Ch 5 Commonly Occurring Infections

26) While reviewing data, the nurse determines that a patient is at risk for pelvic inflammatory disease. Which information did the nurse use to make this clinical determination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Age 23 2. Douches weekly 3. Smokes cigarettes 1 ppd 4. IUD inserted 2 months ago 5. Received HPV vaccination

Answer: 1, 2, 4 Explanation: Pelvic inflammatory disease (PID) occurs most often in sexually active women under age 25. Other risk factors include regular douching and recent insertion of an intrauterine device. Smoking and receiving the HPV vaccination are not risk factors for the development of PID. Page Ref: 84

20) The nurse is concerned that a patient is at risk for developing vulvovaginal candidiasis (VVC). What assessment information caused the nurse to have this concern? Select all that apply. 1. 16 weeks pregnant 2. +3 glucose in the urine 3. Elevated blood pressure 4. Type 2 diabetes mellitus 5. Edematous lower extremities

Answer: 1, 2, 4 Explanation: Predisposing factors to vulvovaginal candidiasis (VVC) infections include pregnancy, glycosuria, and diabetes mellitus. Elevated blood pressure and edematous lower extremities is more likely to be associated with preeclampsia in the pregnant patient. Page Ref: 76

17) A pregnant patient is concerned about the development of several urinary tract infections (U T Is) over the last few months of her pregnancy. What should the nurse explain as reasons for the development of these infections in this patient? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Decrease in bladder tone 2. Hyperemic bladder mucosa 3. Urethral stricture and loss of micturition reflex 4. Ureters elongate and are displaced by the uterus 5. Distal ureters hypertrophy leading to ureteral stenosis

Answer: 1, 2, 4, 5 Explanation: A number of structural and functional changes occur during pregnancy that predispose pregnant women to urinary tract infections. Ureters elongate and are laterally displaced by the gravid uterus. Progesterone, which relaxes smooth muscles, can facilitate hypertrophy of the distal ureters with resulting ureteral stenosis and dilation, especially in the second half of pregnancy. Though the bladder has an increased capacity in pregnancy, it also has a decreased tone because progesterone relaxes the smooth muscle. Estrogen causes the bladder mucosa to become hyperemic and more susceptible to trauma and infection. Pregnancy does not cause urethral strictures and loss of the micturition reflex. Page Ref: 84—85

30) The nurse is caring for a client diagnosed with cystitis. When teaching the client about self-care techniques, which foods or beverages will the nurse advise the client to avoid? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Caffeine 2. Dairy products 3. Alcohol 4. Carbonated beverages 5. Acidic fruit juices

Answer: 1, 3, 4 Explanation: The nurse should advise the client to avoid foods or beverages that are bladder irritants, such as caffeine, alcohol, or carbonated beverages. Dairy products and acidic fruit juices are not considered bladder irritants and would not be included when advising the client to avoid bladder irritants. Page Ref: 86

21) A patient is being assessed for recurrent vulvovaginal candidiasis (VVC) infections. What should the nurse instruct this patient to do to help reduce the incidence of infection? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Avoid douching 2. Use vaginal sprays 3. Wear cotton underwear 4. Avoid tight-fitting clothing 5. Apply cornstarch to the vulva

Answer: 1, 3, 4 Explanation: Ways to prevent the recurrence of VVC include avoiding douching, wearing cotton underwear and avoiding tight-fitting clothing. Vaginal sprays should be avoided since they can irritate the vulva. Applying cornstarch to the vulva could encourage itching. Page Ref: 76—77

25) A college student is distraught after being diagnosed with pediculosis pubis. What should the nurse instruct this student to do to help prevent future infections? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Both partners need to be treated 2. Take the prescribed medication for 10 days 3. Avoid all sexual contact until treated and cured 4. Wash bed linens in hot water and dry in a dryer for 20 minutes 5. Testing for other sexually transmitted infections is recommended

Answer: 1, 3, 4, 5 Explanation: For pediculosis pubis, both partners need to be tested. All sexual contact should be avoided until treated and cured. Bed linens, towels, clothing, and other objects should be machine washed in hot water (at least 103°F) and dried in a hot dryer for 20 minutes. Both partners must be treated and tested for other S T Is. The medication for pediculosis pubis is topical, and repeated if nits are still present. Page Ref: 81—82

24) The nurse is preparing instructions for a patient newly diagnosed with genital herpes. What should the nurse encourage to promote healing of the lesions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Take sitz baths 2. Use vaginal sprays 3. Wear cotton underwear 4. Douche after intercourse 5. Wear loose fitting clothing

Answer: 1, 3, 5 Explanation: Actions to promote healing of genital herpes lesions include taking sitz baths, wearing cotton underwear, and wearing loose fitting clothing. Vaginal sprays and douching after intercourse will not help heal genital herpes lesions. Page Ref: 80

32) A patient seeks medical attention after being exposed to blood during a gang fight several weeks ago. For which types of hepatitis should the nurse anticipate that this patient will be tested? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A 2. B 3. C 4. D 5. E

Answer: 2, 3, 4 Explanation: Hepatitis B, C, and D are transmitted through blood, body fluids, and blood products. Hepatitis A and E are transmitted through the oral-fecal route. Hepatitis A is also transmitted through contaminated food and water. Page Ref: 82

34) The nurse suspects that a newly admitted patient is experiencing manifestations of hepatitis A. What assessment findings did the nurse use to make this clinical determination? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Rash 2. Fever 3. Jaundice 4. Joint pain 5. Gray-colored stool

Answer: 2, 3, 5 Explanation: Hepatitis A is characterized by symptoms of fever, jaundice, and gray-colored bowel movements. A rash and arthritis are associated with hepatitis B, C, and D. Page Ref: 82

14) The nurse in the community clinic is preparing educational materials to be used for teaching patients with sexually transmitted infections. What information should the nurse include regarding the medications metronidazole or tinidazole? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Take this medication until symptoms disappear 2. Abstain from all alcohol while taking these medications 3. Stop taking oral contraceptives while taking these medications 4. Abstain from all alcohol for 72 hours after completing tinidazole 5. Abstain from all alcohol for 24 hours after completing metronidazole

Answer: 2, 4, 5 Explanation: Alcohol should be avoided when taking either metronidazole or tinidazole. When combined with alcohol, both metronidazole and tinidazole can produce effects similar to that of alcohol and Antabuse-abdominal pain, flushing, and tremors. The C D C (2010b) recommends abstaining from alcohol for 24 hours after completing metronidazole and 72 hours after completing tinidazole. If the woman is taking oral contraceptives, a backup nonhormonal contraceptive method is recommended during treatment with metronidazole. The patient should be encouraged to complete the full course of prescribed medications. Page Ref: 74

16) A female patient comes into the clinic because of concerns about a sore that was present on her labia but spontaneously healed. During the interview the patient asks what could occur if the infection is syphilis. In what order should the nurse explain the course of this sexually transmitted infection? 1. Latent period with no lesions 2. Development of a chancre sore 3. Skin eruptions and sore throat occur 4. Tertiary stage with various symptoms 5. Development of a fever, weight loss, and malaise

Answer: 2, 5, 3, 1, 4 Explanation: Syphilis is divided into early and late stages. During the early stage (primary), a chancre appears at the site where the T. pallidum organism entered the body. Symptoms include slight fever, loss of weight, and malaise. The chancre persists for about 4 weeks and then disappears. In 6 weeks to 6 months, secondary symptoms appear. Skin eruptions called condylomata lata, which resemble wart-like plaques and are highly infectious, may appear on the vulva. Other secondary symptoms are acute arthritis, enlargement of the liver and spleen, nontender enlarged lymph nodes, iritis, and a chronic sore throat with hoarseness. A latent phase with no lesions may be followed by a tertiary stage. Page Ref: 80

15) A patient is concerned about contracting herpes genitalis from a sexual partner and asks the nurse what to expect if the infection is present. In which order should the nurse explain the infection to the patient? 1. Emotional trigger occurs 2. Lesions spontaneously appear 3. Take oral acyclovir as prescribed 4. Virus enters a dormant phase with no lesions 5. Development of single or multiple blister-like vesicles

Answer: 5, 3, 4, 1, 2 Explanation: The primary episode (first outbreak) of herpes genitalis is characterized by the development of single or multiple blister-like vesicles. Primary episodes usually last the longest and are the most severe. The recommended treatment of the first clinical episode of genital herpes is oral acyclovir, valacyclovir, or famciclovir. After the lesions heal, the virus enters a dormant phase, residing in the nerve ganglia of the affected area. Recurrences are usually less severe than the initial episode and seem to be triggered by emotional stress, menstruation, ovulation, pregnancy, and frequent or vigorous intercourse. Recurrence of the lesions is less severe. Page Ref: 80

9) The nurse obtains a health history from four clients. To which client should she give priority for teaching about cervical cancer prevention? A) Age 30, treated for P I D B) Age 25, monogamous C) Age 20, pregnant D) Age 27, uses a diaphragm

Answer: A Explanation: A) Exposure to sexually transmitted infections increases the risk of abnormal cell changes and cervical cancer. B) Practicing monogamy does not increase the risk of cervical cancer. C) Pregnancy does not increase the risk of cervical cancer. D) Use of a diaphragm does not increase the risk of cervical cancer. Page Ref: 84

22) A patient and her partner are being treated for trichomoniasis. What should the nurse emphasize when teaching the couple about this infection? A) Avoid intercourse until symptom free B) Ensure a repeat test is completed in 3 months C) Limit alcohol intake while taking metronidazole D) Have annual screening for recurrence of the infection

Answer: A Explanation: A) In trichomoniasis, partners should avoid intercourse until both are cured. Retesting for gonorrhea is recommended 3 months following treatment secondary to increasing prevalence and the potential for P I D. Alcohol should be avoided, not limited, for 48 hours after taking metronidazole because of an effect similar to that of alcohol and disulfiram (Antabuse). Annual screening for sexually active individuals up to age 25 is recommended for chlamydia. Page Ref: 78

7) A client comes to the clinic complaining of difficulty urinating, flu-like symptoms, genital tingling, and blister-like vesicles on the upper thigh and vagina. She denies having ever had these symptoms before. The medication the physician is most likely to order would be: A) Oral acyclovir B) Ceftriaxone I M C) Azithromycin P O D) Penicillin G I M

Answer: A Explanation: A) Malaise, dysuria, and tingling or painful vesicles are indicative of a primary herpes simplex outbreak. Acyclovir treats herpes. B) Ceftriaxone I M does not treat herpes. C) Azithromycin does not treat herpes. D) Penicillin does not treat herpes. Page Ref: 80

27) After a pelvic examination, a patient is scheduled for tests to diagnose pelvic inflammatory disease. Which finding from the physical examination suggested to the nurse practitioner that further testing is required? A) Cervical tenderness B) Greenish vaginal discharge C) Open sores along the vagina D) Condylomata acuminata on the vulva

Answer: A Explanation: A) Manifestations of pelvic inflammatory disease include cervical tenderness or the chandelier sign. Greenish vaginal discharge is associated with gonorrhea. Open sores along the vagina might be associated with genital herpes. Condylomata acuminata on the vulva are genital warts. Page Ref: 84

6) The nurse seeing a client just diagnosed with Chlamydia trachomatis knows that which client is at greatest risk for the infection? A) 16-year-old sexually active girl, using no contraceptive B) 22-year-old mother of two, developed dyspareunia C) 35-year-old woman on oral contraceptives D) 48-year-old woman with hot flashes and night sweats

Answer: A Explanation: A) Teens have the highest incidence of sexually transmitted infections, especially chlamydia. A client not using contraceptives is not using condoms, which decrease the risk of contracting a S T I. B) Dyspareunia sometimes develops with chlamydia infection, but dyspareunia is not a symptom specific to chlamydia. C) There is no correlation between oral contraceptive use and an increased rate of chlamydia infection. Additionally, chlamydia is more commonly seen in young women. D) This client is experiencing signs of menopause, not of chlamydia infection. Page Ref: 78

29) A patient schedules an appointment to be seen in the community clinic for dysuria, urgency, frequency, blood in the urine, and low back pain. For which health problem should the nurse provide care for this patient? A) Cystitis B) Pyelonephritis C) Glomerulonephritis D) Asymptomatic bacteriuria

Answer: A Explanation: A) The classic initial symptoms of cystitis include dysuria, urgency, frequency, low back pain and hematuria. Manifestations of acute pyelonephritis include a sudden onset with chills, high temperature, costovertebral angle tenderness or flank pain, nausea, vomiting, and general malaise. Manifestations of glomerulonephritis include periorbital edema, elevated blood pressure, and urinary changes. Asymptomatic bacteriuria has no characteristic manifestations. Page Ref: 85

10) The nurse is discharging a client after hospitalization for pelvic inflammatory disease (P I D). Which statements indicate that teaching was effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. A) "I might have infertility because of this infection." B) "It is important for me to finish my antibiotics." C) "Tubal pregnancy could occur after PID." D) "My PID was caused by a yeast infection." E) "I am going to have an IUD placed for contraception."

Answer: A, B, C Explanation: A) Women sometimes become infertile because of scarring in the fallopian tubes as a result of the inflammation of PID. B) Antibiotic therapy should always be completed when a client is diagnosed with any infection. C) The tubal scarring that occurs from tubal inflammation during PID can prevent a fertilized ovum from passing through the tube into the uterus, causing an ectopic or tubal pregnancy. D) PID is caused by bacteria, most commonly Chlamydia trachomatis or Neisseria gonorrhoeae. E) An intrauterine device (IUD) in place increases the risk of developing PID; a client who has a history of PID is not a good candidate for an IUD. Page Ref: 84

4) The nurse is seeing clients in the women's clinic. Which client should be treated with ceftriaxone I M and doxycycline orally? A) A pregnant client with gonorrhea and a yeast infection B) A nonpregnant client with gonorrhea and chlamydia C) A pregnant client with syphilis D) A nonpregnant client with chlamydia and trichomoniasis

Answer: B Explanation: A) A pregnant client would not be treated with doxycycline. B) The combined treatment of ceftriaxone I M and doxycycline orally provides dual treatment for gonorrhea and chlamydia, which frequently occur together. C) The combined treatment of ceftriaxone I M and doxycycline orally is not the correct treatment for syphilis, and a pregnant client would not be treated with doxycycline. D) The combined treatment of ceftriaxone I M and doxycycline orally is not the correct treatment for trichomoniasis. Page Ref: 77

13) The nurse is preparing an education session for women on the prevention of urinary tract infections (UTIs). Which statement should be included? A) Lower urinary tract infections rarely occur in women. B) The most common causative organism of cystitis is E. coli. C) Wiping from back to front after a B M will help prevent a UTI. D) Back pain often develops with a lower urinary tract infection.

Answer: B Explanation: A) About 60% of women will experience an episode of cystitis during their lifetime. B) E. coli is present in 75% to 90% of women with UTIs. C) Wiping from back to front increases the risk of UTIs because the E. coli of the bowel is being drawn toward the urethra. Women should be instructed always to wipe from front to back. D) Low back or flank pain is a sign of pyelonephritis, which is an upper urinary tract infection. Page Ref: 85

5) The nurse is providing follow-up education to a client just diagnosed with vaginal herpes. What statement by the client verifies correct knowledge about vaginal herpes? A) "I should douche daily to prevent infection." B) "I could have another breakout during my period." C) "I am more likely to develop cancer of the cervix." D) "I should use sodium bicarbonate on the lesions to relieve discomfort."

Answer: B Explanation: A) Douching does not prevent infection. B) Menstruation seems to trigger recurrences of herpes. C) There is no relation between herpes and cancer of the cervix. D) Burow's (aluminum acetate) solution, not sodium bicarbonate, relieves discomfort. Page Ref: 80

8) The nurse is caring for a client hospitalized for pelvic inflammatory disease. Which nursing intervention would have priority? A) Encourage oral fluids B) Administer cefotetan Ⅳ C) Enforce bed rest D) Remove I U C, if present

Answer: B Explanation: A) Encouraging oral fluids is not a priority. B) Administration of medications to treat the disease is the first priority. C) Bed rest is not a priority. D) Removal of an I U C is not a nursing intervention. Page Ref: 84

33) The nurse is planning teaching for a patient diagnosed with hepatitis A. What should the nurse emphasize when instructing the patient about this disease process? A) It is a chronic illness B) It is not a chronic illness C) A vaccination is not available D) It occurs in East and South Asia

Answer: B Explanation: A) Hepatitis A is self-limiting and is not a chronic condition. Hepatitis B, C, and D infections are chronic. There is a vaccination available for hepatitis A. Hepatitis E is common worldwide and occurs primarily in East and South Asia. Page Ref: 82

28) The nurse is reviewing laboratory testing completed for a patient with suspected pelvic inflammatory disease. Which test result should the nurse identify as supporting this diagnosis? A) Decreased hematocrit level B) Elevated sedimentation rate C) Decreased hemoglobin level D) Elevated white blood cell count

Answer: B Explanation: B) In pelvic inflammatory disease the woman may have an elevated sedimentation rate. Decreased hematocrit and hemoglobin levels would indicate bleeding. An elevated white blood cell count indicates an infection, which may or may not occur with pelvic inflammatory disease. Page Ref: 84

2) The nurse is providing discharge instructions to a client with a diagnosis of vulvovaginal candidiasis (V V C), and knows the client understands when she makes which of the following statements? A) "I need to apply the miconazole for 10 days." B) "I need to douche daily." C) "I need to add yogurt to my diet." D) "I need to wear nylon panties."

Answer: C Explanation: A) Applying miconazole for 10 days does not prevent or assist in treating vulvovaginal candidiasis. B) Douching daily does not prevent or assist in treating vulvovaginal candidiasis. C) Yogurt helps reestablish normal vaginal flora. D) Wearing nylon panties does not prevent or assist in treating vulvovaginal candidiasis. Page Ref: 77

11) Which of the following diagnostic tests would the nurse question when ordered for a client diagnosed with pelvic inflammatory disease (P I D)? A) CBC (complete blood count) with differential B) Venereal Disease Research Laboratory (VDRL) C) Throat culture for Streptococcus A D) RPR (Rapid Plasma Reagin)

Answer: C Explanation: A) CBC with differential will be ordered to give an indication of the severity of the infection. B) The Venereal Disease Research Laboratory (VDRL) test checks for syphilis. C) Streptococcus of the throat is not associated with PID. D) RPR is a test for syphilis, a cause of PID. Page Ref: 84

3) The nurse provides a couple with education about the consequences of not treating chlamydia, and knows they understand when they make which statement? A) "She could become pregnant." B) "She could have severe vaginal itching." C) "He could get an infection in the tube that carries the urine out." D) "It could cause us to develop a rash."

Answer: C Explanation: A) Chlamydia does not cause a woman to become pregnant. B) Chlamydia does not cause vaginal itching. C) Chlamydia is a major cause of nongonococcal urethritis (N G U) in men. D) Chlamydia does not cause a rash. Page Ref: 77

12) Women with pyelonephritis during pregnancy are at significantly increased risk for which condition? A) Foul-smelling discharge B) Ectopic pregnancy C) Preterm labor D) A colicky large intestine

Answer: C Explanation: A) Foul-smelling discharge is not a symptom of pyelonephritis. B) Ectopic pregnancy is not a symptom of pyelonephritis. C) Women with pyelonephritis during pregnancy are at significantly increased risk of preterm labor, preterm birth, development of adult respiratory distress syndrome, and septicemia. D) A colicky large intestine is an incorrect response. Page Ref: 85

19) A patient in the 2nd trimester of pregnancy is diagnosed with bacterial vaginosis. Which medication regimen should the nurse expect to be prescribed for this patient? A) Metronidazole 500 mg orally one dose B) Metronidazole 250 mg orally once a day for 7 days C) Metronidazole 500 mg orally twice a day for 7 days D) Metronidazole 250 mg orally twice a day for 14 days

Answer: C Explanation: C) The recommended treatment of bacterial vaginosis during pregnancy is Metronidazole 500 mg orally twice a day for 7 days. One dose of metronidazole is not sufficient. Metronidazole 250 mg should be taken 3 times for 7 days to be effective. Metronidazole 250 mg does not need to be taken for 14 days. Page Ref: 74

23) A patient is being instructed on adverse effects of gonorrhea. For which reason should the nurse instruct the patient to contact the healthcare provider? A) Dysuria B) Urinary frequency C) Sharp abdominal pain D) Purulent, greenish-yellow vaginal discharge

Answer: C Explanation: C) Women should be informed of signs that the infection is worsening, such as sharp abdominal pain, and be encouraged to seek further care. Dysuria, urinary frequency, and purulent, greenish-yellow vaginal discharge are manifestations of gonorrhea and do not indicate that the infection is getting worse. Page Ref: 79—80

1) A nonpregnant client is diagnosed with bacterial vaginosis (BV). What does the nurse expect to administer? A) Penicillin G 2 million units IM one time B) Zithromax 1 mg PO bid for 2 weeks C) Doxycycline 100 mg PO bid for a week D) Metronidazole 500 mg PO bid for a week

Answer: D Explanation: A) Penicillin is not used to treat bacterial vaginosis. B) Zithromax is not used to treat bacterial vaginosis. C) Doxycycline is not used to treat bacterial vaginosis. D) The nonpregnant woman who is diagnosed with bacterial vaginosis (BV) is treated with metronidazole 500 mg orally twice a day for 7 days. Page Ref: 78

31) A patient treated for a urinary tract infection a month ago is experiencing symptoms of the same infection. What should the nurse suspect is the reason for the reoccurrence of the infection? A) Using oral contraceptives B) Wearing cotton underwear C) Cleansing from front to back D) Stopped antibiotics after 3 days

Answer: D Explanation: D) Not completing a full course of prescribed antibiotics could cause remaining bacteria to grow, leading to another infection. Use of oral contraceptives is not a risk factor for the development of a urinary tract infection. Wearing cotton underwear and cleansing from front to back are actions that reduce the risk of developing urinary tract infections. Page Ref: 86

18) The nurse suspects that a patient is experiencing bacterial vaginosis. What finding caused the nurse to make this clinical determination? A) Dysuria B) Vaginal itching C) Thick white vaginal discharge D) Fishy odor to vaginal discharge

Answer: D Explanation: D) The person with bacterial vaginosis may have a thin watery discharge with a fishy odor. Dysuria, vaginal itching, and thick white vaginal discharge are manifestations of vulvovaginal candidiasis. Page Ref: 74