NRNP 6540 MIDTERM EXAM LATEST WITH QUESTIONS AND ANSWERS (VERIFIED ANSWERS

NRNP 6540 MIDTERM EXAM LATEST 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 twodose 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 3 Answer: According to Coll and colleagues, one study