MSN 624 COMPREHENSIVE EXAM UPDATED QUESTIONS
AND SOLUTIONS GRADED A+
✔✔Lipid Screening in Pediatric - ✔✔All children should undergo cholesterol screening
once between ages 9-11 years and once between ages 17-21 years.
Non-fasting total cholesterol and high-density lipoprotein (HDL) can be used for the
initial lipid screening test.
Clinicians may recommend low-fat or no-fat dairy at age 1 year for high-risk patients.
For patients who fail lifestyle changes and require lipid-lowering medications,
pharmacologic treatment should be considered at age 10 years.
Once low-density lipoprotein (LDL) is optimized, high non-HDL cholesterol may be
targeted for residual CVD risk reduction
✔✔We vaccinate older adults because... - ✔✔-preventing illness is an important clinical
responsibility of healthcare providers
-older adults are at greater risk of morbidity and mortality from specific infectious
diseases, such as influenza and pneumococcal disease
-"heard immunity" is an important concept in long-term care and within families
✔✔vaccinating older adults vs younger adults - ✔✔the immune response to vaccines
tends to decline as a person ages
-frail, undernourished, and depressed older adults have suboptimal antibody responses
to vaccinations
-stressed caregivers also have reduced response to vaccines
✔✔barriers to vaccination - ✔✔-lack of knowledge (providers and patients)
-myths and misperceptions
-vaccine shortages
-system wide issues
-limited access
-complex schedules and regimens
-fragmented health records
-fair reimbursement
✔✔immunizations for adults
specifically targeted vaccines - ✔✔-influenza
-PPSV23
-Td/Tdap
-Zoster (>60 years)
✔✔immunizations for adults
, may be indicated - ✔✔HBV (>60 years, permissive)
✔✔vaccine payment for older adults
medicare
Part B - ✔✔outpatient benefit
-covers 1 PPSV23 and annual influenza vaccinations
✔✔vaccine payment for older adults
medicare
Part D - ✔✔-covers vaccines not covered by Part B, including Tdap, zoster
-subject to copays, deductibles, and coverage gap
✔✔vaccine payment for older adults
Private - ✔✔fee-for-service
-health insurance plan
-managed care
-PPO
✔✔affordable care act - ✔✔intent: improves access to health care
Immunization provisions
-ACIP recommend vaccines covered
-no cost sharing for in-network
applies to medicare, medicaid, and private insurance
✔✔ACA: implications for pharmacists - ✔✔Out of network: cost share may be applied,
managed care may not have out-of-network payment
Part B and D vaccines are not affected
Cannot participate in medicaid provider fee increase
✔✔why adults don't get vaccinated
patient reasons - ✔✔-have not been told by provider that they need it
-don't know when to get vaccinated
-think that "healthy people don't need shots"
✔✔why adults don't get vaccinated
PROVIDER thinks that patient - ✔✔-have concerns about vaccine adverse effects
-dislike needles
-lack insurance coverage
-lack knowledge about disease prevention
✔✔adult vaccination: a team approach - ✔✔-ambulatory care
AND SOLUTIONS GRADED A+
✔✔Lipid Screening in Pediatric - ✔✔All children should undergo cholesterol screening
once between ages 9-11 years and once between ages 17-21 years.
Non-fasting total cholesterol and high-density lipoprotein (HDL) can be used for the
initial lipid screening test.
Clinicians may recommend low-fat or no-fat dairy at age 1 year for high-risk patients.
For patients who fail lifestyle changes and require lipid-lowering medications,
pharmacologic treatment should be considered at age 10 years.
Once low-density lipoprotein (LDL) is optimized, high non-HDL cholesterol may be
targeted for residual CVD risk reduction
✔✔We vaccinate older adults because... - ✔✔-preventing illness is an important clinical
responsibility of healthcare providers
-older adults are at greater risk of morbidity and mortality from specific infectious
diseases, such as influenza and pneumococcal disease
-"heard immunity" is an important concept in long-term care and within families
✔✔vaccinating older adults vs younger adults - ✔✔the immune response to vaccines
tends to decline as a person ages
-frail, undernourished, and depressed older adults have suboptimal antibody responses
to vaccinations
-stressed caregivers also have reduced response to vaccines
✔✔barriers to vaccination - ✔✔-lack of knowledge (providers and patients)
-myths and misperceptions
-vaccine shortages
-system wide issues
-limited access
-complex schedules and regimens
-fragmented health records
-fair reimbursement
✔✔immunizations for adults
specifically targeted vaccines - ✔✔-influenza
-PPSV23
-Td/Tdap
-Zoster (>60 years)
✔✔immunizations for adults
, may be indicated - ✔✔HBV (>60 years, permissive)
✔✔vaccine payment for older adults
medicare
Part B - ✔✔outpatient benefit
-covers 1 PPSV23 and annual influenza vaccinations
✔✔vaccine payment for older adults
medicare
Part D - ✔✔-covers vaccines not covered by Part B, including Tdap, zoster
-subject to copays, deductibles, and coverage gap
✔✔vaccine payment for older adults
Private - ✔✔fee-for-service
-health insurance plan
-managed care
-PPO
✔✔affordable care act - ✔✔intent: improves access to health care
Immunization provisions
-ACIP recommend vaccines covered
-no cost sharing for in-network
applies to medicare, medicaid, and private insurance
✔✔ACA: implications for pharmacists - ✔✔Out of network: cost share may be applied,
managed care may not have out-of-network payment
Part B and D vaccines are not affected
Cannot participate in medicaid provider fee increase
✔✔why adults don't get vaccinated
patient reasons - ✔✔-have not been told by provider that they need it
-don't know when to get vaccinated
-think that "healthy people don't need shots"
✔✔why adults don't get vaccinated
PROVIDER thinks that patient - ✔✔-have concerns about vaccine adverse effects
-dislike needles
-lack insurance coverage
-lack knowledge about disease prevention
✔✔adult vaccination: a team approach - ✔✔-ambulatory care
