Chapter 76: Care of Patients with Sexually Transmitted Disease Nursing School Test Banks

Chapter 76: Care of Patients with Sexually Transmitted Disease

Test Bank

MULTIPLE CHOICE

1. The nurse is teaching a young woman about her risk of contracting a sexually transmitted disease (STD). Which statement by the client indicates that further instruction is needed?

a.

I am at decreased risk for an STD if I dont rely on contraceptive sponges or foams to protect me.

b.

I am at decreased risk for an STD because I am using an intrauterine device for contraception.

c.

I am at increased risk for an STD because of the way that my body is designed as a woman.

d.

I will be at increased risk for an STD if I rely on oral contraceptives to protect me from contracting a disease.

ANS: B

Using an intrauterine device provides no protection against contracting a sexually transmitted disease. Other risk factors that increase a young womans chances of contracting a sexually transmitted disease include the vascularity of the vagina and reliance on contraceptive sponges or foams or on oral contraceptives for protection against pregnancy and STDs.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

2. Which statement by a middle-aged woman indicates that further instruction is needed for her and her partner regarding prevention of sexually transmitted diseases (STDs)?

a.

Im glad we dont have to use condoms anymore because I cant get pregnant.

b.

Changes in my vagina may make me more likely to be at risk for an STD.

c.

I told my partner that we need to switch to condoms instead of the pill now.

d.

I should report any evidence of infection, even if symptoms are minor.

ANS: A

The female who is probably postmenopausal should still use barrier protection to decrease the risk of contracting a sexually transmitted disease. Unfortunately, many women forget that they need barrier protection (i.e., condoms) once the need for contraception is gone. Any evidence of infection should be reported promptly because vaginal atrophy makes this client more vulnerable to develop an STD.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Teaching/Learning

3. The nurse is conducting an assessment on a client and identifies a lesion that appears as a smooth indurated area. Which is the highest priority action on the part of the nurse?

a.

Question the client further regarding sexual practices.

b.

Ask the client about any associated symptoms.

c.

Document the findings and obtain a specimen of fluid from the lesion.

d.

Don gloves before continuing to assess the lesion any further.

ANS: D

The lesion could be a chancre, which is highly contagious. The nurse should be wearing gloves. The nurse should finish assessment of the lesion before continuing to interview the client and documenting findings. The nurse does need to collect fluid for a culture, but the nurses safety is the priority.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

4. The nurse is counseling a client who has recently been diagnosed with syphilis. Which is the highest priority instruction that the nurse provides to the client regarding sexual partners?

a.

As long as both of you are being treated, abstinence is not necessary.

b.

If you both have the same disease, you can continue to have sex.

c.

Your partner must be treated with antibiotics within the next 90 days.

d.

Once the health department gets your partners name, confidentiality is not considered to be important.

ANS: C

Once a client has been diagnosed with syphilis, his or her partner must be prophylactically treated as soon as possible, preferably within the next 90 days. Sexual abstinence is required of both partners until they complete treatment. Although the disease will be reported to the local health department, all information will be held in strictest confidence.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1656

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Teaching/Learning

5. A client has been diagnosed with genital herpes. Which statement by the client indicates an accurate understanding of the disease and treatment?

a.

Antiviral drugs can cure genital herpes and prevent a recurrence.

b.

I can prevent outbreaks with suppressive antiviral therapy.

c.

Suppressive therapy will prevent shedding of the virus.

d.

Medication should be taken only when symptoms are present.

ANS: B

No cure for the disease is known, but it can be controlled with suppressive therapy with

antiviral drugs. The client can be shedding the virus with no symptoms present and despite the use of antiviral medications. Medications should be taken on a suppressive basis or as soon as the client has symptoms.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes) MSC: Integrated Process: Teaching/Learning

6. A client has recently been diagnosed with gonorrhea. The client comes from a deeply religious family. When the nurse finds the client weeping, the client tells the nurse, Im being punished for having an affair. How does the nurse respond?

a.

Surely you dont really believe that.

b.

Why dont we get you a sedative?

c.

Tell me more about how you feel.

d.

Which religion do you practice?

ANS: C

The priority for the nurse is to gain more information to have a clear understanding about how the client feels. The other answers discount the seriousness of the clients feelings or are evasive.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Therapeutic Communication)

MSC: Integrated Process: Nursing Process (Assessment)

7. A client has just been diagnosed with a recurrence of genital herpes simplex. She asks how this is possible because she has not had sex since she was diagnosed and treated 1 year ago. Which is the nurses best response?

a.

Sometimes one course of therapy is not enough to eradicate the disease.

b.

The disease can be controlled but is never cured, and outbreaks are common.

c.

Did you take the medication exactly the way it was prescribed for you?

d.

If you have more than one sex partner, you may have more than one strain.

ANS: B

Viral diseases cannot be cured. Antiviral drugs suppress viral replication but do not kill the organism. The causative virus remains in the body and can become active at any time. The other statements are not accurate.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1656

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Teaching/Learning

8. A client has secondary syphilis. What precautions are necessary for the nurse to take when caring for this client?

a.

No precautions in addition to Standard Precautions are necessary.

b.

Gloves should be worn whenever direct contact with the clients skin is required.

c.

Handwashing is required before and after contact with the client.

d.

A mask should be worn by anyone entering the clients room.

ANS: B

The secondary stage of syphilis is a systemic disease, with microorganisms present in the clients blood. Skin lesions and rashes are present. These lesions are considered highly contagious and should not be touched without gloves. Handwashing before and after contact is needed but is not sufficient to prevent spread of the disease. Masks are not needed.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

9. A client with primary syphilis was treated with an intramuscular injection of benzathine penicillin G. Later, the client reports a hard painful lump at the injection site and aching joints. Which is the nurses highest priority initial action?

a.

Assess the clients vital signs.

b.

Give the client acetaminophen (Tylenol).

c.

Document the finding in the chart.

d.

Apply a warm compress to the site.

ANS: A

A common reaction to penicillin injections for primary syphilis is the Jarisch-Herxheimer reaction, caused by rapid destruction of the causative microorganism and release of intracellular products. This is not usually serious, but it can cause fever and hypotension. The nurse should first assess the clients blood pressure for stability and should take the temperature. Then if the clients condition warrants, the nurse can administer acetaminophen or even fluids if needed. Documentation can be completed after the assessment is done. A warm compress to the site may or may not be helpful.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Diagnostic Tests/Treatments/Procedures)

MSC: Integrated Process: Nursing Process (Implementation)

10. Which statement made by a client about condom use indicates a need for clarification?

a.

I will use a new condom each time I have intercourse.

b.

I will use an oil-based lubricant whenever I have intercourse.

c.

I will always use a latex condom rather than a natural membrane condom.

d.

I will keep the condom on until I have withdrawn from the vagina.

ANS: B

Oil-based lubricants can dissolve or damage the condom. Only water-soluble lubricants should be used with condoms. The other statements are accurate.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Health Promotion and Maintenance (Self-Care)

MSC: Integrated Process: Nursing Process (Evaluation)

11. A client has been diagnosed with Trichomonas vaginalis. Which statement by the client indicates an accurate understanding of this disease?

a.

I need to have a throat culture for Trichomonas.

b.

This will affect only my vagina and can cause itching.

c.

My partner does not need to be treated.

d.

My lymph nodes may stay swollen after treatment.

ANS: B

Trichomoniasis affects only the vagina in females, leading to itching and vaginal discharge. Men can get it too, so both partners need treatment. Lymph nodes are not affected.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Evaluation)

12. A client with pelvic inflammatory disease (PID) from gonorrhea asks how this can cause sterility. Which is the nurses response?

a.

The infection damages the ovary so that less estrogen is secreted and ovulation is not possible.

b.

The infection remains in your body and can infect your baby, so it is best if you dont become pregnant.

c.

If the infection is present in the fallopian tubes, it can cause enough scarring to block the tubes permanently.

d.

The infection causes such damage to the cervix that it cannot contain a pregnancy inside the uterus for longer than 3 months.

ANS: C

The chronic inflammation sets up scar tissue formation in the fallopian tubes, thereby narrowing or completely blocking the lumens. This situation can prevent fertilization by not allowing sperm to reach the ovulated egg. Irreversible scarring or stricture, causing sterility, may occur even before the condition is diagnosed. The other statements are inaccurate.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1663

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Alterations in Body Systems) MSC: Integrated Process: Teaching/Learning

13. A client is brought to the emergency department by the family, who state that the client was diagnosed last week with gonorrhea but has not taken the medications yet. Today the family notes that the client is not acting right and seems confused. Which action by the nurse is most appropriate?

a.

Start an IV and notify the health care provider about the clients diagnosis.

b.

Perform a thorough neurologic assessment and document the findings.

c.

Administer acetaminophen (Tylenol) if the client has a fever.

d.

Ask the client why he or she has not started the medication regimen yet.

ANS: A

A rare but possible complication of gonorrhea is meningitis. Because the client has a change in mental status according to the family, the nurse must prepare the client for IV antibiotics to be given as soon as possible. The provider needs to know the diagnosis of untreated gonorrhea to help plan appropriate, rapid care. Conducting a neurologic examination and administering Tylenol are appropriate but do not take priority over initiating appropriate therapy. When the client is stable, the nurse can assess for reasons leading to noncompliance and offer appropriate assistance, such as referral to social services if the client cannot afford medications.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities) MSC: Integrated Process: Nursing Process (Analysis)

14. A client was diagnosed with chancroid. Which manifestation does the nurse associate with this condition?

a.

Vaginal discharge

b.

High fever

c.

History of ectopic pregnancies

d.

Genital ulcers

ANS: D

Chancroid is characterized by genital ulcers and occasionally by enlarged lymph nodes. The other assessment findings are not related to chancroid.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Analysis)

15. Which disease process places the client at greatest risk for development of an ectopic pregnancy?

a.

Chlamydia infection

b.

Genital herpes

c.

Human papilloma virus infection

d.

Pelvic inflammatory disease (PID)

ANS: D

Pelvic inflammatory disease is a leading cause of infertility and ectopic pregnancies. The other diseases are not as likely to cause an ectopic pregnancy.

DIF: Cognitive Level: Knowledge/Remembering REF: p. 1663

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialPotential for Complications from Surgical Procedures and Health Alterations)

MSC: Integrated Process: Nursing Process (Assessment)

16. Which should be the nursing focus for a female client during the initial outbreak of genital herpes simplex?

a.

Instruction in condom use

b.

Promotion of comfort

c.

Prevention of pregnancy

d.

Institution of isolation

ANS: B

The initial outbreak of genital herpes simplex in a woman causes severe discomfort. Promotion of comfort is the first priority, because clients may not be receptive to instruction attempts until some degree of comfort has been achieved.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationIllness Management) MSC: Integrated Process: Nursing Process (Implementation)

17. A female client is diagnosed with human papilloma virus (HPV) infection. Which intervention by the nurse takes priority?

a.

Instruct the client on using podofilox (Condylox) cream.

b.

Prepare the client for a Pap test and HPV DNA testing.

c.

Teach the client to take all medications until they are gone.

d.

Encourage the client to drink 8 to 10 glasses of water daily.

ANS: B

Because certain strains of HPV cause cervical cancer, the client needs to have a Pap smear and HPV DNA testing done. The nurse should also teach her to use topical medications, such as Condylox, but this is not as high a priority as diagnostic testing. The other two options are not related to infection with HPV.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Management of CareEstablishing Priorities) MSC: Integrated Process: Nursing Process (Analysis)

18. A 24-year-old woman has just been diagnosed with human papilloma virus (HPV) infection. She is very angry at her ex-boyfriend, who has been her only sexual contact. She is crying and says that she isnt going to tell him that he is infected. Which is the nurses best response?

a.

You do not have to tell him because this is not a reportable disease in this state.

b.

Because there is no cure for this disease, telling him would be of no benefit.

c.

He should be told so he can take precautions to prevent the spread of infection.

d.

You should tell him because he may not know that this can cause cancer.

ANS: C

Many clients are angry at the person who infected them with a sexually transmitted disease. Even though HPV is not a reportable disease in many states, all contacts should be told, so that they can take precautions to prevent infecting others. Although some strains of HPV do cause cancer, this is not the primary reason for telling a male sexual contact about the infection.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Psychosocial Integrity (Coping Mechanisms)

MSC: Integrated Process: Nursing Process (Implementation)

19. A client has been diagnosed with anal cancer. Which test does the nurse prepare the client for?

a.

Darkfield microscopy

b.

Culture of discharge

c.

Blood draw for the Venereal Disease Research Laboratory (VDRL) test

d.

Human papilloma virus (HPV) DNA

ANS: D

Human papilloma virus is known to cause cancers of the genitals, anus, and perianal areas. The client needs to undergo testing for HPV DNA. Darkfield microscopy is used to detect syphilis. Discharge is tested for gonorrhea, Chlamydia, and pelvic inflammatory disease. The VDRL is also used for syphilis.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Reduction of Risk PotentialDiagnostic Tests) MSC: Integrated Process: Nursing Process (Assessment)

20. A female client admitted for cardiac problems also has condyloma acuminatum. Which type of precautions does the nursing staff implement with this client?

a.

Standard

b.

Airborne

c.

Contact

d.

Droplet

ANS: A

Although it is considered highly contagious, condyloma acuminatum requires close intimate contact for transmission. Only Standard Precautions are needed for health care providers.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Safe and Effective Care Environment (Safety and Infection ControlStandard Precautions/Transmission-Based Precautions/Surgical Asepsis)

MSC: Integrated Process: Nursing Process (Implementation)

21. Why are women more likely than men to have silent sexually transmitted disease (STD) infection?

a.

Women are less susceptible to STDs and are not assessed often for them.

b.

Lesions may not be visible, or the woman can be asymptomatic.

c.

A mans longer urethra provides increased opportunity for bacteria to multiply.

d.

Symptoms of infection in women are likely to be systemic and vague, not local.

ANS: B

Most clinical manifestations of an STD in a man are experienced in or around the penis. Most of a womans genital mucous membranes are inside the vagina and around the cervix, where direct observation of any lesions is unlikely. Also some women have no symptoms or only vague symptoms of STDs, and this leads to a delay in diagnosis.

DIF: Cognitive Level: Comprehension/Understanding REF: p. 1660

TOP: Client Needs Category: Physiological Integrity (Physiological AdaptationPathophysiology)

MSC: Integrated Process: Nursing Process (Assessment)

22. The nurse manages a clinic in an area with a high rate of sexually transmitted diseases (STDs). Which strategy best helps decrease the rate of infection?

a.

Start an expedited partner treatment program.

b.

Use a single-dose drug given in the clinic.

c.

Provide referrals to a low-cost pharmacy.

d.

Plan occasional community educational programs.

ANS: B

Although all options could decrease the occurrence rate of STDs, administering the medications needed to control two common STDs (gonorrhea and Chlamydia) right in the clinic improves compliance and will help decrease rates of infection in the fastest way. The manager would need to investigate the legal issues surrounding expedited partner treatment before starting a program.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesExpected Actions/Outcomes)

MSC: Integrated Process: Nursing Process (Implementation)

23. The nurse assesses a client and finds the manifestation shown in the photograph. Which drug does the nurse prepare to administer to the client?

a.

Doxycycline (Vibramycin)

b.

Ceftriaxone (Rocephin)

c.

Acyclovir (Zovirax)

d.

Podophyllin (Pododerm)

ANS: D

The image is of a perianal HPV infection, which can be treated by provider-applied Pododerm. Doxycycline is used to treat chlamydia, ceftriaxone is for gonorrhea, and acyclovir is for herpes.

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral Therapies-Expected Actions/Outcomes) MSC: Integrated Process: Nursing Process (Analysis)

COMPLETION

1. A client weighing 110 lb is admitted with acute pelvic inflammatory disease. The client is ordered to receive an initial dose of gentamicin (Garamycin), 2 mg/kg. The client will receive an initial dose of gentamicin of ____ milligrams.

ANS:

100

1 kg = 2.2 lb

110 lb/(2.2 kg/lb) = 50 kg

2 mg/kg 50 kg = 100 mg of gentamicin

DIF: Cognitive Level: Application/Applying or higher REF: N/A

TOP: Client Needs Category: Physiological Integrity (Pharmacological and Parenteral TherapiesDosage Calculation)

MSC: Integrated Process: Nursing Process (Implementation)

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