Chapter 69: Concepts of Care for Patients With Sexually Transmitted Infections

1. The nurse hears a patient tell her partner that condoms with spermicide are important to protect themselves from sexually transmitted infections (STIs). What is the appropriate nursing response? A. Teach that spermicide has not been shown to be effective in STI prevention. B. Do nothing because the nurse should not be listening to the client's conversation. C. Educate that spermicide must be used with water-based lubricant to be effective. D. Affirm that spermicide helps to block transfer of sexually transmitted organisms.

A

Which teaching will the nurse provide to a client who has been prescribed antibiotics for pelvic inflammatory disease (PID)? Select all that apply. A. "Finish all of the prescribed drug even if you begin to feel better." B. "If you feel nauseated from the antibiotics, take a dose of Tums or Maalox." C. "Take antibiotics with food to decrease the chance of stomach irritation." D. "You may resume intercourse once you have been on the antibiotic for 48 hours." E. "You will need to return to see the health care provider after finishing drug therapy."

A, E

8. A 24 year-old female has been diagnosed with genital warts. Which action by the nurse is best? a. Encourage the client to complete STI screening. b. Recommend an over-the-counter wart treatment for genital tissue. c. Report the case to the Centers for Infection Control and Prevention (CDC). d. Discuss popular options for contraception.

ANS: A Clients with HPV should be fully screened for other STIs since co-infection is common. Over the counter treatments should not be applied to genital tissue. HPV is not reportable. Contraception is not related

5. A client with multiple sexual partners has been assessed for symptoms of dysuria and green, malodorous vaginal discharge. The nurse administers and injection of ceftriaxone and gives the client a prescription for doxycycline. The client asks why two drugs are needed. What answer by the nurse is best? a. "It is very common to be infected with both gonorrhea and chlamydia." b. "Giving two medications increases the chance of curing the infection." c. "Some people are not affected by the injection and need more medication." d. "This will prevent you from needing a 3-month follow-up test."

ANS: A This client has signs of gonorrhea. Co-infection with gonorrhea and chlamydia is common, so the client being treated for gonorrhea also needs treatment for chlamydia with oral antibiotics. It is fairly accurate to say two medications increases the chance of cure, but does not really explain the situation. Giving the client two medications is not because some people are not affected by the injection nor is it to prevent needing a 3-month follow-up test. Testing for re-infection with chlamydia is recommended by the CDC.

14. A primary care clinic sees some clients with sexually transmitted infections. Which diseases would the nurse be required to report to the local authority? (Select all that apply.) a. Chlamydia b. Gonorrhea c. Syphilis d. Human immune deficiency virus e. Pelvic inflammatory disease f. Human papilloma virus

ANS: A, B, C, D Chlamydia, gonorrhea, syphilis, human immune deficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) are all reportable to local authorities in every state. Pelvic inflammatory disease and HPV do not need to be reported.

17. A client has pelvic inflammatory disease (PID). What complications does the nurse monitor the client for? (Select all that apply.) a. Chronic pelvic pain b. Infertility c. Ectopic pregnancy d. Tubo-ovarian abscess e. Peri-hepatitis f. Pancreatitis

ANS: A, B, C, D, E Possible complications of PID include chronic pelvic pain, infertility, ectopic pregnancy, tubo-ovarian abscess, peri-hepatitis, inflammation of the liver capsule, and inflammation of the peritoneal surfaces of the anterior right upper quadrant.

18. The nurse is teaching a client who is taking an oral antibiotic for treatment of a sexually transmitted infection (STI). Which statements by the client indicate a correct understanding of the treatment? (Select all that apply.) a. "I need to drink at least eight glasses of fluid each day with my antibiotic." b. "I should read the instructions to see if I can take the medication with food." c. "Antacids should not interfere with the effectiveness of the antibiotic." d. "I need to wait 7 days after this injection to engage in intercourse." e. "It should not matter if I skip a couple of doses of the antibiotic."

ANS: A, B, D When a client is being treated with an oral antibiotic for an STI, 8 to 10 glasses of fluid should be routine, medication instructions should be reviewed, and at least a week break should occur between the antibiotic and sexual intercourse to allow for the medication's full effects if the medication was given in a single dose. Use of antacids and missing doses could decrease the effectiveness of the antibiotic.

15. A nurse wants to reduce the risk potential for transmission of chlamydia and gonorrhea with a client diagnosed with both infections. Which items should be included in the client's teaching plan? (Select all that apply.) a. Expedited partner therapy b. Abstinence until therapy is completed c. Use of intrauterine devices d. Proper use of condoms e. Rescreening for infection f. Use of oral contraception

ANS: A, B, D, E As part of client/partner education, the nurse should explain the expedited partner therapy (practice of treating both sexual partners by providing medication to the client for the partner). The nurse should also emphasize the need for abstinence from sexual intercourse until treatment is finished, proper use of condoms, and rescreening for reinfection 3 to 12 months after treatment. The use of an intrauterine device and oral contraception is not part of the plan.

16. A client being treated for syphilis visits the office with a possible allergic reaction to benzathine penicillin G. Which abnormal findings would the nurse expect to document? (Select all that apply.) a. Red rash b. Shortness of breath c. Heart irregularity d. Chest tightness e. Anxiety f. Confusion

ANS: A, B, D, E The nurse should keep all clients at the office for at least 30 minutes after the administration of benzathine penicillin G. Allergic signs and symptoms consist of rash, shortness of breath, chest tightness, and anxiety. Heart irregularity and confusion are not seen as an allergic manifestation.

13. A client has a positive HSV-2 test but is asymptomatic. What action by the nurse is best? a. Encourage the client to have frequent STI screening. b. Teach the client ways to prevent getting STIs. c. Provide the same education as if the client were symptomatic. d. Inform the client that partner notification is unnecessary.

ANS: B

2. A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at this time? a. "Have you been using latex condoms?" b. "Are you allergic to penicillin?" c. "When was your last sexual encounter?" d. "Do you have a history of sexually transmitted infections?"

ANS: B Benzathine penicillin G is the evidence-based treatment for primary, secondary, and early latent syphilis. The client needs to be assessed for allergies before treatment. The other questions would be helpful in the client's history of sexually transmitted infections but not as important as knowing whether the client is allergic to penicillin.

12. A college student seeks information from the school's nurse about how to avoid sexually transmitted infections (STIs) without abstinence as a choice. Which statement by the nurse is best? a. "Urinating after intercourse will eliminate the risk of infection." b. "A vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV)." c. "Oral contraception can prevent pregnancy and STIs." d. "Good handwashing helps prevent infection associated with STIs."

ANS: B Gardasil and Gardasil 9 are used to provide immunity for HPV types 6, 11, 16, and 18 and others that are high risk for cervical cancer and genital warts. While there is some truth that urination after intercourse may decrease the risk of infection by flushing out organisms, it does not eliminate the risk of contaminating bacteria traveling up the urethra or from skin-to-skin contact. The other statements are not accurate.

3. A client with genital herpes has painful blisters on her vulva. After teaching the client self-care measures, which statement indicates the need for further education? a. "Pouring water over my genitals will decrease the pain of urinating." b. "I will wash my hands carefully after applying ointment." c. "When I don't have lesions, I am not contagious to my sexual partner." d. "I should increase my fluid intake when I have open lesions."

ANS: C A client with genital herpes can still spread the disease when asymptomatic through viral shedding. The client is taught to use condoms with all sexual activity. Pouring water over the genitals (or urinating in the shower) will help decrease the pain of urine passing over open lesions. Good handwashing is important. Open lesions can lead to fluid loss so the client is taught to increase fluid intake.

1. A nurse is assessing a client who presents with a scaly rash over the palms and soles of the feet and the feeling of muscle aches and malaise. Which action by the nurse is most appropriate? a. Reassure the client that these lesions are not infectious. b. Assess the client for hearing loss and generalized weakness. c. Don gloves and further assess the client's lesions. d. Take a history regarding any cardiovascular symptoms.

ANS: C The client is displaying symptoms similar to secondary syphilis, with flulike symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the client's lesions with gloves since the client is highly contagious at this stage. Tertiary syphilis may display in the form of cardiovascular or central nervous system symptoms. Neurosyphilis can appear at any time, in any state, and can include hearing loss.

10. A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease. She is in pain, with a rating of 7 on a scale of 0-10. What comfort measure can the nurse delegate to assistive personnel (AP)? a. Administer acetaminophen with codeine. b. Apply an ice pack to the lower abdomen. c. Position the client in a semi-Fowler position. d. Teach the client to increase intake of fluids.

ANS: C The client with pelvic inflammatory disease usually experiences lower abdominal tenderness. The AP can position the client. Only the nurse can administer medications and perform teaching. A heating pad, not an ice pack, is used for comfort.

9. A female client returned to the clinic with a yellow vaginal discharge after being treated for Chlamydia infection 3 weeks ago. Which statement by the client alerts the nurse that there may be a recurrence of the infection? a. "I did practice abstinence while taking the medication." b. "I took doxycycline two times a day for a week." c. "I never told my boyfriend about the infection." d. "I did drink wine when taking the medication for Chlamydia."

ANS: C There is a good possibility that the boyfriend reinfected the client after the medication regimen was finished. Both the client and the boyfriend need to be treated. The other statements were in compliance with the recommendations of abstinence and the usual medication regimen with doxycycline. Wine should not interfere with the treatment.

7. A client has been treated for syphilis with IM penicillin. The next day the client calls the clinic to report fever, chills, achy muscles, and a worsening rash. What statement by the nurse is most appropriate? a. "You must be allergic to penicillin; over the counter antihistamines will help." b. "Please go to the nearest emergency department if you develop shortness of breath." c. "You can take acetaminophen or ibuprofen for the pain and achiness." d. "I think you should come in to the clinic either today or tomorrow and be checked."

ANS: C This client has signs of a Jarisch-Herxheimer reaction which is caused when the organisms' cell walls are disrupted and cellular contents are released rapidly. It is usually self-limiting and benign. Antipyretics and mild analgesics treat the symptoms. The client does not need to monitor for shortness of breath, come in to the clinic, or get antihistamines for an allergic reaction.

11. A client with pelvic inflammatory disease is seen by the nurse 72 hours after starting oral antibiotics. Which finding leads the nurse to take immediate action? a. Feelings of anger that her partner infected her b. Loose stools over the last 2 days c. Anorexia and nausea d. Chills and a temperature of 101° F (38.3° C)

ANS: D Chills and fever could indicate a persistent infection and the immediate need to alter the dose or type of antibiotic. Anger is a normal reaction to a sexually transmitted infection and the pain of pelvic inflammatory disease. Gastrointestinal symptoms are common side effects of antibiotics but not an immediate cause for intervention.

4. A 30-year-old male client is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate? a. "Gardasil protects against all HPV strains." b. "You are too old to receive the vaccine." c. "Only females can receive the vaccine." d. "You will only need 1 dose of the vaccine."

ANS: D Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 and Gardasil 9 protects against 5 more strains. The vaccine is recommended for people aged 9 to 26 years of age, but Gardasil 9 can be given up to age 45. Both males and females can get the vaccine. Depending on the timing and type of vaccine, either 2 to 3 doses are required.

6. While evaluating a client for treatment of gonorrhea, which question is the most important for the nurse to ask? a. "Do you have a history of sexually transmitted infection?" b. "When was your last sexual encounter?" c. "When did your symptoms begin?" d. "Can you remember your partners and contact them to get treated?"

ANS: D Sexual partners, as well as the client, should be tested and treated for gonorrhea. Asking about sexually transmitted infection history, last sexual encounter, and onset of symptoms would be helpful with the history taking, but the priority is treating the client's sexual partners to limit the spread of the infection

2. The nurse is caring for a 33-year-old female client who has been intimate with women and men. What teaching will the nurse provide regarding the Gardisil 9 vaccine? A. "Patients older than 26 cannot receive an HPV vaccine." B. "You will need three doses of the vaccine instead of two." C. "I will give you a single dose and you will be protected from future HPV." D. "HPV vaccines must be administered to people who have never had intercourse."

B

The nurse is caring for a client who has just been diagnosed with primary syphilis. Which client statement reflects that teaching has been effective? Select all that apply. A. "I can resume having intercourse right after this injection." B. "At least this infection is not as serious as gonorrhea or chlamydia." C. "I'm afraid, but I'm going to tell my partners about my diagnosis." D. "After my treatment, I still need several follow-up appointments." E. "I can take acetaminophen if I get a fever and chills after this shot." F. "I am going to wait here in the clinic 30 minutes after treatment."

C, D, E, F