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Chapter 44. Nursing Care of Patients With Sexually Transmitted Infections Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. During data collection the nurse notes the presence of a chancre on a male patient’s penis. For which sexually transmitted infection should the nurse focus additional data collection? a. Herpes b. Syphilis c. Gonorrhea d. Chlamydia

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2. A patient is diagnosed with a parasitic infection caused by close contact with another person’s genitals. For which infection should the nurse plan care? a. Phthirus pubis b. Treponema pallidum c. Neisseria gonorrhoeae d. Chlamydia trachomatis

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3. It is documented in the medical record that a patient has gummas. For which sexually transmitted infection should the nurse plan care? a. Syphilis b. Gonorrhea c. Chlamydia d. Genital herpes

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4. The nurse is assisting with teaching a 22-year-old female patient who is diagnosed with a sexually transmitted infection (STI). She says, “I don’t understand. My boyfriend always wears a condom.” Which understanding by the nurse should guide teaching in this situation? a. Condoms are a reliable source of protection against STIs. b. It is a myth that condoms provide any protection against STIs. c. Condoms can decrease the risk of STIs, but they are not foolproof. d. Condoms must be used with a spermicide to guarantee protection against STIs.

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5. The nurse is providing care for a patient with genital herpes who has vesicular lesions. What term should the nurse use to describe these lesions to the patient? a. Warts b. Rashes c. Blisters d. Papules

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6. Human papillomavirus (HPV) produces verrucous growths. What term should the nurse use to describe these lesions to the patient? a. Warts b. Rashes c. Blisters d. Papules

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7. The nurse is collecting data on a patient with Chlamydia. Which assessment finding should be reported immediately to the RN or physician? a. Painful urination b. Red conjunctivae

c. Vaginal discharge d. Sharp pain at the base of the ribs ____

8. Because Trichomonas is relatively large, unusually shaped, and diagnosed quickly, the nurse is asked to assist the physician obtain which type of specimen? a. Culture b. Blood test c. Wet mount d. Litmus paper

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9. A patient diagnosed with Trichomonas asks the nurse how the diagnosis will affect her risk for cervical cancer. Which response by the nurse is best? a. “Wet-mount slides should be done yearly to help detect cervical cancer.” b. “Serological testing will be done to detect tumor proteins and screen for cervical cancer.” c. “Papanicolaou smears should be done more frequently because results may be altered by Trichomonas.” d. “Culture and sensitivity testing is done with Papanicolaou (Pap) smears every other year to determine if you have cervical cancer.”

____ 10. A patient asks why the physician has recommended systemic interferon treatment for genital warts. Which explanation should the nurse provide to the patient? a. “Interferon can improve liver function.” b. “Interferons can increase your red blood cell count.” c. “Interferon treatment does not have any side effects.” d. “Interferon therapy can attack warts all over the body at the same time.” ____ 11. A patient with hepatitis B virus (HBV) delivers a 6-pound 2-ounce baby boy. Which action should the nurse anticipate will be needed for the infant? a. Intravenous antibiotics for 12 hours b. Antiviral eye medication less than 2 hours after birth c. There is no treatment that is safe and effective for infants. d. HBV-immune globulin less than 12 hours after birth and then HBV vaccine series ____ 12. The nurse must bathe a patient with herpes. What is the nurse’s best protection against contracting sexually transmitted infections (STIs) from patients while providing perineal hygiene? a. Wearing gloves at all times b. Washing hands following care c. Practicing standard precautions d. Avoiding touching patients who have STIs ____ 13. The nurse is caring for a pregnant woman who is fearful that her unborn child will be born blind because of having a sexually transmitted infection (STI). For which STI should the nurse plan care to prevent ophthalmia neonatorum in the newborn? a. Syphilis b. Gonorrhea c. Genital warts d. Genital herpes ____ 14. The nurse is caring for a young woman who is newly diagnosed with genital warts. She states, “I heard you can get cancer from STIs. Is that true?” Which response by the nurse is correct? a. “No, you cannot get cancer from STIs.” b. “Yes, most STIs can lead to cancerous changes if not treated promptly.” c. “Yes, some STIs have been linked to cancer, so adequate treatment is very important.”

d. “No, that is not true, but a diagnosis of cancer does increase the risk of contracting an STI.” ____ 15. The nurse is identifying ways for a young adult to reduce the risk of contracting a sexually transmitted infection (STI). What should the nurse teach about the relationship between consumption of alcohol and immediate risk of contracting an STI? a. Alcohol may reduce inhibitions. b. Alcohol increases risk for liver disease. c. Alcohol lowers the body’s resistance to infection. d. Alcohol impairs the integrity of the mucous membranes, providing a portal of entry for infection. ____ 16. The nurse reviews the ways to prevent condom breakage with a patient. Which patient statement indicates that more teaching is necessary? a. “Condoms should never be reused.” b. “I should use a water-soluble lubricant.” c. “Before I use a condom, I should inflate it and check it for holes and leaks.” d. “I should make sure to leave a half inch extra space at the end of the condom.” ____ 17. The nurse is assisting with the admission of a known intravenous drug abuser to a medical unit. In addition to drug abuse, which disorder in the patient’s history is most consistent with a diagnosis of hepatitis? a. Jaundice b. Diabetes mellitus c. Bowel obstruction d. Chronic headaches ____ 18. The nurse is teaching a patient the importance of completing treatment for gonorrhea. On which information is the nurse basing this teaching? a. Gonorrhea is not treatable. b. Only men experience symptoms; women are usually asymptomatic. c. Men and women may be asymptomatic and still transmit the infection. d. Treatment is associated with many serious side effects, so compliance is low. ____ 19. The nurse is assisting in the preparation of a teaching seminar for adolescents to prevent the development of a sexually transmitted infection (STI). Which nonsexual activity should the nurse teach that may transmit a sexually transmitted infection (STI)? a. Sharing a cigarette b. Borrowing a hairbrush c. Coughing and sneezing d. Sharing intravenous drug equipment ____ 20. A patient asks for the best way to prevent contracting a sexually transmitted infection (STI). What response should the nurse make to this patient’s question? a. Abstinence b. Oral contraceptives c. Condom with spermicide d. Prophylactic oral antibiotics ____ 21. A patient diagnosed with genital warts asks how they developed. Which pathogen should the nurse explain as causing genital warts? a. Sarcoptes scabiei b. Hepatitis A and B c. Human papillomavirus

d. Chlamydia trachomatis ____ 22. The nurse is caring for a 76-year-old retired man who is undergoing evaluation for dementia. What would be an important part of the man’s history to report to the physician? a. The patient has a history of syphilis. b. The patient was exposed to Chlamydia. c. The patient has a history of hepatitis B. d. The patient has a history of genital warts. ____ 23. A patient is undergoing treatment that involves the burning of lesions with heat or chemical agents. The nurse recognizes that this patient most likely has which condition? a. Syphilis b. Chlamydia c. Hepatitis B d. Genital warts ____ 24. The nurse is providing care for a newborn. Which intervention should the nurse make to prevent development of ophthalmia neonatorum? a. Interferon injection b. Antibiotic eyedrops c. Vitamin K injection d. Hepatitis B virus (HBV)-immune globulin ____ 25. While reviewing a medical record the nurse notes that patient has a “strawberry” cervix. For which sexually transmitted infection (STI) would the nurse plan care? a. Gonorrhea b. Herpes simplex c. Trichomoniasis d. Human papillomavirus infection ____ 26. The nurse is preparing a poster presentation identifying the frequency of sexually transmitted infections (STIs) in the United States. Which STI should the nurse highlight as being the most commonly diagnosed? a. Gonorrhea b. Chlamydia c. Trichomoniasis d. Human papillomavirus ____ 27. While assisting a health care provider (HCP) conduct a pelvic examination, the patient complains of severe pain during the bimanual examination. For which health problem should the nurse suspect this patient is going to need care? a. Syphilis b. Gonorrhea c. Pelvic inflammatory disease d. Human papillomavirus infection ____ 28. While assisting with care, the nurse counsels the patient diagnosed with a sexually transmitted infection (STI) about notification of sexual partners. Which patient statement indicates the need for further teaching? (Select all that apply.) a. “I can contact my sexual partners myself.” b. “Reporting regulations are the same throughout the country.” c. “A report form will be completed in my chart that includes a list of my sexual contacts.” d. “The public health authority can notify a list of sexual contacts without including my identity.”

Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 29. The nurse is assisting with teaching a patient who has been exposed to hepatitis B. Which symptoms should the nurse explain may occur before jaundice appears? (Select all that apply.) a. Rash b. Nausea c. Confusion d. Dark-colored urine e. Muscle or joint pain f. Elevated blood glucose ____ 30. The nurse is reviewing prescribed laboratory tests for a patient demonstrating manifestations of syphilis. What diagnostic tests should the nurse expect to be prescribed for this patient? (Select all that apply.) a. RPR b. NAT c. VDRL d. ELISA e. Culture f. CD4 counts ____ 31. A 24-year-old woman diagnosed with Chlamydia has been prescribed doxycycline. What should be included in the nurse’s teaching about the drug treatment? (Select all that apply.) a. “Take this drug with a meal.” b. “Do not take with dairy products.” c. “Avoid unnecessary exposure to sunlight.” d. “Abstain from alcohol for at least 48 hours after treatment.” e. “Use birth control methods to ensure you do not become pregnant.” ____ 32. The nurse is teaching a patient about the use of condoms to prevent sexually transmitted infections (STIs). Which information should the nurse include in this teaching? Select all that apply. a. Condoms can decrease the risk of transmitting STDs. b. Latex condoms are less likely to break than other types. c. Inflating the condom prior to use allows for effective inspection. d. Condoms should be used no more than twice and then discarded properly. e. Use of a water-soluble lubricant with a condom increases its effectiveness in preventing the spread of an STD. f. Use of a petroleum-based lubricant with a condom increases its effectiveness in preventing the spread of an STD. ____ 33. The nurse is providing care for a patient recently diagnosed with Chlamydia. Which information should the nurse recommend be included in patient teaching? (Select all that apply.) a. “Women with Chlamydia may complain of a sore throat.” b. “Chlamydia is characterized by the development of chancres.” c. “Ophthalmia neonatorum is seen in infants born to women with Chlamydia.” d. “Chlamydia can be transmitted sexually and by blood and body fluid contact.” e. “The risk of ectopic pregnancy is increased in women with a history of Chlamydia.” f. “The Chlamydia virus can lie dormant in the nervous system tissues and reactivate when an individual is under stress or has a compromised immune system.”

____ 34. The nurse notes that a patient is diagnosed with vulvovaginitis. What should the nurse expect when assessing this patient? (Select all that apply.) a. Vaginal edema b. Vaginal discharge c. Areas of ecchymosis d. Dark brown vaginal bleeding e. Complaints of vaginal itching and burning ____ 35. A patient in labor is diagnosed with mucopurulent cervicitis. For which health problems should the nurse anticipate providing care to the newborn? (Select all that apply.) a. Pneumonia b. Conjunctivitis c. Irregular heart rate d. Flaccid extremities e. Cyanotic extremities ____ 36. A patient diagnosed with syphilis reminds the HCP of having an allergy to penicillin. Which medications should the nurse expect to be prescribed for this patient? (Select all that apply.) a. Gentamicin b. Amoxicillin c. Tetracycline d. Doxycycline e. Erythromycin ____ 37. While providing a bath the nurse suspects that an older female patient has a Trichomonas infection. What type of discharge did the nurse observe to come to this conclusion? (Select all that apply.) a. Frothy discharge b. Foul-smelling discharge c. Yellow-green discharge d. Open sores on the labia majora e. Wart-like growths on the labia minora

Chapter 44. Nursing Care of Patients With Sexually Transmitted Infections Answer Section MULTIPLE CHOICE 1. ANS: B The primary stage of syphilis begins with the entry of the Treponema pallidum spirochete through the skin or mucous membranes. Between 3 and 90 days later, a papule develops at the site of entry, then sloughs off, leaving a painless, red, ulcerated area called a chancre. A. Herpes is associated with vesicular skin lesions. C. D. Gonorrhea and Chlamydia are not associated with skin lesions. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application 2. ANS: A Genital parasites are not a true sexually transmitted infection (STI), but they may be transmitted during close body contact. The two most commonly seen parasites are pubic lice (Phthirus pubis, commonly called “crabs” because of the shape of the lice) and scabies (Sarcoptes scabiei). B. C. D. Treponema pallidum, Neisseria gonorrhoeae, and Chlamydia trachomatis are not parasites. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application 3. ANS: A In the tertiary stage of syphilis, the spirochete may form gummas, which are tumors of a rubbery consistency that can break down and ulcerate, leaving holes in body tissues. D. Herpes is associated with vesicular skin lesions. B. C. Gonorrhea and Chlamydia are not associated with skin lesions. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application 4. ANS: C Condoms can greatly decrease the risk of STIs, but condoms can have tiny channels in the rubber (or other elastic material) that can allow microorganisms to pass through. Condoms can break, slip off, or be applied improperly. Petroleum-based lubricants may weaken latex condoms. A. Condoms do not provide a barrier for any area other than the penis and most of the vagina (or anus). B. Some STIs may still be transmitted by contact of surrounding uncovered tissues. D. Spermicide helps protect against pregnancy. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 5. ANS: C Vesicles are small blisters. A. B. D. Warts, rashes, and papules do not have the same characteristics. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 6. ANS: A Verrucous means “wart-like.” B. D. D. HPV causes wart-like growths, not rashes, blisters, or papules. PTS: 1

DIF: Moderate

KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 7. ANS: D Fitz-Hugh–Curtis syndrome, a surface inflammation of the liver, can also be caused by C. trachomatis. This inflammation may cause nausea, vomiting, and sharp pain at the base of the ribs that sometimes refers to the right shoulder and arm. A. B. C. Vaginal discharge, painful urination, and conjunctivitis are also concerns but are not as health-threatening as liver inflammation. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Analysis | 8. ANS: C When wet-mount slides of Trichomonas discharge are viewed under a microscope, the organisms can be identified by their motility and whip-like flagella. A. B. D. Trichomonas is not diagnosed through a culture, blood test, or litmus paper. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 9. ANS: C Trichomonas may produce abnormal Pap smear readings, which require that more frequent Pap smears be done to provide adequate surveillance of cellular changes. A. Wet mount can identify the organism but not cellular changes. B. D. Serological testing and culture and sensitivity testing are not performed to detect cervical changes caused by Trichomonas. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 10. ANS: D Systemic interferon treatments attack warts all over the body at the same time, rather than individually as with topical treatments. This speeds the process of treatment. A. B. C. Interferons can produce side effects of flulike symptoms, a drop in the number of white blood cells, and changes in liver function. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Pharmacological and Parenteral Therapies | Cognitive Level: Application 11. ANS: D It is recommended that all babies of HBV-positive mothers receive HBV immune globulin less than 12 hours after birth and then be immunized with HBV vaccine 1 week, 1 month, and 6 months after birth. A. Antibiotics are not effective against viruses. B. Eye medication may be necessary for gonorrhea or chlamydia. C. The infant needs to receive the HBV vaccination. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 12. ANS: C A nurse’s best protection against catching infections from blood and body fluids of infected patients is the strict practice of standard precautions and maintaining his or her own healthy, intact skin. A. Wearing gloves at all times is not appropriate. B. Washing hands is essential but is not sufficient. D. Touching patients cannot and should not be avoided. PTS: 1 DIF: Moderate KEY: Client Need: Safe and Effective Care Environment—Safety and Infection Control | Cognitive Level: Application 13. ANS: B

Newborns born to mothers who have gonorrhea can develop ophthalmia neonatorum, which involves inflammation of the conjunctiva and deeper parts of the eye and can, ultimately, result in blindness. A. C. D. Syphilis, genital warts, and genital herpes are not associated with infant eye problems. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 14. ANS: C Herpes, human papillomavirus (HPV), and hepatitis (not most sexually transmitted infections [STIs]) have been associated with cancers. A. Cancer has been associated with some STIs. B Most STIs do not cause cancer. D. Having a diagnosis of cancer does not increase the risk of contracting an STI. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 15. ANS: A Consumption of alcohol or other psychoactive drugs can reduce inhibitions and may result in unintended sexual encounters, which can transmit STIs. B. C. D. Alcohol does cause liver disease and may indirectly reduce resistance, but these are not the mechanisms by which immediate STI risk increases. PTS: 1 DIF: Moderate KEY: Client Need: Physiological Integrity—Reduction of Risk Potential | Cognitive Level: Application 16. ANS: C Condoms should never be inflated to test th...