis is sexual activity, as the parasite can be transmitted to sexual partners. The other symptoms are not listed as predisposing risk factors for this condition.

A client is experiencing situational low self-esteem about acquiring a sexually transmitted infection. Which nursing intervention may help foster the client's self-esteem? Affirm the client's good judgment in seeking treatment. Explain the cause of the sexually transmitted infection (STI). Schedule an appointment for follow-up care. Provide the client with a telephone number for obtaining accurate information.

Affirm the client's good judgment in seeking treatment. o The nurse should affirm the client's good judgment in seeking treatment. Acknowledging positive action helps increase the client's self-esteem. Explaining the cause of the STI and how to avoid potential consequences or complications dispels inaccurate beliefs and misconceptions and helps the client to acquire realistic information. It does not help the client's self-esteem to be positive. Providing the client with a telephone number for obtaining objective and authoritative information helps the client to ask more questions about an STI and its treatment. Medical follow-up promotes compliance with therapeutic regimen and does not help the client's self-esteem to be positive.

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last 6 months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of medication is most likely to resolve her symptoms? An antiviral agent A quinolone antibiotic An azole antifungal agent A penicillin antibiotic

An azole antifungal agent o The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if certain conditions (such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use) enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.

A client has been diagnosed with a chlamydial infection. Select the pharmacologic treatment of choice. Azithromycin Bactrim Acyclovir Ceclor

Azithromycin o The CDC recommends the use of azithromycin or doxycycline in the treatment of chlamydial infection; penicillin is ineffective. Azithromycin or amoxicillin is the preferred choice in pregnancy.

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last 6 months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms? ciprofloxacin, a fluoroquinolone antibiotic Clotrimazole, an antifungal agent. Penicillin V potassium, a broad-spectrum antibiotic Tenofovir, an antiviral agent

Clotrimazole, an antifungal agent. o The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use, enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.

A client with herpes simplex virus (HSV) states, "I can stop taking my drugs because I'm cured. My lesions are gone." Knowing the pathophysiology behind the disappearance of HSV symptoms, the health care provider suspects the client is experiencing which phase of infection? Production of exotoxins Inhibition of cell-mediated immunity Replication of the squamous epithelium Periods of latency in the nervous system

Periods of latency in the nervous system o The clinical course of HSV infection is a product of the virus's ability to remain latent in the dorsal root ganglia for long periods. Latency refers to the ability to maintain disease potential in the absence of clinical signs and symptoms. When latent, the immune system is ineffective, but the virus does not actively inhibit the cell-mediated immune system. HSV does not produce exotoxins, and replication of squamous epithelium accounts for the warts caused by HSV.

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea? dry, hacking cough painless chancre burning on urination diffuse skin rash

burning on urination o Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.

When developing a program for STI prevention, which action would need to be done first? interfering with the mode of transmission getting individuals to change their behaviors increasing the availability of resources educating on how to promote sexual health

educating on how to promote sexual health o The key to successful treatment and prevention of STIs is education to promote sexual health. Behavior changes, increasing the availability of resources, and interfering with modes of transmission are important, but all of these require education.

The nurse is assessing a 68-year-old female client. The client presents with mild lower abdominal pain, greenish-yellow vaginal discharge, and pain during urination. Which question is appropriate for the nurse to ask the client next? · "Have you ever had a urinary tract infection?" · "Do you still have your gallbladder?" · "Have you checked your temperature today?" · "Are you currently sexually active?"

· "Are you currently sexually active?" o Nurses should abandon biases that older adults are sexually inactive. Therefore, based on the client's symptoms, the nurse would determine if the client is sexually active. The client has symptoms of gonorrhea. If the client is sexually active, the client should be tested. Vaginal discharge is not a symptom of gallstones or a urinary tract infection. Asking the client if she has checked her temperature today is closed-ended and provides no information for the nurse. Instead of asking about temperature, the nurse would assess the client's temperature.

A male college student has arrived at the student clinic complaining of tingling, itching, and pains in his groin. Upon inspection, the nurse notices some pustules and vesicles. While taking a detailed sexual history, the nurse should ask which question to rule out further complications? · "Have you noticed excessive swelling in your scrotum the last few days?" · "Do you get cold sores very often?" · "Do you have pain when you urinate or difficulty starting the stream?" · "Have you been experiencing flank pain and bloody urine?"

· "Do you have pain when you urinate or difficulty starting the stream?" o The initial symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. In men, the infection can cause urethritis and lesions of the penis and scrotum. Urethritis is characterized by pain with urination and difficulty starting the stream. Cold sores are not related to genital herpes. Swelling of the scrotum is common in epididymitis. Flank pain and bloody urine are associated primarily with kidney stone formation.

A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the client from infecting others in the future. Which statement by the client demonstrates the best understanding of his health problem? · "Either me or a partner could end up with an eye infection from chlamydia that could make us blind." · "Each of the 3 stages of the disease seems to be worse than the previous one." · "Even though I couldn't end up sterile, a woman that I give it to certainly could." · "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it."

· "Even if I spread it to someone else, there's a good chance she won't have any symptoms or know she has it." o Three-quarters (75%) of women with chlamydial infections are asymptomatic. Blindness is a rare complication in adults who live in industrialized countries and both men and women can become sterile from the effects. Syphilis, not chlamydial infections, has a course of three distinct stages.

A client comes to the clinic and is diagnosed with genital herpes. Which statement by the client indicates that the nurse's teaching about management of the disease has been effective? · "I will use antibacterial ointment on the area to relieve the pain." · "I will use condoms for intercourse until the medication is all gone." · "I will take the acyclovir every 8 hours for the next week." · "I will need to take all of the medication to be sure the infection is cured."

· "I will take the acyclovir every 8 hours for the next week." o There is no known cure for genital herpes, and the methods of treatment are largely symptomatic. The antiviral drug valacyclovir has become the cornerstone for management of genital herpes. Valacyclovir, the active component of acyclovir, has good bioavailability, which enables improved dosing schedules and increased compliance.

A pregnant 23-year-old diagnosed with herpes simplex virus (HSV) is receiving prenatal care from her family physician. To prevent transmission of the virus to her baby, the physician will educate the client by making which statement? · "After your cesarean section, it will be safest if you don't breast-feed your child." · "If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with." · "A vaginal delivery will be safe as long as intravenous antibiotics are given prior to, and during, labor." · "We'll have to book you a cesarean delivery in order to ensure your baby isn't exposed to the virus."

· "If there aren't any visible lesions when you enter labor, a vaginal delivery will be safe to go ahead with." o Vaginal delivery is safe in the absence of lesions at the onset of labor. HSV does not preclude breast-feeding. Antibiotics are used for women positive for group B streptococcus infections, not herpes virus.

Which factors are known to contribute to vaginal yeast infections? Select all that apply. · Inflammation of Skene and Bartholin glands. · Poorly controlled diabetes · Recent antibiotic therapy · Excessive physical exercise · Use of oral contraceptives · High hormone levels during pregnancy

· Poorly controlled diabetes · Recent antibiotic therapy · Use of oral contraceptives o Reported risk factors for the overgrowth of C. albicans include recent antibiotic therapy, which suppresses the normal protective bacterial flora; high hormone levels owing to pregnancy or the use of oral contraceptives, which cause an increase in vaginal glycogen stores; and uncontrolled diabetes mellitus or HIV infection, because they compromise the immune system. Exercise and glandular inflammation are not noted risk factors for yeast infections.

A client diagnosed with genital herpes asks the nurse about future sexual experiences. Which response by the nurse is appropriate? · "As long as you wear a condom and have intercourse while no lesions are present, you will not spread the virus to your partner." · "Future sexual intercourse should be avoided due to the high risk of transmitting the virus to others and causing yourself additional outbreaks." · "If your partner has been exposed to the herpes virus in the past, then there is no significant risk of reinfecting your partner." · "If you plan to have future sexual relationships, you need to let your partner know of your history prior to intercourse."

· "If you plan to have future sexual relationships, you need to let your partner know of your history prior to intercourse." o The client should be instructed to notify future partners before having intercourse with them. Herpes simplex virus transmission can occur both during and between recurrences. Transmission is more likely to occur during an outbreak but can also happen during times of no outbreak. The client does not have to avoid any future sexual experiences, because condom use decreases transmission. The client needs to be properly educated on how to prevent transmission to others and avoid contracting another sexually transmitted infection in the future. Sexual intercourse does not increase the client's chance of future outbreaks. Prior contact with the virus does not confer immunity.

The nurse is caring for a female client diagnosed with vulvovaginal candidiasis. Which instruction will the nurse include in the teaching session with the client? · "It is okay for you to take your oral fluconazole tablet with or without food." · "Use superabsorbent tampons and change frequently." · "It is best for you to wear cotton underwear." · "Notify your health care provider if you note thick, white vaginal discharge."

· "It is best for you to wear cotton underwear." o The nurse would inform the client fluconazole can be taken with or without food. As a preventive measure for the client with frequent vulvovaginal candidiasis, the nurse should instruct the client to wear cotton underwear, not silk. The nurse should instruct the client to use pads instead of superabsorbent tampons, to avoid douching the affected area (as it washes away protective vaginal mucus), and to reduce dietary intake of simple sugars and soda. There is no need to notify the health care provider of expected symptoms such as thick, white vaginal discharge, itching, or inflammation.

A female client is diagnosed with chlamydia during a routine pelvic examination. Which statement by the client indicates that the nurse's teaching about management of the disease has been effective? · "The infection is not contagious and will resolve on its own in a few days." · "My partner will need to take antibiotics at the same time I do." · "I will use condoms during sex until I finish taking all the antibiotics." · "I will use antibiotic cream as directed twice a day until the infection is cured."

· "My partner will need to take antibiotics at the same time I do." o Simultaneous antibiotic treatment of both sexual partners is recommended. Abstinence from sexual activity is encouraged to facilitate cure.

Which instruction is essential for the nurse to include in the care plan for a client with herpes simplex virus-1 (HSV-1)? · "This disease is transmitted by oral secretions." · "Hand washing prevents the spread of infection." · "This disease is not transmitted to others by contact." · "Wear a mask at all times."

· "This disease is transmitted by oral secretions." o HSV is transmitted by contact with infectious lesions or secretions. HSV-1 is transmitted by oral secretions, and infections frequently occur in childhood. The client does not need to wear a mask. Hand washing helps to limit the spread of contaminated secretions; however, it does not prevent the spread of infection.

A female client with genital herpes is prescribed acyclovir as treatment. After teaching the client about this treatment, which statement by the client indicates effective teaching? · "This drug will help to suppress any symptoms of the infection." · "The severity of future attacks will be much less after using this drug." · "If I use this drug, I will be cured of the infection." · "This drug will help reduce my risk for a recurrence after discontinuing it."

· "This drug will help to suppress any symptoms of the infection." o No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. Advances in treatment with acyclovir 400 mg orally three times daily for 7 to 10 days, famciclovir 250 mg orally three times daily for 7 to 10 days, or valacyclovir 1 g orally twice daily for 7 to 10 days have resulted in an improved quality of life for those infected with herpes simplex virus (HSV). However, according to the CDC, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.

The nurse is providing education on the prevention of sexually transmitted infections (STIs) to clients. The nurse understands which client is at the highest risk of contracting an STI? · A 30-year-old client who consumes alcohol multiple times per week, uses cocaine, and has a history of prostitution. · A 20-year-old client who reports having protected sexual intercourse with three others, male and female, over the past five years. · A 25-year-old client who refused to receive the human papillomavirus vaccine and whose parents both have HIV. · A 17-year-old client who is in a monogamous relationship with a 25-year-old partner and engages in unprotected sex.

· A 30-year-old client who consumes alcohol multiple times per week, uses cocaine, and has a history of prostitution. o The nurse will look for the client with the most risk factors for contracting an STI. The 30-year-old client is at the highest risk due to the use of alcohol and drugs and a history of forced sexual activity (3 risk factors). Other risk factors include age of 24 years or less, multiple partners, unprotected intercourse, and a history of STIs. Although the 17-year-old client is young and having unprotected intercourse, the client is in a monogamous relationship, indicating only 2 risk factors. The 20-year-old client is young and has protected intercourse with multiple partners (2 risk factors). The 25-year-old has no risk factors.

A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection? · Papanicolaou smear · viral culture of vesicular fluid · IgG/IgM antibody testing · treponemal testing

· viral culture of vesicular fluid o Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicles. The IgG/IgM antibody testing is frequently done for screening purposes. Papanicolaou (Pap) smears are an insensitive and nonspecific diagnostic test for HSV and should not be relied on for diagnosis. Treponemal testing is used to diagnose syphilis.

A client presents to the outpatient clinic complaining of gray discharge that has a fishy odor. The health care provider sees "clue cells" on wet-mount microscopic exam. This would most likely lead to the diagnosis of: · Chlamydia · Syphilis · Bacterial vaginosis · Trichomonas vaginalis

· Bacterial vaginosis o The diagnosis of bacterial vaginosis is made when at least three of the following signs or symptoms are present: abnormal gray discharge, vaginal pH above 4.5 (usually 5.0-6.0), positive fishy odor of vaginal discharge on addition of 10% potassium hydroxide, and appearance of characteristic "clue cells" on wet-mount microscopic studies. T. vaginalis an anaerobic protozoan that is shaped like a turnip and has three or four anterior flagella. Chlamydia exists in two morphologically distinct forms during its unique life-a small, infectious elementary body and a large, noninfectious reticulate body. The diagnosis of syphilis can be made rapidly by dark-field microscopic examination of the exudate from skin lesions. However, the test is reliable only when a specimen with actively motile T. pallidum is examined immediately by a trained microscopist. It does, however, evoke a humoral immune response and production of antibodies that provide the basis for serologic tests.

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last 6 months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms? · Tenofovir, an antiviral agent · Clotrimazole, an antifungal agent. · Penicillin V potassium, a broad-spectrum antibiotic · ciprofloxacin, a fluoroquinolone antibiotic

· Clotrimazole, an antifungal agent. o The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use, enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.

While in its dormant state, what structure provides residence for herpes simplex virus to allow for replication? · Local lymph nodes · Subcutaneous tissue · Dorsal root ganglia · Mucous membrane

· Dorsal root ganglia o In genital herpes, the virus ascends through the peripheral nerves to the sacral dorsal root ganglia. The virus can remain dormant in the dorsal root ganglia, or it can reactivate, in which case the viral particles are transported back down the nerve root to the skin, where they multiply and cause a lesion to develop. During the dormant or latent period, the virus replicates in a different manner so that the immune system or available treatments have no effect on it. Local lymph nodes respond to the inflammation of reactivation; the mucous membrane becomes erythematous and painful when lesions form; subcutaneous tissue is not damaged by the vesicles and shallow ulcerations.

A 22-year-old female client states she has vaginal itching with pain and small vesicles that appear on the vagina when she is stressed. The health care provider suspects the client most likely is experiencing which condition? · Molluscum contagiosum infection · Chlamydia trachomatis infection · Genital warts · Genital herpes

· Genital herpes o The symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Curd-like exudate and dome-like lesions fits the description of Molluscum contagiosum infection. Chlamydia trachomatis infection is a vaginal/cervical infection and does present with itching but not vesicles. Chancroid lesions start as macules and progress to pustules.

A client was diagnosed with herpes simplex virus (HSV) several months ago and has adapted his lifestyle to limit the frequency and severity of recurrences. Which actions help facilitate this goal? Select all that apply. · Limiting antibiotic use · Getting adequate sleep · Eating a nutritious diet · Limiting sun exposure · Limiting stress

· Getting adequate sleep · Limiting stress o Numerous factors, including emotional stress, lack of sleep, overexertion, other infections, vigorous or prolonged coitus, and premenstrual or menstrual distress, have been identified as triggering mechanisms for HSV recurrence. Diet, antibiotics, and sun exposure are not known to contribute to episodes of recurrence.

Bacterial vaginosis is the most common vaginal infection seen by health care providers. What is the predominant symptom of bacterial vaginosis? · Thick, cottage cheese-like discharge with a fishy odor · Grayish white discharge with a fishy odor · Small, painless papules · Painless chancres

· Grayish white discharge with a fishy odor o The predominant symptom of bacterial vaginosis is a thin, grayish white discharge that has a foul, fishy odor.

Select the treatment of choice for syphilis. · Topical clotrimazole cream · UV radiation to the genital area · Oral amoxicillin for 10 days · Long-acting penicillin in a single injection

· Long-acting penicillin in a single injection o The treatment of choice for syphilis is penicillin. Because of the spirochetes' long generation time, effective tissue levels of penicillin must be maintained for several weeks. Long-acting injectable forms of penicillin are used.

Select the correct statement regarding herpes simplex virus. · The virus is not contagious. · Only two strains of the virus are considered sexually transmittable. · The virus will not reactivate. · Herpes simplex virus cannot be transmitted if lesions are not present.

· Only two strains of the virus are considered sexually transmittable. o Herpes simplex infections are highly contagious. There are eight types of HSV; however, only two are considered sexually transmitted. The virus can be reactivated, and it will transmit if lesions are not present.

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis? · Abstinence will be required until the infection resolves, since treatments do not yet have proven efficacy. · Antifungal medications are effective against the anovulation and risk of HIV that accompany the infection. · Oral antiprotozoals to client and sexual partners to help prevent complications. · Vaginal suppositories and topical ointments can provide symptom relief but cannot eradicate the microorganism.

· Oral antiprotozoals to client and sexual partners to help prevent complications. o The treatment of choice for Trichomonas vaginalis is oral metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment and eradication of the infection is possible with treatment.

A pregnant client arrives at the community clinic reporting fever blisters and cold sores on the lips, eyes, and face. The health care provider has diagnosed it as the primary episode of genital herpes simplex virus (HSV), for which antiviral therapy is recommended. Which information should the nurse offer the client when educating her about managing the infection? · Kissing during the primary episode does not transmit the virus. · Safety of antiviral therapy during pregnancy has not been established. · Antiviral drug therapy cures the infection completely. · Recurrent HSV infection episodes are longer and more severe.

· Safety of antiviral therapy during pregnancy has not been established. o The nurse should inform the client that there is no evidence to suggest that antiviral therapy is completely safe during pregnancy. HSV cannot be cured completely, even with timely antiviral drug therapy, and there may be recurrences. The viral shedding process continues for 2 weeks during the primary episode, and kissing during this period may transmit the disease. Recurrent HSV-infection episodes are shorter and milder.

A nurse educator is teaching a client about sexually transmitted infections. The client would learn that which medications are appropriate to treat chlamydia? Select all that apply. · metronidazole · acyclovir · azithromycin · doxycycline · ceftriaxone

· azithromycin · doxycycline · ceftriaxone o Antibiotics are usually used in treating this STI. The CDC treatment options for chlamydia include doxycycline or azithromycin. Because of the common co-infection of chlamydia and gonorrhea, a combination regimen of ceftriaxone with doxycycline or azithromycin is prescribed frequently.

A client is diagnosed with chlamydia and gonorrhea and is receiving azithromycin as treatment. In addition to this medication, the nurse anticipates that the client will also be prescribed which drug? · doxycycline · tetracycline · miconazole · ceftriaxone

· ceftriaxone o Individuals with chlamydia usually receive treatment with doxycycline or azithromycin. However, since they also are infected with gonorrhea, ceftriaxone will be commonly added to the regimen. Miconazole is used to treat candidal infections. Tetracycline or erythromycin is used to treat gonococcal ophthalmia neonatorum.

The school nurse is leading a discussion with a group of adolescents on the various sexually transmitted infections (STIs). The nurse determines the session is successful when the students correctly choose which STIs as considered curable with proper treatment? Select all that apply. · chlamydia · trichomoniasis · condylomata acuminata · gonorrhea · herpes type 2 virus

· chlamydia · trichomoniasis · gonorrhea o Chlamydia and gonorrhea are curable with antibiotic therapy. Trichomoniasis is curable with metronidazole or tinidazole. Although the warts (condylomata acuminata) can be removed, the virus remains and is not cured. Antivirals control the symptoms of condylomata acuminata and herpes type 2 virus but do not cure the diseases.

During unprotected sex, a 17-year-old female high school senior has been exposed to the human papillomavirus (HPV). The school nurse would recognize that the student is at a considerable risk for developing which diagnosis? · gonorrhea · candidiasis · genital herpes · condylomata acuminata

· condylomata acuminata o HPV is an identified precursor to condylomata acuminata, or genital warts. Herpes, gonorrhea, and candidiasis are not likely to result directly from HPV.

Which finding would the nurse most likely find in a male diagnosed with a chlamydia trachomatis infection? · erectile dysfunction · hematuria · dysuria · painful ejaculation

· dysuria o A male with the diagnosis of chlamydia will first experience dysuria as the primary symptom. The other symptoms listed do not correlate to men with the diagnosis of chlamydia.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? · syphilis · genital herpes · chlamydia · gonorrhea

· genital herpes o Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

A nurse is reviewing the history of a client diagnosed with pelvic inflammatory disease. Which factors would the nurse identify as placing the client at increased risk for this condition? Select all that apply. · intrauterine contraceptive device inserted 3 weeks ago · residence in a suburban area · 29 years of age · multiple sex partners · vaginal douching approximately once a week

· intrauterine contraceptive device inserted 3 weeks ago · multiple sex partners · vaginal douching approximately once a week o All sexually active women are at risk of PID, but common risk factors include age less than 25 years old, residence in an inner city, multiple sexual partners, sex with a new partner, insertion of an intrauterine contraceptive (IUC) within the past 6 weeks, vaginal douching, history of STI in the woman or her partner, lack of barrier contraceptive use, and a previous episode of PID.

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a v yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms? · penicillin · valacyclovir · azithromycin · metronidazole

· metronidazole o The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, enable the protozoan to proliferate. Trichomoniasis responds well to treatment with metronidazole.

A nurse is assessing a client diagnosed with bacterial vaginosis. What is a symptom of bacterial vaginosis? · cottage cheese-like discharge · intense itching of the vulva · warts in the vulva and labia · vaginal odor smelling of fish

· vaginal odor smelling of fish o Bacterial vaginosis causes a "stale fish" vaginal odor. Cottage cheese-like discharge is seen in candidiasis and not in bacterial vaginosis, in which the discharge is thin and gray-white. Intense itching of the vulva is associated with candidiasis, not vaginosis. Warts in the vulva and labia are seen in human papillomavirus infection, not in vaginosis.