Immunizations

A four-month-old infant is in the clinic to receive vaccinations. The infant experienced redness and swelling at the injection site following the first dose of diphtheria, tetanus, & acellular pertussis (DTaP). The infant's parent asks whether the infant should receive the second dose. How should the nurse respond?

Explain that this was a mild reaction and is not a contraindication for the next dose. The nurse should explain that localized redness and swelling are common mild reactions and these are not considered contraindications for the next dose of DTaP.

The nurse teaches the parents of an infant about which sign of a mild reaction that may occur after vaccination?

Loss of appetite Loss of appetite is a common mild reaction, particularly in infants, along with fussiness and sleepiness. This is not a medical emergency, and it should be self-limiting.

An infant is at the clinic for a Nine-month well visit. The nurse reviews the chart and notes the infant did not receive the third DTaP vaccine at the six month visit. Which action by the nurse is most appropriate?

Give third dose The nurse should give the third dose at the nine month well visit since this will allow the infant to catch up.

In which ways can healthcare reform improve immunization rates? Select all that apply.

Provide free or low-cost vaccinations Providing free or low-cost vaccinations is a way healthcare reform can overcome barriers to immunization. Increase the number of clinics providing vaccinations Increasing clinics providing vaccinations is a way healthcare reform can overcome barriers to immunization. Increase the availability of vaccines without need for health care provider referral Increased availability of vaccines without the need for health care provider referral is a way healthcare reform can overcome barriers to immunization.

The nurse is reviewing the immunization record of a 10-week-old infant in the clinic for a well visit. The infant received the second dose of Hepatitis B (Hep B) and the first dose of rotavirus (RV1) at eight weeks of age. Which vaccines should the nurse prepare to administer at this visit?

Inactivated poliovirus (IPV) The nurse should prepare to administer the first dose of IPV, which should be given at two months of age. Pneumococcal conjugate (PCV13) The nurse should prepare to administer the first dose of PCV13, which should be given at two months of age. Haemophilus influenzae type b (Hib) The nurse should prepare to administer the first dose of Hib, which should be given at two months of age. Diphtheria, tetanus, & acellular pertussis (DTaP) The nurse should prepare to administer the first dose of DTaP, which should be given at two months of age.

A 15-year-old patient is in the clinic for a well visit. The nurse notes that the patient received the first Hep B vaccination with Recombivax HB over eight months ago and the second dose four months ago. Which action is most appropriate?

No action is necessary because Recombivax HB is a dose-dose series. Recombivax HB is an adult formulation licensed for use for individuals aged 11 through 15 years. It is a two-dose series, and the doses are recommended to be administered with an interval of four months.

A 17-year-old patient has recently been diagnosed with Hodgkin disease (a type of lymphoma or blood cancer). The nurse reviews the immunization record and notes that the patient is up to date on all regularly scheduled vaccines. The nurse prepares to administer which additional vaccine for this high-risk patient?

Pneumococcal conjugate (PPSV23) Even though the patient has received the four-dose series of pneumococcal conjugate (PCV13), the CDC recommends adose of PPSV23 for patients ages 6 to 18 who are in certain high-risk groups. one dose of PPSV23 should be administered at least eight weeks after the most recent dose of PCV13.

A two-year-old child is in the clinic for a well visit. The nurse notes that the patient's vaccinations are up to date. Which additional vaccination would the nurse suggest to the provider after noting a recent diagnosis of type one diabetes mellitus?

Pneumococcal polysaccharide (PPSV23) The nurse would suggest the pneumococcal polysaccharide (PPSV23) vaccine for this patient, due to the recent diagnosis of diabetes mellitus. The CDC recommends that providers administer PPSV23 at least eight weeks after the most recent dose of PCV13 for children with certain high-risk conditions.

A 12-month-old infant is brought to the clinic for a well visit. The parents ask if their infant can receive the diphtheria, tetanus, & acellular pertussis (DTaP) vaccine today. The nurse reviews the chart and notes that the infant's DTaP #3 was administered at age eight months. Which is the best response by the nurse?

"The last DTaP was very recent. We will schedule the next dose in two more months." The fourth dose of (DTaP) may be given as early as age 12 months, provided that at least six months have elapsed since the last dose. In two more months, the next dose should be administered, but it is not advised to administer the dose before then. See catch-up immunization schedule.

The nurse administers a dose of the human papillomavirus (HPV) vaccine to an 11-year-old patient in the clinic. The nurse should provide which instruction to the patient's parents?

"Your child needs the second dose in one to two months." Human papillomavirus (HPV) is a three-dose series. The first dose was given today. The second dose should be administered in one to two months. The third dose is administered 16 weeks after dose #2.

A nurse is planning to teach a class on overcoming barriers to immunization through patient and family education. Which examples of this should the nurse include?

Educate parents about the safety of vaccinations. Educating parents about the safety of vaccinations helps parents feel more comfortable and knowledgeable about the care their child is receiving. It can also help identify and resolve any misconceptions they may have. Educate parents about the difference between mild and serious vaccine reactions. Educating parents about the differences between mild and serious vaccine reactions can help them to feel less worried if their child experiences a common mild reaction after receiving a vaccine. Mild reactions are not dangerous and are not a reason to avoid future doses. Educate parents about the individual and societal importance of vaccination. Parents should understand the benefit for their own child's safety and health as well as the role vaccination plays in protecting the health of the community.

A nine-year-old patient comes to the clinic before a trip to China. The nurse reviews the record and notes that the patient has received the following vaccine doses: 3 Hep B, 2 RV1, 5 DTaP, 4 HIB, 4 PCV13, 2 MMR, and 2 Varicella. Which vaccination(s) will the nurse recommend?

Hep A The nurse should recommend Hep A vaccination at this time because of the upcoming trip to China. The CDC recommends that individuals who will be traveling to countries that have high or intermediate rate of infection should receive Hep A before traveling.

Which vaccinations are appropriate to administer at a one-month well visit?

Hep B #1 Hep B can be given at a one-month visit. Administer Hep B #1 at one-month visit if no prior dose was given at birth. It is permissible to give Hep B #2 at the one-month visit if Hep B #1 was given at birth.

The nurse is caring for a four-year-old patient receiving chemotherapy for non-Hodgkin's lymphoma. The patient is up to date on regularly scheduled vaccines. Which additional vaccine dose does the nurse recommend for this patient?

Hib Haemophilus influenzae type b vaccine is indicated for patients aged 12 to 59 months (just under five years) who are in certain high-risk groups, including those who are receiving chemotherapy.

The nurse is reviewing the patient education handout with the parent of a patient. The parent asks, "Can you tell me if any of these risks are really serious?" Which does the nurse identify as an example of a rare, but serious, reaction a patient may experience following vaccination?

Seizure A seizure is a rare, but severe and potentially dangerous reaction that can lead to permanent brain damage. In very rare instances, seizure may be long-lasting and lead to coma. This reaction is a medical emergency.

The parents of a young child explain that they do not want the child vaccinated because they are afraid the child will suffer permanent injury as a result of adverse immunization effects. In which way(s) should the nurse address the concerns of these parents?

-Provide a printed vaccine information sheet describing the safety of vaccination. Providing written materials describing the safety of vaccinations will help relieve anxiety the parents may have. -Verbally educate the parents about the common, mild adverse effects of vaccination. Verbally educating the parents about the common, mild adverse effects to vaccinations can help relieve anxiety the parents may have about the adverse effects their child may experience.

An 11-year-old patient is seen in the clinic. The nurse notes that the patient received all recommended vaccines up until the age of 6. After the child's parents give consent, what action does the nurse take?

Administer the Tdap vaccine The nurse should administer tetanus, diphtheria, & acellular pertussis (Tdap). This vaccine is recommended for patients aged seven years and older who are not fully immunized with DTaP. If additional doses are needed, the Td vaccine is used.

An 18-year-old patient with human immunodeficiency virus (HIV) presents to the clinic for a second meningococcal vaccine. The nurse notes that the patient received the first Menactra vaccine nine weeks ago. Which is most appropriate nursing action?

Administer the meningococcal vaccine immediately. The nurse should administer the second dose of the meningococcal vaccine (Menactra) to this high-risk patient. Adolescents aged 11 through 18 years with human immunodeficiency virus (HIV) infection should receive a two-dose primary series of Menactra or Menveo with at least eight weeks between doses. The patient received the first dose nine weeks ago and the second dose may be given now.

The nurse should advise parents about which mild reaction that may occur one to two weeks after receiving the live, attenuated influenza vaccine [LAIV)?

Fever Live, attenuated influenza vaccine (LAIV) is a live vaccine. Live vaccines can cause a fever as the immune system reacts during the first one to two weeks after the vaccination. This is considered a mild reaction and is not a contraindication to future doses.

A 12-year-old with Hodgkin disease (a type of lymphoma or blood cancer) visits the clinic for a well child visit. The nurse reviews the immunization record and sees that the patient is up to date on all regularly scheduled vaccinations and also received 1 dose of PPSV23 at age 7. The patient later received 1 dose of meningococcal vaccine, 1 dose of Tdap, and 3 doses of HPV vaccine at age 11, and the annual influenza vaccine each year. Which vaccination does the nurse suggest that the patient receive at this visit?

PPSV23 vaccine For many children in high-risk groups, including those with Hodgkin disease, a single booster dose of PPSV23 should be administered five years after the first dose. This patient received the first dose of PPSV23 at age seven years (after the PCV13 series was complete), so dose two can be administered now.

The nurse is teaching the parents of an infant about adverse vaccine reactions. The nurse explains that which of these is considered a medical emergency?

Seizure It is rare, but seizures may occur after vaccination. Seizures are a medical emergency because in some instances, they may lead to brain damage or coma. If this serious adverse effect is observed, parents should seek immediate medical attention.

An unimmunized five-month-old infant is brought to the clinic. The parents decide to vaccinate the infant. Based on the catch up schedule, what vaccines will the infant need to receive today?

Inactivated poliovirus (IPV)The infant will receive IPV #1 today. The infant may receive IPV #2 in four weeks (per catch up schedule). Pneumococcal conjugate (PCV13)The infant will receive PCV13 #1 today. The infant may receive PCV13 #2 in four weeks (per catch up schedule). Haemophilus influenzae type b (Hib) The infant will receive Hib #1 today. The infant may receive Hib #2 in four weeks (per catch up schedule). Diphtheria, tetanus, & acellular pertussis (DTaP) The infant will receive DTaP #1 today. The infant may receive DTaP #2 in four weeks (per catch up schedule).

A 12-year-old patient was recently diagnosed with sickle cell disease. The nurse notes that the patient is up to date with regular vaccines including completion of the four-dose series of PCV13 by age 15 months. The patient received one dose of PPSV23 and one dose of meningococcal vaccine nine weeks ago. Which vaccine does the nurse expect to administer today?

Administer a dose of meningococcal vaccine. Children with certain health conditions including sickle cell disease who have not yet received a complete series of meningococcal vaccine are recommended to receive two doses in a series, separated by at least eight weeks. This 10-year-old patient was recently diagnosed, so the patient would not have received the meningococcal vaccine series previously (the first dose is given at age 11 years). This dose should now be administered.

A healthy child is brought to the clinic for a 15-month well visit. The nurse notes that the toddler received haemophilus influenzae type b (Hib) #4; measles, mumps, rubella (MMR)#1; and pneumococcal conjugate (PCV13)#4 at the one-year visit. Which vaccination(s) will the nurse prepare for this visit?

Diphtheria, tetanus, & acellular pertussis (DTaP) The nurse will prepare the fourth dose of diphtheria, tetanus, & acellular pertussis (DTaP) at this visit. DTaP is given at age 15 to 18 months unless it was given at 12 months. Varicella (VAR) The nurse will prepare the first dose of varicella (VAR), which is to be given at 12 to 15 months. The second dose will be given at four to six years.

A nurse is studying rates of immunization among immigrant families in a large city. The nurse plans to gather data on how improved communication affects the rate of immunization in this population. Which are examples of communication that the nurse would expect to improve immunization rates?

-Documentation of vaccinations administered Timely and accurate documentation of all vaccinations administered improves communication between health care providers and facilitates the efficient delivery of immunizations according to the recommended schedule. -Use of interpreters for teaching patients and families with a language barrier Health care providers should use an interpreter to teach patients and families with a language barrier about the importance and risks associated with vaccines. This allows providers to answer questions and to be the teaching has been effective. -Providing vaccine information sheets prior to obtaining consent to vaccinate Providing the patient and family with vaccine information sheets prior to obtaining consent to vaccinate will help answer some of the common questions parents have about the vaccines their child will receive.

The nurse is reviewing the immunization record for a healthy six-month-old patient at a well visit. The record indicates that the patient received all the recommended vaccines up to this point, including two doses each of RV1, PCV13, and DTaP. Which vaccine(s) should the nurse prepare for this visit? Select all that apply.

Hepatitis B (Hep B) The third dose of Hep B is usually administered at the six month visit. The first doses of Hep B are administered at birth and again between one to two months of age. The third dose of Hep B is administered between 6 and 18 months of age. Inactivated poliovirus (IPV) The nurse should prepare inactivated poliovirus (IPV) for this visit. This vaccine may be administered any time between 6 and 18 months of age. The final dose in the IPV series can be administered on or after the fourth birthday, at least six months after the last dose. Pneumococcal conjugate (PCV13) The nurse should prepare pneumococcal conjugate (PCV13) for this visit. This will be the third dose in the four-dose series. The final dose of PVC13 will be administered between 12 to 18 months of age. Diphtheria, tetanus, & acellular pertussis (DTaP) The nurse should prepare the third dose of diphtheria, tetanus, & acellular pertussis (DTaP) to administer at the visit. The first two doses are administered at two and four months of age, the third at six months, the fourth between 15 and 18 months, and a booster is given between four and six years of age.

The school nurse is auditing the students' immunization records. The nurse reviews the record of a six-year-old who has received four doses of DTaP, three doses of IPV, two doses of MMR, and two doses of varicella since age four. The nurse makes a note to follow up with the student's parents about which vaccine(s)? Select all that apply.

Influenza (LAIV) The school immunization record does not indicate that the child has received any annual influenza vaccinations. This vaccine is recommended to all healthy individuals beginning at age six months. Inactivated poliovirus (IPV) The fourth and final dose of inactivated poliovirus (IPV) is given between four and six years of age. The record indicates that only three doses of IVP have been administered. To remain up to date, this child should see the primary care provider to receive this vaccine soon. Diphtheria, tetanus, & acellular pertussis (DTaP) The fifth dose of diphtheria, tetanus, & acellular pertussis (DTaP) is given between four to six years of age. This child's record indicates that only four doses have been administered to date. The child should receive another dose of DTaP to remain up to date.

The parents of an infant ask for information about the vaccines their child is scheduled to receive at the upcoming four-month well visit. The nurse provides patient education handouts about which vaccine(s) typically administered at four months of age?

Rotavirus (RV1) Rotavirus is administered at the four month visit. If Rotarix (RV1) is used, this would be the second and final dose. If RotaTeq (RV5) is used for either the first or second dose, then a three-dose series is required at ages two, four, and six months. Inactivated poliovirus (IPV) The IPV vaccine is administered at the four month visit. This is the second shot in the series. The next will be due between 6 and 18 months of age. Pneumococcal conjugate (PCV13) Pneumococcal conjugate (PCV13) is administered at the four month visit. This four-dose series is administered at ages two, four, and six months and again between 12 and 15 months of age. Haemophilus influenzae type b (Hib) Haemophilus influenzae type b (Hib) is due at the four month visit. Depending on the specific vaccine used, this may be the final dose in a two-dose primary series or another dose may be required to complete the primary series. A booster dose is administered between 12 to 15 months of age to complete the full Hib series.

An 11-year-old patient is in the clinic for a well visit. The nurse notes that the patient has previously received three doses of Hep B, two doses of Hep A, four doses of Hib, four doses of PCV, four doses of IPV, two doses of MMR, and one dose of VAR. Which vaccines will the nurse plan to administer today?

Varicella (VAR) The nurse will plan to administer the second and final dose of varicella (VAR) vaccine. This vaccine series is recommended to be administered at age 12 to 15 months and age four to six years, but since the patient has only received one dose to date, the nurse will plan to administer the second catch up dose today. Human papillomavirus (HPV) The nurse will plan to administer the first of the three-dose HPV series today. The recommendation is to administer the three doses on a schedule of zero, one to two, and six months to all adolescents aged 11 to 12 years. Meningococcal conjugate vaccine The nurse will plan to administer the first dose of meningococcal vaccine today. A single dose of Menactra or Menveo should be given at age 11 to 12 years, with a booster dose at age 16 years. Tetanus and diphtheria toxoids and acellular pertussis (Tdap) The nurse will plan to administer the first and only dose of Tdap, which is recommended at age 11 to 12 years. Tdap may be administered regardless of when the last tetanus and diphtheria toxoid-containing vaccine was given.