A male client is diagnosed with primary syphilis.
Which query by the nurse is a priority at this time?
Are you allergic to penicillin?
When was your last sexual encounter?
Do you have a history of sexually transmitted infections?
Have you been using latex condoms?
The Correct Answer is A
Choice A rationale
Primary syphilis is caused by the spirochete Treponema pallidum and is classically treated with a single intramuscular injection of Benzathine penicillin G. Because penicillin is the definitive, first-line treatment for this infection, assessing for allergies is the highest priority to prevent life-threatening anaphylaxis. While other questions are important for public health and history, the immediate clinical priority is ensuring that the prescribed curative medication can be administered safely to the patient without causing a severe allergic reaction.
Choice B rationale
Inquiring about the timing of the last sexual encounter is important for epidemiological tracking and determining the incubation period. However, this information is secondary to ensuring safe medical treatment for the patient's current infection. The primary stage of syphilis is characterized by a painless chancre, which usually appears 10 to 90 days after exposure. While this helps in mapping the disease progression, it does not influence the immediate pharmacological intervention as critically as the assessment of potential drug allergies.
Choice C rationale
Obtaining a history of previous sexually transmitted infections (STIs) is a standard part of a comprehensive sexual health assessment. It helps identify patterns of high-risk behavior and potential co-infections, such as HIV, which is commonly found alongside syphilis. While this contributes to the long-term plan of care and patient education, it is not the most urgent question. The nurse must first establish the safety of the current treatment plan before delving into the broader historical context of the client's health.
Choice D rationale
Asking about condom use is essential for assessing the client's risk-reduction practices and for providing future preventative education. Primary syphilis is highly contagious and transmitted through direct contact with a sore during vaginal, anal, or oral sex. Understanding the client's use of barrier methods helps in counseling, but it does not change the immediate need for antibiotic therapy. Prioritizing the allergy assessment ensures that the client receives the necessary treatment to stop the spread of the spirochetes.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Erosive arthritis is not typically associated with Systemic Lupus Erythematosus (SLE). While many SLE patients experience joint pain and swelling known as lupus arthritis, it is characteristically non-erosive and non-deforming. This distinguishes it from rheumatoid arthritis, where the inflammatory process actively destroys bone and cartilage. In SLE, the joint involvement is usually transient and does not show the classic "punched-out" erosions on radiographic imaging, making this finding an unlikely or invalid sign for a typical SLE diagnosis.
Choice B rationale
Pericarditis is a well-recognized manifestation of Systemic Lupus Erythematosus and is the most common cardiac complication of the disease. It involves inflammation of the pericardium, the sac surrounding the heart, which can cause chest pain and a pericardial friction rub. Since SLE is a multisystem inflammatory disease that frequently targets serous membranes, the presence of pericarditis is highly consistent with the pathology of SLE and would be a valid sign found in a patient's medical record.
Choice C rationale
Photosensitivity is a classic and highly valid sign of Systemic Lupus Erythematosus. Approximately 60 to 90 percent of patients with SLE experience an abnormal reaction to ultraviolet (UV) light, which can trigger both skin rashes and systemic disease flares. UV exposure causes skin cell damage and the release of nuclear antigens that react with circulating antibodies, worsening the autoimmune response. Therefore, a history of skin reactions to sunlight is a key diagnostic criterion for the condition.
Choice D rationale
A red, macular facial rash, commonly known as the malar or "butterfly" rash, is the most iconic physical sign of Systemic Lupus Erythematosus. This rash typically spreads across the bridge of the nose and the cheeks while sparing the nasolabial folds. It is a valid clinical finding that appears in a large percentage of patients, particularly during periods of disease activity. Its presence is one of the primary physical markers used by clinicians to identify and monitor SLE.
Correct Answer is ["A","C","D","E"]
Explanation
Choice A rationale
Cocaine is a potent vasoconstrictor that causes a rapid increase in maternal blood pressure and significant uterine artery constriction. This sudden vascular compromise can lead to premature separation of the placenta from the uterine wall, known as placenta abruption. This condition is a life-threatening emergency for both the mother and the fetus due to the risk of severe hemorrhage and impaired fetal oxygenation caused by the drug's sympathetic nervous system stimulation.
Choice B rationale
Erythroblastosis fetalis is a hemolytic disease of the newborn that occurs due to Rh incompatibility between the mother and the fetus. It involves the maternal immune system producing antibodies that attack fetal red blood cells. There is no known scientific or physiological link between the use of cocaine and the development of Rh isoimmunization or hemolytic anemia. This condition is strictly related to blood group antigens rather than substance abuse or maternal vasoconstriction.
Choice C rationale
The systemic effects of cocaine involve the inhibition of norepinephrine reuptake at nerve endings, leading to a state of chronic sympathetic overactivity. This results in persistent vasoconstriction and increased peripheral vascular resistance, which manifests as gestational hypertension. The cardiovascular strain placed on the mother by regular cocaine use increases the likelihood of developing preeclampsia or other hypertensive disorders of pregnancy, which can have devastating effects on maternal organ systems and placental perfusion.
Choice D rationale
Cocaine use during pregnancy causes chronic intrauterine hypoxia due to decreased blood flow through the placental bed. When the fetus is deprived of adequate oxygen and essential nutrients over a long period, growth is significantly restricted. This often results in the infant being small for gestational age at birth. The vasoconstrictive properties of the drug limit the transfer of glucose and amino acids, which are necessary for normal fetal weight gain and development.
Choice E rationale
Substance abuse is frequently associated with various lifestyle factors, including poor nutritional intake. Cocaine acts as a powerful appetite suppressant, which often leads to the mother neglecting her caloric and vitamin requirements. Inadequate maternal nutrition further compounds the risks to the fetus, as the lack of essential building blocks like folic acid, iron, and protein can lead to anemia, low birth weight, and other developmental complications during the gestation period.
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