Chapter 07: Sexually Transmitted and Other Infections Lowdermilk: Maternity & Women's Health Care, 12th Edition

1. Which manifestation differentiates primary syphilis from secondary syphilis?

a. Fever, headache, and malaise

b. Widespread rash

c. Identified by serologic testing

d. Appearance of a chancre 2 months after infection

ANS: D

Primary syphilis is characterized by a primary lesion (the chancre), which appears 5 to 90 days after infection. The chancre begins as a painless papule at the site of inoculation and erodes to form a nontender, shallow, and clean ulcer several millimeters to centimeters in size. Secondary syphilis occurs 6 weeks to 6 months after the appearance of the chancre and is characterized by a widespread maculopapular rash. The individual may also experience fever, headache, and malaise. Latent syphilis are those infections that lack clinical manifestations; however, they are detected by serologic testing.

2. Which statement made by a nurse regarding the prophylactic vaccination to prevent human papillomavirus (HPV) demonstrates a need for further education?

a. "Currently there is only one vaccine for the HPV available."

b. "The vaccine is given in three doses over a 6-month period."

c. "The vaccine is recommended for both boys and girls." d. "Ideally, the vaccine is administered before the first sexual contact."

ANS: A

Three vaccines for HPV are available—Cervarix, Gardasil and Gardasil 9—and other vaccines continue to be investigated. They are most effective if administered before the first sexual contact. Recommendations are that vaccines be administered to 11- and 12-year-old girls and boys. The vaccine can be given to girls as young as 9 years of age and young women ages 13 to 26 years in three doses over a 6-month period.

3. Which sexually transmitted infection (STI) is the most commonly reported in American women?

a. Gonorrhea

b. Syphilis

c. Chlamydia

d. Candidiasis

ANS: C

Chlamydia is the most common STI in women in the United States and one of the most common causes of pelvic inflammatory disease (PID). Gonorrhea is probably the oldest communicable disease in the United States and second to Chlamydia in reported conditions. Syphilis has reemerged as a common STI, affecting black women more than any other ethnic or racial group. Candidiasis is a relatively common fungal infection.

4. The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a. Miconazole ointment

b. Topical podofilox 0.5% solution or gel

c. Two doses of penicillin administered intramuscularly (IM)

d. Metronidazole by mouth

ANS: B

Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athlete's foot. Penicillin IM is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis

5. Which condition is the most life-threatening virus to the fetus and neonate?

a. Hepatitis A virus (HAV)

b. Herpes simplex virus (HSV)

c. Hepatitis B virus (HBV)

d. Cytomegalovirus (CMV)

ANS: C

HBV is the most life-threatening viral condition to the fetus and neonate. HAV is not the most threatening to the fetus nor is HSV the most threatening to the neonate. Although serious, CMV is not the most life-threatening viral condition to the fetus.

6. Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)?

a. Oral antiviral therapy

b. Bed rest in a semi-Fowler position

c. Antibiotic regimen continued until symptoms subside

d. Frequent pelvic examination to monitor the healing progress

ANS: B

The woman with acute PID should be on bed rest in a semi-Fowler position. Broad-spectrum antibiotics are used; antiviral therapy is ineffective. Antibiotics must be taken as prescribed, even if symptoms subside. Few pelvic examinations should be conducted during the acute phase of the disease

7. On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a "fishy" odor and reports of pruritus. Based upon these findings, which condition would the nurse suspect?

a. Bacterial vaginosis

b. Candidiasis

c. Trichomoniasis

d. Gonorrhea

ANS: A

Most women with bacterial vaginosis complain of a characteristic "fishy" odor. The discharge is usually profuse, thin, and has a white, gray, or milky color. Some women may also experience mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellow-to-green, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. Although they may have a purulent endocervical discharge, the discharge is usually minimal or absent.

8. Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes?

a. Herpes simplex virus 2 (HSV-2)

b. Human papillomavirus (HPV)

c. Human immunodeficiency virus (HIV)

d. Cytomegalovirus (CMV)

ANS: A

The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of the HSV infection commonly have only local symptoms that usually are less severe than those of the initial infection. With HPV infection, lesions are a chronic problem. The HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with the HIV infection characterizes AIDS, which has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection

9. Once the Human immunodeficiency virus (HIV) has entered the body, what is the time frame for seroconversion to HIV positivity?

a. 6 to 10 days

b. 2 to 4 weeks

c. 6 to 12 weeks

d. 6 months

ANS: C

Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus hasentered the body. Both 6 to 10 days and 2 to 4 weeks are too short for seroconversion to HIV positivity to occur, and 6 months is too long

10. Which sexual transmitted infection (STI) does not respond well to antibiotic therapy?

a. Chlamydia

b. Gonorrhea

c. Genital herpes

d. Syphilis

ANS: C

Genital herpes is a chronic and recurring viral infection for which no known cure is available; therefore, it does not respond to antibiotics. Chlamydia is a bacterial infection that is treated with doxycycline or azithromycin. Gonorrhea is a bacterial infection that is treated with any of several antibiotics. Syphilis is a bacterial infection that is treated with penicillin

11. Which statement regarding the various forms of hepatitis is accurate?

a. Vaccine exists for hepatitis C virus (HCV) but not for hepatitis B (HBV).

b. Hepatitis A (HAV) is acquired by eating contaminated food or drinking polluted water.

c. Hepatitis B (HBV) is less contagious than HIV.

d. Incidences of hepatitis C (HCV) is decreasing.

ANS: B

Contaminated milk and shellfish are common sources of infection for HAV. A vaccine exists for HBV but not for HCV. HBV is more contagious than HIV. The incidence of HCV is on the rise.

12. A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed to help confirm the diagnosis. Which condition is this client most likely experiencing?

a. Bacterial vaginosis

b. Candidiasis

c. Yeast infection

d. Trichomoniasis

ANS: D

Although uncomfortable, a speculum examination is always performed, and a wet smear obtained if the client exhibits symptoms of trichomoniasis. The presence of many white blood cell protozoa is a positive finding for trichomoniasis. A normal saline test is used to test for bacterial vaginosis. A potassium hydroxide preparation is used to test for candidiasis. Yeast infection is the common name for candidiasis, for which the test is a potassium hydroxide preparation

13. is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal Group B Streptococcus (GBS) infection?

a. Positive prenatal Group B Streptococcus culture

b. Preterm birth at 37 weeks or less of gestation

c. Intrapartum maternal temperature of 38 C (100.4°F) or higher

d. Premature rupture of membranes (PROM) lasting 12 hours

ANS: D

PROM 18 hours or longer before the birth increases the risk for neonatal GBS infection. Positive prenatal culture is a risk factor for neonatal GBS infection. Preterm birth at 37 weeks or less of gestation remains a risk factor for neonatal GBS infection. Maternal temperature of 38 C or higher is also a risk factor for neonatal GBS infection.

14. Which clinical presentation should the nurse assess for if a pregnant client is experiencing a Jarisch-Herxheimer reaction? (Select all that apply)

a. Vomiting and diarrhea

b. Headache

c. Preterm labor contractions

d. CHOICE BLANK

e. Bright red vaginal bleeding Arthralgia

ANS: B C, E

Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. The reaction is an acute febrile reaction that occurs within the first 24 hours of treatment and is accompanied by headache, myalgias, and arthralgia. If the client is pregnant, then she is at risk for preterm labor and birth. Neither vaginal bleeding, vomiting nor diarrhea are anticipated.

15. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn possibly infected with human immunodeficiency virus (HIV)?

a. Wearing gloves.

b. Wearing mouth, nose, and eye protection.

c. Wearing a mask.

d. Washing the hands after medication administration.

ANS: A

Standard Precautions should be consistently used in the care of all persons. Personal protective equipment in the form of gloves should be worn during infant eye prophylaxis, care of the umbilical cord, circumcision site care, diaper changes, handling of colostrum, and parenteral procedures. Masks are worn during respiratory isolation or if the health care practitioner has a cough. Mouth, eye, and nose protection are used to protect the mucous membranes if client-care activities are likely to generate splashes or sprays of body fluids. The hands should be washed both before having contact with the client and after administering medications.

16. Which sexually transmitted infection (STI) can be successfully treated?

a. Herpes simplex virus

b. Acquired immunodeficiency syndrome (AIDS)

c. Venereal warts

d. Chlamydia

ANS: D

The usual treatment for Chlamydia bacterial infection is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. No known cure is available for HSV; therefore, the treatment focuses on pain relief and preventing secondary infections. Because no cure is known for AIDS, prevention and early detection are the primary focus of care management. HPV causes condylomata acuminata (venereal warts); no available treatment eradicates the virus.

17. What is the drug of choice for the treatment of gonorrhea?

a. Penicillin G

b. Tetracycline

c. Ceftriaxone

d. Acyclovir

ANS: C

Ceftriaxone is effective for the treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis

18. Which sexual behaviors are associated with high exposure to a sexually transmitted infection (STI)? (Select all that apply.)

a. Monogamy

b. Unprotected anal intercourse

c. Multiple sex partners

d. Dry kissing

e. Self-masturbation

ANS: B, C

Engaging in unprotected anal intercourse or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI. Dry kissing self-masturbation, and monogamy are considered safe sexual practices

19. Which statements regarding the Human papillomavirus (HPV) are accurate? (Select all that apply.) HPV infections:

a. HPV is thought to be less common in pregnant women than in women who are not pregnant.

b. HPV is thought to be more common in pregnant than in non-pregnant women.

c. HVP was previously referred to as genital warts.

d. HVP was previously referred to as herpes.

e. HVP is thought to sometimes cause cervical cancer.

ANS: B, C, E

HPV infections are thought to be more common in pregnant women than in women who are not pregnant, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is an STI with more than 30 known serotypes, several of which are associated with cervical cancer.

20. The nurse understands that the risk of perinatal transmission of human immunodeficiency virus (HIV) can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care of a pregnant client with a viral load of more than 1000 copies/ml.? (Select all that apply.)

a. Intrapartum treatment with antiviral medications

b. Cesarean birth

c. Postpartum treatment with antiviral medications

d. Avoidance of breastfeeding

e. Pneumococcal, HBV, and Haemophilus influenzae vaccine

ANS: A, B, D

The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce the transmission of the HIV to as low as 1% to 2%. The client who refuses a cesarean birth should be given intravenous antiviral therapy during labor. Ideally, medications should be given prenatally. Administration of antiviral drugs in the postpartum period will not reduce transmission to the infant. All women who are HIV positive should be encouraged to receive these immunizations. They will not reduce the risk of perinatal transmission.

21. Which infections, collaboratively referred to as TORCH infections, are capable of crossing the placenta and causing serious prenatal effects on the fetus? (Select all that apply.)

a. Toxoplasmosis

b. Cytomegalovirus (CMV)

c. Rubella

d. Clostridium

e. Herpes simplex 1 (HSV-1)

ANS: A, B, C, E

Toxoplasmosis, cytomegalovirus (CMV), rubella virus, and HSV are collectively known as TORCH infections. Clostridium is not associated Torch infections.

22. Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.)

a. Menstruation

b. Trauma

c. Febrile illness

d. Soap

e. Ultraviolet light

ANS: A, B, C, E

Stress, menstruation, trauma, febrile illness, chronic illnesses, and ultraviolet light have all been found to trigger genital herpes. Women might elect to keep a diary of symptoms to help identify stressors. Lesions should be cleansed with saline or simple soap and water. Lesions can be kept dry by using a blow dryer, wearing cotton underwear, and wearing loose clothing. Tea bags or hydrogen peroxide might also be helpful.