HEALTH PROMOTION

In an immunocompetent adult, the length of incubation for the influenza virus is on average:

1 to 4 days

Precautions for use of live attenuated vaccines in special populations

1. pregnancy 2. immune suppression, except HIV 3. HIV CD4 <200 4. infants with SCID

In the US, universal childhood HBV began in what year?

1982

A health 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?

2

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

24 year old woman who is 20 weeks pregnant

Which patient should not receive vaccination against HBV?

28 year old male acutely ill with bacterial meningitis

Approximately ____ of healthcare workers receive the flu shot annually.

3/4 or more

Of the following, who is at greatest risk for invasive pneumococcal infection?

34 year old woman who underwent splenectomy after MVC

Which of the following should not receive vaccination against influenza?

4 month old infant who was born at 32 weeks gestation

All of the following patients received PPSV23 5 years ago. Who is a candidate for receiving a second dose of PPSV23 immunization at this time?

66 year old woman with COPD

For which of the following patients should an NP order varicella antibody titers?

72 year old with shingles

IIV4

9 mcg/dose; adults 18 to 64

Average risk for pneumonia

<65 years of age without any chronic medical conditions; no pneumococcal vaccine needed

Highest risk pneumonia

>65 years old, or with immunocompromised conditions; Age >65: PCV13 followed by PPSV23 1 year later Younger adults with high risk conditions: PCV13, followed by PPSV23 > 8 weeks later

Peak infectivity of persons with hepatitis A usually occurs: A. before 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.

A. Before the onset of jaundice

Which of the following statements is correct about the varicella virus?

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

In the United States, what proportion of all reported Hep A cases have no specific risk factor identified?

Approximately 50%

The components of brief intervention for treating tobacco use:

Ask Advise Assess Assist Arrange

a sedentary, obese 52 y/o woman is dx with HTN 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? a. try taking your medications when you brush your teeth b. you really need to try to improve your health c. tell me what you feel will get in your way of improving your health d. could you start with reducing the amt of salty foods in your diet?

B. "you really need to improve your health"

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

B. reliably increases long term smoking abstinence rates

According to USPSTF, which of the following women would most likely be eligible for genetic testing to detect BRCA mutation in order to assess risk for breast and ovarian cancer? A. 42 year old at average risk of breast CA B. 36 year old who breastfed three children C. 46 year old with two first degree relatives with breast and ovarian D. 38 year old with first degree relative diagnosed with colorectal cancer

C. 46 year old female with two degree relatives with breast and ovarian cancer

Which of the following types of cancer screening is not routinely recommended in a 55 year old woman? A. Breast B. Skin C. Endometrial D. Colorectal

C. Endometrial

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? A. "How many cigarettes a day are you currently smoking?" B. "On a scale of 0 to 10, how strong is your desire to smoke?" C. "Have you noticed any changes in your mood?" D. "Are you having any trouble sleeping?"`

C. Have you noticed any changes in your mood?

Which of the following is a recommended method of annual colorectal cancer screening for a 62 year old male? A. DRE B. in office FOBT C. at home FOBT D. sigmoidoscopy

C. at home FOBT

Linda is 52 year old woman who presents for a follow up visit for HTN, DMII, and HLD. 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 mothers 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?

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

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 primary prevention for this patient is:

Counseling for safe sex practices

Which of the following women should have screening for cervical cancer? A. An 18 year old who has genital warts B. 17 year old with coitarche 3 years ago and four male sexual partners C. 80 year old with HF and remote history of abnormal Pao D. 21 year old who has had one sexual partner and consistent condom use

D 21 year old who has had one sexual partner and consistent condom use

Which of the following is an example of primary prevention activity in a 76 year old woman with osteoporosis?

Ensure adequate illumination of the home

Jason is a healthy 18 year old who presents for primary care. According to his immunization record, he received two doses of HBV vaccine 1 month apart at age 14 years. Which of the following best describes his vaccine needs?

He should receive a single dose of HBV vaccine now

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

HBV post exposure prophylaxis

In a person with complete HBV vaccine series and who did not receive post vaccine testing, a single vaccine booster dose should be given. In a person who is the in the process of being vaccinate but who has not yet completed the vaccine series should receive HBIG and complete the vaccine series.

Which of the following statements best describes Zanamivir or Oseltavimir in the care of patients with or at risk for influenza?

Initiation of therapy early in acute influenza illness can help minimize severity of disease when the illness is caused by a non resistant strain

When advising a patient about the influenza nasal spray vaccine the NP considers the following:

It contains live attenuated virus

Which of the following statements is true about poliovirus infection?

It is transmitted via the fecal oral route

When advising an adult patient about pneumococcal immunization, the NP considers the following about the vaccine:

Its use is seldom associated with significant adverse reactions

A middle aged man with COPD who is about to receive injectable influenza vaccine should be advised that:

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

Live attenuated vaccines

MMR Varicella LAIV4 (IN flu) Zoster (Zostavax) Rotavirus 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?

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

Which of the following is recommended for a 65 year old woman in generally good health who has not received a pneumococcal vaccine?

PCV13 now and PPSV23 in 1 year

When considering an adult's risk for measles, mumps, and rubella, the NP considers the following:

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

PPSV23

Pneumovax, contains polysaccharides from 23 strains; lower immunogenicity than Prevnar; Not licensed for use in children younger than 2

A woman who has been advised to receive varicella-zoster immune globulin (VZIG) asks about its risks. You respond that IG is a:

Pooled blood product with an excellent safety profile

PCV13

Prevnar; contains polysaccharides from 13 strains Routinely used in early childhood Also for use in adults > 65 Associated with higher immunogenicity

Which wound presents the greatest risk for tetanus infection?

Puncture wound obtained while gardening

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:

Receive a single dose of HBV vaccine

You see a woman who has been sexually active with a man newly diagnosed with Hep B. She has not received HBV vaccine in the past. You advise her that she should:

Received Hep B IG and hep B immunization series

Small pox vaccination

Routine vaccination was discontinued in 1972 after global eradication US still has doses in case of outbreak; vaccination after exposure will significantly reduce symptoms and disease progression

Secondary prevention measures for a 78 year old man with COPD include:

Screening for mood disorders

Which of the following statements best describes amantadine or rimantadine use in the care of patients with or at risk for influenza?

Significant resistance to select strains of influenza limits the usefulness of these medications

Influenza protection options for a 62 year old man with HTN, HLD, and DMII include receiving:

TIV in standard dose via intramuscular injection

A 50 year old man with HTN and HLD 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:

Tdap

An 18 year old man without health problems has no primary tetanus immunization series documented. Which of the following represents the immunization needed?

Tdap vaccine now with a dose of Td vaccine in 1 and 6 months

Tdap

Tetanus Diptheria Pertusiss requires one booster in adulthood; additional boosters can be Td

Concerning HBV vaccine, which of the following is true:

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

Concerning the MMR vaccine, which of the following is true?

There is no credibly scientific evidence that MMR use increases the risk of autism

A 28 year old male presents with recently diagnosed with HIV infection. The NP recommends:

Vaccination with PCV13 now and revaccination with PPSV23 in 8 weeks

Tertiary prevention measures for a 69 year old woman with heart failure include:

adjusting therapy to minimize dyspnea

When working on weight reduction with a middle aged man with a BMI 33, an NP considers that one of the first actions should be to:

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

Hep B vaccine should not be given to a person with history of anaphylaxis to:

baker's yeast

Which of the following represents the food or beverage that is least likely to be contaminated with the Hep A virus?

bowl of hot soup

A 44 year old woman with asthma presents asking for the flu shot. She is seen today for an urgent care visit diagnosed with lower UTI and prescribed Bactrim. She is without fever or GI upset with stable respiratory status. You inform her that she:

can receive the immunization today

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:

community immunity

An example of a primary prevention measure for a 78 year old man with COPD is:

conducting a home survey to minimize fall risk

inactivated IIV3

contains a greater dose of antigen when compared to standard flu vaccine (60 mcg); use in adults age 65 and up

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

contemplation

How is the variola virus that causes smallpox transmitted?

direct deposit of infective droplets

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:

given MMR immunization now

Which of the following products provides passive immunity?

hep B immune globulin (HBIG)

Risks associated with chronic Hep B include all of the following:

hepatocellular carcinoma cirrhosis systemic hypertension

Most common route of HAV transmission:

ingestion of contaminated food or water

LAIV 4

intranasal, live attenuated flu vaccine; NOT for pregnant women; can otherwise be used ages 2 through 49

When advising a patient about injectable influenza immunization, the NP considers the following about the use of this vaccine:

it is recommended for virtually all members of the population

smallpox disease includes which of the following characteristics?

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

Varicella vaccine

live attenuated virus

Small pox vaccine contains:

live vaccinia virus

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 he 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

In which of the following groups is routine HBsAg screening recommended?

pregnant women

Which of the following is usually viewed as the most cost effective form of health care?

primary prevention

RIV3

recombinant hemagglutinin vaccine, indicated for age 18 to 49 EGG FREE

Active immunity is defined as:

resistance developed in response to an antigen

The most common mode of influenza virus transmission is via:

respiratory droplet

When answering questions about the HAV vaccine, the NP considers that it:

should be offered to adults who frequently travel to developing countries

IIV3

standard flu shot, age 6 months and up; 15 mcg/dose

Usual treatment for an adult with acute Hep A includes:

supportive care

TIG

tetanus immune globulin administer with deep and dirty wounds in individuals with unclear immunization history

Increased risk for pneumonia

those >19 and <65 years old, cigarette smokers, or with chronic medical conditions, but without immune compromise should receive PPSV23 and with revaccination PPSV3 5 years later

HAV vaccine

two dose schedule single antigen: 0 months and 6-18 months combined (A/B): three doses, 0, 1, 6 months

Which of the following is true about the MMR vaccine?

two doses given at least one month part are recommended for adults who have never been previously immunized

A brief intervention that provides motivation to quit tobacco use should be:

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