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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.
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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.
Which of the following patients should the nurse plan on teaching about the Gardasil vaccine?
- A. A 50-year-old man who has multiple sexual partners
- B. A 23-year-old woman who is pregnant for the first time
- C. An 11-year-old female who has never been sexually active
- D. A 28-year-old male who is in a monogamous relationship
Correct Answer: C
Rationale: HPV vaccines include Gardasil (HPV4) and Cervarrix (HPV2) HPV2 or HPV4 vaccine is recommended for women 9-26 years of age and HPV4 vaccine is recommended for men aged 9-26 years. It is not recommended for women during pregnancy, or for older women.
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.
A patient in the sexually transmitted infection (STI) clinic expresses concern about possible exposure to gonorrhea by her partner. Which of the following actions should the nurse take to determine if the patient has gonorrhea?
- A. Interview the patient about symptoms of gonorrhea.
- B. Take a sample of cervical discharge for Gram staining.
- C. Draw a blood specimen or rapid plasma reagin (RPCR) testing.
- D. Obtain vaginal secretions for a nucleic acid amplification test (NAAT).
Correct Answer: D
Rationale: NAAT has a high sensitivity (similar to a culture) for gonorrhea. Because women have few symptoms of gonorrhea, asking the patient about symptoms is not helpful in making a diagnosis. Smears and Gram staining are not useful because the female genitourinary tract has many normal flora that resemble $N$. gonorthoeae. RPR testing is used to detect syphilis.
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.