Ch. 55 STIs Flashcards
(15 cards)
A young man seeks care at the health clinic because he has developed a profuse, purulent urethral discharge with painful urination. During assessment of the patient, what is it most important that the nurse gather information about?
a.
Recent sexual contacts
b.
A history of previous similar symptoms
c.
All of his sexual contacts within the past year
d.
A history of bladder infections or mumps affecting the testicles
ANS: A
The patient’s symptoms indicate gonorrhea. All sexual contacts of patients with gonorrhea must be examined and treated to prevent re-infection after resumption of sexual relations. The “ping-pong” effect of re-exposure, treatment, and reinfection can cease only when infected partners are treated simultaneously.
During the nursing assessment of a 23-year-old female patient, the nurse considers the patient’s risk for sexually transmitted infections (STIs). Which of the following findings indicates a need for patient teaching?
a.
Has a stable, monogamous relationship with her boyfriend
b.
Has never been tested for syphilis or Chlamydia
c.
Has annual pelvic examinations with Pap smears
d.
Has multiple sex partners but uses oral contraceptives
ANS: D
The patient’s statement indicates that she may have multiple partners, a risk factor for STIs. Oral contraceptives do not protect against STIs.
A patient with gonorrhea is treated with a single intramuscular dose of ceftriaxone (Rocephin) and is given a prescription for doxycycline (Vibramycin) 100 mg twice daily for 7 days. What should the nurse explain to the patient about this combination of antibiotics?
a.
They are prescribed to treat any coexisting chlamydial infection.
b.
They will eradicate resistant strains of Neisseria gonorrhoeae.
c.
They prevent the development of resistant organisms.
d.
They prevent reinfection in addition to treating the original infection.
ANS: A
Given that the incidence of concurrent infection with gonorrhea and chlamydia is high, patients are usually treated for both.
A patient who has undergone laboratory tests for an insurance screening has a positive Venereal Disease Research Laboratory test. What is the nurse’s first action?
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 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 after successful treatment, so the nurse should inquire about previous treatment before doing other assessments or testing.
A Gram-stained smear of a patient’s urethral discharge reveals the presence of N. gonorrhoeae. The patient tells the nurse that he had sexual contact with a new girlfriend but does not think he was exposed to gonorrhea because she did not appear to have any infection. In responding to the patient, what should the nurse explain?
a.
Women develop subclinical cases of gonorrhea that do not cause tissue damage or symptoms.
b.
Women do not develop gonorrhea infections but can serve as carriers to spread the infection to males.
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 infection affects only the ovaries and not the other genital organs.
ANS: C
Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked.
A patient with secondary syphilis has a rash on her palms and the soles of her feet and moist papules in the anal and vulvar area. While caring for the patient, what is it important for the nurse to do?
a.
Wear gloves when touching the patient.
b.
Wash the perianal area with an antiseptic solution.
c.
Place the patient in a private room for protective isolation.
d.
Assess the patient for the presence of gummas in the skin and soft tissue.
ANS: A
Exudate from any lesions with syphilis is highly contagious; therefore, gloves should be worn.
Primary genital herpes is diagnosed in a patient seeking care for lesions on her vulva and perineum. After the nurse teaches the patient about management of the disease, which statement by the patient indicates that the teaching has been effective?
a.
“I will take the acyclovir (Zovirax) every 8 hours for the next week.”
b.
“I will use condoms for intercourse until the medication is all gone.”
c.
“I will use the acyclovir ointment on the area to relieve the pain.”
d.
“I will need to take all of the medication to be sure the infection is cured.”
ANS: A
The treatment regimen for primary genital herpes infections includes acyclovir 400 mg three times daily for 7 to 10 days.
The nurse should inform women who have a history of STIs that the risk of infertility or ectopic pregnancies is highest following infection by which of the following STIs? a. Treponema pallidum b. N. gonorrhoeae c. Condylomata acuminata d. Herpes simplex virus type 2 (HSV-2)
ANS: B
Complications of gonorrhea include scarring of the fallopian tubes, which can lead to tubal pregnancies and infertility.
A woman who is 20 weeks pregnant is diagnosed with primary syphilis. She tells the nurse that she is very worried about the effect of the infection on the baby. What is the most appropriate response to the patient’s concern?
a.
“Syphilis will not affect the baby in any way because the microorganism does not cross the placental barrier.”
b.
“Instillation of erythromycin into the eyes of the newborn will prevent any problems of transmission to the baby.”
c.
“A single intramuscular injection of penicillin at this point in your pregnancy will cure both you and the fetus of syphilis.”
d.
“If you have active genital lesions at the time you begin labour, a Caesarean delivery will be performed to prevent transmission to the baby.”
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.
Which of the following is the recommended therapy for treatment of small external genital warts? a. Penicillin b. Podophyllin resin c. Cryotherapy d. Aluminum salts
ANS: B Podophyllin resin (10% to 25%), a cytotoxic agent, is recommended therapy for small external genital warts.
A patient returns to the clinic for follow-up after treatment for nongonococcal urethritis. Direct fluorescent antibody tests are positive for chlamydia. What should the nurse recognize is the most likely cause of the continued infection?
a.
The microorganisms developed resistance to the antibiotic.
b.
The patient did not take the full course of antibiotics as directed.
c.
The patient did not advise his sexual partners of the need for treatment.
d.
The patient failed to wash his hands and perform basic hygiene measures.
ANS: C
A common reason for recurrence of symptoms is reinfection because infected partners have not been simultaneously treated.
Which virus is responsible for genital warts? a. Cytomegalovirus b. HSV c. Human immunodeficiency virus d. Human papillomavirus (HPV)
ANS: D
HPV is the virus that causes genital warts.
The incidence of syphilis has steadily increased in Canada since 1999. Which of the following groups would be at highest risk of contracting syphilis? a. Men having sex with men b. Married men having casual affairs c. Women having sex with women d. University students
ANS: A
Infectious syphilis rates are highest among men having sex with men, among sex trade workers, and in situations in which sex is exchanged for food, shelter, or protection.
Which of the following is the most appropriate question for the nurse to ask when obtaining a detailed and accurate sexual history?
a.
“Are you a homosexual?”
b.
“Do you only have sex with those of the opposite sex?”
c.
“Do you have sex with men or women or both?”
d.
“Have you ever had anal sex?”
ANS: C
The most appropriate question to ask is whether the patient has had sex with men or women or both; this question is nonjudgemental and is not value-laden.
Cervarix, an HPV vaccine, is recommended for which of the following populations? a. Females before sexual intercourse b. Males and females between the ages of 9 and 26 c. Females between the ages of 13 and 20 d. Any sexually active female
ANS: B
Cervarix is recommended for administration to females and males between the ages of 9 and
