Chapter 25: The Child with Cancer

A toddler with leukemia is on intravenous chemotherapy treatments. The toddler's lab results are WBC: 1000; neutrophils: 7%; nonsegmented neutrophils (bands): 7%. What is this child's absolute neutrophil count (ANC)? (Record your answer in a whole number.)

ANS: 140 To calculate an ANC for a WBC = 1000; neutrophils = 7%; and nonsegmented neutrophils (bands) = 7%, the steps are Step 1: 7% + 7% = 14% Step 2: 0.14 ´ 1000 = 140 ANC

A young child with leukemia has anorexia and severe stomatitis. The nurse should suggest that the parents try which intervention? a.Relax any eating pressures. b.Firmly insist that child eat normally. c.Begin gavage feedings to supplement diet. d.Serve foods that are either hot or cold.

ANS: A A multifaceted approach is necessary for children with severe stomatitis and anorexia. First, the parents should relax eating pressures. The nurse should suggest that the parents try soft, bland foods; normal saline or bicarbonate mouthwashes; and local anesthetics. The stomatitis is a temporary condition. The child can resume good food habits as soon as the condition resolves.

The nurse is caring for an adolescent with osteosarcoma being admitted to undergo chemotherapy. The adolescent had a right above-the-knee amputation 2 months ago and has been experiencing "phantom limb pain." Which prescribed medication is appropriate to administer to relieve phantom limb pain? a.Amitriptyline (Elavil) b.Hydrocodone (Vicodin) c.Oxycodone (OxyContin) d.Alprazolam (Xanax)

ANS: A Amitriptyline (Elavil) has been used successfully to decrease phantom limb pain. Opioids such as Vicodin or OxyContin would not be prescribed for this pain. A benzodiazepine, Xanax, would not be prescribed for this type of pain.

An adolescent with osteosarcoma is scheduled for a leg amputation in 2 days. The nurse's approach should include which action? a.Answering questions with straightforward honesty b.Avoiding discussing the seriousness of the condition c.Explaining that, although the amputation is difficult, it will cure the cancer d.Assisting the adolescent in accepting the amputation as better than a long course of chemotherapy

ANS: A Honesty is essential to gain the child's cooperation and trust. The diagnosis of cancer should not be disguised with falsehoods. The adolescent should be prepared for the surgery so he or she has time to reflect on the diagnosis and subsequent treatment. This allows questions to be answered. To accept the need for radical surgery, the child must be aware of the lack of alternatives for treatment. Amputation is necessary, but it will not guarantee a cure. Chemotherapy is an integral part of the therapy with surgery. The child should be informed of the need for chemotherapy and its side effects before surgery.

The nurse is administering an IV chemotherapeutic agent to a child with leukemia. The child suddenly begins to wheeze and have severe urticaria. Which is the most appropriate nursing action? a.Stop drug infusion immediately. b.Recheck rate of drug infusion. c.Observe child closely for next 10 minutes. d.Explain to child that this is an expected side effect.

ANS: A If an allergic reaction is suspected, the drug should be immediately discontinued. Any drug in the line should be withdrawn, and a normal saline infusion begun to keep the line open. Rechecking the rate of drug infusion, observing the child closely for next 10 minutes, and explaining to the child that this is an expected side effect can all be done after the drug infusion is stopped and the child is evaluated.

The nurse is teaching nursing students about childhood nervous system tumors. Which best describes a neuroblastoma? a.Diagnosis is usually made after metastasis occurs. b.Early diagnosis is usually possible because of the obvious clinical manifestations. c.It is the most common brain tumor in young children. d.It is the most common benign tumor in young children.

ANS: A Neuroblastoma is a silent tumor with few symptoms. In more than 70% of cases, diagnosis is made after metastasis occurs, with the first signs caused by involvement in the nonprimary site. In only 30% of cases is diagnosis made before metastasis. Neuroblastomas are the most common malignant extracranial solid tumors in children. The majority of tumors develop in the adrenal glands or the retroperitoneal sympathetic chain. They are not benign but metastasize.

A nurse is conducting a staff in-service on childhood cancers. Which is the primary site of osteosarcoma? a.Femur b.Humerus c.Pelvis d.Tibia

ANS: A Osteosarcoma is the most frequently encountered malignant bone cancer in children. The peak incidence is between ages 10 and 25 years. More than half occur in the femur. After the femur, most of the remaining sites are the humerus, tibia, pelvis, jaw, and phalanges.

The nurse is admitting a child with a Wilms tumor. Which is the initial assessment finding associated with this tumor? a.Abdominal swelling b.Weight gain c.Hypotension d.Increased urinary output

ANS: A The initial assessment finding with a Wilms (kidney) tumor is abdominal swelling. Weight loss, not weight gain, may be a finding. Hypertension occasionally occurs with a Wilms tumor. Urinary output is not increased, but hematuria may be noted.

The nurse is taking care of an adolescent with osteosarcoma. The parents ask the nurse about treatment. The nurse should make which accurate response about treatment for osteosarcoma? a.Treatment usually consists of surgery and chemotherapy. b.Amputation of the affected extremity is rarely necessary. c.Intensive irradiation is the primary treatment. d.Bone marrow transplantation offers the best chance of long-term survival.

ANS: A The optimal therapy for osteosarcoma is a combination of surgery and chemotherapy. Intensive irradiation and bone marrow transplantation are usually not part of the therapeutic management.

The nurse is preparing to give oral care to a school-age child with mucositis secondary to chemotherapy administered to treat leukemia. Which preparations should the nurse use for oral care on this child? (Select all that apply.) a.Chlorhexidine gluconate (Peridex) b.Lemon glycerin swabs c.Antifungal troches (lozenges) d.Lip balm (Aquaphor) e.Hydrogen peroxide

ANS: A, C, D Preparations that may be used to prevent or treat mucositis include chlorhexidine gluconate (Peridex) because of its dual effectiveness against candidal and bacterial infections, antifungal troches (lozenges) or mouthwash, and lip balm (e.g., Aquaphor) to keep the lips moist. Agents that should not be used include lemon glycerin swabs (irritate eroded tissue and can decay teeth), hydrogen peroxide (delays healing by breaking down protein), and milk of magnesia (dries mucosa).

The treatment of brain tumors in children consists of which therapies? (Select all that apply.) a.Surgery b.Bone marrow transplantation c.Chemotherapy d.Stem cell transplantation e.Radiation f.Myelography

ANS: A, C, E Treatment for brain tumors in children may consist of surgery, chemotherapy, and radiotherapy alone or in combination. Bone marrow and stem cell transplantation therapies are used for leukemia, lymphoma, and other solid tumors where myeloablative therapies are used. Myelography is a radiographic examination after an intrathecal injection of contrast medium. It is not a treatment.

A young boy will receive a bone marrow transplant (BMT). This is possible because one of his older siblings is a histocompatible donor. Which is this type of BMT called? a.Syngeneic b.Allogeneic c.Monoclonal d.Autologous

ANS: B Allogeneic transplants are from another individual. Because he and his sibling are histocompatible, the BMT can be done. Syngeneic marrow is from an identical twin. There is no such thing as a monoclonal BMT. Autologous refers to the individual's own marrow.

In which position should the nurse place a 10-year-old child after a large tumor was removed through a supratentorial craniotomy? a.On the inoperative side with the bed flat b.On the inoperative side with the head of bed elevated 20 to 30 degrees c.On the operative side with the bed flat and pillows behind the head d.On the operative side with the head of bed elevated 45 degrees

ANS: B If a large tumor was removed, the child is not placed on the operative side because the brain may suddenly shift to that cavity, causing trauma to the blood vessels, linings, and the brain itself. The child with an infratentorial procedure is usually positioned on either side with the bed flat. When a supratentorial craniotomy is performed, the head of bed is elevated 20 to 30 degrees with the child on either side or on the back. In a supratentorial craniotomy, the head elevation facilitates CSF drainage and decreases excessive blood flow to the brain to prevent hemorrhage. Pillows should be placed against the child's back, not head, to maintain the desired position.

The home care nurse has been visiting an adolescent with recently acquired tetraplegia. The teen's mother tells the nurse, "I'm sick of providing all the care while my husband does whatever he wants to, whenever he wants to do it." Which should be the initial action of the nurse? a.Refer mother for counseling. b.Listen and reflect mother's feelings. c.Ask father, in private, why he does not help. d.Suggest ways the mother can get her husband to help.

ANS: B It is appropriate for the nurse to reflect with the mother about her feelings, exploring issues such as an additional home health aide to help care for the child and provide respite for the mother. It is inappropriate for the nurse to agree with the mother that her husband is not helping enough. It is a judgment beyond the role of the nurse and can undermine the family relationship. Counseling is not necessary at this time. A support group for caregivers may be indicated. Asking the father why he does not help and suggesting ways to the mother to get her husband to help are interventions based on the mother's assumption of minimal contribution to the child's care. The father may have a full-time job and other commitments. The parents need to have an involved third person help them through the negotiation of responsibilities for the loss of their normal child and new parenting responsibilities.

Which is often administered to prevent or control hemorrhage in a child with cancer? a.Nitrosoureas b.Platelets c.Whole blood d.Corticosteroids

ANS: B Most bleeding episodes can be prevented or controlled with the administration of platelet concentrate or platelet-rich plasma. Nitrosoureas, whole blood, and corticosteroids would not prevent or control hemorrhage.

One of the supervisors for a home health agency asks the nurse to give the family a survey evaluating the nurses and other service providers. The nurse should recognize this as: a.inappropriate, unless nurses are able to evaluate family. b.appropriate to improve quality of care. c.inappropriate, unless nurses and other providers agree to participate. d.inappropriate, because family lacks knowledge necessary to evaluate professionals.

ANS: B Quality assessment and improvement activities are essential for virtually all organizations. Family involvement is essential in evaluating a home care plan and can occur on several levels. The nurse can ask the family open-ended questions at regular intervals to assess their opinion of the effectiveness of care. Families should also be given an opportunity to evaluate the individual home care nurses, the home care agency, and other service providers periodically. The nurse is the care provider. The evaluation is of the provision of care to the patient and family. The nurse's role is not to evaluate the family. Quality-monitoring activities are required by virtually all health care agencies. During the evaluation process, the family is requested to provide their perceptions of care.

A ventilator-dependent child is cared for at home by his parents. Nurses come for 4 hours each day giving the parents some relief. Which other strategy should the nurse recommend to give the parents a break from the responsibilities of caring for a ventilator-dependent child? a.Encourage members from the parent's church group to provide some relief care. b.Train a trusted grandparent to provide an occasional break from the responsibilities of care. c.Encourage the parents to pay out of pocket for additional private duty nurses. d.Suggest the parents place the child in a care facility.

ANS: B Respite care provides temporary relief to parents and allows a break from the responsibilities of caring for the ventilator-dependent child on a daily basis. For example, a trusted and trained grandparent or extended family member may be called in to give the family a break from caring for the child. Members of the parent's church group would not have the training necessary to care for a ventilator-dependent child. Asking the parents to pay out of pocket for additional care would put a financial burden on the family. Suggesting the family place the child in a care facility is inappropriate.

A 5-year-old boy is being prepared for surgery to remove a brain tumor. Nursing actions should be based on which statement? a.Removal of tumor will stop the various symptoms. b.Usually the postoperative dressing covers the entire scalp. c.He is not old enough to be concerned about his head being shaved. d.He is not old enough to understand the significance of the brain.

ANS: B The child should be told what he will look and feel like after surgery. This includes the size of the dressing. The nurse can demonstrate on a doll the expected size and shape of the dressing. Some of the symptoms may be alleviated by the removal of the tumor, but postsurgical headaches and cerebellar symptoms such as ataxia may be aggravated. Children should be prepared for the loss of their hair, and it should be removed in a sensitive, positive manner if the child is awake. Children at this age have poorly defined body boundaries and little knowledge of internal organs. Intrusive experiences are frightening, especially those that disrupt the integrity of the skin.

A boy with leukemia screams whenever he needs to be turned or moved. Which is the most probable cause of this pain? a.Edema b.Bone involvement c.Petechial hemorrhages d.Changes within the muscles

ANS: B The invasion of the bone marrow with leukemic cells gradually causes a weakening of the bone and a tendency toward fractures. As leukemic cells invade the periosteum, increasing pressure causes severe pain. Edema, petechial hemorrhages, and changes within the muscles would not cause severe pain.

Which is the usual presenting symptom for testicular cancer? a.Hard, painful mass b.Hard, painless mass c.Epididymis easily palpated d.Scrotal swelling and pain

ANS: B The usual presenting symptom for testicular cancer is a heavy, hard, painless mass that is either smooth or nodular and palpated on the testes. A hard, painful mass, an epididymis easily palpated, and scrotal swelling and pain are not the clinical presentations of testicular cancer.

A clinic nurse is conducting a staff in-service for other clinic nurses about signs and symptoms of a rhabdomyosarcoma tumor. Which should be included in the teaching session? (Select all that apply.) a.Bone fractures b.Abdominal mass c.Sore throat and ear pain d.Headache e.Ecchymosis of conjunctiva

ANS: B, C, E The initial signs and symptoms of rhabdomyosarcoma tumors are related to the site of the tumor and compression of adjacent organs. Some tumor locations, such as the orbit, manifest early in the course of the illness. Other tumors, such as those of the retroperitoneal area, only produce symptoms when they are relatively large and compress adjacent organs. Unfortunately, many of the signs and symptoms attributable to rhabdomyosarcoma are vague and frequently suggest a common childhood illness, such as "earache" or "runny nose." An abdominal mass, sore throat and ear pain, and ecchymosis of conjunctiva are signs of a rhabdomyosarcoma tumor. Bone fractures would be seen in osteosarcoma, and a headache is a sign of a brain tumor.

Which expected appearance will the nurse explain to parents of an infant returning from surgery after an enucleation was performed to treat retinoblastoma? (Select all that apply.) a.A lot of drainage will come from the affected socket. b.The face may be edematous or ecchymotic. c.The eyelids will be sutured shut for the first week. d.There will be an eye pad dressing taped over the surgical site. e.The implanted sphere is covered with conjunctiva and resembles the lining of the mouth.

ANS: B, D, E After enucleation surgery, the parents are prepared for the child's facial appearance. An eye patch is in place, and the child's face may be edematous or ecchymotic. Parents often fear seeing the surgical site because they imagine a cavity in the skull. A surgically implanted sphere maintains the shape of the eyeball, and the implant is covered with conjunctiva. When the eyelids are open, the exposed area resembles the mucosal lining of the mouth. The dressing, consisting of an eye pad taped over the surgical site, is changed daily. The wound itself is clean and has little or no drainage. So expecting a lot of drainage is not accurate to tell parents. The eyelids are not sutured shut after enucleation surgery.

An adolescent will receive a bone marrow transplant (BMT). The nurse should explain that the bone marrow will be administered by which route? a.Bone grafting b.Bone marrow injection c.IV infusion d.Intra-abdominal infusion

ANS: C Bone marrow from a donor is infused intravenously, and the transfused stem cells will repopulate the marrow. Because the stem cells migrate to the recipient's marrow when given intravenously, this is the method of administration.

The home health nurse asks a child's mother many questions as part of the assessment. The mother answers many questions and then stops and says, "I don't know why you ask me all this. Who gets to know this information?" The nurse should take which action? a.Determine why the mother is so suspicious. b.Determine what the mother does not want to tell. c.Explain who will have access to the information. d.Explain that everything is confidential and that no one else will know what is said.

ANS: C Communication with the family should not be invasive. The nurse needs to explain the importance of collecting the information, its applicability to the child's care, and who will have access to the information. The mother is not being suspicious and is not necessarily withholding important information. She has a right to understand how the information she provides will be used. The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals.

The nurse is monitoring a 7-year-old child post surgical resection of an infratentorial brain tumor. Which vital sign findings indicate Cushing's triad? a.Increased temperature, tachycardia, tachypnea b.Decreased temperature, bradycardia, bradypnea c.Bradycardia, hypertension, irregular respirations d.Bradycardia, hypotension, tachypnea

ANS: C Cushing's triad is a hallmark sign of increased intracranial pressure (ICP). The triad includes bradycardia, hypertension, and irregular respirations. Increased or decreased temperature is not a sign of Cushing's triad.

What is the most common clinical manifestation(s) of brain tumors in children? a.Irritability b.Seizures c.Headaches and vomiting d.Fever and poor fine motor control

ANS: C Headaches, especially on awakening, and vomiting that is not related to feeding are the most common clinical manifestation(s) of brain tumors in children. Irritability, seizures, and fever and poor fine motor control are clinical manifestations of brain tumors, but headaches and vomiting are the most common.

A mother of a 5-year-old child, with complex health care needs and cared for at home, expresses anxiety about attending a kindergarten graduation exercise of a neighbor's child. The mother says, "I wish it could be my child graduating from kindergarten." The nurse recognizes that the mother is experiencing: a.abnormal anxiety. b.ineffective coping. c.chronic sorrow. d.denial.

ANS: C Home care nurses should be aware that parents may experience chronic sorrow as a parental stressor. Chronic sorrow as a normal grief response is associated with a living loss (the loss of a healthy child) that is cyclical in nature. This is a normal response and does not indicate abnormal anxiety, ineffective coping, or denial.

Which is most descriptive of the pathophysiology of leukemia? a.Increased blood viscosity occurs. b.Thrombocytopenia (excessive destruction of platelets) occurs. c.Unrestricted proliferation of immature white blood cells (WBCs) occurs. d.First stage of coagulation process is abnormally stimulated.

ANS: C Leukemia is a group of malignant disorders of the bone marrow and lymphatic system. It is defined as an unrestricted proliferation of immature WBCs in the blood-forming tissues of the body. Increased blood viscosity may occur secondary to the increased number of WBCs. Thrombocytopenia may occur secondary to the overproduction of WBCs in the bone marrow. The coagulation process is unaffected by leukemia.

Home care is being considered for a young child who is ventilator-dependent. Which factor is most important in deciding whether home care is appropriate? a.Level of parents' education b.Presence of two parents in the home c.Preparation and training of family d.Family's ability to assume all health care costs

ANS: C One of the essential elements is the family's training and preparation. The family must be able to demonstrate all aspects of care for the child. In many areas, it cannot be guaranteed that nursing care will be available on a continual basis, and the family will have to care for the child. The amount of formal education reached by the parents is not the important issue. The determinant is the family's ability to care adequately for the child in the home. At least two family members should learn and demonstrate all aspects of the child's care in the hospital, but it does not have to be two parents. Few families can assume all health care costs. Creative financial planning, including negotiating arrangements with the insurance company and/or public programs, may be required.

A school-age child with leukemia experienced severe nausea and vomiting when receiving chemotherapy for the first time. Which is the most appropriate nursing action to prevent or minimize these reactions with subsequent treatments? a.Encourage drinking large amounts of favorite fluids. b.Encourage child to take nothing by mouth (remain NPO) until nausea and vomiting subside. c.Administer an antiemetic before chemotherapy begins. d.Administer an antiemetic as soon as child has nausea.

ANS: C The most beneficial regimen to minimize nausea and vomiting associated with chemotherapy is to administer the antiemetic before the chemotherapy is begun. The goal is to prevent anticipatory symptoms. Drinking fluids will add to the discomfort of the nausea and vomiting. Waiting until nausea and vomiting subside will help with this episode, but the child will have the discomfort and be at risk for dehydration. Administering an antiemetic as soon as the child has nausea does not prevent anticipatory nausea.

When communicating with other professionals, it is important for home care nurses to: a.ask others what they want to know. b.share everything known about the family. c.restrict communication to clinically relevant information. d.recognize that confidentiality is not possible.

ANS: C The nurse will need to share, through both oral and written communication, clinically relevant information with other involved health professionals. Asking others what they want to know and sharing everything known about the family is inappropriate. Patients have a right to confidentiality. The nurse is not permitted to share information about clients, except clinically relevant information that pertains to the child's care. Confidentiality permits the disclosure of information to other health professionals on a need-to-know basis.

The home health nurse is caring for a child who requires complex care. The family expresses frustration related to obtaining accurate information about their child's illness and its management. Which is the best action for the nurse? a.Determine why family is easily frustrated. b.Refer family to child's primary care practitioner. c.Clarify family's request, and provide information they want. d.Answer only questions that family needs to know about.

ANS: C The philosophic basis for family-centered practice is the recognition that the family is the constant in the child's life. It is essential and appropriate that the family have complete and accurate information about their child's illness and management. The nurse may first have to clarify what information the family believes has not been communicated. The family's frustration arises from their perception that they are not receiving information pertinent to their child's care. Referring the family to the child's primary care practitioner does not help the family. The home health nurse should have access to the necessary information. Questions about what they need and want to know concerning their child's care should be addressed.

The school nurse is discussing testicular self-examination with adolescent boys. Why is this important? a.Epididymitis is common during adolescence. b.Asymptomatic sexually transmitted diseases may be present. c.Testicular tumors during adolescence are generally malignant. d.Testicular tumors, although usually benign, are common during adolescence.

ANS: C Tumors of the testes are not common, but when manifested in adolescence, they are generally malignant and demand immediate evaluation. Epididymitis is not common in adolescence. Asymptomatic sexually transmitted disease would not be evident during testicular self-examination. The focus of this examination is on testicular cancer. Testicular tumors are most commonly malignant.

The nurse is preparing a child for possible alopecia from chemotherapy. Which should be included? a.Explain to child that hair usually regrows in 1 year. b.Advise child to expose head to sunlight to minimize alopecia. c.Explain to child that wearing a hat or scarf is preferable to wearing a wig. d.Explain to child that when hair regrows, it may have a slightly different color or texture.

ANS: D Alopecia is a side effect of certain chemotherapeutic agents. When the hair regrows, it may be a different color or texture. The hair usually grows back within 3 to 6 months after cessation of treatment. The head should be protected from sunlight to avoid sunburn. Children should choose the head covering they prefer.

Which is a common clinical manifestation of Hodgkin disease? a.Petechiae b.Bone and joint pain c.Painful, enlarged lymph nodes d.Enlarged, firm, nontender lymph nodes

ANS: D Asymptomatic, enlarged, cervical or supraclavicular lymphadenopathy is the most common presentation of Hodgkin disease. Petechiae are usually associated with leukemia. Bone and joint pain are not likely in Hodgkin disease. The enlarged nodes are rarely painful.

Which is the most effective pain-management approach for a child who is having a bone marrow aspiration? a.Relaxation techniques b.Administration of an opioid c.EMLA cream applied over site d.Conscious or unconscious sedation

ANS: D Effective pharmacologic and nonpharmacologic measures should be used to minimize pain associated with procedures. For bone marrow aspiration, conscious or unconscious sedation should be used. Relaxation, opioids, and EMLA can be used to augment the conscious or unconscious sedation.

A child with leukemia is receiving triple intrathecal chemotherapy consisting of methotrexate, cytarabine, and hydrocortisone. What will the triple intrathecal chemotherapy prevent? a.Infection b.Brain tumor c.Drug side effects d.Central nervous system (CNS) disease

ANS: D For certain children, CNS prophylactic therapy is indicated. This drug regimen is used to prevent CNS leukemia and will not prevent infection or drug side effects. If the child has a brain tumor in addition to leukemia, additional therapy would be indicated.

A family wants to begin oral feeding of their 4-year-old son, who is ventilator-dependent and currently tube-fed. They ask the home health nurse to feed him the baby food orally. The nurse recognizes a high risk of aspiration and an already compromised respiratory status. The most appropriate nursing action is to: a.refuse to feed him orally because the risk is too high. b.explain the risks involved, and then let the family decide what should be done. c.feed him orally because the family has the right to make this decision for their child. d.acknowledge their request, explain the risks, and explore with the family the available options.

ANS: D Parents want to be included in the decision making for their child's care. The nurse should discuss the request with the family to ensure this is the issue of concern, and then they can explore potential options together. Merely refusing to feed the child orally does not determine why the parents wish the oral feedings to begin and does not involve them in the problem solving. The decision to begin or not change feedings should be a collaborative one, made in consultation with the family, nurse, and appropriate member of the health care team.

Myelosuppression, associated with chemotherapeutic agents or some malignancies such as leukemia, can cause bleeding tendencies because of a(n): a.decrease in leukocytes. b.increase in lymphocytes. c.vitamin C deficiency. d.decrease in blood platelets.

ANS: D The decrease in blood platelets secondary to the myelosuppression of chemotherapy can cause an increase in bleeding. The child and family should be alerted to avoid risk of injury. Decrease in leukocytes, increase in lymphocytes, and vitamin C deficiency would not affect bleeding tendencies.

Which immunization should not be given to a child receiving chemotherapy for cancer? a.Tetanus vaccine b.Inactivated poliovirus vaccine c.Diphtheria, pertussis, tetanus (DPT) d.Measles, rubella, mumps

ANS: D The vaccine used for measles, mumps, and rubella is a live virus and can result in an overwhelming infection. Tetanus vaccine, inactivated poliovirus vaccine, and diphtheria, pertussis, tetanus (DPT) are not live virus vaccines.