Nokea
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.
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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.
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.
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 patient with positive Venereal Disease Research Laboratory (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests have a rash on the palms and the soles of the feet and moist papules in the anal and vulvar area. Which of the following actions should the nurse include in the plan of care?
- A. Assess for arterial aneurysms.
- B. Place the patient in a private room.
- C. Wear gloves when touching the patient.
- D. Apply antibiotic ointments to the perineum.
Correct Answer: C
Rationale: Exudate from any lesions with syphilis is highly contagious. Systemic antibiotics, rather than local treatment of lesions, are used to treat syphilis. The patient does not require a private room because the disease is spread through contact with the lesions. This patient has clinical manifestations of secondary syphilis and does not need to be monitored for manifestations of tertiary syphilis.
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.