Sexually Trasmitted Problems NCLEX

A nurse is teaching a client with genital herpes. Education for this client should include an explanation of:
a) why the disease is transmittable only when visible lesions are present.
b) the need for the use of petroleum products.
c) the option of disregarding safer-sex practices now that he’s already infected.
d) the importance of informing his partners of the disease.
D) Importance of informing his partners of the disease.
Clients with genital herpes should inform their partners of the disease to help prevent transmission. Petroleum products should be avoided because they can cause the virus to spread. The notion that genital herpes is only transmittable when visible lesions are present is false. Anyone not in a long-term, monogamous relationship, regardless of current health status, should follow safer-sex practices.
Katrina Sterrett, a 26-year-old preschool teacher, is being seen by a physician who is part of the internist group where you practice nursing. She is undergoing her annual physical and is having many lab tests done as a condition of her employment and upcoming wedding. She is returning for her results and is devastated to learn that she has the sexually-transmitted infection, gonorrhea. What would contribute to her ignorance of her condition?
a) Being asymptomatic
b) All options are correct
c) Being sexually inactive
d) Knowing the signs and symptoms of STIs
A) Being asymptomatic
Many women who have gonorrhea are asymptomatic, a factor that contributes to the spread of the disease.
Within the free clinic where you practice nursing, you hold weekly sexual education classes open to the public. Within the classroom, you communicate the CDC’s numbers for the incidence of STIs and their impact upon public health. Which is the fastest-spreading bacterial STI in the United States?
a) Gonorrhea
b) Chlamydia
c) Herpes simplex 1
d) HPV
B) Chlamydia
Chlamydia is the most common and fastest-spreading bacterial STI in the United States.

A nurse is caring for a client diagnosed with a chlamydia infection. The nurse teaches the client about disease transmission and advises the client to inform his sexual partners of the infection. The client refuses, stating, “This is my business and I’m not telling anyone. Beside, chlamydia doesn’t cause any harm like the other STDs.” How should the nurse proceed?

a) Do nothing because the client’s sexual habits place him at risk for contracting other STDs.
b) Educate the client about why it’s important to inform sexual contacts so they can receive treatment.
c) Inform the health department that this client contracted an STD.
d) Inform the client’s sexual contacts of their possible exposure to chlamydia.

B) Educate the client about why it’s important to inform sexual contacts so they can receive treatment.
The nurse should educate the client about the disease and how it impacts a person’s health. Further education allows the client to make an informed decision about notifying sexual contacts. The nurse must maintain client confidentiality unless law mandates reporting the illness; contacting sexual contacts breaches client confidentiality. Doing nothing for the client is judgmental; everyone is entitled to health care regardless of his health habits.

A nurse is teaching a health class to a group of clients likely to be at highest risk for gonorrhea. What is the age range of the clients?

a) 60 to 70 years
b) 15 to 24 years
c) 25 to 29 years
d) 30 to 45 years

B) 15 to 24 years
Gonorrhea is the second most frequently reported communicable disease in the United States. Its highest incidence occurs in the 15- to 24-year-old age group.

A 16-year-old patient comes to the free clinic and is diagnosed with primary syphilis. The patient states that she contracted this disease by holding hands with someone who has syphilis. What is the most appropriate nursing diagnosis for this patient?

a) Alteration in comfort related to impaired skin integrity
b) Fear related to complications
c) Noncompliance with treatment regimen related to age
d) Knowledge deficit related to modes of transmission

D) Knowledge deficit related to modes of transmission.
Syphilis is spread mainly by sexual contact and may be congenital. The patient displays knowledge deficit about the modes of transmission for syphilis.

A 22-year-old patient has presented to her primary care provider for her scheduled Pap smear. Abnormal results of this diagnostic test may imply infection with:

a) human papillomavirus (HPV).
b) Chlamydia trachomatis.
c) Candida albicans.
d) Trichomonas vaginalis.

A) human papillomavirus (HPV)
Although a Pap smear does not test directly for HPV, dysplasia of cervical cells is strongly associated with HPV infection. An abnormal Pap smear is not indicative of chlamydial infection, trichomoniasis, or candidiasis.

A female college student is distressed at the recent appearance of genital warts, an assessment finding that her care provider has confirmed as attributable to human papillomavirus (HPV) infection. Which of the following information should the nurse give the patient?

a) “It’s important to start treatment soon, so you will be prescribed pills today.”
b) “I’d like to give you an HPV vaccination if that’s okay with you.”
c) “There is a chance that these will clear up on their own without any treatment.”
d) “Unfortunately, this is going to greatly increase your chance of developing pelvic inflammatory disease.”

C) There is a chance that these will clear up on their own without any tx
Genital warts may resolve spontaneously, although this does not preclude recurrence. Pharmacologic treatments are topical and vaccination is ineffective after infection has occurred. HPV infection is not correlated with pelvic inflammatory disease (PID).

A client is being treated for gonorrhea. Which agent would the nurse expect the physician to prescribe?

a) Tetracycline
b) Ceftriaxone
c) Penicillin
d) Levofloxacin

B) Ceftriaxone
The microorganism N. gonorrhoeae has become increasingly resistant to penicillin and tetracyclines, and fluoroquinolones (such as levofloxacin). Therefore, the current CDC (2006) recommendation for treating gonorrhea is a single intramuscular dose of a broad-spectrum cephalosporin such as ceftriaxone (Rocephin) or oral dosing with cefixime (Suprax).

A client with a history of HSV-2 infection asks the nurse about future sexual activity. Which of the following responses would be most appropriate?

a) “Inform all potential sexual partners about the infection, even if it is inactive.”.
b) “Use a condom during sexual activity if the infection becomes active again.”
c) “If the infection has healed, you probably don’t have to use a condom.”
d) “Refrain from all sexual activity until you don’t have another outbreak for a year.”

A) Inform all potential sexual partners about the infection, even if its inactive.
The nurse should advise the client to inform all potential sexual partners of the HSV infection even if it is in an inactive state. The nurse should also advise the client to use a condom during sexual activity even if the disease is dormant and to avoid sexual contact if the infection is active. Condoms do not protect skin and mucous membranes left exposed.

A male client reports urethral pain and a creamy yellow, bloody discharge from the penis. The nurse associates these characteristics with which of the following sexually transmitted infections?

a) Gonorrhea
b) Candidiasis
c) Chancroid
d) Trichomoniasis

A) Gonorrhea
In men, the initial symptoms of gonorrhea include urethral pain and a creamy, yellow, sometimes bloody discharge. Candidiasis, trichomoniasis, and bacterial vaginosis are vaginal infections that can be sexually transmitted, and the male partner usually is asymptomatic. Chancroid causes genital ulcers; the lesions begin as macules, progress to pustules, and then rupture.

A client with primary syphilis is allergic to penicillin. The nurse would expect the physician to order which agent?

a) Podophyllum resin
b) Tetracycline
c) Ceftriaxone
d) Acyclovir

C) Tetracycline
Clients who are allergic to penicillin are given a 14-day regimen of tetracycline or doxycycline. Acyclovir is used to treat genital herpes. Ceftriaxone may be used for gonorrhea. Podophyllum resin is used to treat genital warts.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment?

a) Syphillis
b) Gonorrhea
c) Chlamydia
d) Genital herpes

D) Genital herpes
Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

A student nurse is caring for a male patient diagnosed with gonorrhea. The patient is receiving ceftriaxone and doxycycline. The nursing instructor asks the student why the patient is receiving two antibiotics. What is the student nurse’s best response?

a) “This combination of medications will eradicate the infection faster than a single antibiotic.”
b) “Many people infected with gonorrhea are infected with chlamydia as well.”
c) “The combination of these two antibiotics reduces the risk of reinfection.”
d) “There are many resistant strains of gonorrhea, so more than one antibiotic may be required for successful treatment.”

B) Many people infected with gonorrhea are infected with chlamydia as well
Treatment of gonorrhea includes the antibiotic ceftriaxone. Because many people with gonorrhea have a coexisting chlamydial infection, doxycycline or azithromycin is prescribed as well. There has been an increase in the number of resistant strains of gonorrhea, but that isn’t the reason for this dual therapy. This combination of antibiotics doesn’t reduce the risk of reinfection or provide a faster cure.

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding?

a) Palmar rash
b) Development of gummas
c) Development of central nervous system lesions
d) Genital chancres

D) Genital chancres
Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which of the following would the nurse expect to include as the most common STI in the United States?

a) Chlamydia
b) Syphilis
c) Genital herpes
d) Gonorrhea

A) Chlamydia
Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. One in five people older than age 12 is infected with the virus that causes genital herpes.

A patient has herpes simplex 2 viral infection (HSV-2). The nurse recognizes that which of the following should be included in teaching the patient?

a) The virus causes “cold sores” of the lips.
b) Treatment is focused on relieving symptoms.
c) The virus may be cured with antibiotics.
d) The virus when active may not be contracted during intercourse.

B) Treatment is focused on relieving symptoms
HSV-2 causes genital herpes and is known to ascend the peripheral sensory nerves and remain inactive after infection, becoming active in times of stress. The virus is not curable, but treatment is aimed at controlling symptoms. HSV-1 causes “cold sores,” and varicella zoster causes shingles.

A male patient comes to the clinic and is diagnosed with gonorrhea. Which symptom most likely prompted him to seek medical attention?

a) Painful red papules on the shaft of the penis
b) Foul-smelling discharge from the penis
c) Rashes on the palms of the hands and soles of the feet
d) Cauliflower-like warts on the penis

B) Foul smelling discharge from the penis
Signs and symptoms of gonorrhea in men include purulent, foul-smelling drainage from the penis and painful urination. Rashes on the palms of the hands and soles of the feet are a sign of the secondary stage of syphilis. Cauliflower-like warts on the penis are a sign of human papillomavirus. Painful red papules on the shaft of the penis may be a sign of the first stage of genital herpes.

Max Thornton, a 24-year-old chef, is being seen by a physician at the urology group where you practice nursing. He has developed a painless ulcer on his penis and is rather concerned about his health. The urologist will be communicating his diagnosis of syphilis and prescribing treatment. What is the typical span of time between infection and developing symptoms with syphilis?

a) 14 days
b) 21 days
c) 35 days
d) 28 days

B) 21 Days
In syphilis, the time between infection and the first occurrence of symptoms is about 21 days

A client is diagnosed with chlamydia and is distraught. “How can I have this problem? I don’t have any symptoms!” she says. The nurse teaches the client that the percentage of women with chlamydia who are asymptomatic is as high as

a) 100%
b) 75%
c) 50%
d) 25%

B) 75%
As many as 75% of all infected women and 25% of all infected men are asymptomatic.

A nurse is teaching a community health class of women and explains that a sexually transmitted infection (STI) is associated with an increased risk of infertility in women. Which of the following STIs would the nurse identify?

a) Herpes simplex
b) Syphilis
c) Chlamydia
d) Gonorrhea

C) Chlamydia
Women with chlamydial infection may be asymptomatic and may unknowingly experience damage to the reproductive system. Herpes simplex virus (HSV), syphilis, and gonorrhea consistently produce symptoms in infected women.

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported?

a) Syphilis
b) Condylomata acuminata
c) Genital herpes
d) Hepatitis B

A) Syphilis
The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDs. Genital herpes, hepatitis B, veneral warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law.

A client with genital herpes asks the nurse about what to expect with the infection. Which of the following responses would be most appropriate?

a) Once you take the medication, the infection will be gone for good.
b) You might have to try several different medications before finding one that works.
c) Even though you don’t have symptoms, you could still spread the infection.
d) You can expect other outbreaks, each of which will be longer than the first.

C) Even though you don’t have symptoms, you could still spread the infection
Genital herpes can be transmitted during asymptomatic periods of viral shedding. Herpes recurs because after the initial infection, the virus remains dormant in the ganglia of the nerves that supply the area. Symptoms usually are more severe with the initial outbreak. Subsequent episodes usually are shorter and less intense. When the virus is active, shedding viral particles are infectious. Herpes infection is a highly contagious STI that is controllable but not curable. Herpes virus responds well to the antiviral drugs acyclovir, valacyclovir, and famciclovir.

When obtaining the health history from a client, which factor would lead the nurse to suspect that the client has an increased risk for sexually transmitted infections (STIs)?

a) Hive-like rash for the past 2 days
b) Clear vaginal discharge
c) Weight gain of 5 lbs in one year
d) Five different sexual partners

D) Five different sexual partners
The number of sexual partners is a risk factor for the development of STIs. A rash could be related to numerous underlying conditions. A weight gain of 5 lbs in one year is not a factor increasing one’s risk for STIs. A change in the color of vaginal discharge such as yellow, milky, or curd-like, not clear, would suggest a STI.

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age?

a) 26
b) 35
c) 18
d) 32

A) 26
The CDC (2007) recommends annual screening for Chlamydia in all sexually active women younger than 26 years of age and in women with new or multiple sexual partners.

A nurse is assessing a woman with vaginal discharge. The nurse suspects bacterial vaginosis when the client states which of the following?

a) “The discharge is yellowish but thin.”
b) “I noticed a strange fishy odor during my period.”
c) “The discharge looks almost like cottage cheese.”
d) “I’ve been experiencing some really intense itching.”

I noticed a strange fishy odor during my period
Bacterial vaginosis is characterized by a fishlike odor that is particularly noticeable after sexual intercourse or during menstruation. Most clients do not experience local discomfort or pain; more than one half of clients do not notice any symptoms. Intense itching is often associated with candidiasis or trichomoniasis. A cottage-cheese like discharge is associated with candidiasis. A thin, yellow discharge is most commonly noted with trichomoniasis.

A nurse is developing a plan of care for a female client experiencing her first outbreak of genital herpes. Which nursing diagnosis would the nurse most likely identify as the priority?

a) Acute pain related to the development of the genital lesions
b) Deficient knowledge related to the disease and its transmission
c) Ineffective coping related to the increased stress associated with the infection
d) Hyperthermia related to body’s response to an infectious process

A) Acute pain related to the development of the genital lesions
Although deficient knowledge, ineffective coping, and hyperthermia are possible nursing diagnoses, the priority would be acute pain because the initial infection is usually very painful and lasts about 1 week.

The nurse is gathering data from a male client who is suspected of having gonorrhea. Which of the following would the nurse most likely find?

a) Testicular pain
b) Purulent rectal discharge
c) Pain on urination
d) Skin rash

C) Pain on urination
In men, symptoms usually appear 2 to 6 days after infection. Urethritis with a purulent discharge and pain on urination are the most common signs and symptoms. A small proportion of men are asymptomatic. An anal infection is accompanied by painful bowel elimination and purulent rectal discharge. Skin rash is associated with disseminated gonorrhea. Testicular pain would be associated with Chlamydia.

A nurse is assisting with a physical examination of a male client. Which of the following signs and symptoms is most clearly suggestive of primary genital herpes?

a) Emergence of hard, painless nodules on the shaft of the penis
b) Presence of purulent, whitish discharge from the penis
c) Production of cloudy, foul-smelling urine
d) Itching, pain, and the emergence of pustules on the penis

D) Itching, pain, and the emergence of pustules on the penis
The initial symptoms of primary genital herpes infection include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. Firm, subcutaneous nodules are not associated with herpes simplex virus (HSV), and the production of penile discharge and cloudy urine are not suggestive of the disease.

A nurse is providing care to a client with chlamydia. The nurse anticipates that the client will also receive treatment for which of the following?

a) Mycoplasma
b) Trichomoniasis
c) Human papillomavirus
d) Gonorrhea

D) Gonorrhea
There is a high incidence of corinfection with chlamydia and gonorrhea. Therefore, the client would also receive treatment for gonorrhea. Typically chlamydial infections do not occur in conjunction with mycoplasma, trichomoniasis, or human papillomavirus.
The nurse is caring for a patient newly diagnosed with HIV. The patient asks what would determine the actual development of AIDS. The nurse’s response is based on the knowledge that which of the following is a diagnostic criterion for AIDS?
A) Presence of HIV antibodies
B) CD4+ T cell count <200/µl
C) White blood cell count <5000/µl
D) Presence of oral hairy leukoplakia
B) CD4+ T cell count <200µl
Diagnostic criteria for AIDS include a CD4+ T-cell count <200/µl and/or the development of specified opportunistic infections, cancers, wasting syndrome, or dementia. The other options may be found in patients with HIV disease, but do not define the advancement of the disease to AIDS.
When teaching a patient infected with HIV regarding transmission of the virus to others, which of the following statements made by the patient would identify a need for further education?
A) “I will need to isolate any tissues I use so as not to infect my family.”
B) “I will notify all of my sexual partners so they can get tested for HIV.”
C) “Unprotected sexual contact is the most common mode of transmission.”
D) “I do not need to worry about spreading this virus to others by sweating at the gym.”
A) I will need to isolate any tissues I use so as not to infect my family.
HIV is not spread casually. The virus cannot be transmitted through hugging, dry kissing, shaking hands, sharing eating utensils, using toilet seats, or attending school with an HIV-infected person. It is not transmitted through tears, saliva, urine, emesis, sputum, feces, or sweat.
A hospital has seen a recent increase in the incidence of hospital-acquired infections (HAIs). Which of the following measures should be prioritized in the response to this trend?
A) Use of gloves during patient contact
B) Frequent and thorough hand washing
C) Prophylactic, broad-spectrum antibiotics
D) Fitting and appropriate use of N95 masks
B) Frequent and thorough hand washing
Hand washing remains the mainstay of the prevention of HAIs. Gloves, masks, and antibiotics may be appropriate in specific circumstances, but none of these replaces the central role of vigilant, thorough hand washing.
Standard precautions should be used when providing care for
A) All patients regardless of diagnosis.
B) Pediatric and gerontologic patients.
C) Patients who are immunocompromised.
D) Patients with a history of infectious diseases.
A) All patients regardless of diagnosis.
Standard precautions are designed for all care of all patients in hospitals and health care facilities.
The nurse is providing care for a patient who has been living with HIV for several years. Which of the following assessment findings most clearly indicates an acute exacerbation of the disease?
A) A new onset of polycythemia
B) Presence of mononucleosis-like symptoms
C) A sharp decrease in the patient’s CD4+ count
D) A sudden increase in the patient’s WBC count
C) A sharp decrease in the patient’s CD4+ count
A decrease in CD4+ count signals an exacerbation of the severity of HIV. Polycythemia is not characteristic of the course of HIV. A patient’s WBC count is very unlikely to suddenly increase, with decreases being typical. Mononucleosis-like symptoms such as malaise, headache, and fatigue are typical of early HIV infection and seroconversion.
A patient comes to the clinic after being informed by a sexual partner of possible recent exposure to syphilis. The nurse will examine the patient for which of the following characteristic findings of syphilis in the primary clinical stage?
A) Chancre
B) Alopecia
C) Condylomata lata
D) Regional adenopathy
A) Chancre
Chancres appear in the primary stage of the bacterial invasion of Treponema pallidum, the causative organism of syphilis. The other findings do not appear until the secondary stage of syphilis, occurring a few weeks after the chancres appear.
Teaching for patients with a sexually transmitted disease (STD) would include (select all that apply)
A) Treatment of sexual partner is important.
B) Douching may help provide relief of itching.
C) Cotton undergarments are preferred over synthetic materials.
D) Sexual abstinence is indicated during the communicable phase of the disease.
E) Condoms should be used during as well as after treatment during sexual activity.
A,C,D,E
Douching may spread the infection or alter the local immune responses and is therefore contraindicated in patients with STDs. All other choices are appropriate patient teaching.
A 22-year-old male is being treated at a college health care clinic for gonorrhea. Which of the following teaching points should the nurse include in patient teaching?
A) “While being treated for the infection, you will not be able to pass this infection on to your sexual partner.”
B) “While you’re taking your antibiotics, you will need to abstain from participating in sexual activity or drinking alcohol.”
C) “It’s important to complete your full course of antibiotics in order to ensure that you become resistant to reinfection.”
D) “The symptoms of gonorrhea will resolve on their own, but it is important for you to abstain from sexual activity while this is occurring.”
B) While you’re taking your antibiotics, you will need to abstain from participating in sexual activity or drinking alcohol
Treatment for gonorrhea necessitates abstinence from sexual activity (to prevent infection of partners) and alcohol (to avoid urethral irritation). The disease is not self limiting nor does successful treatment confer future resistance.
Screening for chlamydia is recommended for young women because
A) Chlamydia is frequently comorbid with HIV.
B) Chlamydial infections may progress to sepsis.
C) Untreated chlamydial infections can lead to infertility.
D) Chlamydial infections are treatable only in the early stages of infection.
C) Untreated chlamydial infections can lead to infertility.
Because of the potential for infertility, screening for chlamydia is recommended for women under 25. Sepsis is not a primary risk of chlamydia and is not noted to be strongly correlated with HIV infection. The disease is treatable at all stages of infection.
A 30-year-old female patient has sought care because of the recent appearance of itchy lesions on her vulva, some of which have recently burst. The patient’s description of her problem would lead you to first suspect
A) HIV.
B) Gonorrhea.
C) Chlamydia.
D) Genital herpes.
D) Gential herpes
A primary episode of genital herpes is often marked by multiple small, vesicular lesions on the genitals. This symptomatology is not commonly associated with gonorrhea, chlamydia, or HIV.
The physical assessment and history of a 29-year-old female patient are indicative of human papillomavirus (HPV) infection. You would perform patient teaching related to
A) Gardasil.
B) Antibiotic therapy.
C) Wart removal options.
D) Treatment with antiviral drugs.
C) Wart removal options
The HPV vaccine (Gardasil) is ineffective in cases of existing HPV, whereas neither antiviral nor antibiotic drugs are effective treatments. Patient teaching should focus on the various options for physically removing the warts.

A client is diagnosed as being in the primary stage of syphilis? Which of the following would the nurse expect as a finding?

a) Development of gummas
b) Palmar rash
c) Genital chancres
d) Development of central nervous system lesions

C) Genital chancres
Primary syphilis is characterized by the appearance of a chancre at the site of exposure. A rash on the palms is associated with secondary syphilis, whereas gummas and central nervous system (CNS) lesions are indicative of tertiary syphilis.

A client with AIDS is brought to the clinic by their family. The family tells the nurse the client has become forgetful, with a limited attention span, decreased ability to concentrate, and delusional thinking. What condition is represented by these symptoms?

a) Cytomegalovirus (CMV)
b) Distal sensory polyneuropathy (DSP)
c) HIV encephalopathy
d) Candidiasis

C) HIV encephalopathy
HIV encephalopathy, also called AIDS dementia complex or ADC, is a neurologic condition that causes the degeneration of the brain, especially in areas that affect mood, cognition, and motor functions. Such clients exhibit forgetfulness, limited attention span, decreased ability to concentrate, and delusional thinking. DSP is characterized by abnormal sensations, such as burning and numbness in the feet and later in the hands. Candidiasis is a yeast infection that may develop in the oral, pharyngeal, esophageal, or vaginal cavities or in the folds of the skin. CMV infects the choroid and retinal layers of the eye, leading to blindness, and can also cause ulcers in the esophagus, colitis, diarrhea, pneumonia, and encephalitis.

A client with genital herpes simplex infection asks the nurse, “Will I ever be cured of this infection?” Which response by the nurse would be most appropriate?

a) “All you need is a dose of penicillin and the infection will be gone.”
b) “There is a new vaccine available that prevents the infection from returning.”
c) “Once you have the infection, you develop an immunity to it.”
d) “There is no cure, but drug therapy helps to reduce symptoms and recurrences.”

D) There is no cure, but drug therapy helps to reduce symptoms and recurrences
Genital herpes is a life-long viral infection. No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. A vaccine is available for HPV infection but not genital herpes. Penicillin is used to treat syphilis. No immunity develops after a genital herpes infection.

A client visits the nurse complaining of diarrhea every time they eat. The client has AIDS and wants to know what they can do to stop having diarrhea. What should the nurse advise?

a) Reduce food intake.
b) Encourage large, high-fat meals.
c) Avoid residue, lactose, fat, and caffeine.
d) Increase the intake of iron and zinc.

C) Avoid residue, lactose, fat, and caffeine
Diarrhea may subside when the client avoids residue, lactose, fat, and caffeine. Although eating may seem to cause diarrhea, the client must understand that limiting the intake of food to control diarrhea only exacerbates wasting. The client will tolerate a low-fat, high-carbohydrate, soft or liquid diet better than large, high-fat meals. The client should be advised to avoid large doses of iron and zinc because they can impair the functioning of the immune system.

A client is prescribed didanosine (Videx) as part of his highly active antiretroviral therapy (HAART). Which instruction would the nurse emphasize with this client?

a) “You should take the drug with an antacid.”
b) “It doesn’t matter if you take this drug with or without food.”
c) “Be sure to take this drug about 1/2 hour before or 2 hours after you eat.”
d) “When you take this drug, eat a high-fat meal immediately afterwards.”

C) Be sure to take this drug about 1/2 hour before or 2 hours after you eat
Didanosine should be taken 30 to 60 minutes before or 2 hours after meals. Other antiretroviral agents, such as abacavir, emtricitabine, or lamivudine can be taken without regard to meals. High-fat meals should be avoided when taking amprenavir. Atazanavir should be taken with food and not with antacids.

When developing the plan of care for a client with a primary immunodeficiency, which nursing diagnosis would be the priority?

a) Risk for infection related to altered immune cell function
b) Impaired skin integrity related to persistent deep skin abscesses
c) Anxiety related to an inherited disorder
d) Grieving related to the poor prognosis of the condition

A) Risk for infections related to altered immune cell function
Although anxiety and impaired skin integrity may be appropriate, the priority nursing diagnosis for any immunodeficiency is the risk for infection. Although primary immunodeficiencies can be serious, they are rarely fatal. Therefore, the nursing diagnosis of grieving would be inappropriate.

A group of students are reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which of the following as the cause of condylomata?

a) Human papilloma virus
b) Haemophilus ducreyi bacillus
c) Herpes virus
d) Treponema pallidum

A) Human papilloma virus
Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.

After teaching a client with immunodeficiency about ways to prevent infection, the nurse determines that teaching was successful when the client states which of the following?

a) “I will clean my kitchen counter with hot water.”
b) “Alcohol is good to clean any skin areas that are dry or chafed.”
c) “I should avoid eating cooked fruits and vegetables.”
d) “I should avoid being around other people who have an infection.”

D) I should avoid being around other people who have an infection.
Strategies to prevent infection include avoiding being around others who have an infection and avoiding crowds. The client should avoid consumption of raw fruits and vegetables and use creams and emollients to prevent or manage dry, chafed, or cracked skin. A disinfectant, not just hot water, should be used to clean kitchen and bathroom surfaces.

A 45-year-old waitress with a history of IV drug use also is HIV-positive. She has been following her antiretroviral medication regimen faithfully and is doing well. She’s attending college to get a social work degree and is focused on a bright future. In her regular CD counts, what factor will indicate she has progressed from HIV to AIDS?

a) CD count > 200/mm
b) CD count > 100/mm
c) CD count < 200/mm
d) CD count < 100/mm

C) CD count <200/mm
A CD (T-cell) count of less than 500/mm indicates immune suppression; a CD (T-cell) count of 200/mm or less is an indicator of AIDS.

A patient comes to the free clinic complaining of urethral discharge. On assessment, the nurse notes that the patient is feverish. During the assessment, the patient admits to having unprotected sex. The nurse suspects the patient may have a diagnosis of what?

a) HIV
b) Chlamydia
c) Syphilis
d) Gonorrhea

D) Gonorrhea
The signs and symptoms of gonorrhea include fever; urethral, vaginal, and rectal discharge; and in untreated cases, arthritis.

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect to find which of the following once the microorganism disseminates throughout the body?

a) Painful joints
b) Intermenstrual bleeding
c) Sore throat
d) Painful urination

A) Painful joints
The client with an anal gonorrheal infection experiences symptoms of gonorrhea where the microorganism has invaded the rectum. After the microorganism disseminates throughout the body, the client may manifest a skin rash, fever, and painful joints. Other symptoms such as infections of the urinary tract or vagina, sore throat, intermenstrual bleeding due to cervicitis, and painful urination are associated with the organism’s invasion of those structures, depending on the nature of the sexual contact.

Which information would be most appropriate for a nurse to provide to a client who has never used a condom?

a) A condom can be used, even if it is old, so long as the pack is unopened.
b) A new condom should be used for each sex act.
c) Cheap condoms of any brand can be used based on monetary constraints.
d) A fresh condom should be unrolled over a limp penis before it becomes erect.

B) A new condom should be used for each sex act
Information that is important to provide when explaining the use of a condom include the following: use condoms manufactured and tested in the United States, discard old or deteriorated condoms, unroll a fresh condom over the erect penis, remove the condom before the penis becomes limp, and use a new condom for each sex act.

A client has undergone diagnostic testing for human immunodeficiency virus (HIV) using the enzyme immunoassay (EIA) test. The results are positive and the nurse prepares the client for additional testing to confirm seropositivity. The nurse would prepare the client for which test?

a) Nucleic acid sequence-based amplification
b) Western blot assay
c) OraSure test
d) p24 antigen capture assay

B) Western blot assay
A positive EIA test indicates seropositivity. To confirm this, a Western blot assay would be done. The OraSure test uses saliva to perform an EIA test. The p24 antigen test and nucleic acid sequence-based amplification test are used to test viral load and evaluate response to treatment. However, the reverse transcriptase-polymerase chain reaction (RT-PCR) and nucleic acid sequence-based tests have replaced the p24 antigen test. The RT-PCR tests may be used to confirm a positive EIA result.

A mother brings her young child to the clinic for an evaluation of an infection. The mother states, “He’s been taking antibiotics now for more than 2 months and still doesn’t seem any better. It’s like he’s always sick.” During the history and physical examination, which of the following would alert the nurse to suspect a primary immunodeficiency?

a) Superficial wound on the child’s left leg
b) History of fungal diaper rash
c) Ten ear infections in the past year
d) Weight within age-appropriate parameters

C) Ten ear infections in the past year
The mother has already reported one of the warning signs associated with primary immunodeficiencies–the use of antibiotics for 2 or more months with little effect. Another warning sign is eight or more new ear infections within 1 year. Therefore, the report of 10 ear infections in the past year would increase the nurse’s suspicion. Recurrent, deep skin, or organ abscesses, failure of an infant to gain weight or grow normally, and persistent thrush (yeast infection) in the mouth or elsewhere on the skin after age 1 year would be additional warning signs. A superficial wound on the leg, age-appropriate weight, and a history of a fungal diaper rash would not be considered warning signs.

A nurse educator is preparing to discuss immunodeficiency disorders with a group of fellow nurses. What would the nurse identify as the most common secondary immunodeficiency disorder?

a) SCID
b) AIDS
c) DAF
d) CVID

B) AIDS
AIDS, the most common secondary disorder, is perhaps the best-known secondary immunodeficiency disorder. It results from infection with the human immunodeficiency virus (HIV). DAF refers to lysis of erythrocytes due to lack of decay-accelerating factor (DAF) on erythrocytes. CVID is a disorder that encompasses various defects ranging from IgA deficiency (in which only the plasma cells that produce IgA are absent) to severe panhypoglobulinemia (in which there is a general lack of immunoglobulins in the blood). Severe combined immunodeficiency disease (SCID) is a disorder in which both B and T cells are missing.

A student nurse is doing clinical hours at an OB/GYN clinic. The student is helping to develop a plan of care for a patient with gonorrhea has presented at the clinic. The student knows that the care plan for this patient should be include what in the treatment of gonorrhea?

a) Concurrent treatment for chlamydia
b) Avoidance of the use of tampons
c) Vaginal smears every 6 months
d) Radiation therapy to destroy cancerous cells

A) Concurrent treatment for chlamydia
Because of the high incidence of coinfection with chlamydia and gonorrhea, treatment for gonorrhea should also include treatment for chlamydia. One cause of cervicitis is chlamydia. A management strategy used in the treatment of chlamydia is a cytologic examination of cervical smear. Avoiding the use of tampons is part of the self-care management of a patient with possible toxic shock syndrome (TSS). Gonorhhea is considered a sexually transmitted infection (STI), not a carcinoma.

You are caring for a client who has a diagnosis of HIV. Part of this client’s teaching plan is educating the client about his or her medications. What is essential for the nurse to include in the teaching of this client regarding medications?

a) The use of condoms
b) What vaccinations to have
c) Side effects of drug therapy
d) The action of each antiretroviral drug

C) Side effects of drug therapy
Describing the side effects of drug therapy is essential, with the admonition to refrain from discontinuing any of the prescribed drugs without first consulting the prescribing physician. Although the client may want to know how the drugs work in general, the specific action of each antiretroviral drug is not essential information. Teaching about condoms and vaccinations may be appropriate, but these topics are not directly related to the client’s HIV medications.

The nurse receives report on 4 clients. Which client should the nurse see first? 1. Client admitted 12 hours ago with acute asthma exacerbation who needs a dose of IV methylprednisolone [21%] 2. Client admitted 2 days ago with congestive …

A nurse is counseling the spouse of a client who has a history of alcohol abuse. What does the nurse explain is the main reason for drinking alcohol in people with a long history of alcohol abuse? 1 They are …

1. When formulating a definition of “health,” the nurse should consider that health, within its current definition, is: 1. The absence of disease 2. A function of the physiological state 3. The ability to pursue activities of daily living 4. …

A client is diagnosed with Cushing syndrome. Which clinical manifestation does the nurse expect to increase in a client with Cushing syndrome? Glucose level After surgical clipping of a ruptured cerebral aneurysm, a client develops the syndrome of inappropriate secretion …

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