Chapter 51: Sexually Transmitted Infections

28. A patient who is using imiquimod (Aldara) for genital warts asks the outpatient clinic nurse how long she must use the medication. The nurse replies that she must apply the medication for _____ weeks.

ANS: 16 The protocol for Aldara is application three times a day for 16 weeks. DIF: Cognitive Level: Knowledge REF: p. 1168 OBJ: 6 TOP: Genital Warts KEY: Nursing Process Step: Implementation

18. What is characteristic of the primary stage syphilis? a. Chancre b. Alopecia c. Pruritus d. Dry skin

ANS: A A typical lesion, a chancre, is the first sign of syphilis. DIF: Cognitive Level: Knowledge REF: p. 1170-1171 OBJ: 4 TOP: Syphilis KEY: Nursing Process Step: Assessment

16. A nurse asks a patient to repeat the instructions to evaluate her knowledge about safe sex practices. Which statement indicates an understanding? a. "Body massage would be considered safe." b. "Mutual open-mouth kissing is safe." c. "Vaginal intercourse with a properly used condom is safe." d. "Anal sex with a condom made of latex is a safe sex practice."

ANS: A Body massage is considered a safe sex practice. DIF: Cognitive Level: Comprehension REF: p. 1179 OBJ: 9 TOP: Safety of Various Sexual Practices KEY: Nursing Process Step: Evaluation

7. A patient at the outpatient clinic is reluctant to identify her sexual contacts. Why is the reporting of contacts essential? a. Slows transmission and spread of infections b. Increases public awareness c. Increases state funding for treatment d. Collects data for research

ANS: A Confirmed cases are reported to the health department. The purpose is to identify and treat infected individuals so that transmission can be slowed. DIF: Cognitive Level: Comprehension REF: p. 1166 OBJ: 2 TOP: Reporting STIs KEY: Nursing Process Step: Implementation

5. A woman diagnosed with gonorrhea is astounded and states that she had no idea that she had an STI. What should the nurse explain about gonorrhea? a. It produces no symptoms in half of those in the early stages of the infection. b. It always produces a foul vaginal discharge. c. It causes a vaginal chancre that is not easily detected. d. It may appear to be an upper respiratory infection in the early stages of the infection.

ANS: A More than half of those in the early stages of gonorrhea have no symptoms at all. Symptoms of gonorrhea typically occur 3 days to 3 weeks after exposure and are more apparent in men than in women. No chancre is exhibited, as with syphilis, and gonorrhea does not produce a foul discharge. DIF: Cognitive Level: Application REF: p. 1170 OBJ: 4 TOP: Gonorrhea KEY: Nursing Process Step: Assessment

21. What does chlamydial infection place a person at greater risk for? a. HIV if exposed to it b. Urinary infections c. Hepatitis B if exposed to it d. Opportunistic bacterial infections

ANS: A Patients who have a chlamydial infection are five times more likely to contract HIV if exposed to it. DIF: Cognitive Level: Knowledge REF: p. 1166 OBJ: 8 TOP: Chlamydia KEY: Nursing Process Step: Implementation

13. Which method is used to identify organisms of gonorrhea? a. Smears and cultures b. Serologic tests c. Antibody screening d. Sensitivity testing

ANS: A Smears from genital discharge can be studied on a smear. DIF: Cognitive Level: Knowledge REF: p. 1170 OBJ: 1 TOP: Tests Used to Diagnose STIs KEY: Nursing Process Step: Assessment

11. A couple comes to the emergency department for the treatment of an STI. The man's presenting symptoms include a creamy penile discharge and frequent urination. The woman has lower abdominal pain and a vaginal discharge. What should the nurse recognize these symptoms to characterize? a. Chlamydial infection b. Gonorrhea infection c. HSV type B d. Trichomoniasis

ANS: A Symptoms in men are penile discharge, thin at first and then creamy, and frequent urination. Symptoms in women are a vaginal discharge and lower abdominal pain. DIF: Cognitive Level: Comprehension REF: p. 1166-1167 OBJ: 4 TOP: Chlamydia KEY: Nursing Process Step: Assessment

25. A nurse explains that STIs must be reported to the local public health department. Which are considered reportable diseases? (Select all that apply.) a. HIV b. Acquired immunodeficiency syndrome (AIDS) c. Gonorrhea d. Chlamydia e. Viral hepatitis

ANS: A, B, C, E All confirmed cases of HIV, AIDS, gonorrhea, syphilis, and viral hepatitis are reportable. Chlamydia is not reportable. DIF: Cognitive Level: Knowledge REF: p. 1166 OBJ: 2 TOP: Reportable Diseases KEY: Nursing Process Step: Implementation

27. A nurse recognizes that a patient with an STI may not cooperate in reporting sexual contacts. What fears might prevent reporting? (Select all that apply.) a. Judgment by health care workers b. Identifying self as infected c. Rejection by contacts d. Infecting others e. Reprisal from identified contacts

ANS: A, B, C, E Infection of others has already occurred. DIF: Cognitive Level: Comprehension REF: p. 1165 OBJ: 2 TOP: Impediments to Reporting STIs KEY: Nursing Process Step: Assessment

26. What body areas might systemic (disseminated) gonorrhea involve? (Select all that apply.) a. Heart b. Eyes c. Meninges d. Skin e. Joints

ANS: A, C, D, E Systemic gonorrhea may damage all of the body areas mentioned except the eyes. DIF: Cognitive Level: Knowledge REF: p. 1169-1170 OBJ: 4 TOP: Systemic Gonorrhea KEY: Nursing Process Step: Implementation

8. A patient with gonorrhea is taking a protocol of tetracycline antibiotics. Which statement by the nurse is most likely to help overcome patient noncompliance? a. "You should take all of this medicine." b. "Failing to take the entire medicine amount will make your disease resistant to it." c. "You will become sterile if you do not complete the supply of medicines." d. "The doctor wants you to take all of this medication."

ANS: B Explain to the patient that medication-resistant disease is a real possibility if the entire amount of the prescription is not taken. Sterility is not related to noncompliance with the medication, but it is related to repeated occurrence of the gonorrhea. DIF: Cognitive Level: Application REF: p. 1170 OBJ: 8 TOP: Treatment Noncompliance KEY: Nursing Process Step: Planning

20. Which antiviral drug is commonly used to relieve symptoms of herpes simplex virus (HSV)? a. Tetracycline (Achromycin) b. Acyclovir (Zovirax) c. Erythromycin (E-Mycin) d. Metronidazole (Flagyl)

ANS: B No cure is available for HSV infection, but oral antiviral drugs similar to acyclovir (Zovirax) help partially control the signs and symptoms during initial and recurrent episodes. DIF: Cognitive Level: Knowledge REF: p. 1168 | p. 1173 OBJ: 8 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Assessment

15. What instruction should be included by a health educator giving a presentation on how to use condoms correctly? a. Condoms are 100% effective when used correctly. b. The effectiveness of condoms deteriorates in heat. c. Any style and material of condom is safe to use. d. Use of petroleum jelly will ease application.

ANS: B Protect condoms from heat and sunlight to keep them from deteriorating. DIF: Cognitive Level: Comprehension REF: p. 1180 OBJ: 9 TOP: Condoms KEY: Nursing Process Step: Implementation

9. A patient with syphilis is seen at the clinic and complains of body aches, pustules, fever, and sore throat. Which stage of syphilis should the nurse recognize these symptoms identify? a. Primary b. Secondary c. Latent d. Late

ANS: B Symptoms in the secondary stage are body aches, rash, pustules, fever, and sore throat. DIF: Cognitive Level: Comprehension REF: p. 1171 OBJ: 4 TOP: Syphilis KEY: Nursing Process Step: Assessment

2. A nurse is completing a history of illnesses for a young woman who suspects she may have a sexually transmitted infection (STI). What specific symptom(s) should the nurse ask this patient if she experienced? a. Lethargy and fatigue b. Genital discharge c. Abdominal cramps d. Heavy menses

ANS: B With an STI, the patient usually complains of genital discharge. DIF: Cognitive Level: Application REF: p. 1176 OBJ: 7 TOP: Collecting Data KEY: Nursing Process Step: Assessment

10. Doxycycline (Vibramycin) has been prescribed for a patient who has gonorrhea. What instruction should the nurse provide to the patient before beginning the medication? a. Take the medication with food or crackers. b. Refrain from sexual relations for 4 weeks. c. Follow up to determine if the treatment was effective. d. Keep the medication in the refrigerator.

ANS: C Follow-up examinations are important to determine whether treatment has been effective to prevent reinfection of the partner. DIF: Cognitive Level: Application REF: p. 1170 OBJ: 6 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Implementation

3. A patient has been diagnosed with herpes simplex virus, type 2 (HSV type 2). What instruction should the nurse provide? a. Avoid telling anyone about the condition. b. Wear close-fitting undergarments. c. Wash towels and personal items daily. d. Soak the sores with peroxide every day.

ANS: C Inform the patient that the virus can survive on objects such as towels. DIF: Cognitive Level: Application REF: p. 1174 OBJ: 8 TOP: Herpes Simplex Virus, Type 2 KEY: Nursing Process Step: Implementation

4. A nurse is caring for a patient taking acyclovir (Zovirax). Which side effects of this drug should the nurse be alert for? a. Fever and bone marrow suppression b. Vaginal burning and skin irritation c. Dizziness, headache, and nausea d. Leukopenia and peripheral neuropathy

ANS: C Side effects include dizziness, headache, nausea and vomiting, renal failure, and seizures. DIF: Cognitive Level: Comprehension REF: p. 1168 OBJ: 6 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Planning

1. A nurse in the outpatient clinic notes that a patient has been treated for syphilis three separate times in the past 2 years. What should the antibiotic treatment for this patient consist of this time? a. Penicillin G b. Penicillin G today and a follow-up with another injection in 1 month c. Penicillin G today and 3 months of oral tetracycline antibiotic medications d. Penicillin G today and a 2-month protocol of oral antiviral agents

ANS: C The patient who has had syphilis for more than 1 year will need a long-term antimicrobial remedy, as well as an initial dose of penicillin G. Antiviral agents are not used in the treatment of a bacterial disease. DIF: Cognitive Level: Comprehension REF: p. 1172-1173 OBJ: 4 TOP: Drug Protocol for Syphilis KEY: Nursing Process Step: Planning

24. A patient with a chlamydial infection is taking a 7-day course of doxycycline (Vibramycin). What information should the nurse provide? a. Return in 1 month for a follow-up culture. b. Take the drug on an empty stomach with a minimum of fluid. c. Delay sexual activity until cured. d. Expect genital or anal itching or burning.

ANS: C The patient with a chlamydial infection should delay sexual activity until completely clear. Follow-up cultures are obtained 4 to 7 days after the initiation of the drug, and the drug should be taken with food or milk. DIF: Cognitive Level: Application REF: p. 1169-1170 OBJ: 6 TOP: Vibramycin KEY: Nursing Process Step: Implementation

12. A pregnant patient with HSV type 2 has a Herp-Test performed in the physician's office 1 day before she is due to deliver by cesarean section. The test result is negative. What should the nurse know this means? a. The delivery must be by cesarean section. b. The patient must start on an antiviral protocol today. c. The baby will have to have antiviral medication 24 hours after birth. d. The delivery may be accomplished vaginally.

ANS: D A negative Herp-Test result shows no active viral disease, and the birth can be accomplished vaginally if the physician prefers. DIF: Cognitive Level: Comprehension REF: p. 1166 OBJ: 4 TOP: Herp-Test KEY: Nursing Process Step: Planning

22. A patient at the outpatient clinic who has received an intramuscular dose of ceftriaxone sodium (Rocephin) calls and complains of pain and induration at the injection site. What should the nurse advise the patient to do? a. Undergo 30 minutes of active exercise to speed absorption of the drug. b. Make an appointment at the clinic for evaluation to initiate another drug. c. Immediately come to the clinic for treatment of the allergic reaction. d. Place a warm compress on the area.

ANS: D A warm compress may be applied to the area because these symptoms are the expected results of the injection, not allergic reactions. Another drug is not needed. DIF: Cognitive Level: Application REF: p. 1167 OBJ: 6 TOP: Rocephin KEY: Nursing Process Step: Implementation

14. A gynecologist caring for a pregnant patient who has gonorrhea prescribed cefixime (Suprax) instead of the more common tetracycline hydrochloride (Achromycin). What is the rationale for this decision? a. Gonorrhea is less likely to be resistant to Suprax. b. Achromycin requires a longer treatment protocol than Suprax. c. Suprax is a more potent drug that Achromycin. d. Achromycin is contraindicated in a patient who is pregnant.

ANS: D Achromycin is contraindicated during pregnancy and lactation. DIF: Cognitive Level: Application REF: p. 1170 OBJ: 6 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Planning

6. A nurse giving instruction to a patient with an STI says, "I am supposed to tell you about STIs, but you probably know more about them than I do." What is this nurse doing? a. Admitting her own ignorance about STIs b. Trying to get the patient's attention c. Referencing current statistics d. Making a judgmental statement

ANS: D Judgmental behavior on the part of health care providers discourages people from seeking appropriate medical care. DIF: Cognitive Level: Comprehension REF: p. 1179 OBJ: 5 TOP: Behavior of Health Care Workers KEY: Nursing Process Step: Implementation

17. A female patient, newly diagnosed with gonorrhea, screams, "I am going to kill my husband. I mean it." What is the nurse's best response? a. "Are you sure it is your husband who gave you gonorrhea?" b. "Yikes! Killing your spouse seems extreme." c. "Shall I report your spouse as a sexual contact?" d. "I can understand your anger. How best can you deal with it?"

ANS: D Provide an opportunity to talk. Help the patient focus on the source of anxiety with the use of open-ended questions. DIF: Cognitive Level: Application REF: p. 1165 | p. 1179 OBJ: 9 TOP: STI Implementations KEY: Nursing Process Step: Implementation

23. What should a nurse caution a patient taking Flagyl for Trichomonas to do? a. Double the dose if any doses are missed. b. Report dark urine. c. Take the drug on an empty stomach. d. Abstain from alcohol while taking the drug.

ANS: D The use of alcohol while taking Flagyl has serious side effects. Dark urine is expected, doses should not be doubled, and the drug should be taken with a full glass of water. DIF: Cognitive Level: Application REF: p. 1168 OBJ: 6 TOP: Flagyl KEY: Nursing Process Step: Implementation

19. What does diagnosis with the human papilloma virus (HPV) increase a person's risk for? a. Uterine fibroids b. Chronic vaginitis c. Premature menopause d. Cervical cancer

ANS: D Women with HPV or condylomata acuminate are advised to have annual Pap smears because they are at an increased risk for cervical cancer. DIF: Cognitive Level: Knowledge REF: p. 1174 OBJ: 9 TOP: Human Papilloma Virus KEY: Nursing Process Step: Implementation