Nokea
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.
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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.
A male patient who has been diagnosed with gonococcal urethritis tells the nurse about recent sexual contact with a woman but says she did not appear to have any disease. Which of the following information should the nurse provide in response to the patient's statement?
- A. Women do not develop gonorrhea infections butThorized can serve as carriers to spread the disease to males.
- B. Women develop subclinical cases of gonorrhea that do not cause tissue damage or clinical manifestations.
- C. Many women are not aware they have gonorrhea because they often do not have symptoms of infection.
- D. When gonorrhea infections occur in women, the disease affects only the ovaries and not the genital organs.
Correct Answer: C
Rationale: Many women with gonorrhea are asymptomatic or have minor symptoms that are overlooked. The disease may affect both the genitals and the other reproductive organs and cause complications such as pelvic inflammatory disease (PID). Women who can transmit the disease have active infections.
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 caring for a patient who is 6 weeks' pregnant and is diagnosed with primary syphilis. Which of the following information should the nurse plan to discuss with the patient?
- A. The likelihood of a stillbirth
- B. The need for Caesarean section
- C. Intramuscular injection of penicillin
- D. Use of antibiotic eye drops for the newborn
Correct Answer: C
Rationale: In pregnant women with syphilis, penicillin G benzathine, 2.4 million Units by intramuscular route weekly for 1-3 doses is administered, depending on the stage of syphilis. Treatment administered in the second half of pregnancy may pose a risk of premature labour and fetal distress. Instillation of enythromycin into the eyes of the newborn is used to prevent gonorheal eye infections. C-section is used to prevent the transmission of herpes to the newborn. Although stillbirth can occur if the fetus is infected with syphilis, treatment before the tenth week of gestation will eliminate in utero transmission to the fetus.
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.