Chapter 41: Management of Clients with Sexually Transmitted Infections Nursing School Test Banks

Black & Hawks: Medical-Surgical Nursing, 8th Edition

Test Bank

Chapter 41: Management of Clients with Sexually Transmitted Infections

MULTIPLE CHOICE

1. When teaching clients strategies for primary prevention of sexually transmitted diseases (STDs), the nurse should

a.

encourage compliance with medical treatment.

b.

encourage early treatment of infected individuals.

c.

provide risk reduction counseling.

d.

treat all the clients sexual partners.

ANS: C

Primary prevention includes measures to prevent the disease from occurring. Health education about STDs should be provided as part of primary prevention. Medical treatment, early treatment, and treating all the clients sexual partners are not primary prevention.

DIF: Application/Applying REF: pp. 973-977 OBJ: Application

MSC: Health Promotion and Maintenance Disease Prevention

2. The nurse conducting health education about gonorrhea would teach a client that

a.

gonorrhea is difficult to treat effectively.

b.

gram-negative organisms multiply rapidly.

c.

the organisms can survive for a long period outside the body.

d.

there is a large carrier population because it can be asymptomatic in women.

ANS: D

Gonorrhea may be asymptomatic in women. A large carrier population refers to people who carry the organism and have no manifestations but can transmit the disease. With the right antibiotic, most strains of gonorrhea are easily treated. The organism does not multiply particularly rapidly, and it cannot live long outside the human body.

DIF: Application/Applying REF: p. 982 OBJ: Intervention

MSC: Health Promotion and Maintenance Health Promotion Programs

3. A client has developed salpingitis as a complication of gonorrhea. The nurse explains that this problem could lead to

a.

a shortened latency period.

b.

chlamydial infection.

c.

infertility.

d.

reinfection.

ANS: C

The most common complication of gonorrhea in women is salpingitis, which can progress to the serious complication of pelvic inflammatory disease (PID). Gonorrhea does not have a latency period. Chlamydia often co-exists with gonorrhea but is not caused by salpingitis. Reinfection can occur but is usually caused by non-compliance with treatment or not having sexual partners treated.

DIF: Application/Applying REF: p. 982 OBJ: Intervention

MSC: Physiological Integrity Potential for Alterations in Body Systems

4. The physician has prescribed ceftriaxone (Rocephin) administered intramuscularly, followed by doxycycline (Vibramycin) orally for 7 days, to treat a client with gonorrhea. The nurse would explain that the rationale for the second medication is

a.

because some strains of Neisseria gonorrhoeae are resistant to antibiotics.

b.

that two drugs are better tolerated than one large dose.

c.

to prevent reinfection.

d.

to treat a chlamydial co-infection.

ANS: D

Doxycycline is added for the presumptive treatment of co-infection with Chlamydia trachomatis, because chlamydial infections often co-exist with gonorrheal infections. There is some resistance to quinolone antibiotics, and certain clients should not be treated with them. The two-drug regimen is not better tolerated nor does it prevent reinfection.

DIF: Application/Applying REF: p. 978 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

5. A client with uncomplicated gonorrhea who is treated with ceftriaxone and doxycycline asks if a follow-up examination and culture will be necessary. The most appropriate response by the nurse is

a.

No, because the disease cannot recur.

b.

No, because treatment failure with these medications is rare.

c.

Yes, because monthly cultures are now recommended.

d.

Yes, because reinfection is very probable.

ANS: B

After therapy for uncomplicated gonorrhea is completed, a follow-up examination and culture (test of cure) are not necessary. Treatment failure following combined ceftriaxone-doxycycline therapy is rare. This differs from the recommendation to re-test in 3-12 months because of the high rates of STDs seen in people who have been recently treated for them.

DIF: Application/Applying REF: p. 983 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

6. The statement made by a client being treated for gonorrhea that would indicate that teaching has been effective is I

a.

can get some antibiotics to take home, in case I get infected again.

b.

dont want to get this again because treatment is lengthy and expensive.

c.

will come back after I finish all my medicine.

d.

wont have sex until I have completed my medications.

ANS: D

Before resuming sexual activity, the client should finish all prescribed medication. The clients partner(s) need to be treated too. Clients should not be given extra antibiotics to save for later incidents of gonorrheal infection. Treatment is neither lengthy nor expensive, and test-of-cure is not necessary.

DIF: Comprehension/Understanding REF: p. 983 OBJ: Evaluation

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

7. The nurse working in an ambulatory clinic explains that the most common bacterial STD in the United States is

a.

chlamydia.

b.

genital herpes.

c.

gonorrhea.

d.

syphilis.

ANS: A

Infection with Chlamydia organisms is the most common bacterial STD in the United States. In 2004 more than 900,000 new cases were reported. Overall, HPV infection is most common, but exact figures are not known. HPV is caused by a virus.

DIF: Knowledge/Remembering REF: p. 981 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

8. To make a definite diagnosis in a client with suspected chlamydial infection, the nurse should prepare the client for

a.

biopsy.

b.

blood study.

c.

culture.

d.

Papanicolaou (Pap) smear.

ANS: C

Culture of exudate from the urethra, endocervix, or rectum remains a good test for Chlamydia, although other testing options are available. Biopsies and blood studies have no role in the diagnosis of Chlamydia. A woman being tested for STDs should be given the opportunity to be tested for other STDs. The Pap smear remains a valuable test for cervical cancer and should be discussed with women presenting for STD testing and offered per guidelines.

DIF: Analysis/Analyzing REF: pp. 981-982 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

9. In teaching a client receiving doxycycline for the treatment of chlamydial infection, the nurse should include

a.

avoidance of alcoholic beverages while taking doxycycline.

b.

increasing fluid intake while taking doxycycline.

c.

protecting the medication from sunlight.

d.

using a condom as a birth control method.

ANS: D

Doxycycline may decrease the effect of birth control pills. Alcohol does not interfere with the medications action. The medication does not need protection from sunlight and while increased fluid intake is always important for a person with an infection, this is not an intervention related to doxycycline.

DIF: Application/Applying REF: p. 978 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

10. The nurse would assess a female client with second-stage syphilis for

a.

local lymphadenopathy.

b.

maculopapular, nonpruritic rash on the palms and soles of the feet.

c.

presence of a chancre.

d.

yellow, mucopurulent vaginal discharge.

ANS: B

Indications of the second stage of syphilis include generalized rash. Typically, a maculopapular and nonpruritic rash appears on the palms of the hands and soles of the feet. Few other diseases cause a rash in these locations. Lymphadenopathy is present in secondary syphilis, but it is generalized. Chancre is the cardinal sign of primary stage disease. Syphilis does not cause vaginal discharge.

DIF: Application/Applying REF: p. 984 OBJ: Assessment

MSC: Physiological Integrity Physiological Adaptation-Pathophysiology

11. A client whose VDRL test was positive asks the nurse if he has syphilis. The nurses best response is

a.

A blood culture is necessary to make the diagnosis.

b.

A positive VDRL indicates syphilis.

c.

The FTA-ABS test will need to be done.

d.

This study is specific for gonorrhea.

ANS: C

The Venereal Disease Research Laboratories (VDRL) test may be false-positive if performed during the early stages of several common viral illnesses. The fluorescent treponemal antibody absorption (FTA-ABS) serologic test is more specific because it measures antibodies specific to Treponema pallidum. FTA-ABS is used when VDRL is positive but the diagnosis of syphilis is still uncertain. Blood cultures are not used to diagnose syphilis, and the VDRL is not used to test for gonorrhea.

DIF: Comprehension/Understanding REF: p. 985 OBJ: Intervention

MSC: Physiological Integrity Reduction of Risk Potential-Diagnostic Tests

12. A female caller to an STD hotline is crying, saying that her husband is accusing her of cheating on him after she was diagnosed with chlamydia. The best response by the nurse would be

a.

I can refer you to a marriage counselor if you think your husband would go.

b.

There is a lot of information about chlamydia on the CDC website. I can give you that address.

c.

There is no way to tell when you got infected because chlamydia often does not cause symptoms in women.

d.

You need to tell your husband to see his doctor so he can be evaluated and treated if needed.

ANS: C

A diagnosis of an STD can cause great distress not only on a personal level but also in a relationship where questions of fidelity may arise. It is important for the client and her significant other to realize that Chlamydia is often asymptomatic for years in women, so judgments about fidelity are not helpful. While offers of marriage counseling and website addresses may be helpful, they do not address the primary problem of psychosocial distress in the client.

DIF: Analysis/Analyzing REF: p. 981 OBJ: Intervention

MSC: Psychosocial Integrity Stress Management

13. The nurse is counseling a client with herpes simplex virus (HSV) infection. Which of the following would best meet most clients needs in coping with this diagnosis?

a.

Contact information for a support group

b.

Information about promising drug trials

c.

Websites containing STD information

d.

Written information about the disease and treatment

ANS: A

Research has verified the importance of support groups for most people with chronic illnesses. The other three options are helpful and should not be discounted when assessing client needs

DIF: Application/Applying REF: p. 987 OBJ: Intervention

MSC: Psychosocial Integrity Coping Mechanisms

14. A client with genital herpes asks the nurse what effect the herpes will have on her becoming pregnant and having a child. The nurses response is based on the fact that active genital herpes lesions can cause

a.

birth defects.

b.

infection of the fetus in utero.

c.

infection of the newborn during vaginal delivery.

d.

sterility.

ANS: C

Newborns can be infected during vaginal delivery when active genital lesions are present. Cesarean birth prevents this transmission. Birth defects, intrauterine infection, and sterility do not occur.

DIF: Comprehension/Understanding REF: p. 986 OBJ: Intervention

MSC: Physiological Integrity Potential for Complications from Health Alterations

15. The nurse is teaching a client with herpes simplex virus (HSV) type 2 appropriate methods to prevent further spread of the virus while lesions are present. The nurse stresses that clients should

a.

apply warm soaks to the lesions.

b.

complete antibiotic therapy.

c.

maintain separate towels and other personal items.

d.

stop using condoms because they are irritating.

ANS: C

For avoiding autoinoculation from the genital area to other body sites, clients should be advised to wash their hands thoroughly after any contact with herpetic lesions. Infected clients should have separate towels and other personal items and should be instructed to avoid touching their eyes. Condoms should be worn even during latent periods. Warm soaks may be comforting, but do not prevent spread. Antibiotics are not used for HSV infection.

DIF: Application/Applying REF: p. 986 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

16. A female client with genital warts who was treated with topical podophyllin and tincture of benzoin would indicate to the nurse the need for further teaching when the client says

a.

I need to come for frequent treatment until all the warts disappear.

b.

Ill be glad when these warts are cured.

c.

Ill make sure my boyfriend is treated.

d.

These warts are usually spread by having sex.

ANS: B

There is no cure for genital warts. A variety of chemical, mechanical, and ablative techniques are used for visible lesions, but no specific antiviral therapy for the human papillomavirus (HPV) is available. A series of treatments is needed to eliminate all visible warts.

DIF: Comprehension/Understanding REF: p. 989 OBJ: Evaluation

MSC: Health Promotion and Maintenance Disease Prevention

17. A client is receiving metronidazole (Flagyl) orally for treatment of trichomoniasis. The nurse should explain to the client that

a.

alcoholic beverages and products containing alcohol should be avoided.

b.

douching is necessary after sexual contact.

c.

recurrence generally is rare.

d.

the medication must be taken for 14 days.

ANS: A

The nurse should advise clients taking metronidazole not to drink alcoholic beverages or take alcohol-containing products because alcohol may cause nausea, vomiting, and headaches. Douching is not a recommended practice at any time. Recurrence is fairly common. Metronidazole is taken as a one-time dose, or for 7 days in recurring infection.

DIF: Application/Applying REF: p. 990 OBJ: Intervention

MSC: Physiological Integrity Pharmacological and Parenteral Therapies-Expected Effects/Outcomes

18. When caring for clients with STDs, the nurse is aware that the best method of infection control is

a.

good hand-washing.

b.

disease-based isolation techniques.

c.

no extra infection control measures.

d.

universal precautions.

ANS: D

Universal precautions should be used in the care of all clients. Good hand-washing, while important, is not sufficient and there are no specific disease-based isolation recommendations for STDs.

DIF: Knowledge/Remembering REF: p. 972 OBJ: Intervention

MSC: Safe, Effective Care Environment Safety and Infection Control-Standard/Transmission Based/Other Precautions

19. A nurse is teaching a community group about STDs, including proper use of condoms. The nurse informs the group that condom failure is generally due to

a.

environmental concerns.

b.

improper or inconsistent use.

c.

latex versus non-latex construction.

d.

manufacturers defect.

ANS: B

Condom failure is primarily caused by improper or inconsistent use rather than a product defect.

DIF: Knowledge/Remembering REF: p. 979 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

20. An adolescent female states that she cannot use condoms because her boyfriend wont let her. Which action by the nurse would best fill the role of the advocate for this client?

a.

Give the adolescent pamphlets to share with the boyfriend.

b.

Help the teen practice negotiation techniques.

c.

Reinforce teaching on the consequences of STDs.

d.

Teach the client the proper way to apply a condom.

ANS: B

Assertive communication and negotiation skills are vital when talking about sensitive topics like condom use with partners. Teens often need help developing these skills. Practicing skills is a concrete action they can use to help ensure their sexual health.

DIF: Analysis/Analyzing REF: pp. 976, 979 OBJ: Evaluation

MSC: Safe, Effective Care Environment Disease Prevention

21. The nurse determines that the woman who least needs screening for chlamydial infection is a

a.

22-year-old with multiple partners.

b.

35-year-old with a single partner

c.

high-risk pregnant woman.

d.

sexually active 17-year-old.

ANS: B

Priority groups for chlamydial testing include adolescents and women 20 to 24 years old who have new or multiple sexual partners or who do not use condoms routinely. All pregnant women should be screened for common STDs. The 35-year-old woman with a single partner is at lowest risk.

DIF: Comprehension/Understanding REF: p. 973 OBJ: Assessment

MSC: Health Promotion and Maintenance Health Screening

22. The ambulatory care nurse is aware that after the appearance of the primary lesions, latent syphilis will begin in approximately

a.

1 month.

b.

3 to 6 months.

c.

1 to 2 years.

d.

3 to 5 years.

ANS: C

Latent syphilis usually occurs 1 to 2 years after the primary lesion and can last as long as 50 years.

DIF: Knowledge/Remembering REF: p. 984 OBJ: Assessment

MSC: Physiological Integrity Pathophysiological Adaptation-Pathophysiology

23. As part of health teaching for a female client with genital warts, the nurse would explain that

a.

condom use is recommended.

b.

genital warts are cured after medication therapy.

c.

testing for warts eliminates the need for Pap smears.

d.

this disorder is unrelated to development of genital cancers.

ANS: A

Condom use should be encouraged in clients with genital warts, and more frequent Pap smears are needed. There is increased risk of genital cancers. Genital warts are not curable. The vast majority of cervical cancers are related to genital warts.

DIF: Comprehension/Understanding REF: p. 989 OBJ: Intervention

MSC: Health Promotion and Maintenance Disease Prevention

MULTIPLE RESPONSE

1. The nurse caring for clients with STDs knows that which diseases are reportable in all states? (Select all that are correct.)

a.

Chlamydia

b.

Gonorrhea

c.

Herpes simplex virus (genital)

d.

Human papilloma virus

e.

Syphilis

ANS: A, B, E

Chlamydia, gonorrhea, and syphilis are reportable to state health departments in all states, although compliance varies considerably.

DIF: Knowledge/Remembering REF: pp. 972-973 OBJ: Intervention

MSC: Safe, Effective Care Environment Management of Care-Legal Rights and Responsibilities

Elsevier items and derived items 2009 by Saunders, an imprint of Elsevier Inc.

Some material was previously published.

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