CMN 571 -- NP Questions from NPC Exam and Practice

Secondary prevention measures for a 78-year-old man with chronic obstructive pulmonary disease 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.

A

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

A

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. live attenuated influenza vaccine (LAIV)

A

Which of the following statements best describes zanamivir (Relenza) or oseltamivir (Tamiflu) use 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 influenza vaccine.

A

Identify whether the item has the characteristics of 23-valent pneumococcal polysaccharide vaccine (PPSV23) or 13-valent pneumococcal conjugate vaccine (PCV13). A. Routinely used in early childhood ________ B. Use is associated with greater immunogenicity ________ C. Routinely used in all well adults age 65 years or older________ D. Not licensed for use in children younger than 2 years of age________

A - PCV13 *B - PCV13* - Use of PCV13 is associated with greater immunogenicity when compared with PPSV23, but it does not provide protection against as many pneumococcal serotypes, and is routinely used in childhood. *C - PPSV23* D - PPSV23

How is the varicella virus most commonly transmitted? A. droplet transmission B. contact with inanimate reservoirs C. contact transmission D. water-borne transmission

A - The virus is transmitted via respiratory droplet and contact with open lesions.

When considering an adult's risk for measles, mumps, and rubella (MMR), 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. Most cases in the United States occur in infants. D. The use of the MMR vaccine is often associated with protracted arthralgia.

A - Two immunizations 1 month apart are recommended for adults born after 1957 because adults born before then are considered immune as a result of having had these diseases (native or wild infection); vaccine against these three formerly common illnesses was unavailable until the 1960s.

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.

A -- Active immunization through the use of vaccines provides long-term protection from disease.

Jason is a healthy 18-year-old who presents for primary care. According to his immunization record, he received two dose of HBV vaccine 1 month apart at age 14 years. Which of the following best describes his HBV vaccination needs? A. He should receive a single dose of HBV vaccine now. B. A three-dose HBV vaccine series should be started during today's visit. C. He has completed the recommended HBV vaccine series. D. He should be tested for HBsAb and further immunization recommendations should be made according to the test results.

A -- If only the *third dose* is delayed, it should be administered as soon as possible; the entire three doses series does not need to be repeated.

Which of the following statements best describes amantadine or rimantadine use in the care of patients with or at risk for influenza? A. Significant resistance to select strains of influenza limits the usefulness of these medications. B. The primary action of these therapies is in preventing influenza A during outbreaks. C. These therapies are active against influenza A and B. D. The use of these products is an acceptable alternative to influenza vaccine.

A -- The adamantane derivatives (*amantadine and rimantadine) are approved only for treatment and prevention of influenza A*, whereas the neuraminidase inhibitor drugs (zanamivir and oseltamivir) are approved for use in influenza A and influenza B. Ongoing CDC viral surveillance has shown *high levels of resistance of influenza A viruses to amantadine and similar medications*. Because of this significant level of resistance, amantadine and rimantadine are no longer recommended by the CDC for the treatment of influenza.

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 this time she had had two sex partners. An example of a primary prevention activity for this patient is: A. screening for sexually transmitted infection. B. counseling about safer sexual practices. C. prescribing therapies for minimizing allergy. D. obtaining a liquid-based Papanicolaou (Pap) test.

B

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.

B - As with all vaccines, giving additional doses to patients with an unclear immunization history is safe.

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 in the past. How many doses of influenza vaccine should she receive this flu season? A. 1 B. 2 C. 3 D. 4

B - Children *younger than 9 years* who are receiving *initial influenza immunization* need *two doses* of *vaccine separated by 4 or more weeks*.

For which of the following patients should an NP order varicella antibody titers? A. a 14 year old with an uncertain immunization history B. a healthcare worker who reports having had varicella as a child C. a 22-year-old woman who received two varicella immunizations 6 weeks apart D. a 72 year old with shingles

B - Healthcare workers need titer drawn because of their increased exposure to disease.

You see Harold, a 25-year-old man who recently had multiple sexual encounters without condom use with a male partner who has chronic hepatitis B. Harold provides documentation of receiving a properly timed hepatitis B immunization series. In addition to counseling about safer sexual practices, you also advise that Harold: A. needs to repeat his hepatitis B immunization series. B. receive a single dose of HBV vaccine. C. be tested for hepatitis B surface antibody (HBsAb). D. should receive hepatitis B immune globulin (HBIG) and a single dose of the hepatitis B immunization series.

B - In a person who has *written documentation* of a complete HBV vaccine series and who did not receive postvaccination testing, *a single vaccine booster dose* should be given with a nonoccupational known HBsAg-positive exposure source.

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.

B - In an immunocompetent adult, the influenza virus has *a short incubation period, with a range of 1 to 4 days (average of 2 days)*. Adults pass the illness on 1 day before the onset of symptoms and continue to remain infectious for approximately 5 days after the onset of the illness. Children remain infectious for 10 or more days after the onset of symptoms and can shed the virus before the onset of symptoms. People who are immunocompromised can remain infectious for up to 3 weeks.

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.

B - Influenza viruses spread from person to person largely via respiratory droplet from an infected person, primarily through a cough or sneeze.

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 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.

B - The MMR vaccine is safe to use during lactation, but its use during pregnancy is discouraged because of the theoretical but unproven risk of congenital rubella syndrome from the live virus contained in the vaccine.

Maria is a 28-year-old healthy woman who is 6 weeks pregnant. Her routine prenatal laboratory testing reveals she is not immune to varicella. She voices her intent to breastfeed her infant for at least 6 months. Which of the following represents the best advice for Maria? A. She should receive VZV vaccine once she is in her second trimester of pregnancy. B. Maria should be advised to receive two doses of VZV vaccine after giving birth. C. Once Maria is no longer breastfeeding, she should receive one dose of VZV vaccine. D. A dose of VZIG should be administered now.

B - Women who do not have evidence of immunity should receive the first dose of varicella vaccine on completion or termination of pregnancy and before discharge from the healthcare facility. The second dose should be administered 4 to 8 weeks after the first dose.

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 use 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.

B - the evidence reviewed did not support an association between autism and the MMR vaccine. Although the preservative thimerosal, a mercury derivative, has been mentioned as a possible autism contributor, the MMR vaccine licensed for use in the United States does not contain this preservative.

Of the following, who is at greatest risk for invasive pneumococcal infection? A. a 68-year-old man with chronic obstructive pulmonary disease B. a 34-year-old woman who underwent splenectomy after a motor vehicle accident C. a 50-year-old man with a 15-year history of type 2 diabetes D. a 75-year-old woman with decreased mobility as a result of severe osteoporosis

B -- Indications for adults to receive pneumococcal vaccine include a variety of chronic health problems such as chronic lung disease (including asthma), chronic cardiovascular diseases, diabetes mellitus, chronic liver disease including cirrhosis, chronic alcohol abuse, cigarette smokers age 19 years or older, malignancy, chronic renal failure or nephrotic syndrome, *functional or anatomic asplenia (e.g., sickle cell disease or splenectomy [if elective splenectomy is planned, vaccinate at least 2 weeks before surgery])*, immunocompromising conditions or recipient of immunosuppressing medications, select organ transplant, cochlear implants, and cerebrospinal fluid leak.

An example of a primary prevention measure for a 78-year-old man with chronic obstructive pulmonary disease 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 fecal occult blood test (FOBT).

B -- Primary prevention measures include activities provided to individuals to prevent the onset or acquisition of a given disease. The goal of primary prevention measures is to spare individuals the suffering, burden, and cost associated with the clinical condition and is the first level of healthcare. An example is health-protecting education and counseling, such as encouraging the use of car restraints and bicycle helmets, counseling about safer sexual practices, and *providing information on accident and fall prevention*. Given its focus on preventing illness or injury, primary prevention is usually viewed as the most effective form of healthcare.

Hepatitis B vaccine should not be given to a person with a history of anaphylactic reaction to: A. egg. B. baker's yeast. C. neomycin. D. streptomycin.

B -- Recombinant hepatitis B vaccine, which does not contain live virus, is well tolerated but is contraindicated in those who have a history of *anaphylactic reaction to baker's yeast*

All of the following patients received pneumococcal vaccine 5 years ago. Who is a candidate for receiving a second dose of antipneumococcal immunization at this time? A. a 45-year-old man who is a cigarette smoker B. a 66-year-old woman with COPD C. a 35-year-old man with moderate persistent asthma D. a 72-year-old woman with no chronic health problems

B -- Revaccination after 5 years after the first PPSV23 dose is recommended for individuals older than age 2 years but younger than age 65 years who are at highest risk of pneumococcal infection or are at greatest risk of having a rapid decline in antibody levels, including sickle cell disease, splenectomy, chronic renal failure, nephrotic syndrome, immunocompromise, generalized malignancy, or on immunosuppressing medications.

Tertiary prevention measures for a 69-year-old woman with heart failure include: A. administering antipneumococcal vaccine. B. adjusting therapy to minimize dyspnea. C. surveying skin for precancerous lesions. D. reviewing safe handling of food.

B Tertiary prevention measures are part of the management of an established disease. The goal is to minimize disease associated complications and the negative health effects of the conditions to the patient. Examples include *medications and lifestyle modification* to normalize blood glucose levels in individuals with diabetes mellitus and *in conjunction with the treatment of heart failure, aimed at improving or minimizing disease-related symptoms*.

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.

C

A middle-aged man with chronic obstructive pulmonary disease who is about to receive injectable influenza vaccine should be advised that: A. it is more than 90% effective in preventing influenza. B. its use is contraindicated in the presence of psoriasis vulgaris. C. localized reactions such as soreness and redness at the site of the immunization are fairly common. D. a short, intense, flulike syndrome typically occurs after immunization.

C

Concerning hepatitis B virus (HBV) vaccine, which of the following is true? A. The vaccine contains live, whole HBV. B. Adults should routinely have anti-hepatitis B surface antibody titers measured after three doses of vaccine. C. The vaccine should be offered during treatment for sexually transmitted diseases in unimmunized adults. D. Serologic testing for hepatitis B surface antigen (HBsAg) should be done before hepatitis B vaccination is initiated in adults.

C

Influenza protection options for a 62-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 (TIV) via intramuscular injection C. trivalent inactivated vaccine (TIV) in standard dose via intramuscular injection. D. appropriate antiviral medication as the initial onset of influenza-like illness.

C

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

C

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.

C

An 18-year-old man has no primary tetanus immunization series documented. Which of the following represents the immunization needed? A. three doses of diphtheria, tetanus, and acellular pertussis (DTaP) vaccine 2 months apart B. tetanus IG now and two doses of tetanus-diphtheria (Td) vaccine 1 month apart C. tetanus, diphtheria, and acellular pertussis (Tdap) vaccine now with a dose of Td vaccine in 1 and 6 months D. Td vaccine as a single dose

C - For adults receiving initial immunization, a series of *three vaccine doses* is needed. Two of the three can be Td, and one should be Tdap.

When advising a patient about the influenza nasal spray vaccine, the NP considers the following: A. Its use is acceptable during pregnancy. B. Its use is limited to children younger than 6 years. C. It contains live, attenuated virus. D. This is the preferred method of influenza protection in the presence of airway disease.

C -- LAIV is approved for use in healthy people ages 2 to 49 years old. Individuals who should not receive LAIV include children younger than 2 years; adults older than 49 years; patients with a health condition that places them at high risk for complications from influenza, including chronic heart disease, chronic lung disease such as asthma or reactive airways disease, diabetes or kidney failure, and immunosuppression; children or adolescents receiving long-term high-dose aspirin therapy; people with a history of Guillain-Barré syndrome; pregnant women; and people with a history of allergy to any of the components of LAIV.

In which of the following groups is routine HBsAg screening recommended? A. hospital laboratory workers B. recipients of hepatitis B vaccine series C. pregnant women D. college students

C -- Without intervention, approximately 40% of infants born to mothers with HBV will develop chronic hepatitis B and approximately one-fourth of the infected infants will go on to die from chronic liver disease. As a result, *all pregnant women should be screened for HBsAg at the first prenatal visit, regardless of HBV vaccine history*.

Approximately ____ of healthcare providers receive influenza immunization annually. A. one-quarter B. one-half C. two-thirds D. three-quarters or more

D

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 due to containing live virus. D. Its use is recommended for virtually all members of the population.

D

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 asthma. C. It protects against community-acquired pneumonia caused by atypical pathogens. D. Its use is seldom associated with significant adverse reactions.

D

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 at least 1 month apart are recommended for young adults who have not been previously immunized.

D

All of the following individuals have not received vaccination against HBV. The vaccine should not be given in which of the following patients? A. a 35-year-old man with multiple sclerosis B. a 25-year-old woman with a past history of Guillain-Barré syndrome C. a 48-year-old woman with systemic lupus erythematosus D. a 28-year-old man who is acutely ill with bacterial meningitis

D - As with all vaccines, immunization against HBV should be delayed in the face of *serious or life-threatening illness*

Risks associated with chronic hepatitis B include all of the following except: A. hepatocellular carcinoma. B. cirrhosis. C. continued infectivity. D. systemic hypertension.

D - Chronic hepatitis B is a potent risk factor for the development of *hematoma or primary hepatocellular carcinoma* and hepatic *cirrhosis*. Although usually appearing clinically well, a person with chronic hepatitis B continues to be able to *transmit the virus*.

A woman who has been advised to receive varicellazoster immune globulin (VZIG) asks about its risks. You respond that IG is a: A. synthetic product that is well tolerated. B. pooled blood product that often transmits infectious disease. C. blood product obtained from a single donor. D. pooled blood product with an excellent safety profile.

D - For individuals without evidence of immunity who have contraindications for vaccination but are at risk for severe disease and complications, use of VZIG is recommended for post-exposure prophylaxis. VZIG, as with all forms of IG, provides temporary, passive immunity to infection. IG is *a pooled blood product with an excellent safety profile.*

You see a woman who has been sexually active with a man newly diagnosed with acute hepatitis B. She has not received hepatitis B vaccine in the past. You advise her that she should: A. start a hepatitis B immunization series. B. limit the number of sexual partners she has. C. be tested for hepatitis B surface antibody (HBsAb). D. receive hepatitis B immune globulin (HBIG) and hepatitis B immunization series.

D -- *Unvaccinated persons should receive HBIG and hepatitis B vaccine as soon as possible after exposure*, preferably within 24 hours of the at-risk exposure.

When a critical portion of a community is immunized against a contagious disease, most members of the community, 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. epidemiologic D. community

D -- In *herd or community immunity*, 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