FNP 2
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 (HBIG) Passive immunity is provided when a person receives select antibodies produced in another host, usually via the administration of IG, after exposure to an infective agent (A). This type of immunity is not preferred as passive immunity is only temporary and requires the patient to present following exposure to an infecting agent. Incorrect: Active immunity can be acquired through vaccination (B, C, D) or following an active infection. Active immunity via vaccination is preferred over passive immunity as active immunity provides long-term protection from the disease.
Which of the following statements best describes antiviral use 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 disease when the illness is caused by a nonresistant 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 medications is an acceptable alternative to the influenza vaccine
Correct: A. initiation of therapy early in acute influenza illness can help minimize the severity of disease when the illness is caused by a nonresistant 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) (A). Incorrect: Oseltamivir is indicated for the treatment or prevention of influenza caused by either influenza A or B strains (B, C). Though antivirals can be effective in preventing flu, the preferred method is vaccination due to lower cost, lower risk of adverse effects, and higher effectiveness (D).
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 the MMR vaccine is often associated with protracted arthralgia
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 these diseases as a result of having these diseases through native or wild infection (A). Incorrect: Though 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 in otherwise healthy individuals (B). The vaccine contains live but weakened 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 rash or sore throat (D).
Which of the following is usually viewed as the most cost-effective form of health care? 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 health care as it eliminates all the costs associated with treating the disease (A). Incorrect: Though not as cost-effective as primary prevention measures, secondary prevention measures are also cost-effective in health care, particularly if screening is performed to identify disease at early stages where treatment and recovery are possible (B). Tertiary prevention is often considered a failure of primary prevention measures and is the costliest approach to care (C). "Cancer-reduction measures" is a nondefined term, though any management approaches for an established disease can be considered part of tertiary prevention measures (D).
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 (A). 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 (i.e., IG) (B) or naturally by a fetus or infant from the mother (D). The resistance of a group to an infectious agent describes an aspect of herd immunity (C), which can be accomplished when a certain percentage of the population has active immunity (either through vaccination or following infection) against an infecting agent.
Secondary prevention measures for a 78-year-old man with COPD whose medications include an inhaled corticosteroid, long-acting beta-2 agonist, 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: 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 (A) and cancer. Incorrect: Immunizations (B) and advising about the appropriate use of car passenger restraints (D) are aimed to prevent disease or injury and are considered primary prevention measure. Obtaining a serum theophylline level (C) is part of the management plan for the patient's COPD diagnosis and thus is a tertiary prevention measure.
In an immunocompetent adult, the length of incubation for the influenza virus is on average: A. less than 24 hours B. 1 to 4 days C. 4 to 7 days D. more than 1 week
Correct: B. 1 to 4 days For the immunocompetent adult, the incubation period for influenza is relatively short and between 1 and 4 days. Adults can be contagious from 1 day before the start of symptoms to approximately 5 days after the onset of symptoms.
A healthy 6-year-old girl presents for care. Her parents request that she receive vaccination for influenza and report 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
Correct: B. 2 ACIP recommends that all children aged 6 months to 8 years who are receiving the influenza vaccine for the first time should receive two doses spaced at least 4 weeks apart (B).
Match the appropriate influenza vaccination preparation to each of the following individuals. (Some choices may be used more than once; some questions may have multiple answers.) A healthy 12-month-old infant A. LAIV4 (intranasal) B. IIV4 (intramuscular) C. IIV3, high dose (intramuscular) D. recombinant influenza vaccine (RIV3, intramuscular)
Correct: B. IIV4 (intramuscular) For a 12-month-old, IIV3 or IIV4 (standard dose) are appropriate choices for vaccination.
Match the appropriate influenza vaccination preparation to each of the following individuals. (Some choices may be used more than once; some questions may have multiple answers.) A 12-year-old boy with asthma A. LAIV4 (intranasal) B. IIV4 (intramuscular) C. IIV3, high dose (intramuscular) D. recombinant influenza vaccine (RIV3, intramuscular)
Correct: B. IIV4 (intramuscular) For children 6 months and older, the IIV3 or IIV4 are preferred for immunization. Though LAIV4 is approved for use in children 2 years and older, the American Academy of Pediatrics gives preference to injectable inactivated vaccines as these might offer better protection compared to LAIV4.
Match the appropriate influenza vaccination 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. LAIV4 (intranasal) B. IIV4 (intramuscular) C. IIV3, high dose (intramuscular) D. recombinant influenza vaccine (RIV3, intramuscular)
Correct: B. IIV4 (intramuscular) or C. IIV3, high dose (intramuscular) For patients aged 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).
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 1-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 4-year-old girl who was born at 32 weeks of gestation D. a 32-year-old woman who is breastfeeding a 2-week-old
Correct: B. a 24-year-old woman who is 20 weeks pregnant The MMR live virus vaccine should be used with caution during pregnancy (B). 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.
All of the following patients received PPSV23 more than 5 years ago. Who is a candidate for receiving a second dose of PPSV23 immunization at this time? A. a 45-year-old man who is a cigarette smoker B. a 66-year-old woman with a 10-year history of COPD who received PCV13 1 year go C. a 35-year-old man with moderate persistent asthma D. a 57-year-old woman with atrial fibrillation
Correct: B. a 66-year-old woman with a 10-year history of COPD who received PCV13 1 year ago For those at increased risk and younger than 65 years, a single dose of PPSV23 should be given followed by a dose of PCV13 once they reach 65 years of age, and then a second dose of PPSV23 at least 1 year later. Among the patients listed, the 66-year-old woman is the only one eligible for the second dose of PPSV23 as she has received the first dose over 5 years ago and received PCV13 1 year prior. Incorrect: Those at increased risk of pneumococcal disease include adults 19 to 64 years of age and tobacco users; those with diabetes mellitus; chronic heart, lung, or liver disease; or alcoholism. These individuals should receive one dose of PPSV23 prior to age 65 years, and then a dose of PCV13 at age 65 years (and at least 1 year from the first PPSV23 vaccination) and a second dose of PPSV23 1 year later (and at least 5 years from the first PPSV23 dose). For those at increased risk and younger than 65 years (A, C, D), a second dose of PPSV23 is not needed until after age 65 years (and 1 year following PCV13 vaccination).
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 safe handling of food
Correct: B. adjusting therapy to minimize dyspnea Tertiary prevention measures are part of the management of an established disease. A tertiary prevention measure for this patient with heart failure can include evaluating and adjusting therapy to minimize dyspnea (B). Incorrect: Immunization (A) and reviewing the safe handling of food (D) are both aimed to prevent disease and illness and are considered primary prevention measures. Screening for cancer, such as surveying skin for precancerous lesions (C), is a secondary prevention measure.
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 prescribed medications B. conducting a home survey to minimize fall risk C. checking FEV1 (force expired volume at 1 second) to FVC (forced vital capacity) ratio D. ordering a fecal occult blood test (FOBT)
Correct: B. conducting a home survey to minimize fall risk Primary prevention is the first level of health care 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 include education and counseling on disease prevention and conducting home surveys to minimize the risk of accidents (B). Incorrect: 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 to screen for colorectal cancer (D). Tertiary prevention measures are part of the management of an established disease. For a patient with COPD, this can include assessing respiratory function (C) and reviewing current medication (A).
An 18-year-old woman with allergic rhinitis presents for primary care. She is sexually active with a male partner and is 1 year post-coitarche; during that time she had two sex partners. An example of a 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 allergy D. obtaining a liquid-based Papanicolaou (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 (B). Incorrect: Screening for STIs (A) and performing a Pap test (D) are both part of secondary prevention measures to potentially detect/identify already established diseases. Prescribing medications to minimize allergy (C) can be part of the patient's management plan for allergic rhinitis and is considered a tertiary prevention measure.
A 22-year-old man is starting a job in a college health center and needs proof of German measles, measles, and mumps immunity. He received childhood immunizations and supplies documentation of MMR vaccination at age 1.5 years. 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
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 one dose, the second dose should be give immediately (B). 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).
Influenza protection options for a 68-year-old man with hypertension, dyslipidemia, and type 2 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 IIV4) given via intramuscular injection (B). An adjuvanted vaccine (aIIV3) is also approved for 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 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).
The most common mode of influenza virus transmission is via: A. contact with a contaminated surface 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 droplet (B), 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).
Concerning the MMR vaccine, which of the following is true? A. the link between use of the MMR vaccine and childhood autism has been firmly established B. there is no credible scientific evidence that the 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 thimerosal, a mercury derivative
Correct: B. there is no credible scientific evidence that the 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 (B). 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 linking autism with MMR vaccine use (A). Based on Wakefield's flawed data, one theoretical approach to limit the risk of autism was to separate the vaccine into its individual components (C). Thimerosal, a mercury derivative, might have an association with autism; however, this preservative is not contained in the MMR vaccine (D).
All of the following are considered high-risk populations for serious 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 obse
Correct: B. those of Asian ethnicity Though everyone 6 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 (B). 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 Indians/Alaskan Natives, and the extremely obese (D), among others.
A 28-year-old adult presents who recently found out he is living with HIV. The NP recommends: A. vaccination with PPSV23 now and revaccination with PPSV23 at age 65 years B. vaccination with PCV13 now and revaccination with PPSV23 in 8 weeks C. vaccination with PCV13 now and revaccination with PPSV23 in 5 years D. no vaccination needed until age 65 years
Correct: B. vaccination with PCV13 now and revaccination with PPSV23 in 8 weeks For those at highest risk of pneumococcal disease, such as those living with HIV, the initial vaccination regimen should include PCV13 first followed by PPSV23 at least 8 weeks later (B). A second dose of PPSV23 should be given 5 years following the first dose, and revaccination with PPSV23 can be performed after age 65 years. Incorrect: For younger adults living with HIV, pneumococcal vaccination is recommended with PCV13 initially and then PPSV23 at least 8 weeks later (A, C, D). Other patient populations in the highest risk group include those with congenital or acquired immunodeficiencies, cerebrospinal fluid (CSF) leaks, cochlear implants, sickle cell disease, congenital or acquired asplenia, chronic renal failure, generalized malignancies, solid organ transplant, and iatrogenic immunosuppression.
Identify whether the item has the characteristics of 23-valent PPSV23, 13-valent PCV13, or both. Routinely used in all well adults aged 65 years or older
Correct: Both PCV13 (which replaced the seven-valent vaccine, PCV7) is routinely used in early childhood for protection against pneumococcal disease. The purified capsular polysaccharide vaccine provides greater immunogenicity when compared to PPSV23. Though PPSV23 provides protection against a greater number of serotypes compared to PCV13, it is not approved for use in children younger than 2 years of age. Both vaccines are currently approved for use in adults 65 years and older, with PCV13 recommended to be given first followed by PPSV23 at last 1 year later for those who had not previously been vaccinated against pneumococcal disease.
Which of the following is recommended for a 65-year-old woman in generally good health who has not received any form of pneumococcal vaccine? A. PCV13 only B. PPSV23 only C. PCV13 now and PPSV23 in 1 year D. PPSV23 now and PCV13 in 8 weeks
Correct: C. PCV13 now and PPSV23 in 1 year For those 65 years and older who have not received any pneumococcal vaccination, the recommended schedule is to first receive one dose of PCV13 followed by PPSV23 at least 1 year later. Incorrect: Both pneumococcal vaccines should be administered in adults over 65 years who had not previously received the pneumococcal vaccine (A, B). PCV13 should be given first, followed by PPSV23 at least 1 year later (D).
Which of the following would not be a candidate for an initial dose of the pneumococcal vaccine? A. a healthy 66-year-old man B. a 34-year-old woman who smokes half a pack of cigarettes per day C. a 32-year-old woman in her first trimester of pregnancy D. a 56-year-old man with type 2 diabetes mellitus
Correct: C. a 32-year-old woman in her first trimester of pregnancy An important aim of primary prevention for health-care providers is to recognize high-risk patient populations who are eligible for immunization. In addition to the elderly, patients with a variety of risk factors are eligible for pneumococcal vaccination. However, pregnancy is not among those factors; thus, pregnancy is not an indication for either pneumococcal vaccine (C). Incorrect: Pneumococcal vaccination is indicated for all adults 65 years and older (A) as well as those with certain risk factors for infection and complications, including tobacco users (B), and those with diabetes mellitus (D); chronic heart, lung, or liver disease; or alcoholism. Immunocompromised patients would also be eligible for vaccination.
Which of the following should not receive vaccination against influenza? A. a 19-year-old with a history of hive-form reaction to eating eggs B. a 24-year-old woman who is 8 weeks pregnant C. a 4-month-old infant who was born at 32 weeks of gestation D. a 28-year-old woman who is breastfeeding a 2-week-old infant
Correct: C. a 4-month-old infant who was born at 32 weeks of gestation Influenza vaccination is generally recommended for all individuals aged 6 months and older. Therefore, the 4-month-old infant would be not be administered the vaccine (C). All persons in close contact with the infant should be strongly recommended to get vaccinated 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.
Which of the following statements is most accurate regarding the use of antiviral agents for postexposure prophylaxis against influenza? A. antivirals are not indicated for postexposure 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 vaccination 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 vaccination Though antivirals can be used for postexposure prophylaxis in individuals exposed to the influenza virus, this method is not preferred over vaccination due to higher costs and greater risk of adverse effects when compared to vaccination (C). Incorrect: Certain antivirals are approved for use in postexposure 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).
A 44-year-old woman with asthma presents asking for a "flu shot." She is seen today for an 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 (C). Incorrect: Influenza vaccination 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 is an example of a primary prevention activity in a 76-year-old woman with osteoporosis? A. bisphosphonate therapy B. calcium supplementation C. ensuring adequate illumination in the home D. use of a back brace
Correct: C. ensuring adequate illumination in the home Primary prevention is the first level of health care and includes activities provided to individuals to prevent the onset or acquisition of a given disease or injury. Adequate illumination is important in reducing risk of falls and injury, improper administration of medicines, and so on, and is considered a primary prevention measure (C). This is particularly important in the elderly population as they are at higher risk of fractures and more likely to be taking multiple medications. Incorrect: Tertiary prevention measures are part of the management of an established disease. Bisphosphonate therapy (A), calcium supplementation (B), and the use of a back brace (D) are all part of the management of this patient's osteoporosis and are thus considered tertiary prevention measures.
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 the immunization are fairly common D. a short, intense, flu-like syndrome typically occurs after immunization
Correct: C. localized reactions such as soreness and redness at the site of the 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 microbial therapy. A short, intense illness following immunization can occur, though this is a very rare reaction to the vaccine (D).
Which of the following is an example of invasive pneumococcal disease? A. pneumonia B. acute otitis media C. meningitis D. sinusitis
Correct: C. meningitis Invasive pneumococcal disease is defined as a pneumococcal infection confirmed by the isolation of S pneumoniae from a normally sterile site. This can include the cerebral spinal fluid (meningitis) (C) or the blood (septicemia). Incorrect: Noninvasive pneumococcal disease occurs in areas that are not normally sterile. These can include the sinuses (sinusitis, D), middle ear (otitis media, B), and inner lining of the airways (pneumonia, A).
When a critical portion of a population is immunized against a contagious disease, most members of the group, even the unimmunized, are protected against that 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 (D), a significant portion of a given population has immunity against an infectious agent; the likelihood that the susceptible portion of the group would become infected is minimized. Incorrect: Passive immunity is provided when a person receives select antibodies produced in another host (A), usually via the administration of IG. Humoral immunity is an aspect of immunity mediated by antibodies in body fluids (or humors) (B). Epidemiological immunity is not a defined term (C).
When advising a patient about injectable influenza immunization, the nurse practitioner (NP) considers the following about the use of this vaccine: A. its use is not recommended in sickle cell anemia B. its use is limited to children older than 2 years C. its use is limited because it contains live virus D. its use is recommended for virtually all members of the population
Correct: D. its 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 6 months of age and older (D). It dose 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 6 months and older (B). There are no special precautions for its use in patients with sickle cell anemia (A), and the vaccine does not contain live virus (C), and so virus is not shed following vaccination.
When advising an adult patient about pneumococcal immunization, the NP considers the following about the vaccine: A. the vaccine contains inactivated bacteria B. its use is contraindicated in individuals with lower airway disease C. it protects against community-acquired pneumonia caused by atypical pathogens D. its use is seldom associated with significant adverse reactions
Correct: D. its use is seldom associated with significant adverse reactions The pneumococcal vaccines are generally safe and well tolerated, even with revaccination (D). 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, while PCV13 contains purified capsular polysaccharide from 23 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 serotypes of S pneumoniae and will not prevent infect caused by atypical pathogens (C).
Match the appropriate influenza vaccination preparation to each of the following individuals. (Some choices may be used more than once; some questions may have multiple answers.) A 42-year-old woman with severe egg allergy A. LAIV4 (intranasal) B. IIV4 (intramuscular) C. IIV3, high dose (intramuscular) D. recombinant influenza vaccine (RIV3, intramuscular)
Correct: D. recombinant influenza vaccine (RIV3, intramuscular) Individuals with mild allergic reaction (e.g., hives) 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.
Which of the following is true about the MMR vaccine? A. it contains inactivated virus B. its 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 1 month apart are recommended for adults who have not been previously immunized
Correct: D. two doses given at least 1 month apart are recommended for adults who have not been previously immunized Adults who do not have evidence of immunity to MMR should get immunized. The full effect of the MMR vaccine occurs after administration of two doses given at least 28 days apart (D). Incorrect: The MMR vaccine contains live but weakened 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).
Indicate (Yes or No) whether it is helpful to administer an extra dose of MMR vaccine during the following outbreaks: Rubella
Correct: No During 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.
Identify whether the item has the characteristics of 23-valent PPSV23, 13-valent PCV13, or both. Routinely used in early childhood
Correct: PCV13 PCV13 (which replaced the seven-valent vaccine, PCV7) is routinely used in early childhood for protection against pneumococcal disease. The purified capsular polysaccharide vaccine provides greater immunogenicity when compared to PPSV23. Though PPSV23 provides protection against a greater number of serotypes compared to PCV13, it is not approved for use in children younger than 2 years of age. Both vaccines are currently approved for use in adults 65 years and older, with PCV13 recommended to be given first followed by PPSV23 at last 1 year later for those who had not previously been vaccinated against pneumococcal disease.
Identify whether the item has the characteristics of 23-valent PPSV23, 13-valent PCV13, or both. Use is associated with greater immunogenicity
Correct: PCV13 PCV13 (which replaced the seven-valent vaccine, PCV7) is routinely used in early childhood for protection against pneumococcal disease. The purified capsular polysaccharide vaccine provides greater immunogenicity when compared to PPSV23. Though PPSV23 provides protection against a greater number of serotypes compared to PCV13, it is not approved for use in children younger than 2 years of age. Both vaccines are currently approved for use in adults 65 years and older, with PCV13 recommended to be given first followed by PPSV23 at last 1 year later for those who had not previously been vaccinated against pneumococcal disease.
Identify whether the item has the characteristics of 23-valent PPSV23, 13-valent PCV13, or both. Not licensed for use in children younger than 2 years of age
Correct: PPSV23 PCV13 (which replaced the seven-valent vaccine, PCV7) is routinely used in early childhood for protection against pneumococcal disease. The purified capsular polysaccharide vaccine provides greater immunogenicity when compared to PPSV23. Though PPSV23 provides protection against a greater number of serotypes compared to PCV13, it is not approved for use in children younger than 2 years of age. Both vaccines are currently approved for use in adults 65 years and older, with PCV13 recommended to be given first followed by PPSV23 at last 1 year later for those who had not previously been vaccinated against pneumococcal disease.
Indicate (Yes or No) whether it is helpful to administer an extra dose of MMR vaccine during the following outbreaks: Measles
Correct: Yes During 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.
Indicate (Yes or No) whether it is helpful to administer an extra dose of MMR vaccine during the following outbreaks: Mumps
Correct: Yes During 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.
