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Chapter 71: care of patients with sexually transmitted diseases

1. A nurse instructor is teaching a student nurse about the factors that have increased the number of people with sexually transmitted diseases (STDs) seen in practice. Which statement by the student indicates a lack of understanding?
a. “There are improved techniques to diagnose an STD used in practice.”
b. “There is increased incidence of sexual abuse and sexual trafficking.”
c. “Females feel safe using oral agents rather than a condom as contraception.” d. “The organisms causing STDs are all becoming more virulent.”

There is no evidence that the organisms that cause STDs are becoming more virulent, but a client may need to use another anti-infective if allergic or the protocol was not effective. Extensive histories are taken in the clinic of clients of all ages, as well as assessment of laboratory data such as cervical, urethral, oral, or rectal specimens and lesion samples for microbiology and virology. There are changes in sexual attitudes and practices, cultural factors, migration, and international travel. Women often think that the oral contraceptives protect them from an STD.

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.

The client is displaying symptoms similar to secondary syphilis, with flu-like symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the 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.

3. A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at this time?

a. “Have you been using latex condoms?”
b. “Are you allergic to penicillin?”
c. “When was your last sexual encounter?”
d. “Do you have a history of sexually transmitted disease?”

Benzathine penicillin G is the evidence-based treatment for primary syphilis. The client needs to be assessed for allergies before treatment. The other questions would be helpful in the client’s history of sexually transmitted diseases but not as important as knowing whether the client is allergic to penicillin.

4. An African-American female with blisters on the vagina is being treated with acyclovir (Zovirax) for genital herpes. She is angry at her partner for transmitting the infection. Which action by the nurse is best?
a. Encourage the client to engage in sexual activity since she is on medication.
b. Be sensitive to the 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.

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.

5. A 19-year-old female is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate?
a. “Gardasil protects against all HPV strains.”
b. “You are too young to receive the vaccine.”
c. “Only females can receive the vaccine.”
d. “This will lower your risk for cervical cancer.”

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.

6. A 26-year-old client with multiple sexual partners is being assessed for symptoms of dysuria and vaginal discharge. Because the results from the culture of the cervical cells are not available, the client will be treated for both Chlamydia and gonorrhea. Which explanation by the nurse is best?
a. “This early treatment will prevent obstruction to the fallopian tubes.”
b. “Only azithromycin (Zithromax) is prescribed for both sexually transmitted
c. “The treatment will prevent aortic valve disease and aneurysms.”
d. “Oral antibiotic treatment will prevent frequent occurrences of meningitis.”

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 infec

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?”

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.

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.”

False-positive reactions can occur with viral infections, hepatitis, and systemic lupus erythematosus. A health care provider can request more specific treponemal tests such a fluorescent treponemal antibody absorption or microhemagglutination assay for Treponema palladium performed by the laboratory. While it would be good to confirm sexual activity with her future husband, this inquiry could wait until after further testing is performed. Penicillin is the treatment of choice, but as a single 2.4-million-unit dose. A different regimen would be recommended if the client were pregnant.

9. A 23-year-old female has been diagnosed with genital warts. Which action by the nurse is best?
a. Encourage the client to have an annual Papanicolaou (Pap) test.
b. Recommend an over-the-counter wart treatment for genital tissue.
c. Report the case to the Centers for Disease Control and Prevention (CDC). d. Discuss popular options for contraception.

An annual Pap test is recommended (due the strong relationship between genital warts and the development of dysplasia of the cervix) until three normal Pap smears are obtained. The Pap smear can detect any malignancies of the cervix. Prescribed cream or gel such as podofilox (Condylox) is the recommended treatment, but not over-the-counter treatments. Genital warts, or condylomata acuminata, do not have to be reported to the CDC in all states. Pregnancy is not contraindicated with genital warts.

10. A female client returned to the clinic with a yellow vaginal discharge after being treated for Chlamydia infection 3 weeks ago. Which statement by the client alerts the nurse that there may be a recurrence of the infection?
a. “I did practice abstinence while taking the medication.”
b. “I took doxycycline two times a day for a week.”
c. “I never told my boyfriend about the infection.”
d. “I did drink wine when taking the medication for Chlamydia.”

There is a good possibility that the boyfriend re-infected the client after the medication regimen was finished. Both the client and the boyfriend need to be treated. The other statements were in compliance with the recommendations of abstinence and the usual medication regimen with doxycycline. Wine should not interfere with the treatment.

11. A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease. She is in pain, with a rating of 7 on a scale of 0 to 10. What comfort measure can the nurse delegate to the unlicensed assistive personnel (UAP)?
a. Administer Tylenol #3 immediately.
b. Apply a heating pad to the lower abdomen.
c. Position the client in a semi-Fowler’s position. d. Teach the client to increase intake of fluids.

The client with pelvic inflammatory disease usually experiences lower abdominal tenderness. The UAP can position the client. Only the nurse can administer medications, initially apply heat to the client’s abdomen, and perform teaching.

12. A client with pelvic inflammatory disease is seen by the nurse 72 hours after starting oral antibiotics. Which finding leads the nurse to take immediate action?
a. Feelings of anger that her partner infected her
b. Loose stools over the last 2 days
c. Anorexia and nausea
d. Chills and a temperature of 101° F

Chills and fever could indicate a persistent infection and the immediate need to alter the dose or type of antibiotic. Anger is a normal reaction to a sexually transmitted disease and the pain of pelvic inflammatory disease. Gastrointestinal symptoms are common side effects of antibiotics but not an immediate cause for intervention.

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13. A 19-year-old college student seeks information from the school’s nurse about how to avoid sexually transmitted diseases (STDs) without abstinence as a choice. Which statement by the nurse is best?
a. “Urinating after intercourse will eliminate the risk of infection.”
b. “A vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV).”
c. “Oral contraception can prevent pregnancy and STDs.”
d. “Good handwashing helps prevent infection associated with STDs.”

Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and genital warts. While there is some truth that urination after intercourse may decrease the risk of infection by flushing out organisms, it does not eliminate the risk of contaminating bacteria traveling up the urethra. The other statements are not accurate.

14. The nurse teaches a client with genital herpes about effective comfort measures. Which statement by the client indicates a need for further teaching by the nurse?
a. “I can apply warm towels or ice packs to the lesions.”
b. “Sitz baths three times a day may help ease the pain.”
c. “I understand there are anesthetic sprays and ointments.” d. “I really should try to limit urination due to the pain.”

The client should urinate frequently, not limit voiding. Voiding while in the shower or tub should lessen the discomfort. Warm compresses, ice packs, sitz baths, and anesthetic sprays and ointments are all effective comfort measures that can be used with genital herpes.

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