Nokea
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.
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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 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.
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 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 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.