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1.

The nurse determines that a woman with genital herpes (HSV-2) understands her self-care related to this infection when she states: A. B. C. ? ? ? "When I have a baby, I don't want a cesarean." "I can have sex when all the herpes sores have healed." "When I finish the acyclovir prescription, I will be cured."

D. :-) "I must be careful when I have sex because herpes is a lifelong problem."

Genital herpes (HSV-2) is characterized by remissions and exacerbations; it cannot be cured.

2. A 16-year-old adolescent has a steady boyfriend and is having sexual relations with him. She is seeking advice as to how she can protect herself from contracting HIV. The nurse advises her to: A. B. C. D. ? ? ? ? Have her partner withdraw before ejaculating Make certain their relationship is monogamous Seek counseling about various contraceptive methods Be sure that her partner uses a condom when having sex

A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals.

3. When assessing a female client who is suspected of having primary syphilis, the nurse should expect the client to exhibit the early sign of: A. B. C. D. ? ? ? ? Flat wartlike plaques around the vagina and anus An indurated painless nodule on the vulva that begins to drain Glistening patches in the mouth covered with a yellow exudate A maculopapular rash on the palms of the hands and soles of the feet

This is a description of a chancre, which is the initial sign of syphilis.

4. A client who has been diagnosed as having syphilis tells the nurse that it must have been contracted from a toilet seat. The nurse knows that this cannot be true because the causative agent of syphilis is: A. B. X Immobilized by body contact X Chelated by wood and plastic

C. X Destroyed by warmth and moisture D. ? Inactivated when exposed to a dry environment

A dry environment inactivates the Treponema pallidum, making it incapable of causing disease

5. A 35-year-old woman arrives at the women's health care center complaining of frequency and burning pain when urinating. The diagnosis is a urinary tract infection. When instructing this client it is important to: A. B. C. D. ? ? ? ? Encourage her to void every two hours Have her record her fluid intake and output Pour warm water over her vulva whenever she voids Teach her to wash her hands before and after voiding

This medical aseptic technique should limit the spread of microorganisms and help prevent future urinary tract infections if incorporated into her health practices.

6. The nurse in the women's health clinic recognizes that a client who complains of swelling of the labia and throbbing pain in the labial area after sexual intercourse should be treated for: A. ? Urethritis

B. C. D.

? ? ?

Bartholinitis Vaginal hematoma Inflamed Skene's glands

The Bartholin glands are located beneath the vaginal vestibule; if cysts form and they become infected they cause labial, vaginal, or pelvic pain particularly during or after intercourse (dyspareunia).

7. Four days after a vaginal hysterectomy a client calls the telephone follow-up service and tells the nurse that she has a yellowish green vaginal discharge. The nurse advises the client to return to the clinic because the nurse knows that there is a need to assess: A. B. C. D. ? ? ? ? The blood pressure and pulse The specific gravity of her urine For the symptoms of a urinary tract infection For the presence of abdominal pain and a rising temperature

yellowish green vaginal discharge indicates the presence of an infection; further assessment is necessary.

8. The LVN discusses herpes genitalis as part of a sex education program. The nurse should instruct the patients that herpes genitalis is: A. B. C. D. ? ? ? ? Painless in both men and women. Curable with antibiotics. Transmitted via toilet seats. Responsible for systemic and local reactions.

Fever, malaise, and headache may accompany local reactions.

9.

The nurse understands that gonorrhea is difficult to control because: A. B. C. ? ? ? The blood test is expensive and time consuming The causative organism has become resistant to treatment There is no specific diagnostic test for the causative organism The symptoms are vague and the incubation period is relatively

D. ? short

Many clients are asymptomatic; the incubation period is 3 to 5 days.

10. When a student in a high school sex education class asks whether recurrent infection is possible with herpes genitalis, the nurse should reply that: A. B. ? ? A healthy lifestyle will prevent recurrences Once herpes genitalis has been effectively treated, recurrence is rare

C. ? Although attacks do recur they are not as severe as the initial infection D. ? activity The surest way to prevent recurrent attacks is to abstain from sexual

The initial attack is both local and systemic; recurrent attacks are milder and localized.

11. The nurse evaluates that a young female client who is being treated for a sexually transmitted infection understands instructions regarding future sexual contacts when she states: A. ? "If I have sex, nothing I do will really prevent me from getting another sexually transmitted infection." B. ? "If I get a sexually transmitted infection I can take whatever you give me because I'm not allergic to any drugs."

C. ? "I will not have unprotected sex again and I will tell my partners to be tested for sexually transmitted infections." D. ? "I must ask my partners if they have a sexually transmitted infection and if they say no, then I'll know that I can have sex."

The most effective strategies for preventing sexually transmitted infections in oneself and sex partners is through the use of condoms and having sex partners tested to identify their status and be treated if necessary.

12. A client at 16 weeks' gestation is being treated for Trichomonas vaginalis. The statement that best indicates to the nurse that the client has learned measures to prevent recurrence is, "I will: A. B. C. D. ? ? ? ? "Void immediately after intercourse." "Persuade my sexual partner to be treated." "Insert a vaginal suppository after intercourse." "Douche immediately after having sexual intercourse."

The male should be treated to prevent the infection from passing back and forth between him and his sexual partner.

13. The nurse is caring for a client with dysuria. Urinary tract infection is the presumed diagnosis and a urine analysis is completed. The nurse is aware that the results exclusively indicating the development of infection would include the presence of: A. B. C. D. ? ? ? ? Nitrate Protein Bilirubin Erythrocytes

The presence of nitrate in the urine is characteristic of infection.

14. A client comes to the infectious disease clinic because a sexual partner was recently diagnosed as having gonorrhea. The health history reveals that the client has engaged in receptive anal intercourse. The nurse should assess the client for: A. B. C. D. ? ? ? ? Melena Anal itching Constipation Ribbon-shaped stools

Anal itching and irritation result from erythema and edema of the anal crypts from the gonococci.

15. The nurse should ask the client with secondary syphilis about sexual contacts during the past: A. B. C. D. ? ? ? ? 21 days 30 days 3 months 6 months

The client is in the secondary stage, which begins from 6 weeks to 6 months after primary contact; therefore, a 6-month history is needed to ensure that all possible contacts and original contacts are located.

16. A client is suspected of having late-stage (tertiary) syphilis. When obtaining a health history, the nurse recognizes that the statement by the client that most supports this diagnosis would be: A. B. C. D. ? ? ? ? "I noticed a wart on my penis." "I have sores all over my mouth." "I've been losing a lot of hair lately." "I'm having trouble keeping my balance."

Neurotoxicity, as manifested by ataxia, is evidence of tertiary syphilis, which may involve the CNS; other CNS signs include confusion, paralysis, delusions, impaired judgment, and slurred speech.

17. A young sexually active client at the family planning clinic is advised to have a Pap smear. She has never had a Pap smear before. The nurse's explanation of the procedure should include that: A. B. C. D. ? ? ? ? Pap smears can detect cancer of the cervix Vaginal bleeding is expected after a Pap smear Colposcopy will be used to magnify the cervix Scraping the cervix is the most uncomfortable part

Pap smears can detect cancer of the cervix by screening for atypical as well as cancerous cells.

18. Immediately after a sexual assault, appropriate nursing care should include:

A. B. C. D.

? ? ? ?

Obtaining a history of the assault from the client Informing the police before the client is examined Asking the client to collect a clean-catch urine specimen Testing the client's urine for seminal alkaline phosphatase

This routine screening for information provides a basis for assessing trauma; in a younger client it also is necessary to assess the risk for pregnancy.

19. The school nurse discusses herpes genitalis as part of a high school sex education program. The nurse should instruct the students that herpes genitalis is: A. B. ? ? Painless in women Curable with penicillin

C. D.

? ?

Transmitted via fomites such as toilet seats Responsible for local as well as systemic reactions

Fever, malaise, and headache may accompany local reactions.

20. The nurse understands that gonorrhea is difficult to control because: A. B. C. ? ? ? Blood cultures are time consuming The causative organism is a virus diagnostic test is very painful

D. ? The incubation period is relatively short and there might be no symtpoms at all

Many clients are asymptomatic; the incubation period is 3 to 5 days.

21. A 20-year-old client is being treated for epididymitis. Teaching for this client should include the fact that epididymitis is often a result of a A. B. C. D. ? ? ? ? Virus Parasite Sexually Transmitted Infection Protozoa

Among men younger than 35 years of age, epididymitis is most frequently caused by a sexually transmitted infection. Causative organisms are usually chlamydia or Neisseria gonorrhea. The other major form of epididymitis is bacterial, caused by the Escherichia coli or Pseudomonas. The nurse should always include safe sex teaching for a client with epididymitis. The client should also be advised against anogenital intercourse, because this is a mode of transmission of gram-negative rods to the epididymis.

22. Women who have had an STD are at increased risk for: A. B. C. D. ? ? ? ? infertility HIV/AIDS getting another STD Cancer

75%-90% of women with chlamydia are asymptomatic and can remain infectious for years if untreated. Chlamydia and/or gonorrhea infection may result in PID, tubal infertility, tubal ectopic pregnancy and chronic pelvic pain.

23. The nurse explains to a sexually active woman with a history of a mucopurulent discharge and bleeding associated with cervical dysplasia, dysuria, and dyspareunia that she will receive erythromycin or amoxicillin for the treatment of: A. B. C. D. ? ? ? ? Herpes simplex 2 Treponema pallidum Neisseria gonorrhoeae Chlamydia trachomatis

These are the signs and symptoms of and the treatment for a chlamydial infection.

24. A home care nurse begins caring for a 25-year-old female client who has just been diagnosed with human immunodeficiency virus (HIV) infection. The client asks the nurse, "How could this have happened?" The nurse responds to the question based on the most frequent mode of HIV transmission, which is A. ? hugging an HIV-positive sexual partner without using barrier precautions. B. ? inhaling cocaine.

C. ? sharing food utensils with an HIV-positive person without proper cleaning of the utensils.

D. ? having sexual intercourse with an HIV-positive person without using a condom.

HIV infection is transmitted through blood and body fluids, particularly vaginal and seminal fluids. A blood transfusion is one way the disease can be contracted. Other modes of transmission are sexual intercourse with an infected partner and sharing needles for intravenous drug injections with an infected person. Women now have the highest rate of newly diagnosed HIV infection. Many of these women have contracted the HIV virus from unprotected sex with male partners. HIV cannot be transmitted by hugging, inhaling cocaine, or sharing food utensils.

25. A client with HIV is taking zidovudine (AZT). AZT is a drug that acts to A. B. C. D. ? ? ? ? destroy the virus. enhance the body's antibody production. slow replication of the virus. neutralize toxins produced by the virus

Zidovudine (AZT) interferes with replication of HIV and thereby slows progression of HIV infection to acquired immunodeficiency syndrome (AIDS). There is no known cure for HIV infection. Today, clients are not treated with monotherapy but are usually on triple therapy due to a much-improved clinical response. Decreased viral loads with the drug combinations have improved the longevity and quality of life in clients with HIV/AIDS. AZT does not destroy the virus, enhance the body's antibody production, or neutralize toxins produced by the virus.

26. Women who have human papillomavirus (HPV) are at risk for development of A. B. C. D. ? ? ? ? sterility. cervical cancer. uterine fibroid tumors. irregular menses.

Women who have human papillomavirus (HPV) are much more likely to develop cervical cancer than women who have never had the disease. Cervical cancer is now considered a sexually transmitted disease (STD). Regular examinations, including Pap tests, are recommended to detect and treat cervical cancer at an early stage. HPV does not cause sterility, uterine fibroid tumors, or irregular menses.

27. Which of the following nursing diagnoses would most likely be a priority for a client with herpes genitalis? A. B. C. D. ? ? ? ? Disturbed Sleep Pattern Imbalanced Nutrition: Less Than Body Requirements Pain. Ineffective Breathing Pattern.

Pain is a common problem in women with herpes genitalis. Analgesia may be prescribed for the pain along with antiviral therapy such as valacyclovir (Valtrex), acyclovir, or famciclovir. Clients frequently describe the pain as an intense burning. Urination can be very painful because of the burning sensation from herpes lesions in the perineal area. Sleep disturbances, nutritional deficits, and ineffective breathing patterns are not frequently associated with herpes genitalis.

28. The primary reason that a herpes simplex virus (HSV) infection is a serious concern to a client with HIV infection is that it A. B. C. D. ? ? ? ? is an acquired immunodeficiency virus (AIDS)defining illness. is curable only after 1 year of antiviral therapy. leads to cervical cancer. causes severe electrolyte imbalances.

HSV infection is one of a group of disorders that, when diagnosed in the presence of HIV infection, are considered to be diagnostic for AIDS. Other AIDS-defining illnesses include Kaposi's sarcoma; cytomegalovirus of the liver, spleen, or lymph nodes; and Pneumocystis carinii pneumonia. HSV infection is not curable and does not cause severe electrolyte imbalances. HPV can lead to cervical cancer.

29. In educating a client about HIV, the nurse should take into account the fact that the most effective method known to control the spread of HIV infection is A. B. C. D. ? ? ? ? premarital serologic screening. prophylactic treatment of exposed people. laboratory screening of pregnant women. ongoing sex education about preventive behaviors.

Education to prevent behaviors that cause HIV transmission is the primary method of controlling HIV infection. Behaviors that place people at risk for HIV infection include unprotected sexual intercourse and sharing of needles for intravenous drug injection. Educating clients about using condoms during sexual relations is a priority in controlling HIV transmission.

30. A male client with HIV infection becomes depressed and tells the nurse "I have nothing worth living for now." Which of the following statements would be the best response by the nurse? A. ? "You are a young person and have a great deal to live for." "You should not be too depressed; we are close to finding a cure for "You are right; it is very depressing to have HIV."

B. ? AIDS." C. ?

D. ? "Tell me more about how you are feeling about being HIV positive."

The nurse should respond with a statement that allows the client to express his thoughts and feelings. After sharing feelings about their diagnosis, clients will need information, support, and community resources. Statements of encouragement or agreement do not provide an opportunity for the client to express himself.

31. The organism responsible for causing syphilis is classified as a A. ? virus.

B. C. D.

? ? ?

fungus. rickettsia. spirochete.

Treponema pallidum, the organism that causes syphilis, is classified as a spirochete because of its corkscrew appearance. There are more than 100 different types of STD caused by various types of organisms. Viruses and bacteria are responsible for many common STDs. Fungi and rickettsia do not cause STDs.

32. The typical chancre of syphilis appears as A. B. C. D. ? ? ? ? a grouping of small, tender pimples. an elevated wart. a painless, moist ulcer. an itching, crusted area.

The chancre of syphilis is characteristically a painless, moist ulcer. The serous discharge is very infectious. Because the chancre is usually painless and disappears, the client may not be aware of it or may not seek care.

33. When interviewing a client with newly diagnosed syphilis, the public health nurse should be aware that the spread of the disease can be controlled by A. B. C. D. ? ? ? ? motivating the client to undergo treatment. obtaining a list of the client's sexual contacts. increasing the client's knowledge of the disease. reassuring the client that records are confidential.

An important aspect of controlling the spread of STDs is obtaining a list of the sexual contacts of an infected client. These contacts, in turn, should be encouraged to obtain immediate care. Many people with STDs are reluctant to reveal their

sexual contacts, which makes controlling STDs difficult. Increasing clients' knowledge of the disease and reassuring clients that their records are confidential can motivate them to seek treatment, which does help to control the spread of the disease, but it is not as critical as information about the client's sexual contacts.

34. Benzathine penicillin G, 2.4 million units IM, is prescribed as treatment for an adult client with primary syphilis. The intramuscular injection is administered in A. B. C. D. ? ? ? ? the deltoid. the upper outer quadrant of the buttock. the quadriceps lateralis of the thigh. the midlateral aspect of the thigh.

Because of the large dose, the upper outer quadrant of the buttocks is the recommended site. The Centers for Disease Control and Prevention (CDC) recommends Benzathine penicillin G 2.4 million units IM in a single dose for adults with primary or secondary syphilis who are not allergic to penicillin. The deltoid and the quadriceps lateralis of the thigh are not large enough for the recommended dose. In infants and small children, the midlateral aspect of the thigh may be preferred.

35. A priority nursing diagnosis for a client with primary syphilis is A. ? Deficient Knowledge related to lack of exposure to information about mode of transmission. B. C. D. ? ? ? Pain related to cutaneous skin lesions on palms and soles. Ineffective Tissue Perfusion related to a bleeding chancre. Disturbed Body Image related to alopecia.

A client with primary syphilis is at risk of transmitting the disease to sexual partners if he or she is not knowledgeable about how the disease is spread. Cutaneous lesions on the palms and soles and alopecia are signs of secondary syphilis. Chancres do not bleed sufficiently to alter tissue perfusion. Chancres often disappear even without treatment.

36. An 18-year-old female college student is seen at the university health center. She undergoes a pelvic examination and is diagnosed with gonorrhea. Which of the following responses by the nurse would be best when the client says that she is nervous about the upcoming pelvic examination? A. ? "Can you tell me more about how you're feeling?"

B. ? "You're not alone. Most women feel uncomfortable about this examination." C. D. ? ? "Do not worry about Dr. Smith. He's a specialist in female problems." "We'll do everything we can to avoid embarrassing you."

Asking the client to describe her nervousness gives her the opportunity to express her concerns. It also allows the nurse to understand her better and gives the nurse a base to respond to the client's stated fears, questions, or need for further information. Responses that make assumptions about the source of the concern or offer reinforcement are not supportive and block successful communication.

37. When educating a female client with gonorrhea, the nurse should emphasize that for women gonorrhea A. B. C. D. ? ? ? ? is often marked by symptoms of dysuria or vaginal bleeding. does not lead to serious complications. can be treated but not cured. may not cause symptoms until serious complications occur.

Many women do not seek treatment because they are unaware that they have gonorrhea. They may be symptom-free or have only very mild symptoms until the disease progresses to pelvic inflammatory disease (PID). Dysuria and vaginal bleeding are not present in gonorrhea. Gonorrhea can lead to very serious complications. It can be cured with the proper treatment.

38. Which of the following groups has experienced the greatest rise in the incidence of STDs over the past two decades?

A. B. C. D.

? ? ? ?

Teenagers. Divorced people. Young married couples. Older adults.

Statistics reveal that the incidence of STDs is rising more rapidly among teenagers than among any other age group. Many reasons have been given for this trend, including a change in societal mores and increasing sexual activity among teenagers. During this developmental stage, teenagers may engage in high-risk sexual behaviors because they often are living in the present and feel that it won't happen to them.

39. A 16-year-old sexually active male client presents to the clinic with a complaint of burning on urination and a milky discharge from the urethral meatus. Documentation on the client's chart should include which of the following information? Select all that apply. A. B. C. D. ? ? ? ? History of unprotected sex (sex without a condom). Length of time since symptoms presented. History of fever or chills. Presence of any enlarged lymph nodes on examination.

The client is suspected of having a sexually transmitted infection. Therefore, the client's sexual history, assessment, and examination must be documented, including symptoms (such as fever, chills, and enlarged glands) and their onset and duration. Allergies are critical to document for every client, but are especially noteworthy in this case because antibiotics will be ordered. If a sexually transmitted infection is confirmed, sexual contacts need to be treated. To protect privacy, the names and phone numbers should never be placed in the chart. The public health department will also assist in obtaining information and treating known sexual contacts.

40. A 19-year-old male client is diagnosed with Chlamydia. Azithromycin (Zithromax) 1 gram is ordered. The supply of azithromycin is in 250-milligram tablets. The number of tablets to be administered is

A. B. C. D.

? ? ? ?

1 0 2 4

41. A female client with gonorrhea informs the nurse that she has had sexual intercourse with her boyfriend and asks the nurse, "Would he have any symptoms?" The nurse responds that in men the symptoms of gonorrhea include A. B. C. D. ? ? ? ? impotence. scrotal swelling. urinary retention. dysuria

Dysuria and a mucopurulent urethral discharge characterize gonorrhea in men. Gonococcal symptoms are so painful and bothersome for men that they usually seek treatment with the onset of symptoms. Impotence, scrotal swelling, and urinary retention are not associated with gonorrhea.

42. The nurse assesses the mouth and oral cavity of a client with HIV because the most common opportunistic infection initially presents as A. B. C. D. ? ? ? ? HSV lesions on the lips. oral candidiasis. cytomegalovirus (CMV) infection. aphthae on the gingiva.

The most common opportunistic infection in HIV initially presents as oral candidiasis, or thrush. The client with HIV should always have an oral assessment. HSV and CMV are opportunistic infections that present later in AIDS. Aphthous stomatitis, or recurrent canker sores, is not an opportunistic infection, although the sores are thought to occur more often when the client is under stress.

43. A 28-year-old male client is diagnosed with acute epididymitis. The nurse would expect to find that the symptoms that caused the client to seek medical care are A. B. C. D. ? ? ? ? burning and pain on urination severe tenderness and swelling in the scrotum. foul-smelling ejaculate. foul-smelling urine.

Epididymitis causes acute tenderness and pronounced swelling of the scrotum. Gradual onset of unilateral scrotal pain, urethral discharge, and fever are other key signs. It is occasionally, but not routinely, associated with urinary tract infection. Burning and pain on urination and foul-smelling ejaculate or urine are not classic symptoms of epididymitis.

44. Which of the following bacterial STDs is the most common? A. B. C. D. ? ? ? ? Scabies Syphilis Chlamydia HIV

45. Which STD besides HIV/AIDS can be detected by a blood test? A. B. C. D. ? ? ? ? gonorrhea syphilis chlamydia trichomoniasis

Syphilis can be detected by blood test. Gonorrhea, chlamydia are detected by swabs or urine. Trichomoniasis is detected by wet mount or culture swab.

46. Mrs Hawk is being treated with penicillin for syphilis. Twelve hours after the first injection of penicillin, the client develops fever, musculoskeletal pain, and tachycardia. The nurse recognizes these manifestations as being suggestive of: A. B. ? ? anaphylaxis to penicillin. complications of the syphilis infection.

C. ? resulting from the release of toxins from the spirochetes into the bloodstream. D. ? resulting from the client's anxiety regarding the diagnosis of syphilis.

Jarisch-Herxheimer reaction should not be confused with reaction to antibiotics; is common on starting treatment of primary or secondary disease due to lysis of treponemes.