Fitzgerald: Chapter 2 Health Promotion and Disease Prevention Flashcards
Examples of primary prevention include…
Primary prevention is the first level of health care. Examples include: health-protecting education and counseling, immunizations, conducting home surveys, and chemoprophylaxis.
Primary prevention focuses on preventing illness or injury.
Common forms of passive immunity include:
a. herd immunity
b. annual influenza vaccination
c. having chicken pox
d. acquisition of immunity from mother to child via the placenta
d. acquisition of immunity from mother to child via the placenta
Passive immunity is a different type of immunity which is acquired when a person’s own immune system plays no active role in fighting the pathogen; instead, he is given someone else’s antibodies.
answer a is incorrect because Herd immunity describes a state of immunity acquired when a significant fraction of the population develops resistance to an infection for some reason other than prior exposure or immunization, and which breaks the chain of subsequent spread of the infection. At this point, the infection is highly unlikely to spread because a significant number of people have reached the stage of ‘herd immunity’.
answer b is incorrect because it is a form of active immunization (not passive). Individuals are injected with the virus which triggers the body to develop antibodies about two weeks after the injection.
Immunity obtained following an active infection is an example of active (not passive) immunity.
List examples of Secondary Prevention measures.
Examples of secondary prevention include screening examinations for pre-clinical evidence of cancer, such as mammography, colonoscopy, and cervical examination with a pap test.
Additional examples of secondary prevention include screening for clinical conditions with protracted asymptomatic., Such as a blood pressure measurement to detect hypertension and a lipid profile to detect hyperlipidemia.
List examples of tertiary prevention measures
Examples of tertiary prevention measures include medications and lifestyle modification to normalize black glucose levels in individuals with diabetes mellitus, and in conjunction with the treatment of heart failure, aimed at improving or minimizing disease related symptoms.
The goal of tertiary prevention is to minimize disease associated complications and the negative health effects of the established clinical conditions.
An example of a primary prevention measure for a 78-year-old man with chronic obstructive pulmonary disease (COPD) is:
A. Reviewing the use of prescribe medications
B. Conducting at home survey to minimize fall risk
C. Checking FEV1 (Forced expired volume at 1 second) to FVC (Forced vital capacity) ratio
D. Ordering if you got a cult blood test
Correct answer:
B. conducting a home survey to minimize fall risk
Primary prevention is the first level of healthcare and includes activities provided to individuals to prevent the onset or acquisition of a given disease or injury. Though this often involves immunization against infectious diseases, primary prevention can also be education and counseling on disease prevention and conducting home surveys to minimize the risk of accidents.
Incorrect answer:
Secondary prevention measures include activities provided to identify and treat asymptomatic persons who have risk factors for a given disease or are in preclinical disease. This can involve screening for cancer, such as ordering FOBT (fecal occult blood test) to screen for colorectal cancer. Tertiary prevention measures are part of the management of an established disease. For a patient with COPD, this can include assessing respiratory function, and review and current medications.
Which of the following is an example of a primary prevention activity in a 76 – year old woman with osteoporosis?
A. Biphosphonate therapy
B. Calcium supplementation
C. Ensuring adequate illumination in the home
D. Use of a back brace
Correct answer:
C. Ensuring adequate illumination in the home
Primary prevention is the first level of healthcare and includes activities provided to individuals to prevent the onset or acquisition of a given disease or injury. Adequate illumination is important in reducing the risk of falls and injury, improper administration of medicines, and so on, and is considered a primary prevention measure. This is particularly important in the elderly population as they are at a higher risk of fractures and more likely to be taking multiple medication’s.
Incorrect answer:
Biphosphonate therapy, calcium supplementation, and the use of a back brace are all examples of tertiary prevention. Tertiary prevention measures are part of the management of an established disease.
Secondary prevention measures for a 78-year-old man with COPD whose medications include an inhaled corticosteroid, long acting beta two agonists, and theophylline, include:
A. Screening for mood disorders
B. Administering influenza vaccine
C. Obtaining a serum theophylline level
D. Advising about appropriate use of car passenger restraints
Correct answer:
A. Screening for mood disorders
Secondary prevention measures include activities provided to identify and treat asymptomatic persons who have risk factors for a given disease or are in preclinical disease. These measures typically involve screening tests, such as screening for mood disorders and cancer.
Incorrect:
Immunizations and advising about the appropriate use of car passenger restraints or aim to prevent disease or injury and are considered primary prevention measures. Obtaining a serum Theophylline level is part of the management plan for the patient’s COPD diagnosis and is a tertiary prevention measure.
Tertiary prevention measures for a 69-year-old woman with heart failure include:
A. Administering pneumococcal vaccine
B. Adjusting therapy to minimize dyspnea
C. Surveying skin for precancerous lesions
D. Reviewing the safe handling of food
Correct answer:
B. Adjusting therapy to minimize dyspnea
Tertiary prevention measures are part of the management of an established disease. It tertiary prevention measure for this patient with heart failure can include evaluating and adjusting therapy to minimize dyspnea.
Incorrect answer:
Immunization and reviewing the safe handling of food are both aim to prevent disease and illness and are considered primary prevention measures. Screening for cancer, such as surveying the skin for precancerous lesions is a secondary prevention measure.
Which of the following products provides passive immunity?
A. Hepatitis B immune globulin (HBIG)
B. Measles, mumps, and rubella (MMR) Vaccine
C. Pneumococcal conjugate vaccine
D. Influenza vaccine
Correct:
A. Hepatitis B immune globulin
Passive immunity is provided with a person receives select antibodies produced in another host, usually via the administration of IG, after exposure to an infected agent. This type of immunity is not preferred as passive immunity is only temporary and requires the patient to be present following exposure to an infecting agent.
Incorrect:
Active immunity can be acquired through vaccination or following an active infection. Active immunity via vaccination is preferred overpass of immunity as active immunity provides long-term protection from the disease.
Active immunity is defined as:
A. Resistance developed in response to an antigen
B. Immunity conferred by an antibody produced in another host
C. The resistance of a group to an infectious agent
D. Defense against disease acquired naturally by the infant from the mother
Correct:
A. Resistance developed in response to an antigen
Active immunity is defined as resistance developed through exposure to an antigen. Active immunity can be acquired through vaccination or following an active infection.
Incorrect:
Passive immunity is acquired when a person receives select antibodies produced in another host. This can be through administration of antibodies or naturally by a fetus or infant from the mother. The resistance of a group to an infectious agent describes an aspect of herd immunity, which can be accomplished when a certain percentage of the population has active immunity (either through vaccination or following infection) against and infecting agent
Which of the following is usually viewed as the most cost effective form of healthcare?
A. Primary prevention
B. Secondary prevention
C. Tertiary prevention
D. Cancer-reduction measures
Correct:
A. Primary prevention
The goal of primary prevention is to prevent a disease or injury before it happens. In this manner, it is the most cost effective approach to healthcare as it eliminates all the costs associated with treating the disease.
Incorrect:
Though not as cost-effective as primary prevention measures, secondary prevention measures are also cost-effective in healthcare, particularly if screening is performed to identify disease at the early stages where treatment and recovery are possible. Tertiary prevention is also considered a failure of primary prevention approach to care. Cancer reduction measures are a non-defined term, though any management approaches for the established disease can be considered part of tertiary prevention measures.
An 18-year-old woman with allergic rhinitis presents for primary care. She is sexually active with a male partner and is one year post coitarche; During that time she had two sexual partners. An example of primary prevention activity for this patient is:
A. Screening for sexually transmitted infection (STI)
B. Counseling about safer sexual practices
C. Prescribing therapies for minimizing allergies
D. Obtaining a liquid based pap test
Correct:
B. Counseling about safer sexual practices
The goal of primary prevention is to prevent a disease or injury before it happens. Educating the patient about safer sexual practices is important in reducing the risk for sexually transmitted diseases.
Incorrect:
Screening for STI’s and performing a pap test are part of secondary prevention measures to potentially detect/identify already established diseases. Prescribing medication’s to minimize allergy can be a part of the patient management for allergic rhinitis and is considered tertiary prevention measure.
When a critical portion of a population is immunized against a contagious disease, most members of the group, even the unimmunized, are protected against the disease because there is little opportunity for an outbreak. This is known as ________ immunity.
A. Passive
B. Humoral
C. Epidemiological
D. Community
Correct:
D. Community
In herd or community immunity, a significant portion of a given population has immunity against the infectious agent; the likelihood that the susceptible portion of the group would become infected is minimize.
Incorrect:
Passive immunity is provided when a person receives select antibodies produced in another host, usually via the administration of IG. Humoral immunity is an aspect of immunity mediated by antibodies in the body fluids (or humors). Epidemiological immunity is not a defined term.
True or False:
Influenza is five times more likely to cause serious disease in a pregnant woman when compared to a non-pregnant woman.
Correct: True
Because of the change in the respiratory and immune system normally present during pregnancy influenza is five times more likely to cause a serious disease in pregnant women when compared to non-pregnant women.
When advising a patient about injectable influenza immunization, the nurse practitioner considers the following about the use of this vaccine:
A. It’s a use is not recommended in sickle cell anemia
B. It’s use is limited to children older than two years
C. It’s use is limited because it contains live virus
D. Its use is recommended for virtually all members of the population
Correct D. it’s use is recommended for virtually all members of the population.
The injectable inactivated influenza vaccine IIV3 or IIV4 is the traditional “flu shot” that is approved for use in virtually all members of the population six months of age or older. It does not contain live virus and so can be used in pregnant women and patients with compromised immunity.
Incorrect: IIV3 or IIV4 can be used for generally all individuals six months and older (B). There are no special precautions for its use when patients with sickle cell anemia (A), And the vaccine does not contain live virus (C), and so virus is not shed following vaccination.
A middle-aged man with COPD who is about to receive injectable influenza vaccine should be advised of the following:
A. It is more than 90% effective in preventing influenza
B. Its use is contraindicated in the presence of select common health conditions including COPD
C. Localized reactions such as soreness and redness at the site of immunization are fairly common
D. A short, intense, flu like syndrome typically occurs after immunization
Correct C. Localize reactions such as soreness and redness at the site of immunization are fairly common.
The most common adverse effect of the flu shot is soreness and redness at the site of immunization, though this typically resolves after a short period of time. Local redness is generally expected with all vaccines when an immunogenic substance is injected into tissue.
Incorrect: current estimates of influenza vaccine effectiveness generally range between 40% and 50% (A). The vaccine is not contraindicated for any common health conditions, such as COPD (B), and can even be administered to individuals with mild to moderate illness and those currently taking anti-microbial therapy. A short, intense illness following immunization can occur, though this is a very rare reaction to the vaccine (D).
A 44-year-old Woman with asthma presents asking for a “flu shot.” She is seen today for urgent care visit, is diagnosed with a lower urinary tract infection, and is prescribed trimethoprim-sulfamethoxazole. She is without fever or gastrointestinal upset with stable respiratory status. You inform her that she:
A. should return for the immunization after completing her antibiotic therapy
B. would likely develop a significant reaction if immunized today
C. can receive the immunization today
D. is not a candidate for any form of influenza vaccine
Correct C. can receive the immunization today.
For this patient with mild to moderate illness and who is generally stable, she is eligible to receive the influenza vaccine even while taking antimicrobial therapy.
Incorrect: influenza vaccine can be given to individuals with mild to moderate illness (D) as well as those on antimicrobial therapy (A). Current illness does not increase the risk of severe adverse reactions of the vaccine (B). The vaccine should be used with precautions for those with moderate to severe illness with or without fever and those with egg allergies other than hives (e.g., angioedema, respiratory distress, lightheadedness, or recurrent emesis).
Which of the following statements is most accurate regarding the use of antiviral agents for post exposure prophylaxis against influenza:
A. Antivirals are not indicated for post exposure prophylaxis.
B. The use of antivirals is less expensive than vaccines for prevention of flu.
C. Antivirals have a higher risk of adverse effects compared to vaccinations.
D. When properly timed, using an antiviral is nearly 100% effective in preventing influenza.
Correct C. Antivirals have a higher risk of adverse effects compared to vaccinations.
The antivirals can be used for post exposure prophylaxis and individuals exposed to the influenza virus, this method is not preferred over vaccination due to the higher cost and greater risk of adverse effects when compared to vaccination.
Incorrect: certain antivirals are approved for use in post exposure prophylaxis (A), though this is not the preferred method to prevent influenza. Antiviral treatment is more expensive compared to vaccination (B) and still has a high rate of treatment failure (D).
Which of the following statements best describes antiviral used such as oseltamivir (Tamiflu) in the care of patients with or at risk for influenza?
A. Initiation of therapy early in acute influenza illness can help minimize the severity of the disease when the illness is caused by a non-resistant viral strain.
B. The primary indication is in preventing influenza A during outbreaks.
C. The drugs are active only against influenza B.
D. The use of these medication’s is an acceptable alternative to the influenza vaccine.
Correct A. Initiation of therapy early in acute influenza illness can help minimize the severity of the disease when the illness is caused by a non-resistant viral strain.
Antivirals can be effective in reducing the duration and severity of influenza, particularly when taken soon after the onset of symptoms (less than 48 hours).
Incorrect: Oseltamivir (Tamiflu) is indicated for the treatment or prevention of influenza caused by either influenza A or B strains (B, C). The antivirals can be effective in preventing flu, the preferred method is vaccination due to the lower cost, lower risk of adverse effects, and higher effectiveness (D).
All of the following are considered high-risk populations for severe flu-related complications except:
A. children between 6 and 59 months.
B. those of Asian ethnicity.
C. adults with renal dysfunction.
D. those who are extremely obese.
Correct B. Those of Asian ethnicity
So everyone six months and older should receive the influenza vaccine, certain patient populations are considered to be at a higher risk of serious influenza related complications. However, those of Asian ethnicity are not considered to be among this high-risk group.
Incorrect: those considered at high risk of influenza related complications include young children (6 to 59 months) (A) and older adults (50 years and older), any person who is immune compromised, those with chronic health disorders including respiratory, renal, and hepatic) (C), American Indian/Alaskan natives, and the extremely obese (D), among others.
The most common method of influenza virus transmission is via:
A. contact with contaminated service.
B. respiratory droplet.
C. Saliva contact.
D. skin-to-skin contact.
**Correct B. respiratory droplet.
**
Though the influenza virus can live on surfaces for a short while, the most common method of transmission is person-to-person via respiratory droplets, primarily following a cough or sneeze.
Incorrect: The most common mode of transmission of influenza virus is via respiratory droplet. Transmission can occur more rarely through contaminated surface (A) or saliva contact (C). The virus cannot be spread through skin to skin contact (D).
In an immunocompetent adult, the length of incubation for the influenza virus is on average:
A. less than 24 hours.
B. 1-4 days.
C. 4-7 days.
D. more than one week.
Correct B. 1-4 days.
For the immunocompetent adult, the incubation period for influenza is relatively short in between 1 to 4 days. Adults can be contagious from 1 day prior to the start of symptoms to approximately 5 days after the onset of symptoms.
Influenza protection options for a 68-year-old man with hypertension, dyslipidemia, and type two diabetes mellitus include receiving:
A. Live attenuated influenza vaccine via nasal spray.
B. high-dose trivalent inactivated vaccine (IIV3) via intramuscular injection.
C. IIV4 via jet injector.
D. appropriate antiviral medication at the initial onset of influenza-like illness.
Correct B. high-dose trivalent inactivated vaccine (IIV3) via intramuscular injection.
Appropriate vaccines for adults 65 years and older include inactivated influenza vaccine standard or high-dose formulation, (IIV3 or IIV 4) given via intramuscular injection. An advantage vaccine (aIIV3) is also approved her older adults.
Incorrect: for adults 65 years and older, the live attenuated influenza virus (LAIV4) is not appropriate (approved for those 2 through 49 years) (A), nor are the vaccines delivered via a jet injector (approved for those 18 to 64 years) (C). Use of an antiviral for prophylaxis is not preferred over vaccination, particularly in an older adult with chronic medical conditions (D).
Which of the following should not receive vaccination against influenza?
A. a 19-year-old with history of hive-form reaction to eating eggs
B. a 24-year-old woman who is eight weeks pregnant
C. a 4-month-old infant who was born at 32 weeks of gestation
D. a 28 year old woman who is breast-feeding a 2-week-old infant
Correct C. a 4-month-old infant who was born at 32 weeks of gestation.
Influenza vaccine is generally recommended for all individuals age 6 months and older. Therefore, the 4-month-old infant would not be administered the vaccine (C). All persons in close contact with the infant should be strongly recommended to get the vaccine to protect the infant from the flu.
Incorrect: For those with only a hive-form reaction to eggs, immunization with any age-appropriate vaccine is acceptable (A). Vaccination is also recommended at any time during pregnancy (B), as well as for nursing mothers (D), as this can provide some protection to the child through passive immunity
