Chapter 31 Peds Final Immunizations
The nurse is discussing varicella immunization with a parent of a 13-month-old infant. The parent is reluctant to vaccinate because "it is not necessary." Which comment by the nurse will be most persuasive for immunization?
"Children not immunized are at risk if exposed to the disease." Rational: The most compelling argument for vaccinating for varicella is that children not immunized are at risk if exposed to the disease. The parent needs to know that the infant has a greater chance of contracting the illness if not immunized. The contagious nature of the disease, low risk of the vaccine, nor the declining rate of incidence are not appropriate explanations for why the infant should have the vaccine.
The nurse manager is orienting a new nurse. Which statement by the new nurse would indicate that the nurse manager should intervene?
"I do not need to document the vaccine manufacturer's name in the child's permanent record."
The nurse is discussing measles, mumps, and rubella vaccination with a mother who is concerned about using the combined vaccine for her 12-month-old. Which statement by the nurse will be most helpful to the mother in accepting the vaccine?
"The vaccine is shown to be effective and safe and will reduce the number of injections your child will need." Rationale: The mother may not understand that combining the vaccines creates no safety problems or effectiveness issues, and the one shot reduces the number of injections her child must endure. The other statements are true and offer some reassurance as to safety and efficacy but are not as helpful to the parent in understanding how she can protect her child from unnecessary discomfort.
Which question by the nurse is the best one to elicit complete information about a young boy's immunization status?
"When and where did your child receive his last immunization?"
A mother tells the nurse that she is newly pregnant and asks about her 15-month-old's need for the chicken pox immunization because her two older children did "fine" when they had the disease. What is the nurse's best response?
"When your child avoids chicken pox, it protects other children from being exposed to the disease. Some cannot be immunized because of their health conditions."
A nurse is working to provide health promotion services throughout the community. What institutions or organizations best serve as important avenues for disseminating health promotion information? Select all that apply.
A. Churches, synagogues, and mosques B.Schools (public and private) C. Day care centers
The nurse will record what information about each vaccine after immunizing a child? Select all that apply.
A. lot number and expiration date of vaccine B. site and route of vaccine administration C. manufacturer of vaccine
The nurse is preparing to administer a diphtheria, tetanus and pertussis vaccine to a 3-year-old child. Which version of the formulation of the vaccine should be administered?
DTaP Rationale: The vaccine currently used for children younger than age 7 is diphtheria, tetanus, acellular pertussis (DTaP). The older version of this vaccine was DPT. Diphtheria and tetanus (DT) vaccine is used for children younger than age 7 who have contraindications to pertussis immunization. The TdaP is used clients over the age of 7.
The nurse is preparing to administer a routine vaccine to a pediatric client. When obtaining the vaccine, the nurse discovers the refrigerator containing the facility's vaccines has been unplugged for an unknown amount of time and is warmer than the proper storage temperature. Which action by the nurse is appropriate?
Discard all of the vaccines and reschedule the child for another appointment
Infants born to mothers who are HbsAg (hepatitis B surface antigen)-positive need to receive the hepatitis B immunoglobulin (HBIg) within how many hours?
HBIg needs to be given within 12 hours.
A nurse asking questions during an infant's health surveillance visit has the mother tell her: "My baby was premature and weighed 3 pounds at birth." The medical record provides an Apgar score of 5 at 5 minutes and indicates the child received gentamicin in the neonatal intensive care unit (NICU). What should the nurse consider as the greatest risk for this child?
Hearing deficit The greatest risk is for a hearing deficit. All factors point in that direction: low birth weight, Apgar less than 6 at 5 minutes, and having received an ototoxic medication. This child should have had a hearing evaluation prior to discharge from the NICU and now should be screened periodically at well-child visits. This premature infant is also at risk for anemia, hypertension, feeding problems, visual defects, and gross motor problems that would not be of the same concern in the full-term child. pg 245
The student nurse is working on a program to address barriers to immunizations. Which would be an example of an intervention that the student nurse should include?
Providing combination vaccines to reduce the number of shots the child is to receive. Rationale: One of the top parental concerns regarding vaccine safety is that too many vaccines are given during a single office visit. Manufacturer-produced combination vaccines address this issue. Scheduling separate appointments for each child in a family actually increases the barriers to proper immunization. Modified vaccine schedules can put the child at risk for contracting a disease. Free immunizations can be administered at a variety of agencies, not just public health agencies.
The nurse is preparing to administer an intramuscular immunization to a 1-month-old infant. What action will the nurse take?
Request the parent to remove the infant's pants so the vastus lateralis muscle is accessible.
While enrolled in a geography course, a student nurse learns that diarrheal illness is deadly for large numbers of infants in Third World countries. What vaccine will this nursing student identify as part of the solution to this problem?
Rotavirus (RV) Rotavirus is a very common cause of gastroenteritis among young children that spreads readily via the fecal-oral route. The disease is most severe in children between 4 and 23 months, causing severe, watery diarrhea that results in dehydration. The other vaccines do not prevent diarrheal illness. pg 261
Before administering an immunization to their child, the nurse asks parents to take which priority action?
Sign a consent form Parents must sign a consent form before immunization of the child after receiving full information about the vaccines, their importance, and their administration. Reassuring the child and assisting in restraining are both important but are not the priority. Having the child's immunization record with them allows this record to be updated; otherwise, a full record should be given to the parent
During a well-check for a 2-year-old client, the nurse notes the client's vaccinations are not up to date. The caregiver states, "It is hard to make it to all the appointments, but my child will get caught up before going to school." Which response by the nurse is most appropriate?
To prevent serious illnesses, it is vital your child receive all vaccines as scheduled." Rationale: The most important tool to increase immunization awareness is education. The nurse would educate the caregiver on the importance of the child receiving vaccinations first. The nurse should not guilt the caregiver by stating the child is "worth it," nor can the nurse generalize a statement about the health of the child such as "I think things will be okay." Depending on the laws of the school district the child will attend, vaccines may be required before starting school; however, the caregiver has already stated this knowledge.
Curious parents ask what type of immunity is provided to their child through immunization with various vaccines. What will be the nurse's answer?
artificially acquired active immunity Rationale: Artificially acquired active immunity develops through vaccine administration of an antigen that stimulates the child's body to produce antibodies against that antigen (pathogen) and to remember the antigen should it reappear. Natural immunity is produced through natural invasion of an antigen (pathogen). Natural and artificial passive immunity involves providing antibodies to fight a pathogen rather than expecting the child's body to produce them. This type of immunity has a short life.
