STIs chapter 71 infectious diseases
Ectopic pregnancy Explanation: All patients who have had PID need to be informed of the signs and symptoms of ectopic pregnancy because they are prone to this complication. Other complications include bacteriemia with septic shock and thrombophlebitis with possible embolization. Patients who have PID are not prone to inguinal lymphadenopathy
Patients who have had pelvic inflammatory disease (PID) are prone to which of the following complications?
Penicilin G benzathine Explanation: a single dose of PEnicilin G benzathine IM injection is the medication of choice for early syphilis or early latent syphilis of less than 1 year duration. Those allergic to penicillin are usually treated with doxycycline or tetracycline. Not Rocephin.
Which of the following is the medication of choice for early syphilis?
A painless genital ulcer that appeared about 3 weeks after unprotected sex. Explanation: a painless genital ulcer is a symptom of primary syphilis, as is patchy hair loss.
A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?
Syphilis Explanation: Syphilis is manifested by a painless chancre lesion. Psoriasis is exhibited by plaques with scales. Kaposi's sarcomas are cutaneous lesions blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions. pg.2107
Painless chancre lesions are associated with which systemic disease?
"Colonization becomes infection when the host and organism interact." Explanation: The term colonization is used to describe microorganisms present without host interference or interaction. Infection indicates a host interaction with an organism. Organisms reported in microbiology test results often reflect colonization rather than infection. Clinical evidence of redness, heat, and pain and laboratory evidence of white blood cells on the wound specimen smear suggest infection. In this situation, the host identifies the staphylococci as foreign. Infection is recognized by the host reaction (manifested by signs and symptoms) and by laboratory-based evidence of white blood cell reaction and microbiologic organism identification. Colonization does not require treatment with antibiotics because the host has not experienced physiological consequences from the presence of colonization. Infection may require treatment with antibiotics due to the severity of the host reaction.
The nurse educator, who is teaching a class on sexually transmitted infections, recognizes that teaching has been effective when students indicate which statement is true about the difference between colonization and infection?
"I'll wear occlusive underwear to prevent transmission of the virus." Explanation: The client should wear loose, cotton underwear to promote cleanliness and dryness in the genital area. Sitz baths can promote cleanliness and decrease inflammation in the area. A hair dryer, set on a cool setting, can be used to carefully dry the lesions in the perineal area. Drinking plenty of fluids is advised to decrease dysuria, which accompanies genital herpes
The nurse has been teaching a client with genital herpes how to care for the lesions. Which of the following statements by the client indicates that she needs additional instruction?
Impaired Skin Integrity Explanation: The priority nursing diagnosis focuses on the Impaired Skin Integrity. Interventions would include nursing instruction on the care of the skin to prevent further infection to self and others. The nurse would also focus on the management of the disease. Because this is a reoccurrence, Knowledge Deficit is not a priority. Psychosocial nursing diagnoses are not a priority at this time unless other data suggests. pg.1653
The nurse is caring for a client with genital herpes experiencing a reoccurrence. Which nursing diagnosis would be the priority?
Genital herpes Explanation: Chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes is not. pg.1653
The nurse is presenting a community lecture about STIs. She emphasizes that some STIs are easily cured with early and adequate treatment. Which of the following is not among these easily treated diseases
Chlamydia trachomatis infection Explanation: Chlamydia is a common sexually transmitted disease (STD) requiring the treatment of all current sexual partners to prevent reinfection. Bartholinitis results from obstruction of a duct. Candidiasis is a yeast infection that commonly occurs as a result of antibiotic use. Sexual partners may become infected, although men can usually be treated with over-the-counter products. Endometriosis occurs when endometrial cells are seeded throughout the pelvis and isn't an STD.
Which condition of generally requires the identification and treatment of sexual partners?
Metronidazole (Flagyl) Explanation: The most effective treatment for trichomoniasis is metronidazole and tinidazole. Penicillin G benzathine is used for syphilis. Doxycycline and azithromycin are used in the treatment of Chlamydia.
Which of the following is the most effective treatment for trichomoniasis?
Syphilis Explanation: The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDs. Genital herpes, hepatitis B, veneral warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law. pg.2107
An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported?
IV penicillin G—single dose Explanation: A single dose of parenterally administered penicillin G (Pfizerpen, Wycillin) is used to treat primary and secondary syphilis. pg.2107
Max Thornton, a 24-year-old chef, is being seen by a physician at the urology group where you practice nursing. He has developed a painless ulcer on his penis and is rather concerned about his health. The urologist will be communicating his diagnosis of syphilis and prescribing treatment. What would you expect the physician prescribe as treatment?
Acyclovir Explanation: Acyclovir is an antiviral and is prescribed for herpes. Penicillin G may be used to treat syphilis and gonorrhea. Erythromycin may be used to treat syphilis, gonorrhea, chlamydia, chancroid, lymphogranuloma venereum, and prophylactically to prevent eye infections in newborns. Ceftriaxone is used to treat gonorrhea. pg.1653
Mr. Jones, a client in your clinic, has been diagnosed with gonorrhea. The physician is selecting a drug to prescribe for him. Which of the following would not be prescribed?
Syphilis Explanation: Syphilis is manifested by a painless chancre or ulcerated lesion. Psoriasis is exhibited by plaques with scales. Kaposi's sarcoma are cutaneous lesions blue-red or dark brown in color. Urticaria is wheals or hives due to infection or allergic reactions. pg.2107
Painless chancre or ulcerated lesions are associated with which systemic disease?
"Wash your hands thoroughly to avoid transferring the infection to your eyes." Explanation: Adults and children with gonorrhea may develop gonococcal conjunctivitis by touching the eyes with contaminated hands. The client should avoid sexual intercourse until treatment is completed, and a follow-up culture confirms that the infection has been eradicated (which usually takes 4 to 7 days). A client who doesn't refrain from intercourse before treatment is completed should use a condom in addition to informing sex partners of the client's health status and instructing them to wash well after intercourse. Meningitis and widespread CNS damage are potential complications of untreated syphilis, not gonorrhea. pg.2108
A client is diagnosed with gonorrhea. When teaching the client about this disease, the nurse should include which instruction?
Direct identification in a specimen from the chancre sore Explanation: The conclusive diagnosis of syphilis can be made by direct identification of the spirochete obtained from the chanter lesions of primary syphilis. Serologic tests such as VDRL, RPR-CT, and FTA-ABS are used in the diagnosis of secondary and tertiary syphilis.
A client with suspected primary syphilis is to undergo diagnostic testing. Which of the following would the nurse expect to be done to confirm this diagnosis?
2 Explanation: The dosage ordered is one-half the amount of the drug supplied. Therefore, the nurse would give 2 mL. To calculate the amount, set up a proportion: 2.4/4 = 1.2/x; cross multiply and solve for x, which is 2. pg.2107
A client with syphilis is to receive penicillin G benazathine 1.2 million units IM as a single dose. The pharmacy supplies the medication, which is labeled as 2.4 million units/4 mL. How many milliliters would the nurse administer? Enter the number ONLY.
Human papilloma virus Explanation: Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid. pg.1647
A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata?
Foul-smelling discharge from the penis Explanation: Symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are symptoms of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red
A nurse is assessing a male client diagnosed with gonorrhea. Which symptom most likely prompted the client to seek medical attention?
Educate the client about why it's important to inform sexual contacts so they can receive treatment. Explanation: the nurse should educate the client about the disease and how it impacts a person's health. Further education allows the client to make informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits. pg.2108
A nurse is caring for a client diagnosed with chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, "This is my business and I'm not telling anyone. Beside, chlamydia doesn't cause any harm like the other STDs." How should the nurse proceed?
Burning on urination Explanation: Burning on urination may be a symptom of gonorrhea or urinary tract infection. A dry, hacking cough is a sign of a respiratory infection, not gonorrhea. A diffuse rash may indicate secondary stage syphilis. A painless chancre is the hallmark of primary syphilis. It appears wherever the organisms enter the body, such as on the genitalia, anus, or lips.
A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea?
"Many people infected with gonorrhea are infected with chlamydia as well. "Explanation: Treatment for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin (Zithromax) is also ordered. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure. pg.2109
A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond?
"Many people infected with gonorrhea are infected with chlamydia as well." Explanation: Treatment for gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin (Zithromax) is also ordered. There has been an increase in the number of resistant strains of gonorrhea, but that isn't the reason for this dual therapy. This combination of antibiotics doesn't reduce the risk of reinfection or provide a faster cure.
A nurse is caring for a male client with gonorrhea who's receiving ceftriaxone (Rocephin) and doxycycline (Vibramycin). The client asks the nurse why he's receiving two antibiotics. How should the nurse respond?
wear a condom every time he has intercourse. Explanation: Wearing a condom during intercourse considerably reduces the risk of contracting STDs. Asking all potential sexual partners if they have an STD; considering intercourse safe if his partner has no visible discharge, lesions, or rashes; and expecting to limit the number of sexual partners won't reduce the risk of contracting an STD to the extent wearing a condom will. A monogamous relationship also reduces the risk of contracting STDs. pg.2106
A nurse is caring for a male client with gonorrhea. The client asks how he can reduce his risk of contracting another sexually transmitted disease (STD). The nurse should instruct the client to:
A client who complains of genital pruritus and paresthesia Explanation: Pruritus and paresthesia as well as redness of the genital area are prodromal symptoms of recurrent herpes infection. These symptoms occur 30 minutes to 48 hours before the lesions appear. Headache and fever are symptoms of viremia associated with the primary infection. Vaginal and urethral discharge is also a local sign of primary infection. Dysuria and lymphadenopathy are local symptoms of primary infection that may also occur with recurrent infection.
A nurse is caring for the following clients who have a history of genital herpes infection. Which client is most at risk for an outbreak of genital herpes?
Acute pain related to the development of the genital lesions Explanation: Although deficient knowledge, ineffective coping, and hyperthermia are possible nursing diagnoses, the priority would be acute pain because the initial infection is usually very painful and lasts about 1 week. pg.2109
A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority?
the importance of informing his partners of the disease. Explanation: 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. pg.2109
A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:
Chlamydia Explanation: Co-infection with chlamydia often occurs in clients infected with gonorrhea. Therefore, the nurse would expect the client to receive treatment for both of these diseases. Human immunodeficiency virus, syphilis, and herpes simplex are not commonly associated with gonorrhea. pg.2108
The nurse is providing care to a client who has been diagnosed with gonorrhea. The nurse also prepares the client for treatment of which of the following?
Consistently uses condoms with sexual activity Explanation: Consistent use of condoms for sexual activity indicates that the client has knowledge of the disorder and its transmission, thereby taking steps to reduce the risk of transmission. This action supports achievement of the outcome. Sexual activity even when lesions are not present can still lead to transmission of the infection. Lesions should be cleaned with mild soap and water and patted dry; occlusive ointments, powders, or dressings should be avoided because they do not allow the lesions to dry. pg.2106
The following outcome appears on the plan of care for a client with genital herpes: "Client demonstrates knowledge about measures to reduce the risk of transmission and recurrences." Which of the following, if reported by the client, would support achievement of this outcome?
Opportunistic Explanation: An opportunistic or superinfection occurs among immunocompromised hosts. Examples would be yeast infections in the mouth, bladder infections, gastroenteritis, and Pneumocystis carinii. An acute infection has a sudden onset with serious and sometimes life-threatening manifestations. A chronic infection is an extended infection that resists treatment. A secondary infection is a complication of some other disease process that occurred first. pg.2109
The nurse is caring for a client who has acquired immunodeficiency disease (AIDS) and has developed oral thrush. What type of infection is the nurse aware that has developed due to the immunocompromised state of the client?
Many people are asymptomatic and show no symptoms contributing to the spread of the disease. Explanation: The nurse is most correct to place information regarding prevention of sexually transmitted diseases in bold letters. The information that many people are asymptomatic and show no symptoms is an important point to stress. Common age-groups are an interesting fact. Repercussions of the disease are also important to highlight; however, prevention is most important. pg.1652
The nurse is completing a community education via a pamphlet on sexually transmitted diseases. Which key point would the nurse place in bold letters?
With proper treatment, the disease can eventually be cured. Explanation: For a client with syphilis, proper treatment will improve the symptoms of skin lesions and other sequelae of infection, with serology eventually reflecting a cure. Typically, early syphilis or early latent syphilis is treated with a one-time intramuscular dose of penicillin G benzathine; three injections at one week intervals are used for clients with late latent or latent syphilis of unknown duration. Condoms significantly reduce the risk of transmission of syphilis and other sexually transmitted infections. Sexual contact is avoided until previous or current partners have been treated.
When developing a teaching plan for a client with syphilis, which of the following would be most important to include?
With proper treatment, the disease can eventually be cured. Explanation: For a client with syphillis, proper treatment will improve the symptoms of skin lesions and other sequelae of infection, with serology eventually reflecting a cure. Typically, early syphilis or early latent syphilis is treated with a one-time intramuscular dose of penicillin G benzathine; three injections at one week intervals are used for clients with late latent or laten syphilis of unknown duration. Condoms significantly reduce the risk of transmission of syphilis and other sexually transmitted infections. Sexual contact is avoided until previous or current partners have been treated. pg.2107
When developing a teaching plan for a client with syphillis, which of the following would be most important to include?
Culture Explanation: The gold standard for HSV diagnosis is a culture of the lesion. Serology may help determine new versus chronic infection when obtained concurrently with positive culture of the lesion. The other diagnostics may be used for diagnosis of skin disorders, but would not be used for HSV
Which of the following is the gold standard for herpes simplex virus (HSV) diagnosis?
Human papillomavirus (HPV) Explanation: HPV infection is the most common STI among young, sexually active people. Millions of Americans are infected with HPV, many unaware that they carry the virus.
Which of the following is the most common sexually transmitted infection (STI) among young, sexually active people?
10 years Explanation: HIV is transmitted through sexual, percutaneous, or perinatal contact. The incubation period for HIV infection is greater than 3 to 6 months. The incubation period for HIV infection is greater than 1 year. The incubation period for HIV infection is greater than 5 years. The median incubation period for AIDS infection is 10 years. pg.2086
Which of the following is the usual incubation period (infection to first symptom) for AIDS?
Acyclovir (Zovirax) Explanation: The antiviral agents acyclovir (Zovirax), valacyclovir (Valtrex), and famciclovir (Famvir) are recommended to suppress the viral load and decreases recurrence and shedding. Flagyl and Cleocin are not used for this action.
Which of the following medications are used to suppress viral load of the HSV-2 infection?
You must inform all sexual partners. Explanation: The spread of the infection could quickly multiple if the client's sexual partners are infected and continue to spread the virus to others; thus, it is most important to emphasize that all sexual partners must be informed. All of the other options are correct but not most important. pg.1653
Which of the following nursing instructions is most important for the nurse to emphasize to the client with a new HSV-2 diagnosis?
Untreated genital warts may resolve on their own, remain unchanged, or increase in size or number. Explanation: Untreated genital warts do not lead to AIDS. Untreated genital warts may resolve on their own, remain unchanged, or increase in size or number. They may lead to cervical or other pelvic reproductive types of cancer. pg.1652
Which of the following statements holds true for a client with untreated genital warts? Choose the correct option.
Latency Explanation: Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. A period of latency occurs when the infected person has no signs or symptoms of syphilis. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.
Which stage or period of syphilis occurs when the infected person has no signs or symptoms of syphilis?
"I need to treat this infection so it doesn't spread into my pelvis because I want to have children someday." Explanation: Chlamydia is a common cause of pelvic inflammatory disease and infertility. It doesn't affect the kidneys or cause birth defects. It can cause conjunctivitis and respiratory infection in neonates exposed to infected cervicovaginal secretions during delivery. Use of a diaphragm isn't a risk factor.
Which statement made by a client with a chlamydial infection indicates understanding of the potential complications?
Herpes infection Explanation: The nurse is most accurate to highlight the herpes infection as the virus can remain dormant in the ganglia of the nerves. Symptoms are usually more severe with the initial outbreak. Subsequent episodes are usually shorter and less intense. The other infections are important to note in the history. pg.1653
Which type of sexually transmitted disease is the nurse most accurate to highlight in the client's history as it remains dormant in the body and can reoccur at any time?
"All parts of the chain of infection have to be present for the disease to be passed to another human." Explanation: All components in the chain of infection must be present for an infectious disease to be transmitted from one human or animal to a susceptible host. This makes options A, B, and C incorrect. pg.2085
You are a school nurse teaching a health class about the chain of infection in the transmission of sexually transmitted diseases (STDs). A student asks you which part of the chain of infection can be missing when transmission occurs. What would be your best answer?
