Karch Pharmacology Ch. 18 - Vaccines and Sera

A 69-year-old patient comes to the clinic to talk to the nurse. The patient asks the nurse about when he should get the pneumonia vaccine. The patient's medical record reveals that he received the vaccine at age 55. What should the nurse tell the patient? A) "This vaccine is only given once and you have already had it." B) "This vaccine is given every 10 years and you will be due next year." C) "This vaccine is only repeated if the first dose was given before age 65. You should have another vaccine." D) "This vaccine is no longer recommended. Don't worry about getting pneumonia."

A The pneumonia vaccine contains 23 strains and is believed to offer lifetime protection. The tetanus vaccine is given every 10 years. The vaccine is recommended for anyone at risk, especially those over age 65. Options C and D are distracters.

The nurse is preparing for a visit with a 4-month-old infant. What immunizations will the nurse prepare? (Select all that apply.) A) Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) B) Inactivated poliovirus vaccine (IPV) C) Haemophilus influenzae type b vaccine (Hib) D) Varicella E) meningococcal

A, B, C 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 patient is at high risk for development of the disease before that age.

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.) A) Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) B) Inactivated poliovirus vaccine (IPV) C) Measles, mumps, and rubella vaccine (MMR) D) Hepatitis B E) Haemophilus influenzae type b vaccine (Hib)

A, B, C The 4- to 6-year-old, preparing to enter school needs booster DTaP, IPV, MMR, influenza and varicella. High-risk groups, which does not include this child, will also need HepA and MCV.

An immune compromised patient is exposed to hepatitis A virus. The physician orders an injection of immunoglobulin as prophylaxis. What adverse effects would the nurse advise the patient might occur? (Select all that apply.) A) Fever B) Rhinitis C) Angioedema D) Severe abdominal pain E) Urticaria

A, C, E Adverse effects include tenderness, muscle stiffness at site of injection; urticaria, angioedema, nausea, vomiting, chills, fever, and chest tightness. An immune compromised patient would not be told to watch for rhinitis or severe abdominal pain because these are not anticipated adverse effects.

A 55-year-old patient presents at the emergency department complaining of chest tightness and difficulty breathing. The patient tells the nurse he had immune sera earlier that day at the clinic. What does the nurse suspect is happening with this patient? A) Delayed hypersensitivity reaction B) An allergic reaction to the immune sera C) Serum sickness D) The response of the body to the immune sera

B Adverse effects can be attributed either to the effect of immune sera on the immune system (e.g., rash, nausea, vomiting, chills, fever) or to allergic reactions (e.g., chest tightness, falling blood pressure, difficulty breathing). Local reactions (e.g., swelling, tenderness, pain, muscle stiffness at the injection site) are very common. Serum sickness would manifest with fever, arthritis, flank pain, myalgia, and arthralgia.

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 what? A) A bee sting B) A specific protein C) A foreign substance in the body D) A snake bite

B 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 it protects the person from the more devastating effects of disease. This protein may be a foreign substance, a bee sting, or a snake bite, but these answers are too narrow in focus.

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? A) To keep track of where the immune sera was given B) To identify who gave the immune sera C) To avoid future reactions D) To identify the lot number of the immune sera used

C Provide a written record of immune sera use and encourage the patient or family to store that information safely 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 as this information will have no value in the future.

A mother has brought her infant to the clinic for the first immunization. What would the nurse be sure to include when providing patient education for the infant's mother? A) Avoid having her child get more than one vaccine at a time. B) Stop the immunizations after 2 years of age. C) Keep a written record of the child's immunizations. D) Omit immunizations if the injections are too upsetting for her child.

C Provide thorough patient teaching, including measures to avoid adverse effects, warning signs of problems, the need to keep a written record of immunizations, to increase knowledge about drug therapy, and to increase compliance with the drug regimen. Immunization records are often requested when the child is being enrolled in school so it is important for the mother to maintain these records. 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.

A mother brings her 18-month-old son into the clinic for his diphtheria, tetanus, and pertussis vaccine. The child has a runny nose, a fever of 102.4ºF and is coughing. What should the nurse do? A) Administer the vaccine but monitor the child afterward for an extended time period. B) Give an antipyretic and administer vaccine when temperature is within normal range. C) Administer a reduced dose of the vaccine today and a normal dose when child is healthy. D) Hold the immunization until the child is free of allergic or cold-like symptoms.

D The nurse should not administer the immunization if the child exhibits signs of acute infection because the vaccine can cause mild infection and can exacerbate acute infections. The child should be free of infection for several days before the immunization is given. Treating the fever, extended monitoring, or smaller doses will not overcome this risk and the only option is to hold the immunization until the child is healthy.

The nursing instructor is discussing immunity with her clinical group. What statement would the instructor make that would be accurate about immunity? A) Active immunity occurs with injected antibodies that react with specific antigens. B) Serum sickness results when the body fights antibodies injected as a form of active immunity. C) Passive immunity occurs when foreign proteins are recognized and the body produces antibodies. D) Passive immunity is limited, lasting only as long as the antibodies circulate.

D 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 found in 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. Serum sickness is a massive immune reaction against the injected antibodies that occur with passive immunity.

The clinic nurse is explaining recommended vaccines to the local parent-teacher association. What vaccine would the nurse tell the attendees is recommended for children older than 7 years and for adults? A) Measles-mumps-rubella (MMR) B) Typhoid C) Diphtheria D) Varicella B

Diphtheria and tetanus toxoids, combined, adsorbed (DT, Td) two IM injections of 0.5 mL at intervals of 4 to 8 weeks, with booster of 0.5 mL in 6 to12 months. Immunization is required for adults and children older than 7 years of age against diphtheria and tetanus. Tetanus booster is required every 10 years or with injury that could precipitate tetanus. Options A, B, and D are not correct.

The clinic nurse is administering vaccines at well-baby checkups. Before administering a diphtheria, tetanus, and pertussis (DTP) vaccine, what vital sign is most important for the nurse to check? A) Temperature B) Pulse C) Blood pressure D) Respirations

A Caution should be used whenever a vaccine is given to a child with a history of febrile convulsions or cerebral injury, or in any condition in which a potential fever would be dangerous. Caution also should be used in the presence of any acute infection. As a result, checking the child's temperature is most important because this would be an indicator of potential infection. The nurse should ask the mother about history of febrile seizures or any condition that would make a fever dangerous.

The nursing instructor is explaining the best way to assess whether active immunity has developed from the administration of the hepatitis B series. What would the instructor cite as the best assessment method? A) Serum antibody levels B) Liver not palpable C) Aspartate aminotransferase within normal limits D) Absence of symptoms of hepatitis B infection

A In many cases, antibody titers (i.e., levels of the antibody in the serum) can be used to evaluate a patient's response to an immunization and to determine the need for a booster dose.

The nurse is developing a written plan of care for a patient receiving vaccines. What would be an appropriate nursing diagnosis for this patient? A) Ineffective tissue perfusion if severe reaction occurs B) Chronic pain related to local, gastrointestinal (GI), and flu-like effects C) Monitoring effectiveness of comfort measures and adherence to the regimen D) Monitoring patient's blood serum levels

A Nursing diagnoses related to drug therapy might include ineffective tissue perfusion if severe reaction occurs. Option B is incorrect because vaccines do not generally cause chronic pain. Options C and D are implementations, not diagnoses.

A young mother asks the clinic nurse about the "chickenpox" vaccine. The mother states that she and her husband have both had chickenpox, but that she wants to protect her child if she can. What should the nurse tell the mother about the recommendation for the varicella vaccine? A) It is recommended for all children who have not been exposed to the varicella virus. B) It is not recommended for children under the age of 6. C) It is not recommended for children who have not been exposed to the varicella virus. D) It is recommended only for adults who have not had chickenpox.

A ProQuad is an immunization against measles, mumps, rubella, and varicella virus vaccine indicated for children aged 12 months to 12 years. Varicella virus vaccine is indicated for adults and children older than 12 months of age. Immune globulin can be administered for short-term passive immunity to those exposed to chickenpox who are at high risk for complications from the disease such as those with immunoglobulin deficiency.

The mother of a 2-month-old child tells the nurse, "I've been reading about how vaccines cause autism so I have decided not to give my child any of these vaccines." What is the nurse's best response? A) "Extensive studies have found no link between the measles-mumps-rubella (MMR) vaccine and autism." B) "Extensive studies are being conducted and so far they have not found a link to autism." C) "Research has found no link between the chickenpox vaccine and autism." D) "Many parents agree that withholding vaccines is best and that is your choice to make."

A The Immunization Safety Review Committee Board of Health Promotion and Disease Prevention of the Institute of Medicine under the auspices of the Centers for Disease Control and Prevention and the National Institutes of Health have concluded that no evidence supports any linkage between the use of MMR vaccine and the development of autism. The chickenpox virus is not involved in the debate. Although it is the mother's choice to make, many parents make an uninformed decision out of fear, so it is important for the nurse to provide the necessary education because children who do not receive essential immunizations put the community at risk. A child who is exposed to measles and then comes in contact with a pregnant woman can cause fetal damage or death.

A patient is brought to the emergency department after being bitten by a rattlesnake. The nurse asks the patient to describe the snake that bit him. Why would the nurse ask this question? A) Antivenin is very specific for antigens to which they can respond. B) Antivenin can only respond to cells that have not been attacked by the venom. C) Antivenin only responds to a specific group of spiders or snakes. D) Antivenin is very non-specific about a class of snakes or spiders.

A 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. Therefore, options B, C, and D are incorrect.

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.) A) "These are common adverse effects reported after immunizations." B) "Bring the baby back to the clinic for an examination." C) "Apply a warm moist compress to the baby's leg." D) "Aspirin can be given to manage fever symptoms." E) "Symptoms should subside within 2 to 3 days."

A, C, E 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.

The nurse explains the purpose of vaccines is to promote what? (Select all that apply.) A) Active immunity B) Passive immunity C) Short-term immunity D) Lifetime immunity E) Activation of the immune system

A, D, E 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 patients will require smaller booster doses to maintain immunity.

A public health nurse is on a mission trip to Africa where she is administering Dryvax. The patient asks the purpose of this drug and the nurse explains it will prevent what? A) Yellow fever B) Smallpox C) Chickenpox D) Rabies

B Dryvax is the immunization for smallpox disease. Varivax is the immunization for chickenpox infection. YF-Vax is the immunization for yellow fever and RabAvert is the immunization for rabies.

A male patient, aged 78 presents in the emergency department after stepping on a nail. The patient tells the nurse that he had his last tetanus shot 12 years ago and asks whether he will need another shot today. The nurse explains that tetanus boosters are required how often? A) Yearly B) Every 10 years C) Every 2 years D) Every 5 years

B Having a tetanus booster shot every 10 years will help to protect older adults from exposure to that illness. Ask the patient about any adverse reaction to previous tetanus boosters, and weigh that risk against the possible exposure to tetanus. Options A, C, and D are incorrect information to give the patient.

A 14-year-old boy is brought to the clinic by his mother. The patient has a note from his basketball coach explaining that a member of the team has been diagnosed with hepatitis A infection. The nurse notes that the patient has an extensive list of allergies. What is the nurse's priority action when administering the immune globulin? A) Perform a hepatitis A antibody check. B) Monitor the patient carefully and have emergency equipment ready if needed. C) Apply ice to the injection site to slow the absorption of the serum. D) Give the patient aspirin and a corticosteroid before the injection to modulate reaction.

B If a patient has known allergies, it is important to monitor the patient carefully and have emergency equipment ready if needed after injection of proteins such as immune globulin. Severe allergic reactions, including anaphylaxis, could occur. Ice would slow absorption of the immune globulin, delaying the reaction and delivery of the immune globulin to the bloodstream where it can act on the hepatitis A virus. If a person had hepatitis A antibodies, the immune globulin would not be needed. The delay in getting that information could be problematic if the patient had been exposed to hepatitis A. Aspirin should be avoided in children due to risk of Reye's syndrome. Corticosteroids can reduce immune response and so would be contraindicated.

The nurse works in a geriatric clinic and promotes administration of influenza immunizations to patients over age 65 how frequently? A) Once at age 65 B) Yearly C) Every 5 years D) As a one-time dose

B In addition, adults with chronic diseases are advised to be immunized yearly with an influenza vaccine, and also once with a pneumococcal pneumonia vaccine. Options A, C, and D are incorrect.

A group of nursing students are presenting information on the hepatitis B vaccine. What would the students prepare to tell others about the recommended population? A) Children under the age of 15 B) Infants and people at risk for contracting the disease C) People with diabetes mellitus or renal disease D) People over the age of 65

B Patients indicated to receive the vaccine are susceptible people and infants. Indications for receiving the vaccine do not include children under the age of 15, people with diabetes or renal disease, or all people over the age of 65.

The nurse is caring for a 35-year-old woman who came to her gynecologist today to receive a Gardasil injection. The patient says she is sexually active since age 14, admitting to more than 10 sexual partners, and has used oral birth control as a contraceptive because "I don't like using barrier methods." The provider tells the patient she is not a good candidate for the injection and the patient asks the nurse why. What is the nurse's best response? A) "Gardasil is only given to women between the ages of 9 and 26 years of age." B) "The drug is only effective if administered before exposure to human papillomavirus (HPV)." C) "The drug cannot be administered to a woman who is sexually active." D) "The drug cannot be administered until further Food and Drug Administration (FDA) testing has been completed."

B This patient is not a candidate for Gardasil primarily because she has most likely already been exposed to HPV and there would be no benefit to the injection. Gardasil is a vaccine that needs to be administered before exposure to be effective. Although the drug is normally given to women aged 9 to 26 years old, it could be given to an older person who has not become sexually active yet. Although sexual activity would not preclude administering the injection to a young girl who has had only one sexual partner, multiple partners increase the likelihood of exposure to HPV. The FDA continues to monitor testing related to the need for booster shots and the length of time the immunity remains active, as well as long-term adverse effects of the drug but the drug is available to the public by prescription.

A mother brings her 18-month-old child into the clinic for a well-baby check-up. A nurse will administer measles, mumps, and rubella vaccine (MMR) to the child. What dosage will the nurse administer? A) 1.0 mL subcutaneously B) 0.75 mL subcutaneously C) 0.5 mL subcutaneously D) 0.25 mL subcutaneously

C The nurse will administer 0.5 mL. This is the recommended dose for adults and children older than 15 months of age.

A patient is to receive a physical examination before starting immune sera therapy. What would the nurse assess for? A) Assess mental status changes B) Physical characteristics C) Pulse pressure D) Adventitious breath sounds

D 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.

The mother of a newborn is learning about immunization schedules. The nurse tells this mother her child will ideally receive the immunization for measles, mumps, and rubella (MMR) on what schedule? A) 2 months, 4 months, between 6 and 18 months, and between 4 and 6 years B) 2 months, 4 months, 6 months, and between 12 and 15 months C) Between 12 and 15 months and between 4 and 6 years D) Between 24 months and 18 years of age

C The recommended schedule for the MMR is the first dose between 12 and 15 months and the second dose between 4 and 6 years. The schedule for inactivated poliovirus is 2 and 4 months, between 6 and 18 months, and between 4 and 6 years. Immunization for Haemophilus influenzae is 2, 4, and 6 months and between 12 and 15 months. The schedule for hepatitis A is between 24 months and 18 years of age.

The nurse is presenting an educational event about vaccines at a local elementary school. When talking about vaccines, the nurse explains they are generally contraindicated in what situations? A) In people who have renal impairment B) In people who have hepatic failure C) In people who are immunosuppressed D) In people who are over 65

C The use of vaccines is contraindicated in the presence of immune deficiency because the vaccine could cause disease and the body would not be able to respond as anticipated if in an immunodeficient state, during pregnancy because of potential effects on the fetus and on the success of the pregnancy, in patients with known allergies to any of the components of the vaccine (refer to each individual vaccine for specifics, sometimes including eggs, where some pathogens are cultured), or in patients who are receiving immune globulin or who have received blood or blood products within the last 3 months because a serious immune reaction could occur. Vaccines are not contraindicated in people with renal impairment or who have hepatic failure nor are they contraindicated in people over the age of 65.

When discussing vaccines in class, a student asks the nursing instructor what an antitoxin is. What is the instructor's best response? A) It is an immune serum for snake bites. B) It is a type of vaccine. C) It is a form of active immunity. D) It is a form of passive immunity.

D 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 against 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. Antivenin is used to refer to immune sera that have antibodies to venom that might be injected through spider or snake bites.

A patient has come to the clinic for an allergy shot. The patient asks the nurse what immunoglobulin (Ig) is located in the body's tissues and is thought to be responsible for allergic reactions. What is the nurse's best response? A) IgG is thought to be responsible for allergic reactions. B) IgA is thought to be responsible for allergic reactions. C) IgM is thought to be responsible for allergic reactions. D) IgE is thought to be responsible for allergic reactions.

D IgE is the immune globulin that is associated with allergic reactions. These antibodies react with mast cells, causing the release of histamine and other inflammatory chemicals when they have combined with the antigen. IgG, IgA, and IgM are not involved in allergic reactions.

A patient, aged 72, is brought to the clinic by her daughter. The daughter asks how often her mother should receive the influenza vaccine. What would be the nurse's best response? A) "Your mother only needs the influenza vaccine once in her lifetime." B) "Your mother needs the influenza vaccine every 10 years." C) "Your mother should receive the vaccine once, with two booster injections." D) "Your mother needs the influenza vaccine yearly."

D In general, all adults with chronic diseases are advised to be immunized yearly with an influenza vaccine, and once with a pneumococcal pneumonia vaccine. Options A, B, and C are incorrect information to give to the patient and her daughter.

What occurs when the host human responds to the injected antibodies circulating through the body? A) The host forms antigen-antibody complexes with the injected antibodies. B) The host produces a passive immunity to the antibodies. C) The circulating antibodies attack the host cells. D) The host produces its own antibodies to the injected antibodies.

D 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 that is manifested by fever, arthritis, flank pain, myalgia, and arthralgia. Options A, B, and C are incorrect answers to the question.

The nurse is describing the schedule for vaccinations to the parents of a new baby. The nurse explains the measles-mumps-rubella (MMR) vaccine is first administered at what age? A) 1 month B) 3 months C) 6 months D) 15 months

D MMR is administered initially as a combined vaccine at 15 months. Therefore, options A, B, and C are incorrect.

A nurse is providing patient education to the mother of a child receiving a first immunization. The nurse tells the mother that after the injection, it is normal for the child to exhibit what signs and symptoms? A) Vomiting and diarrhea B) High fever and sweating C) Lethargy, drowsiness, and irritability D) Pain, redness, and swelling at site of injection

D Normal reactions to immunizations include pain, redness, and swelling at the site of the injection. Vomiting, diarrhea, high fever, sweating, lethargy, or drowsiness would not be expected and should be reported. The child could also be slightly irritable due to the pain at the injection site.