Ch 52: Sexually Transmitted Infections
A 21-year-old college student has come to see the nurse practitioner for treatment of a vaginal infection. Physical assessment reveals inflammation of the vagina and vulva, and vaginal discharge has a cottage cheese appearance. These findings are consistent with: a. candidiasis b. trichomoniasis c. bacterial vaginosis d. Chlamydia
A ~ The signs and symptoms of candidiasis include inflammation of the vagina and vulva and a cottage cheese appearance to the vaginal discharge
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.
14. A gynecologist caring for a pregnant patient who has gonorrhea prescribed cefixime (Suprax) instead of the more common tetracycline hydrochloride (Achromycin). What is the rationale for this decision? a. Gonorrhea is less likely to be resistant to Suprax. b. Achromycin requires a longer treatment protocol than Suprax. c. Suprax is a more potent drug that Achromycin. d. Achromycin is contraindicated in a patient who is pregnant.
ANS: D Achromycin is contraindicated during pregnancy and lactation. DIF: Cognitive Level: Application REF: p. 1170 OBJ: 6 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Planning
21. What does chlamydial infection place a person at greater risk for? a. HIV if exposed to it b. Urinary infections c. Hepatitis B if exposed to it d. Opportunistic bacterial infections
ANS: A Patients who have a chlamydial infection are five times more likely to contract HIV if exposed to it. DIF: Cognitive Level: Knowledge REF: p. 1166 OBJ: 8 TOP: Chlamydia KEY: Nursing Process Step: Implementation
13. Which method is used to identify organisms of gonorrhea? a. Smears and cultures b. Serologic tests c. Antibody screening d. Sensitivity testing
ANS: A Smears from genital discharge can be studied on a smear. DIF: Cognitive Level: Knowledge REF: p. 1170 OBJ: 1 TOP: Tests Used to Diagnose STIs KEY: Nursing Process Step: Assessment
8. Which infection, reported in the health history of a female patient who is having difficulty conceiving, will the nurse identify as a risk factor for infertility? a. N. gonorrhoeae b. Treponema pallidum c. Condyloma acuminatum d. Herpes simplex virus type 2
A Complications of gonorrhea include scarring of the fallopian tubes, which can lead to tubal pregnancies and infertility. Syphilis, genital warts, and genital herpes do not lead to problems with conceiving, although transmission to the fetus (syphilis) or newborn (genital warts or genital herpes) is a concern. REF: 1230
15. Which patient will the nurse plan on teaching about the Gardasil vaccine? a. A 24-yr-old female patient who has not been sexually active b. A 34-yr-old female patient who has multiple sexual partners c. A 24-yr-old female patient who is pregnant for the first time d. A 34-yr-old female patient who is in a monogamous relationship
A Gardasil is recommended for female patients ages 9 through 26 years, preferably those who have never been sexually active. It is not recommended for women during pregnancy or for older women. REF: 1235
12. A 29-yr-old female patient is diagnosed with Chlamydia during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says which of the following? a. "My partner will need to take antibiotics at the same time I do." b. "Go ahead and give me the antibiotic injection, so I will be cured." c. "I will use condoms during sex until I finish taking all the antibiotics." d. "I do not plan on having children, so treating the infection is not important."
A Sex partners should be treated simultaneously to prevent reinfection. Chlamydia is treated with oral antibiotics. Abstinence from sexual intercourse is recommended for 7 days after treatment, and condoms should be recommended during all sexual contacts to prevent infection. Chronic pelvic pain, as well as infertility, can result from untreated Chlamydia. REF: 1239
2. A 20-yr-old female patient who is being seen in the family medicine clinic for an annual physical examination reports being sexually active. The nurse will plan to teach the patient about a. testing for Chlamydia infection. b. immunization for herpes simplex. c. infertility associated with the human papillomavirus (HPV). d. the relationship between the herpes virus and cervical cancer.
A Testing for Chlamydia is recommended by the Centers for Disease Control and Prevention for all sexually active women younger than age 25 years. HPV infection does not cause infertility. There is no vaccine available for herpes simplex, and herpes simplex infection does not cause cervical cancer. REF: 1230
10. A 19-yr-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not sought treatment until now because "the warts are so disgusting." Which nursing diagnosis is consistent with these data? a. Disturbed body image related to feelings about the genital warts b. Ineffective coping related to denial of increased risk for infection c. Risk for infection related to lack of knowledge about transmission d. Anxiety related to impact of condition on interpersonal relationships
A The patient's statement that her lesions are disgusting suggests that disturbed body image is the major concern. There is no evidence to indicate ineffective coping or lack of knowledge about mode of transmission. The patient may be experiencing anxiety, but there is nothing in the data indicating that the genital warts are impacting interpersonal relationships. REF: 1239
4. A 46-yr-old patient who has had blood drawn for an insurance screening has a positive Venereal Disease Research Laboratory (VDRL) test. Which action should the nurse take next? a. Ask the patient about past treatment for syphilis. b. Explain the need for blood and spinal fluid cultures. c. Schedule fluorescent treponemal antibody absorption (FAT-Abs) testing. d. Assess for the presence of chancres, flulike symptoms, or a rash on the trunk.
A When antibody testing is positive for syphilis, the antibodies remain present for an indefinite period of time even after successful treatment, so the nurse should inquire about previous treatment before doing other assessments or testing. Culture, FAT-Abs testing, and assessment for symptoms may be appropriate based on whether the patient has been previously treated for syphilis. REF: 1236
19. The nurse in the outpatient clinic notes that the following patients have not received the human papillomavirus (HPV) vaccine. Which patients should the nurse plan to teach about benefits of the vaccine (select all that apply)? a. A 24-yr-old male patient who has a history of genital warts b. An 18-yr-old male patient who has had one male sexual partner c. A 38-yr-old female patient who has never been sexually active d. A 20-yr-old female patient who has a newly diagnosed Chlamydia infection e. A 30-yr-old female patient whose sexual partner has a history of genital warts
A, B, D The HPV vaccines are recommended for male and female patients between ages 9 through 26 years. There are several types of HPV. Ideally, the vaccines are administered before patients are sexually active, but they offer benefit even to those who already have HPV infection because the vaccines protect against HPV types not already acquired. REF: 1235
17. A 39-yr-old patient with a history of IV drug use is seen at a community clinic. The patient reports difficulty walking, stating, "I don't know where my feet are." Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-Abs) test results. Based on the patient history, what will the nurse assess (select all that apply)? a. Heart sounds b. Genitalia for lesions c. Joints for swelling and inflammation d. Mental state for judgment and orientation e. Skin and mucous membranes for gummas
A, D, E The patient's clinical manifestations and laboratory tests are consistent with tertiary syphilis. Valvular insufficiency, gummas, and changes in mentation are other clinical manifestations of this stage. REF: 1236
18. What is characteristic of the primary stage syphilis? a. Chancre b. Alopecia c. Pruritus d. Dry skin
ANS: A A typical lesion, a chancre, is the first sign of syphilis. DIF: Cognitive Level: Knowledge REF: p. 1170-1171 OBJ: 4 TOP: Syphilis KEY: Nursing Process Step: Assessment
16. A nurse asks a patient to repeat the instructions to evaluate her knowledge about safe sex practices. Which statement indicates an understanding? a. "Body massage would be considered safe." b. "Mutual open-mouth kissing is safe." c. "Vaginal intercourse with a properly used condom is safe." d. "Anal sex with a condom made of latex is a safe sex practice."
ANS: A Body massage is considered a safe sex practice. DIF: Cognitive Level: Comprehension REF: p. 1179 OBJ: 9 TOP: Safety of Various Sexual Practices KEY: Nursing Process Step: Evaluation
7. A patient at the outpatient clinic is reluctant to identify her sexual contacts. Why is the reporting of contacts essential? a. Slows transmission and spread of infections b. Increases public awareness c. Increases state funding for treatment d. Collects data for research
ANS: A Confirmed cases are reported to the health department. The purpose is to identify and treat infected individuals so that transmission can be slowed. DIF: Cognitive Level: Comprehension REF: p. 1166 OBJ: 2 TOP: Reporting STIs KEY: Nursing Process Step: Implementation
5. A woman diagnosed with gonorrhea is astounded and states that she had no idea that she had an STI. What should the nurse explain about gonorrhea? a. It produces no symptoms in half of those in the early stages of the infection. b. It always produces a foul vaginal discharge. c. It causes a vaginal chancre that is not easily detected. d. It may appear to be an upper respiratory infection in the early stages of the infection.
ANS: A More than half of those in the early stages of gonorrhea have no symptoms at all. Symptoms of gonorrhea typically occur 3 days to 3 weeks after exposure and are more apparent in men than in women. No chancre is exhibited, as with syphilis, and gonorrhea does not produce a foul discharge. DIF: Cognitive Level: Application REF: p. 1170 OBJ: 4 TOP: Gonorrhea KEY: Nursing Process Step: Assessment
11. A couple comes to the emergency department for the treatment of an STI. The man's presenting symptoms include a creamy penile discharge and frequent urination. The woman has lower abdominal pain and a vaginal discharge. What should the nurse recognize these symptoms to characterize? a. Chlamydial infection b. Gonorrhea infection c. HSV type B d. Trichomoniasis
ANS: A Symptoms in men are penile discharge, thin at first and then creamy, and frequent urination. Symptoms in women are a vaginal discharge and lower abdominal pain. DIF: Cognitive Level: Comprehension REF: p. 1166-1167 OBJ: 4 TOP: Chlamydia KEY: Nursing Process Step: Assessment
25. A nurse explains that STIs must be reported to the local public health department. Which are considered reportable diseases? (Select all that apply.) a. HIV b. Acquired immunodeficiency syndrome (AIDS) c. Gonorrhea d. Chlamydia e. Viral hepatitis
ANS: A, B, C, E All confirmed cases of HIV, AIDS, gonorrhea, syphilis, and viral hepatitis are reportable. Chlamydia is not reportable. DIF: Cognitive Level: Knowledge REF: p. 1166 OBJ: 2 TOP: Reportable Diseases KEY: Nursing Process Step: Implementation
27. A nurse recognizes that a patient with an STI may not cooperate in reporting sexual contacts. What fears might prevent reporting? (Select all that apply.) a. Judgment by health care workers b. Identifying self as infected c. Rejection by contacts d. Infecting others e. Reprisal from identified contacts
ANS: A, B, C, E Infection of others has already occurred. DIF: Cognitive Level: Comprehension REF: p. 1165 OBJ: 2 TOP: Impediments to Reporting STIs KEY: Nursing Process Step: Assessment
26. What body areas might systemic (disseminated) gonorrhea involve? (Select all that apply.) a. Heart b. Eyes c. Meninges d. Skin e. Joints
ANS: A, C, D, E Systemic gonorrhea may damage all of the body areas mentioned except the eyes. DIF: Cognitive Level: Knowledge REF: p. 1169-1170 OBJ: 4 TOP: Systemic Gonorrhea KEY: Nursing Process Step: Implementation
20. Which antiviral drug is commonly used to relieve symptoms of herpes simplex virus (HSV)? a. Tetracycline (Achromycin) b. Acyclovir (Zovirax) c. Erythromycin (E-Mycin) d. Metronidazole (Flagyl)
ANS: B No cure is available for HSV infection, but oral antiviral drugs similar to acyclovir (Zovirax) help partially control the signs and symptoms during initial and recurrent episodes. DIF: Cognitive Level: Knowledge REF: p. 1168 | p. 1173 OBJ: 8 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Assessment
15. What instruction should be included by a health educator giving a presentation on how to use condoms correctly? a. Condoms are 100% effective when used correctly. b. The effectiveness of condoms deteriorates in heat. c. Any style and material of condom is safe to use. d. Use of petroleum jelly will ease application.
ANS: B Protect condoms from heat and sunlight to keep them from deteriorating. DIF: Cognitive Level: Comprehension REF: p. 1180 OBJ: 9 TOP: Condoms KEY: Nursing Process Step: Implementation
9. A patient with syphilis is seen at the clinic and complains of body aches, pustules, fever, and sore throat. Which stage of syphilis should the nurse recognize these symptoms identify? a. Primary b. Secondary c. Latent d. Late
ANS: B Symptoms in the secondary stage are body aches, rash, pustules, fever, and sore throat. DIF: Cognitive Level: Comprehension REF: p. 1171 OBJ: 4 TOP: Syphilis KEY: Nursing Process Step: Assessment
2. A nurse is completing a history of illnesses for a young woman who suspects she may have a sexually transmitted infection (STI). What specific symptom(s) should the nurse ask this patient if she experienced? a. Lethargy and fatigue b. Genital discharge c. Abdominal cramps d. Heavy menses
ANS: B With an STI, the patient usually complains of genital discharge. DIF: Cognitive Level: Application REF: p. 1176 OBJ: 7 TOP: Collecting Data KEY: Nursing Process Step: Assessment
10. Doxycycline (Vibramycin) has been prescribed for a patient who has gonorrhea. What instruction should the nurse provide to the patient before beginning the medication? a. Take the medication with food or crackers. b. Refrain from sexual relations for 4 weeks. c. Follow up to determine if the treatment was effective. d. Keep the medication in the refrigerator.
ANS: C Follow-up examinations are important to determine whether treatment has been effective to prevent reinfection of the partner. DIF: Cognitive Level: Application REF: p. 1170 OBJ: 6 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Implementation
3. A patient has been diagnosed with herpes simplex virus, type 2 (HSV type 2). What instruction should the nurse provide? a. Avoid telling anyone about the condition. b. Wear close-fitting undergarments. c. Wash towels and personal items daily. d. Soak the sores with peroxide every day.
ANS: C Inform the patient that the virus can survive on objects such as towels. DIF: Cognitive Level: Application REF: p. 1174 OBJ: 8 TOP: Herpes Simplex Virus, Type 2 KEY: Nursing Process Step: Implementation
4. A nurse is caring for a patient taking acyclovir (Zovirax). Which side effects of this drug should the nurse be alert for? a. Fever and bone marrow suppression b. Vaginal burning and skin irritation c. Dizziness, headache, and nausea d. Leukopenia and peripheral neuropathy
ANS: C Side effects include dizziness, headache, nausea and vomiting, renal failure, and seizures. DIF: Cognitive Level: Comprehension REF: p. 1168 OBJ: 6 TOP: Drugs to Treat STIs KEY: Nursing Process Step: Planning
1. A nurse in the outpatient clinic notes that a patient has been treated for syphilis three separate times in the past 2 years. What should the antibiotic treatment for this patient consist of this time? a. Penicillin G b. Penicillin G today and a follow-up with another injection in 1 month c. Penicillin G today and 3 months of oral tetracycline antibiotic medications d. Penicillin G today and a 2-month protocol of oral antiviral agents
ANS: C The patient who has had syphilis for more than 1 year will need a long-term antimicrobial remedy, as well as an initial dose of penicillin G. Antiviral agents are not used in the treatment of a bacterial disease. DIF: Cognitive Level: Comprehension REF: p. 1172-1173 OBJ: 4 TOP: Drug Protocol for Syphilis KEY: Nursing Process Step: Planning
24. A patient with a chlamydial infection is taking a 7-day course of doxycycline (Vibramycin). What information should the nurse provide? a. Return in 1 month for a follow-up culture. b. Take the drug on an empty stomach with a minimum of fluid. c. Delay sexual activity until cured. d. Expect genital or anal itching or burning.
ANS: C The patient with a chlamydial infection should delay sexual activity until completely clear. Follow-up cultures are obtained 4 to 7 days after the initiation of the drug, and the drug should be taken with food or milk. DIF: Cognitive Level: Application REF: p. 1169-1170 OBJ: 6 TOP: Vibramycin KEY: Nursing Process Step: Implementation
12. A pregnant patient with HSV type 2 has a Herp-Test performed in the physician's office 1 day before she is due to deliver by cesarean section. The test result is negative. What should the nurse know this means? a. The delivery must be by cesarean section. b. The patient must start on an antiviral protocol today. c. The baby will have to have antiviral medication 24 hours after birth. d. The delivery may be accomplished vaginally.
ANS: D A negative Herp-Test result shows no active viral disease, and the birth can be accomplished vaginally if the physician prefers. DIF: Cognitive Level: Comprehension REF: p. 1166 OBJ: 4 TOP: Herp-Test KEY: Nursing Process Step: Planning
22. A patient at the outpatient clinic who has received an intramuscular dose of ceftriaxone sodium (Rocephin) calls and complains of pain and induration at the injection site. What should the nurse advise the patient to do? a. Undergo 30 minutes of active exercise to speed absorption of the drug. b. Make an appointment at the clinic for evaluation to initiate another drug. c. Immediately come to the clinic for treatment of the allergic reaction. d. Place a warm compress on the area.
ANS: D A warm compress may be applied to the area because these symptoms are the expected results of the injection, not allergic reactions. Another drug is not needed. DIF: Cognitive Level: Application REF: p. 1167 OBJ: 6 TOP: Rocephin KEY: Nursing Process Step: Implementation
6. A nurse giving instruction to a patient with an STI says, "I am supposed to tell you about STIs, but you probably know more about them than I do." What is this nurse doing? a. Admitting her own ignorance about STIs b. Trying to get the patient's attention c. Referencing current statistics d. Making a judgmental statement
ANS: D Judgmental behavior on the part of health care providers discourages people from seeking appropriate medical care. DIF: Cognitive Level: Comprehension REF: p. 1179 OBJ: 5 TOP: Behavior of Health Care Workers KEY: Nursing Process Step: Implementation
17. A female patient, newly diagnosed with gonorrhea, screams, "I am going to kill my husband. I mean it." What is the nurse's best response? a. "Are you sure it is your husband who gave you gonorrhea?" b. "Yikes! Killing your spouse seems extreme." c. "Shall I report your spouse as a sexual contact?" d. "I can understand your anger. How best can you deal with it?"
ANS: D Provide an opportunity to talk. Help the patient focus on the source of anxiety with the use of open-ended questions. DIF: Cognitive Level: Application REF: p. 1165 | p. 1179 OBJ: 9 TOP: STI Implementations KEY: Nursing Process Step: Implementation
23. What should a nurse caution a patient taking Flagyl for Trichomonas to do? a. Double the dose if any doses are missed. b. Report dark urine. c. Take the drug on an empty stomach. d. Abstain from alcohol while taking the drug.
ANS: D The use of alcohol while taking Flagyl has serious side effects. Dark urine is expected, doses should not be doubled, and the drug should be taken with a full glass of water. DIF: Cognitive Level: Application REF: p. 1168 OBJ: 6 TOP: Flagyl KEY: Nursing Process Step: Implementation
19. What does diagnosis with the human papilloma virus (HPV) increase a person's risk for? a. Uterine fibroids b. Chronic vaginitis c. Premature menopause d. Cervical cancer
ANS: D Women with HPV or condylomata acuminate are advised to have annual Pap smears because they are at an increased risk for cervical cancer. DIF: Cognitive Level: Knowledge REF: p. 1174 OBJ: 9 TOP: Human Papilloma Virus KEY: Nursing Process Step: Implementation
3. A patient with gonorrhea is treated with a single IM dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100 mg bid for 7 days. The nurse explains to the patient that this combination is prescribed to a. prevent reinfection during treatment. b. treat any coexisting chlamydial infection. c. eradicate resistant strains of N. gonorrhoeae. d. prevent the development of resistant organisms.
B Because there is a high incidence of co-infection with gonorrhea and Chlamydia, patients are usually treated for both. The other explanations about the purpose of the antibiotic combination are not accurate. REF: 1229
6. A patient admitted with chest pain is also found to have positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-Abs) tests, rashes on the palms and the soles of the feet, and moist papules in the anal and vulvar area. Which action will the nurse include in the plan of care? a. Assess for arterial aneurysms. b. Wear gloves for patient contact. c. Place the patient in a private room. d. Apply antibiotic ointment to the perineum.
B Exudate from any lesions with syphilis is highly contagious. Systemic antibiotics, rather than local treatment of lesions, are used to treat syphilis. The patient does not require a private room because the disease is spread through contact with the lesions. This patient has clinical manifestations of secondary syphilis and does not need to be monitored for manifestations of tertiary syphilis. REF: 1240
5. A 48-yr-old male patient who has been diagnosed with gonococcal urethritis tells the nurse he had recent sexual contact with a woman but says she did not appear to have any disease. In responding to the patient, the nurse explains that a. women do not develop gonorrhea infections but can serve as carriers to spread the disease to men. b. women may not be aware they have gonorrhea because they often do not have symptoms of infection. c. women develop subclinical cases of gonorrhea that do not cause tissue damage or clinical manifestations. d. when gonorrhea infections occur in women, the disease affects only the ovaries and not the genital organs.
B Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked. The disease may affect both the genitals and the other reproductive organs and cause complications such as pelvic inflammatory disease. Women who can transmit the disease have active infections. REF: 1230
14. A 32-yr-old patient who is diagnosed with Chlamydia tells the nurse that she is very angry because her husband is her only sexual partner. Which response should the nurse make first? a. "You may need professional counseling to help resolve your anger." b. "It is understandable that you feel angry about contracting an infection." c. "Your feelings are justified and you should share them with your husband." d. "It is important that both you and your husband be treated for the infection."
B This response expresses the nurse's acceptance of the patient's feelings and encourages further discussion and problem solving. The patient may need professional counseling, but more assessment of the patient is needed before making this judgment. The nurse should also assess further before suggesting that the patient share her feelings with the husband because problems such as abuse might be present in the relationship. Although it is important that both partners be treated, the patient's anger suggests that the feelings need to be acknowledged first. REF: 1239
18. Which topics will the nurse include when preparing to teach a patient with recurrent genital herpes simplex (select all that apply)? a. Infected areas should be kept moist to speed healing. b. Sitz baths may be used to relieve discomfort caused by the lesions. c. Genital herpes can be cured by consistent use of antiviral medications. d. Recurrent genital herpes episodes usually are shorter than the first episode. e. The virus can infect sexual partners even when you do not have symptoms.
B, D, E Patients are taught that shedding of the virus and infection of sexual partners can occur even in asymptomatic periods, that recurrent episodes resolve more quickly, and that sitz baths can be used to relieve pain caused by the lesions. Antiviral medications decrease the number of outbreaks but do not cure herpes simplex infections. Infected areas may be kept dry if this decreases pain and itching. REF: 1233
11. When a 31-yr-old male patient returns to the clinic for follow-up after treatment for gonococcal urethritis, a purulent urethral discharge is still present. Which question will the nurse ask to identify a possible cause of recurrent infection? a. "Did you take the prescribed antibiotic for a week?" b. "Did you drink at least 3 quarts of fluids every day?" c. "Were your sexual partners treated with antibiotics?" d. "Do you wash your hands after using the bathroom?"
C A common reason for recurrence of symptoms is reinfection because infected partners have not been simultaneously treated. Because gonorrhea is treated with one dose of antibiotic, antibiotic therapy for a week is not needed. An adequate fluid intake is important, but a low fluid intake is not a likely cause for failed treatment. Poor hygiene may cause complications such as ocular trachoma but will not cause a failure of treatment. REF: 1239
9. A patient is diagnosed with primary syphilis during her eighth week of pregnancy. The nurse will plan to teach the patient about the a. likelihood of a stillbirth. b. plans for cesarean section c. intramuscular injection of penicillin. d. antibiotic eye drops for the newborn.
C A single injection of penicillin is recommended to treat primary syphilis. This will treat the mother and prevent transmission of the disease to the fetus. Instillation of erythromycin into the eyes of the newborn is used to prevent gonorrheal eye infections. C-section is used to prevent the transmission of herpes to the newborn. Although stillbirth can occur if the fetus is infected with syphilis, treatment before the 10th week of gestation will eliminate in utero transmission to the fetus. REF: 1237
1. A male patient who has a profuse, purulent urethral discharge with painful urination is seen at the clinic. Which information will be most important for the nurse to obtain? a. Sexual orientation b. Immunization history c. Recent sexual contacts d. Contraceptive preference
C Information about sexual contacts is needed to help establish whether the patient has been exposed to a sexually transmitted infection and because sexual contacts also will need treatment. The other information also may be gathered but is not as important in determining the plan of care for the patient's current symptoms. REF: 1237
7. Which statement by a 24-yr-old patient indicates that the nurse's teaching about management of primary genital herpes has been effective? a. "I will use acyclovir ointment on the area to relieve the discomfort." b. "I will use condoms for intercourse until the medication is all gone." c. "I will take the acyclovir (Zovirax) every 8 hours for the next week." d. "I will need to take all of the medication to be sure the infection is cured."
C The treatment regimen for primary genital herpes infections includes acyclovir 400 mg 3 times daily for 7 to 10 days. The patient is taught to abstain from intercourse until the lesions are gone. (Condoms should be used even when the patient is asymptomatic.) Acyclovir ointment is not effective in treating lesions or reducing pain. Herpes infection is chronic and recurrent. REF: 1233
16. After the nurse has taught a patient with a newly diagnosed sexually transmitted infection (STI) about expedited partner therapy, which patient statement indicates that the teaching has been effective? a. "I will tell my partner that it is important to be examined at the clinic." b. "I will have my partner take the antibiotics if any STI symptoms occur." c. "I will make sure that my partner takes all of the prescribed medication." d. "I will have my partner use a condom until I have finished the antibiotics."
C With expedited partner therapy, the patient is given a prescription or medications for the partner. The partner does not need to be evaluated by the health care provider but is presumed to be infected and should be treated concurrently with the patient. Use of a condom will not treat the presumed STI in the partner. REF: 1239
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).
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.
13. A patient in the sexually transmitted infection (STI) clinic tells the nurse that she is concerned she may have been exposed to gonorrhea. To determine whether the patient has gonorrhea, the nurse will plan to a. interview the patient about symptoms of gonorrhea. b. take a sample of cervical discharge for Gram staining. c. draw a blood specimen or rapid plasma reagin (RPR) testing. d. obtain secretions for a nucleic acid amplification test (NAAT).
D NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms may not be helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble Neisseria gonorrhoeae. RPR testing is used to detect syphilis. REF: 1229
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.
