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Chapter 74: Care of Patients with Sexually Transmitted Diseases

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Chapter 74: Care of Patients with Sexually Transmitted Diseases Ignatavicius: Medical­Surgical Nursing, 8th Edition MULTIPLE CHOICE 1. A nurse instructor is teaching a student nurse about the fact... ors 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 anti­infective 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| evidence­based 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 client’s lesions. d. Take a history regarding any cardiovascular symptoms. ANS: C The client is displaying symptoms similar to secondary syphilis, with flu­like symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the client’s 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?” This study source was downloaded by 100000832361371 from CourseHero.com on 05-21-2022 11:43:13 GMT -05:00 https://www.coursehero.com/file/18603768/Care-of-Patients-with-Sexually-Transmitted-Diseases/ Your text here 1 c. “When was your last sexual encounter?” d. “Do you have a history of sexually transmitted disease?” ANS: B Benzathine penicillin G is the evidence­based treatment for primary syphilis. The client needs to be assessed for allergies before treatment. The other questions would be helpful in the client’s 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 African­American 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 client’s 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 19­year­old 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 This study source was downloaded by 100000832361371 from CourseHero.com on 05-21-2022 11:43:13 GMT -05:00 https://www.coursehero.com/file/18603768/Care-of-Patients-with-Sexually-Transmitted-Diseases/ 6. A 26­year­old 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 client’s 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 False­positive 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 [Show More]

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