Fitzgerald: Chapter 2 Health Promotion and Disease Prevention

Question 1

Examples of primary prevention include…

Answer 1

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.

Question 2

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

Answer 2

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.

Question 3

List examples of Secondary Prevention measures.

Answer 3

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.

Question 4

List examples of tertiary prevention measures

Answer 4

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.

Question 5

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

Answer 5

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.

Question 6

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

Answer 6

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.

Question 7

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

Answer 7

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.

Question 8

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

Answer 8

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.

Question 9

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

Answer 9

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.

Question 10

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

Answer 10

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

Question 11

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

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

True or False:
Influenza is five times more likely to cause serious disease in a pregnant woman when compared to a non-pregnant woman.

Answer 14

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.

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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).

Question 17

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

Answer 17

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).

Question 18

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.

Answer 18

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).

Question 19

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.

Answer 19

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).

Question 20

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.

Answer 20

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.

Question 21

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.

Answer 21

**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).

Question 22

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.

Answer 22

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.

Question 23

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.

Answer 23

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).

Question 24

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

Answer 24

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

Question 25

A healthy 6-year-old girl presents for care. Her parents request that she received vaccination for influenza and reports that she has not received this vaccine. How many doses of influenza vaccine should she receive this flu season?
A. 1
B. 2
C. 3
D. 4

Answer 25

Correct B. 2

ACIP recommends that all children age 6 months to 8 years who are receiving the influenza vaccine for the first time should receive two doses spaced at least four weeks apart.

Question 26

Match the appropriate influenza vaccine preparation to each of the following individuals. (Some choices may be used more than once; some questions may have multiple answers.)

__A healthy 67-year-old man
__A 12-year-old boy with Asthma
__A 42-year-old woman with severe egg allergy
__A healthy 12-month-old infant

A. LAIV4 (Intranasal)
B. IIV4 (intramuscular)
C. IIV3, high does (intramuscular)
D. Recombinant influenza vaccine (RIV3, intramuscular)

Answer 26

Correct
B, C:A healthy 67-year-old man
B :A 12-year-old boy with asthma
D:A 42-year-old woman with severe egg allergy
B:A healthy 12-month-old infant

67-year-old man: For patient’s age 65 years and older, the high-dose IIV3 can be used and might induce a greater immunogenic response compared to the standard dose vaccine. When high-dose vaccine is not available, the IIV3 or IIV4 are appropriate choices as well as the adjuvanted vaccine (aIIV3).

12-year-old boy with asthma: For children six months and older the IIV3 or IIV4 are preferred for immunization. Though LAIV4 is approved for use in children two years and older, the American Academy of pediatrics gives preference to the injectable inactivated vaccines as these might offer a better protection compared to LAIV4.

42-year-old woman with severe egg allergy: Individuals with mild allergic reaction can receive any age-appropriate influenza vaccine. Those with more severe reactions (e.g., angioedema, respiratory distress, lightheadedness, or recurrent emesis) might benefit from the RIV3 vaccine.

12-month-old: For a 12-month-old, IIV3 or IIV4 (standard dose) are appropriate choices for vaccination.

Question 27

When considering the diseases of MMR and the MMR vaccine, 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. The virus is shed after vaccine administration.
D. the use of MMR vaccine is often associated with protracted arthralgia.

Answer 27

Correct A. patients born before 1957 have a high likelihood of immunity against these diseases because of a history of natural infection.

The MMR vaccine was not available until the 1960s. Those born before 1957 are considered to be immune to those diseases as a result of having these diseases through native or wild infection.

Incorrect: The measles and mumps can be associated with severe complications, rubella often leads to a mild illness of 3 to 5 days with little risk of complications and otherwise healthy individuals (B). The vaccine contains live but we can do virus that is not shed following vaccination (C). The MMR vaccine is generally safe and well tolerated with only mild transient adverse reaction, such as a rash or sore throat (D).

Question 28

Which of the following is true about the MMR vaccine?
A. it contains an activated virus.
B. it’s 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 given at least one month apart are recommended for adults who have not been previously immunized.

Answer 28

Correct D. two doses given at least one month apart are recommended for adults who have not been previously immunized.

Adults who do not have evidence of immunity to MMR should get it twice. The full effect of the MMR vaccine occurs after administration of two doses given at least 28 days apart.

Incorrect: The MMR vaccine contains live but weak and virus (A). It is safe to use in individuals with egg allergy (B) but is contraindicated for those with a history of anaphylactic reaction to neomycin or gelatin. The vaccine is safe to give to individuals with an unclear immunization history (C).

Question 29

A 22-year-old man is starting a job in a college health center and needs proof of German measles, measles, and months immunity. He received childhood immunizations and supplies documentation of MMR vaccination at age 15. 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.

Answer 29

Correct B. Give MMR immunization now

Two doses at least 28 days apart are needed for the full effect of the MMR vaccine. Since this individual supplied evidence of obtaining windows, the second dose should be given immediately.

Incorrect: With available documentation of his immunization record, titers are not needed (and rarely performed in the clinical setting) to confirm immunity (A). Active immunity through vaccination is preferred over short term passive immunity through the use of IG for disease prevention (C). Avoiding individuals with skin rashes is impractical for an individual working in the college health center (D).

Question 30

Concerning the MMR vaccine, which of the following is true?
A. the link between use of MMR vaccine and childhood autism has been firmly established.
B. there is no credible scientific evidence that MMR vaccine increases the risk of autism.
C. The use of the combined vaccine is associated with increased autism risk, but giving the vaccine’s three components as separate vaccines minimizes this risk.
D. the vaccine contains theimerosal, a mercury derivative.

Answer 30

Correct B. there is no credible scientific evidence that MMR vaccine increases the risk of autism.

Following the publication by Wakefield and colleagues on a possible link between MMR vaccine and autism, the National Academy of Sciences conducted an extensive review and found no such link. The authors of the Wakefield et al. paper were later found guilty of ethical violations, and several inconsistencies were identified in the study. Unfortunately, the stigma of autism with MMR vaccine (and vaccination in general) remains.

Incorrect: there is no credible evidence leaking autism with MMR vaccine use (A). Based on Wakefield’s flawed data, one theoretical approach to limited risk of autism was just separate the vaccine into its individual components (C). Thimersal, a mercury derivative, may have an association with autism; however, this preservative is not contained in the MMR vaccine (D).

Question 31

Indicate (yes or no) whether it is helpful to administer an extra dose of MMR vaccine during the following outbreaks:

___ rubella
___ measles
___ mumps

Answer 31

Correct:
rubella-No
measles-Yes
mumps-Yes
During the outbreaks of measles and mumps, administration of an extra dose of MMR vaccine can be considered to ensure protection against these diseases that can have severe complications. The same consideration is not needed during rubella outbreaks, as for most individuals, this is typically a mild disease of short duration with little risk of complications.

Question 32

When advising an adult patient about pneumococcal immunization, the NP considers the following about the vaccine:
A. the vaccine contains inactivated bacteria.
B. it’s uses contra indicated an individuals with lower airway disease.
C. It protects against community – acquired pneumonia caused by atypical pathogens.
D. it’s use is seldom associated with significant adverse reactions.

Answer 32

Correct D. It’s use is seldom associated with significant adverse reactions.
The pneumococcal vaccines are generally safe and well tolerated, even with re-vaccination. The most common adverse reactions are local injection site reactions, including pain and redness, which are often mild and transient.

Incorrect: neither pneumococcal vaccines contain inactivated bacteria (A). PPSV23 contains purified pneumococcal polysaccharide from 23 serotypes, whilel PCV13 contains purified capsular polysaccharide from 13 serotypes. The vaccines are recommended for patients with lower airway disease, such as asthma and COPD (B). The vaccine only protects against infections caused by certain zero types of strep pneumonia and will not prevent infection caused by a typical pathogens (C).

Question 33

Assuming all of the following individuals are not immune to MMR, which of the following is not recommended to receive the MMR vaccination?

A. a one year old boy with a history of hive-form reaction to egg ingestion
B. a 24-year-old woman who is 20 weeks pregnant
C. A four-year-old girl who was born at 32 weeks of gestation
D. a 32-year-old woman who is breast-feeding a two week old.

Answer 33

Correct B. a 24-year-old woman who is 20 weeks pregnant

The MMR live virus vaccine should be used with caution during pregnancy. This is based on a theoretical but unproven risk of congenital rubella syndrome from the live virus vaccine.

Incorrect – the MMR vaccine is safe to use among individuals with egg allergy (A) or during lactation (D) and can be administered to children beginning at 1 year of age (or from 6 to 11 months of age if traveling internationally) (C). The vaccine is contraindicated in individuals with a history of anaphylactic reaction to neomycin or gelatin.

Question 34

Which of the following is an example of invasive pneumococcal disease?
A. pneumonia
B. acute otitis media
C. meningitis
D. sinusitis

Answer 34

Correct C. meningitis

Question 35

Usual treatment for an adult with acute hepatitis a includes:
A. interferon alpha therapy
B. high-dose ribavirin
C. parenteral acyclovir
D. supportive care

Answer 35

Correct: D. Supportive Care
HAV infection typically results in a mild, self-limiting infection, and treatment is largely supportive.

Incorrect: antivirals (e.g., acyclovir or ribavirin) are not indicated for treatment of HAV infection (B, C). Interferon alpha is also not recommended for management of this infection (A). Post exposure prophylaxis can include the use of anti-HAV IG, this is reserved for certain patient populations.

Question 36

Peak infectivity of persons with hepatitis A usually occurs:
A. before the onset of jaundice
B. at the time of maximum elevation of liver enzymes
C. during the recovery period
D. at the time of maximum disease-associated symptoms

Answer 36

Correct: A. before the onset of jaundice
The concentration of virus in stool is highest in the two week period prior to the onset of jaundice.

Incorrect: peak infectivity occurs in the two week period before the onset of jaundice, which is before liver enzymes are most elevated (B) and symptoms are most apparent (D). Once jaundice occurs, the level of HAV in the stool diminishes (C).

Question 37

In the United States, what proportion of all reported hepatitis A cases have no specific risk factors identified?
A. approximately 25%
B. approximately 50%
C. Approximately 75%
D. nearly 100%

Answer 37

Correct: B. approximately 50%
Common factors for HAV infection in the United States include men who have sex with men, illegal drug users, and travelers to areas were HAV is endemic. However, about 50% of the HIV cases have no specific risk factor identified.

Question 38

Hey 62-year-old man is recently diagnosed with non-alcoholic fatty liver disease. He does not recall ever having HAV infection, and his immunization history does not show a vaccination for HAV. The NP correctly recommends:
A. That titers should be ordered to check for past HAV infection
B. a single dose of HAV vaccine
C. a two dose series of HAV vaccine
D. That no HAV vaccine is needed as it is contraindicated due to his age

Answer 38

Correct: C. a two dose series of HAV vaccine

For individuals with chronic hepatitis disease (such as non-alcoholic fatty liver disease), vaccination with the two-dose series (single antigen vaccine) is recommended. This is due to a higher risk of rapid decline in liver function, especially in the presence of con commitment infection with hepatitis B or hepatitis C.

Incorrect: titers are rarely needed to confirm prior infection, and the vaccine should simply be given when prior HAV infection is uncertain (A). A two-dose series of the HAV vaccine is needed for optimum protection (B), and there is no contraindication for vaccine use in older adults (D).

Question 39

You see a 27-year-old man who has had no immunizations “since I was a little kid” and has no vaccination record. He states that he ate at a restaurant last week that was leader reported to have a worker identified as being infected with HAV. He is healthy and shows no signs of infection but he’s concerned about contracting HAV. You recommend that he receive:
A. HAV vaccine today.
B. HAV IG within the next week
C. HAV vaccine plus IG today
D. no intervention at this time; monitor for HAV infection symptoms and receive an antiviral if symptoms manifest.

Answer 39

**Correct: A. HAV vaccine today
**
For individuals who might have been exposed to HAV, postexposure prophylaxis with the HAV vaccine is recommended for healthy individuals over 12 months of age. IG can be considered for those 40 years and older given increased risk of more severe manifestations of infection. Both of these treatments are most effective it’s given within two weeks of exposure.

Incorrect: IG (B, C) can be considered for post exposure prophylaxis in individuals 40 years and older when administered within two weeks of the suspected exposure to the virus. The HAV vaccine given today would be recommended (D) to protect against HAV infection, and the patient should be strongly encourage to receive the second dose for long-term immunity.

Question 40

When discussing the use of IG with a 60 year old woman who is recently exposed to HIV, you consider that:
A. IG is derived from pooled donated blood
B. the product must be used within one week of exposure to provide protection
C. Its use in the situation constitutes an example of active immunization
D. A short, intense, flu like illness often occurs after its use

Answer 40

Correct: A. IG is derived from pooled donated blood
IG is a product derived from pooled blood that contains preformed antibodies against the virus.

Incorrect: Post exposure prophylaxis for individuals exposed to HAV includes the HAV vaccination for anyone over 12 months of age. For those over age 40 years, IG should also be offered given the higher risk of complications in older adults. Post exposure prophylaxis is most effective when given within two weeks of exposure to the virus (B). IG provide short-term passive immunization (C) and is generally well tolerated (D). Immunization with HAV vaccine should be encouraged for long-term immunity up to HAV.