Nokea
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.
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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.
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.
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.
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 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.