A nurse is developing a plan of care for a 16-year-old female client experiencing her first outbreak of genital herpes. The client states that she contracted the disease by holding hands with someone who has syphilis. Which nursing diagnosis should the nurse identify as the priority?

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Question 1 of 5

A nurse is developing a plan of care for a 16-year-old female client experiencing her first outbreak of genital herpes. The client states that she contracted the disease by holding hands with someone who has syphilis. Which nursing diagnosis should the nurse identify as the priority?

Correct Answer: B

Rationale: The correct answer is B: Lack of knowledge about the disease and its transmission. This is the priority nursing diagnosis because the client's statement about contracting herpes by holding hands with someone who has syphilis indicates a lack of understanding about how genital herpes is transmitted. The nurse should prioritize educating the client about the disease, its transmission, and prevention to empower the client to make informed decisions about her health. Choices A, C, and D are incorrect: A: Acute pain may be a symptom of genital herpes, but addressing the lack of knowledge about the disease and its transmission is more essential for the client's well-being. C: While coping with the stress of the infection is important, addressing the lack of knowledge should take precedence to prevent further transmission and help the client manage the condition effectively. D: Noncompliance with treatment may be a concern, but addressing the client's lack of knowledge about the disease and its transmission is crucial in promoting understanding and adherence to treatment.

Question 2 of 5

A client who has been diagnosed with HIV develops an oral candida infection. When teaching the client, which instructions will the health care provider include?

Correct Answer: C

Rationale: The correct answer is C: Select foods that are soft or pureed. This is because soft or pureed foods are easier to swallow and less likely to irritate the oral mucosa affected by the candida infection. Rinsing with a commercial mouthwash (choice A) may temporarily relieve symptoms but won't address the root cause. Citrus juices (choice B) can be irritating to the oral mucosa. Hot soups and beverages (choice D) can worsen the discomfort in the mouth. Overall, choosing soft or pureed foods will help alleviate discomfort and promote healing.

Question 3 of 5

How does HPV manifest in HIV-positive clients?

Correct Answer: C

Rationale: The correct answer is C: Condylomata. HPV manifests in HIV-positive clients through the development of genital warts known as condylomata acuminata. This is a common manifestation due to the weakened immune system in HIV-positive individuals. Condylomata lata (choice B) is associated with syphilis, not HPV. Cough (choice A) is not a typical manifestation of HPV in HIV-positive clients. Chancre (choice D) is a primary lesion seen in syphilis, not HPV.

Question 4 of 5

The client receives zidovudine (Retrovir) for treatment of HIV infection. Which assessment data indicates an adverse reaction to the drug?

Correct Answer: C

Rationale: The correct answer is C: Decreased WBC count. Zidovudine is known to cause bone marrow suppression which can lead to a decrease in white blood cell count. This is an adverse reaction as it increases the risk of infections. A: Cough is not a common adverse reaction to zidovudine. B: Enlarged lymph nodes are not directly associated with zidovudine adverse reactions. D: Fever is a non-specific symptom and can occur due to various reasons, not specifically related to zidovudine. Therefore, the most concerning and relevant assessment data indicating an adverse reaction to zidovudine is a decreased white blood cell count.

Question 5 of 5

The primary fetal risk when the mother has any type of anemia is for:

Correct Answer: D

Rationale: The correct answer is D: Reduced oxygen delivery. Anemia in the mother can lead to decreased oxygen-carrying capacity in the blood, resulting in reduced oxygen delivery to the fetus. This can lead to fetal hypoxia, affecting the baby's growth and development. Neonatal anemia (choice A) is a consequence of the mother's anemia affecting the baby after birth, not the primary risk. Elevated bilirubin level (choice B) is not directly related to maternal anemia but may occur in conditions like Rh incompatibility. Limited infection defenses (choice C) is not the primary fetal risk associated with maternal anemia, although it can be a concern in severe cases due to decreased immune response.

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