• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/148

Click to flip

148 Cards in this Set

  • Front
  • Back
What is the most common viral STI seen in ambulatory health care settings?
Human papillovirus (HPV) infections

also known as CONDYLOMATA ACUMINATA or GENITAL WARTS
What is HPV the primary cause of?
Cervical neoplasia/cancer
Where are HPV lesions frequently seen in women?
In the posterior part of the introitus; however, lesions are also found on the buttocks, the vulva, the vagina, the anus, and the cervix
What is the appearance of HPV lesions?
1. Infections of long duration may appear as a cauliflower-like mass.

2. In moist areas such as vaginal introitus, the lesions may appear to have multiple, fine, fingerlike projections

3. Flat-topped papules, 1 to 4 mm in diameter, are seen most often on the cervix. Often, then lesions are visualized only under magnification

4. Warts are usually fleshed colored or slightly darker on Caucasians, black on African-Americans, brown on Asians
What clinical manifestations are present with HPV?
1. Usually painless, but may be uncomfortable, particularly when very large, inflamed, or ulcerated

2. Chronic vaginal discharge, pruritus, or dyspareunia can occur
What is pruritus?
Itching
What is dyspareunia?
Painful sexual intercourse, for either gender
What causes preexisting HPV lesions to enlarge during pregnancy?
Relative state of immunosuppression during pregnancy
What type of delivery is recommended for women with active HPV lesions?
Cesarean birth

(unless all of the growth derives from one stalk, making it possible to push the large lesion to the side, allowing the baby to pass through vaginally)
What is the transmission rate of HPV to the neonate?
Unknown
What is the preventive value of cesarean birth against HPV?
Unknown
What are the symptoms of HPV?
1. Profuse, irritating vaginal discharge
2. Itching
3. Dyspareunia
4. Postcoital bleeding
5. "Bumps" on the vulva or labia
What physical assessments are required whenever HPV lesions are suspected or seen in one area?
Inspection of the vulva, perineum, anus, vagina, and cervix
What methods are used to diagnose HPV?
1. Evaluation of signs and symptoms
2. Papanicolaou (Pap) test
3. Physical examination
4. Viral screening and typing for HPV (but not part of standard practice)
What is condylomata lata?
A form of secondary syphilis and generally are flatter and wider than genital warts
How is HPV treated?
1. Usually difficult to treat

2. No therapy has been shown to eradicate HPV

3. The goal of treatment therefore is removal of warts and relief of signs and symptoms, not the eradication of HPV

4. Clients often must make multiple office visits

5. Eradication of the virus is not considered conclusive even after no visible evidence of wart tissue is present because of the high incidence of recurrence
What pharmacological treatments should not be used during pregnancy?
1. Imiquimod

2. Podophyllin

3. Podofilox
What methods are recommended for removal of HPV lesions during pregnancy?
Cryotherapy or other surgical techniques
What remedies can provide relief from discomfort caused by HPV lesions?
1. Bathing with oatmeal solution and drying the area with a cool hair dryer

2. Keeping the area clean and dry, which also decreases the growth of the warts

3. Cotton underwear and loose-fitting clothes that decrease friction and irritation

4. Maintaining a healthy lifestyle to aid the immune system

5. Diet, rest, stress reduction, exercise
What should clients with HPV be counseled for?
1. Information on how the virus is transmitted
2. That no immunity is conferred with infection
3. That requisition of the infection is likely with repeated contact
4. Partners should be checked even if they are asymptomatic
5. The infection is highly contagious
6. Concurrent vaginitis and STIs should be emphasized
7. Annual check-ups for recurrences and screenings for cervical cancer
8. Have regular Pap tests
What are the preventive strategies against transmission of HPV?
1. Abstinence from all sexual activity
2. Staying in a long-term relationship
3. Prophylactic vaccination
What is HSV?
Herpes simplex virus
How many people in the US are infected with HSV?
About 50 million people (although it is not a reportable disease)
What are the characteristics of an initial HSV genital infection?
1. Multiple painful lesions
2. Fever
3. Chills
4. Malaise
5. Severe dysuria
6. May last 2 to 3 weeks
Which gender generally has a more severe clinical course of HSV infections?
Women
What are the clinical manifestations of women with HSV infections?
1. Lesions that progress from macules to papules, then forming vesicles, pustules, and ulcers that crust and heal without scarring

2. Itching, inguinal tenderness, and lymphadenopathy

3. Sever vulvar edema

4. Cervix may appear normal or be friable, reddened, ulcerated, or necrotic

5. Heavy, watery-to-purulent vaginal discharge

6. Systemic symptoms are usually absent, although the characteristic prodromal genital tingling is common
What are the complications of HSV during pregnancy?
1. Neonatal herpes (most severe)

2. Increased miscarriage rates during first trimester
How is HSV managed?
Directed toward specific treatment during primary and recurrent infections, prevention, self-help measures, and psychologic support
What antiviral medications provide clinical benefits against HSV?
1. Acyclovir

2. Valacyclovir

3. Famiciclovir
What measures help increase comfort in women with active genital herpes?
1. Warm baths with baking soda

2. Keeping lesions dry by blowing the area with a hair dryer set on cool or patting dry with a soft towel

3. Wearing cotton underwear and loose clothing

4. Using drying aids, such as hydrogen peroxide, Burow's solution, or oatmeal baths

5. Applying cool, wet, black tea bags to lesions

6. Applying compresses with an infusion of cloves or peppermint oil and clove oil to lesions

7. Oral analgesics such as aspirin and ibuprofen may be used to relieve pain
What can help prevent recurrences of HSV breakouts?
A diet rich in vitamin C, B-complex vitamins, zinc, and calcium
When is transmission of HSV most likely to occur?
When there is viral shedding (so women should refrain from sexual contact until complete healing of lesions)
What can trigger a breakout of genital herpes?
1. Stress
2. Menstruation
3. Trauma
4. Febrile illnesses
5. Chronic illness
6. UV light
What method of delivery is recommended for HSV?
If visible lesions are not present at onset of labor, vaginal birth is acceptable. Cesarean birth within 4 hours after labor begins or membranes rupture is recommended if visible lesions are present.
Why are women encouraged to have annual Pap tests and gynecological exams?
Because HSV infections may be associated with cervical dysplasia
Which viruses account for all cases of viral hepatitis in humans?
Hepatitis viruses A, B, C, D, and E
Which hepatitis viruses are common among users of IV drugs and recipients of multiple drug transfusions?
Hepatitis D and E viruses
How are Hepatitis A virus infections acquired?
Primarily through a fecal-oral route by ingestion of contaminated food, particularly milk, shellfish, or polluted water, or person-to-person contact
What are the characteristics of an HAV infection?
Flu-like symptoms with malaise, fatigue, anorexia, nausea, pruritus, fever, and right upper quadrant pain
Which antibody is detected in acute HAV infections?
Immunoglobulin M (IgM), which is detectable 5 to 10 days after exposure and can remain positive for up to 6 months
Does an HAV infection cause liver damage?
NO, because HAV infection is self-limited and does not result in chronic infection or chronic liver disease, and treatment is usually supportive
What should be avoided during HAV infection?
Medications and substances that might cause liver damage or that are metabolized in the liver

(e.g. ACETAMINOPHEN or ETHYL ALCOHOL)
What is recommended during HAV infection?
A well-balanced diet
Which hepatitis virus is the most threatening to the fetus and neonate?
Hepatitis B virus (HBV)
What causes HBV infections?
Large DNA virus and is associated with three antigens and their antibodies
Which populations are at risk of HBV infection?
1. Women of Asian, Pacific Island (Polynesian, Micronesian, Melanesian), or Alaskan-Eskimo descent and women born in Haiti or sub-Saharan Africa

2. Women who work or live in institutions for the mentally challenged

3. Women with a history of multiple blood transfusions

4. Health care workers and public safety officers exposed to blood in the workplace
Which group has a greater risk of HBV infection?
1. Women who have a history of acute or chronic liver disease, or work or receive treatment in a dialysis unit, or who have a household or sexual contact with a hemodialysis client

2. People with a history of multiple sexual partners and a history of IV drug use
Where can the hepatitis B surface antigen (HBsAg) be found?
In blood, saliva, sweat, tears, vaginal secretions, and semen
How does perinatal transmission occur?
From exposure to HBsAg-positive vaginal secretions, blood, amniotic fluid, saliva, and breast milk

(occurs most often in infants of mothers who have acute hepatitis infection late in the third trimester or during the intrapartum or postpartum periods)
What is HBV infection?
A disease of the liver and is often a silent infection
What are the symptoms of HBV infection?
1. Arthralgias
2. Arthritis
3. Lassitude
4. Anorexia
5. N/V
6. Headache
7. Fever
8. Abdominal pain
9. Clay-colored stools
10. Dark urine
11. Jaundice
When is screening for HBsAg recommended?
On all women at the first prenatal visit, regardless of whether they have been tested previously, and should be repeated later in the pregnancy or on admission for labor and birth for women with high risk behaviors
What is the "window phase"?
The time period in which a person may continue to be infectious of HBV even though HBsAg cannot be detected in the serum
What components of the history should be obtained when hepatitis B is suspected?
1. Inquiry about symptoms of the disease

2. Risk factors
What physical assessments should be done when hepatitis B is suspected?
1. Inspection of the skin for rashes

2. Inspection of the skin and conjunctiva for jaundice

3. Palpation of the liver for enlargement and tenderness

4. Weight loss, fever, and general debilitation should be noted
What is the management for HBV infection?
1. Women should be advised to increase bed rest; eat a high-protein, low-fat diet; and increase fluid intake

2. Avoid medications metabolized in the liver

3. Avoid alcohol

4. Vaccination during pregnancy
What is the most common blood-borne infection in the United States?
Hepatitis C virus (HCV)
What are the risk factors for HCV?
1. IV drug use
2. STIs, such as hepatitis B and HIV
3. Multiple sexual partners
4. History of blood transfusions
What is the most common risk factor for HCV for pregnant women?
History of injecting IV drugs
How does sexual activity relate to the transmission of HCV?
Studies have shown a positive correlation between sexual activity and HCV transmission, particularly with increasing numbers of sexual partners, failure to use a condom, history of STI such as hepatitis B and HIV, heterosexual sex with a male intravenous drug user, and sexual activities involving trauma
What are the symptoms of hepatitis C?
1. Can be asymptomatic

or

2. Flu-like symptoms similar to hepatitis A. About 10% have fatigue, nausea, and anorexia.
How is HCV infection confirmed during lab testing?
By the presence of anti-C antibody
What is HIV?
Human immunodeficiency virus, a retrovirus
How is HIV transmitted?
Exchange of bodily fluids (semen, blood or, less commonly, vaginal secretions)
What is the most common means of transmission of HIV in women?
Heterosexual sex
What are the characteristics of HIV?
1. Severe depression of the cellular immune system associated with HIV infection characterizes AIDS

2. Once HIV enters the body, seroconversion to HIV positivity usually occurs within 6 to 12 weeks
Which diseases are most opportunistic with HIV infections?
1. Pneumocystis carinii pneumonia (PCP)

2. Candida esophagitis

3. Wasting syndrome

4. HSV

5. Cytomegalovirus
What are the symptoms of HIV?
1. Fever
2. Headache
3. Night sweats
4. Malaise
5. Generalized lymphadenopathy
6. Myalgias
7. Nausea
8. Diarrhea
9. Weight loss
10. Sore throat
11. Rash
When can transmission of HIV from the mother to the fetus occur?
Throughout the perinatal period
Which hepatitis virus currently has no preventative vaccine?
Hepatitis C
What other diseases should HIV-positive women be screened for?
1. Syphilis
2. Gonorrhea
3. Chlamydia
4. Other vaginal infections
What type of therapy should all HIV-infected women be treated with?
Zidovudine or HAART during pregnancy, regardless of their CD4 counts
What should HIV-positive women be vaccinated for?
1. Hepatitis B
2. Pneumococcal infection
3. Haemophilus influenzae type B
4. Viral influenza
What is recommended to support a pregnant woman's immune system?
1. Optimal nutrition
2. Sleep
3. Rest
4. Exercise
5. Stress reduction
What is the most common gynecological complaint?
Vaginal discharge
What is normal vaginal discharge?
Leukorrhea is normally clear to cloudy in appearance, and may turn yellow after drying. The discharge is slightly slimy, nonirritating, and has a mild, nonoffensive odor. Normal vaginal secretions contain lactobacilli and epithelial cells.
What is the normal pH of vaginal secretions?
Acidic, ranging from pH 4 to 5
What is the most common type of vaginitis?
Bacterial vaginosis (BV)
What is the etiology of BV?
Unknown
What is bacterial vaginosis (BV)?
A syndrome in which normal H2O2-producing lactobacilli are replaced with high concentrations of anaerobic bacteria (Gardnerella & Mobiluncus)
What happens during BV?
With proliferation of anaerobes, the level of vaginal amines is increased, and the normal acidic pH of the vagina is altered. Epithelial cells slough, and numerous bacteria attach to their surfaces (clue cells). When the amines are volatilized, the characteristic odor of BV occurs.
What is the characteristic BV discharge?
1. "Fishy" smell in the vaginal area

2. Profuse; thin; and white, gray, or milky in appearance

3. Mild irritation or pruritus (itching)
What is the most effective treatment of bacterial vaginosis?
Oral metronidazole (Flagyl)
What are the side effects of metronidazole?
1. Sharp, unpleasant metallic taste in the mouth
2. Furry tongue
3. Central nervous system reactions
4. Urinary tract disturbances
5. Abdominal distress
6. N/V
7. Headache
What is a contraindication of metronidazole?
Breastfeeding
What is Vulvovaginal candidiasis?
Yeast infection, the second most common type of vaginal infection
What is the most common cause of yeast infections?
Candida albicans
What factors predispose women to yeast infections?
1. Antibiotic therapy
2. Diabetes, especially uncontrolled
3. Pregnancy
4. Obesity
5. Diets high in refined sugars or artificial sweeteners
6. Use of corticosteroids or exogenous hormones
7. Immunosuppressed states
Which antibiotics predispose women to yeast infections?
1. Ampicillin
2. Tetracycline
3. Cephalosporins
4. Metronidazole
What can create a environment ideal for vaginal fungal growth?
Tight-fitting clothing and underwear or pantyhose made of nonabsorbent materials
What are the symptoms of yeast infections?
1. Itchiness
2. Feeling of dryness
3. Painful urination
4. Excoriations resulting from scratching
5. Thick, white, lumpy, and cottage cheese-like discharge
6. Redness and swelling of the vulva, labial folds, the vagina, and the cervix
What is the most common symptom of yeast infections?
Vulvar and vaginal pruritus (itchiness)
What test is conducted for Trichomoniasis?
Saline wet smear

(vaginal secretions mixed with normal saline on a glass slide)
What test is conducted for Candidiasis?
Potassium hydroxide (KOH) prep

(vaginal secretions mixed with KOH on a glass slide)
What test is conducted for bacterial vaginosis?
1. Normal saline smear

2. Whiff test (vaginal secretions mixed with KOH)
What is the vaginal pH with a yeast infection?
Normal

(between 4 to 5)
What is the vaginal pH with trichomoniasis?
pH greater than 4.5
What is the vaginal pH with bacterial vaginosis?
pH greater than 4.5
What is the management of vulvovaginal candidiasis?
1. Exogenous Lactobacillus
2. Miconazole (Monistat)
3. Clotrimazole (Gyne-Lotrimin)
4. Sitz baths
5. Avoid use of tampons
What are the prevention measures of genital tract infections?
1. Practice genital hygiene
2. Choose underwear of hosiery with a cotton crotch
3. Avoid tight-fitting clothing (especially tight jeans)
4. Select cloth car seat covers instead of vinyl
5. Limit time spent in damp exercise clothes (especially swimsuits, leotards, and tights)
6. Limit exposure to bath salts or bubble bath
7. Avoid colored or scented toilet tissue
8. If sensitive, discontinue use of feminine hygiene deodorant sprays
9. Use condoms
10. Void before and after intercourse
11. Decrease dietary sugars
12. Drink yeast-active milk and eat yogurt (with lactobacilli)
13. Do not douche
What the most common cause of vaginal infection?
Trichomoniasis
What organism causes Trichomoniasis?
Trichomonas vaginalis, an anaerobic one-celled protozoan with characteristic flagellae
What are the characteristics of Trichomoniasis?
1. Yellowish to greenish, frothy, mucopurulent, copious, malodorous discharge

2. The cervix and vaginal walls will demonstrate "strawberry spots" or tiny petechiae, and the cervix may bleed on contact
What is the recommended treatment for Trichomoniasis?
Metronidazole, 2 g orally
What is group B streptococcus (GBS) considered as?
Normal part of vaginal flora
What is recommended to decrease the risk of neonatal GBS infection?
1. Screening at 36 to 37 weeks of gestation with a rectovaginal culture

2. IV antibiotic prophylaxis
What are TORCH infections?
1. T = Toxoplasmosis
2. O = other infections (such as hepatitis)
3. R = Rubella virus
4. C = Cytomegalovirus (CMV)
5. H = Herpes simplex
What is toxoplasmosis?
A protozoan infection associated with the consumption of infested raw or undercooked meat and with poor handwashing after handling infected cat litter
How is toxoplasmosis determined?
Through blood studies although laboratory diagnosis is difficult
What is the treatment for toxoplasmosis?
Spiramycin, sulfadine, or a combination of pyrimethamine and sulfadiazine. Although pyrimethamine may be potentially harmful to the fetus, treatment of the parasite is essential
What are the "other" infections of TORCH?
GBS, varicella, and HIV
What is rubella?
A viral infection transmitted by droplets (such as from an infected person's sneeze)

also known as GERMAN MEASLES or 3-DAY MEASLES
What signs and symptoms are seen in the rubella infected mother?
Rash, muscle aches, joint pain, and mild lymphedema
What are the consequences of a rubella infection on the fetus?
1. Miscarriage
2. Congenital anomalies (known as congenital rubella syndrome)
3. Death
Why is the rubella vaccine contraindicated in pregnant women?
Because the women may develop a rubella infection from the live vaccine
What is cytomegalovirus (CMV)?
Mononucleosis-like syndrome
How is CMV transmitted?
By close contacts but also has been isolated from semen, cervical and vaginal secretions, breast milk, placental tissue, urine, feces, and banked blood
How is maternal CMV diagnosed?
In urine or in serum
What are the consequences of a fetal CMV infection?
1. Microcephaly
2. Eye, ear, and dental defects
3. Mental retardation
What is the treatment for CMV?
No treatment is available during pregnancy
What are the potential pregnancy effects of primary genital herpes infection (from herpes simplex virus)?
1. Miscarriage
2. Preterm labor
3. IUGR
Should mothers with HSV have cesarean births?
Not recommended for all mothers with HSV, only the ones with clinical eveidence of active lesions should have C-sections
What are the methods of self-care for STIs?
1. Take medications as directed

2. Use comfort measures for symptom relief as suggested by the health care provider

3. Keep appointment for repeat cultures or checkups to make sure infection is cured

4. Inform sexual partners of the need to be tested or treated, if necessary

5. Abstain from sexual intercourse until treatment is complete

6. Use safer sex practices when sex is resumed

7. Call health care provider immediately if bumps, sores, rashes, or discharges appear

8. Keep all future appointments with the health care provider, even if everything appears normal
What are the recommended preventive measures of STIs?
Complete abstinence from sexual activities that transmit semen, blood, or other body fluids or that allow skin-to-skin contact
What is the primary physical barrier promoted for the prevention of sexual transmission of HIV and other STIs?
Condom (male and female)
What is the female condom?
A lubricated polyurethane sheath with a ring on each end that is inserted into the vagina
The two primary areas of risk for sexually transmitted infections (STIs) are:
a.
Sexual orientation and socioeconomic status
b.
Age and educational level
c.
Large number of sexual partners and race
d.
Risky sexual behaviors and inadequate preventive health behaviors
ANS: D
Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI.
Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals with less education may not be aware of proper prevention techniques; however, these are not the primary areas for STIs. Having a large number of sexual partners is certainly a risk-taking behavior, but race does not increase the risk for STIs.
The most common perinatal complications associated with bacterial sexually transmitted infections (STIs) are:
a.
Preterm labor and preterm birth
b.
Newborn eye infections and low Apgar scores
c.
Nausea, vomiting, and frequent urinary tract infections
d.
Congenital anomalies and infertility
ANS: A
Risk factors associated with bacterial STIs include preterm labor and preterm birth, miscarriage, and intrauterine growth restriction (IUGR).
Perinatal complications of bacterial gonorrhea may lead to newborn eye infections but not necessarily to low Apgar scores. Nausea, vomiting, and frequent urinary tract infections are not associated with bacterial STIs. TORCH infections (which are not entirely sexually transmitted) are associated with congenital anomalies. Untreated STIs may progress to pelvic inflammatory disease (PID) and infertility.
When evaluating a client for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is:
a.
Gonorrhea
b.
Syphilis
c.
Chlamydia
d.
Candidiasis
ANS: C
Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year.
The viral sexually transmitted infection that affects most people in the United States today is:
a.
Herpes simplex virus type 2 (HSV-2)
b.
Human papillomavirus (HPV)
c.
Human immunodeficiency virus (HIV)
d.
Cytomegalovirus (CMV)
ANS: B


Feedback
A
Incorrect: This is a viral STI, but it is not the most prevalent viral STI.
B
Correct: HPV infection, a sexually transmitted infection, is the most prevalent viral STI seen in ambulatory health care settings.
C
Incorrect: This is a viral STI, but it is not the most prevalent viral STI.
D
Incorrect: This is a viral STI, but it is not the most prevalent viral STI.
The Centers for Disease Control and Prevention (CDC) recommends that human papillomavirus (HPV) be treated with client-applied:
a.
Miconazole ointment
b.
Topical podofilox 0.5% solution or gel
c.
Penicillin given intramuscularly for two doses
d.
Metronidazole by mouth
ANS: B
Available treatments are imiquimod, podophyllin, and podofilox.
A woman has a thick, white, lumpy, cottage cheese–like discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner orders which preparation for treatment?
a.
Fluconazole
b.
Tetracycline
c.
Clindamycin
d.
Acyclovir
ANS: A
Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis.
Tetracycline is used to treat syphilis.
Clindamycin is used to treat bacterial vaginosis.
Acyclovir is used to treat genital herpes.
To detect the human immunodeficiency virus (HIV), most laboratory tests focus on:
a.
HIV virus
b.
HIV antibodies
c.
CD4 counts
d.
CD8 counts
ANS: B
The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the HIV.
In order to determine if the HIV is present, the test performed must be able to detect antibodies to the virus, not the virus itself.
CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals.
CD8 counts are not performed in order to detect HIV.
Which virus is most threatening to the fetus and neonate?
a.
Hepatitis A virus
b.
Herpes simplex virus (HSV)
c.
Hepatitis B virus (HBV)
d.
Cytomegalovirus (CMV)
ANS: C
HBV is the virus most threatening to the fetus and neonate.
Care management of a woman diagnosed with acute pelvic inflammatory disease (PID) most likely includes:
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 progress of healing
ANS: B
The woman with acute PID should be on bed rest in a semi-Fowler position.
Broad-spectrum antibiotics are used.
Antibiotics must be taken as prescribed, even if symptoms subside.
Few pelvic examinations should be conducted during the acute phase of the disease.
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; complains of pruritus. Based on these findings, the nurse suspects that this woman has:
a.
Bacterial vaginosis
b.
Candidiasis
c.
Trichomoniasis
d.
Gonorrhea
ANS: A
Most women with bacterial vaginosis (BV) complain of a characteristic “fishy odor.” The discharge usually is profuse, thin, and has a white, gray, or milky color. Some women also may have 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 yellowish to greenish, frothy, mucopurulent, copious, and malodorous discharge.
Women with gonorrhea are often asymptomatic. They may have a purulent endocervical discharge, but discharge usually is minimal or absent.
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 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.
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 HIV infection characterizes acquired immunodeficiency syndrome (AIDS). AIDS has no cure.
In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.
The nurse should know that once the human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within:
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 has entered the body.
Six to 10 days is too short a time period for seroconversion to HIV positivity to occur.
Two to 4 weeks is too short a time period for seroconversion to HIV positivity to occur.
Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body; 6 months is too long.
A 25-year-old single female comes to the gynecologist’s office for a follow-up visit related to her abnormal Pap smear. The test revealed that the client has human papillomavirus (HPV). The client asks, “What is that? Can you get rid of it?” Your best response is:
a.
“It’s just a little lump on your cervix. We can just freeze it off.”
b.
“HPV stands for ‘human papillomavirus.’ It is a sexually transmitted infection that may lead to cervical cancer.”
c.
“HPV is a type of early human immunodeficiency virus. You will die from this.”
d.
“You probably caught this from your current boyfriend. He should get tested for this.”
ANS: B
It is important to inform the client about STIs and the risks involved with HPV.
The health care team has a duty to provide proper information to the client, including information related to sexually transmitted infections (STIs).
HPV and HIV are viruses that can be transmitted sexually, but they are not the same virus.
The onset of HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding frequently is the initial symptom. The client may have had HPV before her current boyfriend. You cannot make any deductions from this limited information.
Which sexually transmitted infection is not bacterial and thus not treatable with antibiotics?
a.
Chlamydia
b.
Gonorrhea
c.
Genital herpes
d.
Syphilis
ANS: C
Genital herpes is a viral infection and therefore does not respond to antibiotics.
Chlamydia is a bacterial infection and is treated with doxycycline or azithromycin.
Gonorrhea is a bacterial infection and is treated with any of several antibiotics.
Syphilis is a bacterial infection and is treated with penicillin.
Which statement about the various forms of hepatitis is accurate?
a.
A vaccine exists for hepatitis C but not for hepatitis B.
b.
Hepatitis A is acquired by eating contaminated food or drinking polluted water.
c.
Hepatitis B is less contagious than human immunodeficiency virus (HIV).
d.
The incidence of hepatitis C is decreasing.
ANS: B
Contaminated milk and shellfish are common sources of infection with hepatitis A.
A vaccine exists for hepatitis B but not for hepatitis C.
Hepatitis B is more contagious than HIV.
The incidence of hepatitis C is increasing.
A saline wet smear (vaginal secretions mixed with normal saline on a glass slide) is the test for:
a.
Bacterial vaginosis
b.
Candidiasis
c.
Yeast infection
d.
Trichomoniasis
ANS: D
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.
Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include (choose all that apply):
a.
Fellatio
b.
Unprotected anal intercourse
c.
Multiple sex partners
d.
Dry kissing
e.
Abstinence
ANS: A, B, C
Engaging in fellatio, unprotected anal intercourse, or having multiple sex partners increases the exposure risk and the possibility of acquiring an STI.
Dry kissing and abstinence are considered “safe” sexual practices.
Which statements are true? Choose all that apply.
a.
Human papillomavirus (HPV) infections are thought to be less common in pregnant women than in women who are not pregnant.
b.
HPV infections are thought to be more common in pregnant women than in women who are not pregnant.
c.
HPV infection previously was called genital warts.
d.
HPV infection previously was called herpes.
e.
HPV may cause cancer.
ANS: B, C, E
HPV infections are thought to be more common in pregnant women, with an increase in incidence from the first trimester to the third trimester. HPV, formerly called venereal or genital warts, is a sexually transmitted infection with more than 30 known serotypes, several of which are associated with cervical cancer.
HPV infections are thought to be more common in pregnant women than in women who are not pregnant. HPV formerly was called genital warts.
A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospital’s maternity unit in labor. The client states that she has tested positive for human immunodeficiency virus (HIV) but has not undergone any treatment during her pregnancy. As her primary nurse you understand that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Select the appropriate interventions that should be included in this client’s plan of care:
a.
Intrapartum treatment with antiviral medications
b.
Cesarean birth
c.
Postpartum treatment with antiviral medications
d.
Avoidance of breastfeeding
e.
Pneumococcal, hepatitis B, and Haemophilus influenzae vaccine
ANS: A, B, D
The prophylactic measures of prenatal antiviral use, elective cesarean birth, and formula feeding reduce transmission as low as 1% to 2%. The client who refuses a cesarean birth should be given antiviral therapy intravenously 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.
TORCH stands for:
Toxoplasmosis
Other infections
Rubella
Cytomegalovirus (CMV)
Herpes simplex virus
The Jarisch-Herxheimer reaction is an acute febrile reaction associated with treatment for __________________.
Syphilis
Rates of syphilis in the United States among women, especially African-Americans, have continued to rise since 2004. Is this statement true or false?
ANS: T
African-American women have the highest rate of syphilis among all ethnic groups in the United States. In 2008 the rate was 36% higher than in 2007.