Lowdermilk, Ch. 7, Sexually Transmitted and Other Infections - final

Which STI does not respond well to antibiotic therapy? a.Chlamydia b.Gonorrhea c.Genital herpes d.Syphilis

ANS: C Genital herpes is a chronic and recurring disease for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin.

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

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

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

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

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

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

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

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

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

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

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a.Bacterial vaginosis b.Candidiasis c.Trichomoniasis d.Gonorrhea

ANS: A Most women with bacterial vaginosis complain of a characteristic "fishy" odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn? a.Wear gloves. b.Wear mouth, nose, and eye protection. c.Wear a mask. d.Wash the hands after medication administration.

ANS: A Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction? a.Vomiting and diarrhea b.Headache, myalgias, and arthralgia c.Preterm labor d.Jarisch-Herxheimer in the first 24 hours after treatment

ANS: A The Jarisch-Herxheimer reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. Vomiting and diarrhea are not anticipated. If the client is pregnant, then she is at risk for preterm labor and birth.

A client exhibits a thick, white, lumpy, cottage cheese-like discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a.Fluconazole b.Tetracycline c.Clindamycin d.Acyclovir

ANS: A The client is experiencing a candidiasis infection. Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat this condition. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes.

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a.Herpes simplex virus 2 (HSV-2) b.HPV c.HIV d.CMV

ANS: A The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.

The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate? a.Only one vaccine for the HPV is available. b.The vaccine is given in three doses over a 6-month period. c.The vaccine is recommended for both boys and girls. d.Ideally, the vaccine is administered before the first sexual contact.

ANS: A Two vaccines for HPV are available—Cervarix and Gardasil—and other vaccines continue to be investigated. These vaccines protect against HPV types 6, 11, 16, and 18. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? a.Strategies to enhance condom use b.Choice of colors and special features c.Leaving the decision up to the male partner d.Places to carry condoms safely

ANS: A When the nurse opens the discussion on safe-sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills with a sexual partner. These include role-playing, rehearsal, cultural barriers, and situations that place the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, these features are not as important as negotiating the use of safe sex practices. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. Although this information is important, it is not relevant if the woman cannot even discuss strategies on how to enhance condom use.

Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a.Fellatio b.Unprotected anal intercourse c.Multiple sex partners d.Dry kissing e.Abstinence

ANS: A, B, C Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices.

Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.) a.Menstruation b.Trauma c.Febrile illness d.Soap e.Ultraviolet light

ANS: A, B, C, E Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.

Which sexually transmitted infection (STI) is the most commonly reported in American women? a.Gonorrhea b.Syphilis c.Chlamydia d.Candidiasis

ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Infection rates are two and a half times that of men. Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis is the earliest described STI. Candidiasis is a relatively common fungal infection.

A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital's maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care? a.Intrapartum treatment with antiviral medications b.Cesarean birth c.Postpartum treatment with antiviral medications d.Avoidance of breastfeeding e.Pneumococcal, HBV, and Haemophilus influenzae vaccine

ANS: A, B, D The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.

A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.) a.Toxoplasmosis b.Other infections c.Roseola d.Clostridium e.Herpes simplex

ANS: A, B, E Toxoplasmosis, other infections, rubella virus, CMV, and HSV are collectively known as TORCH infections. Generally, all TORCH infections produce influenza-like symptoms in the mother; however, fetal effects are generally more serious.

The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.) a.Number of partners b.Level of physical activity c.Prevention of pregnancy d.Protection from STIs e.Past history

ANS: A, C, D, E Level of physical activity is not a component of this assessment. The five Ps include partners, prevention of pregnancy, protection from STIs, understanding of sexual practices, and past history.

The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a.Miconazole ointment b.Topical podofilox 0.5% solution or gel c.Two doses of penicillin administered intramuscularly (IM) d.Metronidazole by mouth

ANS: B Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete's foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate? a.Vaccine exists for hepatitis C virus (HCV) but not for HBV. b.HAV is acquired by eating contaminated food or drinking polluted water. c.HBV is less contagious than HIV. d.Incidence of HCV is decreasing.

ANS: B Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.

A 25-year-old single woman comes to the gynecologist's office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, "What is that? Can you get rid of it?" Which is the best response for the nurse to provide? a."It's just a little lump on your cervix. We can just freeze it off." b."HPV stands for 'human papillomavirus.' It is a sexually transmitted infection that may lead to cervical cancer." c."HPV is a type of early human immunodeficiency virus. You will die from this." d."You probably caught this from your current boyfriend. He should get tested for this."

ANS: B Informing the client about STIs and the risks involved with the HPV is important. The health care team has a duty to provide proper information to the client, including information related to STIs and the fact that although the HPV and HIV are both viruses that can be sexually transmitted, they are not the same virus. The onset of the HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding is frequently the initial symptom. The client may have had the HPV before her current boyfriend. The nurse should make no deductions from this limited information.

Which laboratory testing is used to detect the human immunodeficiency virus (HIV)? a.HIV screening b.HIV antibody testing c.Cluster of differentiation 4 (CD4) counts d.Cluster of differentiation 8 (CD8) counts

ANS: B The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV. HIV-1 and HIV-2 antibody tests are used to confirm the diagnosis. To determine whether the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals. CD8 counts are not performed to detect HIV.

Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)? a.Oral antiviral therapy b.Bed rest in a semi-Fowler position c.Antibiotic regimen continued until symptoms subside d.Frequent pelvic examination to monitor the healing progress

ANS: B The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease.

Which statements regarding the HPV are accurate? (Select all that apply.)HPV infections: a.are thought to be less common in pregnant women than in women who are not pregnant. b.are thought to be more common in pregnant women than in women who are not pregnant. c.were previously called genital warts. d.were previously called herpes. e.may cause cancer.

ANS: B, C, E HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

What is the drug of choice for the treatment of gonorrhea? a.Penicillin G b.Tetracycline c.Ceftriaxone d.Acyclovir

ANS: C Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis.

Which condition is the most life-threatening virus to the fetus and neonate? a.Hepatitis A virus (HAV) b.Herpes simplex virus (HSV) c.Hepatitis B virus (HBV) d.Cytomegalovirus (CMV)

ANS: C HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a.6 to 10 days b.2 to 4 weeks c.6 to 12 weeks d.6 months

ANS: C Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long.

A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing? a.Bacterial vaginosis b.Candidiasis c.Yeast infection d.Trichomoniasis

ANS: D Although uncomfortable, a speculum examination is always performed and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation.

Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection? a.Positive prenatal culture b.Preterm birth at 37 weeks or less of gestation c.Maternal temperature of 38° C or higher d.Premature rupture of membranes (PROM) 24 hours or longer before the birth

ANS: D PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38° C or higher is also a risk factor for neonatal GBS infection.

Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis? a.Fever, headache, and malaise b.Widespread rash c.Identified by serologic testing d.Appearance of a chancre 2 months after infection

ANS: D Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

The nurse providing care in a women's health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a.HSV b.AIDS c.Venereal warts d.Chlamydia

ANS: D The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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