NSG 3250
EXAM 4 STUDY GUIDE
Units 8, 9 & 10
Adult Health Nursing
Galen College of Nursing
This document provides a focused study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-minute
review. The guide is structured to help students
reinforce understanding, identify weak areas, and
prepare confidently for the assessment.
, NSG 3250: EXAM 4 – 8, 9 & 10
UNIT 8
- STIs are the most common infectious diseases in the US and are epidemic in most parts of the world
- Portals of entry of STI-causing microorganisms and sites of infection include the skin and mucosal
linings of the urethra, cervix, vagina, rectum, and oropharynx
Topic Objectives:
Identify each STI through symptomatic and assessment findings
Discuss patient education in the care of and prevention of STIs
Recognize infection control practices when caring for patients with STIs
Quality and Safety Nursing Alert
- The nurse must assess the woman for possible latex allergy because the use of latex barrier methods
(e.g., diaphragm, cervical cap, male condoms) may cause severe allergic reactions, including
anaphylaxis, in patients with latex allergy
Syphilis
Spirochete: Treponema Pallidum
Contracted via sexual contact
Reportable STI
Currently showing increased prevalence in men
If untreated, the disease progresses into 3 phases: primary, secondary, and tertiary
3 Phases of Syphilis
Primary - occurs 2-3 weeks after exposure
- A painless lesion, a chancre, develops on the genitals
o The chancre may be present for up to 3-12 weeks
Secondary - generalized infection due to spread within the body; more systemic
- Rash develops on the trunk and extremities (hands and feet) – very distinctive
Can develop elsewhere
If you see this, they’ve had syphilis for a while
- Contact with lesions can cause spread of infection
- Contact precautions used
- Other s/s include: arthritis, meningitis, fever, malaise (fatigue), and weight loss
Tertiary - final stage causes progressive inflamm. changes which can impact multiple organs
- Manifestations include: aortitis and neurosyphilis (dementia, psychosis, paresis, stroke,
or meningitis)
Aortitis – inflammation of the aorta
- Can invade the brain (neurosyphilis); it can be deadly – cause psychosis
Can cause organ failure
Syphilis Management
Antibiotics are the primary method of treatment
- Penicillin G is the first line choice
, - If allergic, doxycycline is alternate
Dependent on the stage, treatment can vary on the number of injections required
o Want to come back after treatment to see if you test negative
Primary and secondary lesions are highly contagious
Specialized precautions are not required
Gloves should be worn with direct contact along with proper handwashing
Nursing Interventions
- Syphilis is a reportable communicable disease
- In any health care facility, a mechanism must be in place to ensure that all patients who are
diagnosed are reported to the state or local public health department to ensure community
follow-up
- The public health department is responsible for identification of sexual contacts, contact
notification, and contact screening
Chlamydia and Gonorrhea
- The most reported infectious diseases within the US
- Chlamydia is typically a co-infection with gonorrhea; if you get one, you get the other
- The target group for preventive patient education about gonorrhea and chlamydia is the adolescent
and young adult population
Signs and Symptoms
Can be asymptomatic; but symptoms are also common
Most common in women 15-24 years old
Women: purulent discharge in the endocervical canal (most common), UTI s/s, and vaginitis
(especially w/ co-infection); change in vaginal discharge
Men: s/s are more common, burning on urination, penile discharge, painful/swollen testis
If it invades the testis, it can damage the sperm
Complications
Women
- Pelvic inflammatory disease (PID)
Infectious process invades the entire reproductive system
Can cause GI issues, GU, bowel problems… can become chronic
Covered more in depth in the next unit
- Ectopic pregnancy
Potential for losing fallopian tube
Bleeding risk; could die
What are signs and symptoms of this?
o Severe abdominal pain unilateral (rupturing at that point)
o If ruptured – start losing blood volume, could feel dizzy, lightheaded, BP
decreases, HR goes up
o If you know they have a history of this disease process, need to educate
- Endometriosis
Endometrial lining of uterine “gets mad”. Get deposits of endometrial tissues on
other surfaces; causes irritation with implantation
Common to have painful bowel movements
- Infertility
Men
, - Epididymitis
Scrotal support
Pillow under the scrotum
Boxer briefs give good support (not tighty whiteys, no loose boxers)
- Infertility
Arthritis and bacteremia
Medical Management
Because patients are often coinfected with both gonorrhea and chlamydia, the CDC recommends
dual therapy even if only gonorrhea has been laboratory proven
The CDC updates STI therapy recommendations regularly because of growing problems with
bacterial antibiotic resistance patterns and drug shortages
Nursing Interventions
- Gonorrhea and chlamydia are reportable communicable diseases
- The public health department also is responsible for interviewing the patient to identify sexual
contacts so that contact notification and screening can be initiated
- Treated for both if you have one or the other
Along with reinforcing the importance of abstinence, when appropriate, education should address:
Postponing the age of initial sexual exposure
Limiting the number of sexual partners
Using condoms for barrier protection
Young women and those who are pregnant should also be instructed about the importance of
routine screening for chlamydia
The target group for preventive patient education about gonorrhea and chlamydia is
the adolescent and young adult population
Trichomoniasis
- Flagellated protozoan
- Per the CDC, about 3.7 million cases per year in the US
- Having trichomoniasis increases risk for HIV, pregnancy complications, infertility, and PID
o May also leaf to cervical cellular changes
Signs and Symptoms
Can be asymptomatic which increases chances of spread
Malodorous vaginal discharge (may be frothy and discolored)
Vulvitis may occur leading to burning and itching
- Testing of a trichomonal discharge demonstrates a pH greater than 7.45
o Going to be more alkaline
o Greater potential for bacteria to invade and live
- Itching leads to scratching which can make it worse
- Treatment for vulvitis might be cool packs – do NOT use OTC ointments on genitalia
Trichomoniasis Management
Diagnosis is made by microscopic inspection of protozoan
Rx: metronidazole (flagyl) or tinidazole
- Can be given via a 1 time loading dose or 7 days of a smaller dose
- Partners should also receive treatment at the same time to prevent reinfection
- Alcohol should be avoided during treatment due to adverse side effects
EXAM 4 STUDY GUIDE
Units 8, 9 & 10
Adult Health Nursing
Galen College of Nursing
This document provides a focused study guide
It summarizes key concepts, lecture highlights, and
exam-relevant material to support efficient last-minute
review. The guide is structured to help students
reinforce understanding, identify weak areas, and
prepare confidently for the assessment.
, NSG 3250: EXAM 4 – 8, 9 & 10
UNIT 8
- STIs are the most common infectious diseases in the US and are epidemic in most parts of the world
- Portals of entry of STI-causing microorganisms and sites of infection include the skin and mucosal
linings of the urethra, cervix, vagina, rectum, and oropharynx
Topic Objectives:
Identify each STI through symptomatic and assessment findings
Discuss patient education in the care of and prevention of STIs
Recognize infection control practices when caring for patients with STIs
Quality and Safety Nursing Alert
- The nurse must assess the woman for possible latex allergy because the use of latex barrier methods
(e.g., diaphragm, cervical cap, male condoms) may cause severe allergic reactions, including
anaphylaxis, in patients with latex allergy
Syphilis
Spirochete: Treponema Pallidum
Contracted via sexual contact
Reportable STI
Currently showing increased prevalence in men
If untreated, the disease progresses into 3 phases: primary, secondary, and tertiary
3 Phases of Syphilis
Primary - occurs 2-3 weeks after exposure
- A painless lesion, a chancre, develops on the genitals
o The chancre may be present for up to 3-12 weeks
Secondary - generalized infection due to spread within the body; more systemic
- Rash develops on the trunk and extremities (hands and feet) – very distinctive
Can develop elsewhere
If you see this, they’ve had syphilis for a while
- Contact with lesions can cause spread of infection
- Contact precautions used
- Other s/s include: arthritis, meningitis, fever, malaise (fatigue), and weight loss
Tertiary - final stage causes progressive inflamm. changes which can impact multiple organs
- Manifestations include: aortitis and neurosyphilis (dementia, psychosis, paresis, stroke,
or meningitis)
Aortitis – inflammation of the aorta
- Can invade the brain (neurosyphilis); it can be deadly – cause psychosis
Can cause organ failure
Syphilis Management
Antibiotics are the primary method of treatment
- Penicillin G is the first line choice
, - If allergic, doxycycline is alternate
Dependent on the stage, treatment can vary on the number of injections required
o Want to come back after treatment to see if you test negative
Primary and secondary lesions are highly contagious
Specialized precautions are not required
Gloves should be worn with direct contact along with proper handwashing
Nursing Interventions
- Syphilis is a reportable communicable disease
- In any health care facility, a mechanism must be in place to ensure that all patients who are
diagnosed are reported to the state or local public health department to ensure community
follow-up
- The public health department is responsible for identification of sexual contacts, contact
notification, and contact screening
Chlamydia and Gonorrhea
- The most reported infectious diseases within the US
- Chlamydia is typically a co-infection with gonorrhea; if you get one, you get the other
- The target group for preventive patient education about gonorrhea and chlamydia is the adolescent
and young adult population
Signs and Symptoms
Can be asymptomatic; but symptoms are also common
Most common in women 15-24 years old
Women: purulent discharge in the endocervical canal (most common), UTI s/s, and vaginitis
(especially w/ co-infection); change in vaginal discharge
Men: s/s are more common, burning on urination, penile discharge, painful/swollen testis
If it invades the testis, it can damage the sperm
Complications
Women
- Pelvic inflammatory disease (PID)
Infectious process invades the entire reproductive system
Can cause GI issues, GU, bowel problems… can become chronic
Covered more in depth in the next unit
- Ectopic pregnancy
Potential for losing fallopian tube
Bleeding risk; could die
What are signs and symptoms of this?
o Severe abdominal pain unilateral (rupturing at that point)
o If ruptured – start losing blood volume, could feel dizzy, lightheaded, BP
decreases, HR goes up
o If you know they have a history of this disease process, need to educate
- Endometriosis
Endometrial lining of uterine “gets mad”. Get deposits of endometrial tissues on
other surfaces; causes irritation with implantation
Common to have painful bowel movements
- Infertility
Men
, - Epididymitis
Scrotal support
Pillow under the scrotum
Boxer briefs give good support (not tighty whiteys, no loose boxers)
- Infertility
Arthritis and bacteremia
Medical Management
Because patients are often coinfected with both gonorrhea and chlamydia, the CDC recommends
dual therapy even if only gonorrhea has been laboratory proven
The CDC updates STI therapy recommendations regularly because of growing problems with
bacterial antibiotic resistance patterns and drug shortages
Nursing Interventions
- Gonorrhea and chlamydia are reportable communicable diseases
- The public health department also is responsible for interviewing the patient to identify sexual
contacts so that contact notification and screening can be initiated
- Treated for both if you have one or the other
Along with reinforcing the importance of abstinence, when appropriate, education should address:
Postponing the age of initial sexual exposure
Limiting the number of sexual partners
Using condoms for barrier protection
Young women and those who are pregnant should also be instructed about the importance of
routine screening for chlamydia
The target group for preventive patient education about gonorrhea and chlamydia is
the adolescent and young adult population
Trichomoniasis
- Flagellated protozoan
- Per the CDC, about 3.7 million cases per year in the US
- Having trichomoniasis increases risk for HIV, pregnancy complications, infertility, and PID
o May also leaf to cervical cellular changes
Signs and Symptoms
Can be asymptomatic which increases chances of spread
Malodorous vaginal discharge (may be frothy and discolored)
Vulvitis may occur leading to burning and itching
- Testing of a trichomonal discharge demonstrates a pH greater than 7.45
o Going to be more alkaline
o Greater potential for bacteria to invade and live
- Itching leads to scratching which can make it worse
- Treatment for vulvitis might be cool packs – do NOT use OTC ointments on genitalia
Trichomoniasis Management
Diagnosis is made by microscopic inspection of protozoan
Rx: metronidazole (flagyl) or tinidazole
- Can be given via a 1 time loading dose or 7 days of a smaller dose
- Partners should also receive treatment at the same time to prevent reinfection
- Alcohol should be avoided during treatment due to adverse side effects
