Question 1

A school nurse asks a class about the ways HIV can be transmitted.Which of the following comments by a student indicates a need for additional teaching?

Accepted Answer

HIV is not transmitted through casual contact such as touching or hugging someone who has HIV infection.It is not transmitted by insects,coughing,sneezing,office equipment,or sitting next to or eating with someone who has HIV infection.HIV can be transmitted through exposure to blood,semen,vaginal secretions,and breast milk and by sharing needles,syringes,and other equipment used to prepare injectable drugs.It can also be spread by perinatal transmission from mother to child through delivery or breastfeeding and by transfusions of contaminated blood.Worldwide,the largest number of HIV infections result from heterosexual transmission.

Question 2

A client was clearly very relieved when an HIV test came back negative."Thank goodness.I've had sex several times without a condom,and when one of my friends said he was sick,I think I panicked." Which of the following would be most important to emphasize to the client immediately?

Accepted Answer

The client needs to understand that the test cannot identify infections that may have been acquired within the previous 3 months before the test.Appearance of the HIV antibody can take up to 12 weeks; thus,this test could be negative now,but positive in 3 months.All persons who have an STD test should be counseled about risk-reduction activities before and after the test is done.

Question 3

Which of the following best describes the characteristic appearance of lesions of human papillomavirus (HPV)?

Accepted Answer

HPV causes genital warts that appear as textured surface lesions,with what is sometimes described as a cauliflower appearance.The warts are usually multiple and vary between 1 and 5 mm in diameter.The other descriptions are not characteristic of lesions of the human papillomavirus (HPV).

Question 4

A nurse is concerned about the prevalence of tuberculosis among migrant farmworkers.Which of the following activities would be best to use when implementing tertiary prevention?

Accepted Answer

Tertiary prevention is carried out among persons already infected with the disease.In this instance,DOT ensures compliance with treatment to cure the disease and to prevent worsening or the development of secondary problems.Administer purified protein derivative (PPD)to contacts of those with tuberculosis is secondary prevention as this is an at risk population.Providing education about the prevention of tuberculosis to members of the migrant community is a primary prevention strategy as it is aiming to prevent the disease from occurring.Using skin tests to screen migrant health workers for tuberculosis infection is secondary prevention as it is a screening aimed at early detection of the diesase.

Question 5

A student asks the nurse at the student health clinic how AIDS is diagnosed.Which of the following statements would be the best response by the nurse?

Accepted Answer

AIDS is defined as a disabling or life-threatening illness caused by HIV; it is diagnosed in a person with a CD4 T-lymphocyte count of less than 200/ml with or without documented HIV infection.The HIV antibody test (usually the EIA)is the most commonly used screening test for determining whether the antibody to HIV is present but does not confirm AIDS.Positive results with the EIA are tested further with the Western blot test.However,false-negative results are frequent between 6 weeks and 3 months following exposure.

Question 6

The correctional health nurse is doing a quick assessment on a newly admitted inmate who is HIV positive.Which of the following diseases should the inmate receive screening for immediately?

Accepted Answer

HIV-infected persons who live near one another,such as in correctional facilities,must be carefully screened and deemed noninfectious before admission to such settings.A person with HIV is more susceptible to opportunistic infections,the most common of which is TB.Hepatitis B and Hepatitis C are both transmitted through blood and body fluids which is not as highly contagious as tuberculosis which is transmitted through airborne droplets.Herpes zoster (shingles)is spread by direct contact with fluid from the rash blisters.

Question 7

Which of the following provides the best explanation as to why people do not immediately seek medical treatment when they first become ill with HIV?

Accepted Answer

When HIV enters the body,it can cause a flu-like syndrome referred to as a primary infection or acute retroviral syndrome.This may go unrecognized.The symptoms are similar to flu or a bad cold including sore throat,lethargy,rash,fever,and muscle pain.An antibody test at this stage is usually negative.So the person or a medical provider may not recognize the illness as HIV.Thus,it is not worthwhile to be tested during this stage of the illness.

Question 8

A client with tuberculosis (TB)asks why the nurse is required to watch the client swallow the medication each day.Which of the following statements is the best response by the nurse?

Accepted Answer

It is important to be respectful to clients and to consider their perspective and psychological health while also responding truthfully.Directly observed therapy (DOT)programs for TB medication involve the nurse observing and documenting individual clients taking their TB drugs.When clients prematurely stop taking TB medications,there is a risk that the TB will become resistant to the medications.This can affect an entire community of people who are susceptible to this airborne disease.DOT ensures that TB-infected clients receive adequate medication.Thus,DOT programs are aimed at the population level to prevent antibiotic resistance in the community and to ensure effective treatment at the individual level.Many health departments have DOT home health programs to ensure adequate treatment.The risk to client and the community if the client does not follow the treatment regimen is that the TB will become resistant to these medications it does not have to do with the possibility of noncompliance by the patient,that the patient will not remember,or related to the cost of the medications.

Question 9

A male client visits the clinic office complaining of a yellow,green discharge from his penis.Which of the following STDs has the client most likely contracted?

Accepted Answer

The symptoms for gonorrhea in a male include a burning sensation when urinating,or a white,yellow-green discharge from the penis.Some men may get swollen or painful testicles.In men,gonorrhea can cause epididymitis,a painful condition of the testicles that if untreated can lead to infertility.Symptoms of syphilis may not appear for several years after contracting the disease.The first stage of syphilis is called primary syphilis when a chancre,a firm,round,small and painless lesion,develops.Signs and symptoms of HSV-2 infection range from no symptoms to painful lesions or blisters around the genitals,rectum,or mouth.Most people with HPV are asymptomatic.

Question 10

Which of the following statements best explains why HSV-2 infection is more challenging for a client than gonorrhea infection?

Accepted Answer

Unlike gonorrhea,there is no cure for HSV-2 infection; it is considered a chronic disease.Recurrence with HSV-2 is common.The treatment for HSV-2 may be episodic or supressive for frequent recurrence,which is not expensive to treat.HSV-2 may be asymptomatic but does appear as vesicles,painful ulceration of penis,vagina,labia,perineum,anus with lesions lasing 5-6 weeks.

Question 11

Which of the following statements best explains why many health care providers are more afraid of getting hepatitis B than HIV?

Accepted Answer

Both HBV and HIV are blood-borne pathogens.Health care workers may be exposed to either from needle stick injuries and mucous membrane splashes.However,HBV remains alive outside the body for a longer time than does HIV and thus has greater infectivity.The virus can survive for at least 1 week dried at room temperature on environmental surfaces,and therefore infection control measures are crucial in preventing transmission.There is no treatment for hepatitis B,and although some persons never have symptoms and others fight off the disease,many suffer from chronic hepatitis B,a very serious illness.Others may become chronic carriers of the disease.There are multiple populations that have a high prevalence of HBV including injection drug users,persons with STDs or multiple sex partners,immigrants and refugees and their descendents who came from areas where there is a high endemic rate of HBV,health care workers,clients on hemodialysis,and inmates of long-term correctional institutions.Those who are infected with HBV are still able to work in health care.There is no evidence that the fatality rate is higher or sooner with HBV than with HIV.

Question 12

A client who is very upset says to the nurse,"But we always used a condom! How could I have genital warts?" Which of the following would be the best response by the nurse?

Accepted Answer

Warts may grow where barriers,such as condoms,do not cover,and skin-to-skin contact may occur.The challenge of HPV prevention is that condoms do not necessarily prevent infection.Thus,even with correct usage and the use of undamaged condoms transmission may still occur.

Question 13

In the United States,which group is most affected by a new HIV diagnosis?

Accepted Answer

Although new HIV diagnosis in general has declined 19%,young Black gay and bisexual men are the most affected,with an 87% increase in diagnosis.The largest number of new infections in 2014 were in men who had sex with other men,and this was followed by heterosexual transmission.HIV infections in women are primarily due to heterosexual contact or IV drug use.

Question 14

Which of the following best explains why chlamydia is a major focus of public health efforts?

Accepted Answer

Like gonorrhea and other STDs,chlamydia can cause neonatal complications in infants born to infected mothers.It is treated rather easily with antibiotics.Chlamydia does have serious long-term outcomes for the client,but so do syphilis and other STDs.However,unlike syphilis,which in its later stages is rare in the United States,chlamydia is the most common reportable infectious disease in the United States and hence is a major focus of public health.

Question 15

Which of the following best explains why some health clinics allow clients to be tested for HIV anonymously with no record of the client's name,address,or contact information?

Accepted Answer

An advantage of anonymous testing may be that it increases the number of people who are willing to be tested,because many of those at risk are engaged in illegal activities.The anonymity eliminates their concern about the possibility of arrest or discrimination.If testing is anonymous,the client is given an identification coade number that is attached to all records of the test results and is not linked to the person's name and address.Demographic data such as the person's sex,age,and race may be collected,but there is no record of the client's name and associated identifying information.Thus,the client is able to know the results of the test while staying anonymous.It would be a violation of HIPAA for the providers to share the results of this test or any other medical information with family members.The follow up related to payment is not a main concern for the population who is requesting anonymous testing.

Question 16

A nurse is providing education to a client about the use of PrEP.Which of the following statements would the nurse include as part of this teaching?

Accepted Answer

Preexposure prophylaxis,or PrEP,is a new HIV prevention method for people who do not have the infection but would like to reduce their risk of becoming infected.PrEP requires taking a pill to prevent the HIV virus from getting into the body.This prevention method requires strict adherence to taking the medication and having regular HIV testing; it is also used in combination with other HIV prevention methods rather than in isolation (CDC: PrEP,2012b).It has been shown to be effective for people at very high risk for HIV infection through sex; the results about its effectiveness with injection drug users are not yet available.Extreme lethargy and joint pain are not common side effects of PrEP.PrEp provides protection against HIV,not against Hepatitis B.

Question 17

When a nurse discovers that a woman has been treated for cervical cancer,the nurse asks the woman whether she has ever been tested for HIV or other STDs.The woman is offended and asks why the nurse would ask her such a thing.Which of the following statements would be the best response from the nurse?

Accepted Answer

The link between HPV infection and cervical cancer has been established and is associated with specific types of the virus.In 80% to 90% of cases of cervical cancer,evidence of HPV has been found in the tumor.Additionally,HSV-2 infection is linked with the development of cervical cancer.Because the presence of an STD increases the risk for the presence of other STDs,it is essential to screen for this information.There is no evidence that the presence of an STD in women with cervical cancer will lead to congenital defects in offspring.The presence of an STD increases the risk for another STD.There is no evidence of relapse of cervical cancer when there is presence of an STD.

Question 18

A client is being treated for secondary syphilis.Which of the following signs and symptoms would the nurse anticipate the client would exhibit?

Accepted Answer

Secondary syphilis occurs when the organism enters the lymph system and spreads throughout the body.Signs include skin rash on one or more areas of the body and do not cause itching.Other symptoms may include fever,swollen lymph glands,sore throat,patchy hair loss,headaches,weight loss,muscle aches,and fatigue.A chancre at the site of entry is a symptom of primary syphilis.Difficulty coordinating movements is a sign of tertiary syphilis.Jaundice is a sign of congenital syphilis.

Question 19

Which of the following sexually transmitted diseases can be prevented through immunization?

Accepted Answer

Hepatitis B infection can be prevented by immunization; vaccines for the remaining options are not yet available.There are not yet vaccines for chlamydia,gonorrhea,or herpes.

Question 20

A nurse explained to a new mother that because she had tested positive for the hepatitis B virus,her newborn son would need the hepatitis B vaccine immediately and then also an immune globulin injection."Wait," said the new mother."Why is my son getting two shots?" Which of the following statements would be the best response by the nurse?

Accepted Answer

Because infected persons may not have any symptoms,all pregnant women should be tested for HBsAg.If the mother tests positive,her newborn needs hepatitis B immune globulin to provide passive immunity and thus prevent infection.In addition,the newborn is given the hepatitis B vaccine at birth,with two follow-up injections,to build active immunity to the infection.One of the shots provides passive immunity and the other provides active immunity.The active immunity continues to be built up by receiving two follow-up injections weeks later.

Quiz 27: HIV Infection, Hepatitis, Tuberculosis, and Sexually Transmitted Diseases