Lewis ch 53NCLEX

8. When counseling a woman who is having difficulty conceiving, the nurse will be most concerned about a history of infection with a. N. gonorrhoeae. b. Treponema pallidum. c. condyloma acuminatum. d. herpes simplex virus type 2.

ANS: 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.

4. A patient who has labs 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. Discuss the need for blood and spinal fluid cultures. c. Obtain a specimen for fluorescent treponemal antibody absorption (FAT-ABS) testing. d. Assess for the presence of chancres, flulike symptoms, or a bilateral rash on the trunk.

ANS: A Once 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.

2. A 21-year-old woman is being seen in the family medicine clinic for an annual physical exam. The nurse will plan to teach the patient about a. testing for chlamydia infection. b. immunization for herpes simplex. c. the relationship between the herpes virus and cervical cancer. d. the risk of infertility associated with the human papillomavirus (HPV).

ANS: A Testing for chlamydia is recommended for all sexually active females under age 25 by the Centers for Disease Control and Prevention. HPV infection does not cause infertility. There is no vaccine available for herpes simplex, and herpes simplex infection does not cause cervical cancer

10. A 23-year-old patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not had treatment until now because "the warts are so disgusting." Which nursing diagnosis is most appropriate? 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

ANS: 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.

MULTIPLE RESPONSE 1. A 47-year-old patient with a long history of IV drug use is seen at a community clinic, where the patient reports difficulty walking because "I don't know where my feet are." Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-ABS) tests. Based on the patient history, the nurse will assess which of the following (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

ANS: 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.

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 of antibiotics 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.

ANS: 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.

12. A patient is treated for chlamydia that was detected during a routine pelvic examination. The nurse knows that teaching regarding the management of the condition has been effective when the patient says, a. "Go ahead and give me the antibiotic injection so I will be cured." b. "My boyfriend will need to take antibiotics at the same time I do." c. "I will use condoms during sex until I finish taking all the antibiotics." d. "Since I do not plan on having any children, treatment is not as important."

ANS: B 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.

14. A woman 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 are angry with your husband right now." 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."

ANS: 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 also should 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 current anger suggests that this is not the appropriate time to bring this up.

11. When a patient returns to the clinic for follow-up after treatment for gonococcal urethritis, a purulent urethral discharge is still present. When trying to determine the reason for the recurrent infection, which question is most appropriate for the nurse to ask the patient? a. "Did you take the prescribed antibiotic for a week?" b. "Did you drink at least 2 quarts of fluids every day?" c. "Were your sexual partners treated with antibiotics?" d. "Do you wash your hands after using the bathroom?"

ANS: 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.

9. A woman who is 6 weeks' pregnant is diagnosed with primary syphilis. The nurse will plan to teach the patient about a. the likelihood of a stillbirth. b. the need for cesarean section. c. intramuscular injection of penicillin. d. use of antibiotic eye drops for the newborn.

ANS: C A single injection of penicillin is recommended to treat primary syphilis, and 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 tenth week of gestation will eliminate in utero transmission to the fetus.

6. A patient with positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FAT-ABS) tests has a rash 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. Place the patient in a private room. c. Wear gloves when touching the patient. d. Apply antibiotic ointments to the perineum.

ANS: C 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.

15. Which of these patients will the nurse plan on teaching about the Gardasil vaccine? a. A 50-year-old woman who has multiple sexual partners b. A 23-year-old woman who is pregnant for the first time c. An 18-year-old female who has never been sexually active d. A 28-year-old woman who is in a monogamous relationship

ANS: C Gardasil is recommended for females ages 9 through 26, preferably those who have never been sexually active. It is not recommended for men, women during pregnancy, or for older women.

5. A male patient who has been diagnosed with gonococcal urethritis tells the nurse about 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 males. b. women develop subclinical cases of gonorrhea that do not cause tissue damage or clinical manifestations. c. many women are not aware they have gonorrhea because they often do not have symptoms of infection. d. when gonorrhea infections occur in women, the disease affects only the ovaries and not the genital organs.

ANS: C 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 (PID). Women who can transmit the disease have active infections

7. After the nurse teaches the patient who has primary genital herpes about management of the disease, which statement by the patient indicates that the teaching has been effective? a. "I will use the acyclovir ointment on the area to relieve the pain." 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."

ANS: 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.

1. A man who has a profuse, purulent urethral discharge with painful urination is seen at the sexually transmitted disease (STD) clinic. Which information will be most important for the nurse to obtain? a. Contraceptive use b. Sexual orientation c. Immunization history d. Recent sexual contacts

ANS: D Information about sexual contacts is needed to help establish whether the patient has been exposed to an STD 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.

13. A woman in the sexually transmitted disease (STD) clinic tells the nurse that she is concerned she may have been exposed to gonorrhea by her partner. 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 vaginal secretions for a nucleic acid amplification test (NAAT).

ANS: D NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms is not helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble N. gonorrhoeae. RPR testing is used to detect syphilis.