Nokea
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.
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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.
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 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.
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.
The nurse is caring for a patient who is diagnosed with chlamydia and tells the nurse that she is very angry because her husband is her only sexual partner. Which of the following responses should the nurse make first?
- A. You may need professional counselling to help resolve your anger.
- B. It is understandable that you are angry with your husband right now.
- C. Your feelings are justified and you should share them with your husband.
- D. It is important that both you and your husband be treated for the infection.
Correct Answer: B
Rationale: This response expresses the nurse's acceptance of the patient's feelings and encourages further discussion and problem-solving. The patient may need professional counselling, but more assessment of the patient is needed before making this judgment. The nurse should also assess further before suggesting that the patient share her feelings with the husband because problems such as abuse might be present in the relationship. Although it is important that both partners be treated, the patient's current anger suggests that this is not the appropriate time to bring this up.