Nokea
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.
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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 who has blood drawn for screening has a positive Venereal Disease Research Laboratory (VDRL) test. Which of the following actions should the nurse take next?
- A. Ask the patient about past treatment for syphilis.
- B. Discuss the need for blood and spinal fluid cultures.
- C. Obtain a specimen for fluorescent treponemal antibody absorption (FTA-ABS) testing.
- D. Assess for the presence of chanceres, fullike symptoms, or a bilateral rash on the trunk.
Correct Answer: A
Rationale: Once antibody testing is positive for syphilis, the antibodies remain present for an indefinite period of time even after successful treatment, so the nurse should inquire about previous treatment before doing other assessments or testing. Culture, FTA-ABS testing, and assessment for symptoms may be appropriate, based on whether the patient has been previously treated for syphilis.
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.
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 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.