Olds' Maternal-Newborn Nursing and Women's Health, 10e (Davidson)
Chapter 5 Women's Health: Commonly Occurring Infections
1) A nonpregnant client is diagnosed with bacterial vaginosis (BV). What does the nurse expect to administer?
1. Penicillin G 2 million units IM one time
2. Zithromax 1 mg p.o. b.i.d. for 2 weeks
3. Doxycycline 100 mg p.o. b.i.d. for a week
4. Metronidazole 500 mg p.o. b.i.d. for a week
Answer: 4
Explanation: 4. The nonpregnant woman who is diagnosed with bacterial vaginosis (BV) is treated with metronidazole 500 mg orally twice a day for 7 days.
Page Ref: 75
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concept: Nursing Process: Planning
Learning Outcome: 1 Compare vulvovaginal candidiasis and bacterial vaginosis.
MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.
2) The nurse is providing discharge instructions to a client with a diagnosis of vulvovaginal candidiasis (VVC), and knows the client understands when she makes which of the following statements?
1. "I need to apply the miconazole for 10 days."
2. "I need to douche daily."
3. "I need to add yogurt to my diet."
4. "I need to wear nylon panties."
Answer: 3
Explanation: 3. Yogurt helps reestablish normal vaginal flora.
Page Ref: 76
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concept: Nursing Process: Evaluation
Learning Outcome: 1 Compare vulvovaginal candidiasis and bacterial vaginosis.
MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.
3) The nurse is caring for a client in the clinic whom she suspects has vaginosis. Which test best determines whether this sexually active woman has the disorder?
1. The observation of mycelia upon direct microscopy in a 10% potassium hydroxide preparation
2. The addition of a 10% potassium hydroxide solution to the vaginal secretions
3. A vaginal pH of less than 4.5
4. A Gram stain positive for the fungus
Answer: 2
Explanation: 2. Adding a 10% potassium hydroxide solution to the vaginal secretion of a client with bacterial vaginosis, called a "whiff" test, produces a fishy smell.
Page Ref: 74
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concept: Nursing Process: Diagnosis
Learning Outcome: 1 Compare vulvovaginal candidiasis and bacterial vaginosis.
MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.
4) A pregnant client at 24 weeks' gestation is diagnosed with bacterial vaginosis. Her doctor orders Flagyl to treat the problem. What would be appropriate education for the nurse to provide?
1. The client must be careful to observe for signs of preterm labor.
2. The client should advise her partner to seek therapy as soon as possible.
3. The main side effect of the medication is a large amount of vaginal discharge.
4. A repeat culture should be taken 2 weeks after completing the therapy.
Answer: 1
Explanation: 1. Clients with bacterial vaginosis are at risk for preterm labor.
Page Ref: 74
Cognitive Level: Applying
Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control
Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concept: Nursing Process: Implementation
Learning Outcome: 1 Compare vulvovaginal candidiasis and bacterial vaginosis.
MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.
5) A client has been diagnosed with bacterial vaginosis. The nurse obtains a sexual history from the client, including contraceptive measures, number of sexual partners, and frequency of intercourse. What is the rationale for the questions?
1. Clients can infect their sexual partners.
2. The nurse is required by law to ask the questions.
3. Clients with bacterial vaginosis can become infected with HIV and other sexually transmitted diseases more easily.
4. The laboratory needs a full client history in order to know for which organisms and antibiotic sensitivities it should test.
Answer: 3
Explanation: 3. The change in normal flora increases the woman's susceptibility to other organisms, making the client more vulnerable to sexually transmitted diseases, including HIV.
Page Ref: 74
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concept: Nursing Process: Diagnosis
Learning Outcome: 1 Compare vulvovaginal candidiasis and bacterial vaginosis.
MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections.
6) The nurse working in a women's clinic recognizes that which clients are most at risk for developing vulvovaginal candidiasis?
Note: Credit will be given only if all correct and no incorrect choices are selected.
Select all that apply.
1. Clients using antibiotics
2. Immunocompetent clients
3. Pregnant clients
4. Multiparous clients
5. Diabetic clients
Answer: 1, 3, 5
Explanation: 1. A predisposing factor to yeast infections includes the use of antibiotics.
3. Predisposing factors to yeast infections include pregnancy.
5. Predisposing factors to yeast infections include glycosuria and diabetes mellitus.
Page Ref: 75
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Physiological Adaptation
Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concept: Nursing Process: Assessment
Learning Outcome: 1 Compare vulvovaginal candidiasis and bacterial vaginosis.
MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.
7) The nurse provides a couple with education about the consequences of not treating chlamydia, and knows they understand when they make which statement?
1. "She could become pregnant."
2. "She could have severe vaginal itching."
3. "He could get an infection in the tube that carries the urine out."
4. "It could cause us to develop a rash."
Answer: 3
Explanation: 3. Chlamydia is a major cause of nongonococcal urethritis (NGU) in men.
Page Ref: 78
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: VII. 5. Use evidence-based practices to guide health teaching, health counseling, screening, outreach, disease and outbreak investigation, referral, and follow-up throughout the lifespan. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concept: Nursing Process: Evaluation
Learning Outcome: 2 Summarize modes of transmission, treatments, and descriptions of the most commonly occurring sexually transmitted infections (STIs).
MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections.
8) The nurse is seeing clients in the women's clinic. Which client should be treated with ceftriaxone IM and doxycycline orally?
1. A pregnant client with gonorrhea and a yeast infection
2. A nonpregnant client with gonorrhea and chlamydia
3. A pregnant client with syphilis
4. A nonpregnant client with chlamydia and trichomoniasis
Answer: 2
Explanation: 2. The combined treatment of ceftriaxone IM and doxycycline orally provides dual treatment for gonorrhea and chlamydia, which frequently occur together.
Page Ref: 79
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Teamwork: Function completely within one's own scope of practice as leader and member of the health care team and manage delegation effectively. | Nursing/Integrated Concept: Nursing Process: Implementation
Learning Outcome: 2 Summarize modes of transmission, treatments, and descriptions of the most commonly occurring sexually transmitted infections (STIs).
MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.
9) The nurse is providing follow-up education to a client just diagnosed with vaginal herpes. What statement by the client verifies correct knowledge about vaginal herpes?
1. "I should douche daily to prevent infection."
2. "I could have another breakout during my period."
3. "I am more likely to develop cancer of the cervix."
4. "I should use sodium bicarbonate on the lesions to relieve discomfort."
Answer: 2
Explanation: 2. Menstruation seems to trigger recurrences of herpes.
Page Ref: 79
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concept: Nursing Process: Evaluation
Learning Outcome: 3 Describe the health teaching that a nurse needs to provide to a woman with an STI.
MNL LO: 6.2.4 Utilize the nursing process in caring for women at risk for or with a gynecologic infection.
10) The nurse seeing a client just diagnosed with Chlamydia trachomatis knows that which client is at greatest risk for the infection?
1. 16-year-old sexually active girl, using no contraceptive
2. 22-year-old mother of two, developed dyspareunia
3. 35-year-old woman on oral contraceptives
4. 48-year-old woman with hot flashes and night sweats
Answer: 1
Explanation: 1. Teens have the highest incidence of sexually transmitted infections, especially chlamydia. A client not using contraceptives is not using condoms, which decrease the risk of contracting a STI.
Page Ref: 78
Cognitive Level: Applying
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan and evaluation of care. | AACN Essentials Competencies: IX. 2. Recognize the relationship of genetics and genomics to health, prevention, screening, diagnostics, prognostics, selection of treatment, and monitoring of treatment effectiveness, using a constructed pedigree from collected family history information as well as standardized symbols and terminology. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concept: Nursing Process: Assessment
Learning Outcome: 2 Summarize modes of transmission, treatments, and descriptions of the most commonly occurring sexually transmitted infections (STIs).
MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections.
11) A client comes to the clinic complaining of difficulty urinating, flu-like symptoms, genital tingling, and blister-like vesicles on the upper thigh and vagina. She denies having ever had these symptoms before. The medication the physician is most likely to order would be:
1. Oral acyclovir
2. Ceftriaxone IM
3. Azithromycin p.o.
4. Penicillin G IM
Answer: 1
Explanation: 1. Malaise, dysuria, and tingling or painful vesicles are indicative of a primary herpes simplex outbreak. Acyclovir treats herpes.
Page Ref: 79
Cognitive Level: Understanding
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the lifespan, and in all healthcare settings. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills; apply ethical decision making models. | Nursing/Integrated Concept: Nursing Process: Implementation
Learning Outcome: 2 Summarize modes of transmission, treatments, and descriptions of the most commonly occurring sexually transmitted infections (STIs).
MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections.
12) The nurse is evaluating the outcomes of nursing care given a female client with a sexually transmitted infection (STI). Which of the following will the nurse verify about the client?
Note: Credit will be given only if all correct and no incorrect choices are selected.
Select all that apply.
1. Had an identified infection
2. Could identify the mode of transmission
3. Would never cope with the infection
4. Could recognize the symptoms of an STI
5. Would not disclose the STI to her partner
Answer: 1, 2, 4
Explanation: 1. The infection must be identified and cured, if possible. If not, supportive therapy is provided.
2. The client and her partner should be able to describe the infection, its method of transmission, its implications, and the therapy.
4. The client must be able to recognize the symptoms of an STI.
Page Ref: 82
Cognitive Level: Understanding
Client Need/Sub: Health Promotion and Maintenance: Health Promotion/Disease Prevention
Standards: QSEN Competencies: IV. C. 2. Value own and others' contributions to outcomes of care in local care settings. | AACN Essentials Competencies: IX. 9. Monitor client outcomes to evaluate the effectiveness of psychobiological interventions. | NLN Competencies: Context and Environment: Read and interpret data; apply health promotion/disease prevention strategies; apply health policy; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concept: Nursing Process: Evaluation
Learning Outcome: 3 Describe the health teaching that a nurse needs to provide to a woman with an STI.
MNL LO: 6.2.1 Recognize client behaviors associated with the acquisition of sexually transmitted infections.
13) A client comes to the clinic complaining of a thick, white, tenacious discharge and vulvular soreness. Which medication treatment will the nurse teach the client about?
Note: Credit will be given only if all correct and no incorrect choices are selected.
Select all that apply.
1. Silver sulfadiazine
2. Metronidazole
3. Clindamycin cream
4. Ceftriaxone sodium
5. Doxycycline
Answer: 2, 3
Explanation: 2. Metronidazole is the preferred treatment for vulvovaginal candidiasis.
3. Although less effective than metronidazole, clindamycin cream can be used to treat vulvovaginal candidiasis.
Page Ref: 74, 75
Cognitive Level: Applying
Client Need/Sub: Physiological Integrity: Pharmacological and Parenteral Therapies
Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concept: Nursing Process: Planning