Nokea
The nurse is assessing a 22-year-old female patient who being seen in the family medicine clinic for an annual physical exam. Which of the following information should the nurse plan to teach the patient about?
- A. Testing for chlamydia infection
- B. Immunization for herpes simplex
- C. The relationship between the herpes virus and cervical cancer
- D. The risk of infertility associated with the human papillomavirus (HPV)
Correct Answer: A
Rationale: Gonorrheal and chlamydial testing during pelvic examinations and prenatal visits is becoming a major routine part of these programs. Mass application of screening programs for genital chlamydial infections, genital herpes, and HPV infections may also be possible with the advent of rapid, cost-effective tests. HPV infection does not cause infertility. There is no vaccine available for herpes simplex, and herpes simplex infection does not cause cervical cancer.
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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.
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.
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 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.
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.