OB Sexually Trasmitted Problems NCLEX, Practice Nclex questions, sexuality, NUR 113 Prenatal Substance Exposure (Unit 1), NUR 113: Antepartum (Unit 1 PP+Maps)

How long does pregnancy last?

10 Lunar months (40 weeks)

Weight gain for OBESE

11-20 lbs 0.5 lb/wk

FHR at term

110-160 bpm

Max consumption of low mercury fish?

12 oz/wk

First trimester Second trimester Third trimester (length)

14 wks 15-28 wks 29-delivery

Weight gain for OVERweight

15-25 lbs 0.6 lb/wk

Fundus halfway btwn umbilicus and symphysis pubis. (week)

16 wks

FHR during 1st trimester

160-170 bpm

__ trimester = greatest potential for gross abnormalities in fetus

1st

Nagele's Rule for EDB

1st day of LMP - 3 mo + 7 days

Fundus at umbilicus (week)

20 wks

Weight gain for NORMAL weight

25-35 lbs 1 lb/wk

Weight gain for UNDERweight

28-40 lbs 1 lb/wk

Fundus at xiphoid process (week)

36 wks

Max consumption of albacore tuna and home caught fish?

6 oz/wk

Facial signs of FAS evident __ mo - __ yrs

8, 8

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age? a) 26 b) 35 c) 18 d) 32

A) 26 The CDC (2007) recommends annual screening for Chlamydia in all sexually active women younger than 26 years of age and in women with new or multiple sexual partners.

A patient comes to the clinic after being informed by a sexual partner of possible recent exposure to syphilis. The nurse will examine the patient for which of the following characteristic findings of syphilis in the primary clinical stage? A) Chancre B) Alopecia C) Condylomata lata D) Regional adenopathy

A) Chancre Chancres appear in the primary stage of the bacterial invasion of Treponema pallidum, the causative organism of syphilis. The other findings do not appear until the secondary stage of syphilis, occurring a few weeks after the chancres appear.

When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority? a) Risk for infection related to altered immune cell function b) Impaired skin integrity related to persistent deep skin abscesses c) Anxiety related to an inherited disorder d) Grieving related to the poor prognosis of the condition

A) Risk for infections related to altered immune cell function Although anxiety and impaired skin integrity may be appropriate, the priority nursing diagnosis for any immunodeficiency is the risk for infection. Although primary immunodeficiencies can be serious, they are rarely fatal. Therefore, the nursing diagnosis of grieving would be inappropriate.

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported? a) Syphilis b) Condylomata acuminata c) Genital herpes d) Hepatitis B

A) Syphilis The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDs. Genital herpes, hepatitis B, veneral warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law.

A nurse is teaching a health class to a group of clients likely to be at highest risk for gonorrhea. What is the age range of the clients? a) 60 to 70 years b) 15 to 24 years c) 25 to 29 years d) 30 to 45 years

B) 15 to 24 years Gonorrhea is the second most frequently reported communicable disease in the United States. Its highest incidence occurs in the 15- to 24-year-old age group.

A client is diagnosed with chlamydia and is distraught. "How can I have this problem? I don't have any symptoms!" she says. The nurse teaches the client that the percentage of women with chlamydia who are asymptomatic is as high as a) 100% b) 75% c) 50% d) 25%

B) 75% As many as 75% of all infected women and 25% of all infected men are asymptomatic.

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention? a) Painful red papules on the shaft of the penis b) Foul-smelling discharge from the penis c) Rashes on the palms of the hands and soles of the feet d) Cauliflower-like warts on the penis

B) Foul smelling discharge from the penis Signs and symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are a sign of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

A 45-year-old waitress with a history of IV drug use also is HIV-positive. She has been following her antiretroviral medication regimen faithfully and is doing well. She's attending college to get a social work degree and is focused on a bright future. In her regular CD counts, what factor will indicate she has progressed from HIV to AIDS? a) CD count > 200/mm b) CD count > 100/mm c) CD count < 200/mm d) CD count < 100/mm

C) CD count <200/mm A CD (T-cell) count of less than 500/mm indicates immune suppression; a CD (T-cell) count of 200/mm or less is an indicator of AIDS.

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent? a) Podophyllum resin b) Tetracycline c) Ceftriaxone d) Acyclovir

C) Tetracycline Clients who are allergic to penicillin are given a 14-day regimen of tetracycline or doxycycline. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

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 nurse give the patient? a) "It's important to start treatment soon, so you will be prescribed pills today." b) "I'd like to give you an HPV vaccination if that's okay with you." c) "There is a chance that these will clear up on their own without any treatment." d) "Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease."

C) There is a chance that these will clear up on their own without any tx Genital warts may resolve spontaneously, although this does not preclude recurrence. Pharmacologic treatments are topical and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).

Screening for chlamydia is recommended for young women because A) Chlamydia is frequently comorbid with HIV. B) Chlamydial infections may progress to sepsis. C) Untreated chlamydial infections can lead to infertility. D) Chlamydial infections are treatable only in the early stages of infection.

C) Untreated chlamydial infections can lead to infertility. Because of the potential for infertility, screening for chlamydia is recommended for women under 25. Sepsis is not a primary risk of chlamydia and is not noted to be strongly correlated with HIV infection. The disease is treatable at all stages of infection.

Placenta previa, placental vasoconstriction, decreased blood flow to fetus, fetal HTN, IUGR

Cocaine effect on baby

CBC with diff.

Complete blood count. Assesses hemoglobin, hematocrit, red cell index. Determines presence of anemia

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment? a) Syphillis b) Gonorrhea c) Chlamydia d) Genital herpes

D) Genital herpes Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

A 30-year-old female patient has sought care because of the recent appearance of itchy lesions on her vulva, some of which have recently burst. The patient's description of her problem would lead you to first suspect A) HIV. B) Gonorrhea. C) Chlamydia. D) Genital herpes.

D) Gential herpes A primary episode of genital herpes is often marked by multiple small, vesicular lesions on the genitals. This symptomatology is not commonly associated with gonorrhea, chlamydia, or HIV.

A patient comes to the free clinic complaining of urethral discharge. On assessment, the nurse notes that the patient is feverish. During the assessment, the patient admits to having unprotected sex. The nurse suspects the patient may have a diagnosis of what? a) HIV b) Chlamydia c) Syphilis d) Gonorrhea

D) Gonorrhea The signs and symptoms of gonorrhea include fever; urethral, vaginal, and rectal discharge; and in untreated cases, arthritis.

After teaching a client with immunodeficiency about ways to prevent infection, the nurse determines that teaching was successful when the client states which of the following? a) "I will clean my kitchen counter with hot water." b) "Alcohol is good to clean any skin areas that are dry or chafed." c) "I should avoid eating cooked fruits and vegetables." d) "I should avoid being around other people who have an infection."

D) I should avoid being around other people who have an infection. Strategies to prevent infection include avoiding being around others who have an infection and avoiding crowds. The client should avoid consumption of raw fruits and vegetables and use creams and emollients to prevent or manage dry, chafed, or cracked skin. A disinfectant, not just hot water, should be used to clean kitchen and bathroom surfaces.

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this patient? a) Alteration in comfort related to impaired skin integrity b) Fear related to complications c) Noncompliance with treatment regimen related to age d) Knowledge deficit related to modes of transmission

D) Knowledge deficit related to modes of transmission. Syphilis is spread mainly by sexual contact and may be congenital. The patient displays knowledge deficit about the modes of transmission for syphilis.

Amniocentesis

Detects chromosomal abnormalities, genetic/hereditary/developmental disorders

Pap smear

Detects/reveals precancerous conditions of cervix, infectious diseases and inflammation

Tocolytics

Drugs used to suppress premature labor

Gestation is from _____ until _____. (Approx. 280 days)

Fertilization, EDB (Estimated date of birth)

Barbiturates in baby causes _____ _____ _____

Fetal growth retardation

Quickening

Fetal movement felt at 16-20 wks

McDonald's Sign

Flexible uterine body against cervix

Opioids effect on baby

High pitch cry, fist-sucking, seizures, poor consolability

What is the term for when the fundus drops below the xiphoid process at 40 wks (approx.)?

Lightening

Miscarriage, premature and difficulty conceiving if mom is using _____

Nicotine

Placental vasoconstriction, Placenta previa, IUGR, SIDS risk 4x higher

Nicotine effects on fetus

Parity

Number of births AFTER 20 weeks (Pregnancy or birth of twins only counts as 1!)

Opiods effect on mom

Poor nutrition, low iron (anemia), preeclampsia

Rh- mom and Rh+ baby

Potentially fatal combination if not treated. Mom treats Rh+ fetal cells as foreign, and makes antibodies against the fetal blood cells. RhoGAM needed.

Important supplements (x3)

Prenatal Vitamins Folic Acid (Starting PRE-Pregnancy) Iron (Anemia)

Ballotment

Rebounding of fetus against fingers of examiner

First prenatal labs

Rh factor Rubella titer CBC w/ diff Hepatitis B Urinalysis Blood type (RRCHUB)

Placental abruption

Separation of placenta from wall of uterus

Goodell's Sign

Softening of cervix (2nd month)

Cocaine/Crack, Caffeine

Stimulant

Prenatal toxicity by which congenital malformations are produced in an embryo or fetus

Teratogenesis

8. A 17-year-old college student calls the emergency department (ED) and tells the nurse that she was raped by a professor. She wants to come to the ED but only if the nurse can assure her that they will not call her parents. What should be the nurse's first priority? a) Getting the patient into a safe environment and mobilizing support for her. b) Encouraging the student to disclose the name of the professor so that his predatory behavior will be stopped. c) Convincing the student to be assessed for pregnancy, STIs, or other complications. d) Convincing the student to tell her parents so that she can receive their support.

a

14. Which patients would a nurse assess for menstrual cycle irregularities? Select all that apply. a) A patient who is breast-feeding b) A patient who is diagnosed with anorexia c) A patient who chooses to abstain from sexual intercourse d) A patient who has pelvic inflammatory disease e) A patient who is obsessed with exercising f) A patient who has a spinal cord injury

a,b,d,e

6. A 16-year-old female visits a local women's health clinic to obtain contraception. She asks the nurse, "What can I do to protect myself from diseases like AIDS?" Which recommendations are appropriate for anyone who is sexually active to prevent STIs? Select all that apply. a) Have regular checkups for STIs even in the absence of symptoms. b) Learn the common symptoms of STIs and seek help immediately if any develop—even if the symptom is mild. c) If a partner is infected, consider having sex during menstruation when the risk is greatly decreased. d) Douche regularly to remove any bacteria that may form in the vagina. e) Avoid anal intercourse, but if practiced, use a male condom. f)Consider the fact that the younger people are when having sex for the first time, the less susceptible they become to developing an STI.

a,b,e

1. A nurse is teaching parents about normal developmental aspects of sexuality in their children. Which statements from parents would warrant further teaching? Select all that apply. a) "When my 2-year-old son touches his genitals, I push his hand away and tell him 'No'." b) "I should wean my infant by 4 months and encourage him to use a sippy cup." c) "I should explain sexuality to my 9-year-old in a factual manner when she asks me questions about her body." d) "I should explain about body changes to my 11-year-old prior to them happening to alleviate her fears." e) "I should teach my 10-year-old about contraception and ways to avoid sexually transmitted diseases." f) "I should allow my teenager to establish her own beliefs and moral value system by not sharing my own beliefs."

a,b,e,f

3. A nurse is performing sexual assessments of male patients in a long-term care facility. Which patients would the nurse flag as having an increased risk for erectile dysfunction? Select all that apply. a) A 72-year-old male with a history of diabetes b) A 78-year-old male who has a new partner c) A 75-year-old male who has Parkinson disease d) An 80-year-old male who is an alcoholic e) An 85-year-old male who takes antihypertensive medication f) A 76-year-old male who smokes tobacco

a,d,e

13. An 18-year-old female presents at a women's health care clinic seeking oral contraceptives for the first time. She tells the nurse that she wants to have sex with her boyfriend, but doesn't know what to expect. Which statement by the nurse is not accurate? a) "Vaginal intercourse is most commonly performed in the missionary position." b) "The side by side position achieves better clitoral stimulation than the missionary position." c) "Achieving simultaneous orgasms is the goal of vaginal intercourse." d) "The period after coitus is just as significant as the events leading up to it."

c

3 drinks/wk = incr risk of _____

miscarriage

Presumptive Signs of Pregnancy (Subjective)

-Amenorrhea -Fatigue -Nausea/Vomiting -Breast Tenderness -Quickening -Urinary Frequency

G T P A L (What's it stand for?)

-GRAVITY number of pregnancies -TERM after 37 weeks -PREMATURE after 20 weeks, before 37 -ABORTION spontaneous or therapeutic -LIVING number of living children

Nulli- Primi- Multi-

-Never/None -First -More than one

First prenatal visit... (medlineplus.gov)

-Pap smear -Pelvic exam -CBC -Rh Factor and blood type -Rubella screen -Hepatitis -Syphilis -HIV -Cystic fibrosis -Urine analysis

Chadwick's Sign

Bluish discoloration of the cervix, vagina or vulva

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Development of gummas b) Palmar rash c) Genital chancres d) Development of central nervous system lesions

C) Genital chancres Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

The physical assessment and history of a 29-year-old female patient are indicative of human papillomavirus (HPV) infection. You would perform patient teaching related to A) Gardasil. B) Antibiotic therapy. C) Wart removal options. D) Treatment with antiviral drugs.

C) Wart removal options The HPV vaccine (Gardasil) is ineffective in cases of existing HPV, whereas neither antiviral nor antibiotic drugs are effective treatments. Patient teaching should focus on the various options for physically removing the warts.

Heroin, Alcohol

CNS Depressant

T-ACE Screen

Identifiers of risk drinking, alcohol intake sufficient to potentially damage the embryo/fetus. (Tolerance, Annoyance, Cut Down, Eye Opener)

Feelings of ambivalence during the 1st trimester is _____!

NORMAL

Gravida

Number of pregnancies (Pregnancy or birth of twins only counts as 1!)

Morphine, Heroin, OxyContin, Methadone

Opioids

Chronic use of alcohol during pregnancy = malnutrition, _____ and _____ deficiency

folic acid, thiamine

36 wks until delivery (Prenatal visits)

q1wk

28-36 wks (Prenatal visits)

q2wks

First 28 wks (Prenatal visits)

q4wks

15. Which assessment question would be most appropriate for a patient who is experiencing dyspareunia? a) "Do you currently have a new partner?" b) "Have you been diagnosed with a neurologic disorder?" c) "Do you take anti-hypertensive medication?" d) "Do you use antihistamines?"

d

Probable Signs of Pregnancy (Objective)

-Positive Preg. Test -Uterine/Abdominal Enlargement -Hegar's/Goodell's/Chadwick's/McDonald's Sign -Palpable Fetal Outline -Ballotment -Braxton Hicks Contractions

Positive Signs of Pregnancy (Diagnostic)

-Ultrasound -Fetal Heart Tones by doppler or fetoscope -Fetal Movement by Examiner

A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority? a) Acute pain related to the development of the genital lesions b) Deficient knowledge related to the disease and its transmission c) Ineffective coping related to the increased stress associated with the infection d) Hyperthermia related to body's response to an infectious process

A) Acute pain related to the development of the genital lesions Although deficient knowledge, ineffective coping, and hyperthermia are possible nursing diagnoses, the priority would be acute pain because the initial infection is usually very painful and lasts about 1 week.

Standard precautions should be used when providing care for A) All patients regardless of diagnosis. B) Pediatric and gerontologic patients. C) Patients who are immunocompromised. D) Patients with a history of infectious diseases.

A) All patients regardless of diagnosis. Standard precautions are designed for all care of all patients in hospitals and health care facilities.

Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually-transmitted infection, gonorrhea. What would contribute to her ignorance of her condition? a) Being asymptomatic b) All options are correct c) Being sexually inactive d) Knowing the signs and symptoms of STIs

A) Being asymptomatic Many women who have gonorrhea are asymptomatic, a factor that contributes to the spread of the disease.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which of the following would the nurse expect to include as the most common STI in the United States? a) Chlamydia b) Syphilis c) Genital herpes d) Gonorrhea

A) Chlamydia Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. One in five people older than age 12 is infected with the virus that causes genital herpes.

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea has presented at the clinic. The student knows that the care plan for this patient should be include what in the treatment of gonorrhea? a) Concurrent treatment for chlamydia b) Avoidance of the use of tampons c) Vaginal smears every 6 months d) Radiation therapy to destroy cancerous cells

A) Concurrent treatment for chlamydia Because of the high incidence of coinfection with chlamydia and gonorrhea, treatment for gonorrhea should also include treatment for chlamydia. One cause of cervicitis is chlamydia. A management strategy used in the treatment of chlamydia is a cytologic examination of cervical smear. Avoiding the use of tampons is part of the self-care management of a patient with possible toxic shock syndrome (TSS). Gonorhhea is considered a sexually transmitted infection (STI), not a carcinoma.

A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these characteristics with which of the following sexually transmitted infections? a) Gonorrhea b) Candidiasis c) Chancroid d) Trichomoniasis

A) Gonorrhea In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata? a) Human papilloma virus b) Haemophilus ducreyi bacillus c) Herpes virus d) Treponema pallidum

A) Human papilloma virus Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.

When teaching a patient infected with HIV regarding transmission of the virus to others, which of the following statements made by the patient would identify a need for further education? A) "I will need to isolate any tissues I use so as not to infect my family." B) "I will notify all of my sexual partners so they can get tested for HIV." C) "Unprotected sexual contact is the most common mode of transmission." D) "I do not need to worry about spreading this virus to others by sweating at the gym."

A) I will need to isolate any tissues I use so as not to infect my family. HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.

A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate? a) "Inform all potential sexual partners about the infection, even if it is inactive.". b) "Use a condom during sexual activity if the infection becomes active again." c) "If the infection has healed, you probably don't have to use a condom." d) "Refrain from all sexual activity until you don't have another outbreak for a year."

A) Inform all potential sexual partners about the infection, even if its inactive. The nurse should advise the client to inform all potential sexual partners of the HSV infection even if it is in an inactive state. The nurse should also advise the client to use a condom during sexual activity even if the disease is dormant and to avoid sexual contact if the infection is active. Condoms do not protect skin and mucous membranes left exposed.

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect to find which of the following once the microorganism disseminates throughout the body? a) Painful joints b) Intermenstrual bleeding c) Sore throat d) Painful urination

A) Painful joints The client with an anal gonorrheal infection experiences symptoms of gonorrhea where the microorganism has invaded the rectum. After the microorganism disseminates throughout the body, the client may manifest a skin rash, fever, and painful joints. Other symptoms such as infections of the urinary tract or vagina, sore throat, intermenstrual bleeding due to cervicitis, and painful urination are associated with the organism's invasion of those structures, depending on the nature of the sexual contact.

A 22-year-old patient 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) Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

Teaching for patients with a sexually transmitted disease (STD) would include (select all that apply) A) Treatment of sexual partner is important. B) Douching may help provide relief of itching. C) Cotton undergarments are preferred over synthetic materials. D) Sexual abstinence is indicated during the communicable phase of the disease. E) Condoms should be used during as well as after treatment during sexual activity.

A,C,D,E Douching may spread the infection or alter the local immune responses and is therefore contraindicated in patients with STDs. All other choices are appropriate patient teaching.

Max Thornton, a 24-year-old chef, is being seen by a physician at the urology group where you practice nursing. He has developed a painless ulcer on his penis and is rather concerned about his health. The urologist will be communicating his diagnosis of syphilis and prescribing treatment. What is the typical span of time between infection and developing symptoms with syphilis? a) 14 days b) 21 days c) 35 days d) 28 days

B) 21 Days In syphilis, the time between infection and the first occurrence of symptoms is about 21 days

Which information would be most appropriate for a nurse to provide to a client who has never used a condom? a) A condom can be used, even if it is old, so long as the pack is unopened. b) A new condom should be used for each sex act. c) Cheap condoms of any brand can be used based on monetary constraints. d) A fresh condom should be unrolled over a limp penis before it becomes erect.

B) A new condom should be used for each sex act Information that is important to provide when explaining the use of a condom include the following: use condoms manufactured and tested in the United States, discard old or deteriorated condoms, unroll a fresh condom over the erect penis, remove the condom before the penis becomes limp, and use a new condom for each sex act.

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder? a) SCID b) AIDS c) DAF d) CVID

B) AIDS AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe panhypoglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.

The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse's response is based on the knowledge that which of the following is a diagnostic criterion for AIDS? A) Presence of HIV antibodies B) CD4+ T cell count <200/µl C) White blood cell count <5000/µl D) Presence of oral hairy leukoplakia

B) CD4+ T cell count <200µl Diagnostic criteria for AIDS include a CD4+ T-cell count <200/µl and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease, but do not define the advancement of the disease to AIDS.

A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe? a) Tetracycline b) Ceftriaxone c) Penicillin d) Levofloxacin

B) Ceftriaxone The microorganism N. gonorrhoeae has become increasingly resistant to penicillin and tetracyclines, and fluoroquinolones (such as levofloxacin). Therefore, the current CDC (2006) recommendation for treating gonorrhea is a single intramuscular dose of a broad-spectrum cephalosporin such as ceftriaxone (Rocephin) or oral dosing with cefixime (Suprax).

Within the free clinic where you practice nursing, you hold weekly sexual education classes open to the public. Within the classroom, you communicate the CDC's numbers for the incidence of STIs and their impact upon public health. Which is the fastest-spreading bacterial STI in the United States? a) Gonorrhea b) Chlamydia c) Herpes simplex 1 d) HPV

B) Chlamydia Chlamydia is the most common and fastest-spreading bacterial STI in the United States.

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed? a) Do nothing because the client's sexual habits place him at risk for contracting other STDs. b) Educate the client about why it's important to inform sexual contacts so they can receive treatment. c) Inform the health department that this client contracted an STD. d) Inform the client's sexual contacts of their possible exposure to chlamydia.

B) Educate the client about why it's important to inform sexual contacts so they can receive treatment. The nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits.

A hospital has seen a recent increase in the incidence of hospital-acquired infections (HAIs). Which of the following measures should be prioritized in the response to this trend? A) Use of gloves during patient contact B) Frequent and thorough hand washing C) Prophylactic, broad-spectrum antibiotics D) Fitting and appropriate use of N95 masks

B) Frequent and thorough hand washing Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing.

A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse's best response? a) "This combination of medications will eradicate the infection faster than a single antibiotic." b) "Many people infected with gonorrhea are infected with chlamydia as well." c) "The combination of these two antibiotics reduces the risk of reinfection." d) "There are many resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment."

B) Many people infected with gonorrhea are infected with chlamydia as well Treatment of gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin is prescribed as well. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.

A patient has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the patient? a) The virus causes "cold sores" of the lips. b) Treatment is focused on relieving symptoms. c) The virus may be cured with antibiotics. d) The virus when active may not be contracted during intercourse.

B) Treatment is focused on relieving symptoms HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV-1 causes "cold sores," and varicella zoster causes shingles.

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test? a) Nucleic acid sequence-based amplification b) Western blot assay c) OraSure test d) p24 antigen capture assay

B) Western blot assay A positive EIA test indicates seropositivity. To confirm this, a Western blot assay would be done. The OraSure test uses saliva to perform an EIA test. The p24 antigen test and nucleic acid sequence-based amplification test are used to test viral load and evaluate response to treatment. However, the reverse transcriptase-polymerase chain reaction (RT-PCR) and nucleic acid sequence-based tests have replaced the p24 antigen test. The RT-PCR tests may be used to confirm a positive EIA result.

A 22-year-old male is being treated at a college health care clinic for gonorrhea. Which of the following teaching points should the nurse include in patient teaching? A) "While being treated for the infection, you will not be able to pass this infection on to your sexual partner." B) "While you're taking your antibiotics, you will need to abstain from participating in sexual activity or drinking alcohol." C) "It's important to complete your full course of antibiotics in order to ensure that you become resistant to reinfection." D) "The symptoms of gonorrhea will resolve on their own, but it is important for you to abstain from sexual activity while this is occurring."

B) While you're taking your antibiotics, you will need to abstain from participating in sexual activity or drinking alcohol Treatment for gonorrhea necessitates abstinence from sexual activity (to prevent infection of partners) and alcohol (to avoid urethral irritation). The disease is not self limiting nor does successful treatment confer future resistance.

The nurse is providing care for a patient who has been living with HIV for several years. Which of the following assessment findings most clearly indicates an acute exacerbation of the disease? A) A new onset of polycythemia B) Presence of mononucleosis-like symptoms C) A sharp decrease in the patient's CD4+ count D) A sudden increase in the patient's WBC count

C) A sharp decrease in the patient's CD4+ count A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient's WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise? a) Reduce food intake. b) Encourage large, high-fat meals. c) Avoid residue, lactose, fat, and caffeine. d) Increase the intake of iron and zinc.

C) Avoid residue, lactose, fat, and caffeine Diarrhea may subside when the client avoids residue, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client? a) "You should take the drug with an antacid." b) "It doesn't matter if you take this drug with or without food." c) "Be sure to take this drug about 1/2 hour before or 2 hours after you eat." d) "When you take this drug, eat a high-fat meal immediately afterwards."

C) Be sure to take this drug about 1/2 hour before or 2 hours after you eat Didanosine should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.

A nurse is teaching a community health class of women and explains that a sexually transmitted infection (STI) is associated with an increased risk of infertility in women. Which of the following STIs would the nurse identify? a) Herpes simplex b) Syphilis c) Chlamydia d) Gonorrhea

C) Chlamydia Women with chlamydial infection may be asymptomatic and may unknowingly experience damage to the reproductive system. Herpes simplex virus (HSV), syphilis, and gonorrhea consistently produce symptoms in infected women.

A client with genital herpes asks the nurse about what to expect with the infection. Which of the following responses would be most appropriate? a) Once you take the medication, the infection will be gone for good. b) You might have to try several different medications before finding one that works. c) Even though you don't have symptoms, you could still spread the infection. d) You can expect other outbreaks, each of which will be longer than the first.

C) Even though you don't have symptoms, you could still spread the infection Genital herpes can be transmitted during asymptomatic periods of viral shedding. Herpes recurs because after the initial infection, the virus remains dormant in the ganglia of the nerves that supply the area. Symptoms usually are more severe with the initial outbreak. Subsequent episodes usually are shorter and less intense. When the virus is active, shedding viral particles are infectious. Herpes infection is a highly contagious STI that is controllable but not curable. Herpes virus responds well to the antiviral drugs acyclovir, valacyclovir, and famciclovir.

A client with AIDS is brought to the clinic by their family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms? a) Cytomegalovirus (CMV) b) Distal sensory polyneuropathy (DSP) c) HIV encephalopathy d) Candidiasis

C) HIV encephalopathy HIV encephalopathy, also called AIDS dementia complex or ADC, is a neurologic condition that causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.

The nurse is gathering data from a male client who is suspected of having gonorrhea. Which of the following would the nurse most likely find? a) Testicular pain b) Purulent rectal discharge c) Pain on urination d) Skin rash

C) Pain on urination In men, symptoms usually appear 2 to 6 days after infection. Urethritis with a purulent discharge and pain on urination are the most common signs and symptoms. A small proportion of men are asymptomatic. An anal infection is accompanied by painful bowel elimination and purulent rectal discharge. Skin rash is associated with disseminated gonorrhea. Testicular pain would be associated with Chlamydia.

You are caring for a client who has a diagnosis of HIV. Part of this client's teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications? a) The use of condoms b) What vaccinations to have c) Side effects of drug therapy d) The action of each antiretroviral drug

C) Side effects of drug therapy Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client's HIV medications.

A mother brings her young child to the clinic for an evaluation of an infection. The mother states, "He's been taking antibiotics now for more than 2 months and still doesn't seem any better. It's like he's always sick." During the history and physical examination, which of the following would alert the nurse to suspect a primary immunodeficiency? a) Superficial wound on the child's left leg b) History of fungal diaper rash c) Ten ear infections in the past year d) Weight within age-appropriate parameters

C) Ten ear infections in the past year The mother has already reported one of the warning signs associated with primary immunodeficiencies--the use of antibiotics for 2 or more months with little effect. Another warning sign is eight or more new ear infections within 1 year. Therefore, the report of 10 ear infections in the past year would increase the nurse's suspicion. Recurrent, deep skin, or organ abscesses, failure of an infant to gain weight or grow normally, and persistent thrush (yeast infection) in the mouth or elsewhere on the skin after age 1 year would be additional warning signs. A superficial wound on the leg, age-appropriate weight, and a history of a fungal diaper rash would not be considered warning signs.

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding? a) Palmar rash b) Development of gummas c) Development of central nervous system lesions d) Genital chancres

D) Genital chancres Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)? a) Hive-like rash for the past 2 days b) Clear vaginal discharge c) Weight gain of 5 lbs in one year d) Five different sexual partners

D) Five different sexual partners The number of sexual partners is a risk factor for the development of STIs. A rash could be related to numerous underlying conditions. A weight gain of 5 lbs in one year is not a factor increasing one's risk for STIs. A change in the color of vaginal discharge such as yellow, milky, or curd-like, not clear, would suggest a STI.

A nurse is providing care to a client with chlamydia. The nurse anticipates that the client will also receive treatment for which of the following? a) Mycoplasma b) Trichomoniasis c) Human papillomavirus d) Gonorrhea

D) Gonorrhea There is a high incidence of corinfection with chlamydia and gonorrhea. Therefore, the client would also receive treatment for gonorrhea. Typically chlamydial infections do not occur in conjunction with mycoplasma, trichomoniasis, or human papillomavirus.

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of: a) why the disease is transmittable only when visible lesions are present. b) the need for the use of petroleum products. c) the option of disregarding safer-sex practices now that he's already infected. d) the importance of informing his partners of the disease.

D) Importance of informing his partners of the disease. Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.

A nurse is assisting with a physical examination of a male client. Which of the following signs and symptoms is most clearly suggestive of primary genital herpes? a) Emergence of hard, painless nodules on the shaft of the penis b) Presence of purulent, whitish discharge from the penis c) Production of cloudy, foul-smelling urine d) Itching, pain, and the emergence of pustules on the penis

D) Itching, pain, and the emergence of pustules on the penis The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine are not suggestive of the disease.

A client with genital herpes simplex infection asks the nurse, "Will I ever be cured of this infection?" Which response by the nurse would be most appropriate? a) "All you need is a dose of penicillin and the infection will be gone." b) "There is a new vaccine available that prevents the infection from returning." c) "Once you have the infection, you develop an immunity to it." d) "There is no cure, but drug therapy helps to reduce symptoms and recurrences."

D) There is no cure, but drug therapy helps to reduce symptoms and recurrences Genital herpes is a life-long viral infection. No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. A vaccine is available for HPV infection but not genital herpes. Penicillin is used to treat syphilis. No immunity develops after a genital herpes infection.

Neonatal Abstinence Syndrome s/s

Hyperactivity, hypertonia, excessive sucking, high pitch cry

A nurse is assessing a woman with vaginal discharge. The nurse suspects bacterial vaginosis when the client states which of the following? a) "The discharge is yellowish but thin." b) "I noticed a strange fishy odor during my period." c) "The discharge looks almost like cottage cheese." d) "I've been experiencing some really intense itching."

I noticed a strange fishy odor during my period Bacterial vaginosis is characterized by a fishlike odor that is particularly noticeable after sexual intercourse or during menstruation. Most clients do not experience local discomfort or pain; more than one half of clients do not notice any symptoms. Intense itching is often associated with candidiasis or trichomoniasis. A cottage-cheese like discharge is associated with candidiasis. A thin, yellow discharge is most commonly noted with trichomoniasis.

Alcohol w/d care regimen (mom)

Sedation, seizure precaution

Hegar's Sign

Softening of uterine segment

Tx: NAS

Swaddling, frequent feeding (Buprenorphine, methadone)

Cocaine crosses into the breast milk. T/F?

T

11. A school nurse is providing information for parents of teenagers regarding the human papillomavirus (HPV) and the recommended HPV vaccination. What teaching point would the nurse include? a) "HPV causes genital warts and cervical and other genital cancers." b) "HPV causes a single painless genital lesion and can lead to sterility." c) "50% of women between the ages of 14 and 19 are infected with HPV" d) "The HPV vaccination is only recommended for the female population."

a

2. A nurse is counseling an older couple regarding sexuality. Which statement from the couple should the nurse address? a) "We're at the age when we should consider ceasing sexual activity." b) "We need more time for sexual stimulation than we used to." c) "If we are unable to have sex we can still have an intimate relationship." d) "If we change our position we can still have sex and be more comfortable."

a

7. A patient tells the nurse that she would like to use a mechanical barrier for birth control. Which method might the nurse recommend? a) Diaphragm b) Oral contraceptive pills c) Depo-Provera d) Evra patch

a

5. The mother of an 8-year-old boy tells the nurse that she is worried because she has found her son masturbating on occasion. She asks the nurse how she should "handle this problem." What would be the best response of the nurse to this mother's concern? a) "Children should be taught not to masturbate because most people believe self-stimulation is wrong." b) "Masturbation is a means of learning what a person prefers sexually, and overreacting to it can lead to the child thinking sex is bad or dirty." c) "There are serious health risks associated with frequent masturbation, and the practice should be discouraged in children." d) "Children who masturbate demonstrate sexual dysfunction and should be seen by a child psychologist."

b

10. A nurse is assessing a 27-year-old female patient who visits her gynecologist. The patient tells the nurse that she has been having a vaginal discharge that "smells bad and is green and foamy." She also complains of burning upon urination and dyspareunia. What sexually transmitted infection would the nurse suspect? a) Human papillomavirus (HPV) b) Syphilis c) Trichomoniasis d) Herpes simplex virus

c

12. A 38-year-old patient tells the nurse counselor that he can only get sexual pleasure by looking at the body of a person other than his wife from a distance. The nurse documents this data as: a) Masochism b) Pedophilia c) Voyeurism d) Sadism

c

4. A school nurse is providing sex education classes for adolescents. Which statement by the nurse accurately describes normal sexual functioning? a) "Each person is born with a certain amount of sexual drive, which can be depleted in later years." b) "If you want to be a great athlete, sexual abstinence is necessary when you are training." c) "If you have a nocturnal emission (wet dream) it is an indicator of a sexual disorder." d) "It is natural for a woman to have as strong a desire for sex and enjoy it as much as a man."

d

9. A nurse is teaching patients about contraception methods. Which statement by a patient indicates a need for further teaching? a) "Depo-Provera is not effective against sexually transmitted infections, but contraceptive protection is immediate if I get the injection on the first day of my period." b) "The hormonal ring contraceptive, NuvaRing, protects against pregnancy by suppressing ovulation, thickening cervical mucus, and preventing the fertilized egg from implanting in the uterus." c) "Abstinence may be an effective method of contraception and may be used as a periodic or continuous strategy." d) "Withdrawal is an effective method of birth control as well as an effective method of reducing the spread of sexually transmitted infections."

d

5 drinks/wk = incr risk of _____ _____

intrauterine death (3-5x than non-drinkers)

Alcohol abstinence during pregnancy is leading preventable cause of _____ _____.

mental retardation