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Medical Surgical Nursing 3rd Edition deWit Stromberg Dallred Test Bank

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Medical Surgical Nursing 3rd Edition deWit Stromberg Dallred Test Bank

ISBN-13: 978-0323243780

ISBN-10: 0323243789

 

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Medical Surgical Nursing 3rd Edition deWit Stromberg Dallred Test Bank

ISBN-13: 978-0323243780

ISBN-10: 0323243789

 

 

 

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Free Nursing Test Questions:

Chapter 40: Care of Patients with Sexually Transmitted Infections

deWit: Medical-Surgical Nursing: Concepts & Practice, 3rd Edition

 

MULTIPLE CHOICE

 

  1. The nurse is caring for a homosexual man with a rectal tear and inflamed rectal tissue. The nurse understands that these findings increase the patient’s risk for which disorder?
a. An abscess
b. Human immunodeficiency virus (HIV) infection
c. Hemorrhoids
d. Rectal hemorrhage

 

 

ANS:  B

Open lesions and inflamed tissue increase the risk of HIV infection.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   941

OBJ:   7 (theory)       TOP:   Exposure to HIV

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The nurse instructs a sexually active teenager that frequent douching can cause which infection?
a. Syphilis
b. Bacterial vaginosis
c. Pelvic inflammatory disease (PID)
d. Purulent vaginitis

 

 

ANS:  B

Bacterial vaginosis is caused when frequent douching changes the pH of the vaginal vault and creates an environment conducive to bacterial invasion. Sexually transmitted infections (STIs) like syphilis are not transferred by douching. PID is a condition that most often results from an untreated infection. Vaginitis is an inflammatory condition that does not result from douching.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   942

OBJ:   9 (theory)       TOP:   Vaginosis: Douching

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. Why are women at a greater risk for contracting sexually transmitted infections (STIs) than men?
a. Male secretions are in contact with female mucous membranes for longer periods of time.
b. Estrogens increase susceptibility of vaginal membranes.
c. Penile friction to the vaginal wall encourages STIs.
d. Changing hormonal levels create a vaginal environment conducive to bacterial growth.

 

 

ANS:  A

Male secretions are in contact with female mucous membranes longer than female secretions are in contact with the penis. Estrogen provides for vaginal lubrication and therefore reduces friction and tissue tearing.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   942

OBJ:   1 (theory)       TOP:   Female Incidence of STIs

KEY:  Nursing Process Step: Planning        MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The nurse is educating a sexually active female patient about infection prevention. Which change during the premenstrual period increases the patient’s risk of infection?
a. Cervical secretions become more alkaline.
b. The cervical mucous plug becomes more permeable.
c. Higher estrogen levels increase vaginal lubrication.
d. Lower antibody levels increase risk for infection.

 

 

ANS:  B

The mucous plug in the cervix of women provides protection to the upper genital tract. The hormonal changes make it become more permeable around the menstrual period. This change can result in an increased risk for infections in the upper genital tract, such as pelvic inflammatory disease (PID). Oral contraceptives alter cervical secretions and result in a more alkaline environment. Vaginal lubrication does not increase risk of infection, and antibody levels do not lower during the premenstrual period.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   942

OBJ:   3 (clinical)      TOP:   PID: Etiology

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. Which statement indicates that a patient needs additional education about the vaccine for human papillomavirus (HPV)?
a. “I know I must have three doses of the vaccine.”
b. “Girls as young as 9 years of age may be vaccinated.”
c. “I am relieved that the vaccine protects me from all HPV infections.”
d. “I know I should continue having regular Pap smears.”

 

 

ANS:  C

The vaccine protects against the most prevalent infections, genital warts and precancerous cervical lesions, but not against all HPV infections. The remaining statements are correct.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   943

OBJ:   3 (clinical)      TOP:   HPV: Vaccinations

KEY:  Nursing Process Step: Evaluation     MSC:  NCLEX: Health Promotion and Maintenance

 

  1. During an assessment of an older adult patient, the nurse observes a red rash on the palms of the hands and the soles of the feet. What should the nurse do next?
a. Notify the charge nurse.
b. Float the patient’s heels on a pillow.
c. Apply a prescribed emollient.
d. Reposition the patient on the left side.

 

 

ANS:  A

A red rash on the palms of the hands and the soles of the feet is consistent with the secondary phase of syphilis. The nurse should notify the charge nurse and health care provider to allow for further workup and treatment as indicated. Floating the patient’s heels or repositioning addresses prevention of skin breakdown, and emollients help decrease dry skin.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   943

OBJ:   8 (theory)       TOP:   Syphilis: Skin Lesions

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. Once a diagnosis of syphilis is confirmed, the nurse understands that she must report the illness to which entity?
a. The World Health Organization (WHO)
b. The Centers for Disease Control and Prevention (CDC)
c. The hospital infection control department
d. The local public health agency

 

 

ANS:  D

STIs are reported to the local public health agency for accumulation by the CDC. The local public health agency will get in touch with the sexual contacts of the patient and attempt to initiate treatment.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   943

OBJ:   3 (clinical)      TOP:   Reporting STIs

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. A female patient comes to the emergency department with severe abdominal pain, a temperature of 101° F, and a foul-smelling, purulent vaginal discharge. The nurse recognizes that these findings are consistent with which infection?
a. Pelvic inflammatory disease (PID)
b. Gonorrhea
c. Syphilis
d. Vaginosis

 

 

ANS:  A

Fever, abdominal pain, and purulent discharge are cardinal indicators of PID. Gonorrhea most often presents in females with vaginal discharge and burning with urination. The initial state of syphilis presents with chancre (hard, painless sore) on the mucous membrane of the mouth or genitals. Vaginosis most often presents with symptoms including a grayish-white discharge that has a fishy odor.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   942

OBJ:   1 (theory)       TOP:   PID: Signs and Symptoms

KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. After being stained with crystal violet, how will a gram-positive gonococcus react?
a. Fluoresce after counterstain is applied.
b. Accept the counterstain.
c. Retain the original stain after the counterstain is applied.
d. Turn dark after the counterstain is applied.

 

 

ANS:  C

Staining procedures differentiate organisms by using dyes that have been found to stain some bacteria in specific ways. An example of this would be a Gram stain, in which bacteria are first stained with crystal violet, then treated with a strong iodine solution, decolorized with ethanol or ethanol acetone, and then counterstained with contrasting dye. Those retaining the initial stain are considered gram positive; those losing the stain but accepting the counterstain are considered gram negative.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   950

OBJ:   3 (theory)       TOP:   Gram Stain: Significance

KEY:  Nursing Process Step: Planning        MSC:  NCLEX: Health Promotion and Maintenance

 

  1. When caring for a male patient with a suspected gonorrheal infection, which action is most important for the nurse to take?
a. Report the infection to the local public health agency.
b. Assess the patient’s temperature hourly.
c. Administer antibiotics before cultures are drawn.
d. Wait 1 hour after the patient voids to collect a urethral swab.

 

 

ANS:  D

Since the urine will have flushed out the organisms, the nurse should wait at least 1 hour postvoid before collecting the specimen. The infection has not been confirmedRemember, no report should be made at this time. The patient’s temperature should be obtained each shift. Administering antibiotics before cultures are drawn may cause cultures to be negative even though the drug or the dose may not be sufficient to cure the infection. If possible, obtain cultures prior to administering antibiotics.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   950

OBJ:   3 (theory)       TOP:   Gonorrhea Swab: Technique

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The nurse is educating a young woman newly diagnosed with genital herpes. Which information is most important for the nurse to include in the teaching plain?
a. Take the entire course of antibiotics.
b. Increase fluid intake to dilute urine.
c. Wash hands after applying topical ointment to lesions.
d. Avoid all sexual contact until lesions completely resolve.

 

 

ANS:  D

To prevent spreading genital herpes, the patient should avoid sex until all the lesions are gone. Genital herpes is a viral condition and symptoms can be managed by antiviral medication. Increasing fluid intake will help to dilute urine and can manage pain, but is of lesser importance than preventing the spread of genital herpes. The patient should don gloves when applying topical ointment.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   951

OBJ:   1 (clinical)      TOP:   Herpes: Prevention of Contagion

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The nurse is caring for a patient with genital herpes. Which manifestation alerts the nurse to a potential signal of an impending outbreak?
a. Elevation in temperature
b. Tingling sensation in the vagina
c. Copious vaginal discharge
d. Migraine-like headache

 

 

ANS:  B

Many women with herpes can predict an outbreak because of tingling or burning in the vagina. Elevations in temperature, increased vaginal discharge, and headaches are not common precursors of a herpes outbreak.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   945

OBJ:   1 (clinical)      TOP:   Herpes: Warning of Outbreak

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. How long after exposure does the incubation period for gonorrhea last?
a. 2 to 6 days
b. 1 week
c. 2 weeks
d. 4 weeks

 

 

ANS:  A

The incubation period is 2 to 6 days before symptoms may appear.

 

PTS:   1                    DIF:    Cognitive Level: Knowledge            REF:   946

OBJ:   6 (theory)       TOP:   Gonorrhea: Incubation Time

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The nurse is aware that men with gonorrhea are more likely to seek medical attention because their symptoms are more visible than those of women. Which clinical manifestation is most consistent with symptoms of gonorrhea in men?
a. Copious, purulent penile discharge
b. Hematuria when initiating the stream of urine
c. Penile ulcers with a foul odor
d. Scaly scrotal lesions

 

 

ANS:  A

Signs and symptoms of gonorrhea in men include purulent penal discharge and scrotal pain. Gonorrhea should not cause hematuria when urinating, penile ulcers with a foul odor, or scaly scrotal lesions.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   946

OBJ:   5 (theory)       TOP:   Gonorrhea: Male Signs

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. Which patient is exhibiting manifestations consistent with the primary stage of syphilis?
a. A female patient with copious vaginal discharge
b. A male patient with a generalized skin rash
c. A female patient with a painless nodule on her vagina
d. A male patient with a gumma

 

 

ANS:  C

Syphilis has three stages. The chancre, or painless, hard nodule, is visible in the primary stage of syphilis and disappears within a few weeks. The secondary stage occurs approximately 6 weeks later; symptoms may include a generalized skin rash. In tertiary syphilis, spirochetes access to all body tissues and a gumma (a soft encapsulated tumor) may appear on any organ.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   948

OBJ:   8 (theory)       TOP:   Syphilis: Primary Stage

KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is caring for a patient with syphilis. Which manifestation indicates that the syphilis has progressed to the secondary stage?
a. Foul-smelling penile discharge
b. Positive serology
c. Purulent skin rash
d. Scrotal swelling

 

 

ANS:  B

A positive serology will appear in the secondary stage of syphilis. Penile discharge is not associated with the secondary stage of syphilis. A generalized skin rash, not purulent, may be seen in the secondary stage of syphilis. Scrotal swelling is not associated with syphilis.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   948

OBJ:   8 (theory)       TOP:   Syphilis: Secondary Stage

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

  1. The nurse is educating a pregnant patient who is human immunodeficiency virus (HIV) positive. Which information is most important for the nurse to include in the teaching plan?
a. Breast-feeding is always best.
b. Talk with your doctor about a vaginal delivery.
c. Engage in oral, rather than vaginal, sex.
d. Remain on the medication protocol.

 

 

ANS:  D

Remaining on medication is essential. Certain prescribed drug combinations may significantly reduce the transmission to the fetus. Patients with HIV should avoid breast-feeding and cesarean birth. HIV can be spread by oral sex.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   947

OBJ:   2 (clinical)      TOP:   HIV: Preventive Actions

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. A patient has been diagnosed with chlamydia for the second time in a 5-month period. Data collection reveals that the patient was not compliant with the plan of treatment with the last infection. Which medication does the nurse anticipate that the provider will prescribe?
a. Doxycycline
b. Erythromycin
c. Diflucan
d. Azithromycin

 

 

ANS:  D

Chlamydia is best treated with a single dose of azithromycin for patients having a compliance problem. Doxycycline requires a 7-day course of therapy and may not be best given this patient’s history. Erythromycin is indicated to manage the disease in pregnant women. Diflucan is an antifungal medication used in the management of candidiasis.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   944

OBJ:   4 (theory)       TOP:   Table 41-1 Common STIs

KEY:  Nursing Process Step: Planning

MSC:  NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

 

  1. The nurse is collecting information from a patient during her annual pelvic examination. The patient reports that she has noted a strong vaginal odor after intercourse. Which condition may be present?
a. Gonorrhea
b. Bacterial vaginosis
c. Chlamydia
d. Syphilis

 

 

ANS:  C

Chlamydia may cause a strong vaginal odor noted after sexual intercourse. Gonorrhea causes vaginal discharge and a difficulty voiding. Bacterial vaginosis is associated with a fishy vaginal odor and discharge. Syphilis causes a chancre sore.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   944

OBJ:   4 (theory)       TOP:   Table 41-1 STIs

KEY:  Nursing Process Step: Assessment

MSC:  NCLEX: Physiological Integrity: Physiological Adaptation

 

MULTIPLE RESPONSE

 

  1. Which routes are ways in which sexually transmitted infections (STIs) are transmitted? (select all that apply.)
a. Sexual intercourse
b. Oral-genital route
c. Contact with infected blood
d. Placenta to infant
e. Contact with infected body fluids

 

 

ANS:  A, B, C, D, E

All options listed are possible transmission routes for STIs.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   941

OBJ:   3 (clinical)      TOP:   STIs: Transmission

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Safe, Effective Care Environment: Safety and Infection Control

 

  1. To which factor(s) can the rise in the number of sexually transmitted infections (STIs) be attributed? (select all that apply.)
a. An increase in the number of sexually active teenagers
b. An increase in the opportunity to have multiple partners
c. A knowledge deficit about signs and symptoms of STIs
d. Teenagers being reluctant to report diseases
e. Young people’s increasing ability to acquire confidential health care

 

 

ANS:  A, B, C, D

Rising numbers of STIs may be attributed to an increase in the number of sexually active teenagers, an increase in the opportunity to have multiple partners, a knowledge deficit about signs and symptoms of STIs, and teenagers being reluctant to report diseases.

Young people are often unable to acquire confidential health care.

 

PTS:   1                    DIF:    Cognitive Level: Comprehension     REF:   941

OBJ:   1 (clinical)      TOP:   Increasing Incidence of STIs

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. How can the use of oral contraceptives increase the risk of acquiring a sexually transmitted infection (STI)?  (select all that apply.)
a. Oral contraceptives cause bone marrow suppression.
b. Oral contraceptives cause an alkaline vaginal environment.
c. Oral contraceptives may reduce the perception of the need for condom use.
d. Oral contraceptives decrease the inflammatory response.
e. Oral contraceptives must be taken regularly in order to be effective.

 

 

ANS:  B, C, E

The use of oral contraceptive pills causes the vaginal vault to become alkaline from cervical secretions, which makes for a conducive environment for STIs. Oral birth control pills make the need for a condom redundant as pregnancy will be averted by the medication. Oral contraceptives do not cause bone marrow suppression, and while birth control must be taken regularly in order to be effective, this contributes to the risk of pregnancy, not an STI.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   942

OBJ:   3 (clinical)      TOP:   Oral Contraceptive: Effect on Rising STI Incidence

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. Which sexually transmitted infections (STIs) must be reported? (select all that apply.)
a. Vaginitis
b. Gonorrhea
c. Pelvic inflammatory disease.
d. Chlamydia
e. Lymphogranuloma

 

 

ANS:  B, C, D, E

All STIs listed are reportable in all states except for vaginitis. Syphilis is also a reportable STI. However, each state may add others to that list.

 

PTS:   1                    DIF:    Cognitive Level: Knowledge            REF:   943

OBJ:   3 (clinical)      TOP:   Reportable STIs

KEY:  Nursing Process Step: Planning        MSC:  NCLEX: Health Promotion and Maintenance

 

  1. Which factors indicate reasons why young patients are frequently reluctant to have their sexually transmitted infections (STIs) reported? (select all that apply.)
a. Fear of parental reaction
b. Embarrassment about their condition
c. Fear of reprisal from identified contacts
d. Fear of information becoming public
e. Fear of rejection by peers

 

 

ANS:  A, B, C, D, E

All options are realistic concerns about reporting contacts.

 

PTS:   1                    DIF:    Cognitive Level: Analysis                REF:   951

OBJ:   3 (clinical)      TOP:   Reporting STIs: Reasons for Reluctance

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. A patient who has been diagnosed with chlamydia is started on a protocol of doxycycline. Which information is important for the nurse to include in the teaching? (select all that apply.)
a. The partner does not need treatment.
b. Use a condom to protect partners from disease.
c. Chlamydia can develop into pelvic inflammatory disease (PID).
d. Take the entire prescription of antibiotics.
e. Chlamydia can result in an ectopic pregnancy.

 

 

ANS:  B, C, D, E

The patient should understand the importance of using condoms to protect her partner and taking the entire course of antibiotics to prevent resistance or relapse. The patient should also understand that chlamydia increases the risk of developing PID or an ectopic pregnancy. The patient’s partner should receive treatment as well.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   944

OBJ:   3 (clinical)      TOP:   Chlamydia: Instructions

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The nurse urges a female patient with gonorrhea to seek medical care. Which complication(s) can occur if gonorrhea is left untreated? (select all that apply.)
a. Ppelvic inflammatory disease (PID)
b. Sterility
c. Obstructed fallopian tubes
d. Ectopic pregnancy
e. Ophthalmia neonatorum in the newborn

 

 

ANS:  A, B, C, D, E

All options are possible complications from untreated gonorrhea.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   946

OBJ:   6 (theory)       TOP:   Gonorrhea: Complications

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

  1. The nurse is providing information to a patient who has recently been diagnosed with genital herpes. Which statements indicate the need for further instruction? (select all that apply.)
a. “I am only contagious when I have open sores.”
b. “The infection is limited to only my genital region.”
c. “There is no permanent cure for this condition.”
d. “I will need to contact my physician for antibiotic cream for the open lesions whenever I have an outbreak.”
e. “I should wash my hands carefully to prevent introduction of bacteria to the area.”

 

 

ANS:  A, B, D

The disease may be spread during outbreaks. It is possible to spread the infection with viral shedding between outbreaks. Herpes is a lifelong condition. There is no cure. The condition’s treatment can include the administration of antiviral medication. Antibiotics are not typically indicated unless a secondary bacterial infection develops. Proper hand hygiene is important to prevent both further spreading of the virus and introduction of bacteria to the affected area.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   945

OBJ:   4 (theory)       TOP:   Table 41-1 Common STIs

KEY:  Nursing Process Step: Evaluation     MSC:  NCLEX: Health Promotion and Maintenance

 

COMPLETION

 

  1. The nurse recommends that the newly diagnosed patient with herpes get current information about her disease from the local _______________.

 

ANS:

health department

 

The health department has clinics and written information in several languages that would be helpful to the newly diagnosed person.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   953

OBJ:   4 (theory)       TOP:   STIs: Information Source

KEY:  Nursing Process Step: Implementation

MSC:  NCLEX: Health Promotion and Maintenance

 

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