Chapter 49: Immunologic Agents PrepU
2 See full question 12s When describing the action of vaccines, the nurse identifies their action as primarily affecting:
B lymphocytes. Explanation: Vaccines exert their action on B cells, which in turn stimulate the formation of antibodies. Interleukins, histamine release, and effector T cells are not affected by vaccines. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
16 See full question 29s The nurse is assigned to perform telephone triage for the clinic and receives a call from a young mother whose 6-month-old baby received her third diphtheria-pertussis-tetanus immunization that morning. The mother reports the baby's temperature is 99.8° axillary, the site of injection is "a little red," and the baby is irritable. After checking the standing orders provided by the pediatrician, what teaching would the nurse provide this mother? Select all that apply.
"These are common adverse effects reported after immunizations." "Apply a warm moist compress to the baby's leg." "Symptoms should subside within 2 to 3 days." Explanation: The symptoms reported by this mother are all common adverse effects following immunization that will subside within 2 to 3 days. In the meantime, the mother can make the baby more comfortable by administering a weight appropriate dosage of acetaminophen, applying warm compresses to the injection site, and providing a quiet environment. If the symptoms do not subside within 2 to 3 days, the baby should be seen for follow-up care. Aspirin should not be given due to risk of Reye's syndrome. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585. Chapter 49: Immunologic Agents - Page 585 Add a Note
3 See full question 13s The nurse is preparing to administer a dose of the human papillomavirus vaccine to a middle school student. What assessment question should the nurse prioritize when interacting with the student?
"What's your understanding of why you're getting this vaccination?" Explanation: The nurse cannot make the assumption that the client knows about the rationale for the vaccination. The client may know nothing about HPV or its relationship to her future cancer risk. This assessment question can be used to introduce client teaching. A middle school student is unlikely to know whether her parents or caregivers have ensured that her immunizations match the recommended schedule. The HPV vaccine does not require a booster and minimal - if any - side effects are anticipated. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note
5 See full question 12s A client prescribed prednisone 40 mg daily should be provided what information about immunizations by the nurse?
"You should wait at least 3 months after chemotherapy to obtain a live vaccine immunization." Explanation: Clients receiving a systemic corticosteroid in high doses (e.g., prednisone 20 mg or equivalent daily) or for longer than 2 weeks should wait at least 3 months before being given a live virus vaccine. Immunizations are not contraindicated with short-term use (less than 2 weeks) or low to moderate doses (less than 20 mg daily) of prednisone. None of the other options present accurate information concerning immunizations for a client currently prescribed prednisone.
18 See full question 16s A client prescribed prednisone 40 mg daily should be provided what information about immunizations by the nurse?
"You should wait at least 3 months after chemotherapy to obtain a live vaccine immunization." Explanation: Clients receiving a systemic corticosteroid in high doses (e.g., prednisone 20 mg or equivalent daily) or for longer than 2 weeks should wait at least 3 months before being given a live virus vaccine. Immunizations are not contraindicated with short-term use (less than 2 weeks) or low to moderate doses (less than 20 mg daily) of prednisone. None of the other options present accurate information concerning immunizations for a client currently prescribed prednisone. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note
14 See full question 47s For the first time, a 10 year-old female has received an IM injection of Gardasil. What follow-up education should the nurse provide?
"You'll have to get another shot in around 2 months." Explanation: Gardasil requires a series, a with a second dose two months after the first. A fever is not expected, nor is stomach pain. Without the appropriate boosters, the client will not be protected later in life. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note
13 See full question 53s A neonate who weighs 7 lbs, 8 oz kg is prescribed the hepatitis B immune globulin at a dose of 0.06 mL/kg IM. To one decimal place, what dose should the nurse administer?
0.2 Explanation: The neonate's weight in kg is 3.41 kg (7.5 lbs divided by 2.2). The prescribed dose is 0.06 X 3.41, which yields 0.2 mL to one decimal place. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note
4 See full question 23s The onset of protection after the administration of an immune globulin to a client is rapid but its duration is short, typically which time frame?
1 to 3 months Explanation: While onset after immune globulin administration is rapid, the duration is short, only 1 to 3 months. Vaccinations have some minor adverse reactions, such as fever, rashes, and aching joints, are possible with the administration of a vaccine. In most cases, these reactions subside within 48 hours. It is recommended that the live virus vaccines be administered 14 to 30 days before or 6 to 12 weeks after administration of immune globulins. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note
5 See full question 10s A client bitten by a copperhead snake will benefit the most if the antivenin is administered within how long after exposure?
4 hours Explanation: The most effective response from an antivenin is obtained when the drug is administered within 4 hours after exposure. Longer than 4 hours the venom has spread more systemic and may not be beneficial. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note
15 See full question 13s What client would be most likely to benefit from the administration of an antitoxin?
A client in distress who is showing signs and symptoms of botulism Explanation: Botulism is an example of a health problem that can be treated with an antitoxin. HPV and yellow fever do not have a toxic etiology and cannot be treated by an antitoxin. Antitoxins are not used in the treatment of anaphylaxis. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
12 See full question 25s The nurse at an ambulatory clinic has seen several clients with suspected or confirmed infectious diseases in recent days. Which client is most likely to benefit from the administration of an immune serum.
A client who is known to have contracted hepatitis B from sexual activity Explanation: There is a hepatitis B immune globulin, but none exists for influenza, tuberculosis or varicella. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
17 See full question 13s The nurse explains the purpose of vaccines is to promote what? Select all that apply.
Active immunity Lifetime immunity Activation of the immune system Explanation: The word vaccine comes from the Latin word for smallpox, vaccinia. Vaccines are immunizations containing weakened or altered protein antigens that stimulate the formation of antibodies against a specific disease. They are used to promote active immunity that will last for a lifetime, although some clients will require smaller booster doses to maintain immunity. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
4 See full question 30s A hospitalized client is about to receive immunological therapy and asks the nurse to explain the difference between passive and active immunity. In order to provide complete information, the nurse knows to include which information during the teaching session?
Active immunity occurs when a client receives a killed or weakened antigen that stimulates antibodies. These antibodies fight the antigen (for example, chickenpox vaccine). Explanation: Active immunity occurs when a client receives a killed or weakened antigen that stimulates antibodies. These antibodies fight the antigen (for example, chickenpox vaccine). Passive immunity occurs when immune globulin or antivenins are given to provide the person with ready-made antibodies from another human or animal. Cipro is an antibiotic, not an immunologic agent. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
3 See full question 22s A group of students are role playing various scenarios related to biological weapons. In one of the situations, an adult client develops botulism. What is the appropriate choice for treatment?
Antitoxin Explanation: A botulism antitoxin is available for clients who receive specific exposure. There is no bacterial vaccine for botulism. Antivenin would be used to treat a snake bite. Botulism immune globulin is reserved for infants. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note
15 See full question 17s A 79 year-old client has been prescribed a single dose of influenza A vaccine 0.5 mL SC. What is the nurse's best action?
Contact the provider to confirm the route Explanation: The influenza vaccine is given IM, not subcutaneously. The dose is appropriate, but the nurse would have to confirm the route before performing education or administering the vaccine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 589. Chapter 49: Immunologic Agents - Page 589 Add a Note
16 See full question 30s The nurse is preparing for a visit with a 4-month-old infant. What immunizations will the nurse prepare? Select all that apply.
Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) Inactivated poliovirus vaccine (IPV) Haemophilus influenzae type b vaccine (Hib) Explanation: At 4 months of age, the child will receive a DTaP, Hib, IPV, and PCV. Varicella vaccine is not given until the child is at least 1 year of age, and Meningococcal is usually given at age 11 to 12 years unless the client is at high risk for development of the disease before that age. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585,588. Chapter 49: Immunologic Agents - Page 585,588 Add a Note
11 See full question 22s An immunocompromised client is exposed to hepatitis A. The health care provider orders an injection of immunoglobulin as prophylaxis against the hepatitis A. What adverse effects would the nurse advise the client might occur? (Select all that apply.)
Fever Angioedema Urticaria Explanation: Adverse effects: Tenderness, muscle stiffness at site of injection; urticaria, angioedema, nausea, vomiting, chills, fever, and chest tightness. An immunocompromised client would not be told to watch for rhinitis or severe abdominal pain. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note
10 See full question 22s The nurse is teaching a course to students about immunologic agents. In order for the students to understand active immunity, the nurse explains that there are agents that provide active immunity. Which is an active immunity agent?
Haemophilus influenzae type B conjugate Explanation: A vaccine is an active immunity agent. Haemophilus influenzae type B conjugate is a live vaccination. The remainaing answer options offer agents that are either Immune globulins or antivenins which are passive immunity agents. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 587. Chapter 49: Immunologic Agents - Page 587 Add a Note
2 See full question 2m 44s A nurse is to administer a viral vaccine. A vaccine for what would be appropriate?
Hepatitis A Explanation: Hepatitis A would be a viral vaccine. Meningococcal is a bacterial vaccine. Haemophilus influenza B is a bacterial vaccine. Typhoid is a bacterial vaccine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note
1 See full question 18s Which would a nurse expect to administer to a client who has not been immunized and has sustained a bite from an animal with rabies?
Immune globulin Explanation: An immune globulin, specifically rabies immune globulin, would be used to prevent rabies in nonimmunized clients who are exposed to rabies. An antitoxin is used to treat poisonous substances released by invading pathogens, for example, botulism. Antivenin would be used to treat snake bites. Immune sera is a general term that includes immune globulins, antitoxins, and antivenins. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note
1 See full question 4m A client is undergoing a yearly physical. While discussing immunizations, the client states not wanting any immunizations because they can cause diseases. The nurse's best response is:
Immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines. Explanation: In general, immunizing agents are quite safe, and risks of the diseases they prevent are greater than the risks of the vaccines. However, risks and benefits for particular recipients should be considered because no vaccine is completely effective or completely safe. Some people may develop a disease after being immunized against it. However, if this happens, symptoms are usually less severe and complications are fewer than if the person had not been immunized. Adverse effects are usually mild and of short duration. Although the FDA evaluates vaccine safety before and after a vaccine is marketed, some adverse effects become apparent only after a vaccine is used in a large population. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
7 See full question 14s A mother has brought her infant to the clinic for the first immunization. What would the nurse be sure to include when providing education for the infant's mother?
Keep a written record of the child's immunizations. Explanation: Provide thorough client teaching, including measures to avoid adverse effects, warning signs of problems, and the need to keep a written record of immunizations, to increase knowledge about drug therapy and to increase compliance with the drug regimen. The nurse would not teach the mother to avoid having her child take more than one vaccine at a time; or to stop the immunizations after the age of 2 or to omit the immunizations if the injections are too upsetting to her child. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585. Chapter 49: Immunologic Agents - Page 585 Add a Note
1 See full question 25s The nurse is teaching the parents of a child who has received immunizations and possible adverse effects. What would the nurse identify as common adverse effects? (Select all that apply.)
Nodule at the injection site Fretfulness Chills Anorexia Explanation: Common adverse effects include moderate fever, rash, malaise, chills, fretfulness, drowsiness, anorexia, vomiting, irritability, and pain, redness, swelling, and nodule formation at the injection site. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note
8 See full question 19s When discussing vaccines in class, a student asks the instructor what an antitoxin is? What is an example of an antitoxin?
Passive immunity Explanation: An antitoxin is an example of passive immunity. Antitoxins contain antibodies to very specific toxins. The antibodies are injected into the system and react with invading pathogens. Active immunity occurs when the body recognizes a foreign protein and begins producing antibodies to react with that specific protein or antigen. Vaccines are immunizations containing weakened or altered protein antigens that stimulate formation of antibodies against a specific disease. They are used to promote active immunity. Toxoids are vaccines that are made from the toxins produced by the microorganisms. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
20 See full question 14s Which statement should the nurse include in a discussion about passive immunity?
Passive immunity provides temporary protection from disease. Explanation: Passive immunity results from parenteral administration of immune serum containing disease-specific antibodies to a nonimmune person. Passive immunity is only temporary, and the person still needs a vaccine against a specific disease to develop antibodies that provide long-term immunity. It is inaccurate to characterize passive immunity as being safer than active immunity. Administration of antigens results in active immunity.
4 See full question 11s A nurse is participating in an influenza vaccination clinic on a college campus. What action will best prepare the nurse for this role?
Review the procedure for intramuscular injection Explanation: Influenza vaccinations are given by the IM route. The nurse must monitor for adverse effects, but it is unnecessary to teach each client the details of serum sickness. Clients do not need to know their blood types. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 589. Chapter 49: Immunologic Agents - Page 589 Add a Note
17 See full question 12s A client, currently undergoing chemotherapy, asks what type of immunizations to get in the next few months. Which is the nurse's best response?
Such clients should not be given live vaccines and should wait for 3 months after stopping chemotherapy to get the vaccines. Explanation: Clients with active malignant disease may be given killed vaccines but should not be given live vaccines. When vaccines are used, they should be given at least 2 weeks before the start of chemotherapy or 3 months after chemotherapy is completed. Passive immunity with immunoglobulins may be used in place of active immunity. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note
3 See full question 10s Which is responsible for a delayed-type immune response?
T lymphocytes Explanation: T lymphocytes are responsible for a delayed-type immune response, seen in cell-mediated immunity. Antibody-mediated immunity involves the B lymphocytes and is referred to as humoral immunity. When exposed to an antigen, the B cells produce antibodies as a defense against the offending antigen. Macrophages are a type of large white blood cell in cell-mediated immunity that engulfs and destroys an antigen. An antibody is a globulin (protein) produced by the B lymphocytes as a defense against an antigen. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
19 See full question 14s What is the difference between toxoids and vaccines?
Toxoids always require occasional boosters. Explanation: Many (but not all) vaccines produce long-lasting immunity. Attenuated live vaccines produce immunity, usually lifelong, that is similar to that produced by natural infection. Toxoids are bacterial toxins or products that have been modified to destroy toxicity while retaining the ability to induce antibody formation. Immunization with toxoids is not permanent; scheduled repeat doses (boosters) are required to maintain immunity. No immunization is wholly free of adverse effects. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
5 See full question 10s What would contraindicate the administration of scheduled immunizations at a client visit for a 6-month-old infant?
a low-grade fever Explanation: Contraindications to most vaccines and toxoids include acute febrile illness. Fussy crying, loose stools, and poor feeding would warrant further assessment but may not contraindicate the administration of a vaccine.
5 See full question 6s Which statement best describes the recommended vaccination schedule for a 63-year-old client?
a tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age Explanation: Recommended immunizations for older adults have usually consisted of a tetanus-diphtheria (Td) booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age. A second dose of pneumococcal vaccine may be given at 65 years if the first dose was given 5 years previously. None of the other options present accurate information concerning currently recommended vaccination scheduling for older clients.
9 See full question 22s A client is to receive a physical prior to starting immune sera therapy. What would the nurse assess for?
adventitious breath sounds Explanation: Perform a physical assessment to determine baseline status before beginning therapy and for any potential adverse effects; inspect for presence of any skin lesions to monitor for hypersensitivity reactions; monitor temperature to monitor for possible infection, pulse, respirations, and blood pressure; auscultate lungs for adventitious sounds; assess level of orientation and affect to monitor for hypersensitivity reactions to the vaccine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note
6 See full question 10s The nurse should monitor clients receiving human immune globulin intravenous (IGIV) products closely for problems with which organs?
kidneys Explanation: IGIV products have been associated with renal impairment, acute renal failure, osmotic nephrosis, and death, so the nurse should monitor a client's renal function carefully during the administration of IGIV products. The liver, heart, and lungs are not affected. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note
7 See full question 22s When educating clients on the immune system, the nurse identifies which white blood cells to be involved in cell-mediated immunity (CMI) along with T lymphocytes?
macrophages Explanation: Macrophages are involved in maintaining CMI along with T lymphocytes. Macrophages are large cells that surround, engulf, and destroy microorganisms and cellular debris. T lymphocytes and macrophages work together to destroy the antigens in CMI. T lymphocytes attack the antigens directly without producing antibodies. Neutrophils, eosinophils, and basophils are not associated with T lymphocytes in cell-mediated immunity. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
20 See full question 15s A client about to receive an injection of influenza vaccination should be informed of the possibility of experiencing which short-term adverse effect? Select all that apply.
malaise muscle aches low-grade fever erythema at the injection site Explanation: Influenza vaccine via injection may cause pain, induration, and erythema at injection sites and flu-like symptoms such as chills, fever, malaise, and muscle aches. Anorexia is not generally associated with the short-term adverse effects of an influenza vaccination.
1 See full question 24m 31s When describing cell-mediated immunity, a nurse would explain that this type of immunity depends on which response or action?
the action of T lymphocytes Explanation: Cell-mediated immunity depends on the actions of T lymphocytes. Antibody-mediated immunity involves the B lymphocytes and is referred to as humoral immunity. When exposed to an antigen, the B cells produce antibodies as a defense against the offending antigen. Antigen--antibody response is antibodies formed in response to exposure to a specific antigen. Globulins are proteins present in blood serum or plasma that contain antibodies. Immune globulins are solutions obtained from human or animal blood containing antibodies that have been formed by the body to specific antigens. Globulin production occurs when antigens are present. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
5 See full question 22s A client being vaccinated for measles asks the nurse about the contents of the vaccine. During the explanation, the nurse mentions a poisonous substance produced by some bacteria that is capable of stimulating antitoxin production. Which is the nurse referring to in the explanation?
toxin Explanation: A toxin is a substance that is capable of stimulating the body to produce antitoxins, which act in the same manner as antibodies. Toxins are powerful substances, and they can be attenuated and used as toxoids to produce antitoxins. Toxoids are attenuated toxins, which are capable of stimulating antibody production and creating immunity. Vaccines are attenuated or killed antigens, which are capable of stimulating antibody production and creating immunity. Immune globulins are antibodies containing solutions formed to specific antigens and are obtained from human or animal blood. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
4 See full question 16s The nurse must administer which to a client prior to exposure to the disease-causing organism in order for the client to be protected against the disease?
toxoids Explanation: The nurse must administer toxoids and vaccines to a client prior to exposure to the disease-causing organism in order for the client to be protected against the disease. Immune globulins are solutions obtained from human or animal blood containing antibodies that have been formed by the body to specific antigens. Antivenins are used for passive, transient protection from the toxic effects of bites by spiders (black widow and similar spiders) and snakes (rattlesnakes, copperhead and cottonmouth, and coral). An antibody is a globulin (protein) produced by the B lymphocytes as a defense against an antigen. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
5 See full question 9s The parents of an infant are skeptical of immunizing their child, stating, "I've heard a lot about the risks of autism, and I'm not comfortable with increasing that risk." What is the nurse's best response?
"Could we talk about some of the risks that you heard about?" Explanation: The nurse should take an approach that is respectful and which fosters further dialogue without dismissing or downplaying the parents' concerns.
11 See full question 34s A client has been exposed to hepatitis A after eating at a restaurant. The client's care provider has prescribed a dose of hepatitis A immune globulin. the nurse learns that the client has a history of chronic renal failure and successfully received a donor kidney three years ago. What is the nurse's best action?
Administer the immune globulin as prescribed Explanation: Organ transplants do not contraindicate the use of immune globulins, which do not differ significantly from the antibodies that are produced by active immunity. There would be no obvious reason to admit the client for care or to increase the client's fluid intake. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note
2 See full question 8s A 55-year-old presents at the Emergency Department reporting chest tightness and difficulty breathing. The client tells the nurse they had immune sera earlier that day at the clinic. What does the nurse suspect is happening with this client?
An allergic reaction to the immune sera Explanation: Adverse effects can be attributed either to the effect of immune sera on the immune system (rash, nausea, vomiting, chills, fever) or to allergic reactions (chest tightness, falling blood pressure, difficulty breathing). Local reactions, such as swelling, tenderness, pain, and muscle stiffness at the injection site are very common. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note
1 See full question 14s A male client is brought to the Emergency Department (ED) after being bitten by a rattlesnake. The nurse asks the client to describe the snake that bit him. Why would the nurse ask this question?
Antivenin is very specific for antigens to which they can respond. Explanation: The term antivenin is used to refer to immune sera that have antibodies to venom that might be injected through spider or snake bites. These drugs are used to provide early treatment following exposure to known antigens. They are very specific for antigens to which they can respond. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note
9 See full question 15s The nurse at the pediatric clinic gives the mother of an infant a written record of the infant's immune sera use. The nurse encourages the mother to keep the information. What is the rationale behind keeping a written record of immune sera use?
Avert future reactions Explanation: Provide a written record of immune sera use and encourage the patient or family to keep that information to ensure proper medical treatment and to avert future reactions. Written records are not kept to keep track of where the immune sera was given or to identify who gave the immune sera or to identify the lot number of the immune sera used. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 586. Chapter 49: Immunologic Agents - Page 586 Add a Note
3 See full question 19s A client has undergone organ transplant and fears that she will die of a virus infection because of the postoperative anti-rejection drug therapy. The nurse should provide what information to the client about anti-rejection treatment?
CMV-IGIV is routinely administered for prevention of cytomegalovirus after organ transplant. Explanation: Cytomegalovirus immune globulin (CMV-IGIV) is routinely administered for prevention of cytomegalovirus infection after organ transplant. BIG-IV treats infant botulism. Imogam treats rabies exposure. Atgam is lymphocyte immune globulin administered as an anti-rejection agent. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note
1 See full question 7s A school nurse at a large high school is attempting to determine correct vaccine guidelines. What is the best source for current recommendations?
Centers for Disease Control and Prevention Explanation: Recommendations regarding immunizations change periodically as additional information and new immunizing agents become available. Consequently, health care providers need to update their knowledge at least annually. The best source of information for current recommendations is the Centers for Disease Control and Prevention. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
4 See full question 13s The mother of a preschool aged child brings her child to the clinic and asks what immunizations the child needs before starting school. What immunizations will the nurse expect this child needs if the child is healthy and has received immunizations on schedule in the past? Select all that apply.
Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) Inactivated poliovirus vaccine (IPV) Measles, mumps, and rubella vaccine (MMR) Hepatitis A Explanation: The 4- to 6-year-old, preparing to enter school needs booster DTaP, IPV, MMR, influenza and varicella. Hepatitis A vaccine is administered at age 2 or 3. HPV vaccine is given to older children. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note
3 See full question 26s Routine immunization can help reduce the spread of disease. Which of the following is a strategy that is used to promote routine immunization?
Combining vaccines so that only one injection is required Explanation: Two strategies to promote immunization are the development of combination vaccines and the administration of multiple vaccines during one visit to a health care provider. Combination vaccines decrease the number of injections, and giving multiple vaccines during a single visit allows patients to schedule immunizations more easily. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 585. Chapter 49: Immunologic Agents - Page 585 Add a Note
14 See full question 19s The school nurse is interviewing the family of a 5 year-old who is beginning kindergarten. The parents state that the child's immunizations are all "up to date." The nurse recognizes that the child has immunity to what illnesses? Select all that apply.
Diphtheria Varicella Tetanus Hepatitis B Poliovirus Explanation: Childhood immunization schedules dictate immunizations against polio, diphtheria, varicella, tetanus and hepatitis B. Human papillomavirus is administered at age 11 or 12. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note
6 See full question 18s The nursing instructor is discussing immunity with the clinical group. What statement would the instructor make that would be an accurate statement concerning immunity?
Passive immunity is limited. Explanation: Unlike active immunity, passive immunity is limited. It lasts only as long as the circulating antibodies last because the body does not produce its own antibodies as with active immunity. People are born with active immunity in which the body recognizes a foreign protein and begins producing antibodies to react with specific proteins or antigens. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
4 See full question 28s A 45-year-old female client is being seen at the oncology clinic for a two-year follow up for cancer. Within the past two days, the client was exposed to hepatitis A and requests immune globulin prophylaxis. The nurse checks the electronic health record and discovers the client has had extensive immunosuppressive drug therapy in the past. The nurse knows that the client's history guides the nurse to take which of the following actions?
Teach the client that the administration of immune globulin is contraindicated for clients with a history of immunosuppressive drug therapy and leukemia. Explanation: The administration of immune globulin is contraindicated for clients with a history of immunosuppressive drug therapy and leukemia. The administration of immune globulin is contraindicated for both males and females with a history of cancer or immunosuppressive drug therapy. Immune globulin prophylaxis is indicated for up to two weeks after exposure to Hepatitis A. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 583. Chapter 49: Immunologic Agents - Page 583 Add a Note
10 See full question 34s What occurs when the host human responds to the injected antibodies circulating through the body?
The host produces its own antibodies to the injected antibodies. Explanation: In some cases, the host human responds to the circulating injected antibodies, which are foreign proteins to the host's body, by producing its own antibodies to the injected antibodies. This results in serum sickness, a massive immune reaction which is manifested by fever, arthritis, flank pain, myalgia, and arthralgia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, pp. 580-582. Chapter 49: Immunologic Agents - Page 580-582 Add a Note
3 See full question 11s A 65-year-old client has come to the clinic after receiving the shingles vaccine two weeks ago. The client asks the nurse how long the immunity will last. The nurse would include which information in the explanation?
The varicella virus (shingles) vaccine protects the recipient for several years or for life. Explanation: The varicella virus (shingles) vaccine protects the recipient for several years or, in some cases, for life. There is no recommended booster vaccine available. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 581. Chapter 49: Immunologic Agents - Page 581 Add a Note
4 See full question 27s A 72-year-old female client has come to the primary care provider's office asking for the varicella virus vaccine to prevent shingles. The nurse knows that the vaccine can only be administrated to people who have never had herpes zoster before for which reason?
The varicella virus vaccine contains the live, attenuated varicella virus that causes a mild form of the infection, producing immunity against the virus. Explanation: The varicella virus vaccine contains the live, attenuated varicella virus that causes a mild form of the infection, producing immunity against the virus. The varicella virus vaccine does not include killed varicella virus. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 581. Chapter 49: Immunologic Agents - Page 581 Add a Note
5 See full question 5s A client receives an immunization. The nurse interprets this as providing the client with which type of immunity?
artificially acquired active immunity Explanation: Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual still manufactures specific antibodies against the disease. Naturally acquired active immunity occurs when the person is exposed to and experiences a disease and the body manufactures antibodies to provide future immunity to the disease. Passive immunity occurs when immune globulins or antivenins are administered. This type of immunity provides the individual with ready-made antibodies from another human or an animal. When a person is exposed to certain infectious microorganisms (the source of antigens), the body actively builds an immunity (forms antibodies) to the invading microorganism. This is called active immunity.
18 See full question 21s When teaching new parents about the benefits of adhering to the recommended vaccination schedule for their infant, the nurse should cite protection against which diseases? Select all that apply.
measles varicella poliomyelitis hepatitis B Explanation: Measles, varicella, polio, and HBV are all within the schedule of infant vaccinations. The zoster vaccination to prevent herpes zoster (shingles) is recommended for adults 60 years and older. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 588. Chapter 49: Immunologic Agents - Page 588 Add a Note
19 See full question 23s The school nurse at a junior high school shares with the student's parents that which vaccination will require administration of booster?
meningococcal vaccine Explanation: Adolescents should receive meningococcal vaccine at age 11 or 12 with a booster dose at age 16. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 587. Chapter 49: Immunologic Agents - Page 587 Add a Note
8 See full question 22s A student asks the instructor how vaccines provide active immunity. The instructor's best answer explains that active immunity is provided by stimulating production of antibodies to a:
specific protein. Explanation: Vaccines provide active immunity by stimulating production of antibodies to a specific protein, which may produce the signs and symptoms of a mild immune reaction, but protects the person from the more devastating effects of disease. All responses are essentially correct. However, "a specific protein" is the best answer to the question. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
2 See full question 11s The administration of immune globulins or antivenins to a client is a form of what type of immunity?
passive immunity Explanation: Passive immunity occurs when immune globulins or antivenins are administered. This type of immunity provides the individual with ready-made antibodies from another human or an animal. When a person is exposed to certain infectious microorganisms (the source of antigens), the body actively builds an immunity (forms antibodies) to the invading microorganism. This is called active immunity. Artificially acquired active immunity occurs when an individual is given a killed or weakened antigen, which stimulates the formation of antibodies against the antigen. The antigen does not cause the disease, but the individual still manufactures specific antibodies against the disease. Naturally acquired active immunity occurs when the person is exposed to and experiences a disease and the body manufactures antibodies to provide future immunity to the disease. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 582. Chapter 49: Immunologic Agents - Page 582 Add a Note
12 See full question 11s A nursing student is scheduled to receive the hepatitis B series. What type of immunity will this immunization provide?
passive immunity Explanation: The hepatitis B series produces passive immunity. Passive immunity occurs when antibodies are formed by the immune system of another person or animal and transferred to the host. Active immunity is produced by the person's own immune system in response to a disease caused by a specific antigen or administration of an antigen from a source outside the body, usually by injection. Innate or natural immunity, which is not produced by the immune system, includes the general protective mechanisms. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 590. Chapter 49: Immunologic Agents - Page 590 Add a Note
2 See full question 17s A nurse is educating a group of nursing students about the contraindications of human immune globulin. Which would the nurse include? Select all that apply.
preexisting renal disease age more than 65 years diabetes mellitus Explanation: Human immune globulin intravenous (IGIV) product can cause renal impairment, osmotic nephrosis, and death as its complications. Hence, it is contraindicated in individuals with acute renal failure, pre-existing renal disease, or diabetes mellitus; individuals older than 65 years; or clients receiving nephrotoxic drugs. Human immune globulin is not contraindicated in pregnancy or anemic disorders but should be administered with caution. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note
1 See full question 16s A group of students are reviewing class material about immunizations and vaccines. The students demonstrate understanding of the topic when they state that immunizations and vaccines:
provide the person with active immunity. Explanation: Vaccines provide active immunity. Severe reactions are rare. The person experiences an immune response without having to suffer the full course of the disease. Vaccines promote the formation of antibodies against a specific disease. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, pp. 580-581. Chapter 49: Immunologic Agents - Page 580-581 Add a Note
2 See full question 13s A student asks the instructor how vaccines provide active immunity. The instructor's best answer explains that active immunity is provided by stimulating production of antibodies to a:
specific protein. Explanation: Vaccines provide active immunity by stimulating production of antibodies to a specific protein, which may produce the signs and symptoms of a mild immune reaction, but protects the person from the more devastating effects of disease. All responses are essentially correct. However, "a specific protein" is the best answer to the question. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 580. Chapter 49: Immunologic Agents - Page 580 Add a Note
2 See full question 11s A client is scheduled to receive an immunization. Administration of live vaccine is contraindicated in the client with:
steroid therapy. Explanation: A risk of producing disease exists with live vaccines, especially in people with impaired immune function. Clients who are on steroid therapy should not receive live vaccines due to impaired immune function. No evidence supports withholding immunizations related to renal insufficiency or hepatic failure. Clients over the age of 65 should receive immunizations as needed to protect from infectious disease. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 584. Chapter 49: Immunologic Agents - Page 584 Add a Note
3 See full question 12s When instructing the parents of a child who has received immunization in the vastus lateralis, which reaction is most common in the days after the administration?
tenderness and redness at the site Explanation: Pain, tenderness, and redness at the injection site are associated with the administration of immunizations. Nausea, vomiting, diarrhea, rash, edema, weakness, or difficulty walking are not general reactions to immunizations. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 587. Chapter 49: Immunologic Agents - Page 587 Add a Note
13 See full question 10s A 70-year-old client is seen in the family practice clinic. Which vaccine should be administered to prevent herpes zoster?
zoster vaccine Explanation: Zoster vaccine is administered to adults 60 years and older to prevent herpes zoster (shingles). The Haemophilus influenzae type B is not administered to prevent herpes zoster. HPV and pneumococcal vaccine do not address the risk factors for shingles. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 49: Immunologic Agents, p. 589. Chapter 49: Immunologic Agents - Page 589 Add a Note
