Chapter 74: Care of Patients with Sexually Transmitted Diseases

Question 1

A nurse instructor is teaching a student nurse about the factors that have increased the number of people with sexually 
 transmitted diseases (STDs) seen in practice. Which statement by the student indicates a lack of understanding?

Answer 1

The organisms causing STDs are all becoming more virulent.

There is no evidence that the organisms that cause STDs are becoming more virulent, but a client may need to use another anti-infective if allergic or the protocol was not effective.

Question 2

A nurse is assessing a client who presents with a scaly rash over the palms and soles of the feet and the feeling of muscle aches and malaise. The nurse suspects syphilis. Which action by the nurse is appropriate?

Answer 2

Don gloves and further assess the clients lesions.

The client is displaying symptoms similar to secondary syphilis, with flu-like symptoms and rash due to the spirochetes circulating throughout the bloodstream. Therefore, the nurse needs to further assess the clients lesions with gloves since the client is highly contagious at this stage

Question 3

A male client is diagnosed with primary syphilis. Which question by the nurse is a priority at this time?

Answer 3

Are you allergic to penicillin?

Benzathine penicillin G is the evidence-based treatment for primary syphilis. The client needs to be assessed for allergies before treatment.

Question 4

An African-American female with blisters on the vagina is being treated with acyclovir (Zovirax) for genital herpes. She is angry at her partner for transmitting the infection. Which action by the nurse is best?

Answer 4

Be sensitive to the clients feelings and refer her to a support group

The nurse needs to be sensitive and supportive of the client since infected clients may feel angry, lonely, and isolated. Allow the client to verbalize her feelings and refer her to a local support group, such as the National Herpes Resource Center.

Question 5

A 19-year-old female is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate?

Answer 5

This will lower your risk for cervical cancer.

Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and warts. The vaccine is recommended for people ages 10 to 26 years.

Question 6

A 26-year-old client with multiple sexual partners is being assessed for symptoms of dysuria and vaginal discharge. Because the results from the culture of the cervical cells are not available, the client will be treated for both Chlamydia and gonorrhea. Which explanation by the nurse is best?

Answer 6

This early treatment will prevent obstruction to the fallopian tubes.

Both gonorrhea and Chlamydia can cause pelvic inflammatory disease and scarring of the fallopian tubes, resulting in infertility problems. Azithromycin is the treatment of choice for both sexually transmitted diseases, but ceftriaxone (Rocephin) is also recommended for treatment of gonorrhea

Question 7

While evaluating a male client for treatment of gonorrhea, which question is the most important for the nurse to ask?

Answer 7

What are the names of your recent sexual partners?
“Can you remember your partners and contact them to get treated?

Sexual partners, as well as the client, should be tested and treated for gonorrhea.

Question 8

Before marriage, a female client has a blood test drawn for syphilis. The test reveals a positive Venereal Disease Research Laboratory (VDRL) serum test. What is the advice that the nurse should give the client?

Answer 8

Submit to a more specific treponemal test to confirm the infection

False-positive reactions can occur with viral infections, hepatitis, and systemic lupus erythematosus. A health care provider can request more specific treponemal tests such a fluorescent treponemal antibody absorption or microhemagglutination assay for Treponema palladium performed by the laboratory.

Question 9

A 23-year-old female has been diagnosed with genital warts. Which action by the nurse is best?

Answer 9

Encourage the client to have an annual Papanicolaou (Pap) test.
Encourage the client to complete STI screening

An annual Pap test is recommended (due the strong relationship between genital warts and the development of dysplasia of the cervix) until three normal Pap smears are obtained. The Pap smear can detect any malignancies of the cervix. Clients with HPV should be fully screened for other STIs since co-infection is common.

Question 10

A female client returned to the clinic with a yellow vaginal discharge after being treated for Chlamydia infection 3 weeks ago. Which statement by the client alerts the nurse that there may be a recurrence of the infection?

Answer 10

I never told my boyfriend about the infection

There is a good possibility that the boyfriend re-infected the client after the medication regimen was finished. Both the client and the boyfriend need to be treated.

Question 11

A woman is admitted to the hospital for antibiotic therapy for pelvic inflammatory disease. She is in pain, with a rating of 7 on a scale of 0 to 10. What comfort measure can the nurse delegate to the unlicensed assistive personnel (UAP)?

Answer 11

Position the client in a semi-Fowlers position

The client with pelvic inflammatory disease usually experiences lower abdominal tenderness. The UAP can
position the client.

Question 12

A client with pelvic inflammatory disease is seen by the nurse 72 hours after starting oral antibiotics. Which finding leads the nurse to take immediate action?

Answer 12

Chills and a temperature of 101 F (38.3 C)

Chills and fever could indicate a persistent infection and the immediate need to alter the dose or type of antibiotic.

Question 13

A 19-year-old college student seeks information from the schools nurse about how to avoid sexually transmitted diseases (STDs) without abstinence as a choice. Which statement by the nurse is best?

Answer 13

A vaccine can prevent genital warts caused by some strains of the human papilloma virus (HPV).

Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 that are high risk for cervical cancer and
genital warts.

Question 14

The nurse teaches a client with genital herpes about effective comfort measures. Which statement by the client indicates a need for further teaching by the nurse?

Answer 14

I really should try to limit urination due to the pain.

The client should urinate frequently, not limit voiding. Voiding while in the shower or tub should lessen the discomfort. Warm compresses, ice packs, sitz baths, and anesthetic sprays and ointments are all effective comfort measures that can be used with genital herpes.

Question 15

A primary care clinic sees some clients with sexually transmitted diseases. Which clients would the nurse be required to report to the local authority in every state, according to the Centers for Disease Control and Prevention? (Select all that apply.)

Answer 15

Client with Chlamydia
Woman with gonorrhea
Man with syphilis
Client with human immune deficiency virus

Chlamydia, gonorrhea, syphilis, chancroid, human immune deficiency virus (HIV), and acquired immune deficiency syndrome (AIDS) are all reportable to local authorities in every state.

Question 16

A nurse wants to reduce the risk potential for transmission of chlamydia and gonorrhea with a female client diagnosed with both diseases. Which items should be included in the clients teaching plan? (Select all that apply.)

Answer 16

Expedited partner therapy
Abstinence until therapy is completed
Proper use of condoms
Re-screening for infection

As part of client/partner education, the nurse should explain the expedited partner therapy (practice of treating both sexual partners by providing medication to the client for the partner). The nurse should also emphasize the need for abstinence from sexual intercourse until treatment is finished, proper use of condoms, and re-screening
for re-infection 3 to 12 months after treatment.

Question 17

A client being treated for syphilis visits the office with a possible allergic reaction to benzathine penicillin G. Which abnormal findings would the nurse expect to document? (Select all that apply.)

Answer 17

Red rash
Shortness of breath
Chest tightness
Anxiety

The nurse should keep all clients at the office for at least 30 minutes after the administration of benzathine penicillin G. Allergic manifestations consist of rash, shortness of breath, chest tightness, and anxiety, depicting anaphylaxis and serum sickness.

Question 18

Which risk factors would the nurse teach a 23-year-old client about to prevent pelvic inflammatory disease
(PID)? (Select all that apply.)

Answer 18

Having multiple sexual partners
Using an intrauterine device (IUD)
Smoking
Having a history of sexually transmitted diseases (STDs)

Some of the same factors that place women at risk for STDs also place women at risk for PID: sexually active women of age younger than 26 years, multiple sexual partners, use of an IUD, smoking, and a history of STDs

Question 19

The nurse is teaching a client who is taking an oral antibiotic for treatment of a sexually transmitted disease (STD). Which statements by the client indicate a correct understanding of the treatment? (Select all that apply.)

Answer 19

I need to drink at least 8 glasses of fluid each day with my antibiotic.
I should read the instructions to see if I can take the medication with food.
I need to wait 7 days after the last dose of the antibiotic to engage in intercourse.

When a client is being treated with an oral antibiotic for an STD, 8 to 10 glasses of fluid should be routine, medication instructions should be reviewed, and at least a week break should occur between the last dose of the antibiotic and sexual intercourse to allow for the medications full effects

Question 20

A client with genital herpes has painful blisters on her vulva. After teaching the client self-care measures, which statement indicates the need for further education?

Answer 20

“When I don’t have lesions, I am not contagious to my sexual partner.”

A client with genital herpes can still spread the disease when asymptomatic through viral shedding. The client is taught to use condoms with all sexual activity.

Question 21

A 30-year-old male client is asking the nurse about the vaccine for human papilloma virus (HPV). Which statement by the nurse is accurate?

Answer 21

“You will only need 1 dose of the vaccine.

Gardasil is used to provide immunity for HPV types 6, 11, 16, and 18 and Gardasil 9 protects against 5 more strains.

Question 22

A client with multiple sexual partners has been assessed for symptoms of dysuria and green, malodorous vaginal discharge. The nurse administers and injection of ceftriaxone and gives the client a prescription for doxycycline. The client asks why two drugs are needed. What answer by the nurse is best?

Answer 22

“It is very common to be infected with both gonorrhea and chlamydia.”

This client has signs of gonorrhea. Co-infection with gonorrhea and chlamydia is common, so the client being treated for gonorrhea also needs treatment for chlamydia with oral antibiotics.

Question 23

A client has been treated for syphilis with IM penicillin. The next day the client calls the clinic to report fever, chills, achy muscles, and a worsening rash. What statement by the nurse is most appropriate?

Answer 23

“You can take acetaminophen or ibuprofen for the pain and achiness.”

This client has signs of a Jarisch-Herxheimer reaction which is caused when the organisms’
cell walls are disrupted and cellular contents are released rapidly. It is usually self-limiting
and benign.

Question 24

A client has a positive HSV-2 test but is asymptomatic. What action by the nurse is best?

Answer 24

Inform the client that partner notification is unnecessary

Question 25

A client has pelvic inflammatory disease (PID). What complications does the nurse monitor the client for? (Select all that apply.)

Answer 25

Chronic pelvic pain
Infertility
Ectopic pregnancy
Tubo-ovarian abscess
Peri-hepatitis

Possible complications of PID include chronic pelvic pain, infertility, ectopic pregnancy, tubo-ovarian abscess, peri-hepatitis, inflammation of the liver capsule, and inflammation of the peritoneal surfaces of the anterior right upper quadrant.