primary care: health promotion

give MMR immunization now.

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: obtain rubella, measles (rubeola), and mumps titers. give MMR immunization now. advise him to obtain IG if he has been exposed to measles or rubella. advise him to avoid individuals with skin rashes.

Immunizations should take place without regard for his health status.

A 30-year-old man with HIV lives with his two pre-school-aged children. Which of the following statements best represents advice you should give him about immunizing his children? Immunizations should take place without regard for his health status. The children should not receive influenza vaccine. MMR vaccine should not be given. Children should not receive poliovirus immunization.

can receive the immunization today.

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: should return for the immunization after completing her antibiotic therapy would likely develop a significant reaction if immunized today. can receive the immunization today. is not a candidate for any form of influenza vaccine

Tdap

A 50-year-old man with hypertension and dyslipidemia presents for a primary care visit. He states, "It has been at least 10 years since my last tetanus shot." He should be immunized with: Td. Tetanus IG. Tdap. None of the above, owing to his concomitant health problems.

2

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? 1 2 3 4

localized reactions such as soreness and redness at the site of the immunization are fairly common.

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

"You really need to try to improve your health."

A sedentary, obese 52-year-old woman is diagnosed with hypertension and states, "It is going to be too hard to diet, exercise, and take these pills." What is the least helpful response to her statement? "Try taking your medication when you brush your teeth." "You really need to try to improve your health." "Tell me what you feel will get in your way of improving your health." "Could you start with reducing the amount of salty foods in your diet?"

pooled blood product that often transmits infectious disease

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

resistance developed in response to an antigen.

Active immunity is defined as: resistance developed in response to an antigen. immunity conferred by an antibody produced in another host. the resistance of a group to an infectious agent. defense against disease acquired naturally by the infant from the mother.

a 28-year-old man who is acutely ill with bacterial meningitis

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

a 66-year-old woman with COPD

All of the following patients received pneumococcalvaccine 5 years ago. Who is a candidate for receiving asecond dose of antipneumococcal immunization at thistime? a 45-year-old man who is a cigarette smoker a 66-year-old woman with COPD a 35-year-old man with moderate persistent asthma a 72-year-old woman with no chronic health problems

tetanus, diphtheria, and acellular pertussis (Tdap) vac-cine now with a dose of Td vaccine in 1 and 6 months

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

counseling about safer sexual practices.

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: screening for sexually transmitted infection. counseling about safer sexual practices. prescribing therapies for minimizing allergy. obtaining a liquid-based Papanicolaou (Pap) test.

conducting a home survey to minimize fall risk.

An example of a primary prevention measure for a 78-year-old man with chronic obstructive pulmonary disease is: the use prescribed medications conducting a home survey to minimize fall risk. checking FEV1 FVC ratio. ordering fecal occult blood test.

three-quarters or more

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

used at every clinical visit that the tobacco user has, regardless of reason for the visit.

Brief intervention that provides motivation to quit tobacco use should be: used at every clinical visit that the tobacco user has, regardless of reason for the visit. offered when the tobacco user voices concern about the health effects of smoking. applied primarily during visits for conditions that are clearly related to or exacerbated by tobacco use, such as respiratory tract disease. when the clinician is conducting a comprehensive health assessment, such as with the annual physical examination.

The vaccine should be offered during treatment for sexually transmitted diseases in unimmunized adults.

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

there is no credible scientific evidence that MMR use increases the risk of autism.

Concerning the MMR vaccine, which of the following is true? the link between use of MMR vaccine and child-hood autism has been firmly established. there is no credible scientific evidence that MMR use increases the risk of autism. the use of the combined vaccine is associated with increased autism risk, but giving the vaccine's three components as separate vaccines minimizes the is risk. the vaccine contains thimerosal, a mercury derivative.

contemplation.

During an offce visit, a 38-year-old woman states, "I drink way too much but do not know what to do to stop." According to the Stages of Change Transtheo-rectical Model, her statement is most consistent with a person at the stage of: precontemplation. contemplation. preparation. action.

precontemplation.

During an office visit, a 48-year-old man who smokes two packs of cigarettes per day states, "My kids are begging me to quit. My dad smoked and died when he was 80. I am not sure what all the fuss is about." According to the Stages of Change Transtheoretical Model, his statement is most consistent with a person at the stage of: precontemplation. contemplation. preparation. action

a healthcare worker who reports having had varicella as a child

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

droplet transmission

How is the varicella virus most commonly transmitted? droplet transmission contact with inanimate reservoirs contact transmission water-borne transmission

1982

In the United States, universal childhood HBV began in what year? 1962 1972 1982 1992

Approximately 75%

In the United States, what proportion of all reported hepatitis A cases have no specific risk factor identified? Approximately 25% Approximately 50% Approximately 75% Nearly 100%

pregnant women

In which of the following groups is routine HBsAgscreening recommended? hospital laboratory workers recipients of hepatitis B vaccine series pregnant women college students

He should receive a single dose of HBV vaccine now.

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? He should receive a single dose of HBV vaccine now. A three-dose HBV vaccine series should be started during today's visit. He has completed the recommended HBV vaccine series. He should be tested for HBsAb and further immunization recommendations should be made according to the test results.

Can we work on a plan to help you to get back to being smoking-free?

Linda is a 52-year-old woman who presents for a follow-up visit for hypertension, type 2 diabetes mellitus, and dyslipidemia. She has a 50-pack year cigarette smoking history, quit smoking 6 months ago, and now reports smoking about 10 cigarettes per day for the past 2 weeks while being particularly stressed during her 78-year-old mother's recent serious illness. Linda states, "I give up. I guess I cannot quit." Which of the following is the most appropriate response to Linda's statement? Do you think your mother's illness was a trigger for your smoking? Can we work on a plan to help you to get back to being smoking-free? Once your mom is well again, you should try quitting again. You sound really discouraged about this.

Maria should be advised to receive two doses of VZV vaccine after giving birth.

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? She should receive VZV vaccine once she is in her second trimester of pregnancy. Maria should be advised to receive two doses of VZV vaccine after giving birth. Once Maria is no longer breast feeding, she should receive one dose of VZV vaccine. A dose of VZIG should be administered now.

ingestion of contaminated food or water.

Of the following, the most common route of hepatitis Avirus (HAV) transmission is: needle sharing. raw shellfish ingestion. ingestion of contaminated food or water. exposure to blood and body fluids.

a 34-year-old woman who underwent splenectomyafter a motor vehicle accident

Of the following, who is at greatest risk for invasivepneumococcal infection? a 68-year-old man with chronic obstructive pul-monary disease a 34-year-old woman who underwent splenectomyafter a motor vehicle accident a 50-year-old man with a 15-year history of type 2diabetes a 75-year-old woman with decreased mobility as aresult of severe osteoporosis

before onset of jaundice

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

systemic hypertension.

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

screening for mood disorders.

Secondary prevention measures for a 78-year-old manwith chronic obstructive pulmonary disease include: screening for mood disorders. administering influenza vaccine. obtaining a serum theophylline level. advising about appropriate use of car passenger restraints

lesions all at the same stage during the eruptive phase of the illness

Smallpox disease includes which of the following characteristics? usually mild disease lesions that erupt over several days loss of contagiousness when vesicles form lesions all at the same stage during the eruptive phase of the illness

live vaccinia virus.

Smallpox vaccine contains: live vaccinia virus. a virus fragment. dead smallpox virus. an antigenic protein

adjusting therapy to minimize dyspnea.

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

Ask, Advise, Assess, Assist, Arrange.

The components of brief intervention for treating tobacco use include: Ask, Advise, Assess, Assist, Arrange. Advise, Intervene, Counsel, Follow up, Prescribe. Document, Counsel, Caution, Describe, Demonstrate. Advise, Describe, Confer, Prescribe, Document.

respiratory droplet.

The most common mode of influenza virus transmission is via: contact with a contaminated surface. respiratory droplet. saliva contact. skin-to-skin contact.

reliably increases long-term smoking abstinence rates.

The use of FDA-approved pharmacologic intervention in tobacco use: makes little difference in smoking cessation rates. reliably increases long-term smoking abstinence rates. is helpful but generally poorly tolerated. poses a greater risk to health than continued tobacco use.

supportive care.

Usual treatment for an adult with acute hepatitis A includes: interferon-alfa therapy. high-dose ribavirin. parenteral acyclovir. supportive care.

community

When a critical portion of a community is immunized against a contagious disease, most members of the com-munity, even the unimmunized, are protected against that disease because there is little opportunity for an outbreak. This is known as _________ immunity. passive humoral epidemiologic community

Its use is recommended for virtually all members of the population.

When advising a patient about injectable influenza immunization, the nurse practitioner (NP) considers the following about the use of this vaccine: Its use is not recommended in sickle cell anemia. Its use is limited to children older than 2 years. Its use is limited due to containing live virus. Its use is recommended for virtually all members of the population.

It contains live, attenuated virus.

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

Its use is seldom associated with significant adverse reactions

When advising an adult patient about pneumococcalimmunization, the NP considers the following aboutthe vaccine: the vaccine contains inactivated bacteria. Its use is contraindicated in individuals with asthma. It protects against community-acquired pneumonia caused by atypical pathogens. Its use is seldom associated with significant adverse reactions

should be offered to adults who frequently travel to developing countries.

When answering questions about HAV vaccine, the NP considers that it contains live virus. should be offered to adults who frequently travel to developing countries. is contraindicated for use in children younger than age 6 years. usually confers lifelong protection after a single injection.

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

When considering an adult's risk for measles, mumps, and rubella (MMR), the NP considers the following: Patients born before 1957 have a high likelihood of immunity against these diseases because of a history of natural infection. Considerable mortality and morbidity occur with all three diseases. Most cases in the United States occur in infants The use of the MMR vaccine is often associated with protracted arthralgia

ask the patient about what he believes contributes to his weight issues.

When working with a middle-aged man with a body mass index of 33 kg/m2on weight reduction, an NP considers that one of the first actions should be to: add an exercise program while minimizing the need for dietary changes ask the patient about what he believes contributes to his weight issues. refer the patient to a nutritionist for diet counseling. ask for a commitment to lose weight.

direct deposit of infective droplets

Which of the following best describes how the variola virus that causes smallpox is transmitted? direct deposit of infective droplets surface contact blood and body fluids vertical transmission

at-home FOBT

Which of the following is a recommended method of annual colorectal cancer screening for a 62-year-oldman? digital rectal examination in-office fecal occult blood test (FOBT) at-home FOBT Sigmoidoscopy

ensuring adequate illumination in the home

Which of the following is an example of a primary prevention activity in a 76-year-old woman with osteoporosis? bisphosphonate therapy calcium supplementation ensuring adequate illumination in the home use of a back brace

A 24-year-old woman who is 20 weeks pregnant

Which of the following is not recommended to receive the MMR vaccination? A 1-year-old boy with a history of hive-form reaction egg ingestion A 24-year-old woman who is 20 weeks pregnant A 4-year-old girl who was born at 32 weeks of gestation A 32-year-old woman who is breastfeeding a 2 week old.

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

Which of the following is true about the MMR vaccine? It contains inactivated virus. Its use is contraindicated in patients with a history of egg allergy. Revaccination of an immune person is associated with risk of significant systemic allergic reaction. two doses at least 1 month apart are recommended for young adults who have not been previously immunized.

primary prevention

Which of the following is usually viewed as the mostcost-effective form of healthcare? primary prevention secondary prevention tertiary prevention cancer-reduction measures

hepatitis B immune globulin (HBIG)

Which of the following products provides passive immunity? hepatitis B immune globulin (HBIG) measles, mumps, and rubella (MMR) vaccine pneumococcal conjugate vaccine live attenuated influenza vaccine (LAIV)

a bowl of hot soup

Which of the following represents the food or beverage that is least likely to be contaminated with the hepatitis A virus? a lettuce salad a bowl of hot soup a plate of peeled mango a glass of ice tea

4-month-old infant who was born at 32 weeks of gestation

Which of the following should not receive vaccination against influenza? a 19 year-old with a history of hive-form reaction to eating eggs a 24-year-old woman who is 8 weeks pregnant a 4-month-old infant who was born at 32 weeks of gestation a 28-year-old woman who is breast feeding a 2 week old.

Significant resistance to select strains of influenza limits the use fullness of these medications.

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

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.

Which of the following statements best describeszanamivir (Relenza) or oseltamivir (Tamifu) use in the care of patients with or at risk for influenza? 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. The primary indication is in preventing influenza A during outbreaks. The drugs are active only against influenza B. The use of these medications is an acceptable alter-native to influenza vaccine. .

Although highly protective against invasive varicella disease, mild cases of chickenpox have been reported in immunized individuals.

Which of the following statements is correct about the varicella vaccine? It contains killed varicella-zoster virus. The use of the vaccine is associated with an increase in reported cases of shingles Varicella vaccine should be offered to adults who were U.S. born prior to 1980 and report a childhood history of chickenpox. Although highly protective against invasive varicella disease, mild cases of chickenpox have been reported in immunized individuals.

It is transmitted via the fecal−oral route.

Which of the following statements is true about poliovirus infection? It is transmitted via the fecal−oral route. Rates of infection among household contacts are about 30% Sporadic outbreaks continue to occur in North America. It is transmitted via aerosol and droplets.

A 21-year-old who has had one male sexual partner and consistent condom use

Which of the following women should have screening for cervical cancer? An 18-year-old who has a history of genital warts A 17-year-old with coitarche 3 years ago and four male sexual partners An 80-year-old with heart failure and a remote his-tory of normal Pap test results A 21-year-old who has had one male sexual partner and consistent condom use

a puncture wound obtained while gardening

Which wound presents the greatest risk for tetanus infection? a puncture wound obtained while gardening a laceration obtained while trimming beef a human bite an abrasion obtained by falling on a sidewalk

receive a single dose of HBV vaccine.

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: needs to repeat his hepatitis B immunization series. receive a single dose of HBV vaccine. be tested for hepatitis B surface antibody (HBsAb). should receive hepatitis B immune globulin (HBIG)and a single dose of the hepatitis B immunization series.

"Have you noticed any changes in your mood?"

You see a 48-year-old patient who started taking varenicline (Chantix) 4 weeks ago to aid in smoking cessation. Which of the following is the most important question to ask during today's visit? "How many cigarettes a day are you currently smoking?" "On a scale of 0 to 10, how strong is your desire to smoke?" "Have you noticed any changes in your mood?" "Are you having any trouble sleeping?"

receive hepatitis B immune globulin (HBIG) and hepatitis B immunization series.

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: start a hepatitis B immunization series. limit the number of sexual partners she has be tested for hepatitis B surface antibody(HBsAb). receive hepatitis B immune globulin (HBIG) and hepatitis B immunization series.