Ch. 46 STIs all

A client is diagnosed with granuloma inguinale. Which question should the nurse ask the client?

"Have you traveled outside of the country recently?"

A client asks how his condition, Condylomata acuminata, is caused. What is the nurse's best response?

"Human papillomavirus (HPV) is the cause of your condition."

A female client is diagnosed with chlamydia during a routine pelvic examination. Which statement by the client indicates that the nurse's teaching about management of the disease has been effective?

"My partner will need to take antibiotics at the same time I do."

A 40 year-old woman with gray, runny vaginal discharge that has a foul, fishy odor has been told that she most likely has vaginosis. Which of the following phenomena most likely contributed to her present condition?

A sharp reduction in the number of lactobacilli in the client's vaginal flora.

A patient develops Reiter's syndrome. Which of the following symptoms will the nurse assess? Select all that apply.

Conjunctivitis Pain in the joints

A woman asks "Why do I have to tell my sexual partner about chlamydia? I thought this was a "female" disease." What is the nurse's best response?

"The condition is transmittable to men and may cause infertility."

In teaching a client about genital warts, which statement is correct for the nurse to say?

"The incubation period is 6 weeks to 3 months."

A client asks why his partners need to know that he was diagnosed with syphilis. What is the nurse's best response?

"They will have to be treated prophylactically."

A young woman has contracted the human papillomavirus (HPV) and has developed genital warts. The client is eager to receive an HPV vaccine, citing the large number of television advertisements she has seen. How should the nurse best respond?

"Unfortunately, these vaccines may be less effective once you have HPV."

A client has been diagnosed with syphilis after seeking care for a penile lesion. The nurse should anticipate which intervention?

Administration of injectable penicillin

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last 6 months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of medication is most likely to resolve her symptoms?

An azole antifungal agent

A nurse is attempting to culture a lesion to determine if a client has genital herpes. What is the nurse's best action?

Attempt to culture a lesion as soon as it develops.

A patient was diagnosed with human immunodeficiency virus (HIV), which causes acquired immunodeficiency syndrome (AIDS). The nurse realizes that the patient needs further teaching about the disease process based on which of the following statements made by the patient?

"HIV only infects B cells."

Which client is at highest risk of developing trichomoniasis?

A client who is sexually active

Select the treatment of choice for syphilis.

Long-acting penicillin in a single injection

Which assessment question is most likely to address the causation of a woman's new case of candidiasis? "Have you recently begun a new sexual relationship?" "Have you been on antibiotics recently?" "Have you noticed any new growths on your vagina recent months?" "Do you use condoms during sexual activity?"

"Have you been on antibiotics recently?" Recent antibiotic therapy frequently underlies causes of candidiasis. The disease is not normally transmitted by sexual contact, and tissue growth is not an associated sign.

A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the care provider give the client? A) "There is a chance that these will clear up on their own without any treatment." B) "It's important to start treatment soon, so I will prescribe you pills today." C) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease." D) "I'd like to give you an HPV vaccination if that's okay with you."

A) "There is a chance that these will clear up on their own without any treatment."

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

A) A large percentage (70%) of those infected experience no symptoms of the disease.

A couple presents to an infertility clinic. The health care provider will focus testing on which of the following sexually transmitted infections (STIs) that is very damaging to the reproductive system but rarely exhibits symptoms of infection? A) Chlamydial infection B) Herpes simplex virus infection C) Gonorrhea D) Syphilis

A) Chlamydial infection

A client has been diagnosed with a chlamydial infection. Select the pharmacological treatment of choice.

Azithromycin

A female receives a PAP smear result indicating she has human papillomavirus (HPV) infection. As part of her education, the nurse will emphasize the need for continued follow-up since HPV is directly associated with: A) Uterine cancer B) Cervical dysplasia C) Genital herpes lesions D) Urinary tract infections

B) Cervical dysplasia

When educating a teenager diagnosed with genital herpes (herpes simplex virus type 2, HSV-2), the health care provider needs to inform her of the importance of careful follow-up since she may be at greater risk for future development of: A) Cervical cancer B) HIV transmission C) Localized necrosis D) Urinary tract infection

B) HIV transmission

A client with a history of candidiasis is concerned about why the signs and symptoms always occur after she is prescribed an antibiotic. Which statements by the client indicate that further teaching is indicated? Select all that apply. A. Antibiotics suppress the immune system, which kills the normal bacteria flora and allows candidiasis to thrive. B. It is important to complete the full course of antibiotics to prevent the outbreak of candidiasis from occurring. C. Antibiotics cause an increase in vaginal glycogen stores, which promotes candidiasis. D. The candidiasis outbreaks are not likely associated with the antibiotic therapy but rather the chronic nature of the infection.

B. It is important to complete the full course of antibiotics to prevent the outbreak of candidiasis from occurring. C. Antibiotics cause an increase in vaginal glycogen stores, which promotes candidiasis. D. The candidiasis outbreaks are not likely associated with the antibiotic therapy but rather the chronic nature of the infection. It is likely that antibiotic therapy does trigger the outbreak of candidiasis since, appropriately taken, antibiotics do suppress the immune system, which kills the normal bacteria flora, allowing candidiasis to thrive. The use of oral contraceptives that increases vaginal glycogen.

A woman and her male partner both have contracted gonorrhea. The nurse should monitor both clients for signs and symptoms of what complication?

Bacteremic heart valves

The nurse provides prophylactic treatment for a neonate to prevent conjunctival gonorrhea. The nurse is aware that the intervention will reduce the risk of: Blindness Pruritus Genital infection Urethritis

Blindness Neonates are routinely treated with various antibacterial agents applied to the conjunctiva within 1 hour of birth to protect against undiagnosed gonorrhea and other diseases. Neonates born to infected mothers can acquire the infection during passage through the birth canal and are in danger of developing gonorrheal conjunctivitis, with resultant blindness.

A client presents to the out-client clinic complaining of gray discharge that has a fishy odor. The health care provider sees "clue cells" on wet-mount microscopic exam. This would most likely lead to the diagnosis of: A) Trichomonas vaginalis B) Chlamydial C) Bacterial vaginosis D) Syphilis

C) Bacterial vaginosis

A sexually transmitted infection that is caused by a microorganism with two morphologically distinct forms is: A) Chancroid B) Candidiasis C) Trichomonas vaginalis D) Chlamydia

D) Chlamydia

While in its dormant state, herpes simplex virus resides and replicates in the: A) Local lymph nodes B) Subcutaneous tissue C) Mucous membrane D) Dorsal root ganglia

D) Dorsal root ganglia

Which of the following events is associated with the primary stage of syphilis? A) Development of gummas B) Development of central nervous system lesions C) Palmar rash D) Genital chancres

D) Genital chancres

Of the following STIs, for which STI should the nurse anticipate a prescription for antibiotics such as tetracycline or doxycycline since this infection will respond to antibiotic treatment? A) Human papillomavirus (HPV) infection B) Herpes simplex virus type 2 (HSV-2) infection C) Candidiasis D) Lymphogranuloma venereum (LGV)

D) Lymphogranuloma venereum (LGV)

A client states "I'm not getting this sexually transmitted infection (STI) treated. It doesn't bother me!" What is the nurse's best response? A. "Ok, it is your choice." B. "If it doesn't bother you then it doesn't have to be treated." C. "I will tell your health care provider." D. "Sexually transmitted infections can spread to other organs. It needs to be treated."

D. "Sexually transmitted infections can spread to other organs. It needs to be treated." STIs can cause vaginitis, infections in the external genitalia, the genitourinary system, and even become systemic if not treated. The nurse should not ignore this and should emphasize that the infection needs to be treated.

A client who has been diagnosed with gonorrhea asks the nurse if anyone has to know about it. The best response by the nurse is:

Gonorrhea is a reportable sexually transmitted infection.

Bacterial vaginosis is the most common vaginal infection seen by health care providers. What is the predominant symptom of bacterial vaginosis?

Grayish white discharge with a fishy odor

A female client is found to have genital warts during a routine pelvic examination. Which sexually transmitted infection will the nurse prepare to test for?

HPV

A nurse is caring for a patient in whom genital herpes is being ruled out. Which of the following information helps to confirm the diagnosis? Select all that apply.

Painful lesions Pustules Pain on urination Itching

Which assessment finding is most clearly suggestive of initial genital herpes (herpes simplex virus, HSV) in a male client?

Itching, pain, and the emergence of pustules on the penis

A male client presents at the clinic with flulike symptoms and reports a weight loss of 10 pounds without trying. On physical examination, the client is found to have splenomegaly and large, tender, fluctuant inguinal lymph nodes. While taking the nursing history, it is discovered that the client prefers male sexual partners, and that 2 weeks ago the client had small, painless papules. What disease would the nurse suspect the client has? Genital herpes Chancroid Syphilis Lymphogranuloma venereum

Lymphogranuloma venereum An important characteristic of lymphogranuloma venereum is the early (1 to 4 weeks later) development of large, tender and sometimes fluctuant inguinal lymph nodes called buboes.

The nurse determines that teaching was effective when a client who has been treated for Chlamydia states the importance of:

No follow-up is needed

A client presents with gonorrhea. Which of the following is a primary nursing action?

Reporting the case to the Centers for Disease Control and Prevention

The public health nurse is presenting a program on the prevalence of STIs. Which information should be included in the presentation? Select all that apply.

STIs may be asymptomatic. Drugs can manage infections but do not control the spread.

Select the most reliable test to diagnose syphilis.

Serology

A client presents with copious, frothy, malodorous green/yellow vaginal discharge. A diagnosis of Trichomoniasis is made. The client tells the nurse that she has not been sexually active and is concerned. Select the possible modes of transmission. Select all that apply.

Sexual contact Fomites Swimming pools Hot tubs

While teaching a class on health promotion to a group of high school students a student asks, "How is herpes simplex virus type 2 (HSV-2) transmitted?" Which response by the nurse is most accurate? Sexual encounters Fomites Contaminated food or water Kissing

Sexual encounters Genital herpes is known as HSV-2 and is spread by sexual encounters. Molluscum contagiosum = transmitted from skin-to-skin contact, fomites, and autoinoculation. Kissing is usually not a method of transmission for sexually transmitted infections.

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

Syphillis

Which clients would the nurse determine are at increased risk of infection with gonorrhea? Select all that apply.

The client who is younger than 25 years of age The client who does not use condoms The client with multiple sexual partners

Which client will the nurse determine is a candidate for continuous antiviral suppressive therapy for genital herpes?

The client with more than six outbreaks this year

Which client will the nurse determine is a candidate for continuous antiviral suppressive therapy for genital herpes? The client who has just had a first outbreak The client who wants to prevent contracting genital herpes The client who has had a particularly painful outbreak The client with more than six outbreaks this year

The patient with more than six outbreaks this year Continuous antiviral suppressive therapy for genital herpes is usually recommended for clients with more than six outbreaks in a year. The other clients are not candidates for this type of therapy. The therapy does not prevent clients from contracting the disease.

A client has been diagnosed with candidiasis. Which symptom was present to diagnose this condition?

Thick white secretions

A patient has been diagnosed with candidiasis. Which of the following symptoms were present to diagnose this condition?

Thick white secretions.

Select the condition that contributes to the risk of infertility in males.

Trichomoniasis

A nurse is interviewing a client about issues with infertility. Which condition contributes to the risk of infertility in both men and women? Trichomoniasis Chancroid Genital warts Herpes simplex

Trichomoniasis Trichomoniasis increases the risk of infertility in women because the trichomonads serve as vectors for the spread of pathogens into the fallopian tubes. In men it contributes to decreased mobility and viability of sperm. The others do not have the same risks for infertility.

Which symptoms would a nurse assess in a male client with gonorrhea? Select all that apply.

Urethral pain Creamy, yellow discharge Bloody discharge

A client's presentation and recent sexual history are suggestive of gonorrhea. This suspected diagnosis can best be confirmed by:

culturing a sample of the client's penile discharge.

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last 6 months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms?

metronidazole

A nurse is educating a group of students about the spread of sexually transmitted infections. Which is a potential portal of entry for most sexually transmitted infections?

mouth

A client is diagnosed with trichomoniasis. Which findings likely helped to confirm this diagnosis?

sexual activity

Which assessment finding correlates to advanced (tertiary) syphilis?

Dementia

In a client suspected of having gonorrhea with active symptoms, what does the nurse tell the client about confirming the diagnosis?

"Since you have discharge, we can perform a culture."

Which instruction is essential for the nurse to include in the care plan for a client with herpes simplex virus-1 (HSV-1)?

"This disease is transmitted by oral secretions."

A male diagnosed with gonorrhea will likely complain of which of the following clinical manifestations? Select all that apply. A) Creamy, yellow discharge B) Pain in the urethra with urination C) Difficulty starting a stream of urine D) "Fish"-smelling discharge from the penis E) Diffuse pelvic pain

A) Creamy, yellow discharge B) Pain in the urethra with urination

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

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

A sexually active female presents to the clinic with white copious vaginal discharge, itch, swelling, and dysuria. The nurse anticipates the client will be treated for the overgrowth of which organism?

Candida albicans

A adolescent asks the nurse if there is anything that would greatly increase her risk of acquiring herpes simplex virus (HSV). Which response would be the most accurate for the nurse to reply?

Engaging in oral-genital sex

A nurse suspects a client has trichomoniasis based on which assessed vaginal discharge?

Frothy green

Which event is associated with the primary stage of syphilis? Development of gummas Development of central nervous system lesions Palmar rash Genital chancres

Genital chancres Primary syphilis is characterized by the appearance of a chancre at the site of exposure. Secondary syphilis = rash on the palms Tertiary syphilis = gummas. central nervous system (CNS) lesions

When screening for a sexually transmitted disease (STD), a microscopic evaluation of a discharge culture reveals hyphae and a pH level of 4.2. Which conditions are not likely to present based on these findings? Select all that apply.

N. gonorrhoeae C. trachomatis T. vaginalis

An male client presents with urethral itching, burning, pain, and a creamy, yellow discharge following unprotected sex with a new partner 3 days ago. The nurse anticipates the client to be diagnosed with which sexually transmitted infection?

Neisseria gonorrhoeae

For a woman, what is the most serious long-term outcome of an infection resulting from exposure to the N. gonorrhoeae bacteria?

Sterility

A male client is diagnosed with gonococcal urethritis. He tells the nurse he had recent sexual contact with a woman but states she did not appear to have any disease. What is the nurse's best response to the client?

"Women may not know they have gonorrhea because they may not have symptoms."

A woman who has developed vulvovaginal candidiasis will likely go to her health care provider complaining of: Select all that apply. A) Redness B) Edema C) Frothy, foul-smelling discharge D) Painful urination E) Pustules on labia

A) Redness B) Edema D) Painful urination

A female client presents an STD clinic. She is in the first trimester of pregnancy and has tested positive for gonorrhea. Because strains of N. gonorrhoeae have become resistant to penicillin, the current treatment recommendation includes: A) High-dose cefixime given in a single dose B) Ten-day supply of Flagyl C) Doxycycline over the course of 1 week D) No treatment until after the baby is born

A) High-dose cefixime given in a single dose

A 22-year-old client has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with: A) Human papillomavirus (HPV) B) Chlamydia trachomatis C) Candida albicans D) Trichomonas vaginalis

A) Human papillomavirus (HPV)

An elderly female has slowly developed dementia and loss of vision. She is being evaluated for nursing home placement. Routine admission blood work reveals that the client tested positive for which STI associated with her current symptoms? A) Tertiary syphilis B) Chlamydial C) Gonorrhea D) Human papillomavirus infection

A) Tertiary syphilis

A client presents to a STI clinic. Her primary complaint is related to purulent exudate and bleeding after intercourse. The health care worker will primarily focus on the diagnosis of which STI? A) Gonorrhea B) Chlamydial infection C) Human papillomavirus infection D) Genital herpes simplex virus infection

A) Gonorrhea The gonococcus is a pyogenic (i.e., pus-forming), Gram-negative diplococcus that evokes inflammatory reactions characterized by purulent exudates. Internal human papillomavirus (HPV) condylomata acuminata warts are cauliflower-shaped lesions that affect the mucous membranes of the vagina, urethra, anus, or mouth. The initial symptoms of primary genital herpes (herpes simplex virus, HSV) infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles.

Men whose sexual partners have been diagnosed with Trichomonas vaginalis will likely exhibit: A) No symptoms of infection B) Copious amounts of frothy discharge from the penis C) Numerous pustules on the penal shaft D) Redness and pain at the urethral meatus

A) No symptoms of infection

The physiological reasoning behind giving acyclovir, an antiviral medication, to a client diagnosed with genital herpes would include the fact that these drugs: A) Attack the cell wall and totally destroy the virus, thus curing the client B) Interfere with viral DNA replication, which can decrease the frequency of recurrences C) Will prevent the organism from developing a resistance to the treatment protocols D) Can be obtained without a prescription and usually applied topically

B) Interfere with viral DNA replication, which can decrease the frequency of recurrences

A client with herpes simplex virus (HSV) presents to the clinic stating, "I can stop taking my drugs because I'm cured. My lesions are gone." The health care provider bases his or her response knowing the pathophysiology behind the disappearance of HSV symptoms infection relates to: A) Replication of the squamous epithelium B) Periods of latency in the nervous system C) Inhibition of cell-mediated immunity D) Production of exotoxins

B) Periods of latency in the nervous system

The most prevalent vaginal infection to be spread through sexual contact is: A) Candidiasis B) Trichomoniasis C) Vulvovaginitis D) Bacterial vaginosis

B) Trichomoniasis

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

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

A client presents to the GYN clinic complaining of large amounts of frothy yellow-green discharge that smells very foul. Immediately, the health care provider is thinking this client most likely has: A) Candidiasis B) Trichomoniasis C) Bacterial vaginosis D) Chlamydial infection

B) Trichomoniasis Trichomoniasis causes a copious, frothy, malodorous, green or yellow discharge. Vaginal discharge candidiasis = odorless, thick, cheesy. Bacterial vaginosis = thin, grayish white discharge, foul, fishy odor. Chlamydial STI may be asymptomatic, but most women have mucopurulent drainage or hypertrophic cervical changes on examination.

Which of the following signs and symptoms is most clearly suggestive of primary genital herpes in a male client? A) Presence of purulent, whitish discharge from the penis B) Emergence of hard, painless nodules on the shaft of the penis C) Itching, pain, and the emergence of pustules on the penis D) Production of cloudy, foul-smelling urine

C) Itching, pain, and the emergence of pustules on the penis

Which of the following phenomena is thought to underlie the decreased reported incidence of some sexually transmitted infections (STIs)? A)Increased knowledge of the correct use of condoms B)Increased public funding for health promotion activities C)Decreased reporting of cases of certain STIs D)Decreased numbers of sexual partners among young adults

C) Decreased reporting of cases of certain STIs The actual incidence and prevalence of some STIs are thought to exceed reported rates. Consequently, apparent decreases are not thought to reflect reality. The actual figures of total STIs are probably much higher because many STIs are not reportable or not reported. This trend in reported incidence is not attributed to changes in condom use, health promotion, or decreased numbers of sexual partners.

A female client is infected with human papillomaviruses (HPV) following unprotected sexual intercourse. The nurse prepares to teach the client about the risk of developing which of the following cancers?

Cervical

A 22-year-old female client states she has vaginal itching with pain and small vesicles that appear on the vagina when she is stressed. The health care provider suspects the client most likely is experiencing which condition? Genital herpes Molluscum contagiosum infection Genital warts Chlamydia trachomatis infection

Genital herpes The symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Molluscum contagiosum = Curd-like exudate and dome-like lesions Chlamydia trachomatis = vaginal/cervical infection and does present with itching but not vesicles. Chancroid lesions = start as macules, progress to pustules.