Chapter 46 PrepU

A female client is found to have genital warts during a routine pelvic examination. Which sexually transmitted infection will the nurse prepare to test for? a. Adenovirus b. Herpes simplex virus c. Human papillomavirus d. Chlamydia trachomatis

Human papillomavirus Condylomata acuminata, or genital warts, are caused by the human papillomavirus (HPV).

A 22-year-old client has presented to the primary health care provider for an annual Papanicolaou (Pap) test. Which infection will give abnormal results of this diagnostic test? a. Chlamydia trachomatis b. Trichomonas vaginalis c. Human papillomavirus (HPV) d. Candida albicans

Human papillomavirus (HPV) Although a Pap test does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. The only test for HPV is for high-risk HPV DNA. An abnormal Pap test is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

The nurse assesses a client during perineal care and finds a foul odor coming from the vaginal area. What is the best statement for the nurse to make? a. "You will need medication therapy. I am going to call the health care provider." b. "You need to make certain that you wash daily." c. "You may have an infection." d. "Do you have any other symptoms?"

"Do you have any other symptoms?" A foul odor in itself is not a diagnosis. The nurse needs more assessment before planning intervention. The only statement that assesses further is the nurse asking "Do you have any other symptoms?" If the client has an infection or other condition, there may be symptoms such as itching, pain, and burning. Implementation cannot begin with the stated information.

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? a. "I will use antibiotic cream as directed twice a day until the infection is cured." b. "The infection is not contagious and will resolve on its own in a few days." c. "I will use condoms during sex until I finish taking all the antibiotics." d. "My partner will need to take antibiotics at the same time I do."

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

In teaching a client about genital warts, which statement is correct for the nurse to say? a. "If you are infected, you will see warts right away." b. "The infection will start about a day after you are exposed." c. "The warts often never develop and you will not know if you are a carrier." d. "The incubation period is 6 weeks to 3 months."

"The incubation period is 6 weeks to 3 months." The incubation period for human papillomavirus-induced genital warts ranges from 6 weeks to 8 months with a mean of 2 to 3 months.

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

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

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

A client who is sexually active 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.

Which information is essential for a nurse to include in the teaching plan for a client receiving metronidazole for trichomoniasis? a. After taking the medication, sit upright for half an hour. b. Do not take food with this medication. c. Do not drink grapefruit juice while on this medication. d. Abstinence is recommended until the therapy is completed

Abstinence is recommended until the therapy is completed. The client should refrain from sexual activity until therapy with metronidazole is completed due to the risk of transmitting the parasite to sexual partners.

There is no known cure for genital herpes, and methods of treatment are often symptomatic. Pharmacologic management of genital herpes includes which drugs? a. Nonsteroidal anti-inflammatory drugs b. Acyclovir c. Topical corticosteroid compounds d. AZT

Acyclovir The antiviral drugs acyclovir, valacyclovir, and famciclovir have become the cornerstone for management of genital herpes. The other drugs are not used in the treatment of genital herpes.

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? a. Asking about other symptoms b. Flushing the area with an antibiotic wash c. Applying an antifungal cream d. Encouraging better hygiene

Asking about other symptoms 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 nurse is attempting to culture a lesion to determine if a client has genital herpes. What is the nurse's best action? a. Attempt to culture a lesion as soon as it develops. b. Wait until day 5 to attempt to culture a lesion. c. Wash the area well before attempting a culture. d. Culture a lesion first thing in the morning.

Attempt to culture a lesion as soon as it develops. The likelihood of obtaining a positive culture decreases with each day that elapses after a lesion develops. It is best to attempt a culture as soon as it develops. The chance of obtaining a positive culture from a crusted lesion is slight. It does not matter what time of day it is when the culture is collected, nor does the area have to be washed.

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

Azithromycin 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.

During infertility workup, the client is diagnosed with chlamydial infection. The health care provider will especially be looking for which complication of chlamydial infections that can interfere with egg transportation? a. Amenorrhea b. Fallopian tube damage c. Vaginal adhesions d. Uterine cancer

Fallopian tube damage Chlamydia causes a wide variety of genitourinary infections; Chlamydia trachomatis infection is the most common reportable sexually transmitted infection (STI) in the United States. In women, untreated infection can lead to severe reproductive complications, including infertility, pelvic inflammatory disease, ectopic pregnancy, and chronic pelvic pain; in men, it can cause prostatitis and epididymitis with subsequent infertility. The cervix frequently hypertrophies and becomes erythematous, edematous, and extremely friable. This can lead to greater fallopian tube damage. Chlamydial infections are not associated with any reproductive cancers or amenorrhea.

A male reports urethral pain and a creamy yellow, bloody discharge from the penis. The provider suspects the client has which sexually transmitted infection? a. Trichomoniasis b. Chancroid c. Gonorrhea d. Candidiasis

Gonorrhea In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

A client who has been diagnosed with gonorrhea asks the nurse if anyone has to know about it. The best response by the nurse is: a. If the client abstains from sexual intercourse, it does not need to be reported. b. Gonorrhea is a reportable sexually transmitted infection. c. It is only reported after the second infection. d. It is only reported if a client is married.

Gonorrhea is a reportable sexually transmitted infection. All sex partners within 60 days prior to discovery of the infection should be contacted, tested, and treated. There are no exceptions to the requirement.

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

Only two strains of the virus are considered sexually transmittable. 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 client presents with gonorrhea. Which of the following is a primary nursing action? a. Inserting a peripherally inserted central catheter b. Treating all members of the client's family c. Keeping the client hospitalized for treatment d. Reporting the case to the Centers for Disease Control and Prevention

Reporting the case to the Centers for Disease Control and Prevention Gonorrhea is a reportable sexually transmitted infection.

Which assessment finding helps the nurse confirm that the client has genital warts? a. Soft, raised lesions on external genitalia b. Dark red, hard lesions on external genitalia c. Dark brown or black papules on external genitalia d. Hard white lesions with dark centers

Soft, raised lesions on external genitalia Genital warts typically present as soft, raised, fleshy lesions on the external genitalia, including the penis, scrotum, perineum, and perianal skin.

A young woman is almost ready to deliver, and she has an outbreak of genital herpes. What is the nurse's best action? a. Apply topical anesthetics generously as delivery will be painful. b. Make certain the woman takes pain medication prior to delivering. c. Wash the area vigorously prior to delivery to decrease the risk of transmission to the baby. d. Tell the woman about a cesarean section.

Tell the woman about a cesarean section. A woman who presents with a genital herpes outbreak prior to delivery should be told about a cesarean section, which is recommended to protect the newborn from transmission. Washing the area and applying pain medication will not stop the transmission of this disease. Oral pain medication is helpful during delivery; however, vaginal delivery is not recommended with this condition.

A client has been diagnosed with candidiasis. Which symptom was present to diagnose this condition? a. Urinary retention b. Pustules c. Severely painful lesions d. Thick white secretions

Thick white secretions Candidiasis presents with thick, white, curdlike secretions; however, it is possible the secretions can be thin. The other symptoms are not usually associated with this condition.

A client was diagnosed with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). The nurse realizes that the client needs further teaching about the disease process based on which statement? a. "HIV only infects B cells." b. "The infection requires a host cell." c. "After infection the HIV virus can exist in a latent state." d. "HIV is a retrovirus."

"HIV only infects B cells." The retroviruses such as HIV have a unique mechanism of replication. After entry into the host cell, the viral RNA genome is first translated into DNA by a viral enzyme called reverse transcriptase. The viral DNA copy is then integrated into the host chromosome where it exists in a latent state, similar to the herpes viruses. Reactivation and replication require a reversal of the entire process. Some retroviruses lyse the host cell during the process of replication. In the case of HIV, the infected cells regulate the immunologic defense system of the host, and their lysis leads to a permanent suppression of the immune response.

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

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

Which statement(s) is true concerning syphilis? Select all that apply. a. It is a reportable systemic sexually transmitted infection (STI). b. The disease is more prevalent in men. c. The disease is eradicated in North America. d. The disease is caused by a virus. e. Primary spread of the disease is through direct contact with lesions.

-It is a reportable systemic sexually transmitted infection (STI). -The disease is more prevalent in men. -Primary spread of the disease is through direct contact with lesions. Syphilis is a reportable systemic sexually transmitted infection caused by a spirochete, which is a type of bacteria. The disease is not eradicated in North America, and it is more prevalent in men than women. Primary spread is through direct contact with lesions.

What is the US Centers for Disease Control and Prevention's recommended treatment for a chlamydial infection in men? a. Penicillin b. Ceftriaxone c. Ciprofloxacin d. Doxycycline

Doxycycline The CDC recommends the use of azithromycin or doxycycline in the treatment of chlamydial infection. Penicillin is ineffective. Azithromycin is the preferred choice in pregnancy. Ceftriaxone is the recommended treatment for gonorrhea.

A female client presents to the clinic with a rash on the palms of her hands, symptoms of hair loss, and the development of elevated, red-brown lesions that have begun to ulcerate and produce a foul discharge. Based on these symptoms, the nurse plans to test the client for which sexually transmitted infection? a. Gonorrhea b. Syphilis c. Chlamydia d. Genital herpes

Syphilis The timing of the second stage of syphilis varies even more than that of the first, lasting from 1 week to 6 months. The symptoms of a rash (especially on the palms, mucous membranes, meninges, lymph nodes, stomach, soles, and liver), fever, sore throat, stomatitis, nausea, loss of appetite, and inflamed eyes may come and go for a year but usually last for 3 to 6 months. Secondary manifestations may include some loss of hair and condylomata lata. These lesions are elevated, red-brown lesions that may ulcerate and produce a foul discharge. They are 2 to 3 cm in diameter, contain many spirochetes, and are highly infectious.

A young woman has contracted the human papillomavirus (HPV) and has developed genital warts. The client is eager to receive an HPV vaccine, citing the large number of television advertisements she has seen. How should the nurse best respond? a. "These will only be effective if you already received an injection in your teens." b. "Unfortunately, these vaccines are not effective once you have HPV." c. "That treatment is something you will have to discuss with your primary health care provider." d. "Your primary health care provider will likely recommend watchful waiting for the next few weeks."

"Unfortunately, these vaccines are not effective once you have HPV." Currently, there is no treatment to eradicate HPV once a person has become infected. Vaccines are ineffective against active infection of a certain type of HPV or colonization of the same. This is true regardless of whether a vaccine was administered in the client's teens. Referring the client to the primary health care provider without supplying any anticipatory guidance would be inappropriate.

An older adult client may be experiencing symptoms of tertiary syphilis. Which characteristic would the nurse associate with tertiary syphilis years after the initial infection? a. Chancre papules b. Condylomata lata c. Dementia d. Maculopapular rash

Dementia Tertiary syphilis is a delayed response of the untreated disease. The symptomatic tertiary stage frequently affects the cardiovascular system, central nervous system, and the liver, bones, and testes. Central nervous system lesions can produce dementia, blindness, or injury to the spinal cord, with ataxia and sensory loss. Chancre is the primary syphilitic lesion. Second-stage syphilis is characterized by a maculopapular rash of the palms of the hands or soles of the feet. Condylomata lata are genital lesions that are highly infectious.

A male client presents to the clinic with profuse, purulent urethral discharge with painful urination. Which information will be most important for the nurse to obtain? a. Contraceptive use b. Sexual orientation c. Recent sexual contacts d. Immunization history

Recent sexual contacts The Centers for Disease Control and Prevention (CDC) requires reporting of chlamydia, syphilis, and gonorrhea and, therefore, tracks these three STIs most specifically. There are many factors that contribute to the increased prevalence and the continued spread of STIs. One key factor is that STIs are frequently asymptomatic, which promotes the spread of infection by people who are unaware they are carrying the infection. Obtaining a list of recent partners can help to identify and treat potential carriers.

The primary reason genital herpes has reached epidemic proportions throughout the world relates to the fact that: a. the lesions (LSILs) occur on the cervix and can only be detected by a Pap test. b. the organism spreads upward to the prostate gland in males and fallopian tubes in females. c. the lesions take a long time to incubate and the small papules are usually located inside the vagina. d. a large percentage (70%) of those infected experience no symptoms of the disease.

a large percentage (70%) of those infected experience no symptoms of the disease. Persons infected with HSV-1 remain at risk for acquiring HSV-2. Most cases of HSV-2 infection are subclinical, manifesting as asymptomatic or symptomatic but unrecognized infections. These subclinical infections can occur in people who have never had a symptomatic outbreak or they can occur between recognized clinical recurrences. Up to 70% of genital herpes is spread through asymptomatic shedding by people who do not realize they have the infection. Transient HPV infections can develop low-grade squamous intraepithelial lesions (LSILs) of the cervix as detected on a Pap test, colposcopy, or biopsy. Lesions of LGV can incubate for a few days to several weeks and thereafter cause small, painless papules or vesicles that may go undetected. If untreated, gonorrhea spreads from its initial sites upward into the genital tract. In males, it spreads to the prostate and epididymis; in females, it commonly moves to the fallopian tubes.