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A patient is treated for chlamydia that was detected during a routine pelvic examination. Which of the following patient statements indicate that teaching regarding the management of the condition has been effective?
- A. Go ahead and give me the antibiotic injection so I will be cured.
- B. My boyfriend will need to take antibiotics at the same time I do.
- C. I will use condoms during sex until I finish taking all the antibiotics.
- D. Since I do not plan on having any children, treatment is not as important.
Correct Answer: B
Rationale: Sex partners should be treated simultaneously to prevent reinfection. Chlamydia is treated with oral antibiotics. Abstinence from sexual intercourse is recommended for 7 days after treatment, and condoms should be recommended during all sexual contacts to prevent infection. Persistent pelvic pain, as well as infertility, can result from untreated chlamydia.
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A patient with positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests have a rash on the palms and the soles of the feet and moist papules in the anal and vulvar area. Which of the following actions should the nurse include in the plan of care?
- A. Assess for arterial aneurysms.
- B. Place the patient in a private room.
- C. Wear gloves when touching the patient.
- D. Apply antibiotic ointments to the perineum.
Correct Answer: C
Rationale: Exudate from any lesions with syphilis is highly contagious. Systemic antibiotics, rather than local treatment of lesions, are used to treat syphilis. The patient does not require a private room because the disease is spread through contact with the lesions. This patient has clinical manifestations of secondary syphilis and does not need to be monitored for manifestations of tertiary syphilis.
The nurse is assessing a patient at the community clinic who has a long history of IV drug use and reports difficulty walking because 'I don't know where my feet are.' Diagnostic screening reveals positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests. Which of the following assessments should the nurse implement based on the patient history?
- A. Heart sounds
- B. Gentalta for lesions
- C. Joints for swelling and inflammation
- D. Mental state for judgement and orientation
- E. Skin and mucous membranes for gummas
Correct Answer: A,D,E
Rationale: The patient's clinical manifestations and laboratory tests are consistent with late (tertiary) syphilis; valvular insufficiency, gummas, and changes in mentation are other clinical manifestations of this stage therefore the nurse will assess heart sounds, mental state and the integument system.
The nurse is counselling a patient who is having difficulty in conceiving. Which of the following infections is of most concern to the nurse?
- A. Chamyylla
- B. Treponema pallidum
- C. Condyloama acuminatum
- D. Herpes simplex virus type 2
Correct Answer: A
Rationale: Complications from chlamydial infections in women may result in PID, scarring of the fallopian tubes, which can result in infertility and a higher risk of ectopic or tubal pregnancies. Syphilis, genital warts, and genital herpes do not lead to problems with conceiving, although transmission to the fetis (syphilis) or newborn (genital warts or genital herpes) is a concern.
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.
A patient in the sexually transmitted infection (STI) clinic expresses concern about possible exposure to gonorrhea by her partner. Which of the following actions should the nurse take to determine if the patient has gonorrhea?
- A. Interview the patient about symptoms of gonorrhea.
- B. Take a sample of cervical discharge for Gram staining.
- C. Draw a blood specimen or rapid plasma reagin (RPCR) testing.
- D. Obtain vaginal secretions for a nucleic acid amplification test (NAAT).
Correct Answer: D
Rationale: NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms is not helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble $N$. gonorthoeae. RPR testing is used to detect syphilis.