ch 5 sexually transmitted infections OB
A community health nurse is conducting an educational session at a local community center on sexually transmitted infections (STIs). The nurse considers the session successful when participants identify which statement as correct? a. "Human papillomavirus is the cause of essentially all cases of cervical cancer." b. "At least antibiotics will cure a sexually transmitted infection." c. "Gonorrhea and syphilis are infections seen only in men." d. "STIs can't be transmitted through oral sexual intercourse."
a. "Human papillomavirus is the cause of essentially all cases of cervical cancer." Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer, which is the fourth most common cancer in women in the United States. Up to 95% of cervical squamous cell carcinomas and nearly all preinvasive cervical neoplasms are caused by the HPV. Antibiotics will only cure those STIs caused by bacterial infections. A viral STI infection is a lifetime infection. Gonorrhea and syphilis affect both men and women. Sexually transmitted infections are infections of the reproductive tract caused by microorganisms transmitted through oral sexual intercourse.
A pregnant woman recently diagnosed with the genital herpes virus asks the nurse for more information on the virus. Which responses by the nurse would be appropriate? Select all that apply. a. "The virus remains quiet until a stressful event occurs to reactivate it." b. "Your baby is protected from this infection by the placenta." c. "Many recognize they have the infection and seek treatment immediately." d. "Infections may be transmitted by individuals unaware that they have it." e. "Transmission is through contact of infected mucous membranes."
a. "The virus remains quiet until a stressful event occurs to reactivate it." d. "Infections may be transmitted by individuals unaware that they have it." e. "Transmission is through contact of infected mucous membranes." Genital herpes simplex is transmitted by contact of mucous membranes or breaks in the skin with visible or nonvisible lesions. Most genital herpes infections are transmitted by individuals unaware that they have an infection. Kissing, sexual contact (including oral sex), and vaginal birth are means of transmission. The virus remains latent until stimuli such as fever, stress, ultraviolet radiation, or immunosuppression occurs and reactivates it.
An HIV-positive client who is on antiretroviral therapy reports anorexia, nausea, and vomiting. Which suggestion should the nurse offer the client to cope with this condition? a. Use high-protein supplements. b. Eat dry crackers after meals. c. Limit number of meals to three a day. d. Constantly drink fluids while eating.
a. Use high-protein supplements. The nurse should instruct the client to use high-protein supplements to provide quick and easy protein and calories. The nurse should also instruct the client to eat dry crackers upon arising, not after every meal, and to eat six small meals a day, not three. Drinking fluids constantly while eating is not recommended. The nurse should instruct the client to separate the intake of food and fluids.
Which medication is used to suppress viral load of the HSV-2 infection? a. acyclovir b. penicillin c. metronidazole d. clindamycin
a. acyclovir The antiviral agents acyclovir, valacyclovir, and famciclovir are recommended to suppress the viral load and decrease recurrence and shedding. Metronidazole and clindamycin are not used for this action.
x A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms? a. an azole antifungal agent b. a penicillin antibiotic c. a quinolone antibiotic d. an antiviral agent
a. an azole antifungal agent The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use, enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.
A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea? a. burning on urination b. dry, hacking cough c. diffuse skin rash d. painless chancre
a. burning on urination Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.
A nurse is teaching a group of pregnant young women about sexually transmitted infections (STIs) and the possible effects that may occur in the fetus or newborn. Which STIs would the nurse describe as being transmitted to the newborn during birth? Select all that apply. a. chlamydia b. gonorrhea c. genital herpes d. syphilis e. HIV
a. chlamydia b. gonorrhea c. genital herpes d. HIV Chlamydia, gonorrhea, and genital herpes can be transmitted to the fetus/newborn during birth. An infected mother can transmit HIV infection to her newborn before or during birth and through breastfeeding. Syphilis can be transmitted to the fetus while in utero.
When developing a program for STI prevention, which action would need to be done first? a. educating on how to promote sexual health b. getting individuals to change their behaviors c. increasing the availability of resources d. interfering with the mode of transmission
a. educating on how to promote sexual health The key to successful treatment and prevention of STIs is education to promote sexual health. Behavior changes, increasing the availability of resources, and interfering with modes of transmission are important, but all of these require education.
The nurse in the sexual health clinic is obtaining a health history of a client who suffers form heroin use disorder. The client reports chronic flulike symptoms accompanied by pruritis, fatigue, anorexia, and constant upper right quadrant pain. Which sexually transmitted infection would the nurse suspect? a. hepatitis A b. herpes simplex c. trichomoniasis d. syphilis
a. hepatitis A Hepatitis A produces flulike symptoms with malaise, skin rashes, fatigue, anorexia, nausea, pruritus, fever, and upper right quadrant pain. Symptoms of hepatitis B are similar to those of hepatitis A, but with less fever and skin rash involvement. Syphilis, herpes simplex, and trichomoniasis do not present with these types of symptoms.
A male client appears in the walk-in clinic and requests treatment for trichomoniasis as his girlfriend was recently diagnosed with it. What medication would the health care provider most likely prescribe? a. metronidazole b. acyclovir c. clotrimazole d. penicillin G
a. metronidazole Trichomoniasis is a common vaginal infection with the therapeutic management of metronidazole or tinidazole for both partners. Trichomoniasis is a common, curable sexually transmitted infection (STI) caused by a parasitic protozoa called Trichomonas.
A client who has been treated for recurring gonorrhea visits the sexual health clinic reporting dysuria, urinary frequency, and whitish-yellow vaginal discharge. A pelvic examination reveals cervicitis. How would the nurse interpret these findings? a. the possibility of a chlamydia infection b. an acute stage of the gonorrheal infection c. a reaction to the gonorrheal medications d. a positive pregnancy test
a. the possibility of a chlamydia infection Any woman suspected of having gonorrhea should be tested for chlamydia also because coinfection (45%) is extremely common. The nursing management of chlamydia and gonorrhea includes treatment of both. The prevalence of chlamydia and gonorrhea is increasing dramatically.
The nurse is educating a client newly diagnosed with genital herpes. Which statement by the client indicates teaching has been successful? a. "Once the ulcers heal, I will be healed from this infection." b. "I can spread this infection if I have unprotected anal, vaginal, or oral sex." c. "Genital herpes cannot be spread to newborns." d. "I may notice pain with urination and defecation."
b. "I can spread this infection if I have unprotected anal, vaginal, or oral sex." Genital herpes is a common sexually transmitted infection that can be spread by vaginal, oral, or anal intercourse. This statement indicated effective education by the nurse. There is no cure for genital herpes. Following the initial outbreak, the virus can lie dormant in the body for years. Mothers can spread the virus during pregnancy, childbirth, and breastfeeding. Painful urination may occur; however, painful defecation is not an expected symptom.
The nurse knows which client is at the highest risk for contracting a sexually transmitted infection (STI)? a. 19-year-old client who has had 3 different sexual partners and tested positive for infectious mononucleosis in the past year b. 21-year-old client who tested positive for cocaine use and was treated for trichomoniasis twice in the past 3 years c. 26-year-old client with thin, clear vaginal discharge who has been in a monogamous relationship for the past 4 years d. 30-year-old client who was treated for chlamydia 10 years ago and smokes 2 packs of cigarettes per day
b. 21-year-old client who tested positive for cocaine use and was treated for trichomoniasis twice in the past 3 years Risk factors for contracting an STI include drug use, excessive alcohol use, young age, previous STI, multiple sexual partners, unprotected intercourse, and being forced to have intercourse or perform sexual activities. The 21-year-old client presents with 3 risk factors: age, history of STIs, and drug use. The 19-year-old client has 2 risk factors: age, multiple partners. The 26-year-old client has no risk factors. The 30-year-old client has 1 risk factor: history of STI. Clear, thin vaginal discharge is expected with ovulation and may be noted after heavy exercise.
A nurse who is conducting sessions on preventing the spread of sexually transmitted infections (STIs) discovers that there is a very high incidence of hepatitis B in the community. Which measure should the nurse take to ensure the prevention of the disease? a. Ensure that the drinking water is disease-free. b. Instruct people to get vaccinated for hepatitis B. c. Educate about risks of injecting drugs. d. Educate teenagers to delay onset of sexual activity.
b. Instruct people to get vaccinated for hepatitis B. The nurse should instruct all community members to get vaccinated for prevention of hepatitis B. Ensuring that drinking water is disease-free and educating people about the risks involved with injecting drugs may help prevent hepatitis A, not hepatitis B. Delaying the start of sexual activity by teenagers may not protect them from hepatitis B in the long run.
The nurse cares for multiple female clients. Which client is at the highest risk for developing cervical cancer? a. client who has been taking oral contraceptives for 2 years and became sexually active at 16 years of age b. client who smokes 2 packs of cigarettes a day and birthed a newborn at 39 weeks' gestation when 15 years of age c. client who received the human papillomavirus (HPV) vaccine and has a family history of breast cancer d. client who consumes alcohol 2 to 3 times per week and has an intrauterine device (IUD)
b. client who smokes 2 packs of cigarettes a day and birthed a newborn at 39 weeks' gestation when 15 years of age The nurse will look for the client exhibiting the most risk factors for cervical cancer, which is the client who smokes heavily and birthed her first child before turning 20 years of age. Other risk factors include long-term use of oral contraceptives, multiple sexual partners, becoming sexually active before turning 18 years of age, having a history of human papillomavirus (HPV), family history of cervical cancer, weakened immune system, history of chlamydia, 3 or more full-term pregnancies, diethylstilbestrol (DES) use, low income, and consuming a diet low in fruits and vegetables. Factors that can decrease a client's chances of developing cervical cancer include IUD use. Alcohol consumption is not linked to cervical cancer.
Which finding would the nurse most likely find in a male diagnosed with a chlamydia trachomatis infection? a. erectile dysfunction b. dysuria c. painful ejaculation d. hematuria
b. dysuria A male with the diagnosis of chlamydia will first experience dysuria as the primary symptom. The other symptoms listed do not correlate to men with the diagnosis of chlamydia.
A nurse is reviewing the history of a client diagnosed with pelvic inflammatory disease. Which factors would the nurse identify as placing the client at increased risk for this condition? Select all that apply. a. 29 years of age b. multiple sex partners c. intrauterine cd. vaginal douching approximately once a weekontraceptive device inserted 3 weeks ago d. vaginal douching approximately once a week e. residence in a suburban area
b. multiple sex partners c. intrauterine contraceptive device inserted 3 weeks ago d. vaginal douching approximately once a week All sexually active women are at risk of PID, but common risk factors include age less than 25 years old, residence in an inner city, multiple sexual partners, sex with a new partner, insertion of an intrauterine contraceptive (IUC) within the past 6 weeks, vaginal douching, history of STI in the woman or her partner, lack of barrier contraceptive use, and a previous episode of PID.
A pregnant woman who is HIV-positive comes to the clinic for an evaluation. As part of the visit, the nurse discusses ways the woman can boost her immune system. Which instruction(s) would the nurse likely suggest? Select all that apply. a. getting 5 to 6 hours of sleep each night b. staying away from crowded places c. drinking at least 2 liters of fluid each day. d. eating small amounts of protein e. taking rest periods during the day
b. staying away from crowded places c. drinking at least 2 liters of fluid each day. e. taking rest periods during the day Ways to enhance the pregnant woman's immune system include: Getting adequate sleep each night (7 to 9 hours); avoiding infections (e.g., staying out of crowds, practicing good hand hygiene); decreasing stress; consuming adequate protein and vitamins; increasing fluid intake to 2 liters daily to stay hydrated; and planning rest periods throughout the day to prevent fatigue.
A nurse is assessing a client diagnosed with bacterial vaginosis. What is a symptom of bacterial vaginosis? a. cottage cheese-like discharge b. intense itching of the vulva c. warts in the vulva and labia d. vaginal odor smelling of fish
d. vaginal odor smelling of fish Bacterial vaginosis causes a "stale fish" vaginal odor. Cottage cheese-like discharge is seen in candidiasis and not in bacterial vaginosis, in which the discharge is thin and gray-white. Intense itching of the vulva is associated with candidiasis, not vaginosis. Warts in the vulva and labia are seen in human papillomavirus infection, not in vaginosis.
A parent at an educational session on sexually transmitted infections (STIs) asks the nurse if there are vaccines available to prevent STIs. How should the nurse respond? a. "Researchers have developed a vaccine to prevent human immunodeficiency virus." b. "There is a vaccine to prevent herpes simplex virus." c. "A vaccine has been approved to prevent the human papillomavirus." d. "At present there are no vaccines available to prevent STIs."
c. "A vaccine has been approved to prevent the human papillomavirus." Vaccine-preventable STIs can be effectively prevented through preexposure vaccination. Vaccines are under development or are undergoing clinical trials for certain STIs, including HIV and HSV. The only vaccines currently available are for prevention of hepatitis A virus, hepatitis B virus, and HPV infection. Vaccination efforts focus largely on integrating the use of these available vaccines into STI prevention and treatment activities.
The nurse is educating a female client diagnosed with human papillomavirus (HPV). Which information will the nurse include in the client's education plan? a. "You will be prescribed an antiviral medication to take that will clear your infection." b. "Your best option is to surgically remove genital warts to prevent you from spreading the disease." c. "You should be sure to receive consistent testing for cervical cancer." d. "During colder weather, you will note more outbreaks than during warmer weather."
c. "You should be sure to receive consistent testing for cervical cancer." An infection with HPV is a risk factor for developing cervical cancer. Women with a history of HPV should receive consistent testing/screening for cervical cancer. HPV is a virus; however, no antiviral to date resolves the virus in the body. Surgical removal is an option for genital warts; however, it is not the best option as the virus can still be spread without the presence of warts. Wart removal is done for comfort and appearance. Outbreaks are most noted during times of stress or illness and trauma; outbreaks are not temperature related.
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. 40 b. 32 c. 25 d. 28
c. 25 The CDC (2015) recommends yearly chlamydia testing of all sexually active women aged 25 or younger, older women with risk factors for chlamydial infections (those who have a new sex partner or multiple sex partners), and all pregnant women).
A client is being discharged from the gynecological unit after treatment for acute pelvic inflammatory disease (PID). What priority instruction regarding disease management should the nurse include? a. Provide the client with brochures on sexually transmitted infection prevention. b. Arrange for follow-up visits to her health care provider. c. Discuss the necessity of completing the antibiotic therapy. d. Refer the client to the women's sexual health clinic.
c. Discuss the necessity of completing the antibiotic therapy. It is the priority that the client understands the need to finish the antibiotic therapy required to treat PID in order to eradicate the offending bacterial infection. The STI brochures may be appropriate, but they are not the priority and neither is arranging for follow-up health care provider visits. If the client can access the women's health clinic, a referral can be made, but it is not the priority.
A pregnant client arrives at the community clinic reporting fever blisters and cold sores on the lips, eyes, and face. The health care provider has diagnosed it as the primary episode of genital herpes simplex virus (HSV), for which antiviral therapy is recommended. Which information should the nurse offer the client when educating her about managing the infection? a. Antiviral drug therapy cures the infection completely. b. Kissing during the primary episode does not transmit the virus. c. Safety of antiviral therapy during pregnancy has not been established. d. Recurrent HSV infection episodes are longer and more severe.
c. Safety of antiviral therapy during pregnancy has not been established. The nurse should inform the client that there is no evidence to suggest that antiviral therapy is completely safe during pregnancy. HSV cannot be cured completely, even with timely antiviral drug therapy, and there may be recurrences. The viral shedding process continues for 2 weeks during the primary episode, and kissing during this period may transmit the disease. Recurrent HSV-infection episodes are shorter and milder.
A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection? a. syphilis b. Candida albicans c. gonorrhea d. human immunodeficiency virus
c. gonorrhea Gonorrhea can be transmitted to the newborn in the form of ophthalmia neonatorum during birth by direct contact with gonococcal organisms in the cervix. The newborn would develop congenital syphilis if exposed in utero. Exposure to Candida would cause thrush in the newborn. Exposure to HIV during gestation could lead to the birth of an HIV-positive newborn.
A nurse in the sexual health clinic is assessing a male adolescent client, who has sex with men, for sexually transmitted infection (STI) risk factors. Which factor would the nurse identify as presenting the highest risk for STIs? a. risky sexual behaviors b. the number of sexual partners c. the age of the client d. sexual orientation of the client
c. the age of the client Adolescents tend to think they are invincible and deny the risks of their behavior. This risky behavior exposes them to STIs. Adolescents frequently have unprotected intercourse and they engage in partnerships of limited duration. The other options are all risk factors, but just the fact the client is an adolescent places the client more at risk for a STI, because adolescents will engage in risky sexual behaviors with a larger number of sexual partners without considering risks. The client's sexual orientation should not place the client at risk if precautions are taken.
The nurse is teaching a client about sexually transmitted infections. The nurse determines the teaching was successful when the client makes which statement? a. "Gonorrhea can be prevented with a vaccine." b. "Chlamydia remains localized if not treated." c. "People with trichomoniasis will have burning when they urinate." d. "Genital ulcers are a sign of genital herpes simplex."
d. "Genital ulcers are a sign of genital herpes simplex." The nurse knows the teaching was effective when the client states genital herpes simplex is a sexually transmitted infection associated with genital ulcers. Gonorrhea cannot be prevented with a vaccine. It must be treated with an antibiotic if contracted. Chlamydia can spread to other areas of the body if not treated and lead to long-term health complications. Most people with trichomoniasis have no symptoms. If symptoms are experienced, burning with or after urination may be present.
The clinic nurse is treating a client diagnosed with HIV. Which statement made by the client indicates an understanding of the diagnosis? a. "Right now I have HIV, but eventually it will develop into AIDS." b. "I will not spread HIV to others if I have intercourse with them, if I take my medication." c. "If I do not take my medications as prescribed, my red blood cell count will fall." d. "If my T-cell count drops below 200 cells/mm3 (0.2 × 109/l), my HIV has progressed to AIDS."
d. "If my T-cell count drops below 200 cells/mm3 (0.2 × 109/l), my HIV has progressed to AIDS." The client indicates an understanding of the diagnosis when reporting a CD4 T-cell count of at or below 200 cells/mm3 (0.2 × 109/l) indicates the development of AIDS. Not all persons with HIV will develop AIDS. There are medications available to help slow the process within the body and limit the development of AIDS. While intercourse can lead to the spread of HIV or AIDS, clients are still able to be sexually active if appropriate measures are taken such as using barriers. Taking the prescribed medication may help prevent the spread but is not a definitive measure. The client should notify partners before intercourse occurs and use a condom. Not taking medications as prescribed will lead to a decrease in white blood cell counts initially, not red blood cells.
A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment? a. Avoid extremes of temperature to the genital area. b. Use condoms during sex. c. Increase fluid intake. d. Avoid alcohol.
d. Avoid alcohol. The nurse should counsel the client taking metronidazole to avoid alcohol during the treatment because mixing the two causes severe nausea and vomiting. Avoiding extremes of temperature to the genital area is a requirement for clients with genital ulcers, not trichomoniasis. The nurse should instruct the client to avoid sex, regardless of using condoms, until she and her sex partners are cured (when therapy has been completed and both partners are symptom-free). It is not required to increase fluid intake during treatment.
When describing sexually transmitted infections and testing, the nurse explains that a client is typically tested for chlamydia, gonorrhea, and syphilis at the same time for which reason? a. The symptoms of these diseases are the same, and culture tests alone can determine the disease that has infected the client. b. The infecting bacterium in all cases is the same, and therefore clients have concurrent infections. c. The infections spread through the same medium, and therefore clients have concurrent infections. d. It is not unusual for clients to have concurrent infections with more than one sexually transmitted infection (STI).
d. It is not unusual for clients to have concurrent infections with more than one sexually transmitted infection (STI). It is common practice to test clients for chlamydia, gonorrhea, and syphilis because it is not unusual for clients to have concurrent infections with more than one STI. For chlamydia, the causative microorganism is a bacterium named Chlamydia trachomatis. For gonorrhea, the infection is caused by a bacterium named Neisseria gonorrhoeae. The spirochete Treponema pallidum is the causative microorganism of syphilis. The symptoms of these conditions are not identical. The causative microorganisms do not spread through the same medium.
Which instruction should be given to a woman newly diagnosed with genital herpes? a. Obtain a Papanicolaou test every 3 years. b. Have your partner use a condom when lesions are present. c. Use a water-soluble lubricant for relief of pruritus. d. Limit stress and emotional upset as much as possible.
d. Limit stress and emotional upset as much as possible. Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it is not known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Papanicolaou test is recommended every year.
A woman seen in the emergency department is diagnosed with primary syphilis. What finding is most likely? a. foul-smelling discharge b. vaginal bleeding c. vesicles on the labia d. chancres at the vaginal site
d. chancres at the vaginal site Syphilis is divided into four stages: primary, secondary, latency, and tertiary. Primary syphilis is characterized by a chancre at the site of bacterial entry. Foul-smelling discharge would not be noted. Vesicles on the labia are not associated with syphilis. Bleeding from the vagina could be normal menses and does not correlate with syphilis.
A client with syphilis did not receive treatment and has now progressed into the tertiary stage of the disorder. Which symptoms would the nurse expect the client to exhibit? a. ulcerated chancre, aortic valve insufficiency, lymphadenopathy b. fever, malaise, sore throat c. papular lesion, rash, headache d. heart disease and inflammation of the aorta, eyes, brain, central nervous system, and skin
d. heart disease and inflammation of the aorta, eyes, brain, central nervous system, and skin The client with late or tertiary syphilis is noninfectious because the microorganism has invaded the central nervous system (CNS) as well as other organs of the body. Symptoms of tertiary syphilis include heart disease and neurologic disease that slowly destroys the heart, with inflammation of the aorta, eyes, brain, central nervous system, and skin. Symptoms of secondary syphilis include fever, malaise, rash, headache, sore throat, and lymph node enlargement. Ulcerated chancre occurs in the primary stage.
