37Qw/exp *LOOK Over* OB: Sexually Transmitted and Other Infections

A 21-year-old college student has come to see the nurse practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva, and vaginal discharge has a cottage cheese appearance. These findings are consistent with: a. candidiasis b. trichomoniasis c. bacterial vaginosis d. Chlamydia

A ~ The signs and symptoms of candidiasis include inflammation of the vagina and vulva and a cottage cheese appearance to the vaginal discharge

A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: a) human papillomavirus (HPV). b) Chlamydia trachomatis. c) Candida albicans. d) Trichomonas vaginalis.

A ~ human papillomavirus (HPV) Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

A nurse on the obstetrical unit is admitting a client who is in labor. The client has a positive HIV status.The nurse is aware that which of the following is contraindicated for this client? (Select all that apply.) A. Episiotomy B. Vacuum extraction C. Forceps D. Cesarean birth E. Internal fetal monitoring

A. CORRECT: An episiotomy should be avoided for a client who is HIV positive due to the risk of maternal blood exposure. B. CORRECT: Vacuum extraction during delivery should be avoided because of the risk of fetal bleeding. C. CORRECT: The use of forceps during delivery should be avoided because of the risk of fetal bleeding. D. INCORRECT: A cesarean birth is not contraindicated for this client. E. CORRECT: Internal fetal monitoring should be avoided because of the risk of fetal bleeding.

3. A nurse is caring for a client who has a diagnosis of gonorrhea. Which of the following medications should the nurse anticipate the provider will prescribe? A. Ceftriaxone (Rocephin) B. Fluconazole (Diflucan) C. Metronidazole (Flagyl) D. Zidovudine (Retrovir)

A. CORRECT: Ceftriaxone IM or doxycycline (Vibrarnycin) orally for 7 days is prescribed for the treatment of gonorrhea. B. INCORRECT:Fluconazole is used to treat candidiasis. C. INCORRECT:Metronidazole is used in the treatment of bacterial vaginosis and trichomoniasis. D. INCORRECT:Zidovudine is used to treat HIV/AIDS.

4. A nurse is caring for a client who is in labor. The nurse is aware that which of the following conditions have medications that can be prescribed as prophylactic treatment during labor or immediately following delivery? (Select all that apply.) A. Gonorrhea B. Chlamydia C. HIV D. Group B Streptococcus g-hemolytic E. TORCH

A. CORRECT: Erythromycin (Romycin) is administered to the infant immediately following delivery to treat Neisseria gonotrhoeae. B. CORRECT: Erythromycin (Romycin) is administered to the infant immediately following delivery to treat Chiymydia trachoma tis. C. CORRECT: Retrovir (Zidovudine) is prescribed to the client in labor who is HIV positive. D. CORRECT: Penicillin G or ampicillin (Principen) may be prescribed to treat positive GBS. E. INCORRECT: A TORCH infection may be treated during pregnancy depending upon the infection.

A nurse in an antepartum clinic is providing care for a client. Which of the following clinical findings are suggestive of a TORCH infection? (Select all that apply.) A. Joint pain B. Malaise C. Rash D. Urinary frequency E. Tender lymph nodes

A. CORRECT: TORCH infections are flulike in presentation, such as joint pain. B. CORRECT: TORCH infections are flulike in presentation, such as malaise. C. CORRECT: TORCH infections may include findings such as a rash. D. INCORRECT:Urinary frequency is not a symptom associated with a TORCH infection. E. CORRECT: TORCH infections are fIulike in presentation, such as tender lymph nodes

5. A nurse manager in a prenatal clinic is reviewing ways to prevent a TORCH infection during pregnancy with a group of newly licensed nurses during an education program. Which of the following statements by a nurse indicates understanding of the teaching? A. "Obtain a vaccination against rubella early in pregnancy." B. "Seek prophylactic treatment if cytomegalovirus is detected." C. "A woman should avoid handling dog feces." D. "A woman should avoid consuming undercooked meat."

A. INCORRECT:Vaccination against rubella is contraindicated during pregnancy due to the risk of fetal congenital anomalies. B. INCORRECT:There is no treatment for cytomegalovirus. C. INCORRECT:Toxoplasmosis, a TORCH infection, is contracted by handling cat feces. D. CORRECT: Toxoplasmosis, a TORCH infection, is contracted by consuming undercooked meat.

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a.Bacterial vaginosis b.Candidiasis c.Trichomoniasis d.Gonorrhea

ANS: A Most women with bacterial vaginosis complain of a characteristic "fishy" odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn? a.Wear gloves. b.Wear mouth, nose, and eye protection. c.Wear a mask. d.Wash the hands after medication administration.

ANS: A Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction? a.Vomiting and diarrhea b.Headache, myalgias, and arthralgia c.Preterm labor d.Jarisch-Herxheimer in the first 24 hours after treatment

ANS: A The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.

A client exhibits a thick, white, lumpy, cottage cheese-like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a.Fluconazole b.Tetracycline c.Clindamycin d.Acyclovir

ANS: A The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a.Herpes simplex virus 2 (HSV-2) b.HPV c.HIV d.CMV

ANS: A The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.

The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate? a.Only one vaccine for the HPV is available. b.The vaccine is given in three doses over a 6-month period. c.The vaccine is recommended for both boys and girls. d.Ideally, the vaccine is administered before the first sexual contact.

ANS: A Two vaccines for HPV are available—Cervarix and Gardasil—and other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? a.Strategies to enhance condom use b.Choice of colors and special features c.Leaving the decision up to the male partner d.Places to carry condoms safely

ANS: A When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner. These include role-playing, rehearsal, cultural barriers, and situations that place the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, these features are not as important as negotiating the use of safe sex practices. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. Although this information is important, it is not relevant if the woman cannot even discuss strategies on how to enhance condom use.

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a.Fellatio b.Unprotected anal intercourse c.Multiple sex partners d.Dry kissing e.Abstinence

ANS: A, B, C Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.) a.Menstruation b.Trauma c.Febrile illness d.Soap e.Ultraviolet light

ANS: A, B, C, E Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.

A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital's maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care? a.Intrapartum treatment with antiviral medications b.Cesarean birth c.Postpartum treatment with antiviral medications d.Avoidance of breastfeeding e.Pneumococcal, HBV, and Haemophilus influenzae vaccine

ANS: A, B, D The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.

A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.) a.Toxoplasmosis b.Other infections c.Roseola d.Clostridium e.Herpes simplex

ANS: A, B, E Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are generally more serious.

The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.) a.Number of partners b.Level of physical activity c.Prevention of pregnancy d.Protection from STIs e.Past history

ANS: A, C, D, E Level of physical activity is not a component of this assessment. The five Ps include partners, prevention of pregnancy, protection from STIs, understanding of sexual practices, and past history.

The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a.Miconazole ointment b.Topical podofilox 0.5% solution or gel c.Two doses of penicillin administered intramuscularly (IM) d.Metronidazole by mouth

ANS: B Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete's foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate? a.Vaccine exists for hepatitis C virus (HCV) but not for HBV. b.HAV is acquired by eating contaminated food or drinking polluted water. c.HBV is less contagious than HIV. d.Incidence of HCV is decreasing.

ANS: B Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, "What is that? Can you get rid of it?" Which is the best response for the nurse to provide? a."It's just a little lump on your cervix. We can just freeze it off." b."HPV stands for 'human papillomavirus.' It is a sexually transmitted infection that may lead to cervical cancer." c."HPV is a type of early human immunodeficiency virus. You will die from this." d."You probably caught this from your current boyfriend. He should get tested for this."

ANS: B Informing the client about STIs and the risks involved with the HPV is important. The health care team has a duty to provide proper information to the client, including information related to STIs and the fact that although the HPV and HIV are both viruses that can be sexually transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the HPV before her current boyfriend. The nurse should make no deductions from this limited information.

Which laboratory testing is used to detect the human immunodeficiency virus (HIV)? a.HIV screening b.HIV antibody testing c.Cluster of differentiation 4 (CD4) counts d.Cluster of differentiation 8 (CD8) counts

ANS: B The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed to detect HIV.

Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)? a.Oral antiviral therapy b.Bed rest in a semi-Fowler position c.Antibiotic regimen continued until symptoms subside d.Frequent pelvic examination to monitor the healing progress

ANS: B The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.

Which statements regarding the HPV are accurate? (Select all that apply.) HPV infections: a.are thought to be less common in pregnant women than in women who are not pregnant. b.are thought to be more common in pregnant women than in women who are not pregnant. c.were previously called genital warts. d.were previously called herpes. e.may cause cancer.

ANS: B, C, E HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

What is the drug of choice for the treatment of gonorrhea? a.Penicillin G b.Tetracycline c.Ceftriaxone d.Acyclovir

ANS: C Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

Which sexually transmitted infection (STI) is the most commonly reported in American women? a.Gonorrhea b.Syphilis c.Chlamydia d.Candidiasis

ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

Which STI does not respond well to antibiotic therapy? a.Chlamydia b.Gonorrhea c.Genital herpes d.Syphilis

ANS: C Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.

Which condition is the most life-threatening virus to the fetus and neonate? a.Hepatitis A virus (HAV) b.Herpes simplex virus (HSV) c.Hepatitis B virus (HBV) d.Cytomegalovirus (CMV)

ANS: C HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a.6 to 10 days b.2 to 4 weeks c.6 to 12 weeks d.6 months

ANS: C Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing? a.Bacterial vaginosis b.Candidiasis c.Yeast infection d.Trichomoniasis

ANS: D Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.

Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection? a.Positive prenatal culture b.Preterm birth at 37 weeks or less of gestation c.Maternal temperature of 38° C or higher d.Premature rupture of membranes (PROM) 24 hours or longer before the birth

ANS: D PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38° C or higher is also a risk factor for neonatal GBS infection.

Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis? a.Fever, headache, and malaise b.Widespread rash c.Identified by serologic testing d.Appearance of a chancre 2 months after infection

ANS: D Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a.HSV b.AIDS c.Venereal warts d.Chlamydia

ANS: D The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

The physical assessment and history of a 29-year-old female patient are indicative of human papillomavirus (HPV) infection. You would perform patient teaching related to A) Gardasil. B) Antibiotic therapy. C) Wart removal options. D) Treatment with antiviral drugs.

C ~ Wart removal options The HPV vaccine (Gardasil) is ineffective in cases of existing HPV, whereas neither antiviral nor antibiotic drugs are effective treatments. Patient teaching should focus on the various options for physically removing the warts.

A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the nurse give the patient? a) "It's important to start treatment soon, so you will be prescribed pills today." b) "I'd like to give you an HPV vaccination if that's okay with you." c) "There is a chance that these will clear up on their own without any treatment." d) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease."

C ~ There is a chance that these will clear up on their own without any tx Genital warts may resolve spontaneously, although this does not preclude recurrence. Pharmacologic treatments are topical and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a) why the disease is transmittable only when visible lesions are present. b) the need for the use of petroleum products. c) the option of disregarding safer-sex practices now that he's already infected. d) the importance of informing his partners of the disease.

D ~ Importance of informing his partners of the disease. Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.