NSG 6430 CORE EXAM TEST QUESTIONS AND ANSWERS
GRADED A+
✔✔What testing should be performed on sexually active adolescent men who have sex
with men? - ✔✔Annual syphilis serology, gonorrhea cultures (urethral, rectal, and
pharyngeal), screening for Chlamydia, and HIV screening are recommended.
Homosexual males who are not already immunized should be screened for hepatitis B
as well. Those with negative surface antigen and antibody tests should receive hepatitis
B vaccine.
✔✔What adolescents should be given a cholesterol and fasting triglyceride test? -
✔✔adolescents with heart disease, hypertension, diabetes mellitus, or a family history
of heart disease or hyperlipidemia. Targeted screening in adolescents misses one third
to one half of those with elevated cholesterol concentrations, so some authorities
advocate at least one screening cholesterol test during adolescence.
✔✔Who should be tested for Human Immunodeficiency Virus Antibody Testing? -
✔✔Universal screening for antibody to HIV is being recommended by the CDC for
adults and adolescents. At a minimum, individuals at risk should be encouraged to
receive HIV testing after a discussion regarding the benefits and possible negative
consequences of the results (see Chapter 32). Individuals with any STD should be
screened for others, including HIV infection.
✔✔IMMUNIZATIONS - ✔✔The current immunization schedule is available at
http://www.cdc.gov.
✔✔General vaccine info - ✔✔Vaccination of adolescents is safe and should be seen as
a high priority for adolescents whose previous immunizations are lacking or incomplete.
Adolescents who have been partially vaccinated can have their vaccination completed
without restarting the series. Likewise, adolescents who begin vaccination can complete
it at any time after the vaccination process is interrupted, even if there has been a
substantial delay between doses. Vaccines should not be given more frequently than at
the recommended intervals. Although not every possible combination of vaccines has
been explicitly tested, there are no contraindications to giving any or all of these
vaccines simultaneously as long as they are given at separate and appropriate
anatomic sites.
✔✔Informed consent - ✔✔The clinic or office should obtain a signature of either the
patient, parent, or guardian to acknowledge having been provided with vaccine
information. This should also be noted in the medical record.
✔✔What does the appropriate documentation of vaccines include? - ✔✔consent for
vaccination, immunization type, date of administration, injection site, manufacturer and
lot number of vaccine, and name and address of the health care provider administering
the vaccine.
,✔✔What vaccinations cannot be given during pregnancy? - ✔✔Because of theoretical
risks to the developing fetus, live-attenuated virus vaccines are not routinely given to
pregnant women or to those who are likely to become pregnant within 3 months after
receiving the vaccine.
✔✔What vaccines may be given to pregnant woman - ✔✔inactivated virus vaccines,
bacterial vaccines, or toxoids. This includes tetanus and diphtheria toxoid. There is also
no risk to the fetus from passive immunization of pregnant women with immune
globulin. Because measles-mumps-rubella (MMR) vaccine viruses are not transmitted
from individuals receiving them, children of pregnant women may receive these
vaccines.
✔✔What vaccine should not be given to adolescent patients who have Human
Immunodeficiency Virus-Infected? - ✔✔Varicella
✔✔Diphtheria, Tetanus, Pertussis - ✔✔The ACIP now recommends that adolescents
aged 11 to 18 who have completed their primary vaccination series against diphtheria,
pertussis, and tetanus now receive a single dose of Tdap instead of the Td. The
preferred age for Tdap is age 11 to 12 years; ideally, Tdap should be given concurrently
with the new tetravalent meningococcal conjugate vaccine (Menactra; see below).
Adolescents who have already received a single dose of Td should still receive a single
dose of Tdap between the ages of 11 and 18 years. An interval of at least 5 years is
recommended (but not required) between Td and Tdap in order to reduce the risk of
reactions. After Tdap vaccination, Td boosters continue to be recommended every 10
years throughout life. The dose of Tdap is 0.5 mL administered intramuscularly in the
deltoid muscle.
✔✔Hepatitis A - ✔✔The vaccines are inactivated and come in adult and pediatric
formulations, with different dosages and administration schedules
✔✔Hepatitis B Vaccine - ✔✔Universal vaccination is now recommended in the United
States, and the ACIP recommends the three-dose hepatitis B vaccine series for
adolescents at age 11 to 12 years who have not previously been immunized.
✔✔Haemophilus Influenzae Type B - ✔✔indicated for those adolescents not previously
immunized who are at risk because of splenic dysfunction or other conditions. A single
dose of 0.5 mL is recommended.
✔✔indicated for those adolescents not previously immunized who are at risk because of
splenic dysfunction or other conditions. A single dose of 0.5 mL is recommended. -
✔✔ACIP has recommended that it be routinely given to girls at age 11 to 12. The
quadrivalent vaccine targets HPV types 16 and 18 (the most common HPV types
implicated in cervical cancer) as well as HPV types 6 and 11 (the most common HPV
types associated with genital warts).
, ✔✔What type of HPV is related to 70% of cervical cancer? - ✔✔HPV 16 and 18
✔✔What type of HPV is related to 90% of genital warts? - ✔✔HPV types 6 and 11
✔✔When should Gardasil (quadrivalent) vaccine be administered? - ✔✔The current
recommendation is that the quadrivalent vaccine (Gardasil) be given to girls at age 11 to
12, but the vaccination series of three vaccines can be started as early as age 9 at the
discretion of the health care provider. Ideally vaccination should occur prior to the onset
of sexual activity, as the vaccine will not be effective against any HPV subtypes that
may already have been acquired. However, women between the ages of 13 and 26,
even if they are already sexually active, are thought to benefit from the vaccine as well,
acquiring protection from any HPV subtypes to which they have not already been
exposed. "Catch-up" vaccination has also been recommended by the ACIP. The
vaccine is not currently recommended for males.
✔✔(Pg 40) Meningococcal Vaccine - ✔✔an outbreak in 2006 highlights the importance
of continued vigilance. Many of the involved individuals in this outbreak were college
students, indicating the importance of this age group as susceptible individuals. Mumps
vaccine has few side effects, and more than 90% of susceptible patients develop
protective, long-lasting antibodies. Mumps vaccine is usually administered as MMR.
Susceptible adolescents should receive a single dose of mumps vaccine alone or as
MMR.
✔✔Pneumococcal Vaccine - ✔✔Pneumococcal vaccine is indicated for individuals with
a chronic illness, particularly of the cardiovascular or pulmonary system. It is also
indicated for those who are at increased risk of pneumococcal disease, including
patients with nephrotic syndrome, sickle cell disease, asplenia or functional asplenia,
HIV infection, or B-cell immune deficiency, as well as patients at risk for meningitis. The
duration of immunity is unclear, and revaccination is not currently recommended by the
CDC;
✔✔Polio Virus - ✔✔The last reported case of poliomyelitis caused by locally acquired
wild-type virus in the United States occurred more than 20 years ago. Killed-virus
inactivated poliovirus vaccine (IPV) is now the vaccine of choice, and oral poliovirus
vaccine (OPV) is no longer recommended for use in the United States. Routine
vaccination of nonimmunized adults is not required unless they are at particularly high
risk because of travel to endemic areas, exposure to wild poliovirus, or occupational
exposure. Immunosuppression is not a contraindication to vaccination. There is a
theoretical risk during pregnancy, so vaccination of pregnant women should be avoided.
✔✔Rubella - ✔✔Cases of rubella have often occurred among nonimmunized adults in
outbreaks in colleges and workplaces; therefore proof of rubella and measles immunity
should continue to be required for attendance from both male and female students. All
students who enter institutions of postsecondary education should have documentation
GRADED A+
✔✔What testing should be performed on sexually active adolescent men who have sex
with men? - ✔✔Annual syphilis serology, gonorrhea cultures (urethral, rectal, and
pharyngeal), screening for Chlamydia, and HIV screening are recommended.
Homosexual males who are not already immunized should be screened for hepatitis B
as well. Those with negative surface antigen and antibody tests should receive hepatitis
B vaccine.
✔✔What adolescents should be given a cholesterol and fasting triglyceride test? -
✔✔adolescents with heart disease, hypertension, diabetes mellitus, or a family history
of heart disease or hyperlipidemia. Targeted screening in adolescents misses one third
to one half of those with elevated cholesterol concentrations, so some authorities
advocate at least one screening cholesterol test during adolescence.
✔✔Who should be tested for Human Immunodeficiency Virus Antibody Testing? -
✔✔Universal screening for antibody to HIV is being recommended by the CDC for
adults and adolescents. At a minimum, individuals at risk should be encouraged to
receive HIV testing after a discussion regarding the benefits and possible negative
consequences of the results (see Chapter 32). Individuals with any STD should be
screened for others, including HIV infection.
✔✔IMMUNIZATIONS - ✔✔The current immunization schedule is available at
http://www.cdc.gov.
✔✔General vaccine info - ✔✔Vaccination of adolescents is safe and should be seen as
a high priority for adolescents whose previous immunizations are lacking or incomplete.
Adolescents who have been partially vaccinated can have their vaccination completed
without restarting the series. Likewise, adolescents who begin vaccination can complete
it at any time after the vaccination process is interrupted, even if there has been a
substantial delay between doses. Vaccines should not be given more frequently than at
the recommended intervals. Although not every possible combination of vaccines has
been explicitly tested, there are no contraindications to giving any or all of these
vaccines simultaneously as long as they are given at separate and appropriate
anatomic sites.
✔✔Informed consent - ✔✔The clinic or office should obtain a signature of either the
patient, parent, or guardian to acknowledge having been provided with vaccine
information. This should also be noted in the medical record.
✔✔What does the appropriate documentation of vaccines include? - ✔✔consent for
vaccination, immunization type, date of administration, injection site, manufacturer and
lot number of vaccine, and name and address of the health care provider administering
the vaccine.
,✔✔What vaccinations cannot be given during pregnancy? - ✔✔Because of theoretical
risks to the developing fetus, live-attenuated virus vaccines are not routinely given to
pregnant women or to those who are likely to become pregnant within 3 months after
receiving the vaccine.
✔✔What vaccines may be given to pregnant woman - ✔✔inactivated virus vaccines,
bacterial vaccines, or toxoids. This includes tetanus and diphtheria toxoid. There is also
no risk to the fetus from passive immunization of pregnant women with immune
globulin. Because measles-mumps-rubella (MMR) vaccine viruses are not transmitted
from individuals receiving them, children of pregnant women may receive these
vaccines.
✔✔What vaccine should not be given to adolescent patients who have Human
Immunodeficiency Virus-Infected? - ✔✔Varicella
✔✔Diphtheria, Tetanus, Pertussis - ✔✔The ACIP now recommends that adolescents
aged 11 to 18 who have completed their primary vaccination series against diphtheria,
pertussis, and tetanus now receive a single dose of Tdap instead of the Td. The
preferred age for Tdap is age 11 to 12 years; ideally, Tdap should be given concurrently
with the new tetravalent meningococcal conjugate vaccine (Menactra; see below).
Adolescents who have already received a single dose of Td should still receive a single
dose of Tdap between the ages of 11 and 18 years. An interval of at least 5 years is
recommended (but not required) between Td and Tdap in order to reduce the risk of
reactions. After Tdap vaccination, Td boosters continue to be recommended every 10
years throughout life. The dose of Tdap is 0.5 mL administered intramuscularly in the
deltoid muscle.
✔✔Hepatitis A - ✔✔The vaccines are inactivated and come in adult and pediatric
formulations, with different dosages and administration schedules
✔✔Hepatitis B Vaccine - ✔✔Universal vaccination is now recommended in the United
States, and the ACIP recommends the three-dose hepatitis B vaccine series for
adolescents at age 11 to 12 years who have not previously been immunized.
✔✔Haemophilus Influenzae Type B - ✔✔indicated for those adolescents not previously
immunized who are at risk because of splenic dysfunction or other conditions. A single
dose of 0.5 mL is recommended.
✔✔indicated for those adolescents not previously immunized who are at risk because of
splenic dysfunction or other conditions. A single dose of 0.5 mL is recommended. -
✔✔ACIP has recommended that it be routinely given to girls at age 11 to 12. The
quadrivalent vaccine targets HPV types 16 and 18 (the most common HPV types
implicated in cervical cancer) as well as HPV types 6 and 11 (the most common HPV
types associated with genital warts).
, ✔✔What type of HPV is related to 70% of cervical cancer? - ✔✔HPV 16 and 18
✔✔What type of HPV is related to 90% of genital warts? - ✔✔HPV types 6 and 11
✔✔When should Gardasil (quadrivalent) vaccine be administered? - ✔✔The current
recommendation is that the quadrivalent vaccine (Gardasil) be given to girls at age 11 to
12, but the vaccination series of three vaccines can be started as early as age 9 at the
discretion of the health care provider. Ideally vaccination should occur prior to the onset
of sexual activity, as the vaccine will not be effective against any HPV subtypes that
may already have been acquired. However, women between the ages of 13 and 26,
even if they are already sexually active, are thought to benefit from the vaccine as well,
acquiring protection from any HPV subtypes to which they have not already been
exposed. "Catch-up" vaccination has also been recommended by the ACIP. The
vaccine is not currently recommended for males.
✔✔(Pg 40) Meningococcal Vaccine - ✔✔an outbreak in 2006 highlights the importance
of continued vigilance. Many of the involved individuals in this outbreak were college
students, indicating the importance of this age group as susceptible individuals. Mumps
vaccine has few side effects, and more than 90% of susceptible patients develop
protective, long-lasting antibodies. Mumps vaccine is usually administered as MMR.
Susceptible adolescents should receive a single dose of mumps vaccine alone or as
MMR.
✔✔Pneumococcal Vaccine - ✔✔Pneumococcal vaccine is indicated for individuals with
a chronic illness, particularly of the cardiovascular or pulmonary system. It is also
indicated for those who are at increased risk of pneumococcal disease, including
patients with nephrotic syndrome, sickle cell disease, asplenia or functional asplenia,
HIV infection, or B-cell immune deficiency, as well as patients at risk for meningitis. The
duration of immunity is unclear, and revaccination is not currently recommended by the
CDC;
✔✔Polio Virus - ✔✔The last reported case of poliomyelitis caused by locally acquired
wild-type virus in the United States occurred more than 20 years ago. Killed-virus
inactivated poliovirus vaccine (IPV) is now the vaccine of choice, and oral poliovirus
vaccine (OPV) is no longer recommended for use in the United States. Routine
vaccination of nonimmunized adults is not required unless they are at particularly high
risk because of travel to endemic areas, exposure to wild poliovirus, or occupational
exposure. Immunosuppression is not a contraindication to vaccination. There is a
theoretical risk during pregnancy, so vaccination of pregnant women should be avoided.
✔✔Rubella - ✔✔Cases of rubella have often occurred among nonimmunized adults in
outbreaks in colleges and workplaces; therefore proof of rubella and measles immunity
should continue to be required for attendance from both male and female students. All
students who enter institutions of postsecondary education should have documentation
