Question 1

During unprotected sex, a 17-year-old female high school senior has been exposed to the human papillomavirus (HPV). The school nurse would recognize that the student is at a considerable risk of developing which of the following diagnoses?

Accepted Answer

HPV is an identified precursor to condylomata acuminata, or genital warts. Herpes, gonorrhea, and candidiasis are not likely to result directly from HPV.

Question 2

A campus-based peer counseling group is conducting an information blitz on sexually transmitted diseases. Which of the following statements about genital warts requires correction?

Accepted Answer

Genital warts can take between 6 weeks to 8 months to incubate after exposure. The virus cannot be eliminated, and condoms do not provide proven protection. Vaccine protects against 4 HPV types.

Question 3

A 31-year-old male was diagnosed with genital herpes of the HSV-2 type 5 years ago. He is now broaching the subject with a woman he has recently formed a relationship with. Which of his statements is most accurate?

Accepted Answer

HSV transmission can occur both during and between recurrences. HSV-2 is associated more with genital herpes than cold sores, and cold sores do not provide antibody protection. Prior contact with the virus does not confer immunity.

Question 4

A male college student has arrived at the student clinic complaining of tingling, itching, and pains in his groin. Upon inspection, the nurse notices some pustules and vesicles. While taking a detailed sexual history, the nurse should ask which of the following questions to rule out further complications?

Accepted Answer

The initial symptoms of primary genital herpes infections include tingling, itching, and pain in the genital area, followed by eruption of small pustules and vesicles. In men, the infection can cause urethritis and lesions of the penis and scrotum. Urethritis is characterized by pain with urination and difficulty starting the stream. Cold sores are not related to genital herpes. Swelling of the scrotum is common in epididymitis, while flank pain and bloody urine are associated primarily with kidney stone formation.

Question 5

A pregnant 23-year-old diagnosed with herpes simplex virus (HSV) is receiving prenatal care from her family physician. To prevent transmission of the virus to her baby, the physician will educate to include which of the following accurate statements?

Accepted Answer

Vaginal delivery is safe in the absence of lesions at the onset of labor. HSV does not preclude breast-feeding, and antivirals would not be commonly used in pregnancy, nor would they guarantee a risk-free vaginal delivery.

Question 6

A 20-year-old male has presented to a health clinic with multiple genital lesions that are filled with a viscous, creamy exudate and has subsequently been diagnosed with molluscum contagiosum. What is his care provider most likely to tell him about the plan for treating the diagnosis?

Accepted Answer

Molluscum contagiosum is considered a benign and self-limiting viral illness. Oral antivirals are not a common treatment, and it is not noted to lead to sterility.

Question 7

After hearing horror stories about the signs, symptoms, and course of lymphogranuloma venereum (LGV), a high school student has asked a visiting sexual health educator about the odds of acquiring the disease among sexually active Americans. Which of the following facts will most accurately underlie the educator's response?

Accepted Answer

In the United States, men who have sex with men are the population with the highest prevalence and incidence of LGV. It is bacterial in etiology and affects more men than women.

Question 8

Which of the following factors are known to contribute to vaginal yeast infections? Select all that apply.

Accepted Answer

Reported risk factors for the overgrowth of C. albicans include recent antibiotic therapy, which suppresses the normal protective bacterial flora; high hormone levels owing to pregnancy or the use of oral contraceptives, which cause an increase in vaginal glycogen stores; and uncontrolled diabetes mellitus or HIV infection, because they compromise the immune system. Exercise and glandular inflammation are not noted risk factors for yeast infections.

Question 9

A patient with a yeast infection asks the nurse how they diagnose this infection. The nurse will base her response knowing this is primarily diagnosed by

Accepted Answer

Accurate diagnosis is made by identification of budding yeast filaments or spores on a wet-mount slide using 20% potassium hydroxide. When the wet-mount technique is negative but the clinical manifestations are suggestive of candidiasis, a culture may be necessary. Definite diagnosis consists of more than a visual look at the secretions.Diagnosis of bacterial vaginosis is made by looking at the number of Lactobacillus species under the microscope. DNA testing may be required when dealing with HSV infection.

Question 10

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last 6 months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?

Accepted Answer

The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.

Question 11

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last 6 months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms?

Accepted Answer

The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions such as an imbalance in normal vaginal flora resulting from antibiotic treatment enable the protozoan to proliferate. Patients with trichomoniasis respond well to treatment with metronidazole.

Question 12

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What are the woman's most likely treatment and prognosis?

Accepted Answer

The treatment of choice for Trichomonas vaginalis is oral, metronidazole or tinidazole, medications that are effective against anaerobic protozoans. Antifungals are not a relevant treatment, and eradication of the infection is possible with treatment.

Question 13

A 40-year-old woman with gray, runny vaginal discharge that has a foul, fishy odor has been told that she most likely has vaginosis. Which of the following phenomena most likely contributed to her present condition?

Accepted Answer

Vaginosis is a disorder characterized by a shift in the vaginal flora from one dominated by hydrogen peroxide-producing Lactobacillus to one with greatly reduced numbers of Lactobacillus species and an overgrowth of other organisms. Autoinoculation or sexual transmission of bacteria or protozoa is unlikely to contribute.

Question 14

A 20-year-old male has been diagnosed with a chlamydial infection, and his primary care provider is performing teaching in an effort to prevent the client from infecting others in the future. Which of the following statements by the client demonstrates the best understanding of his health problem?

Accepted Answer

Seventy-five percent of woman with chlamydial infections are asymptomatic. Blindness is a rare complication in adults who live in industrialized countries, and both men and women can become sterile from the effects. Syphilis, not chlamydial infections, has a course of three distinct stages.

Question 15

The health nurse is dealing with a case of untreated chlamydial infection. The nurse suspects the patient has developed Reiter syndrome. Which of the following clinical manifestations would support this diagnosis? Select all that apply.

Accepted Answer

The most serious complication of untreated chlamydial infection is the development of Reiter syndrome. This triad of symptoms includes urethritis, conjunctivitis, and arthritis of weight-bearing joints, such as the knees and sacroiliac and vertebral joints. Pain when urinating occurs in both men and women and is associated with urethritis. Women can also develop reactive arthritis, but the male-to-female ratio for this complication is 5:1. The arthritis begins 1 to 3 weeks after the onset of chlamydial infection. The joint involvement is asymmetric, with multiple affected joints and a predilection of the lower extremities. Cervical tissue friability is not part of Reiter syndrome.

Question 16

While working in a sexually transmitted disease (STD) clinic, the nurse should be aware that which of the following diagnostic tools are available for diagnosing chlamydial infections? Select all that apply.

Accepted Answer

Diagnosis of chlamydial infections takes several forms. The identification of polymorphonuclear leukocytes on Gram stain of penile discharge in the man or cervical discharge in the woman provides presumptive evidence. The direct fluorescent antibody test and enzyme-linked immunosorbent assay that use antibodies against an antigen in the Chlamydia cell wall are rapid tests that are highly sensitive and specific. Nucleic acid amplification tests (NAATs) do not require viable organisms for detection and can produce a positive signal from as little as a single copy of the target DNA or RNA. Western blot is used to verify HIV after a positive ELISA result for HIV.

Question 17

A 55-year-old male has presented to the emergency department because he is alarmed at the genitourinary symptoms he has experienced over the last several days. He reveals that he has had a number of new sexual relationships during a tropical vacation that ended 5 days ago. Over the last several days, he has had increasing pain in his urethra and a creamy yellow discharge from his penis. For the last 2 days, the discharge has been occasionally blood tinged. What differential diagnosis would be the care team's first priority?

Accepted Answer

The rapid onset and bloody penile discharge that the client cites are characteristics of gonorrhea. Neither the onset nor the symptomatology matches syphilis or chancroid, and Chlamydia typically takes longer to manifest and does not normally include bloody discharge.

Question 18

In a busy STD clinic on a large university campus, a group of students have developed tetracycline- and penicillin-resistant strains of N. gonorrhoeae. Given these results, the nurse can expect that which of the following medications will be prescribed?

Accepted Answer

The current treatment recommendation to combat tetracycline- and penicillin-resistant strains of N. gonorrhoeae is ceftriaxone in a single injection; the other medications are not specific for the treatment of gonorrhea.

Question 19

A pregnant teenager has arrived at a free clinic seeking care. She has had no prenatal care and is currently 27 weeks' gestation. Upon testing for a sexually transmitted disease (STD), it is found that she has active T. pallidum (syphilis). Given the fact that she has active syphilis at this stage in her pregnancy, it is very likely her fetus is at risk for: Select all that apply.

Accepted Answer

There is rapid transplacental transmission of the organism from the mother to the fetus after 16 weeks' gestation, so that active infection in the mother during pregnancy can produce congenital syphilis in the fetus. Untreated syphilis can cause prematurity, stillbirth, and congenital defects and active infection in the infant. Unstable blood glucose levels can occur with diabetic mothers, and many infants have some acrocyanosis immediately following birth. Blindness from syphilis can occur decades after initial infection, so it would not be present at birth.

Question 20

Unbeknownst to him, a 30-year-old male has contracted Treponema pallidum during a sexual encounter the night before. Place the following manifestations of the microorganism in the chronological order that they would occur in the absence of treatment. Use all the options.

Accepted Answer

The primary stage of syphilis includes chancre formation, while the secondary stage often involves a rash on the palms and feet. Latency occurs between the second and third stages, the latter often including cardiovascular effect such as aneurysm formation.

Quiz 52: Disorders of Skin Integrity and Function

During unprotected sex, a 17-year-old female high school senior has been exposed to the human papillomavirus (HPV) . The school nurse would recognize that the student is at a considerable risk of developing which of the following diagnoses?