STI and meds

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.

16 The protocol for Aldara is application three times a day for 16 weeks.

The nurse is completing a female reproductive history on a 16 year old. What important assessment(s) should be included? (Select all that apply.) a. Breast self-examination (BSE) routine b. Age of menarche and pattern of menses c. Smoking and blood pressure history when seeking a prescription for oral contraceptive pills (OCPs) d. Sexual orientation and number of partners e. Number of pregnancies, live births, miscarriages, and abortions f. Nutritional intake of carbohydrates

a. Breast self-examination (BSE) routine b. Age of menarche and pattern of menses c. Smoking and blood pressure history when seeking a prescription for oral contraceptive pills (OCPs) d. Sexual orientation and number of partners e. Number of pregnancies, live births, miscarriages, and abortions All women of reproductive age should perform regular BSEs. Onset and pattern of menses provide baseline assessments for future comparison. OCPs are contraindicated in women who smoke or have hypertension. Sexual orientation and number of partners provide a baseline assessment for future STD assessments. Gestational history provides baseline information for future pregnancies. Nutritional intake of carbohydrates is not included when obtaining a female reproductive history.

A patient states that she has a difficult time remembering when to resume her triphasic contraceptive pills following her menses. Which alternative plan will the nurse suggest that she discuss with her health care provider? a. Changing to the 28-day packet b. Using the inert pills every other month c. Changing her prescription to the mini pill d. Calling the health care provider whenever she forgets to get appropriate instruction

a. Changing to the 28-day packet Using the 28-day packet would allow her to continue with the same type of combination oral contraception. The 28-day packet would allow her to continue daily pills and eliminate the need to recall. Using the inert pills on alternate months will alter her menstrual schedule. Changing to the mini pill might not meet her contraceptive needs. It is unnecessary and inappropriate to contact the provider for missed doses.

The nurse is giving instructions to a young female at an outpatient clinic regarding combination OCP therapy. What information will the nurse include? (Select all that apply.) a. Medication should be taken at approximately the same time daily. b. A back up birth control method should be used for the first 6 months. c. Medication should be discontinued 1 year before attempting pregnancy. d. Headaches, dizziness, and chest or abdominal pain should be reported immediately. e. If a pill is missed, take it immediately and remain on schedule for the next dosage.

a. Medication should be taken at approximately the same time daily. d. Headaches, dizziness, and chest or abdominal pain should be reported immediately. e. If a pill is missed, take it immediately and remain on schedule for the next dosage. Medications should be taken at approximately the same time daily. Headaches, dizziness, and chest or abdominal pain should be reported immediately to the health care provider because these may be symptoms of a serious adverse effect. If one pill is missed, patients are directed to take it as soon as possible and continue with their normal schedule. If more than one pill is missed and a period is skipped, patients should return to their health care provider for a pregnancy test before restarting contraception. A back up contraceptive method is recommended at any point with OCP therapy. Because of a possibility of birth defects, the pill should be discontinued 3 months before attempting pregnancy.

Which is more likely to be experienced by women taking the mini pill as an oral contraceptive? a. Ovulation, dysmenorrhea, and break-through bleeding b. Excessive weight gain and breast tenderness c. Increased estrogen related adverse effects d. Difficulty breastfeeding after pregnancy

a. Ovulation, dysmenorrhea, and break-through bleeding The mini pill is made up of progestin, which inhibits ovulation. This form of contraception is an alternative for women particularly susceptible to adverse effects caused by estrogen therapy. Between 30% and 40% of women continue to ovulate with this form of contraception, however, and there is a slightly higher incidence of uterine and tubal pregnancies. Dysmenorrhea, manifested by irregular or infrequent menses and spotting between cycles, is common in women taking the mini pill. The mini pill has a reduced chance for weight gain and breast tenderness, does not contain estrogen, and does not cause difficulty with breastfeeding.

Which type of drug is most effective in the treatment of erectile dysfunction (ED)? a. Phosphodiesterase inhibitors b. Antiandrogen agents c. Sympathomimetic agents d. Alpha 1 adrenergic blocking agents

a. Phosphodiesterase inhibitors Sildenafil (Viagra), a phosphodiesterase inhibitor, increases cyclic guanosine monophosphate concentrations in the corpus cavernosum, which results in smooth muscle relaxation and greater blood flow into the corpus cavernosum, producing an erection. Antiandrogen agents, sympathomimetic agents, and adrenergic blocking agents are not effective in treating ED.

A nurse working at the community health clinic receives a call from a teen patient who reports that she has missed one of her birth control pills. Which response by the nurse is accurate? (Select all that apply.) a. Take the missed pill now. b. Take the next pill at the regularly scheduled time. c. Come into the clinic for a pregnancy test. d. Start with the next months pill packet at day 1. e. Take the missed pill and the next pill together at the next regularly scheduled time.

a. Take the missed pill now. b. Take the next pill at the regularly scheduled time. If a patient misses one pill, she should take the missed pill immediately. Even if a patient misses one pill, she should take the next pill for that day on time after taking the missed pill immediately. A pregnancy test is not necessary. Starting the next months pill packet at day 1 is not the appropriate action to take. Taking both the missed pill and the next pill at the next scheduled time is not the appropriate action to take.

The health care provider has instructed a patient to use over the counter miconazole (Monistat) cream to treat her vaginal yeast infection. What information is important to include in patient education? (Select all that apply.) a. Wash the genital area thoroughly before inserting the vaginal cream. b. Wash the applicator before usage. c. Wear a minipad to catch remaining discharge following vaginal administration. d. Wash hands before and after administration. e. The sexual partner may require treatment as well.

a. Wash the genital area thoroughly before inserting the vaginal cream. c. Wear a minipad to catch remaining discharge following vaginal administration. d. Wash hands before and after administration. e. The sexual partner may require treatment as well. It is imperative that proper cleansing of the genital area be done regularly using soap and water; rinse and dry well. A minipad should be worn to catch remaining discharge. Hands should be washed before and after medication insertion and before and after toileting. Both partners in a sexual relationship require treatment. The male partner may require oral anti infectives. The vaginal applicator should be thoroughly washed with soap and water after each use and then dried.

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.

a. Body massage would be considered safe. Body massage is considered a safe sex practice.

The nurse instructs a patient taking a transdermal contraceptive to avoid placing the patch in which location? a. Breasts b. Buttock c. Abdomen d. Upper outer arm

a. Breasts A transdermal contraceptive patch, which contains estrogen and progestin, should not be placed on the breasts. A transdermal contraceptive patch can be placed on the abdomen, the buttock, and the upper outer arm.

A patient comes to the outpatient clinic and is diagnosed with gonorrhea. What initial treatment would the nurse anticipate will be initiated? a. Ceftriaxone (Rocephin) and cefixime (Suprax) b. Ciprofloxacin (Cipro) and levofloxacin (Levaquin) c. Doxycycline (Vibramycin) and ceftriaxone (Rocephin) d. Doxycycline (Vibramycin) and tetracycline (Panmycin)

a. Ceftriaxone (Rocephin) and cefixime (Suprax) Gonorrhea is initially treated with ceftriaxone and cefixime. Doxycycline is used for the treatment of gonorrhea but is not the initial treatment. Ciprofloxacin, levofloxacin, and tetracycline are not used for the treatment of gonorrhea. Although ceftriaxone is part of the initial treatment, doxycycline is not used until after treatment with ceftriaxone and cefixime.REF: pp. 1167, 1168, 1170, 1171

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

a. Chancre A typical lesion, a chancre, is the first sign of syphilis.

A couple comes to the emergency department for the treatment of an STI. The mans 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

a. Chlamydial infection 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.

A patient is diagnosed with Chlamydia. What should the nurse recognize as the priority for optimizing the patient's health? a. Diagnostic testing for other STIs b. Obtaining a complete list of recent sexual partners c. Teaching the patient the correct application of a condom d. Role-playing with the patient how to discuss sexual history

a. Diagnostic testing for other STIs Patients are often infected with more than one STI concurrently. Therefore, the priority is to identify any co-infections the patient may have and to treat them appropriately and promptly. Obtaining a complete list of recent sexual partners is an appropriate intervention to optimize the sexual health of the patient's partners and prevent reinfection, but it will not remedy the current infection the patient is experiencing. Condom application and discussion of sexual histories are an important skill for patients who are sexually active to prevent future infection.REF: p. 1166

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

a. HIV b. Acquired immunodeficiency syndrome (AIDS) c. Gonorrhea e. Viral hepatitis All confirmed cases of HIV, AIDS, gonorrhea, syphilis, and viral hepatitis are reportable. Chlamydia is not reportable.

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

a. HIV if exposed to it Patients who have a chlamydial infection are five times more likely to contract HIV if exposed to it.

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

a. Heart c. Meninges d. Skin e. Joints Systemic gonorrhea may damage all of the body areas mentioned except the eyes.

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.

a. It produces no symptoms in half of those in the early stages of the infection. 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.

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

a. Judgment by health care workers b. Identifying self as infected c. Rejection by contacts e. Reprisal from identified contacts Infection of others has already occurred.

A patient is scheduled to be treated with penicillin G (Bicillin). What should be the HIGHEST priority postadministration action by the licensed practical nurse (LPN)? a. Monitor the patient for 30 minutes for an allergic reaction. b. Plan to administer the medication by deep injection in a large muscle. c. Implement the scratch test as ordered to assess for an allergic reaction. d. Take care not to pause during the procedure to prevent needle clogging.

a. Monitor the patient for 30 minutes for an allergic reaction. Monitoring the patient for 30 minutes for an allergic reaction is the most important action to implement after the procedure. Planning to administer the medication by deep injection in a large muscle, implementing the scratch test as ordered to assess for an allergic reaction, and taking care not to pause during the procedure to prevent needle clogging are all valid interventions, but should be performed before and during the procedure, not after. REF: p. 1167

Which premedication assessment is essential before initiating finasteride (Proscar) therapy? a. Prostate specific antigen (PSA) level b. Complete blood count (CBC) c. Glucose tolerance d. Sperm count

a. Prostate specific antigen (PSA) level A baseline PSA level is needed. PSA level should decrease with finasteride; any sustained elevation suggests prostate cancer or nonadherence with therapy. Glucose tolerance, CBC values, and sperm count are unaffected by finasteride.

The nurse will be administering tetracycline hydrochloride (Achromycin) to a patient who has syphilis. What should the nurse remember about this treatment? Select all that apply. a. Review the entire medication list. b. The nurse should report anal itching. c. The drug may cause photosensitivity. d. The medication should be given with milk. e. The drug may cause discoloration of developing teeth. f. The drug is contraindicated in pregnancy and lactation.

a. Review the entire medication list. e. The drug may cause discoloration of developing teeth. f. The drug is contraindicated in pregnancy and lactation. Tetracycline interacts with many medications, necessitating the need to review the medication list. Tetracycline is contraindicated in pregnancy and lactation because it can cause discoloration of developing teeth. Anal itching and photosensitivity are side effects of doxycycline. Tetracycline should be given with water; milk, calcium, and antacids should be avoided within 1 hour of administration to promote absorption.REF: p. 1167

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

a. Slows transmission and spread of infections Confirmed cases are reported to the health department. The purpose is to identify and treat infected individuals so that transmission can be slowed.

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

a. Smears and cultures Smears from genital discharge can be studied on a smear.

Why must caution be used when taking a phosphodiesterase inhibitor to enhance male sexual function? a. It can become habit forming. b. Life-threatening consequences can occur with cardiovascular disorders. c. It is an ineffective treatment. d. It is expensive and available only by special prescription.

b. Life-threatening consequences can occur with cardiovascular disorders. The patient must consult with a health care provider before using a phosphodiesterase inhibitor. People with cardiovascular disorders are particularly susceptible to life-threatening consequences with its use. It is unlikely that a patient will develop physiologic dependence on the medication, although psychological dependence may occur. Phosphodiesterase inhibitors can be a very effective treatment for ED. Phosphodiesterase inhibitors are readily available online and are not expensive.

A male patient is newly diagnosed with HIV and is informed that he needs to wear condoms. Which statement by the patient would suggest that further education is required? a. "I will use latex condoms during sexual intercourse." b. "I am not going to be able to use spermicidal agents." c. "I will use only water-based lubricants with the condoms." d. "I will always discard the condoms after they have been used."

b. "I am not going to be able to use spermicidal agents." Spermicidal agents may be used with the condoms. Latex condoms are preferred during sexual intercourse. Only water-based lubricants should be used because others can cause the condom to break. For sanitary disposal, condoms should always be discarded after use.REF: p. 1180

How does the nurse instruct a patient to use the NuvaRing for birth control when she has not used a hormonal contraceptive within the past month? a. "Insert the ring 7 days after the last menstrual cycle." b. "Insert the contraceptive ring on or prior to day 5 of the cycle." c. "Insert the ring during the menstrual cycle and remove it on the last day of bleeding." d. "Insert the ring on the last day of the menstrual cycle and remove it when bleeding begins again."

b. "Insert the contraceptive ring on or prior to day 5 of the cycle." Counting the first day of menstruation as day 1, insert the contraceptive ring on or prior to day 5 of the cycle, even if menses is continuing. A nonhormonal back up contraceptive should be used concurrently for the first 7 consecutive days of continuous ring use. The other methods listed are not the correct methods of using the NuvaRing.

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)

b. Acyclovir (Zovirax) 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.

Which infections are classified as sexually transmitted infections? a. Chlamydia, giardiasis, cytomegalovirus, and hepatitis B b. Chlamydia, gonorrhea, cytomegalovirus, and hepatitis B c. Chlamydia, gonorrhea, cryptosporidiosis, and hepatitis B d. Campylobacteriosis, gonorrhea, cytomegalovirus, and hepatitis B

b. Chlamydia, gonorrhea, cytomegalovirus, and hepatitis B Chlamydia, gonorrhea, hepatitis B, and cytomegalovirus are all classified as sexually transmitted infections. Giardiasis and cryptosporidiosis are waterborne infections, and campylobacteriosis is a foodborne infection.REF: pp. 1166, 1169, 1180

A patient has been diagnosed with herpes simplex. What is the HIGHEST priority nursing action related to this diagnosis? a. Decrease the patient's anxiety by allowing him to verbalize feelings. b. Ensure that the patient notifies his sexual contacts of the diagnosis. c. Instruct the patient to avoid sexual contact when lesions are present. d. Inform the patient that the virus can survive on objects such as towels.

b. Ensure that the patient notifies his sexual contacts of the diagnosis. Ensuring that the patient notifies sexual contacts of the diagnosis is the highest priority because of the risk of infecting additional individuals. Then the nurse should instruct the patient to avoid sexual contact when lesions are present, inform the patient that the virus can survive on objects such as towels, and decrease the patient's anxiety by allowing him to verbalize feelings. REF: p. 1174

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.

b. Failing to take the entire medicine amount will make your disease resistant to it. 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.

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

b. Genital discharge With an STI, the patient usually complains of genital discharge.

Which instruction does the nurse give to a patient with angina who has just received a prescription for sildenafil (Viagra)? a. Avoid frozen and preserved foods when using the drug b. If an anginal attack occurs, lie down and rest; do not take nitroglycerin c. Use the drug no more frequently than every 3 days d. Start with an initial dose of 100 mg and increase to 150 mg if needed

b. If an anginal attack occurs, lie down and rest; do not take nitroglycerin Nitroglycerin can interact fatally with sildenafil, so nitroglycerin should not be taken. The initial dose of sildenafil is 50 mg. Nitrates found in foods do not interact with the sildenafil. Sildenafil can be used once per day.

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

b. Secondary Symptoms in the secondary stage are body aches, rash, pustules, fever, and sore throat.

What herbal supplement may reduce the effectiveness of oral contraceptives? a. Ginseng b. St. John's wort c. Evening primrose oil d. Garlic

b. St. John's wort St. John's wort may increase the liver's metabolism of oral contraceptive hormones, possibly resulting in decreased contraceptive effect. An alternative or additional form of birth control is advisable during concurrent use. Ginseng, evening primrose oil, and garlic do not have an effect on oral contraceptives.

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.

b. The effectiveness of condoms deteriorates in heat. Protect condoms from heat and sunlight to keep them from deteriorating.

The nurse will teach the patient beginning therapy with alfuzosin, an alpha 1 adrenergic blocking agent, to expect which common (and usually self limiting) adverse effect(s)? (Select all that apply.) a. Nausea b. Insomnia c. Dizziness d. Headache e. Lethargy f. Anorexia

c. Dizziness d. Headache e. Lethargy Dizziness, headache, and lethargy are adverse effects of treatment with alfuzosin. Nausea, insomnia, and anorexia are not adverse effects of treatment with alfuzosin.

The nurse at an outpatient clinic is educating a group of young adults regarding prevention of the spread of sexually transmitted infections. Information will include: (Select all that apply.) a. the use of hormonal contraceptives. b. the use of latex condoms when infection is present. c. abstinence. d. frequent use of nonoxynol 9. e. the importance of partner services.

c. abstinence. e. the importance of partner services. Abstinence will prevent sexually transmitted infections, and use of sexual abstinence during the communicable phase of any disease will prevent reinfection. All sexual partners need to understand the importance of partner services, the documentation of all sexual partners for the purpose of providing evaluation and treatment. Hormonal contraceptives do not prevent sexually transmitted infections. When infections are present, abstain from sexual intercourse. A recent study indicates that frequent use of nonoxynol 9 may actually increase the risk of HIV infection during vaginal intercourse because of irritation of vaginal tissues.

A woman using the NuvaRing vaginal ring informs the nurse that the ring was accidentally expelled a day ago. The nurse will instruct this patient to: a. rinse the ring in cool water and reinsert as soon as possible. b. rinse the ring in hot water and reinsert as soon as possible. c. rinse the ring in lukewarm water, reinsert, and use a nonhormonal back up contraceptive. d. insert a new ring.

c. rinse the ring in lukewarm water, reinsert, and use a nonhormonal back up contraceptive. If the ring is expelled for longer than 3 hours, the patient should be instructed to rinse it in cool or lukewarm water, reinsert, and use a nonhormonal back up contraceptive for the next 7 consecutive days of continuous ring use. It is not necessary to insert a new ring after a day.

An LPN is teaching a patient about taking metronidazole (Flagyl). Which statement by the patient indicates a need for further teaching? a. "I can take my medication with food or milk." b. "It's okay if my urine becomes slightly darker." c. "I can still drink a beer every night." d. "If I miss a dose, I will not take a double dose."

c. "I can still drink a beer every night." Alcohol is to be avoided because it can cause a severe reaction. The other options are correct. REF: p. 1168

The nurse is teaching a patient about the use of tamsulosin (Flomax). Which statement by the patient indicates a need for further teaching? a. "I should not drink alcohol while taking this drug." b. "I will take this medication within 30 minutes after eating." c. "I will stop taking this medication if I develop a headache." d. "I will lie down if I become lightheaded."

c. "I will stop taking this medication if I develop a headache." The patient should not stop taking tamsulosin if headache occurs. Headache tends to be self-limiting, and if the headache persists, the patient should be instructed to contact the healthcare provider. Tamsulosin should be taken 30 minutes after eating. Alcohol interacts with tamsulosin and should be avoided while taking this drug. If the patient becomes lightheaded while taking tamsulosin, he should be instructed to lie down.

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.

c. Delay sexual activity until cured. 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.

A patient is prescribed dutasteride (Avodart) for the treatment of benign prostatic hypertrophy. The nurse questions the order after finding that the patient is also taking which medication? a. Tetracycline b. Nitroglycerin c. Diltiazem (Cardizem) d. Warfarin (Coumadin)

c. Diltiazem (Cardizem) Diltiazem is a calcium channel blocker that inhibits the metabolism of dutasteride. Nitroglycerin, tetracycline, and Warfarin do not interact with dutasteride.

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

c. Dizziness, headache, and nausea Side effects include dizziness, headache, nausea and vomiting, renal failure, and seizures.

A female patient develops a urinary tract infection and is started on trimethoprim-sulfamethoxazole (Bactrim). Which information regarding prevention of urinary crystals is important to include in the patient teaching? a. Monitor for signs and symptoms of dyspnea. b. Monitor for signs and symptoms of seizure activity. c. Encourage intake of at least 2000 mL of fluids per day. d. Encourage the use of condoms with sexual intercourse.

c. Encourage intake of at least 2000 mL of fluids per day. The patient taking trimethoprim-sulfamethoxazole is encouraged to drink at least 2000 mL of fluids each day to prevent kidney damage from urinary crystals. Trimethoprim-sulfamethoxazole does not cause dyspnea or seizures.REF: p. 1179

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.

c. Follow up to determine if the treatment was effective. Follow-up examinations are important to determine whether treatment has been effective to prevent reinfection of the partner.

In which situation does the nurse instruct a patient taking the oral contraceptive Tri Levlen to use an additional form of birth control? a. If the patient is drinking grapefruit juice b. If a Pap smear is scheduled c. If the patient is taking penicillin d. If the patient is chewing tobacco

c. If the patient is taking penicillin Penicillin interacts with oral contraceptives and decreases their effectiveness. An additional form of contraception is needed while taking penicillin. A Pap smear, grapefruit juice, and chewing tobacco do not interfere with the contraceptive effects of oral contraceptives.

A school nurse is scheduled to talk to a group of college students about sexually transmitted infections. The nurse would caution the students to avoid which unsafe practices? Select all that apply. a. Mutual masturbation b. Open-mouthed kissing c. Oral sex without a condom d. Ingestion of urine or semen e. Use of own sex devices or toys f. Insertion of hand into vagina or rectum

c. Oral sex without a condom d. Ingestion of urine or semen f. Insertion of hand into vagina or rectum Unsafe practices that could led to sexual transmission of infections include oral sex without a condom, ingestion of urine or semen, insertion of hand into vagina or rectum, vaginal or anal intercourse without a condom, oral-anal contact, and contact with blood. Mutual masturbation, open-mouthed kissing, and use of own sex devices or toys are considered safe practices.REF: p. 1179

The nursing supervisor becomes concerned after overhearing a nurse state, "People who get sexually transmitted infections (STIs) deserve whatever happens to them. They shouldn't have been engaging in promiscuous behavior." Which statement best describes the reason the nursing supervisor is concerned? a. Nursing staff may refuse to care for patients with STIs. b. Caring for patients with STIs lowers the morale of the clinic staff. c. Patients may be reluctant to seek care when they fear being judged. d. The supervisor is concerned patients with STIs may offend the LPN.

c. Patients may be reluctant to seek care when they fear being judged. Judgmental attitudes can function as a barrier to accessing health care services for those with STIs, which can lead to continued spread of the infection. Health care providers need to put aside their personal beliefs to provide excellent nursing care to patients despite the fact that patients may engage in lifestyles that nursing staff may disagree with.REF: p. 1165

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

c. Penicillin G today and 3 months of oral tetracycline antibiotic medications 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.

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.

c. Wash towels and personal items daily. Inform the patient that the virus can survive on objects such as towels.

The nurse is teaching a patient beginning therapy with dutasteride (Avodart). How long will it take before the patient can expect results? a. 24 hours b. 2 weeks c. 1 month d. 6 months

d. 6 months Longer than 6 to 12 months of treatment may be necessary to assess whether a therapeutic response has been achieved.

What is the mechanism whereby estrogen functions as a contraceptive? a. Inhibiting luteinizing hormone (LH), blocking release of ovum from a follicle b. Thinning cervical mucus, which inhibits sperm migration c. Trapping the ovum in the endometrial wall, preventing its growth d. Blocking follicle-stimulating hormone (FSH), thereby preventing release of ovum

d. Blocking follicle-stimulating hormone (FSH), thereby preventing release of ovum Estrogens block pituitary release of FSH, preventing the ovaries from developing a follicle from which the ovum is released. Progestins inhibit pituitary release of LH, the hormone responsible for releasing an ovum from a follicle. Estrogens and progestins alter cervical mucus by making it thick and viscous, inhibiting sperm migration. Hormones also change the endometrial wall, impairing implantation of the fertilized ovum.

A female patient has developed leukorrhea since being on oral broad spectrum antibiotics for the past week for a lower respiratory infection. Which organism causes leukorrhea? a. Herpes simplex b. Mycoplasma hominis c. Human papillomavirus (HPV) d. Candida albicans

d. Candida albicans Candida albicans infections of the mouth, gastrointestinal tract, or vagina may develop as secondary infections during the use of broad spectrum antibiotics, such as penicillins, tetracyclines, and cephalosporins. Herpes simplex, Mycoplasma hominis, and HPV do not cause leukorrhea.

A patient diagnosed with benign prostatic hypertrophy asks why tamsulosin (Flomax), an alpha1 adrenergic blocking agent, has been prescribed. Which explanation by the nurse is most accurate? a. It inhibits the action of testosterone. b. It improves sexual function. c. It reduces the size of the prostate. d. It increases urinary flow.

d. It increases urinary flow. Alpha 1 adrenergic blocking agents are used to relax the smooth muscle of the bladder and prostate. Tamsulosin specifically blocks alpha1 receptors on the prostate gland and certain areas of the bladder neck, causing muscle relaxation and increased urine flow in men with enlarged prostate glands. Adrenergic blocking agents do not affect hormone production, directly affect sexual function, or affect prostate size.

The nurse is obtaining a history on a patient who is seeking oral contraceptives. Which condition would contraindicate the use of oral contraceptives? a. Sexually transmitted diseases (STDs) b. Hypothyroidism c. Varicose veins d. Thromboembolic disease

d. Thromboembolic disease Women who have a history of thromboembolic disease must consult with a health care provider before obtaining a prescription for an oral contraceptive. Serious adverse effects include embolisms and thrombus formation, cardiac abnormalities, seizures, and severe depression. STDs, hypothyroidism, and varicose veins do not pose a problem with contraceptive therapy.

The nurse is instructing a patient on use of a transdermal contraceptive. When evaluating the patients understanding of the information provided, the nurse identifies a need for further education when the patient states: a. Apply the first patch during the first 24 hours of the menstrual period. b. Use a backup contraceptive concurrently for the first 7 days of the first cycle. c. Fold the used patch over on itself before discarding. d. Trim the patch carefully prior to application.

d. Trim the patch carefully prior to application. Patches should not be cut. The first patch should be applied during the first 24 hours of the menstrual period. A backup contraceptive should be used concurrently for the first 7 days of the first cycle. When removing the patch, it should be folded over on itself and placed in a sturdy container.

The nurse is teaching a patient about the use of the transdermal contraceptive patch. Which statement by the patient indicates a correct understanding about the use of this medication? a. "I should apply the patch on the first Sunday after my next menses stops." b. "I will reinforce the patch with tape if it becomes loose." c. "The patch can be applied to any area of skin that is free of hair." d. "I need to use a back up contraceptive for the first 7 days of the first cycle I use the patch."

d. "I need to use a back up contraceptive for the first 7 days of the first cycle I use the patch." Effective contraception is not immediate; therefore, a backup contraceptive is needed. The patient's understanding about the use of the transdermal contraceptive patch is correct. The patch should not be applied to the breast or to areas of irritated skin. The patch is applied on the first Sunday after menses starts. Tape should not be used; if the patch loosens to the point where it needs additional securing, it should be replaced.

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.

d. Abstain from alcohol while taking the drug. 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.

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.

d. Achromycin is contraindicated in a patient who is pregnant. Achromycin is contraindicated during pregnancy and lactation.

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

d. Cervical cancer Women with HPV or condylomata acuminate are advised to have annual Pap smears because they are at an increased risk for cervical cancer.

A student taking combination oral contraceptives reports to the nurse that she has not missed a pill but missed a period. Which instruction does the nurse give to the student? a. Discuss a dose adjustment with her prescriber b. Take two pills per day for the first week of the next cycle c. Get a pregnancy test d. Continue taking the pills as prescriber

d. Continue taking the pills as prescriber It is not uncommon for a woman to occasionally miss a period when on a combination oral contraceptive. The woman should be instructed to start the next pack of pills on the appropriate Sunday. A change in dosage may be indicated if spotting occurs for two or more cycles. In this case, the student should continue to take the medication as ordered. A pregnancy test is not needed unless a second period is missed. If two pills are missed, two pills are taken as soon as remembered and again the next day. No situation would call for taking two pills per day for the first week of the next cycle.

A female patient, newly diagnosed with gonorrhea, screams, I am going to kill my husband. I mean it. What is the nurses 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?

d. I can understand your anger. How best can you deal with it? Provide an opportunity to talk. Help the patient focus on the source of anxiety with the use of open-ended questions.

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 patients attention c. Referencing current statistics d. Making a judgmental statement

d. Making a judgmental statement Judgmental behavior on the part of health care providers discourages people from seeking appropriate medical care.

A patient has been diagnosed with primary syphilis. What should be the HIGHEST priority nursing action related to the administration of the medication used to treat this disease? a. Ensure that ordered blood studies are performed. b. Wear gloves to assess skin and mucous membranes. c. Assess for fever, influenza-like symptoms, and malaise. d. Observe the patient for 30 minutes for allergic reactions.

d. Observe the patient for 30 minutes for allergic reactions. The medication used to treat syphilis is penicillin G, therefore monitoring for an allergic reaction after administering the drugs would be the highest priority action because of the considerable risk of an anaphylactic reaction. The nurse should ensure that ordered blood studies are performed before the administration of the drug. After the administration of the drug, the nurse should assess the patient for fever, influenza-like symptoms, and malaise. The nurse should wear gloves to assess skin and mucous membranes because of the disease process, not the drug administration.REF: p. 1167

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.

d. Place a warm compress on the area. 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.

A patient has been diagnosed with gonorrhea. He tells the nurse that he has been taking his medication and is no longer symptomatic. What should be the HIGHEST priority instruction that the LPN provides to the patient? a. Consider using condoms with sexual activity. b. Ensure that all sexual partners are treated for the disease. c. Consider practicing abstinence while undergoing treatment. d. Take all of prescribed medication even if symptoms are gone.

d. Take all of prescribed medication even if symptoms are gone. Although the nurse should instruct the patient to consider abstinence during treatment, to consider using condoms with sexual activities, and to ensure that all sexual partners are treated for the disease, completing the entire prescribed amount of the medication, even though the symptoms are gone, would be the highest priority instruction, based on the information that the patient has told the nurse. This is the priority because of the need to prevent drug-resistant bacteria. REF: p. 1171

A pregnant patient with HSV type 2 has a Herp-Test performed in the physicians 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.

d. The delivery may be accomplished vaginally. A negative Herp-Test result shows no active viral disease, and the birth can be accomplished vaginally if the physician prefers.

A patient with bacterial vaginosis is being treated with metronidazole (Flagyl). A few days after beginning the treatment, the patient begins to experience vomiting and has a blood pressure of 90/60 mm Hg and a pulse of 110 beats/min. What would the nurse suspect? a. The patient is experiencing normal side effects of the medication. b. The patient is experiencing an adverse reaction from the medication. c. The patient is experiencing an anaphylactic reaction from the medication. d. The patient has consumed alcohol and is experiencing a disulfiram-like reaction.

d. The patient has consumed alcohol and is experiencing a disulfiram-like reaction. When a patient consumes alcohol while taking metronidazole, the combination can trigger a disulfiram-like reaction with vomiting, tachycardia, and hypotension. The patient is experiencing these signs and symptoms. Although the patient is experiencing an adverse reaction, the option does not detail why the patient is experiencing the reaction. Vomiting, tachycardia, and hypotension are not normal side effects of this medication. Vomiting, tachycardia, and hypotension are not signs and symptoms of an anaphylactic reaction from this medication.REF: p. 1175