Chapter 41: Care of Patients with Sexually Transmitted Infections My Nursing Test Banks

Chapter 41: Care of Patients with Sexually Transmitted Infections

MULTIPLE CHOICE

1. The nurse cautions the homosexual man that his inflamed rectal tissue and rectal tear put him at risk for:

a.

an abscess.

b.

human immunodeficiency virus (HIV) infection.

c.

hemorrhoids.

d.

rectal hemorrhage.

ANS: B

Open lesions and inflamed tissue increase the risk of HIV infection.

DIF: Cognitive Level: Comprehension REF: 938 OBJ: 7 (theory)

TOP: Exposure to HIV KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

2. The nurse instructs a sexually active teenager that frequent douching can cause:

a.

a sexually transmitted infection.

b.

bacterial vaginosis.

c.

pelvic inflammatory disease.

d.

purulent vaginitis.

ANS: B

Bacterial vaginosis is caused when frequent douching changes the pH of the vaginal vault and creates an environment conducive to bacterial invasion. Sexually transmitted infections are not transferred by douching. Pelvic inflammatory disease is a condition that most often results from an untreated infection. Vaginitis is an inflammatory condition that does not result from douching.

DIF: Cognitive Level: Comprehension REF: 939 OBJ: 9 (theory)

TOP: Vaginosis: Douching KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

3. The nurse is aware that women are at a greater risk for contracting sexually transmitted infections (STIs) than men because:

a.

of longer period of time during which male secretions are in contact with female mucous membranes.

b.

estrogens make vaginal membranes more susceptible.

c.

penile friction to the vaginal wall encourages STIs.

d.

changing hormonal levels create a conducive vaginal environment.

ANS: A

Male secretions are in contact with female mucous membranes longer than female secretions are in contact with the penis. Estrogen provides for vaginal lubrication and therefore reduces friction and tissue tearing.

DIF: Cognitive Level: Comprehension REF: 939 OBJ: 1 (theory)

TOP: Female Incidence of STIs KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

4. The nurse cautions that infections can enter the upper genital tract as the mucous plug becomes more permeable:

a.

during intercourse.

b.

during premenstrual period.

c.

during postmenstrual period.

d.

while on oral birth control pills.

ANS: B

The mucous plug in the cervix of women provides protection to the upper genital tract. The hormonal changes make it become more permeable around the menstrual period. This change can result in an increased risk for infections in the upper genital tract, such as pelvic inflammatory disease (PID).

DIF: Cognitive Level: Comprehension REF: 939 OBJ: 3 (clinical)

TOP: Pelvic Inflammatory Disease: Etiology

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

5. The nurse identifies a misconception about the vaccination against human papillomavirus (HPV) when the patient says:

a.

I know I must have three doses of the vaccine.

b.

Girls as young as 9 years of age may be vaccinated.

c.

I am relieved that the vaccine protects me from all HPV infections.

d.

I know I should continue having regular Pap smears.

ANS: C

The vaccine protects against the most prevalent infections, genital warts and precancerous cervical lesions, but not against all HPV infections. The remaining statements are correct.

DIF: Cognitive Level: Application REF: 940 OBJ: 3 (clinical)

TOP: HPV: Vaccinations KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Health Promotion and Maintenance

6. The nurse affirms that many skin lesions associated with sexually transmitted infections are in the genital area, but skin lesions of syphilis can be seen in which location?

a.

On palms of hands

b.

Behind the ears

c.

At scalp margins

d.

In the axillae

ANS: A

The rash that occurs in the secondary phase of syphilis is seen on the palms of the hands and the soles of the feet.

DIF: Cognitive Level: Application REF: 940 OBJ: 8 (theory)

TOP: Syphilis: Skin Lesions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

7. On the diagnosis of syphilis in a young female patient, the nurse informs her that her illness must be reported to:

a.

her parents.

b.

the Centers for Disease Control and Prevention (CDC).

c.

the hospital infection control department.

d.

the local public health agency.

ANS: D

STIs are reported to the local public health agency for accumulation by the CDC. The local public health agency will get in touch with the sexual contacts of the patient and attempt to initiate treatment.

DIF: Cognitive Level: Application REF: 940 OBJ: 3 (clinical)

TOP: Reporting Sexually Transmitted Infections (STIs)

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

8. A female patient comes to the emergency department with severe abdominal pain, a temperature of 101 F, and a foul-smelling, purulent vaginal discharge. These assessments lead the nurse to suspect:

a.

pelvic inflammatory disease (PID).

b.

gonorrhea.

c.

syphilis.

d.

vaginosis.

ANS: A

These are the cardinal indicators of PID. Gonorrhea most often presents in females with vaginal discharge and burning with urination. The initial state of syphilis presents with chancre (hard, painless sore) on the mucous membrane of the mouth or genitals. Vaginosis most often presents with symptoms including a grayish-white discharge that has a fishy odor.

DIF: Cognitive Level: Application REF: 939 OBJ: 1 (theory)

TOP: PID: Signs and Symptoms KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

9. A gram-positive gonococcus is an organism that after being stained with crystal violet will:

a.

fluoresce after counterstain is applied.

b.

accept the counterstain.

c.

retain the original stain after the counterstain is applied.

d.

turn dark after the counterstain is applied.

ANS: C

Staining procedures differentiate organisms by using dyes that have been found to stain some bacteria in specific ways. An example of this would be a Gram stain, in which bacteria are first stained with crystal violet, then treated with a strong iodine solution, decolorized with ethanol or ethanol acetone, and then counterstained with contrasting dye. Those retaining the initial stain are considered gram positive; those losing the stain but accepting the counterstain are considered gram negative.

DIF: Cognitive Level: Application REF: 941 OBJ: 3 (theory)

TOP: Gram Stain: Significance KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

10. When collecting a urethral swab from a male patient suspected of having gonorrhea, the nurse will collect the specimen ______ after voiding.

a.

immediately

b.

10 minutes

c.

30 minutes

d.

60 minutes

ANS: D

The specimen should be collected at least 1 hour after voiding as the urine will have flushed out the organisms.

DIF: Cognitive Level: Application REF: 941 OBJ: 3 (theory)

TOP: Gonorrhea Swab: Technique KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

11. The young woman newly diagnosed with genital herpes is reminded that she should avoid sexual intercourse until:

a.

she has been on medication for a week.

b.

she no longer has pain on urination.

c.

her partner has been on medication and is free of lesions.

d.

her lesions are gone.

ANS: D

People with genital herpes should avoid sex until all the lesions are gone.

DIF: Cognitive Level: Application REF: 943 OBJ: 1 (clinical)

TOP: Herpes: Prevention of Contagion KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

12. The nurse explains to a patient who has genital herpes that she may experience a prodromal signal of an impending outbreak, which most likely will include:

a.

elevation in temperature.

b.

tingling sensation in the vagina.

c.

copious vaginal discharge.

d.

migraine-like headache.

ANS: B

Many women with herpes can predict an outbreak because of tingling or burning in the vagina. Elevations in temperature, increased vaginal discharge, and headaches are not common precursors of an outbreak of herpes.

DIF: Cognitive Level: Comprehension REF: 943 OBJ: 1 (clinical)

TOP: Herpes: Warning of Outbreak KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

13. The nurse interviewing a college student who believes he has been exposed to gonorrhea tells him that the incubation period for gonorrhea is usually ______ after exposure.

a.

2 to 6 days

b.

1 week

c.

2 weeks

d.

4 weeks

ANS: A

The incubation period is 2 to 6 days before symptoms may appear.

DIF: Cognitive Level: Comprehension REF: 944 OBJ: 6 (theory)

TOP: Gonorrhea: Incubation Time KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

14. The nurse is aware that men with gonorrhea are more likely to seek medical attention because their symptoms are more visible than those of women. Which clinical manifestation is most consistent with symptoms of gonorrhea experienced by men?

a.

Copious purulent discharge from the penis

b.

Hematuria at the beginning of the urination stream

c.

Ulcer on the penis

d.

Scaly lesions on the scrotum

ANS: A

The man can see his sexual organ and evaluate his urine easily. The man with gonorrhea will have a purulent discharge from the penis and scrotal pain. Vaginal discharges in women are not investigated until there are more significant signs such as changes in odor or color of vaginal secretions.

DIF: Cognitive Level: Application REF: 944 OBJ: 5 (theory)

TOP: Gonorrhea: Male Signs KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

15. The nurse assessing a patient in the primary stage of syphilis can observe:

a.

copious vaginal discharge.

b.

generalized skin rash.

c.

a hard painless sore on the genitals.

d.

appearance of gumma.

ANS: C

Syphilis has three stages. The chancre is visible in the primary stage of syphilis. The primary state refers to the first 3 weeks after infection. The chancre will disappear within a few weeks. The secondary stages occur 6 weeks later. Symptoms vary and may include a generalized skin rash. Tertiary is the late stage. It is the period 1 to 20 years after infection. At that time the spirochetes have had access to all body tissues. Gumma, a soft encapsulated tumor, appears on any organ, causing symptoms (including neurologic).

DIF: Cognitive Level: Comprehension REF: 947 OBJ: 8 (theory)

TOP: Syphilis: Primary Stage KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

16. When the secondary stage of syphilis occurs, a sign that indicates the progression of the disease is:

a.

foul-smelling penile discharge.

b.

positive serology.

c.

purulent skin rash.

d.

scrotal swelling.

ANS: B

A positive serology will appear in the secondary stage of syphilis. Penile discharge is not associated with the secondary stage of syphilis. A generalized skin rash, not purulent, may be seen in the secondary stage of syphilis. Scrotal swelling is not associated with syphilis.

DIF: Cognitive Level: Comprehension REF: 947 OBJ: 8 (theory)

TOP: Syphilis: Secondary Stage KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

17. A pregnant patient who is human immunodeficiency virus (HIV) positive should be encouraged to:

a.

breast-feed baby to increase newborns antibody count.

b.

have a vaginal birth.

c.

engage in oral, rather than vaginal, sex.

d.

remain on medication protocol.

ANS: D

Remaining on medication is essential. Certain prescribed drug combinations may significantly reduce the transmission to the fetus. Patients with HIV should avoid breast-feeding and cesarean birth. HIV can be spread by oral sex.

DIF: Cognitive Level: Application REF: 946 OBJ: 2 (clinical)

TOP: HIV: Preventive Actions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

18. A patient has been diagnosed with chlamydia for the second time in a 5-month period. Data collection reveals that the patient was not compliant with the plan of treatment with the last infection. Which will most likely be the best method of treatment?

a.

Doxycycline

b.

Erythromycin

c.

Diflucan

d.

Azithromycin

ANS: D

Chlamydia is best treated with a single dose of azithromycin for patients having a compliance problem. Doxycycline requires a 7-day course of therapy and may not be best given this patients history. Erythromycin is indicated to manage the disease in pregnant women. Diflucan is an antifungal medication used in the management of candidiasis.

DIF: Cognitive Level: Application REF: 942 OBJ: 4 (theory)

TOP: Table 41-1 Common Sexually Transmitted Infections

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse is collecting information from a patient during her annual pelvic examination. The patient reports that she has noted a strong vaginal odor after intercourse. Which condition may be present?

a.

Gonorrhea

b.

Bacterial vaginosis

c.

Chlamydia

d.

Syphilis

ANS: C

Chlamydia may cause a strong vaginal odor noted after sexual intercourse. Gonorrhea causes vaginal discharge and a difficulty voiding. Bacterial vaginosis is associated with a fishy vaginal odor and discharge. Syphilis causes a chancre sore.

DIF: Cognitive Level: Comprehension REF: 942 OBJ: 4 (theory)

TOP: Table 41-1 Sexually Transmitted Infections

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

MULTIPLE RESPONSE

20. The nurse clarifies that sexually transmitted infections (STIs) are transmitted by: (Select all that apply.)

a.

sexual intercourse.

b.

oral-genital route.

c.

contact with infected blood.

d.

placenta to infant.

e.

contact with infected body fluids.

ANS: A, B, C, D, E

All options listed are possible transmission routes for STIs.

DIF: Cognitive Level: Application REF: 938 OBJ: 3 (clinical)

TOP: STIs: Transmission KEY: Nursing Process Step: Implementation

MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control

21. The nurse tells a high school senior who is newly diagnosed with herpes that the rise in the number of sexually transmitted infections (STIs) can be attributed to: (Select all that apply.)

a.

an increase in the number of sexually active teenagers.

b.

an increase in the opportunity to have multiple partners.

c.

knowledge deficit about signs and symptoms of STIs.

d.

teenagers being reluctant to report diseases.

e.

young peoples inability to acquire confidential health care.

ANS: A, B, C, D, E

All options are valid reasons for the increasing incidence of STIs.

DIF: Cognitive Level: Application REF: 938 OBJ: 1 (clinical)

TOP: Increasing Incidence of STIs KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

22. The nurse points out that the use of oral contraceptives has increased the risk of acquiring a sexually transmitted infection (STI) because oral contraceptive pills: (Select all that apply.)

a.

increase the level of progesterone.

b.

cause an alkaline vaginal environment.

c.

may reduce the perception of the need for condom use.

d.

decrease the inflammatory response.

e.

alter cervical secretions.

ANS: B, C, E

The use of oral contraceptive pills causes the vaginal vault to become alkaline from cervical secretions, which makes for a conducive environment for STIs. Oral birth control pills make the need for a condom redundant as pregnancy will be averted by the medication.

DIF: Cognitive Level: Application REF: 939 OBJ: 3 (clinical)

TOP: Oral Contraceptive: Effect on Rising STI Incidence

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

23. The nurse reviews the list of sexually transmitted infections (STIs) that must be reported, which include: (Select all that apply.)

a.

vaginitis.

b.

gonorrhea.

c.

pelvic inflammatory disease.

d.

chlamydia.

e.

lymphogranuloma.

ANS: B, C, D, E

All STIs listed are reportable in all states except for vaginitis. Syphilis is also a reportable STI. However, each state may add others to that list.

DIF: Cognitive Level: Comprehension REF: 940 OBJ: 3 (clinical)

TOP: Reportable STIs KEY: Nursing Process Step: Planning

MSC: NCLEX: Health Promotion and Maintenance

24. The nurse outlines reasons why young patients are frequently reluctant to have their sexually transmitted infections (STIs) reported, which are: (Select all that apply.)

a.

fear of parental reaction.

b.

embarrassment about their condition.

c.

fear of reprisal from identified contacts.

d.

fear of information becoming public.

e.

fear of rejection by peers.

ANS: A, B, C, D, E

All the options are realistic concerns about reporting contacts.

DIF: Cognitive Level: Analysis REF: 940 OBJ: 3 (clinical)

TOP: Reporting STIs: Reasons for Reluctance

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

25. A patient who has been diagnosed with chlamydia is started on a protocol of doxycycline and is reminded by the nurse that: (Select all that apply.)

a.

her partner does not need treatment.

b.

she should use a condom to protect partners from disease.

c.

the disease can develop into pelvic inflammatory disease.

d.

the entire prescription of antibiotics should be taken.

e.

the disease can result in an ectopic pregnancy.

ANS: B, C, D, E

The partner should be under treatment as well.

DIF: Cognitive Level: Application REF: 942 OBJ: 3 (clinical)

TOP: Chlamydia: Instructions KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

26. The nurse urges a pregnant patient with gonorrhea to seek medical care because, if untreated, gonorrhea can result in: (Select all that apply.)

a.

pelvic inflammatory disease.

b.

sterility.

c.

obstructed fallopian tubes.

d.

ectopic pregnancy.

e.

ophthalmia neonatorum in the newborn.

ANS: A, B, C, D, E

All options are possible complications from untreated gonorrhea.

DIF: Cognitive Level: Application REF: 944 OBJ: 6 (theory)

TOP: Gonorrhea: Complications KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

27. The nurse is providing information to a patient who has recently been diagnosed with genital herpes. Which statements indicates the need for further instruction? (Select all that apply.)

a.

I am only contagious when I have open sores.

b.

The infection is limited to only my genital region.

c.

There is no permanent cure for this condition.

d.

I will need to contact my physician for antibiotic cream for the open lesions whenever I have an outbreak.

e.

Washing my hands is going to be a good method to prevent introduction of bacteria to the area.

ANS: A, B, D

The disease may be spread during outbreaks. It is possible to spread the infection with viral shedding between outbreaks. Herpes is a lifelong condition. There is no cure. The conditions treatment can include the administration of antiviral medication. Antibiotics are not typically indicated.

DIF: Cognitive Level: Application REF: 943 OBJ: 4 (theory)

TOP: Table 41-1 Common Sexually Transmitted Infections

KEY: Nursing Process Step: Evaluation MSC: NCLEX: Health Promotion and Maintenance

COMPLETION

28. The nurse recommends that the newly diagnosed patient with herpes get current information about her disease from the local _______________.

ANS:

health department

The health department has clinics and written information in several languages that would be helpful to the newly diagnosed person.

DIF: Cognitive Level: Application REF: 950 OBJ: 4 (theory)

TOP: Sexually Transmitted Infections: Information Source

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance

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