, Chapter
1. A client recently diagnosed with herpes simplex II asks how to best manage the
lesions. What information should be given to the client?
a. The use of soap should be restricted.
b. It is safe to use a solution of 50% rubbing alcohol and 50% water to clean the lesions.
c. Wearing nylon panties will reduce discomfort.
d. Gentle soap and water can be used to clean the lesions.
Answer: d
Rationale: The lesions need to be kept clean and dry. It is safe to use mild soap and water.
Rubbing alcohol would cause burning of the lesions, and should not be used. Nylon
panties will promote moisture and reduce ventilation to the perineal area.
NURSING PROCESS STEP: Implementation
CLIENT NEEDS CATEGORY: Health Promotion and Maintenance
CLIENT NEEDS SUBCATEGORY: Prevention and/or Early Detection of Health
Problems
COGNITIVE LEVEL: Application
,2. A client recently treated for pelvic inflammatory disease asks how she can best prevent
a recurrence of the disease. What information should be provided to the client?
a. The physician will prescribe prophylactic antibiotic therapy.
b. The use of condoms will be beneficial.
c. Annual gynecological examinations should be scheduled.
d. Douching after intercourse will assist in removing potential pathogens from the genital
area.
Answer: b
Rationale: Condoms provide a barrier from the introduction of pathogens to the woman’s
body. Prophylactic antibiotics are not used to manage pelvic inflammatory disease.
Annual gynecological examinations are recommended, but will not prevent the spread of
the disease. Douching can actually increase the incidence of pelvic inflammatory disease.
Douching will force fluids higher into the woman’s vagina and cervical area.
NURSING PROCESS STEP: Planning
CLIENT NEEDS CATEGORY: Health Promotion and Maintenance
CLIENT NEEDS SUBCATEGORY: Prevention and/or Early Detection of Health
Problems
COGNITIVE LEVEL: Application
3. A client treated for pelvic inflammatory disease is preparing for discharge. During the
teaching session, the use of tampons is discussed. Which of the following statements by
the client indicate the understanding of the content provided? Select all that apply.
, a. “I will be able to wear tampons.”
b. “The use of tampons is forever prohibited.”
c. “Tampons must be changed at least every four hours.”
d. “I should wear pads at night.”
Answers: a; c; d
Rationale: The use of tampons is allowed. Clients using tampons must remember to
change them regularly. Wearing pads at night will ensure the tampons are not left in too
long while the client sleeps.
NURSING PROCESS STEP: Evaluation
CLIENT NEEDS CATEGORY: Physiological Integrity
CLIENT NEEDS SUBCATEGORY: Reduction of Risks Potential
COGNITIVE LEVEL: Application
4. A pregnant client reports to the clinic and learns she has tested positive for herpes
simplex. The nurse develops a plan of care. Which of the following nursing diagnoses
has the highest priority?
a. Injury, Risk for related to the disease process
b. Knowledge, Deficient related to the diagnosis
c. Anxiety related the diagnosis
d. Family Processes, Interrupted related to the effects of the diagnosis on her relationship
with her partner
Answer: a
Rationale: All of the presented nursing diagnoses are of importance to the client. The
client’s greatest risk is related to the potential for complications from the herpes simplex.
Once the risk of injury is addressed, the diagnosis of next greatest importance involves
the knowledge deficit. Anxiety and interrupted family processes can be managed after
the client’s risk for injury and knowledge deficit are managed.
NURSING PROCESS STEP: Diagnosis
CLIENT NEEDS CATEGORY: Safe, Effective Care Environment
CLIENT NEEDS SUBCATEGORY: Management of Care
COGNITIVE LEVEL: Analysis
1. A client recently diagnosed with herpes simplex II asks how to best manage the
lesions. What information should be given to the client?
a. The use of soap should be restricted.
b. It is safe to use a solution of 50% rubbing alcohol and 50% water to clean the lesions.
c. Wearing nylon panties will reduce discomfort.
d. Gentle soap and water can be used to clean the lesions.
Answer: d
Rationale: The lesions need to be kept clean and dry. It is safe to use mild soap and water.
Rubbing alcohol would cause burning of the lesions, and should not be used. Nylon
panties will promote moisture and reduce ventilation to the perineal area.
NURSING PROCESS STEP: Implementation
CLIENT NEEDS CATEGORY: Health Promotion and Maintenance
CLIENT NEEDS SUBCATEGORY: Prevention and/or Early Detection of Health
Problems
COGNITIVE LEVEL: Application
,2. A client recently treated for pelvic inflammatory disease asks how she can best prevent
a recurrence of the disease. What information should be provided to the client?
a. The physician will prescribe prophylactic antibiotic therapy.
b. The use of condoms will be beneficial.
c. Annual gynecological examinations should be scheduled.
d. Douching after intercourse will assist in removing potential pathogens from the genital
area.
Answer: b
Rationale: Condoms provide a barrier from the introduction of pathogens to the woman’s
body. Prophylactic antibiotics are not used to manage pelvic inflammatory disease.
Annual gynecological examinations are recommended, but will not prevent the spread of
the disease. Douching can actually increase the incidence of pelvic inflammatory disease.
Douching will force fluids higher into the woman’s vagina and cervical area.
NURSING PROCESS STEP: Planning
CLIENT NEEDS CATEGORY: Health Promotion and Maintenance
CLIENT NEEDS SUBCATEGORY: Prevention and/or Early Detection of Health
Problems
COGNITIVE LEVEL: Application
3. A client treated for pelvic inflammatory disease is preparing for discharge. During the
teaching session, the use of tampons is discussed. Which of the following statements by
the client indicate the understanding of the content provided? Select all that apply.
, a. “I will be able to wear tampons.”
b. “The use of tampons is forever prohibited.”
c. “Tampons must be changed at least every four hours.”
d. “I should wear pads at night.”
Answers: a; c; d
Rationale: The use of tampons is allowed. Clients using tampons must remember to
change them regularly. Wearing pads at night will ensure the tampons are not left in too
long while the client sleeps.
NURSING PROCESS STEP: Evaluation
CLIENT NEEDS CATEGORY: Physiological Integrity
CLIENT NEEDS SUBCATEGORY: Reduction of Risks Potential
COGNITIVE LEVEL: Application
4. A pregnant client reports to the clinic and learns she has tested positive for herpes
simplex. The nurse develops a plan of care. Which of the following nursing diagnoses
has the highest priority?
a. Injury, Risk for related to the disease process
b. Knowledge, Deficient related to the diagnosis
c. Anxiety related the diagnosis
d. Family Processes, Interrupted related to the effects of the diagnosis on her relationship
with her partner
Answer: a
Rationale: All of the presented nursing diagnoses are of importance to the client. The
client’s greatest risk is related to the potential for complications from the herpes simplex.
Once the risk of injury is addressed, the diagnosis of next greatest importance involves
the knowledge deficit. Anxiety and interrupted family processes can be managed after
the client’s risk for injury and knowledge deficit are managed.
NURSING PROCESS STEP: Diagnosis
CLIENT NEEDS CATEGORY: Safe, Effective Care Environment
CLIENT NEEDS SUBCATEGORY: Management of Care
COGNITIVE LEVEL: Analysis
