STI/HIV Questions
A client with acquired immunodeficiency syndrome (AIDS) is receiving didanosine. When the nurse reviews the client's laboratory test results, which result should be most closely monitored? Protein Glucose Amylase Cholesterol
Amylase Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Didanosine is toxic to the pancreas and the liver. A serum amylase level that is increased by 1.5 to 2 times normal may signify pancreatitis and may be fatal in the client with AIDS. Therefore, the nurse should monitor the results of amylase and liver function studies closely. Alterations in protein, glucose, and cholesterol levels are unrelated to this medication.
The nurse is performing an admission assessment on a client who claims to have multiple sexual partners. The client denies any signs or symptoms of a sexually transmitted infection. Which of the following teaching points is true for this client? "The most common STI is contagious before any symptoms are present so you need routine STI testing" "You will need to be routinely tested for STIs a minimum of every two years" "Signs of a sexually transmitted infection will only be apparent in the genitourinary system, so be aware of any of these changes and report them right away" "You do not need to be tested for an STI until you experience new-onset genital or urinary symptoms, then immediately come in for testing"
"The most common STI is contagious before any symptoms are present so you need routine STI testing" One of the most highly contagious sexually transmitted infections (STIs) is chlamydia, which infects a person and is spread to others before any symptoms are present. It is also common for the client to also be concurrently infected with gonorrhea, so treatment for both is prescribed when one is confirmed present.
After receiving a diagnosis of herpes simplex virus (HSV), the client tells the nurse "I can't possibly tell my partner I have Herpes." Which of the following responses by the nurse is the most appropriate? "This conversation is a tough one to have. What concerns you the most about telling your partner?" "It is your responsibility to tell your partner and use condoms so that your partner does not contract herpes" "You have to tell your client about your diagnosis. Your partner might already have it" "I am sure your partner will understand. Let's practice telling your partner so you feel more confident"
"This conversation is a tough one to have. What concerns you the most about telling your partner?" Acknowledging that this conversation will be difficult roots the client in reality, while asking more about how the client is feeling will help the nurse to guide the conversation.
A client presents to the emergency departments complaining of pelvic and lower back pain. The client was recently diagnosed with chlamydia and gonorrhea infections and underwent treatment with the primary healthcare provider. The nurse suspects the client may have pelvic inflammatory disease (PID). The client asks the nurse "Does this mean I won't be able to have children?" Which of the following therapeutic responses by the nurse is most appropriate? "We won't know more until we complete testing. I wouldn't worry, I think we caught this early" "We won't know for certain until we treat this infection, but you did the right thing by coming in today" "Once we have a better idea of the damage, the provider will be able to give you an answer" "This could mean you are infertile, but we will do everything we can to keep you comfortable"
"We won't know for certain until we treat this infection, but you did the right thing by coming in today" This is the most appropriate response. It demonstrates honesty by the nurse, sets a timeline for an answer, and reassures the client that the client did the right thing by coming to see the healthcare provider.
10. Why should the nurse encourage serologic testing for human immunodeficiency virus (HIV) in the patient with syphilis? a. Syphilis is more difficult to treat in patients with HIV infection. b. The presence of HIV infection increases the risk of contracting syphilis. c. Central nervous system (CNS) involvement is more common in patients with HIV infection and syphilis. d. The incidence of syphilis is increased in those with high rates of indiscriminate sexual activity and drug abuse.
10. d. The risk factors of drug abuse and sexual activity with multiple partners or homosexuality are found in patients with both syphilis and human immunodeficiency virus (HIV) infection and persons at highest risk for acquiring syphilis are also at high risk for acquiring HIV. Syphilitic lesions on the genitals enhance HIV transmission. Also, HIV-infected patients with syphilis appear to be at greatest risk for central nervous system (CNS) involvement and may require more intensive treatment with penicillin to prevent this complication of HIV.
11. What is a primary reason that the normal immune response fails to contain the HIV infection? a. CD4+ T cells become infected with HIV and are destroyed. b. The virus inactivates B cells, preventing the production of HIV antibodies. c. Natural killer cells are destroyed by the virus before the immune system can be activated. d. Monocytes ingest infected cells, differentiate into macrophages, and shed viruses in body tissues.
11. a. Activated CD4+ T cells are the target cells for HIV virus and are destroyed after replication of HIV. CD4+ T cells normally are a major component of the immune system and when infected and destroyed, the immune system is ineffective against HIV and other agents. The virus does not affect natural killer cells, and B lymphocytes are functional early in the disease, as evidenced by positive antibody titers against HIV. Monocytes and tissue macrophages ingest infected cells and may become sites of HIV replication and spread the virus, but this does not make the immune response ineffective.
11. A female patient returns to the clinic with a recurrent urethral discharge after being treated for a chlamydial infection 2 weeks ago. Which statement by the patient indicates the most likely cause of the recurrence of her infection? a. "I took the Vibramycin twice a day for a week." b. "I haven't told my boyfriend about my infection yet." c. "I had a couple of beers while I was taking the medication." d. "I've only had sexual intercourse once since my medication was finished."
11. b. Notification and treatment of sexual partners are necessary to prevent recurrence and the "ping-pong" effect of passing STIs between partners. Vibramycin is prescribed twice a day for 7 days, and although alcohol may cause more urinary irritation in the patient with chlamydia, it will not interfere with treatment. Avoiding sexual intercourse for 7 days after the medication is to prevent transmission.
14. Why do opportunistic diseases develop in an individual with AIDS? a. They are side effects of drug treatment of AIDS. b. They are sexually transmitted to individuals during exposure to HIV. c. They are characteristic in individuals with stimulated B and T lymphocytes. d. These infections or tumors occur in a person with an incompetent immune system
14. d. Organisms that are nonvirulent or that cause limited or localized diseases in an immunocompetent person can cause severe, debilitating, and life-threatening infections and cancers in persons with impaired immune function. The other options are not correct.
15. Priority Decision: What is most important for the nurse to teach the female patient with genital warts? a. Have an annual Papanicolaou (Pap) test. b. Apply topical acyclovir faithfully as directed. c. Have her sexual partner treated for the condition. d. Use a contraceptive to prevent pregnancy, which may exacerbate the disease.
15. a. Some types of genital warts are associated with cancer of the cervix, vagina, vulva, and throat or pharynx. Cancer of the penis, rectum, throat, or pharynx may occur in men. Regular Papanicolaou (Pap) tests in women are critical in detecting early malignancies of the cervix. Oral acyclovir is used to treat HSV-2, but topical use has no value in treating viral STIs. Sexual partners of patients with HPV should be examined and treated, but because treatment does not destroy the virus, condoms should always be used during sexual activity. Genital warts often grow more rapidly during pregnancy, but pregnancy is not contraindicated.
15. Which characteristics describe Pneumocystis jiroveci infection, an opportunistic disease that can be associated with HIV? a. May cause fungal meningitis b. Diagnosed by lymph node biopsy c. Pneumonia with dry, nonproductive cough d. Viral retinitis, stomatitis, esophagitis, gastritis, or colitis
15. c. Pneumocystis jiroveci infection is characterized by pneumonia with a dry, nonproductive cough, hypoxemia, and other symptoms. Cryptococcus infection may cause fungal meningitis. Non-Hodgkin's lymphoma is diagnosed by lymph node biopsy. Cytomegalovirus infection is characterized by viral retinitis, stomatitis, esophagitis, gastritis, or colitis
16. Which opportunistic disease associated with AIDS is characterized by vascular lesions of the skin, mucous membranes, and viscera? a. Kaposi sarcoma c. Herpes simplex type 1 infection b. Candida albicans d. Varicella-zoster virus infection
16. a. Vascular lesions of skin, mucous membranes, and viscera are seen in Kaposi sarcoma. Candida albicans is a common yeast infection of the mouth, esophagus, GI tract, or vagina. Herpes simplex type 1 infection has oral and mucocutaneous vesicular and ulcerative lesions. Varicella- zoster virus infection or shingles is a maculopapular, pruritic rash along dermatomal planes.
16. Which STI actively occurring at the time of delivery would indicate the need for a cesarean section delivery of the woman's baby? a. Syphilis b. Gonorrhea c. Chlamydia d. Genital herpes
16. d. Women with an active HSV genital lesion at the time of delivery have the highest risk of transmitting genital herpes to the neonate, so delivery will be done with a cesarean section (C-section). Syphilis is spread to the fetus in utero and has a high risk of stillbirth, but C-sections are not required. Treatment with parenteral penicillin will cure both the mother and fetus. Prevention of the spread of gonorrhea to the neonate's eyes is done with erythromycin ophthalmic ointment or silver nitrate aqueous solution. Chlamydia spread to the fetus can be prevented by treating the pregnant woman, so a C-section is not required.
17. A patient comes to the clinic and requests testing for HIV infection. Before administering testing, what is most important for the nurse to do? a. Ask the patient to identify all sexual partners. b. Determine when the patient thinks exposure to HIV occurred. c. Explain that all test results must be repeated at least twice to be valid. d. Discuss prevention practices to prevent transmission of the HIV to others.
17. b. Because there is a median delay of several weeks after infection before antibodies can be detected, testing during this "window" may result in false-negative results. Risky behaviors that may expose a person to HIV should be discussed and possible scheduling for repeat testing done. Positive results on initial testing will be verified by additional testing. Identification of sexual partners and prevention practices are important but do not relate immediately to the testing situation.
17. Patient-Centered Care: Although an 18-yr-old girl knows that abstinence is one way to prevent STIs, she does not consider that as an alternative. She asks the nurse at the clinic if there are other measures for preventing STIs. What should the nurse teach her? a. Abstinence is the only way to prevent STIs. b. Voiding immediately after intercourse will decrease the risk for infection. c. A vaccine can prevent genital warts and cervical cancer caused by some strains of HPV. d. Thorough hand washing after contact with genitals can prevent oral-genital spread of STIs.
17. c. A vaccine is available for HPV types 6, 11, 16, and 18 that protects against genital warts and cervical cancer. Although sexual abstinence is the most certain method of avoiding all STIs, it is not usually a feasible alternative. Undamaged condoms also protect against infection. Conscientious hand washing and voiding after intercourse are positive hygienic measures that will help to prevent secondary infections but will not prevent STI
18. The "rapid" HIV antibody testing is performed on a patient at high risk for HIV infection. What should the nurse explain about this test? a. The test measures the activity of the HIV and reports viral loads as real numbers. b. This test is highly reliable, and in 5 minutes the patient will know if HIV infection is present. c. If the results are positive, another blood test and a return appointment for results will be necessary. d. This test detects drug-resistant viral mutations that are present in viral genes to evaluate resistance to antiretroviral drugs.
18. c. The "rapid" test is highly reliable and results are available in about 20 minutes. However, if results are positive from any testing, blood will be drawn for HIV viral load testing and another visit will be necessary to obtain the results of the additional testing and plan for care. CD4+ T cell counts are not used for screening but rather are used to monitor the progression of HIV infection, and new assay tests measure resistance of the
19. Treatment with two nucleoside reverse transcriptase inhibitors (NRTIs) and a protease inhibitor (PI) is prescribed for a patient with HIV infection. The patient asks why so many drugs are necessary for treatment. What should the nurse explain as the primary rationale for combination therapy? a. Cross-resistance between specific antiretroviral drugs is reduced when drugs are given in combination. b. Combinations of antiretroviral drugs decrease the potential for development of antiretroviral-resistant HIV variants. c. Side effects of the drugs are reduced when smaller doses of three different drugs are used rather than large doses of one drug. d. When CD4+ T-cell counts are <500/μL, a combination of drugs that have different actions is more effective in slowing HIV growth.
19. b. The major advantage of combination antiretroviral therapy (ART) is the inhibition of viral replication in several ways as well as decreasing the likelihood of drug resistance, the major factor that limits the ability of ART drugs to inhibit virus replication when they are used alone. The drugs selected should be ones with which the patient has not been previously treated and that are not cross-resistant with antiretroviral agents previously used by the patient.
The client's mother asks the nurse for more information on the HPV 9-valent vaccine. The nurse is providing information and knows that which of the following statements is true? Select all that apply. "HPV 9-valent vaccine will protect your child from the 9 most common strains of HPV" "You must ask your child if they are sexually active before deciding if the shot is needed or not" "HPV 9-valent vaccine is delivered across 3 doses" "If it is not received the first dose of HPV 9-valent vaccine by age 18, it will probably not work" "If your child already has HPV, there is no reason for to go through the trouble of getting a shot"
"HPV 9-valent vaccine will protect your child from the 9 most common strains of HPV" "HPV 9-valent vaccine is delivered across 3 doses" HPV 9-valent vaccine protects against the 9 strains of HPV that occur most frequently and/or are known to cause warts and cancers. HPV 9-valent vaccine is administered over 3 doses, starting no earlier than 9 years of age. The boosters are administered at 2 and 6 months in between boosters.
A nurse is caring for a client with herpes simplex virus. Which of the following statements by the client regarding herpes simplex virus represents an understanding of the plan of care? Select all that apply. "I am most contagious when I have open sores" "My partner will need to get the vaccine because of being under age 26" "My healthcare provider told me I am only required to take acyclovir if I experience an outbreak" "Condoms are 100% effective at preventing the transmission of herpes to my partner" "Because I haven't had an outbreak in 2 years, I am considered cured"
"I am most contagious when I have open sores" "My healthcare provider told me I am only required to take acyclovir if I experience an outbreak" Individuals with herpes simplex virus (HSV) are most contagious when they are newly infected and have open sores. The schedule for taking antivirals such as acyclovir is client-specific; some clients only need to take antivirals when they have an active flare-up.
A client tells the nurse, "I am afraid to tell my partner I have HPV because I might be broken up with." Which of the following is the best response from the nurse? "I'm sure your partner will understand, I can tell your partner really loves you" "It is your duty to report this to your sexual partner" "I understand the conversation might be difficult. Would you like to practice?" "Assure your partner that condoms will prevent HPV"
"I understand the conversation might be difficult. Would you like to practice?" Having this conversation with an intimate partner can be difficult, but supporting the client's decision to share this information is key to preventing the spread of infection. Supporting the client by role-playing allows the client to feel more comfortable going into this conversation.
A pregnant client is talking to the nurse about a current gonorrhea infection. Which of the following statements by the client demonstrates an understanding of the prevention of transmission to the neonate? "Infection risk is low for infants" "We will move forward with a c-section to avoid transmission to my baby" "My baby will receive a dose of IV antibiotics after birth to treat the infection" "If my baby shows signs of infection, then a dose of eye ointment will be given"
"My baby will receive a dose of IV antibiotics after birth to treat the infection" Infants born to mothers with active infections receive a one-time weight-based dose of ceftriaxone.
A nurse is providing discharge education to a client with human papilloma virus (HPV). The nurse know that the client has a good understanding when which of the following statements is made? "As long as I use a condom, my partner will not get HPV" "I can only transmit HPV to my partner when I have warts" "After 2-3 years my HPV will be considered cured" "My healthcare provider might want me to get the gardasil shot even though I already have HPV"
"My healthcare provider might want me to get the gardasil shot even though I already have HPV" This client's healthcare provider may suggest administering the gardasil 9 vaccine to this client in order to protect him/her from contracting other strains of HPV. Gardasil 9 protects against the 9 most common strains of HPV linked to cancer and venereal warts.
A nurse is caring for a client with herpes simplex virus. Which of the follow statements by the client regarding herpes simplex virus represents a need for further teaching by the nurse? "Women are more likely to contract genital herpes" "My antiviral medication will help decrease the symptoms I feel during an outbreak" "I will need to have a cesarean section so my infant does not get herpes" "Once more sores heal up, I don't need to use a condom anymore"
"Once more sores heal up, I don't need to use a condom anymore" This statement is incorrect by the client and requires more teaching. Condom use is encouraged, though it is not 100% effective at preventing HSV transmission. Herpes Simplex Virus, or HSV, is contagious even when a patient is asymptomatic.
20. What is one of the most significant factors in determining when to start ART in a patient with HIV infection? a. Whether the patient has high levels of HIV antibodies b. Confirmation that the patient has contracted HIV infection c. The patient's readiness to commit to a complex, lifelong, uncomfortable drug regimen d. Whether the patient has a support system to help manage the treatment regimen and costs
20. c. Guidelines for initiating ART are being updated continuously because of the development of alternative drugs and problems with long-term side effects and compliance with regimens. Whenever treatment is started, an important consideration is the patient's readiness to initiate ART because adherence to drug regimens is a critical component of the therapy and preventing drug resistance.
21. After teaching a patient with HIV infection about using antiretroviral drugs, the nurse recognizes that further teaching is needed when the patient says a. "I should never skip doses of my medication, even if I develop side effects." b. "If my viral load becomes undetectable, I am no longer able to transmit HIV." c. "I should not use any over-the-counter drugs without checking with my HCP." d. "If I develop a headache with nausea and vomiting, I should report it to my HCP"
21. b. An undetectable viral load in the blood does not mean that the virus is gone; it is still present in lymph nodes and other organs. Transmission is still possible, and use of protective measures must be continued. The other options show understanding.
22. Prophylactic measures that are routinely used as early as possible in HIV infection to prevent opportunistic and debilitating secondary problems include administration of a. isoniazid to prevent tuberculosis. b. zoster virus vaccination to prevent shingles. c. trimethoprim/sulfamethoxazole for toxoplasmosis. d. vaccines for pneumococcal pneumonia, influenza, and hepatitis A and B.
22. d. Pneumococcal pneumonia, influenza, and hepatitis A and B vaccines should be given as early as possible in HIV infection while there is still immunologic function. Isoniazid is used for 9 to 12 months only if a patient has reactive purified protein derivative (PPD) >5 mm, has had high-risk exposure, or has prior untreated positive PPD. Zoster virus vaccination is not recommended for patients with HIV. Trimethoprim/sulfamethoxazole is initiated when CD4+ T cell count is <200/μL or when there is a history of Pneumocystis jiroveci pneumonia (PCP).
23. Priority Decision: A patient identified as HIV antibody positive 1 year ago manifests asymptomatic HIV infection but does not want to start ART at this time. What is the best nursing intervention for the patient at this stage of illness? a. Assist with end-of-life issues b. Provide care during acute exacerbations c. Provide physical care for chronic diseases d. Teach the patient about immune enhancement
23. d. After a patient has positive HIV antibody testing and is in acute disease, the overriding goal is to keep the viral load as low as possible and to maintain a functioning immune system. The nurse should provide teaching regarding ways to enhance immune function (e.g., nutrition, vaccinations, rest and exercise, stress reduction) to prevent the onset of opportunistic diseases in addition to teaching about the spectrum of the infection, options for care, signs and symptoms to watch for, ways to prevent HIV spread, and ways to adhere to treatment regimens when ART drugs are initiated. The asymptomatic stage is too early for the other options.
7. Which manifestations are characteristic of the late or tertiary stage of syphilis (select all that apply)? a. Heart failure b. Tabes dorsalis c. Aortic aneurysms d. Mental deterioration e. Generalized cutaneous rash f. Destructive skin, bone, and soft tissue lesions
7. a, b, c, d, f. In the tertiary (or late) stage of syphilis there can be cardiovascular problems (heart failure, aneurysms, valve insufficiency), gummas (chronic destructive lesions), and neurosyphilis manifestations (mental deterioration, tabes dorsalis, and speech disturbances). Generalized cutaneous rash occurs in the secondary stage of syphilis, a few weeks after the chancre appears.
763. The nurse prepares to give a bath and change the bed linens of a client with cutaneous Kaposi's sarcoma lesions. The lesions are open and draining a scant amount of serous fluid. Which would the nurse incorporate into the plan during the bathing of this client? 1. Wearing gloves 2. Wearing a gown and gloves 3. Wearing a gown, gloves, and a mask 4. Wearing a gown and gloves to change the bed linens, and gloves only for the bath
763. Answer: 2 Rationale: Gowns and gloves are required if the nurse anticipates contact with soiled items such as those with wound drainage, or is caring for a client who is incontinent with diarrhea or a client who has an ileostomy or colostomy. Masks are not required unless droplet or airborne precautions are necessary. Regardless of the amount of wound drainage, a gown and gloves must be worn. Test-Taking Strategy: Focus on the subject, the method of transmission of infection from Kaposi's sarcoma. Read the question, noting the task that is presented; in this case, it is bathing and changing linens. Eliminate option 3, because the method of transmission is not respiratory. Eliminate options 1 and 4 because neither provides adequate protection based on the method of transmission.
767. The nurse is assisting in planning care for a client with a diagnosis of immunodeficiency and should incorporate which action as a priority in the plan? 1. Protecting the client from infection 2. Providing emotional support to decrease fear 3. Encouraging discussion about lifestyle changes 4. Identifying factors that decreased the immune function
767. Answer: 1 Rationale: The client with immunodeficiency has inadequate or absence of immune bodies and is at risk for infection. The priority nursing intervention would be to protect the client from infection. Options 2, 3, and 4 may be components of care but are not the priority. Test-Taking Strategy: Note the strategic word, priority. Use Maslow's Hierarchy of Needs theory to answer the question. Remember that physiological needs are the priority. This will direct you to the correct option.
775. The client with acquired immunodeficiency syndrome is diagnosed with cutaneous Kaposi's sarcoma. Based on this diagnosis, the nurse understands that this has been confirmed by which finding? 1. Swelling in the genital area 2. Swelling in the lower extremities 3. Positive punch biopsy of the cutaneous lesions 4. Appearance of reddish-blue lesions noted on the skin
775. Answer: 3 Rationale: Kaposi's sarcoma lesions begin as red, dark blue, or purple macules on the lower legs that change into plaques. These large plaques ulcerate or open and drain. The lesions spread by metastasis through the upper body and then to the face and oral mucosa. They can move to the lymphatic system, lungs, and gastrointestinal tract. Late disease results in swelling and pain in the lower extremities, penis, scrotum, or face. Diagnosis is made by punch biopsy of cutaneous lesions and biopsy of pulmonary and gastrointestinal lesions. Test-Taking Strategy: Focus on the subject, diagnosing Kaposi's sarcoma. Eliminate options 1 and 2 first, because these symptoms occur late in the development of Kaposi's sarcoma. Then, note the word confirmed in the question. This word will assist in directing you to the option that will confirm the diagnosis, the biopsy of the lesions.
8. Which stage of syphilis is identified by the absence of clinical manifestations and a positive fluorescent treponemal antibody absorption (FTA-Abs) test? a. Latent b. Primary c. Secondary d. Late (tertiary)
8. a. Lack of clinical manifestations but a positive treponemal antibody test with normal cerebrospinal fluid (CSF) occurs in the latent stage. The primary stage is characterized by a chancre, regional lymphadenopathy, and genital ulcers. The secondary stage has flu-like symptoms and cutaneous lesions. The late or tertiary stage is characterized by gummas, cardiovascular changes, and neurosyphilis
8. In each of the following situations identify which option has the highest risk for human immunodeficiency virus (HIV) transmission? a. Transmission to women OR to men during heterosexual intercourse b. Hollow-bore needle used for vascular access OR used for IM injection c. First 2 to 4 weeks of infection OR 1 year after infection d. Perinatal transmission from HIV-infected mothers taking antiretroviral therapy (ART) OR HIV-infected mothers using no therapy e. A splash exposure of HIV-infected blood on skin with an open lesion OR a needle-stick exposure to HIV- infected blood
8. a. women; b. vascular access; c. first 2 to 4 weeks of infection; d. HIV-infected mothers using no therapy; e. needle-stick exposure to HIV-infected blood
9. A premarital blood test for syphilis reveals that a woman has a positive Venereal Disease Research Laboratory (VDRL) test. How should the nurse advise the patient? a. A single dose of penicillin will cure the syphilis. b. She should question her fiancé about prior sexual contacts. c. Additional testing to detect specific antitreponemal antibodies is necessary. d. A lumbar puncture to evaluate cerebrospinal fluid (CSF) is necessary to rule out active syphilis.
9. c. Many other diseases or conditions may cause false- positive test results on nontreponemal Venereal Disease Research Laboratory (VDRL) or rapid plasma reagent (RPR) tests and additional testing is needed before a diagnosis is confirmed or treatment is administered. The diagnosis is confirmed by specific treponemal tests, such as the fluorescent antibody absorption (FTA-Abs) test or the TP-PA test. Analysis of CSF is used to diagnose asymptomatic neurosyphilis
While a nurse is educating students at a middle school health fair, the nurse is approached by a student who shares there are some bumps that look like the pictures of herpes simplex virus. Which of the following responses by the nurse is most appropriate? Telling the student that abstinence would have prevented her infection Requesting the student call her parents to take her to the doctor Asking the client if the sexual partner has ever mentioned having genital herpes Asking the student if she would be comfortable speaking in a more private place about her concerns
Asking the student if she would be comfortable speaking in a more private place about her concerns Requesting the student to talk to the nurse privately is most appropriate so that the nurse can coordinate medical care for the client and evaluate for sexual abuse.
While completing an intake assessment for a 25-year-old client for a routine exam, the client tells the nurse about being treated for a chlamydia infection 3 months prior. The nurse anticipates which of the following interventions? (SATA) Chlamydia and gonorrhea screening PAP smear Pregnancy test Pelvic exam One-time dose azithromycin PO
Chlamydia and gonorrhea screening Pelvic exam The nurse can anticipate a pelvic exam, as the client recently had an STI infection. Chlamydia and gonorrhea screening is correct because patients aged 25 and under are screening annually for chlamydia and these STIs usually coexist. Routine care for a patient treated for Chlamydia includes a 3-month follow-up appointment to check for re-infection.
A client is being treated for syphilis and the nurse knows that which of the following statements regarding tertiary syphilis infection are true? Select all that apply. Detecting and treating syphilis in the first two stages of infection prevents late-stage infection Once in the tertiary stage, the client is no longer contagious Intramuscular pencillin G halts the progression of tertiary syphillis Tertiary syphilis can cause aortic aneurysm and seizures if untreated Tertiary syphilis occurs within 10 years of primary syphilis infection
Detecting and treating syphilis in the first two stages of infection prevents late-stage infection Once in the tertiary stage, the client is no longer contagious Intramuscular pencillin G halts the progression of tertiary syphillis Tertiary syphilis can cause aortic aneurysm and seizures if untreated Detecting syphilis early is the only way to prevent tertiary syphilis. Tertiary infection is the only stage of syphilis that is not contagious. Penicillin infusion is the only way to treat tertiary syphilis and halt the progression of organ damage. Untreated tertiary syphilis can cause cardiac and neurological disasters, such as aortic aneurysm and seizure.
A CD4 T-cell count is measured in a client newly diagnosed with human immunodeficiency virus (HIV). In planning care, the nurse understands that which is accurate regarding the CD4 T-cell count? Select all that apply. Falls in response to a declining viral load Is a primary marker of immunocompetence Plays a role in the cell-mediated immune response Is a direct measure of the magnitude of HIV replication Guides decision making regarding timing of initiation of treatment
Falls in response to a declining viral load Is a primary marker of immunocompetence Guides decision making regarding timing of initiation of treatment Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. CD4 T-cells are a subgroup of lymphocytes that play an important role in the cell-mediated immune response; as such, CD4 T-cells are a primary marker of immunocompetence. Viral load is the direct measure of the magnitude of HIV replication. The CD4 T-cell count rises in response to a declining viral load. CD4 T-cell counts also guide decision making regarding initiation of treatment, when to change medications when treatment is failing, and the need for initiation of treatment against opportunistic infections.
A nurse is giving education to middle schoolers on preventing human papilloma virus (HPV) and knows that which of the following statements are true? Select all that apply. Getting the gardasil vaccine helps prevent pre-cancerous growths Avoiding vaginal sex when a partner has warts helps to prevent the spread of HPV An individual with HPV might not have symptoms for 8-12 months after they are infected Condoms can help to prevent the spread of HPV, but they are not 100% effective An individual might be contagious even if they have not had warts for a few weeks
Getting the gardasil vaccine helps prevent pre-cancerous growths Condoms can help to prevent the spread of HPV, but they are not 100% effective An individual might be contagious even if they have not had warts for a few weeks The gardasil vaccine is effective in preventing pre-cancerous growths and warts. Condoms help to prevent the spread of HPV between mucous membranes, but they do not protect from warts or lesions in the groin and inner thigh regions. HPV is contagious, even once the individual has no visible warts present.
A nurse is caring for a 34-year-old client who has been infected with HIV for 11 years. The client presents with diarrhea, weight loss and a fungal infection in the mouth. Which of the following are appropriate interventions for this client? Select all that apply. Initiate isolation precautions to protect the client from infection Provide meticulous skin care Teach the client wear a mask to protect visitors from infection Monitor red blood cell count Encourage nutritional supplements
Initiate isolation precautions to protect the client from infection Provide meticulous skin care Encourage nutritional supplements This client has signs of progression of HIV to AIDS. Assessment findings in the client with AIDS include malaise, fever, weightloss, diarrhea, fatigue, night sweats, opportunistic infections, neoplasms, fungal/bacterial/viral infections and lymphadenopathy. Once the client's condition has progressed to AIDS, they have a profound susceptibility to infection and malignancy. The goal of isolation precautions for an immunocompromised client is to protect the client, not visitors. Meticulous skin care of the client will help prevent the spread of infection. The client may not feel like eating, so adequate nutritional support is helpful, as well as maintaining fluid and electrolyte balance.
The nurse works with high-risk clients in an urban outpatient setting. Which groups should be tested for human immunodeficiency virus (HIV)? Select all that apply. Injection drug abusers Prostitutes and their clients People with sexually transmitted infections (STIs) People who have had frequent episodes of pneumonia People who recently received a blood transfusion for a surgical procedure
Injection drug abusers Prostitutes and their clients People with sexually transmitted infections (STIs) Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Injection drug abusers, those engaged in prostitution, and people with STIs are high-risk groups that should be tested for HIV per the Centers for Disease Control and Prevention's recommendations. Those who have had frequent episodes of pneumonia and those who recently received a blood transfusion for a surgical procedure are not at risk for HIV unless another compounding factor places them at risk. However, if a blood transfusion was received between 1978 and 1985, the client should be tested.
The nurse is assessing a client with AIDS. Which of the following are expected findings? Select all that apply. Leukopenia Fluid overload Mouth ulcers Skin breakdown Obesity
Leukopenia Mouth ulcers Skin breakdown White blood cells are destroyed by the human immunodeficiency virus. By the time a client progresses to AIDS, labs will reflect profound leukopenia. Stomatitis, or ulcers in the mouth, are a frequent finding with clients who have AIDS. Most commonly these are due to viruses such as cytomegalovirus or herpes simplex virus. Malnutrition and illness leads to weakened skin structure, and results in skin breakdown. This is a common finding in clients with advanced AIDS.
A nurse is caring for a client with AIDS. The client informs the nurse about the client's use of acupuncture to help with the pain. The nurse should be most concerned about this practice due to which of the following factors? Needle use contributing to a risk of transmission Pressure on internal organs affected by the disease An unregulated environment in the acupuncture clinic that could contribute to opportunistic infections Oils and extracts that may affect antiretriviral therapy
Needle use contributing to a risk of transmission Acupuncture uses needles to stimulate certain points on the body to relieve pain, but needle use in a client with HIV or AIDS must be carefully administered. Needles must NOT be reused, and it is commonly reported that needles used for acupuncture are reused without adequate sterilization, which results in a risk for transmission of infection from one client to the next.
While working in the reproductive clinic, the nurse receives the following orders for the treatment of a client with chlamydia. Which of the following orders should the nurse seek clarification of? Assess for conjunctivitis Schedule 1 month follow-up 1000mg azithromycin PO Notify client's sexual partners of risk for infection
Notify client's sexual partners of risk for infection This is not an appropriate intervention and should be questioned. Members of the healthcare team should coach the client on notifying sexual partners, but should not contact the client's sexual partners without permission from the client.
A nurse is caring for a client who recently had blood testing for HIV. The results of the test came back as HIV positive. According to standards set by HIPAA, which of the actions of the nurse is most appropriate? Contact the health department with the client's name and information Place a sign on the client's door that others need to use isolation precautions Notify the provider of the result so that the provider can discuss it with the client Notify the other nurses in the unit for a team meeting
Notify the provider of the result so that the provider can discuss it with the client HIPAA laws provide for protection of a client's personal information. The client is allowed this same protection, regardless of HIV status. If the nurse finds out that a client has tested positive for HIV or another serious condition, the nurse must treat the result with confidentiality just the same as for any other client protected information.
A nurse is educating a group of middle school students on locations of human papilloma virus (HPV). The nurse is correct in explaining that In addition to the cervix, cancers related to HPV are most commonly found in which of the following sites? Penis Vagina Oral cavity Anorectal
Oral cavity HPV-related oropharyngeal cancers have shown a sharp increase in the last 5 years. In fact, more clients were diagnosed with HPV-related oral cancers (12,885 cases) than cervical cancers (10,751) in 2015.
A nurse is assessing a client and asking about symptoms. The nurse knows that which of the following symptoms would lead the nurse to suspect disseminated gonococcal infection (DGI)? (SATA) Purulent vaginal discharge Fever Swollen joints Diffuse rash Wart-like lesions on labia
Purulent vaginal discharge Fever Swollen joints This occurs with DGI. Purulent vaginal discharge occurs with DGI because the body is trying to rid the bacterial infection. Fever occurs because gonorrhea is a bacterial infection that can cause a thermoregulatory response.
An HIV-infected client is in the hospital after developing an opportunistic infection. The client's spouse will provide care to the client at home. What information should the nurse provide to the caregiver about providing home care for the client? Select all that apply. Remind the caregiver not to share personal tools such as toothbrushes or razors Encourage the caregiver to seek help with client care when necessary Educate the caregiver to wash fruits and vegetables when preparing food Teach the caregiver to delay getting immunized for the client's sake Teach the caregiver not to insist the client get out of bed for a day if the client is tired
Remind the caregiver not to share personal tools such as toothbrushes or razors Encourage the caregiver to seek help with client care when necessary Educate the caregiver to wash fruits and vegetables when preparing food These teaching points will help prevent the client from getting infections. Being a caregiver for a loved one with HIV is multifaceted and exhausting, both physically and mentally. The caregiver needs to know how to prevent the client from getting infections, how to prevent the spread of HIV, and how to promote the client's wellness. Additionally, they must attend to their own physical and emotional needs to prevent caregiver burnout. This removes pathogens from food, which is important for the immunocompromised client.
An 18-year-old client is seen at a clinic for treatment of a sexually transmitted infection. It is her second time receiving treatment for an STI within the past year. Despite the recent infections, the client tells the nurse that she is being safer than most of her friends. Which of the following responses from the nurse is most appropriate? I hear you saying that it isn't fair that your friends can be sexually active without consequences but you cannot What is it you are looking for when you decide to have sex with someone? Just because all of your friends are having sex doesn't mean that you need to Repeated sexually transmitted infections can put you at risk of other health problems. Let's talk about how you can prevent this from happening again
Repeated sexually transmitted infections can put you at risk of other health problems. Let's talk about how you can prevent this from happening again The client in this situation is participating in high-risk behaviors that can negatively affect health in the long term. Although the client compares herself to her friends, the client herself is the person receiving treatment, not the friends. The nurse should address the client's behavior to help find better strategies for self care.
A client with acquired immunodeficiency syndrome (AIDS) is experiencing fatigue. The nurse should plan to teach the client which strategy to conserve energy after discharge from the hospital? Bathe before eating breakfast. Sit for as many activities as possible. Stand in the shower instead of taking a bath. Group all tasks to be performed early in the morning.
Sit for as many activities as possible. Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. The client is taught to conserve energy by sitting for as many activities as possible, including dressing, shaving, preparing food, and ironing. The client also should sit in a shower chair instead of standing while bathing. The client needs to prioritize activities, such as eating breakfast before bathing, and should intersperse each major activity with a period of rest.
A client with human immunodeficiency virus infection has signs and symptoms of cryptosporidiosis. The nurse should prepare the client for which test that will assist in confirming the diagnosis? Stool culture Bronchoscopy Sputum culture Chest x-ray study
Stool culture Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Cryptosporidiosis is an intestinal infection caused by Cryptosporidium organisms. The client with cryptosporidiosis will present with signs and symptoms of watery diarrhea, flatus, abdominal distention, pain, and fever. It is important for the nurse to monitor for an electrolyte imbalance. Diagnostic tests include a stool culture with a bowel biopsy. The other options are incorrect.
The nurse is caring for a 35-year-old client who reports a history of syphilis infection discovered at age 25. The nurse knows that which of the following is true regarding syphilis at this stage? The client can begin treatment with IV penicillin and become cured The client can no longer spread the infection to their child in utero The client is no longer contagious through sexual contact The client will have chancre-like sores in the genital area
The client is no longer contagious through sexual contact A client with a latent syphilis infection is no longer contagious through sexual contact, but can pass the infection to a fetus. Latent syphilis can last up to 25 years from initial infection.
A nurse in the infectious diseases unit of the hospital is caring for a client who has been diagnosed with HIV infection. The nurse understands that this client is considered to have developed AIDS with which of the following conditions? Select all that apply. Tuberculosis Vaginal yeast infection Cytomegalovirus CD4 counts below 200 cells/mm3 Pneumocystis Pneumonia
Tuberculosis Cytomegalovirus CD4 counts below 200 cells/mm3 Pneumocystis Pneumonia A client with HIV infection is considered to have AIDS when their CD4 count falls below 200 cells/mm3, or when they have one or more AIDS-defining, life-threatening opportunistic infections regardless of their CD4 count. Examples of common AIDS-related opportunistic infections include Tuberculosis, Pneumocystis Pneumonia, Cytomegalovirus, or invasive cervical or other cancer.
5. In assessing patients for STIs, the nurse needs to know that many STIs can be asymptomatic. Which STIs can be asymptomatic (select all that apply)? a. Syphilis b. Gonorrhea c. Genital warts d. Genital herpes e. Chlamydial infection
a. Syphilis b. Gonorrhea c. Genital warts d. Genital herpes e. Chlamydial infection Rationale: Syphilis (especially in the later stages), gonorrhea, genital warts, genital herpes, and chlamydial infection can all be asymptomatic. Because of the high prevalence of asymptomatic STIs, screening of populations at high risk is needed to identify those who are infected.
11. Which strategy can the nurse teach the patient to eliminate the risk of HIV transmission? a. Using sterile equipment to inject drugs b. Cleaning equipment used to inject drugs c. Taking lamivudine (Epivir) during pregnancy d. Using latex or polyurethane barriers to cover genitalia during sexual contact
a. Using sterile equipment to inject drugs Rationale: Access to sterile equipment is an important risk-elimination tactic. Some communities have needle and syringe exchange programs (NSEPs) that provide sterile equipment to users in exchange for used equipment. Cleaning equipment before use is a risk-reducing activity. It decreases the risk when equipment is shared, but it takes time, and a person in drug withdrawal may have difficulty cleaning equipment. Lamivudine alone is not appropriate for treatment in pregnancy. Barrier methods reduce but do not eliminate risk.
When caring for patients with a sexually transmitted infection, it is important that the nurse teach the patient to: a.advise all sexual partners of the need for treatment. b.use a condom for sexual intercourse during treatment. c.engage in monogamous relationships to prevent re-infection. d.wash the genitalia before sexual intercourse to prevent disease transmission.
a.advise all sexual partners of the need for treatment.
Which of the following are symptoms of Syphilis? (SELECT ALL THAT APPLY) a.chancre sores b.bilateral rash on the skin, including the palms of the hands and the soles of the feet c.thick, yellowish discharge d.large, destructive ulcers called gummas
a.chancre sores b.bilateral rash on the skin, including the palms of the hands and the soles of the feet d.large, destructive ulcers called gummas
Which medications would be used in the treatment of gonorrhea and chlamydia? Select all that apply. a.doxycycline (Vibramycin) b.azithromycin (Zithromax) c.levofloxacin (Levaquin) d.ceftriaxone (Rocephin) e.ciprofloxacin (Cipro) f.Amoxicillin (Ampicillin) g.acyclovir (Zovirax)
a.doxycycline (Vibramycin) b.azithromycin (Zithromax) d.ceftriaxone (Rocephin)
10. Which statement(s) about metabolic side effects of ART is (are) true (select all that apply)? a. These are annoying symptoms that are ultimately harmless. b. ART-related body changes include fat redistribution and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. e. Compared to uninfected people, insulin resistance and hyperlipidemia are more difficult to treat in HIV-infected patients.
b. ART-related body changes include fat redistribution and peripheral wasting. c. Lipid abnormalities include increases in triglycerides and decreases in high-density cholesterol. d. Insulin resistance and hyperlipidemia can be treated with drugs to control glucose and cholesterol. Rationale: Some HIV-infected patients, especially those who have been infected and have received ART for a long time, develop a set of metabolic disorders that include changes in body shape (e.g., fat deposits in the abdomen, upper back, and breasts along with fat loss in the arms, legs, and face) as a result of lipodystrophy, hyperlipidemia (i.e., elevated triglyceride levels and decreases in high-density lipoprotein levels), insulin resistance and hyperglycemia, bone disease (e.g., osteoporosis, osteopenia, avascular necrosis), lactic acidosis, and cardiovascular disease.
2. Which types(s) of isolation precautions is (are) appropriate for a patient with tuberculosis (select all that apply)? a. contact precautions b. droplet precautions c. airborne precautions d. standard precautions e. neutropenic precautions
c. airborne precautions d. standard precautions Rationale: Standard precautions should be used for all patients. In addition to standard precautions, patients with TB should be placed on airborne precautions to minimize risk of transmission and infection of HCPs and visitors.
A primary herpes simplex virus (HSV) infection differs from recurrent HSV episodes in that recurrent HSV episodes: a.are not sexually transmitted b.exhibit systemic manifestations such as fever and muscle pain c.are shorter in duration and less severe than primary episodes d.are triggered by cold weather
c.are shorter in duration and less severe than primary episodes
While educating a client at a 30-week prenatal appointment, which of the following statements by the client regarding a primary syphilis infection represents a need for further education? "If my baby has contracted syphilis, they will treat him/her once I deliver" "Treating my syphilis infection could still help prevent transmission to my baby" "Congenital syphilis has been eradicated in the United States, so I do not need to worry about getting tested" "Depending on my symptoms, I might need to have a C-section to prevent giving my baby Syphilis"
"Congenital syphilis has been eradicated in the United States, so I do not need to worry about getting tested" This statement indicates that further education is necessary, because it is an incorrect statement by the client. Congenital syphilis has not been eradicated in the United States - only Cuba has successfully eradicated the spread of mother to neonate.
A nurse is providing education to a client diagnosed with gonorrhea. Which of the following statements by the client demonstrates a need for further education by the nurse? "If I don't complete this treatment, the infection could spread and become pelvic inflammatory disease" "I should call the office right away if I notice any sores on my skin or swollen joints" "I can resume sexual activity in a week and use condoms to protect my partner" "I will notify my partners from the last 6 months to come in, as I may have given them this infection"
"I will notify my partners from the last 6 months to come in, as I may have given them this infection" This requires further education. This is an incorrect statement by the client and needs further teaching. As long as the client sought treatment at the onset of symptoms, it is likely that this infection has only been there for 7-10 days so partners from 6 months ago don't need to be notified but any current partner should.
A nurse working with clients in a reproductive health clinic. The nurse knows that which of the following statements by the client demonstrates an understanding of a syphilis Infection? "Even though syphilis is not curable, I can take medications to slow the progression of disease" "Since it only takes 2 weeks for syphilis to appear, I can be sure I got this from my current sexual partner" "If I find an open sore on my penis, it is probably from an STI other than syphilis" "Syphilis is reportable to the health department, so they can help me notify my sexual partners"
"Syphilis is reportable to the health department, so they can help me notify my sexual partners" Syphilis infection is reportable to the CDC and local health department, so they can assist in notifying sexual partners of their risk for infection.
1.Gummas _____ 2.Chancre _____ 3.Absence of manifestations _____ 4.Rash on trunk, hands, feet _____ 5.Loss of mental functioning _____ 6.Flu-like symptoms _____ 7.Paralysis _____ 8. Mucous patches on tongue _____ A.Primary Stage B.Secondary Stage C.Latent Stage D.Tertiary/Late Stage
1. D 2. A 3. C 4. B 5. D 6. B 7. D 8. B
75. The male client presents to the public health clinic complaining of joint pain and malaise. On assessment, the nurse notes a rash on the trunk, palms of the hands, and soles of the feet. Which action should the nurse implement next? 1. Determine if the client has had a chancre sore within the last two (2) months. 2. Ask the client how many sexual partners he has had in the past year. 3. Refer the client to a dermatologist for a diagnostic work-up. 4. Have the client provide a clean voided midstream urine specimen.
1. Determine if the client has had a chancre sore within the last two (2) months. / 1. These are signs of second-stage syphilis. The nurse should ask about the development of a chancre sore, one of the first signs of a syphilis infection. TEST-TAKING HINT: If the test taker is aware the symptoms are those of an STD, options "3" and "4" can be eliminated.
1.If your partner does not have a visible Syphilis sore, you are at no risk of infection. ___ 2.A person can have different STIs at the same time. ___ 3.Using condoms during intercourse guarantees that Syphilis will not be transmitted. ___ 4.Highest population affected with Syphilis is young men between the ages of 20-29 years. ___ 5.A typical symptom of secondary-stage Syphilis is a chancre. ___ 6.The HCP is responsible for reporting a case of Syphilis to the local health department. ___
1. False 2. True 3. False 4. False 5. False 6. True
83. Which statement best describes the responsibility of the public health nurse regarding sexually transmitted diseases? 1. Notify the sexual partners of clients diagnosed with an STD. 2. Determine the course of treatment for clients diagnosed with an STD. 3. Explain the legal aspects of STD reporting to a client diagnosed with an STD. 4. Analyze the statistics regarding STD transmission and reporting the findings.
1. Notify the sexual partners of clients diagnosed with an STD. / 1. The public health nurse is responsible for attempting to notify sexual partners of a client diagnosed with an STD of a potential infection and urging the partner to be tested for the disease and to receive treatment. Health departments offer confidential testing and treatment. TEST-TAKING HINT: Answer options "2," "3," and "4" ask the nurse to take on roles not within the nurse's expertise. The nurse must know the Nurse Practice Act of the state where the nurse practices. No state allows the nurse to give legal or medical advice.
74. The female client diagnosed with human papillomavirus (HPV) asks the nurse, "What other problems can HPV lead to?" Which statement is the most appropriate response by the nurse? 1. "HPV is transmitted during sexual intercourse." 2. "HPV infection can cause cancer of the cervix." 3. "It has been known to lead to ovarian problems." 4. "Regular Pap smears can help prevent problems."
2. "HPV infection can cause cancer of the cervix." / 2. Untreated HPV infection is a cause for developing cancer of the cervix. TEST-TAKING HINT: The test taker should choose the answer for the question the client is asking. Option "1" discusses transmission and option "4" discusses prevention; therefore, these two (2) options could be eliminated based on the stem of the question.
3. The laboratory result of a specimen from a 20-yr-old female patient shows human papillomavirus (HPV). What would the nurse suspect the patient's diagnosis to be? a. Syphilis b. Gonorrhea c. Genital warts d. Genital herpes
3. c. Genital warts are caused by human papillomavirus (HPV). Syphilis is caused by T. pallidum. Gonorrhea is caused by N. gonorrhoeae. Genital herpes are caused by HSV.
76. The nurse is caring for a young adult client who has been diagnosed with gonorrhea. Which statement reflects an understanding of the transmission of sexually transmitted diseases? 1. Only lower socioeconomic income people are at risk for gonorrhea and syphilis. 2. The longer a client waits to become sexually active, the greater the risk for an STD. 3. Females can transmit infectious diseases more rapidly than males. 4. If a client is diagnosed with an STD, the client should be evaluated for other STDs.
4. If a client is diagnosed with an STD, the client should be evaluated for other STDs. / 4. If the client has one STD, there is a great likelihood the client has another disease also. If one STD is found, the client should be monitored for others. TEST-TAKING HINT: Option "2" does not make sense: If sexual activity is put off, there cannot be an increased risk. Socioeconomic reasons may be a reason for delaying treatment of a disease, but diseases are not financially based and occur in all socioeconomic levels.
4. A female patient with a purulent vaginal discharge is seen at an outpatient clinic. The nurse suspects a diagnosis of gonorrhea. How would this STI be treated? a. Oral acyclovir (Zovirax) b. Penicillin G Benzathine given IM c. Need a confirmatory test result before treatment d. Ceftriaxone IM with oral azithromycin (Zithromax)
4. d. Gonorrhea is treated with dual therapy of a single dose of IM ceftriaxone and oral azithromycin (Zithromax). Acyclovir would be used for HSV. Penicillin was used to treat gonorrhea, but gonorrhea is now resistant to penicillin. Penicillin G is used to treat syphilis. Nucleic acid amplification testing (NAAT) is used to confirm the diagnosis in women. Because of a short incubation period and high rates of infectivity, treatment for gonorrhea is often given without waiting for positive test result
6. Priority Decision: During evaluation and treatment of gonorrhea in a young man at the health clinic, about what is it most important for the nurse to question the patient? a. A prior history of STIs b. When the symptoms began c. The date of his last sexual activity d. The names of his recent sexual partners
6. d. All sexual contacts of patients with gonorrhea must be notified, evaluated, and treated for STIs to prevent reinfection and further transmission. The other information may be helpful in diagnosis and treatment, but the nurse must try to identify the patient's sexual partners.
A 25-year-old client has been diagnosed with HIV. Which of the following manifestations of endocrine dysfunction have been associated with this type of infection? Diabetes insipidus Excess parathyroid hormone secretion Testicular hypertrophy Adrenal insufficiency
Adrenal insufficiency HIV infection can cause a number of endocrine-related dysfunctions in the affected client. A nurse caring for a client with HIV may most likely see adrenal insufficiency, decreased testosterone and androgen function and altered thyroid function. None of these alterations are related to CD4 counts and can appear in the early or late stages of HIV infection
A client with acquired immunodeficiency syndrome has been started on therapy with zidovudine. The nurse assesses the complete blood cell (CBC) count, knowing that which is an adverse effect of this medication? Polycythemia Leukocytosis Thrombocytosis Agranulocytopenia
Agranulocytopenia Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Zidovudine is a neucloside-nucleotide reverse transcriptase inhibitor used to the virus. An adverse effect of this medication is agranulocytopenia with anemia. The nurse carefully monitors CBC count results for changes that could indicate this occurrence. With early infection in the client who is asymptomatic, the CBC count is monitored monthly for 3 months and then every 3 months thereafter. In clients with advanced disease, the CBC count is monitored every 2 weeks for the first 2 months and then once a month if the medication is tolerated well. The remaining options are not side or adverse effects of the medication.
A client with chlamydia was prescribed an antibiotic and at a routine follow up, it was determined that the client was not taking the antibiotic. The nurse explains to the client that without treatment this infection could cause which of the following? Blindness Deafness Facial Deformities Insanity
Blindness Some strains of Chlamydia infection spread to the eyes of adults and infants and cause blindness.
A nurse is educating middle school students on sexually transmitted infections and knows that which of the following is true regarding syphilis and HPV infection? Both STIs are curable if caught early in their progression Both STIs are contagious even when symptoms are not present Both infections indicate a need for cesarean section delivery Clients with HPV are more likely to contract syphilis
Both STIs are contagious even when symptoms are not present Syphilis and HPV are contagious even when clients are asymptomatic.
A nurse working in a reproductive clinic is caring for a client with gonorrhea. The nurse knows that which of the following sexually transmitted infection is most often found to co-exist with this infection? Herpes simplex virus (HSV) Human immunodeficiency virus (HIV) Chlamydia Syphilis
Chlamydia Gonorrhea and Chlamydia co-infection is so common that a patient diagnosed with gonorrhea is treated for both infections.
A nurse if providing client education on various sexually transmitted infections and knows that which of the following is true of both human papillomavirus (HPV) and herpes simplex virus (HSV)? Clients are contagious even when no symptoms are present Clients can be vaccinated starting at age 9, and no later than age 26 Treatment includes ablating, freezing, or excising lesions The virus is incurable, but can decrease in severity with medication
Clients are contagious even when no symptoms are present Both HPV and HSV are highly contagious STIs that can spread even when the client has no symptoms.
A nurse is caring for a client who is infected with HIV. The nurse recognizes that the client is at risk for skin breakdown because of complications of his illness. Which intervention would the nurse most likely employ to reduce this risk? Regularly take the client outside in a wheelchair Provide pain medication PRN as ordered Encourage food and fluid intake Ensure that the client gets adequate rest
Encourage food and fluid intake Up to 90% of clients who are infected with HIV experience some form of skin impairment, including skin breakdown and wounds. The nurse can take steps to prevent skin breakdown by utilizing the Braden Scale skin assessment tool, which includes nutrition status, mobility, activity, friction and sheer, moisture, and sensory perception. Encouraging food and fluid intake can help to prevent malnutrition that leads to wound development.
T or F: With removal of genital warts, infectivity is decreased.
False
A nurse is caring for a client with chlamydia. The nurse knows that which of the following statements by the client with Chlamydia demonstrate an understanding of the plan of care? I will return in 3 months for a follow-up visit. "As long as I do not have symptoms, I do not need to worry about spreading to my partner" If I use a condom, I don't need to worry about waiting 7 days after treatment to resume sexual activity My partner should come in for treatment if they start to show signs of infection.
I will return in 3 months for a follow-up visit Chlamydia is often asymptomatic, clients are instructed to return in 3 months to monitor for re-infection.
A client with human immunodeficiency virus (HIV) infection has a fever, and histoplasmosis is suspected. The nurse should prepare the client for which diagnostic test to confirm the presence of histoplasmosis? Skin biopsy Sputum culture Western blot test Upper gastrointestinal series
Sputum culture Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Histoplasmosis is an opportunistic infection that affects the lungs and can occur in the client with HIV infection. Diagnostic tests include chest x-ray, sputum culture, lung biopsy, and bronchoscopy. The other options are incorrect. A Western blot test is used to confirm a diagnosis of HIV. A skin biopsy may be done if the client had Kaposi's sarcoma. Gastrointestinal series are done for a client suspected to have a gastrointestinal disorder.
T or F - HSV can be transmitted even if there are no lesions present.
True
T or F - HSV is a lifetime condition.
True
Human papillomavirus (HPV) is associated with: a.cancer of the cervix b.skin cancer c.lung cancer d.spontaneous abortions
a.cancer of the cervix
A client has requested and undergone testing for human immunodeficiency virus (HIV) infection. The client asks what will be done next because the result of the enzyme-linked immunosorbent assay (ELISA) has been positive. Which diagnostic study should the nurse be aware of before responding to the client? No further diagnostic studies are needed. A Western blot will be done to confirm these findings. The client probably will have a bone marrow biopsy done. A CD4+ cell count will be done to measure T helper lymphocytes.
A Western blot will be done to confirm these findings. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. If the result of the ELISA is positive, the Western blot is done to confirm the findings. If the result of the Western blot is positive, the client is considered to be seropositive for the infection and to be infected with the virus. The remaining options are incorrect.
The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who has begun to experience multiple opportunistic infections. Which laboratory test would be most helpful in assessing the client's need for reassessment of treatment? Western blot B lymphocyte count CD4+ cell or T lymphocyte count Enzyme-linked immunosorbent assay (ELISA)
CD4+ cell or T lymphocyte count Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. The T lymphocyte or CD4+ cell count indicates whether the client is responding to the medication treatment. The count should increase if the client is responding and should decrease if the client's response is poor. The Western blot and ELISA are tests to assist in diagnosing human immunodeficiency virus infection. The B lymphocyte count is not a priority marker to monitor with AIDS clients.
The nurse is caring for a client with acquired immunodeficiency syndrome and detects early infection with Pneumocystis jiroveci by monitoring the client for which clinical manifestation? Fever Cough Dyspnea at rest Dyspnea on exertion
Cough Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Pneumocystis jiroveci pneumonia (PCP) is a fungal infection and is a common opportunistic infection. The client with P. jiroveci infection usually has a cough as the first sign. The cough begins as nonproductive and then progresses to productive. Later signs and symptoms include fever, dyspnea on exertion, and finally dyspnea at rest.
During a head-to-toe assessment, the nurse knows which of the following findings is suggestive of a gonorrhea infection? Open, "kissing" lesions on client's penis and scrotum Wart-like lesions on client's inner thigh Diffuse rash across the client's back Creamy, white exudate from client's penis
Creamy, white exudate from client's penis Creamy, white exudate is correct because this type of discharge is a trademark symptom of gonorrhea infection.
The nurse is assigned to care for a client with human immunodeficiency virus (HIV) infection. The nurse reviews the client's health care record and notes documentation of toxoplasmosis encephalitis. On the basis of this information, the nurse would assess for which manifestation? Lesions on the skin Mental status changes Changes in bowel pattern Lesions on the oral mucosa
Mental status changes Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Toxoplasmosis encephalitis, caused by Toxoplasma gondii, is acquired through contact with contaminated cat feces or by ingesting infected, undercooked meat. It manifests with signs and symptoms such as an altered mental status, neurological deficits, headaches, and fever. Additional manifestations include difficulties with speech, gait, and vision; and seizures. The other options are not associated with toxoplasmosis.
5. Which statements accurately describe HIV infection (select all that apply)? a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. d. Untreated HIV infection usually remains in the early chronic stage for 1 year or less. e. Opportunistic diseases occur more often when the CD4+ T cell count is high and the viral load is low.
a. Untreated HIV infection has a predictable pattern of progression. b. Late chronic HIV infection is called acquired immunodeficiency syndrome (AIDS). c. Untreated HIV infection can remain in the early chronic stage for a decade or more. Rationale: The typical course of untreated HIV infection follows a predictable pattern. However, treatment can significantly alter this pattern, and disease progression is highly individualized. Late chronic infection is another term for acquired immunodeficiency syndrome (AIDS). The median interval between untreated HIV infection and a diagnosis of AIDS is about 11 years.
What symptoms of gonorrhea or chlamydia may manifest in a woman? Select all that apply. a. dysuria b. vaginal discharge c. may be asymptomatic d. small vesicular lesions on perineum e. frequency of urination
a. dysuria b. vaginal discharge c. may be asymptomatic e. frequency of urination
A CD4+ lymphocyte count is performed in a client with human immunodeficiency virus (HIV) infection. When providing education about the testing, what should the nurse tell the client? "It establishes the stage of HIV infection." "It confirms the presence of HIV infection." "It identifies the cell-associated proviral DNA." "It determines the presence of HIV antibodies in the bloodstream."
"It establishes the stage of HIV infection." Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. A CD4+ lymphocyte count is performed to establish the stage of HIV infection, to help with decisions regarding the timing of initiation of antiretroviral therapy and prophylaxis for opportunistic infections, and to monitor treatment effectiveness. The remaining options are unrelated to the CD4+ lymphocyte count.
80. The nurse is planning the care of a client diagnosed with pelvic inflammatory disease secondary to an STD. Which collaborative diagnosis is appropriate for this client? 1. Risk for infertility. 2. Knowledge deficit. 3. Fluid volume deficit. 4. Noncompliance.
1. Risk for infertility. / 1. Determining and diagnosing the risk for infertility problems requires collaboration between the nurse and the HCP. TEST-TAKING HINT: The question requires the test taker to determine which are autonomous functions of the nurse. The nurse does not have the capability to prescribe fertility medications or treatments.
1. The current incidence of sexually transmitted infections (STIs) is related in part to what? a. Increased social acceptance of homosexuality b. Increased virulence of organisms that cause STIs c. Use of oral agents rather than condoms as contraceptives d. Increased microorganism resistance to common antibiotics
1. c. Although many factors relate to the current sexually transmitted infections (STI) rates, one major factor is the widespread use of oral contraceptives instead of condoms (both male and female). Condoms are the only contraceptive device that protects against STIs.
18. Patients with which STI are most likely to avoid obtaining and following treatment measures for their infection? a. Syphilis b. Gonorrhea c. HPV infection d. Genital herpes
18. a. STIs, such as syphilis, that can be treated with a single dose or short course of antibiotic therapy often lead to a casual attitude about the outcome of the disease, which leads to nonadherence with instructions and delays in treatment. This is particularly true of diseases that initially show few distressing or uncomfortable symptoms, such as syphili
12. What is the most common way to determine a diagnosis of chlamydial infection in a male patient? a. Cultures for chlamydial organisms are positive. b. The nucleic acid amplification test (NAAT) is positive. c. Gram stain smears and cultures are negative for gonorrhea. d. Signs and symptoms of epididymitis or proctitis are also present.
12. b. The NAAT is more sensitive than other diagnostic tests, can be done with a urine sample, and has results within 24 hours. A cell culture can be used to detect chlamydia organisms, but it requires specific handling and is not as easy or as fast to perform as the NAAT. Gonorrhea and chlamydia have very similar symptoms in men and frequently occur together. Gram stain smears and cultures for N. gonorrhoeae do not definitively diagnose Chlamydia. Manifestations of epididymitis or proctitis may be present, as with other STIs, but are not diagnostic.
12. Which characteristic corresponds with the acute stage of HIV infection? a. Burkitt's lymphoma c. Persistent fevers and night sweats b. Temporary fall of CD4+ T cells d. Pneumocystis jiroveci pneumonia
12. b. The symptoms of acute HIV infection occur 2 to 4 weeks after initial infection, when the CD4+ T cell counts fall temporarily but quickly return to baseline levels. Symptoms include a mononucleosis-like syndrome of fever, swollen lymph nodes, sore throat, headache, malaise, nausea, muscle and joint pain, diarrhea, and/or a diffuse rash. Some people develop neurologic complications. Burkitt's lymphoma and Pneumocystis jiroveci pneumonia are two of the opportunistic diseases that can occur in acquired immunodeficiency syndrome (AIDS). Persistent fevers and drenching night sweats occur in the symptomatic infection stage
13. What are characteristics of a HSV infection (select all that apply)? a. Treatment with acyclovir can cure genital herpes. b. Herpes simplex virus type 2 (HSV-2) is capable of causing only genital lesions. c. Recurrent symptomatic genital herpes may be precipitated by sexual activity and stress. d. To prevent transmission of genital herpes, condoms should be used when lesions are present. e. The primary symptom of genital herpes is painful vesicular lesions that rupture and ulcerate.
13. c, e. Sexual activity and stress may precipitate the recurrence of genital herpes symptoms of painful vesicular lesions that rupture and ulcerate. Acyclovir only decreases recurrences of genital herpes. Herpes simplex virus type 2 (HSV-2) may cause oral or genital lesions. Prevention of the spread of genital herpes is best done with avoidance of sexual activity when lesions are present
13. Which finding supports the diagnosis of acquired immunodeficiency syndrome (AIDS) in the individual with HIV? a. Flu-like symptoms c. CD4+ T cells 200-500/μL b. Oral hairy leukoplakia d. Cytomegalovirus retinitis
13. d. Cytomegalovirus retinitis could be an opportunistic viral infection that occurs when AIDS is diagnosed. Flu-like symptoms occur in the acute HIV infection stage. CD4+ T cells drop to 200 to 500/μL, and oral hairy leukoplakia is seen in the symptomatic infection stage of HIV.
14. During the physical assessment of a female patient with HPV infection, what should the nurse expect to find? a. Purulent vaginal discharge b. Painful perineal vesicles and ulcerations c. A painless, indurated lesion on the vulva d. Multiple coalescing gray warts in the perineal area
14. d. HPV is responsible for causing genital warts, which manifest as discrete single or multiple white to gray warts that may coalesce to form large cauliflower-like masses on the vulva, vagina, cervix, and perianal area. Purulent vaginal discharge is associated with gonorrhea or chlamydia. Painful perineal vesicles and ulcerations are characteristic of genital herpes and a chancre of syphilis is a painless indurated lesion on the vulva, vagina, lips, or mouth
81. Which laboratory test should the nurse expect for the client to rule out the diagnosis of syphilis? 1. Vaginal cultures. 2. Rapid plasma reagin card test (RPR-CT). 3. Gram-stained specimen of the urethral meatus. 4. Immunological assay.
2. Rapid plasma reagin card test (RPR-CT). / 2. The RPR test and the Venereal Disease Research Laboratory (VDRL) test are diagnostic tests for syphilis. TEST-TAKING HINT: The test taker must memorize the tests used to diagnose specific STDs and the symptoms differentiating one STD from another.
84. The nurse is admitting a client diagnosed with trichomoniasis. Which assessment data support this diagnosis? 1. Odorless, white, curdlike vaginal discharge. 2. Strawberry spots on the vaginal surface and itching. 3. Scant white vaginal discharge and dyspareunia. 4. Purulent discharge from the endocervix and pelvic pain.
2. Strawberry spots on the vaginal surface and itching. / 2. A strawberry spot on the vaginal wall or cervix, a fishy smelling vaginal discharge, and itching are symptoms of trichomonas. TEST-TAKING HINT: When studying for a test covering similar diseases, the test taker should concentrate on the information that makes one different from another. Only one STD has a characteristic strawberry spot.
87. The nurse in the gynecology clinic is assessing a 14-year-old client who reports being sexually active. Which information should the nurse teach the client? Select all that apply. 1. Inform the client that the nurse must tell the parents of her being sexually active. 2. Teach the client about possible birth control options. 3. Instruct the client regarding sexually transmitted disease. 4. Demonstrate how a condom is applied correctly. 5. Tell the client the importance of finishing all antibiotics. 6. Discuss the importance of attending parenting classes.
2. Teach the client about possible birth control options. / 2. The nurse should discuss birth control and sexually transmitted diseases with the client. She is at risk for pregnancy and STDs. 3. Instruct the client regarding sexually transmitted disease. 4. Demonstrate how a condom is applied correctly. / 4. The male wears the most commonly used condoms but both partners are responsible for contraception and prevention of STDs. This information will assist the client to know if the device is correctly applied and will have the best chance of preventing both pregnancy and STDs. TEST-TAKING HINT: The test taker could eliminate options "5" and "6" because the client is not currently pregnant.
2. In establishing screening programs for populations at high risk for STIs, the nurse recognizes that which microorganism causes nongonococcal urethritis in men and cervicitis in women? a. Treponema pallidum b. Neisseria gonorrhoeae c. Chlamydia trachomatis d. Herpes simplex virus (HSV)
2. c. Chlamydia trachomatis can cause nongonococcal urethritis in men and cervicitis in women. Herpes simplex virus (HSV) causes genital herpes. Treponema pallidum causes syphilis. Neisseria gonorrhoeae causes gonorrhea.
25. Priority Decision: A patient with advanced AIDS has a nursing diagnosis of impaired memory related to neurologic changes. In planning care for the patient, what should the nurse set as the highest priority? a. Maintain a safe patient environment b. Provide a quiet, nonstressful environment to avoid overstimulation c. Use memory cues such as calendars and clocks to promote orientation d. Provide written instructions of directions to promote understanding and orientation
25. a. All of the nursing interventions are appropriate for a patient with impaired memory, but the priority is the safety of the patient when cognitive and behavioral problems impair the ability to maintain a safe environment.
82. The client is diagnosed with tertiary syphilis. Which signs and symptoms should the nurse expect the client to exhibit? 1. Lymphadenopathy and hair loss. 2. Warts in the genital area. 3. Dementia and psychosis. 4. Raised rash covering the body.
3. Dementia and psychosis. / 3. Aortitis and neurosyphilis (dementia, psychosis, stroke, paresis, and meningitis) are the most common manifestations of tertiary syphilis. TEST-TAKING HINT: The key word in this question is "tertiary." The test taker must decide which disease has three (3) distinct phases and then which symptoms accompany each phase.
77. The young female client is admitted with pelvic inflammatory disease secondary to a chlamydia infection. Which discharge instruction should be taught to the client? 1. The client will develop antibodies to protect against a future infection. 2. This infection will not have any long-term effects for the client. 3. Both the client and the sexual partner must be treated simultaneously. 4. Once the infection subsides, the pain will go away and not be a problem.
3. Both the client and the sexual partner must be treated simultaneously. / 3. If both the client and the sexual partner are not treated simultaneously, the sexual partner can reinfect the client. TEST-TAKING HINT: Options "2" and "4" have a form of absolute. The words "any," "will," or "will not" are absolutes and in health care, there are very few absolutes.
85. The outpatient clinic nurse is working with clients diagnosed with sexually transmitted diseases (STD). Which long-term complication should the nurse discuss with the clients about STDs? 1. Stress the need for clients to completely finish all antibiotics prescriptions. 2. Inform the clients that, legally, many STIs must be reported to the health department. 3. Sexually transmitted diseases can result in reproductive problems. 4. Discuss the myth that acquired immunodeficiency syndrome is an STI.
3. Sexually transmitted diseases can result in reproductive problems. / 3. Because of scarring of reproductive tissue, infertility may be an issue resulting from STI infection. TEST-TAKING HINT: The test taker can rule out option "1" because of the generalized nature of the option; it is not specific to STDs. Option "2" does not address a long-term complication for the client. And option "4" requires the test taker to know the transmission of the disease.
79. The nurse is working in a health clinic. Which disease is required to be reported to the public health department? 1. Pelvic inflammatory disease. 2. Epididymitis. 3. Syphilis. 4. Ectopic pregnancy.
3. Syphilis. / 3. Syphilis is an STD and therefore must be reported to the appropriate health department. TEST-TAKING HINT: Only one (1) answer option is an STD. The other diseases/conditions may be caused by STDs, but they all have other causes as well.
73. The occupational health nurse is preparing a class regarding sexually transmitted diseases (STDs) for employees at a manufacturing plant. Which high-risk behavior information should be included in the class information? 1. Engaging in oral or anal sex decreases the risk of getting an STD. 2. Using a sterile needle guarantees the client will not get an STD. 3. The more sexual partners, the greater the chance of developing an STD. 4. If a condom is used, the client will not get a sexually transmitted disease.
3. The more sexual partners, the greater the chance of developing an STD. TEST-TAKING HINT: In option "2" the word "guarantees" appears, and the nurse cannot guarantee anything in dealing with healthcare issues. Option "4" is an absolute statement—"will not get"—and can be eliminated on this basis.
78. The nurse is assessing a male client for symptoms of gonorrhea. Which data support the diagnosis? 1. Presence of a chancre sore on the penis. 2. No symptoms. 3. A CD4 count of less than 200. 4. Pain in the testes and scrotal edema.
4. Pain in the testes and scrotal edema. / 4. Pain in the testes and scrotal edema can indicate epididymitis, an inflammatory process of the epididymis. This and urethritis are the most common presenting symptoms in a male with gonorrhea. TEST-TAKING HINT: Two (2) answer options mention male anatomy. If the test taker did not know the information, then choosing between these two (2) options might be the appropriate method of elimination.
5. A 22-yr-old woman with multiple sexual partners seeks care after several weeks of experiencing painful and frequent urination and vaginal discharge. Although the results of a culture of cervical secretions are not yet available, the nurse explains to the patient that she will be treated as if she has gonorrhea and chlamydia to prevent a. damage to the fallopian tubes. b. endocarditis and aortic aneurysms. c. disseminated gonococcal infection. d. polyarthritis and generalized adenopathy.
5. a. Upward extension of gonorrhea or chlamydia commonly causes PID, which can cause adhesions and fibrous scarring, leading to tubal pregnancies and infertility. Disseminated gonococcal infection is rare, and endocarditis and aneurysms are associated with syphilis. Polyarthritis and adenopathy are not seen in gonorrhea or chlamydia.
A client reports to the health care clinic for testing for human immunodeficiency virus (HIV) immediately after being exposed to HIV. The test results are negative, and the client expresses relief about not contracting HIV. What should the nurse emphasize when explaining the test results to the client? No further testing is needed. The test should be repeated in 1 month. A negative HIV test result is considered accurate. A negative HIV test result is not considered accurate immediately after exposure.
A negative HIV test result is not considered accurate immediately after exposure. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. A test for HIV should be repeated if results are negative. Seroconversion is the point at which antibodies appear in the blood. The average time for seroconversion is 2 months, with a range of 2 to 10 months. For this reason, a negative HIV test result is not considered accurate immediately after exposure. The remaining options are incorrect.
A client with acquired immunodeficiency syndrome (AIDS) is receiving ganciclovir. The nurse should take which priority action in caring for this client? Monitor for signs of hyperglycemia. Administer the medication without food. Administer the medication with an antacid. Ensure that the client uses an electric razor for shaving.
Ensure that the client uses an electric razor for shaving. Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Because ganciclovir causes neutropenia and thrombocytopenia as the most frequent side effects, the nurse monitors for signs and symptoms of bleeding and implements the same precautions as for a client receiving anticoagulant therapy. The medication may cause hypoglycemia, but not hyperglycemia. The medication does not have to be taken on an empty stomach or without food and should not be taken with an antacid
A client asks the nurse about obtaining a home test kit to test for human immunodeficiency virus (HIV) status. What should the nurse tell the client? Home test kits are not available for testing at this time. Home test kits may not be as reliable as laboratory blood tests. Home test kits are most reliable immediately after a risk event occurs. Home test kits should not be used; rather, it is important to contact the primary health care provider (PHCP) with concerns about the HIV status.
Home test kits may not be as reliable as laboratory blood tests. Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Should a client wish to know his or her HIV status, testing is available from a PHCP or a local public health clinic, or a home test kit can be used. Some test kits may not be as reliable as a laboratory blood test. It is also recommended that a home test be performed at least 3 months after a risk event occurs. If a positive result on a home test occurs, then the individual requires additional testing.
The nurse is caring for a client with acquired immunodeficiency syndrome (AIDS) who is experiencing night fever and night sweats. Which nursing interventions would be helpful in managing this symptom? Select all that apply. Keep liquids at the bedside. Place a towel over the pillowcase. Make sure the pillow has a plastic cover. Keep a change of bed linens nearby in case they are needed. Administer an antipyretic after the client has a spike in temperature.
Keep liquids at the bedside. Place a towel over the pillowcase. Make sure the pillow has a plastic cover. Keep a change of bed linens nearby in case they are needed. Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. For clients with AIDS who experience night fever and night sweats, the nurse may offer the client an antipyretic of choice before the client goes to sleep rather than waiting until the client spikes a temperature. Keeping a change of bed linens and night clothes nearby for use also is helpful. The pillow should have a plastic cover, and a towel may be placed over the pillowcase if diaphoresis is profuse. The client should have liquids at the bedside to drink.
A client with acquired immunodeficiency syndrome (AIDS) is experiencing nausea and vomiting. The nurse should include which measure in the dietary plan? Provide large, nutritious meals. Serve foods while they are hot. Add spices to food for added flavor. Remove dairy products and red meat from the meal.
Remove dairy products and red meat from the meal. Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. The client with AIDS who has nausea and vomiting should avoid fatty products such as dairy products and red meat. Meals should be small and frequent to lessen the chance of vomiting. The client should avoid spices and odorous foods because they aggravate nausea. Foods are best tolerated cold or at room temperature.
The nurse is caring for a client who has just been diagnosed with a Kaposi's sarcoma. The nurse knows this is a type of cancer that affects which organ? Brain Skin Gall bladder Adrenal glands
Skin A Kaposi's sarcoma affects the soft tissues of the skin, and is a tumor caused by the herpes virus. It is most often seen in immunocompromised clients.
A nurse is talking with a client and knows that which of the following statements regarding secondary syphilis is true? Some clients never realize they have had secondary syphilis Infection Once a client has secondary syphilis, it is too late to treat Secondary syphilis is categorized as a chancre-like sore in the affected area Secondary syphilis can occur as late as 25 years after primary infection
Some clients never realize they have had secondary syphilis Infection Many clients miss their secondary syphilis, which is categorized as a diffuse rash across the client's back, hands, and/or torso. Secondary syphilis infection occurs 2-10 weeks after Primary Syphilis
The nurse is caring for a client with human immunodeficiency virus (HIV) infection and notes a diagnosis of cryptococcosis in the client's medical record. The nurse understands that this opportunistic infection most likely was diagnosed by which test? Skin biopsy Viral culture Sputum culture Bone marrow biopsy
Sputum culture Rationale: Human immunodeficiency virus (HIV) can cause acquired immunodeficiency syndrome, which is a viral disease that destroys T cells, thereby increasing susceptibility to infection and malignancy. Cryptococcosis is a fungal infection caused by Cryptococcus neoformans. It usually affects the lungs and central nervous system (brain and spinal cord), but it can also affect other parts of the body. Symptoms of lung involvement include cough, shortness of breath, chest pain, and fever. When it spreads to the brain, manifestations include headache, fever, neck pain, nausea and vomiting, sensitivity to light, confusion, or changes in behavior. Diagnostic tests to confirm its presence in the lungs include chest x-ray studies and a sputum culture.
Which best describes the recommendations from the American Cancer Society regarding initial screening for cervical cancer? Starting at the age of the first menstrual period and annually thereafter Starting at age 18 and every six months thereafter Starting at age 30 unless the woman has delivered a baby Starting at age 21 and then every 3 years
Starting at age 21 and then every 3 years The American Cancer Society has given guidelines for screening for cancer. Many of the screenings are based on age and health status of the person. The ACS recommends that a woman start screening for cervical cancer at age 21, and have a test every 3 years. Women under 21 years of age do not need to be screened for cervical cancer.
A client with acquired immunodeficiency syndrome (AIDS) has a concurrent diagnosis of histoplasmosis. During the assessment, the nurse notes that the client has enlarged lymph nodes. How should the nurse interpret this assessment finding? The histoplasmosis is resolving. The client has disseminated histoplasmosis infection. This is a side effect of the medications given to treat AIDS. The client probably has another infection that is developing.
The client has disseminated histoplasmosis infection. Rationale: Acquired immunodeficiency syndrome is a viral disease caused by the human immunodeficiency virus (HIV), which destroys T cells, thereby increasing susceptibility to infection and malignancy. Histoplasmosis is caused by Histoplasma capsulatum and usually starts as a respiratory infection in the client with AIDS and then becomes a disseminated infection, with enlargement of lymph nodes, spleen, and liver. The client experiences dyspnea, fever, cough, and weight loss. The remaining options are incorrect.
Which best describes the development of cachexia in a client with stomach cancer? Abdominal swelling because of fluid shifts due to protein energy malnutrition The need for total parenteral nutrition because of vitamin deficiencies Purposeful withholding of food and fluid intake by the client Wasting of fat and muscle tissue
Wasting of fat and muscle tissue Cachexia is a term used to describe wasting of adipose and muscle tissue in a client with severe illness such as cancer. A client with cachexia may lose up to 20 percent of original body weight and may appear withdrawn and emaciated. It is caused by an increase in metabolic activity in the body as a result of the illness and not necessarily because of decreased food or fluid intake.
Symptoms of human papillomavirus (HPV) include which of the following? SELECT ALL THAT APPLY a.Usually no symptoms b.Small flesh colored growths in perianal area c.Bleeding with defecation d.Purulent urethral drainage
a.Usually no symptoms b.Small flesh colored growths in perianal area c.Bleeding with defecation