Chapter 52 Sexually Transmitted Infections PDF

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TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

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Chapter52:SexuallyTransmittedInfections TestBank MULTIPLECHOICE 1.A32-year-oldmanwhohasaprofuse,purulenturethraldischargewithpainfulurinationisseenattheclinic Whichinformationwillbemostimportantforthenursetoobtain? a.

Contraceptiveuse

b.

Sexualorientation

c.

Immunizationhistory

d.

Recentsexualcontacts

ANS:D Informationaboutsexualcontactsisneededtohelpestablishwhetherthepatienthasbeenexposedtoa sexuallytransmittedinfection(STI)andbecausesexualcontactsalsowillneedtreatment.Theother informationalsomaybegatheredbutisnotasimportantindeterminingtheplanofcareforthepatientscurrent symptoms. DIF:CognitiveLevel:Apply(application)REF:1238 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 2.A20-year-oldwomanwhoisbeingseeninthefamilymedicineclinicforanannualphysicalexamreports beingsexuallyactive.Thenursewillplantoteachthepatientabout a.

testingforChlamydiainfection.

b.

immunizationforherpessimplex.

c.

infertilityassociatedwiththehumanpapillomavirus(HPV).

d.

therelationshipbetweentheherpesvirusandcervicalcancer.

ANS:A TestingforChlamydiaisrecommendedforallsexuallyactivefemalesunderage25bytheCentersforDisease ControlandPrevention.HPVinfectiondoesnotcauseinfertility.Thereisnovaccineavailableforherpes simplex,andherpessimplexinfectiondoesnotcausecervicalcancer. DIF:CognitiveLevel:Apply(application)REF:1233 TOP:NursingProcess:PlanningMSC:NCLEX:HealthPromotionandMaintenance 3.A22-year-oldpatientwithgonorrheaistreatedwithasingleIMdoseofceftriaxone(Rocephin)andisgiven aprescriptionfordoxycycline(Vibramycin)100mgbidfor7days.Thenurseexplainstothepatientthatthis combinationofantibioticsisprescribedto

TestBank-Medical-SurgicalNursing:AssessmentandManagementofClinicalProblems10e

a.

preventreinfectionduringtreatment.

b.

treatanycoexistingchlamydialinfection.

c.

eradicateresistantstrainsofN.gonorrhoeae.

d.

preventthedevelopmentofresistantorganisms.

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ANS:B Becausethereisahighincidenceofco-infectionwithgonorrheaandchlamydia,patientsareusuallytreatedfor both.Theotherexplanationsaboutthepurposeoftheantibioticcombinationarenotaccurate. DIF:CognitiveLevel:Apply(application)REF:1229 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 4.A46-year-oldmanwhohashadblooddrawnforaninsurancescreeninghasapositiveVenerealDisease ResearchLaboratory(VDRL)test.Whichactionshouldthenursetakenext? a.

Askthepatientaboutpasttreatmentforsyphilis.

b.

Explaintheneedforbloodandspinalfluidcultures.

c.

Obtainaspecimenforfluorescenttreponemalantibodyabsorption(FAT-Abs)testing.

d.

Assessforthepresenceofchancres,flulikesymptoms,orabilateralrashonthetrunk.

ANS:A Onceantibodytestingispositiveforsyphilis,theantibodiesremainpresentforanindefiniteperiodoftime evenaftersuccessfultreatment,sothenurseshouldinquireaboutprevioustreatmentbeforedoingother assessmentsortesting.Culture,FAT-Abstesting,andassessmentforsymptomsmaybeappropriate,basedon whetherthepatienthasbeenpreviouslytreatedforsyphilis. DIF:CognitiveLevel:Apply(application)REF:1230 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 5.A48-year-oldmalepatientwhohasbeendiagnosedwithgonococcalurethritistellsthenursehehadrecent sexualcontactwithawomanbutsaysshedidnotappeartohaveanydisease.Inrespondingtothepatient,the nurseexplainsthat a.

womendonotdevelopgonorrheainfectionsbutcanserveascarrierstospreadthediseaseto males.

b.

womenmaynotbeawaretheyhavegonorrheabecausetheyoftendonothavesymptomsof infection.

c.

womendevelopsubclinicalcasesofgonorrheathatdonotcausetissuedamageorclinical

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manifestations. d.

whengonorrheainfectionsoccurinwomen,thediseaseaffectsonlytheovariesandnotthegenital organs.

ANS:B Manywomenwithgonorrheaareasymptomaticorhaveminorsymptomsthatareoverlooked.Thediseasemay affectboththegenitalsandtheotherreproductiveorgansandcausecomplicationssuchaspelvicinflammatory disease(PID).Womenwhocantransmitthediseasehaveactiveinfections. DIF:CognitiveLevel:Understand(comprehension)REF:1229 TOP:NursingProcess:ImplementationMSC:NCLEX:PhysiologicalIntegrity 6.ApatientadmittedwithchestpainisalsofoundtohavepositiveVenerealDiseaseResearchLaboratory (VDRL)andfluorescenttreponemalantibodyabsorption(FAT-Abs)tests,rashesonthepalmsandthesolesof thefeet,andmoistpapulesintheanalandvulvararea.Whichactionwillthenurseincludeintheplanofcare? a.

Assessforarterialaneurysms.

b.

Wearglovesforpatientcontact.

c.

Placethepatientinaprivateroom.

d.

Applyantibioticointmenttotheperineum.

ANS:B Exudatefromanylesionswithsyphilisishighlycontagious.Systemicantibiotics,ratherthanlocaltreatmento lesions,areusedtotreatsyphilis.Thepatientdoesnotrequireaprivateroombecausethediseaseisspread throughcontactwiththelesions.Thispatienthasclinicalmanifestationsofsecondarysyphilisanddoesnot needtobemonitoredformanifestationsoftertiarysyphilis. DIF:CognitiveLevel:Apply(application)REF:1230 TOP:NursingProcess:PlanningMSC:NCLEX:SafeandEffectiveCareEnvironment 7.Whichstatementbya24-year-oldpatientindicatesthatthenursesteachingaboutmanagementofprimary genitalherpeshasbeeneffective? a.

Iwilluseacyclovirointmentontheareatorelievethepain.

b.

Iwillusecondomsforintercourseuntilthemedicationisallgone.

c.

Iwilltaketheacyclovir(Zovirax)every8hoursforthenextweek.

d.

Iwillneedtotakeallofthemedicationtobesuretheinfectioniscured.

ANS:C

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Thetreatmentregimenforprimarygenitalherpesinfectionsincludesacyclovir400mg3timesdailyfor7to 10days.Thepatientistaughttoabstainfromintercourseuntilthelesionsaregone.(Condomsshouldbeused evenwhenthepatientisasymptomatic.)Acyclovirointmentisnoteffectiveintreatinglesionsorreducing pain.Herpesinfectionischronicandrecurrent. DIF:CognitiveLevel:Apply(application)REF:1238 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 8.Whichinfection,reportedinthehealthhistoryofawomanwhoishavingdifficultyconceiving,willthe nurseidentifyasariskfactorforinfertility? a.

N.gonorrhoeae

b.

Treponemapallidum

c.

Condylomaacuminatum

d.

Herpessimplexvirustype2

ANS:A Complicationsofgonorrheaincludescarringofthefallopiantubes,whichcanleadtotubalpregnanciesand infertility.Syphilis,genitalwarts,andgenitalherpesdonotleadtoproblemswithconceiving,although transmissiontothefetus(syphilis)ornewborn(genitalwartsorgenitalherpes)isaconcern. DIF:CognitiveLevel:Apply(application)REF:1233 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 9.Awomanisdiagnosedwithprimarysyphilisduringhereighthweekofpregnancy.Thenursewillplanto teachthepatientaboutthe a.

likelihoodofastillbirth.

b.

plansforcesareansection

c.

intramuscularinjectionofpenicillin.

d.

antibioticeyedropsforthenewborn.

ANS:C Asingleinjectionofpenicillinisrecommendedtotreatprimarysyphilis.Thiswilltreatthemotherandprevent transmissionofthediseasetothefetus.Instillationoferythromycinintotheeyesofthenewbornisusedto preventgonorrhealeyeinfections.C-sectionisusedtopreventthetransmissionofherpestothenewborn. Althoughstillbirthcanoccurifthefetusisinfectedwithsyphilis,treatmentbeforethetenthweekofgestation willeliminateinuterotransmissiontothefetus. DIF:CognitiveLevel:Apply(application)REF:1230 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity

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10.A19-year-oldpatienthasgenitalwartsaroundherexternalgenitaliaandperianalarea.Shetellsthenurse thatshehasnotsoughttreatmentuntilnowbecausethewartsaresodisgusting.Whichnursingdiagnosisis mostappropriate? a.

Disturbedbodyimagerelatedtofeelingsaboutthegenitalwarts

b.

Ineffectivecopingrelatedtodenialofincreasedriskforinfection

c.

Riskforinfectionrelatedtolackofknowledgeabouttransmission

d.

Anxietyrelatedtoimpactofconditiononinterpersonalrelationships

ANS:A Thepatientsstatementthatherlesionsaredisgustingsuggeststhatdisturbedbodyimageisthemajorconcern. Thereisnoevidencetoindicateineffectivecopingorlackofknowledgeaboutmodeoftransmission.The patientmaybeexperiencinganxiety,butthereisnothinginthedataindicatingthatthegenitalwartsare impactinginterpersonalrelationships. DIF:CognitiveLevel:Apply(application)REF:1236 TOP:NursingProcess:DiagnosisMSC:NCLEX:PsychosocialIntegrity 11.Whena31-year-oldmalepatientreturnstotheclinicforfollow-upaftertreatmentforgonococcal urethritis,apurulenturethraldischargeisstillpresent.Whentryingtodeterminethereasonfortherecurrent infection,whichquestionismostappropriateforthenursetoaskthepatient? a.

Didyoutaketheprescribedantibioticforaweek?

b.

Didyoudrinkatleast2quartsoffluidseveryday?

c.

Wereyoursexualpartnerstreatedwithantibiotics?

d.

Doyouwashyourhandsafterusingthebathroom?

ANS:C Acommonreasonforrecurrenceofsymptomsisreinfectionbecauseinfectedpartnershavenotbeen simultaneouslytreated.Becausegonorrheaistreatedwithonedoseofantibiotic,antibiotictherapyforaweek isnotneeded.Anadequatefluidintakeisimportant,butalowfluidintakeisnotalikelycauseforfailed treatment.Poorhygienemaycausecomplicationssuchasoculartrachomabutwillnotcauseafailureof treatment. DIF:CognitiveLevel:Apply(application)REF:1230 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 12.A29-year-oldfemalepatientisdiagnosedwithChlamydiaduringaroutinepelvicexamination.Thenurse knowsthatteachingregardingthemanagementoftheconditionhasbeeneffectivewhenthepatientsayswhich ofthefollowing?

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a.

MypartnerwillneedtotakeantibioticsatthesametimeIdo.

b.

Goaheadandgivemetheantibioticinjection,soIwillbecured.

c.

IwillusecondomsduringsexuntilIfinishtakingalltheantibiotics.

d.

Idonotplanonhavingchildren,sotreatingtheinfectionisnotimportant.

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ANS:A Sexpartnersshouldbetreatedsimultaneouslytopreventreinfection.Chlamydiaistreatedwithoralantibiotics. Abstinencefromsexualintercourseisrecommendedfor7daysaftertreatment,andcondomsshouldbe recommendedduringallsexualcontactstopreventinfection.Chronicpelvicpain,aswellasinfertility,can resultfromuntreatedChlamydia. DIF:CognitiveLevel:Apply(application)REF:1233 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity 13.A55-year-oldwomaninthesexuallytransmittedinfection(STI)clinictellsthenursethatsheisconcerned shemayhavebeenexposedtogonorrheabyherpartner.Todeterminewhetherthepatienthasgonorrhea,the nursewillplanto a.

interviewthepatientaboutsymptomsofgonorrhea.

b.

takeasampleofcervicaldischargeforGramstaining.

c.

drawabloodspecimenorrapidplasmareagin(RPR)testing.

d.

obtainsecretionsforanucleicacidamplificationtest(NAAT).

ANS:D NAAThasahighsensitivity(similartoaculture)forgonorrhea.Becausewomenhavefewsymptomsof gonorrhea,askingthepatientaboutsymptomsmaynotbehelpfulinmakingadiagnosis.SmearsandGram stainingarenotusefulbecausethefemalegenitourinarytracthasmanynormalflorathatresembleN. gonorrhoeae.RPRtestingisusedtodetectsyphilis. DIF:CognitiveLevel:Apply(application)REF:1230 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 14.A32-year-oldwomanwhoisdiagnosedwithChlamydiatellsthenursethatsheisveryangrybecauseher husbandisheronlysexualpartner.Whichresponseshouldthenursemakefirst? a.

Youmayneedprofessionalcounselingtohelpresolveyouranger.

b.

Itisunderstandablethatyouareangrywithyourhusbandrightnow.

c.

Yourfeelingsarejustifiedandyoushouldsharethemwithyourhusband.

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Itisimportantthatbothyouandyourhusbandbetreatedfortheinfection.

ANS:B Thisresponseexpressesthenursesacceptanceofthepatientsfeelingsandencouragesfurtherdiscussionand problemsolving.Thepatientmayneedprofessionalcounseling,butmoreassessmentofthepatientisneeded beforemakingthisjudgment.Thenurseshouldalsoassessfurtherbeforesuggestingthatthepatientshareher feelingswiththehusbandbecauseproblemssuchasabusemightbepresentintherelationship.Althoughitis importantthatbothpartnersbetreated,thepatientscurrentangersuggeststhatthisisnottheappropriatetime tobringthisup. DIF:CognitiveLevel:Apply(application)REF:1239 OBJ:SpecialQuestions:PrioritizationTOP:NursingProcess:Implementation MSC:NCLEX:PsychosocialIntegrity 15.WhichpatientwillthenurseplanonteachingabouttheGardasilvaccine? a.

A24-year-oldfemalewhohasnotbeensexuallyactive

b.

A34-year-oldwomanwhohasmultiplesexualpartners

c.

A19-year-oldwomanwhoispregnantforthefirsttime

d.

A29-year-oldwomanwhoisinamonogamousrelationship

ANS:A Gardasilisrecommendedforfemalesages9through26,preferablythosewhohaveneverbeensexuallyactive Itisnotrecommendedforwomenduringpregnancyorforolderwomen. DIF:CognitiveLevel:Apply(application)REF:1236 OBJ:SpecialQuestions:MultiplePatientsTOP:NursingProcess:Planning MSC:NCLEX:HealthPromotionandMaintenance 16.Afterthenursehastaughtapatientwithanewlydiagnosedsexuallytransmittedinfectionaboutexpedited partnertherapy,whichpatientstatementindicatesthattheteachinghasbeeneffective? a.

Iwilltellmypartnerthatitisimportanttobeexaminedattheclinic.

b.

IwillhavemypartnertaketheantibioticsifanySTIsymptomsoccur.

c.

Iwillmakesurethatmypartnertakesalloftheprescribedmedication.

d.

IwillhavemypartneruseacondomuntilIhavefinishedtheantibiotics.

ANS:C

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Withexpeditedpartnertherapy,thepatientisgivenaprescriptionormedicationsforthepartner.Thepartner doesnotneedtobeevaluatedbythehealthcareprovider,butispresumedtobeinfectedandshouldbetreated concurrentlywiththepatient.UseofacondomwillnottreatthepresumedSTIinthepartner. DIF:CognitiveLevel:Apply(application)REF:1238 TOP:NursingProcess:EvaluationMSC:NCLEX:PhysiologicalIntegrity MULTIPLERESPONSE 1.A39-year-oldpatientwithahistoryofIVdruguseisseenatacommunityclinic.Thepatientreports difficultywalking,statingIdontknowwheremyfeetare.DiagnosticscreeningrevealspositiveVenereal DiseaseResearchLaboratory(VDRL)andfluorescenttreponemalantibodyabsorption(FTA-Abs)tests.Based onthepatienthistory,whatwillthenurseassess(selectallthatapply)? a.

Heartsounds

b.

Genitaliaforlesions

c.

Jointsforswellingandinflammation

d.

Mentalstateforjudgmentandorientation

e.

Skinandmucousmembranesforgummas

ANS:A,D,E Thepatientsclinicalmanifestationsandlaboratorytestsareconsistentwithtertiarysyphilis.Valvular insufficiency,gummas,andchangesinmentationareotherclinicalmanifestationsofthisstage. DIF:CognitiveLevel:Analyze(analysis)REF:1231 TOP:NursingProcess:AssessmentMSC:NCLEX:PhysiologicalIntegrity 2.Whichtopicswillthenurseincludewhenpreparingtoteachapatientwithrecurrentgenitalherpessimplex (selectallthatapply)? a.

Infectedareasshouldbekeptmoisttospeedhealing.

b.

Sitzbathsmaybeusedtorelievediscomfortcausedbythelesions.

c.

Genitalherpescanbecuredbyconsistentuseofantiviralmedications.

d.

Recurrentgenitalherpesepisodesusuallyareshorterthanthefirstepisode.

e.

Theviruscaninfectsexualpartnersevenwhenyoudonothavesymptomsofinfection.

ANS:B,D,E Patientsaretaughtthatsheddingofthevirusandinfectionofsexualpartnerscanoccureveninasymptomatic periods,thatrecurrentepisodesresolvemorequickly,andthatsitzbathscanbeusedtorelievepaincausedby

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thelesions.Antiviralmedicationsdecreasethenumberofoutbreaks,butdonotcureherpessimplexinfections. Infectedareasmaybekeptdryifthisdecreasespainanditching. DIF:CognitiveLevel:Apply(application)REF:1234 TOP:NursingProcess:PlanningMSC:NCLEX:PhysiologicalIntegrity 3.Thenurseintheoutpatientclinicnotesthatthefollowingpatientshavenotreceivedthehuman papillomavirus(HPV)vaccine.Whichpatientsshouldthenurseplantoteachaboutbenefitsofthevaccine (selectallthatapply)? a.

24-year-oldmanwhohasahistoryofgenitalwarts

b.

18-year-oldmanwhohashadonemalesexualpartner

c.

28-year-oldwomanwhohasneverbeensexuallyactive

d.

20-year-oldwomanwhohasanew...