Chapter 74: Care of Patients with Sexually Transmitted Diseases Nursing School Test Banks

Chapter 74: Care of Patients with Sexually Transmitted Diseases
Ignatavicius: Medical-Surgical Nursing, 8th Edition

MULTIPLE CHOICE

1. A nurse instructor is teaching a student nurse about the factors that have increased the number of people with sexually transmitted diseases (STDs) seen in practice. Which statement by the student indicates a lack of understanding?
a. There are improved techniques to diagnose an STD used in practice.
b. There is increased incidence of sexual abuse and sexual trafficking.
c. Females feel safe using oral agents rather than a condom as contraception.
d. The organisms causing STDs are all becoming more virulent.
ANS: D
There is no evidence that the organisms that cause STDs are becoming more virulent, but a client may need to use another anti-infective if allergic or the protocol was not effective. Extensive histories are taken in the clinic of clients of all ages, as well as assessment of laboratory data such as cervical, urethral, oral, or rectal specimens and lesion samples for microbiology and virology. There are changes in sexual attitudes and practices, cultural factors, migration, and international travel. Women often think that the oral contraceptives protect them from an STD.

DIF: Applying/Application REF: 1531
KEY: Reproductive problems| evidence-based practice| teaching| secondary prevention
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

2. A nurse is assessing a client who presents with a scaly rash over the palms and soles of the feet and the feeling of muscle aches and malaise. The nurse suspects syphilis. Which action by the nurse is appropriate?
a. Reassure the client that this stage is not infectious unless she is pregnant.
b. Assess the client for hearing loss and generalized weakness.
c. Don gloves and further assess the clients lesions.
d. Take a history regarding any cardiovascular symptoms.
ANS: C
The client is displaying symptoms similar to secondary syphilis, with flu-like symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the clients lesions with gloves since the client is highly contagious at this stage. Late latent syphilis is not infectious except to a fetus. Tertiary syphilis may display in the form of cardiovascular or central nervous system symptoms.

DIF: Applying/Application REF: 1532
KEY: Reproductive problems| secondary prevention| nursing assessment| Standard Precautions MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

3. A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at this time?
a. Have you been using latex condoms?
b. Are you allergic to penicillin?
c. When was your last sexual encounter?
d. Do you have a history of sexually transmitted disease?
ANS: B
Benzathine penicillin G is the evidence-based treatment for primary syphilis. The client needs to be assessed for allergies before treatment. The other questions would be helpful in the clients history of sexually transmitted diseases but not as important as knowing whether the client is allergic to penicillin.

DIF: Applying/Application REF: 1533
KEY: Reproductive problems| patient safety| secondary prevention
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

4. An African-American female with blisters on the vagina is being treated with acyclovir (Zovirax) for genital herpes. She is angry at her partner for transmitting the infection. Which action by the nurse is best?
a. Encourage the client to engage in sexual activity since she is on medication.
b. Be sensitive to the clients feelings and refer her to a support group.
c. Reinforce that the disease can no longer be spread to other partners.
d. Reassure the client that sexual activity will not be painful while on acyclovir.
ANS: B
The nurse needs to be sensitive and supportive of the client since infected clients may feel angry, lonely, and isolated. Allow the client to verbalize her feelings and refer her to a local support group, such as the National Herpes Resource Center. Sexual activity should not occur while the lesions are present because of discomfort and viral transmission. Genital herpes is an incurable viral disease, and the antiviral drugs minimize the infection but do not cure it. Condoms should be used to avoid the spread of the disease.

DIF: Applying/Application REF: 1536
KEY: Antiviral medication| reproductive problems| caring| infection control
MSC: Integrated Process: Caring
NOT: Client Needs Category: Psychosocial Integrity

5. A 19-year-old female is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate?
a. Gardasil protects against all HPV strains.
b. You are too young to receive the vaccine.
c. Only females can receive the vaccine.
d. This will lower your risk for cervical cancer.
ANS: D
Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and warts. The vaccine is recommended for people ages 10 to 26 years.

DIF: Remembering/Knowledge REF: 1538
KEY: Reproductive problems| antiviral medications| infection| cancer
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A 26-year-old client with multiple sexual partners is being assessed for symptoms of dysuria and vaginal discharge. Because the results from the culture of the cervical cells are not available, the client will be treated for both Chlamydia and gonorrhea. Which explanation by the nurse is best?
a. This early treatment will prevent obstruction to the fallopian tubes.
b. Only azithromycin (Zithromax) is prescribed for both sexually transmitted diseases.
c. The treatment will prevent aortic valve disease and aneurysms.
d. Oral antibiotic treatment will prevent frequent occurrences of meningitis.
ANS: A
Both gonorrhea and Chlamydia can cause pelvic inflammatory disease and scarring of the fallopian tubes, resulting in infertility problems. Azithromycin is the treatment of choice for both sexually transmitted diseases, but ceftriaxone (Rocephin) is also recommended for treatment of gonorrhea. Aortic valve disease and aneurysms usually occur with tertiary syphilis. Meningitis occurs rarely with a gonorrhea infection and is usually treated with intravenous antibiotic therapy in the hospital setting.

DIF: Applying/Application REF: 1541
KEY: Reproductive problems| infection| antibiotics
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

7. While evaluating a male client for treatment of gonorrhea, which question is the most important for the nurse to ask?
a. Do you have a history of sexually transmitted disease?
b. When was your last sexual encounter?
c. When did your symptoms begin?
d. What are the names of your recent sexual partners?
ANS: D
Sexual partners, as well as the client, should be tested and treated for gonorrhea. Asking about sexually transmitted disease history, last sexual encounter, and onset of symptoms would be helpful with the history taking, but the priority is treating the clients sexual partners to limit the spread of the disease.

DIF: Applying/Application REF: 1539
KEY: Reproductive problems| health promotion| infection
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

8. Before marriage, a female client has a blood test drawn for syphilis. The test reveals a positive Venereal Disease Research Laboratory (VDRL) serum test. What is the advice that the nurse should give the client?
a. Check with your future husband about his sexual activity.
b. You must determine if you are pregnant at this time.
c. Submit to a more specific treponemal test to confirm the infection.
d. Agree to a benzathine penicillin G injection in multiple doses.
ANS: C
False-positive reactions can occur with viral infections, hepatitis, and systemic lupus erythematosus. A health care provider can request more specific treponemal tests such a fluorescent treponemal antibody absorption or microhemagglutination assay for Treponema palladium performed by the laboratory. While it would be good to confirm sexual activity with her future husband, this inquiry could wait until after further testing is performed. Penicillin is the treatment of choice, but as a single 2.4-million-unit dose. A different regimen would be recommended if the client were pregnant.

DIF: Applying/Application REF: 1534
KEY: Reproductive problems| infection| health screening
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

9. A 23-year-old female has been diagnosed with genital warts. Which action by the nurse is best?
a. Encourage the client to have an annual Papanicolaou (Pap) test.
b. Recommend an over-the-counter wart treatment for genital tissue.
c. Report the case to the Centers for Disease Control and Prevention (CDC).
d. Discuss popular options for contraception.
ANS: A
An annual Pap test is recommended (due the strong relationship between genital warts and the development of dysplasia of the cervix) until three normal Pap smears are obtained. The Pap smear can detect any malignancies of the cervix. Prescribed cream or gel such as podofilox (Condylox) is the recommended treatment, but not over-the-counter treatments. Genital warts, or condylomata acuminata, do not have to be reported to the CDC in all states. Pregnancy is not contraindicated with genital warts.

DIF: Applying/Application REF: 1537
KEY: Reproductive problems| nursing interventions| infection
MSC: Integrated Process: Nursing Process: Implementation
NOT: Client Needs Category: Health Promotion and Maintenance

10. A female client returned to the clinic with a yellow vaginal discharge after being treated for Chlamydia infection 3 weeks ago. Which statement by the client alerts the nurse that there may be a recurrence of the infection?
a. I did practice abstinence while taking the medication.
b. I took doxycycline two times a day for a week.
c. I never told my boyfriend about the infection.
d. I did drink wine when taking the medication for Chlamydia.
ANS: C
There is a good possibility that the boyfriend re-infected the client after the medication regimen was finished. Both the client and the boyfriend need to be treated. The other statements were in compliance with the recommendations of abstinence and the usual medication regimen with doxycycline. Wine should not interfere with the treatment.

DIF: Applying/Application REF: 1539
KEY: Reproductive problems| infection
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

11. A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease. She is in pain, with a rating of 7 on a scale of 0 to 10. What comfort measure can the nurse delegate to the unlicensed assistive personnel (UAP)?
a. Administer Tylenol #3 immediately.
b. Apply a heating pad to the lower abdomen.
c. Position the client in a semi-Fowlers position.
d. Teach the client to increase intake of fluids.
ANS: C
The client with pelvic inflammatory disease usually experiences lower abdominal tenderness. The UAP can position the client. Only the nurse can administer medications, initially apply heat to the clients abdomen, and perform teaching.

DIF: Applying/Application REF: 1543
KEY: Reproductive problems| pain| comfort measures| unlicensed assistive personnel (UAP) MSC: Integrated Process: Caring
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

12. A client with pelvic inflammatory disease is seen by the nurse 72 hours after starting oral antibiotics. Which finding leads the nurse to take immediate action?
a. Feelings of anger that her partner infected her
b. Loose stools over the last 2 days
c. Anorexia and nausea
d. Chills and a temperature of 101 F
ANS: D
Chills and fever could indicate a persistent infection and the immediate need to alter the dose or type of antibiotic. Anger is a normal reaction to a sexually transmitted disease and the pain of pelvic inflammatory disease. Gastrointestinal symptoms are common side effects of antibiotics but not an immediate cause for intervention.

DIF: Applying/Application REF: 1542
KEY: Reproductive problems| infection| nursing assessment
MSC: Integrated Process: Nursing Process: Assessment
NOT: Client Needs Category: Physiological Integrity: Physiological Adaptation

13. A 19-year-old college student seeks information from the schools nurse about how to avoid sexually transmitted diseases (STDs) without abstinence as a choice. Which statement by the nurse is best?
a. Urinating after intercourse will eliminate the risk of infection.
b. A vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV).
c. Oral contraception can prevent pregnancy and STDs.
d. Good handwashing helps prevent infection associated with STDs.
ANS: B
Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and genital warts. While there is some truth that urination after intercourse may decrease the risk of infection by flushing out organisms, it does not eliminate the risk of contaminating bacteria traveling up the urethra. The other statements are not accurate.

DIF: Applying/Application REF: 1538
KEY: Reproductive problems| patient teaching| infection| safer sexual practices
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Safe and Effective Care Environment: Management of Care

14. The nurse teaches a client with genital herpes about effective comfort measures. Which statement by the client indicates a need for further teaching by the nurse?
a. I can apply warm towels or ice packs to the lesions.
b. Sitz baths three times a day may help ease the pain.
c. I understand there are anesthetic sprays and ointments.
d. I really should try to limit urination due to the pain.
ANS: D
The client should urinate frequently, not limit voiding. Voiding while in the shower or tub should lessen the discomfort. Warm compresses, ice packs, sitz baths, and anesthetic sprays and ointments are all effective comfort measures that can be used with genital herpes.

DIF: Remembering/Knowledge REF: 1536
KEY: Reproductive problems| pain| comfort measures
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Basic Care and Comfort

MULTIPLE RESPONSE

1. A primary care clinic sees some clients with sexually transmitted diseases. Which clients would the nurse be required to report to the local authority in every state, according to the Centers for Disease Control and Prevention? (Select all that apply.)
a. Client with Chlamydia
b. Woman with gonorrhea
c. Man with syphilis
d. Client with human immune deficiency virus
e. Female with pelvic inflammatory disease
ANS: A, B, C, D
Chlamydia, gonorrhea, syphilis, chancroid, human immune deficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) are all reportable to local authorities in every state. Pelvic inflammatory disease does not need to be reported.

DIF: Remembering/Knowledge REF: 1531
KEY: Reproductive problems| infection control| secondary prevention
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Safe and Effective Care Environment: Safety and Infection Control

2. A nurse wants to reduce the risk potential for transmission of chlamydia and gonorrhea with a female client diagnosed with both diseases. Which items should be included in the clients teaching plan? (Select all that apply.)
a. Expedited partner therapy
b. Abstinence until therapy is completed
c. Use of internal uterine devices
d. Proper use of condoms
e. Re-screening for infection
f. Use of oral contraception
ANS: A, B, D, E
As part of client/partner education, the nurse should explain the expedited partner therapy (practice of treating both sexual partners by providing medication to the client for the partner). The nurse should also emphasize the need for abstinence from sexual intercourse until treatment is finished, proper use of condoms, and re-screening for re-infection 3 to 12 months after treatment. The use of an intrauterine device and oral contraception is not part of the plan.

DIF: Applying/Application REF: 1539
KEY: Reproductive problems| infection| patient-centered care
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential

3. A client being treated for syphilis visits the office with a possible allergic reaction to benzathine penicillin G. Which abnormal findings would the nurse expect to document? (Select all that apply.)
a. Red rash
b. Shortness of breath
c. Heart irregularity
d. Chest tightness
e. Anxiety
ANS: A, B, D, E
The nurse should keep all clients at the office for at least 30 minutes after the administration of benzathine penicillin G. Allergic manifestations consist of rash, shortness of breath, chest tightness, and anxiety, depicting anaphylaxis and serum sickness. Heart irregularity is not seen as an allergic manifestation.

DIF: Remembering/Knowledge REF: 1534
KEY: Reproductive problems| antibiotics| allergic reaction
MSC: Integrated Process: Communication and Documentation
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

4. Which risk factors would the nurse teach a 23-year-old client about to prevent pelvic inflammatory disease (PID)? (Select all that apply.)
a. Having multiple sexual partners
b. Using an intrauterine device (IUD)
c. Smoking
d. Drinking two alcoholic beverages per day
e. Having a history of sexually transmitted diseases (STDs)
ANS: A, B, C, E
Some of the same factors that place women at risk for STDs also place women at risk for PID: sexually active women of age younger than 26 years, multiple sexual partners, use of an IUD, smoking, and a history of STDs. Alcohol consumption does not impact a womans risk for PID.

DIF: Remembering/Knowledge REF: 1542
KEY: Reproductive problems| primary survey| safer sexual practices
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Health Promotion and Maintenance

5. The nurse is teaching a client who is taking an oral antibiotic for treatment of a sexually transmitted disease (STD). Which statements by the client indicate a correct understanding of the treatment? (Select all that apply.)
a. I need to drink at least 8 glasses of fluid each day with my antibiotic.
b. I should read the instructions to see if I can take the medication with food.
c. Antacids should not interfere with the effectiveness of the antibiotic.
d. I need to wait 7 days after the last dose of the antibiotic to engage in intercourse.
e. It should not matter if I skip a couple of doses of the antibiotic.
ANS: A, B, D
When a client is being treated with an oral antibiotic for an STD, 8 to 10 glasses of fluid should be routine, medication instructions should be reviewed, and at least a week break should occur between the last dose of the antibiotic and sexual intercourse to allow for the medications full effects. Use of antacids and missing doses could decrease the effectiveness of the antibiotic.

DIF: Remembering/Knowledge REF: 1543
KEY: Reproductive problems| antibiotics| medication adherence
MSC: Integrated Process: Teaching/Learning
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

SHORT ANSWER

1. A 23-year-old female was admitted to the hospital for intravenous antibiotic treatment of pelvic inflammatory disease. The provider has ordered cefazolin (Ancef) to be administered every 8 hours. At what rate should the nurse infuse the medication if the pharmacy provides 1 g of the medication in 50 mL of 0.9% NaCl to infuse in 30 minutes? (Record your answer using a whole number.) _____ mL/hr

ANS:
100 mL/hr
To calculate using the dimensional analysis method: (50 mL/30 min) (60 min/1 hr) = 100 mL/hr.

DIF: Applying/Application REF: 1545
KEY: Reproductive problems| drug calculation| antibiotics
MSC: Integrated Process: Nursing Process: Analysis
NOT: Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

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