Nokea
A patient has genital warts around her external genitalia and perianal area. She tells the nurse that she has not had treatment until now because 'the warts are so disgusting.' Which of the following nursing diagnoses is best?
- A. Disturbed body image related to alteration in self-perception (feelings about the genital warts)
- B. Ineffective coping related to inadequate confidence in ability to deal with a situation
- C. Risk for infection as evidenced by insufficient knowledge to avoid exposure to pathogens
- D. Anxiety related to threat to current status (impact of condition on interpersonal relationships)
Correct Answer: A
Rationale: The patient's statement that her lesions are disgusting suggests that disturbed body image is the major concern and is quite common in patients that have genital warts. There is no evidence to indicate ineffective coping or lack of knowledge about mode of transmission. The patient may be experiencing anxiety, but there is nothing in the data indicating that the genital warts are impacting interpersonal relationships.
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The nurse is teaching a patient who has primary genital herpes about management of the disease. Which of the following patient statements indicate that the teaching has been effective?
- A. I will use the acyclovir ointment on the area to relieve the pain.
- B. I will use condoms for intercourse until the medication is all gone.
- C. I will take the acyclovir every 8 hours for the next week.
- D. I will need to take all of the medication to be sure the infection is cured.
Correct Answer: C
Rationale: The treatment regimen for primary genital herpes infections includes acyclovir $400 \mathrm{mg}$ three times daily for 7-10 days. The patient is taught to abstain from intercourse until the lesions are gone. (Condoms should be used even when the patient is asymptomatic.) Acyclovir ointment is not effective in treating lesions or reducing pain. Herpes infection is persistent and recurrent.
Which of the following patients should the nurse plan on teaching about the Gardasil vaccine?
- A. A 50-year-old man who has multiple sexual partners
- B. A 23-year-old woman who is pregnant for the first time
- C. An 11-year-old female who has never been sexually active
- D. A 28-year-old male who is in a monogamous relationship
Correct Answer: C
Rationale: HPV vaccines include Gardasil (HPV4) and Cervarrix (HPV2) HPV2 or HPV4 vaccine is recommended for women 9-26 years of age and HPV4 vaccine is recommended for men aged 9-26 years. It is not recommended for women during pregnancy, or for older women.
A patient with gonorrhea is treated with a single IM dose of ceftrixaone and is given a prescription for doxyeycline $100 \mathrm{mg}$ bid for 7 days. Which of the following explanations should the nurse tell the patient about this combination of antibiotics?
- A. Prevent reinfection during treatment.
- B. Treat any coexisting chlamydial infection.
- C. Eradicate resistant strains of $N$, gonorrhheae.
- D. Prevent the development of resistant organisms.
Correct Answer: B
Rationale: Because there is a high incidence of co-infection with gonorrhea and chlamydia, patients are usually treated for both. The other explanations about the purpose of the antibiotic combination are not accurate.
When a patient returns to the clinic for follow-up after treatment for gonoccocal urethritis, a purulent urethral discharge is still present. When trying to determine the reason for the recurrent infection, which of the following questions is best for the nurse to ask the patient?
- A. Did you take the prescribed antibiotic for a week?
- B. Did you drink at least 2 quarts of fluids every day?
- C. Were your sexual partners treated with antibiotics?
- D. Do you wash your hands after using the bathroom?
Correct Answer: C
Rationale: All sexual contacts of patients with gonorrhea must be examined and treated to prevent reinfection after resumption of sexual relations. The 'ping-pong' effect of re-exposure, treatment, and reinfection can cease only when infected partners are treated simultaneously. Because gonorrhea is treated with one dose of antibiotic, antibiotic therapy, for a week is not needed. An adequate fluid intake is important, but a low fluid intake is not a likely cause for failed treatment. Poor hygiene may cause complications such as ocular trachoma but will not cause a failure of treatment.
The nurse is assessing a male patient who has a profuse, purulent urethral discharge with painful urination. Which of the following information is most important for the nurse to obtain?
- A. Contraceptive use
- B. Sexual orientation
- C. Immunization history
- D. Recent sexual contacts
Correct Answer: D
Rationale: Information about sexual contacts is needed to help establish whether the patient has been exposed to an STI and because sexual contacts will also need treatment. The other information may also be gathered but is not as important in determining the plan of care for the patient's current symptoms.