# A pregnant client at 28 weeks gestation presents to the prenatal clinic for a routine visit. During the assessment, the nurse notes painless, shallow ulcerations on the client's external genitalia. The client reports that these lesions appeared about a week ago and are not causing significant discomfort. What is the most important assessment the nurse should perform next? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=542960 > language: ko > subject: Maternal Newborn Health ## 문제 A pregnant client at 28 weeks gestation presents to the prenatal clinic for a routine visit. During the assessment, the nurse notes painless, shallow ulcerations on the client's external genitalia. The client reports that these lesions appeared about a week ago and are not causing significant discomfort. What is the most important assessment the nurse should perform next? ## 보기 1. Obtain a detailed sexual history from the client 2. Assess the client's vital signs and temperature 3. Evaluate for enlarged inguinal lymph nodes **✔ 정답** 4. Perform a complete pelvic examination **정답: 3** ## 해설 Painless, shallow genital ulcers in pregnancy suggest HSV infection. Evaluating for enlarged inguinal lymph nodes is key to confirm systemic involvement and guide diagnosis. Other options are less specific initial assessments. ## 심화 해설 Clinical Reasoning and Prioritization This clinical scenario describes a pregnant client at 28 weeks gestation presenting with painless, shallow ulcerations on the external genitalia. The description is highly suggestive of a primary syphilitic chancre. Syphilis, caused by the spirochete Treponema pallidum, is renowned as the "great imitator" due to its diverse clinical manifestations [1]. In primary syphilis, the classic lesion is a solitary, painless, indurated ulcer with a clean base, and it is typically accompanied by regional lymphadenopathy. The lymphadenopathy associated with a chancre is characterized by enlarged, rubbery, non-tender lymph nodes, which is a critical and often under-assessed sign. The most important next assessment is to evaluate for enlarged inguinal lymph nodes. While obtaining a sexual history and performing a pelvic examination are essential components of a complete evaluation, the immediate priority in the physical assessment sequence is to palpate for regional lymphadenopathy. This finding provides immediate, objective clinical evidence to support the suspicion of primary syphilis before laboratory confirmation. Assessing vital signs and temperature is less specific, as systemic symptoms are typically absent in primary syphilis unless a secondary bacterial infection of the lesion has occurred. The resurgence of syphilis globally, including a sharp increase in incidence among reproductive-age populations, makes this a high-yield NCLEX-RN topic [3]. A recent clinical guideline emphasizes that recognizing the clinical manifestations of syphilis is the first step in breaking the chain of transmission, particularly in pregnant women where the risk of congenital syphilis is a severe consequence . The nurse must be vigilant for the subtle, painless nature of the chancre and the characteristic satellite bubo (enlarged inguinal lymph nodes), as patients often do not seek care for these lesions due to the absence of pain. In the context of the NCLEX-RN, this question tests the ability to differentiate between the assessment steps for a suspected sexually transmitted infection. While a detailed sexual history (Option 1) is crucial for risk stratification, the physical finding of lymphadenopathy is a more immediate and objective clinical indicator of disease progression. A complete pelvic examination (Option 4) would be performed by a provider, not typically as an independent nursing assessment for this presentation. Therefore, palpating for the characteristic satellite lymphadenopathy is the most targeted and prioritized nursing action to gather further data supporting the suspected diagnosis. References (research sources) - [1]Malignant Syphilis in an Immunocompetent Patient: A Case Report and Review of the Literature.Case reportMazzola CV, Bono E, Giacchino I, Calà C, Pipitò L, Cascio A. (2025) · DOI: 10.3390/jcm14248839 - [3]Updates on epidemiology and diagnostic tests of syphilis in South Korea.Research articleKim DY, Park KH. (2026) · DOI: 10.3904/kjim.2025.213 ## 임상 시나리오 Clinical Assessment of Genital Ulcer in Pregnancy This guide outlines the focused physical assessment for a pregnant client presenting with a painless genital ulcer suspicious for primary syphilis. Early recognition and diagnosis are critical to prevent congenital transmission. 1. Prioritize Regional Lymph Node Assessment Immediately palpate the inguinal lymph nodes. The hallmark of a syphilitic chancre is **painless, rubbery, non-tender lymphadenopathy**. This finding provides immediate clinical evidence to support the diagnosis before serologic results are available. 2. Characterize the Lesion Inspect the ulcer without causing discomfort. Document the classic features of a chancre: **solitary, shallow, indurated (firm) border, and a clean, non-purulent base**. Note the absence of pain, which differentiates it from herpes simplex virus lesions. 3. Complete the Focused Assessment After the lymph node evaluation, proceed with a full pelvic examination to assess for additional lesions or discharge. Obtain a detailed sexual history, including partner notification needs, and order syphilis serology (RPR/VDRL and confirmatory treponemal test). 4. Nursing Considerations Maintain a non-judgmental, private environment. Educate the client that syphilis is curable with penicillin, which is safe and effective in pregnancy. Emphasize the urgency of treatment to prevent stillbirth, neonatal death, or congenital syphilis. ## 핵심 개념 - **Primary Syphilis** — The first stage of syphilis, characterized by a painless chancre and regional lymphadenopathy, caused by Treponema pallidum. - **Chancre** — A solitary, painless, indurated ulcer with a clean base, typically appearing on the genitals in primary syphilis. - **Inguinal Lymphadenopathy** — Enlarged, rubbery, non-tender lymph nodes in the groin, a key clinical sign accompanying a syphilitic chancre. - **Treponema pallidum** — The spirochete bacterium that causes syphilis, a sexually transmitted infection with multiple clinical stages. ## 같은 주제 문제 - [A pregnant client at 28 weeks gestation presents to the prenatal clinic for a routine visi…](https://mymerci.kr/pages/nclex_q.php?qn_id=542958) - [A pregnant client at 32 weeks gestation is being evaluated for sexually transmitted infect…](https://mymerci.kr/pages/nclex_q.php?qn_id=542959) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._