1
NRNP 6540 MIDTERM EXAM LATEST 2023-2024
WITH QUESTIONS AND ANSWERS (VERIFIED
ANSWERS).
1. When would the influenza vaccine be absolutely contraindicated?
Correct
Answer: A previous severe allergic reaction to influenza vaccine, regardless of the
component suspected of being responsible for the reaction, is a
contraindication to future receipt of the vaccine.
2. You see a 69-year-old patient who recently moved to town and does not remember his last
tetanus shot. What would you do?
Correct
Answer: You could do one of two strategies: perform serologic testing for tetanus and
diphtheria antitoxin to see if they are immune, or give one dose of Tdap, followed
by Td at least 4 weeks later, followed by another dose of Td 6–12 months later.
Tetanus/Tdap :
In older adults, if the recommended childhood series was not done at all, the
recommendation is one dose of Tdap, followed by Td at least 4 weeks later,
followed by another dose of Td 6–12 months later. If vaccination documentation
is incomplete, the provider can either consider serologic testing for tetanus and
diphtheria antitoxin or assume that no vaccinations have been received and
administer vaccine as directed above for patients who have not been vaccinated.
3. E. D. is a 78-year-old woman who does not remember if she has ever had the immunization for
herpes zoster. She does remember having chicken pox as a child. What would you recommend for
her?
Correct
Answer: Discuss the risks of herpes zoster and SE of vaccination with the patient and
decide on whether to immunize.
Herpes Zoster
Recombinant zoster vaccine (RZV) was approved by the U.S. Food and Drug
Administration in 2017 and recommended by the ACIP in 2017 for use in adults
aged 50 years and older. RZV has a significantly higher efficacy than Zoster
vaccine live ZVL, with rates of 90% to 97% for the prevention of herpes zoster
and rates of 89% for prevention of PHN.
Zoster vaccine live (ZVL) became available in 2006 and was recommended by
the ACIP in 2008 for use in adults aged 60 years and older. It is a one-dose live
attenuated strain of varicella zoster virus. ZVL has an overall vaccine efficacy of
49.1%.
RZV is recommended by the ACIP to be given to adults aged 50 years or older. It
is a two-dose vaccine series with the second dose given 2 to 6 months after the
first. The ACIP recommends using RZV in preference to ZVL.
Neither the Centers for Disease Control and Prevention (CDC) nor the World
, 2
Health Organization (WHO) have updated their recommendations since RZV was
introduced, regarding zoster vaccination for older adults who are not sure of their
zoster vaccination status.
4. Name the most common allergic response to the flu vaccine,
Correct
Answer: All influenza vaccines have the potential to cause an egg-related allergic
reaction. Persons with a history of egg allergy who have experienced only
urticaria after exposure to egg should receive influenza vaccine.
5. Many older adults travel worldwide when they retire. For patients who are planning to travel
overseas, what would you recommend?
Correct
Answer: Before travel, older adults should be up to date on routine vaccines. Older
adults should also receive other vaccines recommended for the countries they
are visiting. These are listed by country on the CDC's Destinations Pages.
6. Give three reasons why older adults are especially vulnerable to complications of influenza
infections.
Correct
Answer: Older individuals are more likely to experience a severe infection, develop
pneumonia, require hospitalization, or die. Mortality rates in patients 75 years
and older are four to eight times higher than those seen for patients aged 65 to
74 years, and over 50 times higher than those seen before the age of 65 years. A
total of 90% of deaths attributable to influenza occur in individuals aged 60 years
and older. Following an acute care hospitalization, many older adults fail to return
to their previous level of function.
Nearly 40% of relatively healthy community-dwelling older adults who reported
the presence of influenza or influenza-like illness required more than 2 weeks to
recover, 20% required new assistance with daily functional tasks, and 13.9%
were hospitalized. Aging impairs the ability of the immune system to adequately
respond to influenza vaccination and infection, both in terms of humoral
(antibody) and cell-mediated responses. The magnitude of these aging-related
declines is increased in the presence of both frailty and chronic cytomegalovirus
infection.
7. You have an 89-year-old patient on hospice care in a long-term care facility. The protocol is for flu
vaccine to be given to all patients each fall. Would you vaccinate? Why, or why not?
Correct
NRNP 6540 MIDTERM EXAM LATEST 2023-2024
WITH QUESTIONS AND ANSWERS (VERIFIED
ANSWERS).
1. When would the influenza vaccine be absolutely contraindicated?
Correct
Answer: A previous severe allergic reaction to influenza vaccine, regardless of the
component suspected of being responsible for the reaction, is a
contraindication to future receipt of the vaccine.
2. You see a 69-year-old patient who recently moved to town and does not remember his last
tetanus shot. What would you do?
Correct
Answer: You could do one of two strategies: perform serologic testing for tetanus and
diphtheria antitoxin to see if they are immune, or give one dose of Tdap, followed
by Td at least 4 weeks later, followed by another dose of Td 6–12 months later.
Tetanus/Tdap :
In older adults, if the recommended childhood series was not done at all, the
recommendation is one dose of Tdap, followed by Td at least 4 weeks later,
followed by another dose of Td 6–12 months later. If vaccination documentation
is incomplete, the provider can either consider serologic testing for tetanus and
diphtheria antitoxin or assume that no vaccinations have been received and
administer vaccine as directed above for patients who have not been vaccinated.
3. E. D. is a 78-year-old woman who does not remember if she has ever had the immunization for
herpes zoster. She does remember having chicken pox as a child. What would you recommend for
her?
Correct
Answer: Discuss the risks of herpes zoster and SE of vaccination with the patient and
decide on whether to immunize.
Herpes Zoster
Recombinant zoster vaccine (RZV) was approved by the U.S. Food and Drug
Administration in 2017 and recommended by the ACIP in 2017 for use in adults
aged 50 years and older. RZV has a significantly higher efficacy than Zoster
vaccine live ZVL, with rates of 90% to 97% for the prevention of herpes zoster
and rates of 89% for prevention of PHN.
Zoster vaccine live (ZVL) became available in 2006 and was recommended by
the ACIP in 2008 for use in adults aged 60 years and older. It is a one-dose live
attenuated strain of varicella zoster virus. ZVL has an overall vaccine efficacy of
49.1%.
RZV is recommended by the ACIP to be given to adults aged 50 years or older. It
is a two-dose vaccine series with the second dose given 2 to 6 months after the
first. The ACIP recommends using RZV in preference to ZVL.
Neither the Centers for Disease Control and Prevention (CDC) nor the World
, 2
Health Organization (WHO) have updated their recommendations since RZV was
introduced, regarding zoster vaccination for older adults who are not sure of their
zoster vaccination status.
4. Name the most common allergic response to the flu vaccine,
Correct
Answer: All influenza vaccines have the potential to cause an egg-related allergic
reaction. Persons with a history of egg allergy who have experienced only
urticaria after exposure to egg should receive influenza vaccine.
5. Many older adults travel worldwide when they retire. For patients who are planning to travel
overseas, what would you recommend?
Correct
Answer: Before travel, older adults should be up to date on routine vaccines. Older
adults should also receive other vaccines recommended for the countries they
are visiting. These are listed by country on the CDC's Destinations Pages.
6. Give three reasons why older adults are especially vulnerable to complications of influenza
infections.
Correct
Answer: Older individuals are more likely to experience a severe infection, develop
pneumonia, require hospitalization, or die. Mortality rates in patients 75 years
and older are four to eight times higher than those seen for patients aged 65 to
74 years, and over 50 times higher than those seen before the age of 65 years. A
total of 90% of deaths attributable to influenza occur in individuals aged 60 years
and older. Following an acute care hospitalization, many older adults fail to return
to their previous level of function.
Nearly 40% of relatively healthy community-dwelling older adults who reported
the presence of influenza or influenza-like illness required more than 2 weeks to
recover, 20% required new assistance with daily functional tasks, and 13.9%
were hospitalized. Aging impairs the ability of the immune system to adequately
respond to influenza vaccination and infection, both in terms of humoral
(antibody) and cell-mediated responses. The magnitude of these aging-related
declines is increased in the presence of both frailty and chronic cytomegalovirus
infection.
7. You have an 89-year-old patient on hospice care in a long-term care facility. The protocol is for flu
vaccine to be given to all patients each fall. Would you vaccinate? Why, or why not?
Correct
