Question 1

When caring for clients with STDs, the nurse is aware that the best method of infection control is

Accepted Answer

Universal precautions should be used in the care of all clients. Good hand-washing, while important, is not sufficient and there are no specific disease-based isolation recommendations for STDs.

Question 2

A nurse is teaching a community group about STDs, including proper use of condoms. The nurse informs the group that condom failure is generally due to

Accepted Answer

Condom failure is primarily caused by improper or inconsistent use rather than a product defect.

Question 3

An adolescent female states that she cannot use condoms because her "boyfriend won't let her." Which action by the nurse would best fill the role of the advocate for this client?

Accepted Answer

Assertive communication and negotiation skills are vital when talking about sensitive topics like condom use with partners. Teens often need help developing these skills. Practicing skills is a concrete action they can use to help ensure their sexual health.

Question 4

The nurse conducting health education about gonorrhea would teach a client that

Accepted Answer

Gonorrhea may be asymptomatic in women. A large carrier population refers to people who carry the organism and have no manifestations but can transmit the disease. With the right antibiotic, most strains of gonorrhea are easily treated. The organism does not multiply particularly rapidly, and it cannot live long outside the human body.

Question 5

The nurse working in an ambulatory clinic explains that the most common bacterial STD in the United States is

Accepted Answer

Infection with Chlamydia organisms is the most common bacterial STD in the United States. In 2004 more than 900,000 new cases were reported. Overall, HPV infection is most common, but exact figures are not known. HPV is caused by a virus.

Question 6

A female caller to an STD hotline is crying, saying that her husband is accusing her of cheating on him after she was diagnosed with chlamydia. The best response by the nurse would be

Accepted Answer

A diagnosis of an STD can cause great distress not only on a personal level but also in a relationship where questions of fidelity may arise. It is important for the client and her significant other to realize that Chlamydia is often asymptomatic for years in women, so judgments about fidelity are not helpful. While offers of marriage counseling and website addresses may be helpful, they do not address the primary problem of psychosocial distress in the client.

Question 7

A client with uncomplicated gonorrhea who is treated with ceftriaxone and doxycycline asks if a follow-up examination and culture will be necessary. The most appropriate response by the nurse is

Accepted Answer

After therapy for uncomplicated gonorrhea is completed, a follow-up examination and culture ("test of cure") are not necessary. Treatment failure following combined ceftriaxone-doxycycline therapy is rare. This differs from the recommendation to re-test in 3-12 months because of the high rates of STDs seen in people who have been recently treated for them.

Question 8

A client is receiving metronidazole (Flagyl) orally for treatment of trichomoniasis. The nurse should explain to the client that

Accepted Answer

The nurse should advise clients taking metronidazole not to drink alcoholic beverages or take alcohol-containing products because alcohol may cause nausea, vomiting, and headaches. Douching is not a recommended practice at any time. Recurrence is fairly common. Metronidazole is taken as a one-time dose, or for 7 days in recurring infection.

Question 9

The nurse is counseling a client with herpes simplex virus (HSV) infection. Which of the following would best meet most clients' needs in coping with this diagnosis?

Accepted Answer

Research has verified the importance of support groups for most people with chronic illnesses. The other three options are helpful and should not be discounted when assessing client needs

Question 10

A client with genital herpes asks the nurse what effect the herpes will have on her becoming pregnant and having a child. The nurse's response is based on the fact that active genital herpes lesions can cause

Accepted Answer

Newborns can be infected during vaginal delivery when active genital lesions are present. Cesarean birth prevents this transmission. Birth defects, intrauterine infection, and sterility do not occur.

Question 11

A client whose VDRL test was positive asks the nurse if he has syphilis. The nurse's best response is

Accepted Answer

The Venereal Disease Research Laboratories (VDRL) test may be false-positive if performed during the early stages of several common viral illnesses. The fluorescent treponemal antibody absorption (FTA-ABS) serologic test is more specific because it measures antibodies specific to Treponema pallidum. FTA-ABS is used when VDRL is positive but the diagnosis of syphilis is still uncertain. Blood cultures are not used to diagnose syphilis, and the VDRL is not used to test for gonorrhea.

Question 12

When teaching clients strategies for primary prevention of sexually transmitted diseases (STDs), the nurse should

Accepted Answer

Primary prevention includes measures to prevent the disease from occurring. Health education about STDs should be provided as part of primary prevention. Medical treatment, early treatment, and treating all the client's sexual partners are not primary prevention.

Question 13

To make a definite diagnosis in a client with suspected chlamydial infection, the nurse should prepare the client for

Accepted Answer

Culture of exudate from the urethra, endocervix, or rectum remains a good test for Chlamydia, although other testing options are available. Biopsies and blood studies have no role in the diagnosis of Chlamydia. A woman being tested for STDs should be given the opportunity to be tested for other STDs. The Pap smear remains a valuable test for cervical cancer and should be discussed with women presenting for STD testing and offered per guidelines.

Question 14

The nurse would assess a female client with second-stage syphilis for

Accepted Answer

Indications of the second stage of syphilis include generalized rash. Typically, a maculopapular and nonpruritic rash appears on the palms of the hands and soles of the feet. Few other diseases cause a rash in these locations. Lymphadenopathy is present in secondary syphilis, but it is generalized. Chancre is the cardinal sign of primary stage disease. Syphilis does not cause vaginal discharge.

Question 15

The nurse is teaching a client with herpes simplex virus (HSV) type 2 appropriate methods to prevent further spread of the virus while lesions are present. The nurse stresses that clients should

Accepted Answer

For avoiding autoinoculation from the genital area to other body sites, clients should be advised to wash their hands thoroughly after any contact with herpetic lesions. Infected clients should have separate towels and other personal items and should be instructed to avoid touching their eyes. Condoms should be worn even during latent periods. Warm soaks may be comforting, but do not prevent spread. Antibiotics are not used for HSV infection.

Question 16

The physician has prescribed ceftriaxone (Rocephin) administered intramuscularly, followed by doxycycline (Vibramycin) orally for 7 days, to treat a client with gonorrhea. The nurse would explain that the rationale for the second medication is

Accepted Answer

Doxycycline is added for the presumptive treatment of co-infection with Chlamydia trachomatis, because chlamydial infections often co-exist with gonorrheal infections. There is some resistance to quinolone antibiotics, and certain clients should not be treated with them. The two-drug regimen is not better tolerated nor does it prevent reinfection.

Question 17

A client has developed salpingitis as a complication of gonorrhea. The nurse explains that this problem could lead to

Accepted Answer

The most common complication of gonorrhea in women is salpingitis, which can progress to the serious complication of pelvic inflammatory disease (PID). Gonorrhea does not have a latency period. Chlamydia often co-exists with gonorrhea but is not caused by salpingitis. Reinfection can occur but is usually caused by non-compliance with treatment or not having sexual partners treated.

Question 18

In teaching a client receiving doxycycline for the treatment of chlamydial infection, the nurse should include

Accepted Answer

Doxycycline may decrease the effect of birth control pills. Alcohol does not interfere with the medication's action. The medication does not need protection from sunlight and while increased fluid intake is always important for a person with an infection, this is not an intervention related to doxycycline.

Question 19

A female client with genital warts who was treated with topical podophyllin and tincture of benzoin would indicate to the nurse the need for further teaching when the client says

Accepted Answer

There is no cure for genital warts. A variety of chemical, mechanical, and ablative techniques are used for visible lesions, but no specific antiviral therapy for the human papillomavirus (HPV) is available. A series of treatments is needed to eliminate all visible warts.

Question 20

The statement made by a client being treated for gonorrhea that would indicate that teaching has been effective is "I

Accepted Answer

Before resuming sexual activity, the client should finish all prescribed medication. The client's partner(s) need to be treated too. Clients should not be given extra antibiotics to save for later incidents of gonorrheal infection. Treatment is neither lengthy nor expensive, and test-of-cure is not necessary.

Quiz 41: Management of Clients with Sexually Transmitted Infections