Nurse Practitioner exam| 1333 question and answers.

Primary prevention prevent the onset or acquisition of a given disease. education and counseling the most effective form of healthcare. Secondary prevention to identify and treat asymptomatic persons who have risk factors for a given disease or in preclinical disease. screening, BP for HTN Lipid Profile for HLD Tertiary prevention management of an established disease. minimize disease medications and lifestyle modification to normalize aimed at improving or minimizing disease-related symptoms. Active immunity is defined as resistance developed in response to an antigen. Which of the following statements best describes zanamivir (Relenza) or oseltamivir (Tamiflu) use in the care of patients with or at risk for influenza? Initiation of therapy early in acute influenza illness can help minimize the severity of disease when the illness is caused by a nonresistant viral strain. Preventive Services Recommended by the USPSTF Preventive Services Recommended by the USPSTF 2 In an immunocompetent adult, the length of incubation for the influenza virus is on average: 1-4 days Adults pass the illness on 1 day before the onset of symptoms and continue to remain infectious for approximately 5 days after the onset of the illness. Children remain infectious for 10 or more days after the onset of symptoms and can shed the virus before the onset of symptoms. People who are immunocompromised can remain infectious for up to 3 weeks. Influenza protection options for a 62-year-old man with hypertension, dyslipidemia, and type 2 diabetes mellitus include receiving: trivalent inactivated vaccine (TIV) in standard dose via intramuscular injection. This is the typical "flu shot." A quadrivalent inactivated vaccine is also available. injected is not live but the nasal spray is Which of the following should not receive vaccination against influenza? A. a 19 year-old with a history of hive-form reaction to eating eggs B. a 24-year-old woman who is 8 weeks pregnant C. a 4-month-old infant who was born at 32 weeks of gestation D. a 28-year-old woman who is breastfeeding a 2 week old. c all members of the population age 6 months and older should receive annual immunization against seasonal influenza. those with an egg allergy that is only hives should be given the vax A healthy 6-year-old girl presents for care. Her parents request that she receive vaccination for influenza and report that she has not received this vaccine in the past. How many doses of influenza vaccine should she receive this flu season? A.1 B.2 C.3 D.4 b All children aged 6 months to 8 years who receive a seasonal influenza vaccine for the first time should receive 2 doses spaced ≥4 weeks apart. high risk populations that need flu vax • All children aged 6 through 59 months. • Adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus). Individuals age 50 years of age and older. • Persons who have immunosuppression (including immunosuppression caused by medications or by HIV infection). • Women who are or will be pregnant during the influenza season. • Children and adolescents (aged 6 months - 18 years) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye's syndrome after influenza virus infection. • Residents of nursing homes and other long-term care facilities. • American Indians/Alaska Natives. • Persons who are morbidly obese (BMI ≥40) kg/m2. • People who live with or care for those at high risk for complications from flu, including: • Healthcare workers. • Household contacts of persons with medical conditions that put them at high risk for complications from the flu. • Household contacts and out of home caregivers of children aged ≤59 months and adults aged ≥50 years, with par- ticular emphasis on vaccinating contacts of children less than 6 months of age. (These children are too young to be vaccinated.) LAIV is approved for___ LAIV is approved for use in healthy people ages 2 to 49 years old It is not for patients with a health condition that places them at high risk for complications from influenza, including chronic heart disease, chronic lung dis- ease such as asthma or reactive airways disease, diabetes or kidney failure, and immunosuppression; children or adolescents receiving long-term high-dose aspirin therapy; people with a history of Guillain-Barré syndrome; pregnant women; and people with a history of allergy to any of the components of LAIV. Adverse effects of LAIV include nasal irritation and discharge, muscle aches, sore throat, and fever. FDA approved antiviral drugs for flu In the United States, four antiviral drugs are approved by the Food and Drug Administration (FDA) for use against influenza: amantadine (Symmetrel), rimantadine (Flumadine), zanamivir (Relenza), and oseltamivir (Tamiflu). which flu drugs are only for influenza A and what are the new reccs for them amantadine (Symmetrel), rimantadine (Flumadine) high levels of resistance of influenza A viruses to amantadine and similar medications. Because of this significant level of resistance, amantadine and rimantadine are no longer recommended by the CDC for the treatment of influenza. adverse affects of the 2 main flu antiviral drugs Zanamivir is inhaled and can cause bronchospasm, especially in patients with asthma or other chronic lung disease. The adverse effects of oseltamivir are largely gastrointestinal; the risk of nausea and vomiting is significantly reduced if the medication is taken with food. When considering an adult's risk for measles, mumps, and rubella (MMR), the NP considers the following: A. Patients born before 1957 have a high likelihood of immunity against these diseases because of a history of natural infection. B. Considerable mortality and morbidity occur with all three diseases. C. Most cases in the United States occur in infants. D. The use of the MMR vaccine is often associated with protracted arthralgia. A The MMR vaccine contains live but weakened (attenuated) virus. Two immunizations 1 month apart are recommended for adults born after 1957 because adults born before then are considered immune as a result of having had these diseases(native or wild infection); vaccine against these three formerly common illnesses was unavailable until the 1960s Which of the following is true about the MMR vaccine? A. It contains inactivated virus. B. Its use is contraindicated in patients with a history of egg allergy. C. Revaccination of an immune person is associated with risk of significant systemic allergic reaction. D. Two doses at least 1 month apart are recommended for young adults who have not been previously immunized. D A 22-year-old man is starting a job in a college health center and needs proof of German measles, measles, and mumps immunity. He received childhood immunizations and supplies documentation of MMR vaccination at age 1.5 years. Your best response is to: A. obtain rubella, measles (rubeola), and mumps titers. B. give MMR immunization now. C. advise him to obtain IG if he has been exposed to measles or rubella. D. advise him to avoid individuals with skin rashes. b As with all vaccines, giving additional doses to patients with an unclear immunization history is safe. quadrivalent MMR, what is it? A quadrivalent vaccine, protecting against measles, mumps, rubella, and varicella (chickenpox), is also available and usually used to immunize younger children. Rubella Rubella typically causes a relatively mild, 3- to 5-day illness with little risk of complication to the person infected. When rubella is contracted during pregnancy, however, the effects on the fetus can be devastating. measles and mumps sx Measles can cause severe illness with serious sequelae, including encephalitis and pneumonia; sequelae of mumps include orchitis and possible decreased male fertility. MMR and pregnant women The MMR vaccine is safe to use during lactation, but its use during pregnancy is discouraged because of the theoretical but unproven risk of congenital rubella syndrome from the live virus contained in the vaccine. Adult immunization schedule special adult vaccine schedule Of the following, who is at greatest risk for invasive pneumococcal infection? A. a 68-year-old man with chronic obstructive pulmonary disease B. a 34-year-old woman who underwent splenectomy after a motor vehicle accident C. a 50-year-old man with a 15-year history of type 2 diabetes D. a 75-year-old woman with decreased mobility as a result of severe osteoporosis B Indications for adults to receive pneumococcal vaccine include a variety of chronic health problems such as chronic lung disease (including asthma), chronic cardiovascular dis- eases, diabetes mellitus, chronic liver disease including cirrhosis, chronic alcohol abuse, cigarette smokers age 19 years or older, malignancy, chronic renal failure or nephrotic syndrome, functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery]), immunocompromising conditions or recipient of immunosuppressing medications, select organ transplant, cochlear implants, and cerebrospinal fluid leak. Other individuals for whom vaccination is indicated include residents of nursing homes or other long-term care facilities, and all adults 65 years or older regardless of health status. Consideration should also be given to recommending PPSV23 for Alaska Natives and American Indians ages 50 through 64 years who are living in areas in which the risk of invasive pneumococcal disease is increased. All of the following patients received pneumococcal vaccine 5 years ago. Who is a candidate for receiving a second dose of antipneumococcal immunization at this time? A. a 45-year-old man who is a cigarette smoker B. a 66-year-old woman with COPD C. a 35-year-old man with moderate persistent asthma D. a 72-year-old woman with no chronic health problems B Revaccination after 5 years after the first PPSV23 dose is recommended for individuals older than age 2 years but younger than age 65 years who are at highest risk of pneumococcal infection or are at greatest risk of having a rapid decline in antibody levels, including sickle cell disease, splenectomy, chronic renal failure, nephrotic syndrome, immunocompromise, generalized malignancy, or on immunosuppressing medications. Identify whether the item has the characteristics of 23-valent pneumococcal polysaccharide vaccine (PPSV23) or 13-valent pneumococcal conjugate vaccine (PCV13). A. Routinely used in early childhood ________ B. Use is associated with greater immunogenicity ________ C. Routinely used in all well adults age 65 years or older________ D. Not licensed for use in children younger than 2 years of age________ A = PCV13 B = PCV13 C = PPSV23 D = PPSV23 The pneumococcal polysaccharide vaccine (Pneumovax PPSV23) contains purified polysaccharide from 23 of the most common S. pneumoniae serotypes. Pneumococcal conjugate vaccine (Prevnar, PCV13) contains purified capsular polysaccharide from 13 serotypes of pneumococcus and is used in select adult populations, particularly the immunocompromised. Use of PCV13 is associated with greater immunogenicity when compared with PPSV23, but it does not provide protection against as many pneumococcal serotypes, and is routinely used in childhood. PPSV23 is not licensed for use in children younger than age 2 years. HIV and pneumo vax Once the diagnosis of HIV infection is made, the patient should receive both PCV13 and PPSV23 vaccines as soon as possible; PCV13 is given first followed by PPSV23 8 weeks later. A second dose of PPSV23 should be administered at least 5 years after the initial dose, and a third dose should be administered at age 65 years if the person was younger than age 65 years at the time of HIV diagnosis. Concerning hepatitis B virus (HBV) vaccine, which of the following is true? A. The vaccine contains live, whole HBV. B. Adults should routinely have anti-hepatitis B surface antibody titers measured after three doses of vaccine. C. The vaccine should be offered during treatment for sexually transmitted diseases in unimmunized adults. D. Serologic testing for hepatitis B surface antigen (HBsAg) should be done before hepatitis B vaccination is initiated in adults. c Hepatitis B vaccine should not be given to a person with a history of anaphylactic reaction to: A. egg. B. baker's yeast. C. neomycin. D. streptomycin. B Jason is a healthy 18-year-old who presents for primary care. According to his immunization record, he received two dose of HBV vaccine 1 month apart at age 14 years. Which of the following best describes his HBV vaccination needs? A. He should receive a single dose of HBV vaccine now. B. A three-dose HBV vaccine series should be started during today's visit. C. He has completed the recommended HBV vaccine series. D. He should be tested for HBsAb and further immunization recommendations should be made according to the test results. A You see Harold, a 25-year-old man who recently had multiple sexual encounters without condom use with a male partner who has chronic hepatitis B. Harold provides documentation of receiving a properly timed hepatitis B immunization series. In addition to counsel- ing about safer sexual practices, you also advise that Harold: A. needs to repeat his hepatitis B immunization series. B. receive a single dose of HBV vaccine. C. be tested for hepatitis B surface antibody (HBsAb). D. should receive hepatitis B immune globulin (HBIG) and a single dose of the hepatitis B immunization series. B personal immunization reactions can someone with chronic hep B transmit infection yes do I need to test for HBV Ab after immunization About 90% to 95% of individuals who receive the HBV vaccine develop HBsAb (anti-HBs) after three doses, im- plying protection from the virus. As a result, routine testing for the presence of HBsAb after immunization is not rec- ommended. HBsAb testing should be considered, however, to confirm the development of HBV protection in individ- uals with high risk for infection what if a vaccinated person is exposed to HepB single vaccine booster small pox is caused by variola virus when is small pos most contagious at onset of rash. They are usually very sick and not able to move much. They are contagious until the last scab falls off small pox arch of sx exposure 7-17 days incubation with no sx and not contagious prodromal fever- 101-104, HA, V, ache rash, starts on tongue, spread to limbs, 24 hrs temp dec day 4 thick lesions diff lesions from chicken pox bec small pox lesions are all same stage For which of the following patients should an NP order varicella antibody titers? A. a 14 year old with an uncertain immunization history B. a healthcare worker who reports having had varicella as a child C. a 22-year-old woman who received two varicella immunizations 6 weeks apart D. a 72 year old with shingles B because of high risk of exposure and potential transmission of disease Maria is a 28-year-old healthy woman who is 6 weeks pregnant. Her routine prenatal laboratory testing reveals she is not immune to varicella. She voices her intent to breastfeed her infant for at least 6 months. Which of the following represents the best advice for Maria? A. She should receive VZV vaccine once she is in her second trimester of pregnancy. B. Maria should be advised to receive two doses of VZV vaccine after giving birth. C. Once Maria is no longer breastfeeding, she should receive one dose of VZV vaccine. D. A dose of VZIG should be administered now. B done before discharge then the second dose 4-8 wks later live attenuated virus vaccines VZV and shingles lies dormant in sensory nerve ganglia 15% with hx of pox get shingles less chance with VZV vs wild indiv w/ shingles cant transmit shingles but can transmit pox if other with no vax or Dz hx An 18-year-old man has no primary tetanus immuniza- tion series documented. Which of the following repre- sents the immunization needed? A. three doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine 2 months apart B. tetanus IG now and two doses of tetanus-diphtheria (Td) vaccine 1 month apart C. tetanus, diphtheria, and acellular pertussis (Tdap) vac- cine now with a dose of Td vaccine in 1 and 6 months D. Td vaccine as a single dose C