HESI Case Study - Gonorrhea

Which interventions can the nurse implement to decrease the the client's anxiety during this examination? (Select all that apply. One, some, or all options may be correct.)

1 Explain each step of the procedure in advance using models.
2 Talk to the client directing relaxation and breathing techniques.
3 Warm a cold speculum between the folds of a heating pad before the exam.
4 Tell the client the procedure is painless and she will feel nothing.
5 Instruct the client that anxiety will make the exam more difficult.
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Which interventions can the nurse implement to decrease the the client's anxiety during this examination? (Select all that apply. One, some, or all options may be correct.)

1 Explain each step of the procedure in advance using models.
2 Talk to the client directing relaxation and breathing techniques.
3 Warm a cold speculum between the folds of a heating pad before the exam.
4 Tell the client the procedure is painless and she will feel nothing.
5 Instruct the client that anxiety will make the exam more difficult.
1 Explain each step of the procedure in advance using models.
2 Talk to the client directing relaxation and breathing techniques.
3 Warm a cold speculum between the folds of a heating pad before the exam.

The nurse decreases the client's anxiety during the exam by explaining the procedure in advance and answering any questions the client has.

Reassuring the client during the procedure will have a relaxing effect.

Preparation of equipment beforehand maximizes the client's comfort.
The client describes the pain in her lower abdomen as sharp and cramping. The HCP prescribes hydrocodone bitartrate 5mg with acetaminophen 325 mg, two tabs PO prior to the client's pelvic exam. Before initiating the treatment, it is most important for the nurse to implement which interventions? (Select all that apply. One, some, or all options may be correct.)

1 Perform a focused assessment on the upper and lower abdomen.
2 Implement a numeric pain assessment on a scale of 1 to 10.
3 Document a baseline of vital signs including a pulse oximetry.
4 Use at least two client identifiers before administering the medication.
5 Initiate the treatment without further delay because the client is in pain.
1 Perform a focused assessment on the upper and lower abdomen.
2 Implement a numeric pain assessment on a scale of 1 to 10.
3 Document a baseline of vital signs including a pulse oximetry.
4 Use at least two client identifiers before administering the medication.

The focused assessment is concerned with one very specific problem area such as pain. It is important to always assess the client before initiating treatment.

Because pain is a subjective experience, the nurse must have a way to measure the severity of pain. The numeric pain scale serves this purpose.

Establishing a base line of vital signs is important for monitory respiratory function before, during, and after the administration of pain medication.

The Joint Commission's National Patient Safety Goals state the purpose of the two client identifiers standard is to reliably identify the individual as the person for whom the service or treatment is intended, and to match the service or treatment to that individual.
The pelvic examination allows for the inspection and palpation of external and internal reproduction structures in order to identify deviations, inform medical diagnoses, and collect specimens for laboratory analysis. Which is the best approach for the nurse to position the client for the pelvic examination?

1 Head flush with top of examination table, hips and knees flexed, feet in stirrups.
2 Genupectoral position with weight of body supported by knees and chest.
3 Buttocks at the edge of the examination table, hips and knees flexed, feet in stirrups.
4 Sim's position on one side with knee and thigh drawn upward to chest.
3 Buttocks at the edge of the examination table, hips and knees flexed, feet in stirrups.

The client assumes the lithotomy position, with her buttocks at the edge of the examination table, her hips and knees flexed, and her feet in stirrups.
The nurse explains to the client that medications will be administered to obtain which expected outcome?

1 The first treatment is one in a series of treatments that will cure the infection.
2 Uncomplicated gonorrhea is cured with a single dose of antibiotic therapy.
3 The infection cannot be cured completely, but medication will reduce the pain.
4 Antiviral medication will cure the infection faster and minimize pain in one dose.
2 Uncomplicated gonorrhea is cured with a single dose of antibiotic therapy.

Gonorrhea infections are cured with a single dose of antibiotic therapy unless there are complications from the infection. Complications from gonorrhea, such as meningitis and endocarditis, require hospitalization for initial treatment and then continued home therapy for up to 4 to 6 weeks.
The client is instructed to return for a follow-up examination if symptoms persist after treatment. The nurse explains to the client that recent research shows that strains of gonorrhea bacteria have emerged that are resistant to penicillin, tetracycline, ciprofloxacin, and cefixime. Which instructions are the most important for the nurse to provide to the client prior to discharge? (Select all that apply. One, some, or all options may be correct.)

1 Direct the client to take medication to her sexual partner.
2 Advise the client to take the antibiotic until symptoms subside.
3 Counsel the client about reinfection from a new or untreated partner.
4 Emphasize compliance with completion of the antibiotic regimen.
5 Recommend abstinence from sexual intercourse until treatment completion.
1 Direct the client to take medication to her sexual partner.
3 Counsel the client about reinfection from a new or untreated partner.
4 Emphasize compliance with completion of the antibiotic regimen.
5 Recommend abstinence from sexual intercourse until treatment completion.

Expedited partner therapy (EPT) is the practice of treating sexual partners of clients with chlamydia or gonorrhea by providing medication to the client to take to their partners.

Instruct patients to cease sexual activity until the antibiotic therapy is completed and they no longer have symptoms; but if abstinence is not possible, urge men and women to use condoms.

Completion of the antibiotic is paramount to curing gonorrhea and preventing drug-resistant gonorrhea.

Abstinence from sexual intercourse until treatment is complete is mandatory to prevent re-infection.
Which instructions are most important for the nurse to include in the healthcare teaching for a client who is diagnosed with gonorrheal infections? (Select all that apply. One, some, or all options may be correct.)

1 Sexual partners should be examined, cultured, and treated with appropriate regimens.
2 Most treatment failures result from reinfections from untreated partners.
3 Complications are consequences of reinfection.
4 Gonorrhea infection can be spread by using public toilets.
5 HCPs are legally responsible for reporting to the local health department.
1 Sexual partners should be examined, cultured, and treated with appropriate regimens.
2 Most treatment failures result from reinfections from untreated partners.
3 Complications are consequences of reinfection.
5 HCPs are legally responsible for reporting to the local health department.

Gonorrhea is a highly communicable disease. Recent (past 30 days) sexual partners should be examined, cultured, and treated with appropriate regimens.

Most treatment failures result from reinfection.

The client must be informed of this, as well as of the consequences of reinfection in terms of chronicity, complications, and potential infertility.

Women should be informed that the case will be reported, told why, and informed of the possibility of being contacted by a health department epidemiologist.
Gonorrhea infection can coexist with other infections. As a result of the client testing positive for gonorrhea, the nurse should prepare her for which treatments?

1 Antimicrobial treatment of gonorrhea and chlamydia.
2 Antiviral treatment of human papillomavirus and syphilis.
3 Antimicrobial treatment of gonorrhea and syphilis.
4 Antiviral treatment of trichomonas and chlamydia.
1 Antimicrobial treatment of gonorrhea and chlamydia.

Management of gonorrhea infections is straightforward, and the cure is usually rapid with appropriate single-dose antibiotic therapy. Another important consideration is a coexisting chlamydial infections. The CDC recommends concomitant treatment for chlamydia.
The client asks the nurse why it is necessary to have additional testing when she already took the prescribed antibiotic to cure the disease. Which responses by the nurse are likely to be the most helpful in explaining the need for further testing? (Select all that apply. One, some, or all options may be correct.)

1 Complications need to be identified and treated, but they cannot be cured.
2 Delay in initial treatment increased the risk for complications.
3 Gonorrhea symptoms can be asymptomatic in women, which delays treatment.
4 Further testing will ensure the bacteria are not resistant to treatments.
5 Additional diagnostic tests will identify any existing complications.
2 Delay in initial treatment increased the risk for complications.
3 Gonorrhea symptoms can be asymptomatic in women, which delays treatment.
5 Additional diagnostic tests will identify any existing complications.

The consequences of delay in treatment and reinfection include chronicity, infertility, and potential complications with the heart, kidneys, and joints.

Because gonococcal infections in women often are asymptomatic, the CDC recommends screening all women at risk for gonorrhea.

Rare complications of gonorrhea in adults include arthritis, meningitis, hepatitis, and disseminated infection.
The client begins to cry and she angrily asks if she will ever be cured of this disease. The client states that she has no idea where her ex-husband is or if he will ever be back. The client is angry and says this is his fault. Which therapeutic approach should the nurse use to try to immediately reduce the the client's stress?

1 Acknowledge to the client that she has the right to feel stressed.
2 Advise the client that getting upset only makes matters worse.
3 Encourage the client to not be so angry because it only hurts her.
4 Listen attentively to the client, but set barriers to angry outbursts.
1 Acknowledge to the client that she has the right to feel stressed.

Acknowledge to the client that she has a right to feel stressed. The medical environment can be frightening, with its foreign language and strange, invasive procedures. This approach is non-argumentative and diffuses the situation.
The client continues to be upset, and she expresses fear that she may contract other sexually transmitted diseases (STDs). Which intervention should the nurse implement first to address the client's fear of contracting other STDs?

1 Teach the client about practicing safe sex.
2 Determine when the client will be ready to date again.
3 Convince the client that she will have to be more careful in the future.
4 Establish a trusting, non-judgmental method to gather complete information.
4 Establish a trusting, non-judgmental method to gather complete information.

Establishing a trusting relationship and using a nonjudgmental approach to gather more complete information may decrease the client's anxiety and fear about having an STD.
The client becomes tearful as she expresses concern about how she will explain her hospitalization to her two teenage daughters. Which approach by the nurse is most helpful in reducing the client's fear? 1 Offer professional resources to assist the client in understanding her diagnosis and treatment. 2 Provide the family with information about the client's diagnosis and treatment. 3 Volunteer to discuss the diagnosis and treatment with the client's daughters on her behalf. 4 Advise the client that the HCP is responsible for informing family members.1 Offer professional resources to assist the client in understanding her diagnosis and treatment. The nurse should encourage client to express her feelings, and the nurse should offer information and professional resources to assist the client in having a correct understanding of her diagnosis and treatment.The client agrees to undergo the Transesophageal Echocardiogram (TEE) but inquires as to the purpose of the test. The nurse explains that the results of this procedure should provide which information? 1 Show the presence of a heart valve infection. 2 Identify scar tissue from a heart attack. 3 Create detailed images of the blood vessels and the blood flow within them. 4 Examine the electrical activity of the heart.1 Show the presence of a heart valve infection. The Transesophageal Echocardiogram (TEE) detects valve abnormalities. Pathogens, usually bacteria, enter the bloodstream by any means and infect the heart valves.To prepare the client for the TEE, which explanation by the nurse is accurate? 1 No special preparation is necessary prior to this procedure. 2 Signing a consent form is not needed for the TEE procedure. 3 The client's throat will be anesthetized throughout this procedure. 4 Gel is applied to the skin to ease movement of the transducer.3 The client's throat will be anesthetized throughout this procedure. The nurse should tell the client what to expect. The throat will be anesthetized and there may be a need to have an intravenous (IV) line installed. A probe is inserted through the esophagus and into the stomach (behind the heart).A cardiothoracic surgeon is consulted and recommends deferring surgery for the client until after antibiotic treatment is complete. The client asks why she should wait if the valve is already damaged. Which response is best for the nurse to provide? 1 The damaged valve can be removed after the infection is treated with antibiotic. 2 Antibiotics completely inhibit embolization from valvular vegetations. 3 Surgery is used in the event antibiotic is ineffective in treating the disease. 4 The client can choose either surgery or antibiotics to treat infective endocarditis.3 Surgery is used in the event antibiotic is ineffective in treating the disease. Antimicrobial are the most common treatment for endocarditis. The cardiac surgeon may be consulted if antibiotic therapy is ineffective in sterilizing a valve, if refractory HF develops secondary to a defective valve, if large valvular vegetations are present, or if multiple embolic events occur.The client asks where on her arm the PICC line will be inserted. Which explanation by the nurse is most helpful? 1 The catheter will be inserted through a vein of the antecubital fossa. 2 The tip of the catheter will reside in the superior vena cava (SVC). 3 Catheters are ideally placed at the caval-atrial junction. 4 The catheter will be inserted at the inner side of the bend of the arm.4 The catheter will be inserted at the inner side of the bend of the arm. A peripherally inserted central catheter (PICC) is a long catheter inserted through a vein of the antecubital fossa (inner aspect of the bend of the arm) or the middle of the upper arm. In adults, the PICC length ranges from 18 to 29 (45 to 74 cm) with the tip residing in the superior vena cava (SVC), ideally at the caval-atrial junction(CAJ). Explanations to client's must be in terms they understand and not medical jargon.The client says that she is still unclear about the placement of the PICC line and needs further explanation. Which is the best approach for the nurse to teach an adult learner? 1 Contact the PICC line nurse to discuss placement with the client. 2 Provide a pamphlet or video for the client to reinforce verbal instructions. 3 Demonstrate simulation placement on a manikin for the client. 4 Reiterate previous instructions given to the client.2 Provide a pamphlet or video for the client to reinforce verbal instructions. Determining a client's literacy status and intervening with appropriate explanation of all healthcare procedures is crucial to the client's understanding of their health care. Written and/or verbal guidelines reinforce verbal instructions.The PICC nurse completes the placement procedure and records a length of 60 cm double-lumen peripherally inserted central catheter in the basilic vein of the left inner arm. After insertion of a PICC line, which action is the most important for the nurse to implement first? 1 Use 10 mL of sterile saline to flush before and after medication administration. 2 Flush with 5 mL of heparin (10 units/mL) in a 5 mL syringe daily. 3 Begin infusion of ceftriaxone 1 g IV every 24 hrs. 4 Contact the radiologist for a chest x-ray indicating placement.4 Contact the radiologist for a chest x-ray indicating placement. Before the catheter can be used for infusion, a chest x-ray indicating that the tip resides in the lower superior vena cava (SVC) is required when the catheter is not placed under fluoroscopy.The client says she has taken penicillin in the past and experienced no allergies to the medication. Which statement indicates that the nurse understands the importance of confirming this information prior to administering penicillin or cephalosporin? 1 Based on the client's history, she will never experience an allergic reaction to penicillin or cephalosporin. 2 A penicillin sensitivity reaction that occurs once inoculates the client from future allergic responses. 3 Despite the client's history, she could experience an allergic reaction to penicillin or cephalosporin. 4 Based on the client's history, she is not likely to react to penicillin but could definitely experience an allergic reaction to cephalosporin.3 Despite the client's history, she could experience an allergic reaction to penicillin or cephalosporin. It is important to obtain a history from the client to determine previous use of penicillin or cephalosporin because persons with a negative history of penicillin sensitivity may still have an allergic response.The nurse reviews the PICC line x-ray report for placement confirmation and prepares to administer the ceftriaxone per the HCP's prescription. To detect any untoward effects of ceftriaxone, it is most important for the nurse to assess the client for which symptoms throughout the duration of the infusion? 1 Discoloration of bilateral extremities. 2 Snoring sounds or stridor. 3 Painful urination. 4 Weak bilateral hand grasp.2 Snoring sounds or stridor. To detect any untoward effects of ceftriaxone the nurse should listen for snoring and stridor (a high-pitched crowing sound). Snoring and stridor occur with airway obstruction resulting from laryngeal spasm or edema stemming from an allergic reaction or anaphylaxis from the ceftriaxone.The ceftriaxone infusion is complete. It is most important for the nurse to implement which intervention for maintaining patency of the PICC line? 1 Use 5 mL syringe and flush the line with 10 mL of sterile saline. 2 Flush the line with 10 mL of sterile saline using a 10 mL syringe. 3 Slide plastic clamp to close off line and flushing is not necessary. 4 Keep plastic clamp open at all times and flush with a 5 mL or 10 mL syringe.2 Flush the line with 10 mL of sterile saline using a 10 mL syringe. The nurse uses 10 mL of sterile saline to flush before and after medication administration, then 20 mL of sterile saline is flushed after drawing blood.The client is to be discharged from the hospital with a prepared antibiotic, IV pump with tubing, alcohol wipes, IV access (PICC), normal saline solution and flushes. When planning the client's discharge, it is most important for the nurse to coordinate with which member of the healthcare team? 1 Case Manager. 2 Home Health Nurse. 3 Pharmacist. 4 Registered Dietician.1 Case Manager. One of the most important members of the interdisciplinary team is the case manager (CM) or discharge planner who collaborates with the nurse and the entire interdisciplinary team to discharge the client. The purpose of the case management process is to provide quality and cost-effective services and resources to achieve positive client outcomes.The nurse removes the old dressing carefully to avoid dislodging the catheter. After removing the dressing, which information should the nurse communicate immediately to the HCP? 1 External catheter length has changed. 2 A brisk blood return aspirated from the catheter lumen. 3 Both lumens are patent when flushed with 5 mL normal saline. 4 The external catheter length is 60 cm.1 External catheter length has changed. After removing the dressing, the nurse should note the external catheter length, and compare this length with the original length at insertion. If the length has changed, the catheter tip location has also changed and may no longer be in a vein appropriate for infusion. The nurse should follow agency policy or notify the HCP about the length change.The client asks if she can continue her daily exercise routine with the PICC line in place when she returns home. Which activities should the nurse instruct the client to continue upon discharge? (Select all that apply. One, some, or all options may be correct.) 1 Perform usual activities of daily living. 2 Keep dressing clean, dry, and intact. 3 Lift light weights as tolerated. 4 Avoid excessive physical activity. 5 Cover with plastic when swimming.1 Perform usual activities of daily living. 2 Keep dressing clean, dry, and intact. 4 Avoid excessive physical activity. It is important for the nurse to instruct the client to continue to perform usual activities of daily living. The nurse should instruct the client to keep the PICC dressing clean, dry, and intact by showering versus bathing to avoid potential infection. The client should be instructed by the nurse to avoid excessive physical activity to avoid dislodgement of the PICC line.Once the client goes home, she will continue the antibiotics and follow up with the HCP for regular blood tests. Which is the most important instruction the nurse should give the client to maintain a positive outcome? 1 Floss teeth every day to remove bacteria from the mouth. 2 Monitor and record temperature daily for up to 6 weeks. 3 Stop taking the antibiotic when you feel better and call the HCP. 4 It is not necessary to remind the HCP or dentist of the clients endocarditis.2 Monitor and record temperature daily for up to 6 weeks. Fever is indicative of reoccurring endocarditis. The nurse should remind the client to monitor and record temperature daily for up to 6 weeks. The client should report fever, chills, malaise, weight loss, increased fatigue, sudden weight gain, or dyspnea to primary care provider.The client is advised that infective endocarditis can damage the heart and become life threatening if not treated properly and completely. Which finding is most indicative of a life threatening complication of infective endocarditis that the nurse should discuss with the client prior to discharge? 1 Sudden weight gain. 2 Pruritus and rash. 3 Nuchal rigidity. 4 Blurred vision.1 Sudden weight gain. Heart failure is the most common complication and the nurse should discuss the signs and symptoms by teaching the client to look for symptoms such as edema and sudden weight gain, which is the cardinal sign of right-sided heart failure.Clear communication between professional caregivers is most important for avoiding medical errors and minimizing client safety risks. Which would be the best method for the nurse to use to report the discharge plans to the home health nurse? 1 Subjective, Background, Application, Requirement (SBAR). 2 Situation, Background, Assessment, Recommendation (SBAR). 3 Simple, Object, Access, Protocol (SOAP). 4 Subjective, Objective, Assessment, Plan (SOAP).2 Situation, Background, Assessment, Recommendation (SBAR). To improve communication between staff nurses and home health nurses, the SBAR procedure was established. Situation describes what is happening. Background is an explanation of any relevant information that applies to the situation. Assessment is the analysis of the problem. The recommendation is what is needed for the client situation.The client asks about the risks and preventions of becoming infected again with endocarditis. It is most important for the nurse to include which instruction in the healthcare teaching of a client diagnosed with infective endocarditis? 1 Remind HCPs and dentists of the client's history of endocarditis. 2 Daily vigorous brushing and flossing teeth reduces risk of reinfection. 3 Reduce risk of antibiotic resistance by not applying antibiotic ointments to open skin. 4 Once the first dose of antibiotic is administered and completed at home, there is no need to continue to monitor your temperature.1 Remind HCPs and dentists of the client's history of endocarditis. The client must remind HCPs and dentists of the infectious endocarditis so that prophylactic antibiotics can be administered before dental or medical procedures to prevent infection.