Lowdermilk ch7 STD

Which are sexually transmitted bacterial infections? Select all that apply. a. Syphilis b. Gonorrhea c. Chlamydia trachomatis d. Vulvovaginal candidiasis e.Pelvic inflammatory disease

A, B, C, E Syphilis is caused by Treponema pallidum, which enters the subcutaneous tissue through microscopic abrasions that can occur during sexual intercourse. Gonorrhea is caused by the aerobic, gram-negative diplococcus N. gonorrhoeae and is transmitted by sexual contact. Chlamydia trachomatis is the most commonly reported STI seen in sexually active women aged 15 to 24. Pelvic inflammatory disease (PID) is caused by N. gonorrhoeae, chlamydia trachomatis, and a wide variety of anaerobic and aerobic bacteria. Women who have multiple sex partners and a history of STIs are at risk for PID. Vulvovaginal candidiasis is a yeast infection caused by Candida albicans and is not sexually transmitted or bacterial. p. 148-152

Which of these are the lowest-risk sexual practices? Select all that apply. a. Abstinence b. Dry kissing c. Wet kissing d. Mutual masturbation e. Hugging, massaging, touching (assuming no break in skin) f. Monogamous (both partners and no high-risk activities), but not tested for HIV or other STIs

A, B, D, E The lowest-risk sexual practices include abstinence; dry kissing; mutual masturbation; and hugging, massaging, and touching (assuming no break in skin). Wet kissing and having partners who are both monogamous and who have used no high-risk activities but have not been tested for HIV or other STIs are low-risk practices, but there are potential risks. P. 147

Which symptoms indicate syphilis? Select all that apply. a. Generalized lymphadenopathy b. Abdominal pain and irregular bleeding c. Wartlike infectious lesions on the vulva d. A painful papule at the site of inoculation e. The presence of rash on the palms and soles

A, C, E Generalized lymphadenopathy indicates secondary syphilis, which occurs 6 weeks to 6 months after the appearance of the chancre. Wartlike infectious lesions, also known as condylomata lata, may develop on the vulva, the perineum, or the anus. The presence of rash on the palms and soles also indicates secondary syphilis. Abdominal pain and irregular bleeding are symptoms of pelvic inflammatory disease (PID). Primary syphilis is a lesion that begins as a painless papule at the site of inoculation and becomes a nontender, shallow, indurated, clean ulcer. p. 151

A female client is receiving treatment for gonorrhea. What does the nurse tell the client while providing care? Select all that apply. a. Recommend that the client be tested for human immunodeficiency virus (HIV) b. Inform the client that the treatment has a poor success rate. c. Reinforce teaching of correct condom use during sexual activity. d. Inform the client that the disease is not reportable. e. Encourage the client to notify her partners about the infection.

A, C, E There is an increased risk for HIV infection in clients who have gonorrhea. Therefore the nurse needs to counsel the client to seek HIV testing. The nurse needs to instruct the client to use a condom during sexual activities, because there may be a chance of reinfection if preventive measures are not taken. Gonorrhea is a highly communicable disease, so the nurse encourages the client to notify her partners about their exposure to the disease so that they can seek appropriate assessment and treatment. The treatment does not have a poor success rate, but reinfection occurs if the client does not take proper preventive measures. Gonorrhea is a reportable communicable disease, and the nurse needs to inform the client that the case will be reported to the health authorities. p. 151

What are some known triggers that cause an outbreak of genital herpes? Select all that apply. a. Stress b. Safety issues c. Menstruation d. Acute illnesses e. Family illnesses f. Ultraviolet light

A, C, F Some known triggers that can cause an outbreak of genital herpes include stress, menstruation, and ultraviolet light. Safety issues and acute or family illnesses are not known triggers for an outbreak of genital herpes. P. 157

Which statement by the student nurse about pelvic inflammatory disease (PID) indicates effective learning? a. PID causes miscarriage. b. The menstrual period facilitates the development of PID. c. N. Gonorrhoeae is the only organism that causes PID. d. PID occurs as organisms spread from the upper genital tract to the vagina.

B During the menstrual period, the cervical os is slightly open and the cervical mucus barrier is absent. In addition, menstrual blood is an excellent medium for the growth of organisms that cause PID. PID may also develop after a miscarriage or an induced abortion. A wide variety of anaerobic and aerobic bacteria, including N. Gonorrhoeae, may cause PID. C. trachomatis is now estimated to cause half of all cases of PID. PID results from the spread of microorganisms from the vagina and endocervix to the upper genital tract. P. 153

The nurse suspects that a client with frequent complaints of diarrhea, weight loss, and rash has human immunodeficiency virus (HIV) infection. The client is afraid of having blood drawn for screening purposes. What does the nurse tell the client? a. "You can take some time to prepare for this test." b. "You can provide a saliva sample for testing." c. "A blood test is the only means of detecting the virus." d. "If you don't get this test done, the virus may prove fatal."

B If a client is unwilling to take a blood test, an oral fluid sample can also be obtained for testing for the presence of HIV infection. It has a sensitivity and specificity rate of more than 99%. The nurse should not advise the client to take time to prepare for the test, because the client may be infected, and prompt treatment may be required. The blood test is not the sole means of detecting the virus. The client can provide a blood sample obtained by fingerstick or venipuncture, an oral fluid sample, or a urine sample for testing. Telling the client that the virus may prove fatal will increase the client's anxiety. Instead the nurse should inform the client about alternative methods of testing. p. 160

Which statements about genital herpes are accurate? Select all that apply. a. Genital herpes is also known as genital warts. b. Stress, menstruation, trauma, and illnesses have been known to trigger recurrences. c. Genital herpes is chronic and recurring, and has no known cure. d. Plain soap and water are all that are needed to clean hands that have come into contact with herpetic lesions. e. Contact isolation is needed for clients with genital herpes.

B, C, D Recurrence of genital herpes can be triggered by stress and illness. The disease is chronic and has no known cure. Good handwashing can prevent the spread of infection from contact with the lesions. Genital warts are one of the most common sexually transmitted infections (STIs); however, they are also known as human papillomavirus (HPV), not genital herpes. Isolation is not appropriate for patients with genital herpes. p. 156-157

Which instructions are given to a client with genital herpes simplex virus (HSV) infection? Select all that apply. a. "Avoid the use of aspirin for pain relief." b. "Take warm sitz baths with baking soda." c. "Take 400 mg of acyclovir orally three times daily for a week." d. "Dry the lesions with cool air from a hair dryer." e. "Clean the lesions once a day with warm water."

B, C, D Warm sitz baths with baking soda increase the client's comfort when the lesions are active. The nurse would also provide the client teaching about the administration of acyclovir, famciclovir, or valacyclovir, which can help decrease the number of HSV infections. The client should dry the lesions by directing cool air from a hair dryer onto them or by patting them dry with a soft towel. Oral analgesics such as aspirin or ibuprofen can be used to relieve pain, because there are no side effects with these medications. The lesions need to be cleaned twice a day with saline to prevent secondary infection. P. 157

What are the maternal effects of Chlamydia? Select all that apply. a. Meningitis b. Preterm labor c. Chorioamnionitis d. Postpartum sepsis e. Postpartum endometritis

B, EChlamydia is a bacterial infection caused by Chlamydia trachomatis. The patient with Chlamydia has a risk of pelvic inflammatory disease, due to which the client may have preterm labor and postpartum endometritis. Meningitis, chorioamnionitis, and postpartum sepsis are most commonly seen in clients with gonorrhea. Chlamydia trachomatis does not affect the brain, fetal membranes, chorion, and amnion. p. 165

A client who is breastfeeding has been diagnosed with gonorrhea. Which treatment plan should be instituted? a. Amoxicillin 500 mg three times a day for 1 week. b. Benzathine Penicillin G 2.4 million units one injection c. Amoxicillin 500 mg three times a day for 7 days and ceftriaxone 250 mg IM injection d. Ceftriaxone 250 mg IM injectio

C Dual therapy of amoxicillin and ceftriaxone can be used for treatment of gonorrhea and empirical treatment of chlamydia. Amoxicillin and ceftriaxone can both be part of the treatment plan for gonorrhea but the client should be treated empirically for chlamydia as well. Benzathine penicillin is indicated for treatment of syphilis in the lactating client. p. 148

What is the most common causative agent of ophthalmia neonatorum? a. Neisseria gonorrhea b. Human papillomavirus c. Chlamydia trachomatis d. Gardnerella and Mobiluncus

C Ophthalmia neonatorum is a conjunctivitis that occurs in newborns. It is most commonly caused by Chlamydia trachomatis. Therefore, it is most commonly seen in the neonates born to clients with Chlamydial infection. Neisseria gonorrhea causes gonococcal infections. Human papillomavirus causes condylomata acuminate or genital warts, but not ophthalmia neonatorum. Gardnerella and Mobiluncus are the anaerobic bacteria that cause bacterial vaginosis, but not ophthalmia neonatorum. p. 148

Which infections are collectively known as TORCH infections? Select all that apply. a. Chlamydia b. Gonorrhea c. Toxoplasmosis d. German measles e. Cytomegalovirus f. Herpes genitalis

C, D, E, F Toxoplasmosis, German measles, cytomegalovirus, and herpes genitalis are collectively known as TORCH infections. The causative agents of these infections cross the placenta and cause influenza-like symptoms in the mother and significant birth defects in the newborn. Chlamydia and gonorrhea do not cause significant birth defects and fetal death. Therefore, Chlamydia and gonorrhea are not TORCH infections. p. 165

Group B streptococci (GBS) are 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 of the following would not be considered a risk factor for neonatal GBS infection? a. Positive prenatal culture b. Preterm birth less than 37 weeks c. Maternal fever of 38° C or greater d. Premature rupture of membranes less than 18 hours

D Premature rupture of the membranes of 18 hours or more, not 18 hours or less, increases the risk for neonatal GBS infection, so this is not a risk factor. A positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at less than 37 weeks remains a risk factor for neonatal GBS infection. Maternal fever of 38° C or greater is also a risk factor for neonatal GBS infection. p. 164-165

Which infection is prevented with the Cervarix and Gardasil vaccines? a. Bacterial vaginosis (BV) b. Vulvovaginal candidiasis (VVC) c. Pelvic inflammatory disease (PID) d. Human papillomavirus (HPV)

D The Cervarix and Gardasil vaccines are recommended for children aged 9 to 26. The vaccines are effective in protecting against human papillomavirus (HPV) infections, which can lead to genital warts and cancers. Bacterial vaginosis (BV) is treated with oral metronidazole (Flagyl); there are not any preventive vaccines for this. Exogenous lactobacillus (found in dairy products or powder, tablet, capsule, or suppository supplements) and garlic have been suggested for prevention and treatment of vulvovaginal candidiasis. Vaccination is not effective in preventing pelvic inflammatory disease (PID). It can be prevented only by practicing risk reduction measures and using barrier methods. p. 156

A pregnant woman is infected with human immunodeficiency virus (HIV), with a viral load of more than 400 copies/ml. It is therefore recommended that she have a caesarean birth at 38 weeks of gestation. On assessment at 36 weeks, the nurse finds that the patient has a viral load of 800 copies/ml and ruptured membranes, and the labor is progressing rapidly. What is the primary health care provider likely to order? a. Scalp pH sampling b. Immediate vaginal birth c. Immediate caesarean birth d. Use of fetal scalp electrode

b. Ruptured membranes and a rapidly progressing labor indicate that the client is ready for vaginal birth. If the viral load in the client is less than 1000 copies/ml at 36 weeks, the patient can be prepared for a vaginal birth. Scalp pH sampling is avoided, because it may result in inoculation of the virus into the fetus. If the viral load is more than 1000 copies/ml, it is recommended that the client have a caesarean birth. The use of a fetal scalp electrode is avoided, because it increases the risk of transmission of infection to the fetus. p. 161