NR602 Midterm Exam with 153 verified
approved Answers.
NR602 Midterm Exam with 153 verified
approved Answers.
Pediatric NP - ANSWER- health promotion, protection, and disease prevention
Primary care NP - ANSWER- well childcare and prevention and/or management of both
common pediatric acute illness and any childhood diseases.
Acute care NP - ANSWER- acute, chronic, or critically ill children. Unstable,
experiencing life-threatening illness, medically fragile and tech dependent.
Primary prevention - ANSWER- keep diseases from being established. Eliminate cause
or increase people's resistance. 2 types of primary prevention are health promotion and
specific protection. Health promotion includes efforts, including lifestyle
changes/choices, nutrition, and maintenance of safe environments. Specific protection
involves actions targeted at specific diseases, such as immunizations, anti-malarial
prophylaxis, and environmental modifications (such as fluoride).
secondary prevention - ANSWER- early diagnosis and prompt treatment- interrupt
disease process- screening early detection and prompt treatment. Goal is to eliminate
or reduce symptoms/progression..
Tertiary care - ANSWER- requires both specialized expertise and equipment. Goal
improves survival and quality of life. There are 2 types: 1) disability limitation-early
symptom management 2) rehabilitation- late symptom management.
Quaternary care - ANSWER- highly specialized expertise and highly unusual or
specialized equipment
Barriers to vaccination - ANSWER- patients feel vaccines are unsafe, may cause
autism, overload or weaken a child's immune system, or are traumatic for the child.
Parents may feel there is a lack of concern about the diseases that are being prevented.
Poverty was a factor, as was a lack of education.
How to encourage parents to get vaccines for their kids - ANSWER- • Acknowledge and
respect the trusted relationship between provider and parent.
• Communicatjm0h e a strong shared commitment with the parent to the health and
well-being of their child.
• Listen to and query parents' reasons for refusing or delaying vaccines; not all vaccine-
hesitant individuals have the same concerns.
• Be familiar with misconceptions and controversies regarding vaccines and be
prepared to address them (e.g., thimerosal-free vaccines).
,NR602 Midterm Exam with 153 verified
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• Emphasize the safety of vaccines, the extensive testing before licensure, and the post-
licensure safety surveillance programs. Explain the serious consequences of not
vaccinating.
• Educate the family about the safety of multiple vaccines to be given simultaneously.
Mention that a healthy infant's/child's immune system capably fights off an estimated
2000 to 6000 germs (antigens) daily when playing, eating, and breathing. The number
of antigens in any combination of vaccines on the current schedule is much lower than
the daily exposure to many substances (150 antigens for the entire Advisory Committee
on Immunization
live vaccine - ANSWER- an attenuated form of the virus that induces immunity but does
not produce disease. Broader and longer-lived immunity. Common fever and rash. This
means the immune system has responded appropriately. Do not give before 1 year of
age. When you give live attenuated vaccines, you must give both on the same day or
you have to wait 4 weeks to give the second one or neither will be effective. NOT TO
BE GIVEN WHILE PREGNANT OR 28 days prior to being preg.
● Precautions- pay close attention when giving immunocompromised indv live vaccine.
Recommendations differ according to condition.
● Measles mump rubella-trivalent vaccine.MMR (2 doses, starting age 12mos)- after
receiving 2 vaccines, efficacy is 98%. S/E rash, high fever 5-12 days after the vaccine. If
given varicella in the quad valiant, the chance of seizures is 2-fold. It is reduced by
giving at the same time and in different spots. NOT TO BE GIVEN WHILE PREGNANT
OR 28 days prior to being preg.
Vaccines - ANSWER- Varicella(2 doses)- 98% efficacy after the 2nd dose. Severe
cases have become uncommon.
● Rotavirus(2 doses)- side effect and contraindication could be intussusception. (an
exception to the rule to not give before age 1).
● Smallpox(0)- irradicated.
● Passive immunization Involves administering an exogenous antibody such as
immunoglobulin
○ Immunoglobulins:
■ ***Respiratory Syncytial Virus Prophylaxis (RSV)
■ Palivizumab (Synagis) is the only product on the American market for use in infants at
high risk for adverse outcomes from respiratory syncytial virus (RSV) infection
■ Given IM, and is a humanized mouse monoclonal antibody, given in 5 monthly IM
injections during RSV season (usu Nov- march or april)
■ and effective in reducing RSV hospitalizations in high-risk infants by 39% to 82%
■ Consider RSV Prophylaxis:
● Infants born 29 wks and 0 days of gestation during RSV season until 12 months old
● Children born prematurely at or before 32 weeks and 0 days of gestation who are
younger than 2 years old with chronic lung disease (CLD) and who required treatment
for their CLD within 6 months of the onset of RSV season (including oxygen therapy);
,NR602 Midterm Exam with 153 verified
approved Answers.
prophylaxis can be given to 2-year-old children with CLD of prematurity who continue to
require medical support during the 6 months prior to the onset of RSV season
● Infants up to 12 months old with hemodynamically significant cyanotic or complicated
congenital heart disease
● Infants up to 12 months old with neuromuscular disorder or congenital anomalies that
compromise clearing of respiratory secretions
killed (inactivated) vaccine - ANSWER- Killed and inactivated vaccines provide systemic
protection (immune globulin G [IgG] antibodies). Still, they may fail to trigger local
mucosal antibody (immune globulin A [IgA]) production, resulting in local colonization or
infection that can be a problem during an epidemic. The inactivate vaccines include
diphtheria-tetanus-pertussis, polio, Hib, hepatitis A, hepatitis B, human papillomavirus,
meningococcus, and pneumococcus.
Common side effects- common side effects-mild to moderate fever and/or local
swelling, pain, and erythema, usually within the first 24 to 72 hours (e.g., to DTaP,
tetanus-diphtheria [Td], or tetanus-diphtheria-acellular pertussis [Tdap], Hib conjugate,
hepatitis B virus [HBV], pneumococcal conjugate [PCV-13]; AAP et al., 2015b).
Concerned about allergic reaction.
TDAP, meningococcal and HPV- Common reaction syncope. Systemic reaction.
Common side effects of the meningococcal vaccine can also include headache and
irritability.
DtAP (4 doses)-Diphtheria-Tetanus-Acellular Pertussis Vaccine - ANSWER- given
younger ages than 7. Pertussis is not long-acting and needs to be given multiple times.
TDAP is given multiple times throughout life, even to the elderly.
● The adult version is actually recommended antenatal vaccination at 27-36 weeks
(third trimester) pregnant (Tdap),
■ Tdap is also a booster vaccine recommended to get every 10yrs as an adult.
Polio (4 doses) - ANSWER- inactivated only available in the US. CDC
recommendations are for immunocompromised individuals. It used to be live, no longer.
Haemophilus influenzae Type B Vaccine(3 doses) - ANSWER- causes pneumonia,
bacteremia, meningitis, epiglottitis, septic arthritis, cellulitis, otitis media, purulent
pericarditis, and other less common infections in children under age 4. Rates
significantly decreased due to immunization
Hepatitis A Virus Vaccine(1-2 doses) - ANSWER- last 14-20 years. Used in under
18mos.
Hepatitis B Virus Vaccine (3 doses) - ANSWER- Immunogenicity lasts until 20 years.
Routine booster doses are not recommended. 3 dose series at age 0, 1-2, 6-18 months
( use monovalent HebB for doses before 6 weeks.
, NR602 Midterm Exam with 153 verified
approved Answers.
Human Papillomavirus (HPV)(2) - ANSWER- ages 9-26 mild with safe effects.
Pregnants should not get. 2 doses 6 months apart.
Influenza Vaccine - ANSWER- yearly. 6 months and older. When enough are
immunized, then we get to herd immunity, protects those who are not immunized.
Meningococcal vaccine(2) - ANSWER- the disease is high morbidity and mortality. 11
through 21 years with a booster at 16 years. Know when to give. Highest risk late high
school/ college. Onboard before at risk
Pneumonicoccal - ANSWER- known serotypes. PCV13 is given to children until 59
months. High-risk should get the PCV23. (vulnerable population: infant, elderly)
VACCINE SCHEDULE - ANSWER- ● Birth- Hep B
● 2 months- Hep B, rotavirus, DTAP, HIB, PCV13, polio (BDRHIP)
● 4 months- rotavirus, DTAP, HIB, PCV13, polio (DRHIP)
● 6 Months- Hep B, DTAP, PCV13, polio (BDRHIP agaIN)
● 12 months- HIB, FLU, MMR, Varicella, Hep A
● 18 month-
● Age 4-6 MMR, VAR, polio, DTAP
● Age 11-12 TDAP, meningococcal, HPV
● Age 16 Meningococcal
Vaccines for Children (VFC) - ANSWER- program enables PCPs to obtain ACIP-
recommended vaccines without cost. These vaccines are free to children younger than
19 years old who are Medicaid-eligible, uninsured, or Native American, or Alaska
Native. In addition, children without immunization insurance coverage are eligible to
receive vaccines at federally qualified health centers (FQHCs) and rural health clinics.
The VFC program successfully reduces disparities in vaccination rates among low-
income children.
Sudden Infant Death Syndrome (SIDS) Prevention- - ANSWER- SUID- any sudden and
unexplained death in infanthood. Includes suffocation, asphyxia, entrapment, infection,
ingestions, metabolic diseases, and trauma (unintentional or nonaccidental).
SIDS - ANSWER- after thorough investigation. Typically thought suffocation and
overheating. Decreased after sleeping infants on their backs. 90% occur before age 6
months. More likely to be premature and or growth restricted.
Recommendations- room shared without bed shared, avoidance of shared substances,
avoid bumper pads and use of bedding, avoid overheating. Breastfeeding and
immunizations. Education- safe sleeping. Alcohol and drugs use prenatal and after the
child is born.
