Lewis: Medical-Surgical Nursing, 7th Edition

Test Bank

Chapter 53: Nursing Management: Sexually Transmitted Diseases

MULTIPLE CHOICE

1. A man seeks care at the health clinic because he has developed a profuse, purulent
urethral discharge with painful urination. During assessment of the patient, it is most
important that the nurse gather information related to
a. sexual contacts.
b. a history of previous similar symptoms.
c. condom use.
d. a history of bladder infections or orchitis.

Correct Answer: A
Rationale: Information about sexual contacts is needed to help establish whether the
patient has been exposed to a sexually transmitted disease (STD) and because sexual
contacts will also need treatment. A previous history of similar symptoms and the
patient’s condom use will be helpful in planning patient teaching, but it is more important
to determine STD exposure and contacts. A history of bladder infection or orchitis may
suggest other causes for the patient’s symptoms but is not the most important information
at this time.

Cognitive Level: Application Text Reference: pp. 1377-1378

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

2. During the nursing assessment of a 23-year-old female patient, the nurse considers the
patient’s risk for sexually transmitted diseases (STDs). Which statement by the
patient indicates the most need for patient teaching?
a. “I have an IUD and have had the same boyfriend for 3 years.”
b. “I have never been tested for syphilis or chlamydia.”
c. “I make an appointment every year for a pelvic exam.”
d. “I use the birth control pill because I am not ready to settle down yet.”

Correct Answer: D
Rationale: The patient’s statement indicates that she may have multiple partners, a risk
factor for STDs. Oral contraceptives do not protect against STDs. The other statements
do not indicate any urgent patient teaching needs.

Cognitive Level: Application Text Reference: pp. 1367, 1377

Nursing Process: Assessment
NCLEX: Health Promotion and Maintenance

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.
Test Bank 53-3

3. A patient with gonorrhea is treated with a single IM dose of ceftriaxone (Rocephin)

and is given a prescription for doxycycline (Vibramycin) 100 mg bid for 7 days. The
nurse explains to the patient that this combination of antibiotics is prescribed to
a. prevent reinfection during treatment.
b. treat any coexisting chlamydial infection.
c. eradicate resistant strains of N. gonorrhoeae.
d. prevent the development of resistant organisms.

Correct Answer: B
Rationale: Since 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.

Cognitive Level: Application Text Reference: pp. 1368-1369, 1372

Nursing Process: Implementation NCLEX: Physiological Integrity

4. A patient who has labs drawn for an insurance screening has a positive VDRL test.
The nurse’s first action should be to
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 (FAT-Abs)
testing.
d. assess for the presence of chancres, flulike symptoms, or a bilateral rash on the
trunk.

Correct Answer: A
Rationale: Once antibody testing is positive for syphilis, the antibodies remain after
successful treatment, so the nurse should inquire about previous treatment before doing
other assessments or testing. Culture, FAT-Abs testing, and assessment for symptoms may
be appropriate based on whether the patient has been treated for syphilis.

Cognitive Level: Application Text Reference: p. 1371

Nursing Process: Implementation NCLEX: Physiological Integrity

5. A Gram stain smear of a patient’s urethral discharge reveals the presence of Neisseria
gonorrhoeae. The patient tells the nurse about recent sexual contact with a woman
but says she did not appear to have any disease. In responding to the patient, the nurse
explains that
a. many women are not aware they have gonorrhea because they often do not have
symptoms of infection.
b. when gonorrhea infections occur in women, the disease affects only the ovaries
and not the genital organs.
c. women develop subclinical cases of gonorrhea that do not cause tissue damage or

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 53-4

clinical manifestations.
d. women do not develop gonorrhea infections but can serve as carriers to spread the
disease to males.

Correct Answer: A
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.

Cognitive Level: Application Text Reference: p. 1368

Nursing Process: Implementation NCLEX: Physiological Integrity

6. A patient with positive Venereal Disease Research Laboratory (VDRL) and

fluorescent treponemal antibody absorption (FAT-Abs) tests has a rash on the palms
and the soles of the feet and moist papules in the anal and vulvar area. While caring
for the patient, it is important for the nurse to
a. wear gloves when touching the patient.
b. apply antibiotic ointments to the perineum.
c. place the patient in a private room.
d. monitor the heart sounds for new murmurs.

Correct Answer: A
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.

Cognitive Level: Application Text Reference: p. 1370

Nursing Process: Implementation
NCLEX: Safe and Effective Care Environment

7. Primary genital herpes is diagnosed in a patient seeking care for lesions on her vulva
and perineum. After the nurse teaches the patient about management of the disease,
which statement by the patient indicates that the teaching has been effective?
a. “I will take the acyclovir (Zovirax) every 8 hours for the next week.”
b. “I will use condoms for intercourse until the medication is all gone.”
c. “I will use the acyclovir ointment on the area to relieve the pain.”
d. “I will need to take all of the medication to be sure the infection is cured.”

Correct Answer: A

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 53-5

Rationale: The treatment regimen for primary genital herpes infections includes
acyclovir 400 mg 3 times daily for 7 to 10 days. The patient is taught to abstain from
intercourse until the lesions are gone. (Condoms should be used even when the patient is
asymptomatic.) Acyclovir ointment is not effective in treating lesions or reducing pain.
Herpes infection is chronic and recurrent.

Cognitive Level: Application Text Reference: p. 1375

Nursing Process: Implementation NCLEX: Physiological Integrity

8. When counseling a woman who is having difficulty conceiving, the nurse will be
most concerned about a history of infection with
a. Treponema pallidum.
b. N. gonorrhoeae.
c. condyloma acuminatum.
d. herpes simplex virus type 2.

Correct Answer: B
Rationale: Complications of gonorrhea include scarring of the fallopian tubes, which can
lead to tubal pregnancies and infertility. Syphilis, genital warts, and genital herpes do not
lead to problems with conceiving, although transmission to the fetus (syphilis) or
newborn (genital warts or genital herpes) is a concern.

Cognitive Level: Application Text Reference: pp. 1367-1368

Nursing Process: Implementation NCLEX: Physiological Integrity

9. A woman who is 20 weeks pregnant is diagnosed with primary syphilis. She tells the
nurse that she is very worried about the effect of the disease on the fetus. The most
appropriate response by the nurse to the patient’s concern is
a. “Instillation of erythromycin into the eyes of the newborn will prevent any
problems of transmission to the baby.”
b. “A single intramuscular injection of penicillin at this point in your pregnancy will
cure both you and the fetus of syphilis.”
c. “If you have active genital lesions at the time you begin labor, a cesarean delivery
will be performed to prevent transmission to the baby.”
d. “Syphilis will not affect the baby in any way because the microorganism does not
cross the placental barrier.”

Correct Answer: B
Rationale: A single injection of penicillin is recommended to treat primary syphilis, and
this will treat the mother and prevent transmission of the disease to the fetus. Instillation
of erythromycin into the eyes of the newborn will prevent gonorrheal eye infections. C-
section is use to prevent the transmission of herpes to the newborn. Syphilis does cross
the placental barrier.

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 53-6

Cognitive Level: Application Text Reference: p. 1371

Nursing Process: Implementation NCLEX: Physiological Integrity

10. A 23-year-old diabetic patient has large masses of genital warts around her external
genitalia and perianal area. She tells the nurse she just tries to ignore them but knows
the reason her boyfriend left her was because they are so disgusting. Based on the
patient’s remarks, the nurse identifies the nursing diagnosis of
a. ineffective coping related to denial of increased risk for infection.
b. anxiety related to impact of condition on interpersonal relationships.
c. risk for infection related to lack of knowledge about mode of transmission.
d. disturbed body image related to genital warts secondary to human papilloma virus
(HPV) infection.

Correct Answer: D
Rationale: The patient’s statement that her lesions are disgusting suggests that disturbed
body image is the major concern. There is no evidence to indicate ineffective coping or
lack of knowledge about mode of transmission. The patient may be experiencing anxiety,
but this is likely to be resolved if the disturbed body image is resolved.

Cognitive Level: Application Text Reference: pp. 1376, 1378-1379

Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

11. When a patient returns to the clinic for follow-up after treatment for nongonococcal
urethritis, a purulent urethral discharge is still present. When trying to determine the
reason for the recurrent infection, which question is most appropriate for the nurse to
ask the patient?
a. “Have you noticed an increase in pain or burning?”
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: A common reason for recurrence of symptoms is reinfection because infected
partners have not been simultaneously treated. Pain or burning may occur with urethritis,
but this question will not help determine why the patient is still symptomatic. 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.

Cognitive Level: Application Text Reference: p. 1372

Nursing Process: Assessment NCLEX: Physiological Integrity

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 53-7

12. A 38-year-old married woman seeks health care for a change in vaginal discharge and
pain on urination. When she is diagnosed with chlamydia, she is furious, saying that
her husband is her only sexual contact, so he must have other sexual contacts. Which
response by the nurse is most appropriate?
a. “You may need professional counseling to help resolve your anger.”
b. “Your feelings are justified and you should share them with your husband.”
c. “It is important that both you and your husband be treated for the infection.”
d. “It is understandable that you are angry with your husband right now.”

Correct Answer: D
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
counseling, 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.

Cognitive Level: Application Text Reference: p. 1378

Nursing Process: Implementation NCLEX: Psychosocial Integrity

13. A patient is treated for chlamydia that was detected during a routine pelvic
examination. The nurse knows that teaching regarding the management of the
condition has been effective when the patient says,
a. “Go ahead and give me the antibiotic injection so I will be cured.”
b. “I will use condoms during sex until I finish taking all the antibiotics.”
c. “My immune system will eventually be able to fight off the infection.”
d. “My sexual partner will need to take antibiotics at the same time I do.”

Correct Answer: D
Rationale: Sex partners should be treated simultaneously to prevent reinfection.
Chlamydia is treated with oral antibiotics. Abstinence from sexual intercourse is
recommended for 7 days after treatment, and condoms should be used during all sexual
contacts to prevent infection. Antibiotic treatment is needed to avoid the complications of
chlamydia infection.

Cognitive Level: Application Text Reference: pp. 1372-1373

Nursing Process: Evaluation NCLEX: Physiological Integrity

14. When the nurse is talking to a group of young adults about prevention of sexually
transmitted diseases (STDs), one of the participants states “I will just plan to take
antibiotics if I get an STD.” Which response by the nurse is appropriate?
a. “STDs can be treated with antibiotics, but it is still important to avoid infection
through the use of condoms.”

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

 Test Bank 53-8

b. “The microorganism that causes syphilis is frequently resistant to treatment with

the commonly used antibiotics.”
c. “Some STDs can not be treated with antibiotics and these may lead to recurrent
infection and increased cancer risk.”
d. “The treatment for bacterial STDs is complex and potentially painful, so avoidance
of infection is important.”

Correct Answer: C
Rationale: Both human papilloma virus (HPV) and herpes simplex infections are viral
and both cause chronic infections. Recurrence of symptoms of HSV is common. HPV
infection is associated with increased risk for cervical cancer. Since some STDs are viral,
antibiotic therapy will not be effective. Syphilis continues to respond to treatment with
benzathine penicillin G (Bicillin) even after 4 decades of use. Since treatment of bacterial
STDs consists of simply taking antibiotics, the nurse should not indicate that the
treatment is complex or painful.

Cognitive Level: Application Text Reference: pp. 1366, 1373, 1375

Nursing Process: Planning NCLEX: Physiological Integrity

15. A woman in the STD clinic tells the nurse that she is concerned she may have been
exposed to gonorrhea by her partner. To determine whether the patient has gonorrhea,
the nurse will plan to
a. interview the patient about symptoms of gonorrhea.
b. take a sample of vaginal discharge for Gram staining.
c. draw a blood specimen or rapid plasma regain (RPR) testing.
d. obtain a cervical specimen for an enzyme immunoassay (EIA).

Correct Answer: D
Rationale: EIA testing has a high sensitivity (similar to a culture) for gonorrhea. Because
women have few symptoms of gonorrhea, asking the patient about symptoms is not
helpful in making a diagnosis. Smears and Gram staining are not useful because the
female genitourinary tract has many normal flora that resemble N. gonorrhoeae. RPR
testing is used to detect syphilis.

Cognitive Level: Application Text Reference: p. 1368

Nursing Process: Planning NCLEX: Physiological Integrity

MULTIPLE RESPONSE

1. A 37-year-old patient with a long history of IV drug use is seen at a community clinic,
where the patient reports difficulty walking because “I don’t know where her feet
are.” Diagnostic screening reveals a positive VDRL and fluorescent treponemal
antibody absorption (FAT-Abs) test. Based on the patient history, the nurse will assess
(Select all that apply.)

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.

Test Bank 53-9

a. visual acuity.
b. genitalia for lesions.
c. heart sounds and aortic pulsations.
d. joints for swelling and inflammation.
e. skin and mucous membranes for gummas.
f. mental state for judgment and orientation.

Correct Answer: C, E, F
Rationale: The patient’s clinical manifestations and laboratory tests are consistent with
tertiary syphilis and valvular insufficiency, gummas, and changes in mentation are other
clinical manifestations of this stage.

Cognitive Level: Application Text Reference: p. 1370

Nursing Process: Assessment NCLEX: Physiological Integrity

Copyright © 2007 by Mosby, Inc., an affiliate of Elsevier Inc.