Chapter 1: Health Promotion and Disease Prevention

Indicate (yes/no) whether each of the following women should undergo a mammogram to screen for breast cancer. ____ 73. a 37-year-old with a second-degree relative diagnosed with breast cancer at age 62 years ____ 74. a 53-year-old with no known risk factors for breast cancer ____ 75. a 76-year-old with New York Heart Association (NYHA) Class III congestive heart failure

73. NO 74. YES 75. NO

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

A

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

A

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

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: A. precontemplation. B. contemplation. C. preparation. D. action.

A

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

A

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 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

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

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

Smallpox vaccine contains: A. live vaccinia virus. B. a virus fragment. C. dead smallpox virus. D. an antigenic protein.

A

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

A

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

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

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 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

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

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

A

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

A

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

A = PCV13 B = PCV13 C = Both D = PPSV23

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 immune globulin (IG) if he has been exposed to measles or rubella. D. advise him to avoid individuals with skin rashes.

B

A 28-year-old male presents who was recently diagnosed with HIV infection. 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.

B

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? A. "Try taking your medication 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 amount of salty foods in your diet?"

B

All of the following patients received pneumococcal polysaccharide vaccine (PPSV23) 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 chronic obstructive pulmonary disease (COPD) C. a 35-year-old man with moderate persistent asthma D. a 57-year-old woman with atrial fibrillation

B

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. B. counseling about safer sexual practices. C. prescribing therapies for minimizing allergy. D. obtaining a liquid-based Papanicolaou (Pap) test.

B

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

Assuming all of the following individuals are not immune to measles, mumps, and rubella, 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

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

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 the Stages of Change Transtheoretical Model, her statement is most consistent with a person at the stage of: A. precontemplation. B. contemplation. C. preparation. D. action.

B

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

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

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

B

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? A. "Do you think your mother's illness was a trigger for your smoking?" B. "Can we work on a plan to help you to get back to being smoking free?" C. "Once your mom is well again, you should try quitting again." D. "You sound really discouraged about this."

B

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

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

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.

B

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

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

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

B

When working on weight reduction with a middle-aged man with a body mass index of 33 kg/m2, an NP considers that one of the first actions should be to: A. add an exercise program while minimizing the need for dietary changes. B. ask the patient about what he believes contributes to his weight issues. C. refer the patient to a nutritionist for diet counseling. D. ask the patient for a commitment to lose weight.

B

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

B

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

22 to 25. Match the most appropriate influenza vaccination preparation for each of the following individuals. ____ 22. A healthy 67-year-old man ____ 23. A 12-year-old boy with asthma ____ 24. A 42-year-old woman with severe egg allergy ____ 25. A healthy 12-month-old infant A. LAIV4 (intranasal) B. IIV4 (intradermal) C. IIV3, high-dose (intramuscular) D. Recombinant influenza vaccine (RIV3, intramuscular)

B C B D B

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 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: A. Td. B. Tetanus IG. C. Tdap. D. none of the above, owing to his concomitant health problems.

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, flu-like syndrome typically occurs after immunization.

C

According to the U.S. Preventive Services Task Force, 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. a 42-year-old at average risk of breast cancer B. a 36-year-old who breastfed three children C. a 46-year-old with two first-degree relatives with breast and ovarian cancers D. a 38-year-old with a first-degree relative diagnosed with colorectal cancer

C

An 18-year-old man without health problems 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

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

In the United States, universal childhood HBV began in what year? A. 1962 B. 1972 C. 1982 D. 1992

C

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

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. TIV in standard dose via intramuscular injection. D. appropriate antiviral medication at the initial onset of influenza-like illness.

C

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

C

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

Which of the following is a recommended method of annual colorectal cancer screening for a 62-year-old man? A. digital rectal examination B. in-office fecal occult blood test (FOBT) C. at-home FOBT D. sigmoidoscopy

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 is recommended for a 65-year-old woman in generally good health who has not received a pneumococcal vaccine? A. PCV13 only B. PPSV23 only C. PCV13 now and PPSV23 in 1 year D. PPSV23 now and PCV13 in 8 weeks

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 infant

C

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

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

A woman who has been advised to receive varicella-zoster 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

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

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

D

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

D

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

D

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

D

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. epidemiologic D. community

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 because it contains 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 given at least 1 month apart are recommended for adults who have not been previously immunized.

D

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

D

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

D

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