OB Exam 1

What is Hepatitis A?

-Viral STI -Transmitted through fecal-oral route -Vaccination is most effective means of preventing transmission MANIFESTATIONS -Flu-like symptoms with malaise -Fatigue -Anorexia -Nausea -Pruritus -Fever -Right upper quadrant pain TREATMENT -Uncurable -Symptom Relief

A male client has a tentative diagnosis of urethritis. The nurse should assess the client for which manifestation of the disorder? 1. Hematuria and pyuria 2. Dysuria and proteinuria 3. Hematuria and urgency 4. Dysuria and penile discharge

Dysuria and penile discharge Rationale: Urethritis in the male client often results from chlamydial infection and is characterized by dysuria, which is accompanied by a clear to mucopurulent discharge. Because this disorder often coexists with gonorrhea, diagnostic tests are done for both and include culture and rapid assays. Hematuria is not associated with urethritis. Proteinuria is associated with kidney dysfunction.

Name the bacterial STI's

Group B Streptococcus Gonorrhea Syphilis Chlamydia Bacterial Vaginosis

STI infection control...

Interrupting the transmission of infection is crucial to STI control Many STIs are reportable; all states require that these STIs be reported to public health officials: -Gonorrhea -Syphilis -Chancroid -Lymphogranuloma venereum -Granuloma inguinale

What are the four types of risk reduction measures?

Physical barriers (condoms), Chemical barriers (nonoynol-9, spermicide), Communication, & Vaccination

What is secondary prevention?

Prompt diagnosis & treatment to prevent personal complications and transmission to others

Name a parasitic STI

Trichomoniasis

The ambulatory care nurse is working with a 22-year-old female client who has been diagnosed with pelvic inflammatory disease (PID). The nurse incorporates which item in a teaching plan for this client? 1. Avoid frequent douching. 2. Undergarments made of nylon are best. 3. Intrauterine devices are a good birth control method. 4. It is necessary to change sanitary pads only every 8 hours.

Avoid frequent douching. Rationale: The client who has been diagnosed with PID should avoid frequent douching because it decreases the natural flora that controls the growth of infectious organisms. The client should wear cotton undergarments, and clothes should not fit tightly. Intrauterine devices increase the client's susceptibility to infection. Sanitary pads should be changed at least every 4 hours. Tampons should not be used during the acute infection, and some health care providers may recommend avoiding them indefinitely. The client also should avoid strong soaps, sprays, powders, and similar products that will irritate the perineum.

Name a fungal STI

Candidiasis (Yeast Infection)

The client has undergone mastectomy. The nurse determines that the client is making the best adjustment to the loss of the breast if which behavior is observed? 1. Refusing to look at the wound 2. Reading the postoperative care booklet 3. Asking for pain medication when needed 4. Participating in the care of the surgical drain

Participating in the care of the surgical drain

A 55-year-old male client confides in the nurse that he is concerned about his sexual function. What is the nurse's best response? 1. "How often do you have sexual relations?" 2. "Please share with me more about your concerns." 3. "You are still young and have nothing to be concerned about." 4. "You should not have a decline in testosterone until you are in your 80s."

Please share with me more about your concerns.

The clinic nurse is performing a psychosocial assessment of a client who has been told that she is pregnant. Which assessment findings indicate to the nurse that the client is at risk for contracting human immunodeficiency virus (HIV)? Select all that apply. 1. The client has a history of intravenous drug use. 2. The client has a significant other who is heterosexual. 3. The client has a history of sexually transmitted infections. 4. The client has had one sexual partner for the past 10 years. 5. The client has a previous history of gestational diabetes mellitus.

The client has a history of intravenous drug use. The client has a history of sexually transmitted infections. Rationale: HIV is transmitted by intimate sexual contact and the exchange of body fluids, exposure to infected blood, and passage from an infected woman to her fetus. Clients who fall into the high-risk category for HIV infection include individuals who have used intravenous drugs, individuals who experience persistent and recurrent sexually transmitted infections, and individuals who have a history of multiple sexual partners. Gestational diabetes mellitus does not predispose the client to HIV. A client with a heterosexual partner, particularly a client who has had only one sexual partner in 10 years, does not have a high risk for contracting HIV.

The nurse reviews the assessment history for a client with a suspected ectopic pregnancy. Which assessment findings predispose the client to an ectopic pregnancy? Select all that apply. 1. Use of diaphragm 2. Use of fertility medications 3. History of Chlamydia 4. Use of an intrauterine device 5. History of pelvic inflammatory disease (PID)

Use of fertility medications History of Chlamydia Use of an intrauterine device History of pelvic inflammatory disease (PID) Rationale: An ectopic pregnancy is one that establishes itself somewhere other than inside the uterus. Multiple factors may predispose a woman to an ectopic pregnancy. Fertility medications, history of sexually transmitted infections, intrauterine devices, and PID have all been associated with ectopic pregnancy. There are no data to support any additional risk for ectopic pregnancy with the use of the diaphragm.

A client with a history of ovarian cysts is seen by the health care provider (HCP). The client has had 2 previous surgeries related to this condition. Her HCP recommends an exploratory laparoscopic procedure for the current ovarian cyst, which has persisted for several months. The client states that the prior ovarian cysts were benign and questions the need for this procedure. Which response is best for the nurse to provide? 1. "A prolonged ovarian abnormality should be evaluated thoroughly." 2. "With your recurrent history, one of these times the cyst will be malignant." 3. "The surgical procedure is minimal, and you will not have to be concerned after you learn the results." 4. "I appreciate your concern regarding another surgical procedure. Would you like to discuss your concerns?"

"A prolonged ovarian abnormality should be evaluated thoroughly." Rationale: An ovarian cyst is considered an abnormal occurrence, and it should be thoroughly evaluated. Not all ovarian cysts are malignant, and this client may never experience a malignancy. Any surgical procedure has some risk and pain associated with it. The nurse cannot promise the procedure will be minimal and that there will be no reason for concern after learning the results. Discussing the concerns does involve therapeutic communication but is not the best response given the situation. In addition, it is nontherapeutic for the nurse to tell the client that he or she appreciates the client's concern.

A female client is suspected of having a vaginal infection caused by the organism Candida albicans. Which assessment question would elicit data associated with this infection? 1. "Have you had any vaginal discharge?" 2. "Do you have any blood in your urine?" 3. "Have you had any flank pain or headaches?" 4. "Have you noticed any swelling in your feet?"

"Have you had any vaginal discharge?" Rationale: Clinical manifestations of a Candida infection include vaginal pain, itching, and a thick white vaginal discharge. Hematuria, edema, flank pain, and headache are clinical manifestations associated with urinary tract infections.

What is Human Immunodeficiency Virus (HIV)?

-A viral STI -Transmission of HIV occurs primarily through exchange of body fluids -Heterosexual transmission now the most common means of transmission MANIFESTATION -Fever -Headache -Night sweats -Malaise -Generalized lymphadenopathy -Myalgias -Nausea -Diarrhea -Weight loss -Sore throat -Rash SCREENING & DIAGNOSIS -Antibody testing -Detection TREATMENT -No cure -Antiretroviral therapy (ART) MANAGEMENT RESOURCES -Death & Dying -Suicide Prevention -Financial assistance -Legal advocacy

A pregnant client has been instructed on the prevention of genital tract infections. Which client statement indicates an understanding of these preventive measures? 1. "I can douche anytime I want." 2. "I can wear my tight-fitting jeans." 3. "I should avoid the use of condoms." 4. "I should wear underwear with a cotton panel liner."

"I should wear underwear with a cotton panel liner." Rationale: Wearing items with a cotton panel liner allows for air movement in and around the genital area. Douching is to be avoided. Wearing tight clothing can irritate the genital area and does not allow for air circulation. Condoms should be used to minimize the spread of genital tract infections.

The nurse is caring for a client with a diagnosis of endometriosis. The client asks the nurse to describe this condition. How should the nurse respond? Select all that apply. 1. "It causes the cessation of menstruation." 2. "It is pain that occurs during ovulation." 3. "It is the presence of tissue outside the uterus that resembles the endometrium." 4. "It is also known as primary dysmenorrhea and causes lower abdominal discomfort." 5. "Major symptoms of endometriosis are pelvic pain, dysmenorrhea, and dyspareunia."

"It is the presence of tissue outside the uterus that resembles the endometrium." "Major symptoms of endometriosis are pelvic pain, dysmenorrhea, and dyspareunia." Rationale: Endometriosis is defined as the presence of tissue outside the uterus that resembles the endometrium in both structure and function. Major symptoms include pelvic pain, dysmenorrhea, and dyspareunia (painful intercourse). The response of this tissue to the stimulation of estrogen and progesterone during the menstrual cycle is identical to that of the endometrium. Amenorrhea is the cessation of menstruation for at least 3 cycles or 6 months in a woman who has an established pattern of menstruation. Amenorrhea can be caused by a variety of factors. Mittelschmerz refers to pelvic pain that occurs midway between menstrual periods. Primary dysmenorrhea refers to menstrual pain without identified pathology.

An adolescent seen in the health care clinic has been diagnosed with endometriosis. The client asks the clinic nurse to describe this condition. Which response should the nurse provide? 1. "It always causes infertility." 2. "It causes the cessation of menstruation." 3. "It is the presence of tissue outside the uterus." 4. "It is also is known as primary dysmenorrhea."

"It is the presence of tissue outside the uterus." Rationale: Endometriosis is defined as the presence of tissue outside the uterus that resembles the endometrium in both structure and function. The response of this tissue to the stimulation of estrogen and progesterone during the menstrual cycle is identical to that of the endometrium. Endometriosis can lead to pelvic scarring, pain, and possible infertility. Amenorrhea is the cessation of menstruation for a period of at least 3 cycles or 6 months in a woman who has established a pattern of menstruation and can be due to a variety of causes. Primary dysmenorrhea refers to menstrual pain without identified pathology.

The nurse is interviewing a middle-aged woman with a history of fibrocystic disorder of the breasts. Which statements made by the client indicate a need for further teaching? Select all that apply. 1. "I might experience pain in my underarm region." 2. "My symptoms will decrease just before menstruation." 3. "After I experience menopause, my symptoms may lessen." 4. "Taking oral contraceptives now will increase my symptoms." 5. "Upon self-breast examination, I may detect lumpiness in the upper, outer area of my breasts."

"My symptoms will decrease just before menstruation." "Taking oral contraceptives now will increase my symptoms." Rationale: The nurse assesses the client with fibrocystic breast disorder for worsening symptoms (breast lumps, painful breasts extending into the underarm region, and possible nipple discharge) before the onset of menses. This is associated with cyclical hormonal changes. Taking oral contraceptive pills and experiencing menopause may also help to decrease the signs and symptoms of fibrocystic disease.

The home health care nurse is providing instructions to a client after a vulvectomy. Which instruction should the nurse provide to the client? 1. "You can engage in sexual activity in 2 weeks." 2. "It is all right to begin to drive a car as long as you do not drive long distances." 3. "Resume activities slowly, keeping in mind that walking is a beneficial activity." 4. "It is important to rest and sit in a chair with your legs elevated as much as possible."

"Resume activities slowly, keeping in mind that walking is a beneficial activity." Rationale: The client should resume activities slowly, and walking is a beneficial activity. Sexual activity is prohibited for approximately 4 to 6 weeks after surgery. Activities to be avoided include driving, heavy housework, wearing tight clothing, crossing the legs, and prolonged sitting and standing. The client should not be instructed to sit in a chair as much as possible because pressure on the surgical site could lead to complications related to the surgery.

A nursing student is doing a presentation on human papillomavirus (HPV) for a young adult group aged 18 to 20 years old. What information should the nursing student include in this presentation? Select all that apply. 1. "Some forms of HPV can lead to cervical cancer." 2. "You cannot get HPV if you have had only 1 sex partner." 3. "There are no vaccinations available to protect against HPV." 4. "HPV is most commonly spread during vaginal or anal sexual contact." 5. "In some types, HPV will go away on its own and does not cause health issues."

"Some forms of HPV can lead to cervical cancer." "HPV is most commonly spread during vaginal or anal sexual contact." "In some types, HPV will go away on its own and does not cause health issues." Rationale: HPV has now become the most common sexually transmitted infection. Some types of HPV have been found to have a strong link to cervical cancer, while other types of HPV may resolve without any intervention. HPV may be contracted with any sexual partner. There is a vaccine for the known strains that may lead to cervical cancer, which can be administered to females from ages 9 to 26 years. HPV is spread through vaginal or anal sexual contact.

A pregnant woman has a positive history of genital herpes but has not had lesions during this pregnancy. What should the nurse plan to tell the client? 1. "You will be isolated from your newborn infant after delivery." 2. "Vaginal deliveries can reduce neonatal infection risks, even if you have an active lesion at the time." 3. "There is little risk to your newborn infant during this pregnancy, during the birth, and after delivery." 4. "You will be evaluated at the time of delivery for genital lesions, and if any are present, a cesarean delivery will be needed."

"You will be evaluated at the time of delivery for genital lesions, and if any are present, a cesarean delivery will be needed." Rationale: With active herpetic genital lesions, cesarean delivery can reduce neonatal infection risks. In the absence of active genital lesions, vaginal delivery is indicated unless there are other indications for cesarean delivery. Maternal isolation is not necessary, but cultures should be obtained from potentially exposed newborn infants on the day of delivery.

What is Pelvic Inflammatory Disease (PID)?

-An infections process that most commonly involves the fallopian tubes, uterus, and occasionally the ovaries and peritoneal surfaces. -Is caused by multiple organisms and is commonly caused by undiagnosed chlamydia. RISK FACTORS -Young age, nulliparity, high rate of new partners, multiple partners, Hx of STI's & PID MANIFESTATIONS -Pain in lower abdomen (Acute, subacute, chronic) -Heavy vaginal discharge with an unpleasant odor. -Abnormal uterine bleeding, especially during or after intercourse, or between menstrual cycles COMPLICATIONS -Etopic pregnancy -Infertility -Chronic pelvic pain SCREENING & DIAGNOSIS -History -Pelvic exam, cervical cultures, & urine samples MANAGEMENT -Prevention -Hospitalization -Education TREATMENT -Doxycycline -Clindamycin -Cefoxitin

What is Chlamydia Trachomatis?

-Bacterial STI -Most common and fastest spreading -Most common cause of PID -Infections often silent (asymptomatic) & highly destructive -Highest rates in sexually active women ages 15-24 (highest 18-20) MANIFESTATION: -Cervical ulcerations -Fallopian tube inflammation SCREENING & DIAGONSIS -Swab culture (cervix for women/penis or anus for men) ---Urine test TREATMENT -Doxycycline & Azithromycin -Azithromycin & Amoxicillin is for pregnant women -All exposed sexual partners should be treated -Antibiotic ointment for perinatal transmission

What is Gonorrhea?

-Bacterial STI -Oldest communicable disease in the US -Second most common STI -Highest rates among teenagers, young adults, & African-Americans -Women are often asymptomatic SCREENING & DIAGONSIS - Swab culture (cervix for women/penis or anus for men) ---Urine test TREATMENT -Cefixime or Ceftriaxone -Concomitant treatment for chlamydia -All exposed sexual partners should be treated

What is Syphilis?

-Bacterial STI -Transmitted through kissing, biting, or oral-genital sex -Transplacental transmission may occur at any time during pregnancy. -Can lead to serious systemic disease and death if untreated STAGES: Primary: 5-90 days after exposure Secondary: 6 weeks - 6 months Tertiary: Develops in one third of women infected SCREENING & DIAGONSIS - Serologic (blood test) TREATMENT -Penicillin -Sexual abstinence during treatment

What is Bacterial Vaginosis (BV)?

-Bacterial Vaginal Infection - MANIFESTATIONS -Thin gray or white vaginal discharge -Pain, itching, or burning inside & outside vagina -Strong, fish-like odor especially after sex -Dysuria COMPLICATIONS -Preterm labor & birth TREATMENT -Metronidazole -Clindamycin

What is group B streptococcus?

-Bacterial Vaginal Infection -A part of the normal vaginal flora, present in 20% to 30% of healthy women -Associated with poor pregnancy outcomes -Important factor in neonatal morbidity and mortality -Screening at 36-37 weeks of gestation MANIFESTATIONS -Most of infected are asymptomatic -UTI's -Other infections/Sepsis

What is Candidiasis?

-Fungal vaginal infection -Yeast infection -Second most common type of vaginal infection PREDISPOSING FACTORS -Antibiotic therapy -Diabetes -Pregnancy -Obesity -Diets high in refined sugars -Use of corticosteroids and hormones -Immunosuppressed states MANIFESTATIONS -Pruritus -Painful ulcerations -"cottage cheese" discharge -Yeasty smell -Feeling of dryness -Painful urination -Red, swollen, painful vulva TREATMENTS -OTC treatments 3-7 days -Oral Fluconazole lx COMFORT MEASURES -Sitz bath -Cool Compress -Oatmeal powder -Avoid intercourse

What is trichomoniasis?

-Parasite that causes vaginitis -Transmitted through sex -Often co-exists with gonorrhea -Common cause of vaginal infection -More common in older women MANIFESTATIONS -Only 30% show s/sx -Vaginal discharge, which can be white, gray, yellow, or green, and usually frothy with an unpleasant smell. -Vaginal spotting or bleeding. genital burning or itching. -Genital redness or swelling. frequent urge to urinate. pain during urination or sexual intercourse. SCREENING & DIAGNOSIS -Speculum examination -Pap test TREATMENT -Metronidazole -Tinidazole

What complications are caused by STI's in pregnant women?

-Premature rupture of membranes -Premature labor -Postpartum sepsis -Dystocia -Miscarriage Pregnancy confers no immunity against infection, and both mother and fetus must be considered when the pregnant woman contracts an infection.

What fetal complications are caused by STI's?

-Preterm birth -Pneumonia -Systemic infection -Congenital infection -Stillbirth

What is Herpes Simplex Virus (HSV)?

-Viral STI -Chronic and recurring disease -Herpes simplex virus 1 (HSV-1) oral herpes -Herpes simplex virus 2 (HSV-2) genital herpes -Both viruses can be transmitted by saliva, body secretions or oral sex. -There is no cure MANIFESTATIONS -Multiple painful lesions -Fever & chills -Malaise -Severe dysuria TREATMENT -Systemic antiviral medications partially control symptoms -Acyclovir -Valacyclovir -Famciclovir COMPLICATIONS -Maternal infection with HSV-2 can have adverse effects on mother and fetus -Neonatal herpes

What is Hepatits B?

-Viral STI -Disease of the liver -Silent infection -Transmitted parenterally, perinatally, orally, & through intimate contact -Carry greatest risk -Most threatening to fetus & neonate -Vaccination is most effective means of preventing transmission MANIFESTATIONS -Usually a silent infection -Jaundice -Light-colored poop -Fever -Fatigue that persists for weeks or months -Stomach trouble like loss of appetite, nausea, and vomiting. -Belly pain TREATMENT -Uncurable -Recovery is usually spontaneous with in 3-16 weeks

What is Hepatitis C?

-Viral STI -Most common blood-borne infection in the US -Increasing numbers of acquiring disease -Transmitted through blood MANIFESTATIONS -Feeling very tired. -Sore muscles. -Joint pain. -Fever. -Nausea or poor appetite. -Stomach pain. -Itchy skin. -Dark urine. TREATMENT -Interferon-alfa or ribavirin is main therapy for HCV infection

What is Human paillomavirus (HPV)?

-Viral STI -Most common viral STI -Previously named genital or venereal warts -More frequent in pregnant women -HPV vaccine available SCREENING & DIAGNOSIS -History of known exposure -Physical inspection -Pap Test -Viral screening & typing (not common) MANAGEMENT -Removal (medication or cryotherapy) -Medications -Counseling

The nurse presents a seminar on sexually transmitted infections. Which information about syphilis should the nurse include in this presentation? Select all that apply. 1. A blood test will confirm the diagnosis. 2. Syphilis signs and symptoms are divided into stages. 3. Syphilis can be spread through vaginal, anal, or oral sex. 4. Having syphilis once provides lifelong immunity from repeat infection. 5. Syphilis will always be present in a chronic state, as there is no cure for this illness.

A blood test will confirm the diagnosis. Syphilis signs and symptoms are divided into stages. Syphilis can be spread through vaginal, anal, or oral sex. Rationale: Syphilis can be cured with the initiation of prompt treatment. A blood test can confirm this diagnosis. Syphilis is staged in relation to signs and symptoms and the length of the infection. Syphilis may be transmitted via vaginal, anal, or oral sex. An individual may be positive for syphilis more than once. Syphilis can be cured by early treatment.

The clinic nurse has conducted a health screening clinic to identify clients who are at risk for cervical cancer. The nurse is reviewing the assessment findings in the records of the clients who attended the clinic. Which client is at lowest risk for developing this type of cancer? 1. A multiparity client 2. A single white client 3. A client with a history of chronic cervicitis 4. A client who had early, frequent intercourse with multiple sexual partners

A single white client Rationale: Risk factors associated with cervical cancer include early, frequent intercourse with multiple sexual partners; multiparity; chronic cervicitis; and a history of genital herpes or human papilloma. Cervical cancer also occurs with higher frequency in African Americans. Regarding the options provided, the single white client is at lowest risk for the development of cervical cancer.

The nurse is instructing a client how to perform a testicular self-examination (TSE). The nurse should explain that which is the best time to perform this exam? 1. After a shower or bath 2. While standing to void 3. After having a bowel movement 4. While lying in bed before arising

After a shower or bath Rationale: The nurse needs to teach the client how to perform a TSE. The nurse should instruct the client to perform the exam on the same day each month. The nurse should also instruct the client that the best time to perform a TSE is after a shower or bath when the hands are warm and soapy and the scrotum is warm. Palpation is easier and the client will be better able to identify any abnormalities. The client would stand to perform the exam, but it would be difficult to perform the exam while voiding. Having a bowel movement is unrelated to performing a TSE.

A client with epididymitis is upset about the extent of scrotal edema. Attempts to reassure the client that this condition is temporary have not been effective. The nurse should plan to address which client problem? 1. Pain related to fluid accumulation in the scrotum 2. Uneasiness related to inability to reduce scrotal swelling 3. Guilt related to the possibility of sterility secondary to scrotal swelling 4. Altered body appearance related to change in the appearance of the scrotum

Altered body appearance related to change in the appearance of the scrotum Rationale: Altered body appearance is a problem when the client has either a verbal or a nonverbal response to a change in the structure or the function of a body part. Pain may apply but does not correlate with the information in the question. There are no data in the question that uneasiness, inability to reduce scrotal swelling, or sterility is a client concern.

The nurse is planning to teach a group of adolescents about the use of condoms as part of a risk reduction program for sexually transmitted infections (STIs). The nurse should plan to include which recommendation in the teaching plan? 1. Condoms should not be lubricated. 2. Use condoms whenever the partner seems "risky." 3. Always apply the condom before inserting the penis into the vagina. 4. Natural membrane condoms can be used because they are just as effective as latex.

Always apply a condom before inserting penis into the vagina. Rationale: To be effective, condoms must be applied before any vaginal penetration occurs. A condom must be used with every sexual encounter if it is to be safe. A lubricated condom may be used to increase sensitivity of the glans. Natural membrane condoms are less effective than latex in preventing the spread of some STIs.

A 33-year-old female client is admitted to the hospital with a tentative diagnosis of Graves' disease. Which symptom related to the menstrual cycle would the client be most likely to report during the initial assessment? 1. Amenorrhea 2. Menorrhagia 3. Metrorrhagia 4. Dysmenorrhea

Amenorrhea Rationale: Amenorrhea or a decreased menstrual flow occurs in the client with Graves' disease. Menorrhagia, metrorrhagia, and dysmenorrhea are also disorders related to the female reproductive system; however, they are not typical manifestations of Graves' disease.

The client seen in the health care clinic has tested positive for gonorrhea. The nurse anticipates that which medication will be prescribed based on this finding? 1. Acyclovir 2. Ceftriaxone 3. Azithromycin 4. Penicillin G benzathine

Ceftriaxone Rationale: Treatment for gonorrhea consists of antibiotic therapy, usually with ceftriaxone and doxycycline. Acyclovir is the treatment for genital herpes simplex virus; azithromycin is the treatment for Chlamydia infection, and penicillin G benzathine is the treatment for syphilis.

A nurse is providing discharge instructions to a client who has just been diagnosed with human papillomavirus (HPV) on her cervix. What is the most important discharge instruction for this client? 1. Take a multivitamin every day. 2. Check for external lesions around the vagina every month. 3. Have Pap tests done as recommended by her provider. 4. Avoid using an intrauterine device (IUD).

Have Pap tests done as recommended by her provider. Rationale: The link between HPV and cervical cancer should be discussed. The client should be instructed regarding regular follow-up after diagnosis and treatment of HPV. Annual Pap tests are essential to assess for disease recurrence.

The nurse is providing teaching to a transgender female to male client who will be started on testosterone therapy. Which information should the nurse include in the teaching session? Select all that apply. 1. Weight loss can be expected. 2. Expect the clitoris to enlarge. 3. Papanicolaou tests are no longer necessary. 4. Menses will stop after the first dose of testosterone. 5. Liver enzymes and cholesterol levels will need to be monitored.

Expect the clitoris to enlarge. Liver enzymes and cholesterol levels will need to be monitored. Rationale: Transgender clients transitioning from female to male will be started on testosterone therapy to enhance masculinization. Expected physiological changes include deepening of the voice, clitoral growth, breast atrophy, increased libido, laryngeal prominence, weight gain, acne, and headaches. Menses will not stop after the first dose of testosterone. It will occur after months, and additional treatment with progesterone may be needed to halt menses. Testosterone therapy can affect liver enzymes, cholesterol, glucose, and coagulation, and therefore these levels will require monitoring.

What are the TORCH infections?

Group of infections capable of crossing the placenta and adversely affecting the fetus Toxoplasmosis Other infections (e.g., hepatitis, HIV) Rubella virus Cytomegalovirus Herpes simplex virus (HSV)

Name viral STI's

HIV HPV HSV HEP A

The community health nurse is preparing an educational class on ovarian cancer for a group of women. Which signs and symptoms should the nurse include in the presentation? Select all that apply. 1. Feeling hungry all the time 2. Having urinary urgency or frequency 3. Experiencing pelvic or abdominal swelling 4. Sense of feeling that something is "falling out" 5. Developing a macular-papular rash over the abdomen

Having urinary urgency or frequency Experiencing pelvic or abdominal swelling Rationale: Signs and symptoms of ovarian cancer are often very subtle. Urinary urgency or frequency, abdominal or pelvic pain or swelling, vague gastrointestinal disturbances such as dyspepsia or gas, and unexplained weight loss are potential signs and symptoms and require further investigation. Hunger and a rash are not associated with this condition. A sense of something "falling out" may be reported by the client experiencing uterine prolapse.

A client has been prescribed pindolol for hypertension. The nurse provides anticipatory guidance, knowing that which common side effect of this medication may decrease client compliance? 1. Impotence 2. Mood Swings 3. Increased appetite 4. Difficulty swallowing

Impotence Rationale: A common side effect of beta-adrenergic blocking agents such as pindolol is impotence. Other common side effects include fatigue and weakness. Central nervous system side effects are rarer and include mental status changes, nervousness, depression, and insomnia. Mood swings, increased appetite, and difficulty swallowing are not side effects of this medication.

A female client seen in the ambulatory care clinic has a history of syphilis infection. The nurse assessing the client for reinfection would expect to observe a lesion on the labia that has which characteristic? 1. Is painless and indurated 2. Has a cauliflower-like appearance 3. Is erythematous and papular in appearance 4. Appears as 1 or more vesicles that then rupture

Is painless and indurated Rationale: The characteristic lesion of syphilis is painless and indurated. The lesion is referred to as a chancre. Genital warts are characterized by cauliflower-like growths or growths that are soft and fleshy. Scabies is characterized by erythematous, papular eruptions. Genital herpes is accompanied by the presence of 1 or more vesicles that then rupture and heal.

What is primary prevention?

Most effective way of reducing STI's in women. Includes knowledge of partner, reduction of sexual partners, low-risk sex, avoiding exchange of body fluids & vaccination

A pregnant client has been diagnosed with a vaginal infection from the organism Candida albicans. Which finding should the nurse expect to note when assessing this client? 1. Costovertebral angle pain 2. Pain, itching, and vaginal discharge 3. Absence of any signs and symptoms 4. Proteinuria, hematuria, edema, and hypertension

Pain, itching, and vaginal discharge Rationale: Clinical manifestations of a vaginal Candida infection include pain; itching; and a thick, white vaginal discharge. Costovertebral angle pain, proteinuria, hematuria, edema, and hypertension are clinical manifestations that may be associated with a urinary tract infection.

The home health care nurse is visiting a client who has undergone a mastectomy. The nurse determines that the client demonstrates greatest adjustment to the loss of the breast if which behavior is noted? 1. The client looks at the surgical site. 2. The client performs the prescribed arm exercises. 3. The client takes the pain medication as prescribed. 4. The client has read all of the postoperative materials provided by the hospital nurse.

The client looks at the surgical site.