OB Ch. 4, 5
A client who is scheduled for hysteroscopy says to a nurse, "I thought I would be able to have children, but now I know that will never be possible." Which response would be most appropriate for the nurse to make? "Adoption is always an acceptable option for anyone." "I will call the health care provider to come visit with you." "The use of surrogates is more acceptable today." "Being childless is not as bad as you think it is."
"I will call the health care provider to come visit with you." The nurse needs to notify the health care provider because the client does not have a clear understanding of the outcomes of the procedure in which she is about to undergo.
A pt is presenting with vaginal discharge that is thin, white, and homogenous. Thie discharge passes the positive whiff test for fishy smell. What possible medications would you administer to this patient?
- Metronidazole (Flaygyl) --> oral or gel - Clindomycin cream Patient is presenting with Bacterial vaginosis
A pt is presenting with a fever, rash, muscle pain, and pharyngitis. They have a past history of intravenous drug use. What possible medications would you administer to this patient?
- antiretroviral therapy (ART) - antiretroviral drugs (ARV)
The nurse is caring for clients in a community health clinic. Which clients does the nurse recognize need screening for sexually transmitted infections? Select all that apply. An incarcerated 28-year-old client. A pregnant woman in the third trimester. Initial examination after a sexual assault. Annual exam for a 24-year-old sexually active woman. A 35-year-old client in a committed heterosexual relationship.
An incarcerated 28-year-old client. A pregnant woman in the third trimester. Initial examination after a sexual assault. Annual exam for a 24-year-old sexually active woman. Those who are incarcerated are at higher risk and men younger than 30 and women younger than 35 should be tested for STIs. All pregnant women are screened at their first visit and in the third trimester. Anyone who has been sexually assaulted should be tested for STIs at the initial examination and 1 to 2 weeks after the assault. Sexually active women under 25 years old should be tested annually. Heterosexual couples in a committed relationship do not need to be screened unless there are multiple partners or one member has been diagnosed with an STI.
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? Provide the client with brochures on sexually transmitted infection prevention. Arrange for follow-up visits to her health care provider. Discuss the necessity of completing the antibiotic therapy. Refer the client to the women's sexual health clinic.
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 pt is presenting with cervicitis, mild sore throat and abnormal vaginal discharge. What possible medications would you administer to this patient?
Dual therapy: - Ceftriaxone (cephalosporin) - Azithromycin Patient is presenting with Gonorrhea. Other clinical manifestations: - abnormal vaginal bleeding - PID - dysuria - enlarged local lymph nodes - bartholin abscess - rectal infection - perihepatitis
The nurse is caring for a male client diagnosed with gonorrhea and chlamydia. Which health care provider order will the nurse question? notification of all recent sexual partners acyclovir 400 mg orally BID avoidance of sexual activity until treatment is complete rapid serum HIV test
acyclovir 400 mg orally BID The nurse would question an order for acyclovir because this is an anti-viral medication used to treat genital herpes. Clients with gonorrhea and chlamydia are treated with antibiotics such as levofloxacin, erythromycin, azithromycin, or tetracycline. The client should notify recent sexual partners to allow them to be tested and treated as needed. The client would be informed to avoid sexual activity until the treatment is complete and to use condoms once sexual activity resumes to prevent future infections. It is recommended for clients with sexually transmitted infections (STIs) be tested for other STIs because risk factors for contracting an STI include a history of STIs.
A 22-year-old Latino woman comes to the clinic for an evaluation. Assessment findings are as follows: Age of first intercourse: 15 years Intrauterine contraception inserted 2 months ago Monogamous partner Use of condoms for sexual activity Cigarette smoking since age 16; approximately 1/2 to 1 pack per day Oral temperature 100.4°F (38°C) The woman is diagnosed with pelvic inflammatory disease (PID). Which information from the woman's assessment would the nurse evaluate as increasing the woman's risk for this condition? Select all that apply. age of first intercourse intrauterine contraceptive device insertion monogamous partner oral temperature cigarette smoking use of condoms latino ethnicity
age of first intercourse intrauterine contraceptive device insertion cigarette smoking latino ethnicity
The nurse in a sexual health clinic is reviewing the history of a 30-year-old client who is an IV drug addict and diagnosed with a sexually transmitted infection. Which therapy would the nurse expect to include in this client's care? hepatitis A and hepatitis B recombinant vaccine HIV vaccine recombinant human papillomavirus vaccine acyclovir
hepatitis A and hepatitis B recombinant vaccine Risk factors for HAV and HBV infection include having multiple sex partners, engaging in unprotected anal intercourse, and having a history of other STIs. The most effective means to prevent the transmission of hepatitis A or B is preexposure immunization. The hepatitis A and hepatitis B recombinant vaccine is available for the prevention of HAV and HBV. Every person seeking treatment for an STI should be considered a candidate for hepatitis B vaccination, and some individuals (e.g., men who have sex with men and injection-drug users) should be considered for hepatitis A vaccination. There is no vaccine to prevent HIV. Scientists believe that a safe and effective HIV vaccine is possible. The recombinant human papillomavirus vaccine is administered to younger males. The antifungal (acyclovir) therapy is not reasonable as the type of STI he has is not specified.
A nurse in the sexual health clinic assesses a female client and notes wart-like lesions on the genital area and rectum. Which diagnosis best correlates with these findings? trichomoniasis infection human papillomavirus syphilis genital herpes
human papillomavirus HPV presents itself with wart-like lesions that are soft, moist, or flesh colored and appear on the vulva and cervix, and inside and surrounding the vagina and anus. The other diagnoses do not present with wart-like lesions.
A nurse is conducting an assessment of a client who is suspected of having pelvic inflammatory disease. Which finding would the nurse identify as mandatory for the diagnosis to be made? Select all that apply. oral temperature above 101°F (38.3°C) mucopurulent vaginal discharge lower abdominal tenderness adnexal tenderness cervical motion tenderness
lower abdominal tenderness adnexal tenderness cervical motion tenderness To reduce the risk of missed diagnosis, the CDC has established criteria for the diagnosis of PID. Minimal criteria (all must be present) are lower abdominal tenderness, adnexal tenderness, and cervical motion tenderness. Additional supportive criteria that support a diagnosis of PID include abnormal cervical or vaginal mucopurulent discharge and oral temperature above 101° F (38.3° C).
A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect which finding once the microorganism disseminates throughout the body? painful joints sore throat intermenstrual bleeding painful urination
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.
The nurse is developing a teaching plan for a client who is HIV positive and prescribed lamivudine. The nurse will include which statement in the teaching? "If you develop a dry mouth or rash while taking lamivudine, call your health care provider." "You need to avoid caffeine while you are taking the antiviral medications." "You need to be sure to use a form of birth control to prevent pregnancy." "If you have increased thirst, you should drink more fluids each day like water."
"If you develop a dry mouth or rash while taking lamivudine, call your health care provider." The nurse would first teach the client of signs and symptoms that require immediate reporting to the health care provider. Action is needed quickly when a client shows signs of a severe reaction, such as black, tarry stools; dry mouth, increased thirst, hunger, urination; rash; fever; unexplained weight loss; and difficulty breathing. Caffeine does not have to be avoided while taking lamivudine, an antiviral medication used to prevent multiplication of the HIV. While pregnancy can be a risk for clients with HIV, it does not have to be avoided. The client would be recommended to discuss pregnancy desires with the health care provider before becoming pregnant to allow for adequate planning.
A client diagnosed with genital herpes asks the nurse about future sexual experiences. Which response by the nurse is appropriate? "If your partner has been exposed to the herpes virus in the past, then there is no significant risk of reinfecting your partner." "Future sexual intercourse should be avoided due to the high risk of transmitting the virus to others and causing yourself additional outbreaks." "If you plan to have future sexual relationships, you need to let your partner know of your history prior to intercourse." "As long as you wear a condom and have intercourse while no lesions are present, you will not spread the virus to your partner."
"If you plan to have future sexual relationships, you need to let your partner know of your history prior to intercourse." The client should be instructed to notify future partners before having intercourse with them. Herpes simplex virus transmission can occur both during and between recurrences. Transmission is more likely to occur during an outbreak but can also happen during times of no outbreak. The client does not have to avoid any future sexual experiences, because condom use decreases transmission. The client needs to be properly educated on how to prevent transmission to others and avoid contracting another sexually transmitted infection in the future. Sexual intercourse does not increase the client's chance of future outbreaks. Prior contact with the virus does not confer immunity.
A female client has been trying to conceive for 3 months. She tells the nurse, "I just know something is wrong with me." Which response by the nurse is best? "It is time to talk to your health care provider about hormone testing." "Do you or your partner have a family history of subfertility?" "The problem can be with the man, woman, or both. We will explore all possibilities." "It can take up to 1 year of regular, unprotected intercourse to conceive."
"It can take up to 1 year of regular, unprotected intercourse to conceive." The nurse would first provide accurate information by informing the client that 3 months is not an adequate time frame to indicate a problem is present. Most couples conceive within 1 year when they have regular intercourse without the use of contraceptives. There is no reason to assess for infertility issues with the female or with the couple's families. It is true that subfertility issues can be related to the man, woman, or both; however, it is not appropriate to indicate there is concern by stating "we will explore all possibilities."
The nurse is caring for a client recently diagnosed with genital herpes. The client asks about appropriate ways to prevent future outbreaks. What is the nurse's best response? "It is important that you always have protected intercourse to prevent spreading the virus." "Regular exercise, getting an adequate amount of sleep, and eating healthy meals are appropriate." "Taking acetaminophen, ibuprofen, or aspirin to relieve pain may be of benefit for you." "Wash sores gently with soap and water and then pat them dry."
"Regular exercise, getting an adequate amount of sleep, and eating healthy meals are appropriate. Recurrent genital herpes outbreaks are triggered by precipitating factors such as stress, fatigue, illness, menstruation, and genital irritation. The best response by the nurse addresses the client's current question. All responses are true and appropriate for a client with genital herpes; however, only the statement regarding ways to prevent future outbreaks is appropriate at this time.
A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching? "Right after surgery, my semen will be sperm-free." "I will have this done in my urologist's office." "I will be awake and will get local anesthesia." "I will be able to go back to work in a day or two."
"Right after surgery, my semen will be sperm-free." After vasectomy, semen no longer contains sperm. However, this is not immediate. The man must submit semen specimens for analysis 8 to 16 weeks after a vasectomy until two specimens show that no sperm is present. When the specimen shows azoospermia, the man's sterility is confirmed. A vasectomy is usually performed under local anesthesia in a urologist's office, and most men can return to work and normal activities in a day or two.
A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize? "Take the medication on an empty stomach." "Start taking the medication when you first get your period." "Add an aspirin to the regimen if you do not get relief right away." "It is normal for your bowel movements to be black."
"Start taking the medication when you first get your period." When taking a nonsteroidal anti-inflammatory drug (NSAID), such as ibuprofen, for dysmenorrhea, it is important for the woman to start therapy prophylactically and use sufficient doses to maximally suppress prostaglandin production. NSAIDs should be taken with food to prevent gastrointestinal upset. They should not be taken with aspirin because doing so can increase the risk of bleeding, which would be noted with black stools.
A woman with candidiasis is prescribed fluconazole. When teaching the woman about this medication, which instruction would the nurse include? "Take 1 dose of the drug by mouth." "Insert the suppository into the vagina daily for 1 week." "Apply the cream to the area for 3 days." "Use the applicator to insert the vaginal tablet."
"Take 1 dose of the drug by mouth." Fluconazole, when prescribed, is a 150-mg oral tablet taken as a single dose. Miconazole, clotrimazole, and terconazole are used intravaginally in the form of a cream, tablet, or suppositories for 3 to 7 days.
The nurse is caring for a female client newly diagnosed with gonorrhea. The client's current male sexual partner tested negative. The client asked the nurse how this is possible. Which response by the nurse is most appropriate? "Women are actually more prone to contract sexually transmitted infections than men." "It is not clearly understood why women get sexually transmitted infections more, but it is not fair!" "This is something your health care provider can more clearly explain to you." "The moist, warm vaginal environment is a perfect breeding ground for microbes."
"The moist, warm vaginal environment is a perfect breeding ground for microbes." Researchers suggest that sexually transmitted infections occur more often in women than in men probably because the moist, warm vaginal environment is conducive to microbial growth and because the vagina, as a receptive orifice, is more readily traumatized during sexual activity. The nurse would respond by addressing the client's question factually. Only stating women are more likely to contract sexually transmitted infections than men does not explain a rationale to the client. The nurse would not pass the client's question to the health care provider when the nurse can address the question. It is not appropriate for the nurse to state an opinion about not being fair.
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. "The virus remains quiet until a stressful event occurs to reactivate it." "Your baby is protected from this infection by the placenta." "Many recognize they have the infection and seek treatment immediately." "Infections may be transmitted by individuals unaware that they have it." "Transmission is through contact of infected mucous membranes."
"The virus remains quiet until a stressful event occurs to reactivate it." "Infections may be transmitted by individuals unaware that they have it." "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.
A client at 32 weeks' gestation has recently been diagnosed with acute herpes type 2. The client asks what can happen to the baby as a result of this infection. How should the nurse best respond? "There is a chance your baby may have a form of intellectual disability." "Your infant is protected from this infection during pregnancy." "You may carry the pregnancy beyond your due date." "There may be a chance your baby will be a heavier birth weight."
"There is a chance your baby may have a form of intellectual disability." Herpes type 2 (genital herpes) contamination can occur during birth. The infant is susceptible to intellectual disability, premature birth, low birth weight, blindness, or even death as a result of this infection. The infant is not protected from the infection as it is contaminated during vaginal birth. Premature birth is a risk, not postdate birth.
A woman seen in the emergency walk-in clinic is diagnosed with chlamydia trachomatis. She asks the nurse how this disease is different from other sexually transmitted infections. What is the nurse's best response? "This STI is characterized by an infection of your cervix." "This STI is an infection that will cause itching in the genital area." "This STI is an infection that results in ulcers in the genital area." "This STI is an infection that will result in the formation of genital warts."
"This STI is characterized by an infection of your cervix." STIs like chlamydia result in cervicitis, which implies the presence of inflammation or infection of the cervix. It produces quantities of purulent discharge. Cervicitis is usually caused by gonorrhea or chlamydia. Chlamydia will not produce ulcers or warts and is not an STI that has itching associated with it.
A female client with genital herpes is prescribed acyclovir as treatment. After teaching the client about this treatment, which statement by the client indicates effective teaching? "If I use this drug, I will be cured of the infection." "This drug will help reduce my risk for a recurrence after discontinuing it." "The severity of future attacks will be much less after using this drug." "This drug will help to suppress any symptoms of the infection."
"This drug will help to suppress any symptoms of the infection." No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. Advances in treatment with acyclovir 400 mg orally three times daily for 7 to 10 days, famciclovir 250 mg orally three times daily for 7 to 10 days, or valacyclovir 1 g orally twice daily for 7 to 10 days have resulted in an improved quality of life for those infected with herpes simplex virus (HSV). However, according to the CDC, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.
The nurse is caring for a client requesting oral contraceptives who has multiple sexual partners. The nurse recommends condoms to the client, but the client states, "I cannot use condoms because I am allergic to latex." Which response by the nurse is appropriate? "I will let the health care provider know you desire oral contraceptive pills." "You can still use condoms because they make latex-free condoms." "We can have you allergy tested to see if certain condoms may work for you." "Do you understand the potential ramifications of having multiple sexual partners?"
"You can still use condoms because they make latex-free condoms." Because this client has multiple partners, there is concern over the risk for sexually transmitted infections (STIs) as well as pregnancy. Condoms are the only method of contraception that protects against STIs, which is an important concern if the client is not in a monogamous relationship. The nurse would inform the client of latex-free condoms and where to purchase them first. Regardless of whether the client chooses to use latex-free condoms, the client can discuss other options for contraception with the health care provider at that time. There is no need to have the client's allergy tested for latex sensitivity. The nurse should educate the client on risks associated with multiple sexual partners; however, using therapeutic language will be most effective.
A pt is presenting with cervical motion tenderness, adnexal tenderness, and lower abdomen tenderness. Their oral temperature is >101F. What possible medications would you administer to this patient?
- broad-spectrum antibiotics - combo of following meds (for 14 days): > cefotaxime > azithromycin > metronidazole Patient is presenting with Pelvic Inflammatory Disease. Other clinical manifestations: - N/V - dysuria - dysmenorrhea - dyspareunia - elevated sed rate - elevated c-reactive protein - prolonged/ increased menstrual bleeding - WBC on saline vaginal smear
A pt is presenting with painful vesicular lesions and is experiencing a fever and general feelings of malaise. What possible medications would you administer to this patient?
-NO existing cure - Antiviral drug therapy to help with symptoms, shedding, and recurrent episodes - acyclovir - valacyclovir - famiciclovir Other clinical manifestations: - superinfection w/ candida - mucopurulent discharge - genital irritation - lymphadenopathy - chills - inguinal tenderness Recurrent infection epsides - lesion characteristics: > itching, tingling, pain, unilateral
The nurse is providing education on the prevention of sexually transmitted infections (STIs) to clients. The nurse understands which client is at the highest risk of contracting an STI? A 17-year-old client who is in a monogamous relationship with a 25-year-old partner and engages in unprotected sex. A 20-year-old client who reports having protected sexual intercourse with three others, male and female, over the past five years. A 25-year-old client who refused to receive the human papillomavirus vaccine and whose parents both have HIV. A 30-year-old client who consumes alcohol multiple times per week, uses cocaine, and has a history of prostitution.
A 30-year-old client who consumes alcohol multiple times per week, uses cocaine, and has a history of prostitution. The nurse will look for the client with the most risk factors for contracting an STI. The 30-year-old client is at the highest risk due to the use of alcohol and drugs and a history of forced sexual activity (3 risk factors). Other risk factors include age of 24 years or less, multiple partners, unprotected intercourse, and a history of STIs. Although the 17-year-old client is young and having unprotected intercourse, the client is in a monogamous relationship, indicating only 2 risk factors. The 20-year-old client is young and has protected intercourse with multiple partners (2 risk factors). The 25-year-old has no risk factors.
A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms? azithromycin valacyclovir penicillin metronidazole
metronidazole The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, enable the protozoan to proliferate. Trichomoniasis responds well to treatment with metronidazole.
A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client? Record body temperature every night Record menses and time of intercourse Chart body temperature for at least a month Record body weight along with the temperature
Chart body temperature for at least a month The nurse should instruct the client to record her temperature each morning immediately upon awakening (at rest) using the same thermometer. The nurse should also instruct the client to record her menses, any events that would alter her temperature (e.g., infections, insomnia), and when she has intercourse. To maintain a basal body temperature chart, the client has to monitor her basal body temperature for several months. It is not necessary to record body weight along with the temperature.
A nurse is conducting education classes at the local high school on reproductive life planning. Which would be appropriate for the nurse to implement during the teaching? Select all that apply. encouragement of abstinence proper condom application various religious viewpoints sexually transmitted infection statistics nurse's personal opinion on abortion (elective termination of pregnancy)
encouragement of abstinence proper condom application sexually transmitted infection statistics The nurse should talk about all safer sex options, including abstinence and its 100% effectiveness. Within that teaching it is important to educate adolescents on the proper techniques for application of a condom as well as to discuss statistics related to sexually transmitted infections.
Which medications are appropriate to treat chlamydia trachomatis? Select all that apply. azithromycin ofloxacin valacyclovir doxycycline acyclovir
azithromycin ofloxacin doxycycline Chlamydia trachomatis is a bacterial infection and treatable with azithromycin, doxycycline, erythromycin, and ofloxacin antibiotics.
A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection? syphilis gonorrhea human immunodeficiency virus Candida albicans
gonorrhea
A primary care provider tells a client to return 2 to 3 months after treatment to have a repeat culture done to verify the cure. This prescription would be appropriate for a woman with which condition? genital warts genital herpes gonorrhea syphilis
gonorrhea Gonococcal infections can be completely eliminated by drug therapy. Genital warts are not curable and are identified by appearance, not culture. Genital herpes is not curable and is identified by the appearance of the lesions or cytologic studies. The diagnosis of syphilis is done using dark-field microscopy or serologic tests
A nurse is teaching a local community group about STIs. When discussing syphilis, the nurse would identify which stages as being most infectious? Select all that apply. primary secondary tertiary late latent early latent
primary secondary early latent If untreated, syphilis is a lifelong infection progressing in orderly staging. The five stages of syphilis infection are (1) primary, (2) secondary, (3) early latent, (4) late latent, and (5) tertiary. The primary, secondary, and early latent stages are considered the most infectious: the estimated risk of per person transmission is 60%.
A pt is initially presenting with a chancre and bilateral swollen lymph nodes. What possible medications would you administer to this patient?
Antibiotic therapy - Benzathine Penicillin G If allergic to penicillin... - doxycycline - tetracycline - erythromycin Patient is presenting with Syphillis. Clinical manifestations depends of 4 stages: > primary: chancre (painless ulcer) + painless bilateral swollen lymph nodes > secondary: flu-like symptoms, maculopapular rash, weight loss, alopecia, adenopathy, fatigue, pharyngitis, fever > latency: no s/s > tertiary: neurologic + heart disease
A client has been diagnosed with condylomata acuminata and requires treatment for the condition. What would be the treatment of choice? cryotherapy antibiotics topically applied antifungal cream avoidance of sexual contact
cryotherapy The treatment of choice would be cryotherapy because it can penetrate deeper than other forms of therapy to eliminate the lesion. The client would be encouraged to stop sexual contact until the lesions are resolved.
A pregnant client is diagnosed with chlamydia and is to receive antimicrobial therapy. Which drug would the nurse least likely expect to be prescribed? doxycycline erythromycin ofloxacin levofloxacin
doxycycline Doxycycline is categorized as pregnancy category D and thus would be least likely prescribed. Erythromycin, ofloxacin, or levofloxacin would be viable alternatives.
What is the most common early symptom of a sexually transmitted infection? menstrual cramping dysuria vaginal discharge amenorrhea
dysuria Sexually transmitted infections common in adolescents present with dysuria as the common denominator for early symptoms in the majority of STIs. The other symptoms may present but not as an early indicator of a sexually transmitted infection.
Clients who have had PID are prone to which complication? ovarian cancer ectopic pregnancy inguinal lymphadenopathy multiple gestation
ectopic pregnancy
A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client? "An IUD will prevent sexually transmitted infections (STIs)." "The insertion procedure for an IUD is painless." "Checking the strings is recommended following insertion." "Expect to have continuous uterine cramps after insertion."
"Checking the strings is recommended following insertion."
During a health education session, a teenage client asks the nurse when she should have her first "Pap test." How should the nurse reply? "It all depends on your family history of cancer." "When you first start having sex." "As soon as possible and every year thereafter." "When you turn 21 years old."
"When you turn 21 years old." Current guidelines recommend that the woman obtain the initial Papanicolaou test at 21 years of age, regardless of when she first has sexual intercourse.
A client with genital herpes asks the nurse about what to expect with the infection. Which response by the nurse is appropriate? "Once you take the medication prescribed, your infection will be resolved. However, you can become reinfected in the future." "You have to be extremely careful in the future. Even if you do not have symptoms, you could still spread the infection to others." "You can expect future outbreaks during times of illness and stress, each of which will be longer than the first outbreak you experienced." "You need to avoid future pregnancies and consider another form of having children as you would spread this to your unborn child."
"You have to be extremely careful in the future. Even if you do not have symptoms, you could still spread the infection to others."
A pt is presenting with endometritis, mucopurulent vaginal discharge, and dysfunctional uterine bleeding. What possible medications would you administer to this patient?
- Azithromycin (Zithromax) - Doxycycline (Vibramycin) - Levofloxain Olfoxacin (Floxin) Patient is presenting with Chlamydia. Other clinical manifestations: - urethritis - saplingitis - bartholinitis
A client expresses interest in having an intrauterine device (IUD) placed for contraception. Which finding noted in the health history would indicate to the nurse that this would not be an appropriate contraceptive option? Sexually active since 16 Dysmenorrhea G1P0 Bicornuate uterus
Bicornuate uterus The client has an abnormally shaped uterus, which could be a contraindication for the use of an IUD due to increased risk for uterine wall perforation. All other findings would not contraindicate the device.
When conducting a health history with a couple who are experiencing subfertility, the nurse will include which of the following? Select all that apply. General health Medication history Sexual history Surgical history School history
General health Medication history Sexual history Surgical history
Which instruction should be given to a woman newly diagnosed with genital herpes? Obtain a Papanicolaou test every 3 years. Have your partner use a condom when lesions are present. Use a water-soluble lubricant for relief of pruritus. Limit stress and emotional upset as much as possible.
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 nurse is caring for a client positive for human immunodeficiency virus (HIV). The client is on triple-combination highly active antiretroviral therapy (HAART). What should the nurse include in the teaching plan when educating the client about the treatment? Select all that apply. Exposure of fetus to antiretroviral agents is completely safe. Successful antiretroviral therapy may prevent acquired immunodeficiency syndrome (AIDS). Unpleasant side effects such as nausea and diarrhea are common. Provide written materials describing diet, exercise, and medications. Ensure that the client understands the dosing regimen and schedule.
Unpleasant side effects such as nausea and diarrhea are common. Provide written materials describing diet, exercise, and medications. Ensure that the client understands the dosing regimen and schedule. The nurse should ensure that the client understands the dosing regimen and schedule. The client should be informed that unpleasant side effects such as nausea and diarrhea are common. The nurse should provide written material describing diet, exercise, and medications to promote compliance and ensure a healthy lifestyle. There is no evidence to suggest that exposure of the fetus to antiretroviral agents during pregnancy is completely safe in the long run. HIV is a lifelong condition, and antiretroviral therapy may delay the onset of AIDS but not prevent it.
The nurse is caring for clients who have STIs. Which client is most at risk for becoming infertile due to the infection? a woman diagnosed with trichomoniasis a woman diagnosed with chlamydia a woman diagnosed with syphilis a woman diagnosed with herpes simplex virus
a woman diagnosed with chlamydia Chlamydia trachomatis is the bacterium that is the leading cause of preventable infertility in women and the most common STI in the United States. Chlamydia is transmitted during vaginal, anal, or oral sex, leading to infections in the associated tissues of these areas. Lymphogranuloma venereum (LGV) is an STI that results from the three strains of Chlamydia trachomatis.
The nurse at a community drop-in clinic is completing a sexual health history on a 15-year-old female client requesting oral contraceptives. Which factor in the client's history would indicate to the nurse the client may be susceptible for contracting a sexually transmitted infection (STI)? adolescent female admits to sexual activity uses a female condom has a long-term boyfriend
adolescent female Female adolescents are more susceptible to STIs due to their anatomy. During adolescence and young adulthood, women's columnar epithelial cells are especially sensitive to the invasion of sexually transmitted organisms. These cells recede to a more protected location as women age. Sexual activity places the client at risk, but the fact that she is very young is a greater risk factor. A female condom would protect the client from an STI as well as having a long-term boyfriend whom she would know well.
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? an azole antifungal agent a penicillin antibiotic a quinolone antibiotic an antiviral agent
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 woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by: dilating the cervix. acting as a toxin to the trophoblastic tissue. blocking the action of progesterone on the endometrium. causing uterine contractions to expel the uterine contents.
causing uterine contractions to expel the uterine contents. Misoprostol works by causing uterine contractions, which help to expel the uterine contents. It has no effect on cervical dilation. Methotrexate is toxic to the trophoblastic tissue. Mifepristone blocks the action of progesterone, which is responsible for preparing the endometrium for implantation and then maintenance of the pregnancy.
A client is being treated for gonorrhea. Which agent would the nurse expect the primary care provider to prescribe? penicillin tetracycline levofloxacin ceftriaxone
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.
A woman comes into the health clinic complaining of thick, cottage cheese-like vaginal discharge, with white patches on her labia that worsens before her menses. She complains of intense pruritus and dyspareunia. The health care provider would order which preparation for treatment? fluconazole tetracycline clindamycin acyclovir
fluconazole Treatment of candidiasis includes miconazole cream or suppository, clotrimazole tablet or cream, terconazole cream or intravaginal suppository, or fluconazole oral tablet. Most of these medications are used intravaginally in the form of a cream, tablet, or suppositories for 3 to 7 days. If fluconazole is prescribed, a 150-mg oral tablet is taken as a single dose. The other medications would not be appropriate.
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? the possibility of a chlamydia infection an acute stage of the gonorrheal infection a reaction to the gonorrheal medications a positive pregnancy test
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.
A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus? when it is thin, watery, and copious when it is thick Cervical mucus is not a reliable indicator. when it does not stretch
when it is thin, watery, and copious The cervical mucus method relies on the changes that occur naturally with ovulation. Before ovulation, cervical mucus is thick and does not stretch when pulled. With ovulation, the mucus becomes thin, copious, watery, transparent, and stretchy.
A client is using high-dose estrogen oral contraceptives. The nurse would assess the client for which finding? yeast infections loss of appetite hypertension acidity and heartburn
yeast infections The nurse should closely monitor for yeast infections in a client who uses high-dose estrogen oral contraceptives. Hormonal changes when using high-dose estrogen oral contraceptives can change the environment of the vagina and make it conducive to the growth of yeast cells. Use of high-dose estrogen oral contraceptives does not maximize risk for hypertension, acidity, heartburn, or appetite loss.
A nurse is conducting a program about genital herpes infection at a community clinic. The nurse determines that additional discussion is needed when the group identifies which activity as a means of transmission? kissing sexual contact giving vaginal birth sharing contaminated needles
sharing contaminated needles Herpes simplex virus is transmitted primarily by direct contact with an infected individual who is shedding the virus and may include kissing, sexual contact, and vaginal birth. Sharing contaminated needles is a means of transmitting HIV.
The nurse is educating a class of high school students on safe sexual practices. The nurse knows the group understood the content when a group member makes which statement? "A diaphragm can be used by males and females." "A condom is the best way to prevent pregnancy." "Spermicide should be applied immediately following intercourse." "Abstinence is the only way to prevent the spread of sexually transmitted infections."
"Abstinence is the only way to prevent the spread of sexually transmitted infections." The nurse knows the group understood the teaching when a group member states abstinence as the only way to guarantee not spreading a sexually transmitted infection (STI). Diaphragms can only be used by female clients and are placed directly in front of the cervical opening. While condoms are effective ways to decrease the potential of pregnancy and limit the spread of STIs, abstinence is the only way to actually prevent pregnancy and STI contraction. Spermicide should be inserted into the vagina 10 to 15 minutes prior to the client having intercourse, not after.
After teaching a client diagnosed with candidiasis about preventive measures, the nurse determines additional teaching is needed when the client makes which statement? "I will avoid consuming foods and drinks that are fermented with yeast." "It is best to eat yogurt that contains live bacterial cultures." "I can wear any style of pants as long as I wear cotton underwear." "I will promptly remove my wet bathing suit after swimming."
"I can wear any style of pants as long as I wear cotton underwear." The nurse should inform the client to avoid tight pants to prevent the recurrence of candidiasis. Cotton underwear is best; however, pants still need to be loose fitting to prevent excessive warmth. It is recommended to decrease sugar intake to prevent recurrent candidiasis infections. Avoiding white rice and flour, foods and drinks fermented with yeast, and foods high in simple sugars are best. Consuming probiotics, such as in yogurt with live bacteria, can help to balance the body's normal bacterial flora. Female clients should also remove wet clothing as soon as possible to keep the perineal area dry.
A client with genital warts is receiving treatment with a local application of trichloroacetic acid. Which client statement indicates adequate understanding of the procedure? "One or two treatments should get rid of the warts." "I'm temporarily not contagious once the warts are destroyed." "Once the warts are gone, then I know I'm cured." "My partner doesn't need to be treated."
"I'm temporarily not contagious once the warts are destroyed." Genital warts when treated chemically will most likely be eradicated after three to six cycles of treatment. Eradication does not mean the condition is cured; the person is temporarily noncontagious once the warts are destroyed. All sexual contacts of the client need to be examined and treated.
A pt is presenting with vaginal pruritus and vaginal discharge that is green/gray, foamy and has a foul order, what possible medications would be administered to this patient?
- Metronidazole (Flagyl) - Tinadazole Patient is presenting with Trichomoniasis. Other clinical manifestations of Trichomoniasis: - sore/itchy vulva - vaginal pruritus - vaginal/vulvar erythema - foul odor and foamy discharge - petechiae / bleeding on cervix - dyspareunia
A nurse is receiving a client from the postanesthesia unit to the recovery unit at the ambulatory surgery center. The client just had a laparoscopic tubal ligation. Which is the nurse's priority assessment? Pain Depression Bleeding Abdominal bloating
Bleeding The nurse's priority assessment is for bleeding from the surgical sites or vagina, which can be an indication of a possible complication of the procedure. Pain is expected following a surgical procedure and will be a concern for the nurse.
A woman who has had repeated candidal infections asks the nurse about ways to help prevent them. Which response(s) by the nurse would be appropriate? Select all that apply. "Wash your underwear in cold water." "Shower instead of taking baths." "Wash your genital area with antibacterial soap frequently." "Use white, unscented toilet paper." "Avoid wearing exercise pants with spandex."
"Shower instead of taking baths." "Use white, unscented toilet paper." "Avoid wearing exercise pants with spandex." Preventive measures for women with frequent vulvovaginal infections include: washing underwear in hot water; showering instead of taking tub baths; washing the genital area with a mild unscented soap; using white, unscented toilet paper; and avoiding tight pants and exercise clothes that contain spandex.
The nurse is teaching a client about sexually transmitted infections. The nurse determines the teaching was successful when the client makes which statement? "Gonorrhea can be prevented with a vaccine." "Chlamydia remains localized if not treated." "People with trichomoniasis will have burning when they urinate." "Genital ulcers are a sign of genital herpes simplex."
"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 nurse is teaching a woman diagnosed with genital herpes. The nurse will provide additional teaching if the client makes which statement? "Once my lesions go away, they could come back at any time." "I will wear loose-fitting underwear and pants while I am healing." "I can take acetaminophen, ibuprofen, or aspirin to help with my pain." "I should apply warm compresses to my lesions to relieve pain and itching."
"I should apply warm compresses to my lesions to relieve pain and itching." The nurse would provide clarification if the client indicates to apply warm compresses. Cool compresses should be used to avoid increasing irritation of the lesions. The lesions can return at any time after healing takes place. Outbreaks are often brought about by fatigue, genital irritation or injury, menstruation, and stress. It is appropriate for the client to take acetaminophen, ibuprofen, or aspirin to help with the pain. Loose-fitting, cotton garments are recommended to promote airflow to the area.
The clinic nurse is treating a client diagnosed with HIV. Which statement made by the client indicates an understanding of the diagnosis? "Right now I have HIV, but eventually it will develop into AIDS." "I will not spread HIV to others if I have intercourse with them, if I take my medication." "If I do not take my medications as prescribed, my red blood cell count will fall." "If my T-cell count drops below 200 cells/mm3 (0.2 × 109/l), my HIV has progressed to AIDS."
"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 client with primary syphilis is allergic to penicillin. The nurse would expect the primary care provider to prescribe which agent? acyclovir ceftriaxone podophyllum resin doxycycline
doxycycline Clients who are allergic to penicillin are given doxycycline or erythromycin. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.
The nurse is caring for four female clients, all prescribed oral contraceptive pills. The nurse will question giving an oral contraceptive pill to which client? 25-year-old client who has had three miscarriages and leads a sedentary lifestyle 30-year-old client who drinks a glass of wine daily and whose aunt had breast cancer 40-year-old client who has a history of asthma and a total cholesterol level of 170 mg/dl (4.40 mmol/l) 37-year-old client who has migraines with aura several times a week and smokes
37-year-old client who has migraines with aura several times a week and smokes The nurse would question giving an oral contraceptive to the 37-year-old client who has migraines with aura and smokes. This client has three risk factors (age, migraines with aura, and smokes) for complications such as deep vein thrombus formation, myocardial infarction, and cerebrovascular accidents. The 25-year-old client should be counseled on becoming active. The 30-year-old client does not have any risk factors. The 40-year-old client should be monitored due to her age; however, her other factors are not contraindications. A total cholesterol level of 200 mg/dl (5.18 mmol/l) or less is considered normal.
