A client with multiple sexual partners has been assessed for symptoms of dysuria and green, malodorous vaginal discharge. The nurse administers an injection of ceftriaxone and an oral dose of azithromycin. The client asks why two drugs are needed.
What answer by the nurse is best?
Giving two medications increases the chance of curing the infection.
Some people are not affected by the injection and need more medication.
This will prevent you from needing a 3-month follow-up test.
It is very common to be infected with both gonorrhea and chlamydia.
The Correct Answer is D
Choice A rationale
Stating that two medications simply increase the chance of a cure is a vague explanation that lacks specific scientific clinical reasoning. While true that multidrug therapy is effective, it does not explain the distinct targeted pathogens involved in the standard treatment protocol for sexually transmitted infections. Rationales should clarify that each antibiotic serves a specific purpose against different biological organisms rather than suggesting the drugs are redundant or just reinforcements for one another in the treatment.
Choice B rationale
This explanation is scientifically inaccurate and potentially confusing to the patient. Ceftriaxone and azithromycin are not administered based on individual resistance to an injection, but rather to provide comprehensive coverage for the most likely causative agents of the patient's symptoms. Implying that the patient might not be affected by an injection suggests a failure of the medication itself rather than a strategic clinical decision to treat two separate and distinct bacterial infections concurrently.
Choice C rationale
Suggesting that dual therapy eliminates the need for follow-up testing is incorrect and promotes poor healthcare compliance. Patients treated for gonorrhea or chlamydia are typically advised to undergo retesting in three months to ensure the infection is fully resolved and to check for reinfection. Antibiotic therapy does not provide long-term immunity or bypass the necessity of clinical surveillance. Proper teaching must emphasize the importance of follow-up care regardless of the initial treatment regimen provided.
Choice D rationale
Clinical guidelines recommend dual therapy because Neisseria gonorrhoeae and Chlamydia trachomatis frequently co-infect patients. Ceftriaxone is a third-generation cephalosporin that inhibits bacterial cell wall synthesis specifically in gonorrhea. Azithromycin is a macrolide that inhibits protein synthesis in chlamydia. Since the symptoms of green, malodorous discharge and dysuria overlap between these two pathogens, treating both simultaneously ensures the eradication of all potential bacteria, reducing the risk of pelvic inflammatory disease and further transmission.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Maintaining a strict non per os status for an additional two weeks is generally unnecessary for most cases of acute pancreatitis and could lead to nutritional deficiencies or muscle wasting. Modern clinical guidelines suggest that enteral feeding should be reestablished as soon as the inflammatory process begins to subside. Prolonged fasting can actually impair the integrity of the intestinal mucosa and increase the risk of bacterial translocation and subsequent infection of pancreatic necrosis.
Choice B rationale
While the return of bowel sounds and the passage of flatus are traditional markers of resolving ileus, they do not specifically reflect the status of pancreatic inflammation. In acute pancreatitis, the primary concern is the autodigestion of the gland caused by premature enzyme activation. Eating based solely on bowel motility without considering the biochemical markers of pancreatic stress could lead to a premature stimulation of digestive enzymes, resulting in a painful relapse of the condition.
Choice C rationale
The decision to resume oral intake is based on the clinical resolution of symptoms and the downward trend of pancreatic enzymes. Serum lipase levels are highly specific to the pancreas; a decrease indicates that the acute inflammatory surge is waning. When the client is relatively pain free and the lipase is moving toward the normal range of 0 to 160 units per liter, it indicates the pancreas can likely handle the stimulation of secretin and cholecystokinin.
Choice D rationale
Hunger is a subjective sensation and is not a reliable indicator of the pathological state of the pancreas. A client may feel hungry even while the pancreas is still highly inflamed and producing high levels of amylase and lipase. Resuming a diet based only on the client's appetite could cause a significant exacerbation of symptoms and worsen the internal injury if the exocrine function of the pancreas has not sufficiently recovered to manage the digestive load.
Correct Answer is B
Explanation
Choice A rationale
Pitting edema occurring at the end of the day is often considered a physiological finding in late pregnancy due to increased venous pressure in the lower extremities and sodium retention. While excessive or generalized edema was previously a diagnostic criterion for preeclampsia, it is no longer specific enough for diagnosis. Dependency edema occurs when hydrostatic pressure exceeds oncotic pressure in the capillaries, which is common in a 34-week gestation primigravida without necessarily indicating a pathological hypertensive state.
Choice B rationale
Proteinuria is a classic diagnostic marker for preeclampsia, indicating glomerular endothelial damage and increased permeability of the basement membrane in the kidneys. A dipstick reading of 3+ or a quantitative measurement of 300 mg over 24 hours reflects significant renal dysfunction. Normally, pregnant women excrete less than 150 mg of protein daily. The presence of 300 mg or more suggests that the systemic vasospasm associated with preeclampsia is affecting the renal vasculature and compromising the filtration barrier.
Choice C rationale
A weight gain of 2 pounds over a period of 2 weeks is generally within the expected parameters for the third trimester of pregnancy, where a gain of approximately 1 pound per week is normal. Rapid, pathological weight gain associated with preeclampsia usually exceeds 3 to 5 pounds in a single week and is caused by significant fluid extravasation into the interstitial spaces. This specific rate of gain does not meet the scientific threshold for alerting the nurse to impending preeclampsia.
Choice D rationale
A blood pressure of 138/84 mmHg does not meet the formal diagnostic criteria for gestational hypertension or preeclampsia. According to clinical guidelines, the blood pressure must be ≥ 140 mmHg systolic or ≥ 90 mmHg diastolic on two separate occasions at least four hours apart. While this reading is on the higher end of the normal range, it does not scientifically confirm the vasospasm and systemic resistance changes required to diagnose preeclampsia in a previously normotensive patient.
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