Ch 12: Drug Therapy: Immunizations

a) Tuberculosis Pg. 211 Immunization for tuberculosis occurs worldwide, but it is not routinely used in the United States.

18. After teaching a group of students about the standard childhood immunizations given today, the instructor determines that the students need additional teaching when they identify which as a common disease for which immunizations are given? a) Tuberculosis b) Diphtheria c) Pertussis d) Poliovirus

c) 0.5 mL Pg. 213 The nurse will administer 0.5 mL. This is the recommended dose for adults and children older than 15 months of age.

1. A mother brings her 18-month-old into the clinic for a well-baby check-up. A nurse will administer measles, mumps, and rubella vaccine (MMR) to the 18-month-old. What dosage will the nurse administer? a) 0.05 mL b) 5 mL c) 0.5 mL d) 0.005 mL

b) The client is currently prescribed prednisone Pg. 220 The use of corticosteroids such as prednisone could alter the body's desired response to a vaccine. A loop diuretic has no significant effect and the client's age is not a contraindication. It is unnecessary to know the client's blood type.

10. A client has presented to the clinic and is requesting the seasonal influenza vaccine. What aspect of the client's health history may contraindicate the safe and effective use of this vaccine? a) The client does not know their blood type and it is not recorded in available health records b) The client is currently prescribed prednisone c) The client is 76 years-old d) The client takes a loop diuretic for the treatment of hypertension

b) A client who takes immunosuppressants post-renal transplant Pg. 219 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. 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.

28. The infection control nurse is assessing the immunization status of many of the hospital's current clients. For what client would vaccination most likely be contraindicated? a) A client who receives dialysis three times weekly for chronic renal failure b) A client who takes immunosuppressants post-renal transplant c) A client who is 82 years old and who has type 1 diabetes d) A client with alcoholic liver disease

b) A tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age Pg. 211 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.

11. The nurse is educating an older adult client on routine vaccines. Which statement best describes the recommended vaccination schedule for an older adult client? a) A tetanus-diphtheria booster every 2 years, annual influenza vaccine, and a yearly administration of pneumococcal vaccine b) A tetanus-diphtheria booster every 10 years, annual influenza vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age c) A tetanus-diphtheria booster and influenza vaccination every fall or winter d) An influenza vaccine booster every 10 years, annual tetanus-diphtheria vaccine, and a one-time administration of pneumococcal vaccine at 65 years of age

a) Rabies vaccine Pg. 215 The ranger has to be administered the rabies vaccine as prophylaxis as he is at high risk for contracting the virus. The MMR vaccine is used in treating measles, mumps, and rubella. The varicella vaccine is used in chickenpox, and the rotavirus vaccine is used in preventing gastroenteritis caused by the rotavirus.

12. A forest ranger arrives at a community clinic for prophylactic vaccination. Which vaccine would be most important to be administered to the ranger? a) Rabies vaccine b) Varicella vaccine c) Measles, mumps, and rubella (MMR) vaccine d) Rotavirus vaccine

c) Three months after his cancer treatment is completed Pg. 219 For clients with active malignant disease, live vaccines should not be given. Although killed vaccines and toxoids may be given, antibody production may be inadequate to provide immunity. If possible, clients should receive needed immunizations 2 weeks before or 3 months after immunosuppressive radiation or chemotherapy treatments.

13. A male client is treated for his cancer of the colon with a combination of chemotherapy and radiation therapy. During a routine provider visit, the nurse determines that the client is behind in his immunizations. For when should the nurse schedule immunizations? a) This appointment b) 30 days after his cancer treatment is completed c) Three months after his cancer treatment is completed d) The next routine appointment

d) Centers for Disease Control and Prevention Pg. 221 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.

14. What is the best source of information for current recommendations regarding immunizations and immunization schedules? a) Local health care provider's office b) Department of Public Health c) Department of Epidemiology d) Centers for Disease Control and Prevention

a) Hepatitis A b) Measles, mumps, and rubella vaccine (MMR) d) Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) e) Inactivated poliovirus vaccine (IPV) Pg. 211 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.

15. The parent of a preschool aged child asks what immunizations the child needs before starting school. If the child is healthy and has received immunizations on schedule in the past, which immunizations should the nurse anticipate the child needing? Select all that apply. a) Hepatitis A b) Measles, mumps, and rubella vaccine (MMR) c) Human papillomavirus d) Diphtheria and tetanus toxoids and acellular pertussis vaccine, adsorbed (DTaP) e) Inactivated poliovirus vaccine (IPV)

c) Temperature Pg. 221 Caution should be used any time 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.

16. A clinic nurse is administering vaccines at well-baby check-ups. The nurse knows that before administering a DTP vaccine, the nurse should check what vital sign? a) Respirations b) Pulse c) Temperature d) Blood pressure

d) Vaccines are used to provide active immunity Pg. 210 Immunization is the process of using vaccines to artificially stimulate active immunity. They promote the formation of antibodies against a specific disease. The person experiences an immune response without having to suffer the full course of the disease. Severe reactions are rare.

17. When describing the use of vaccines to a local community group, what would the nurse include? a) Vaccines promote the development of antigens b) Vaccines can result in signs and symptoms of the full-blown disease c) Vaccines are associated with severe reactions in children d) Vaccines are used to provide active immunity

b) "The drug is only effective if administered before exposure to human papillomavirus (HPV)" Pg. 211 This client 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.

19. The nurse is caring for a 30-year-old woman who came to her gynecologist today to receive a Gardasil injection, stating that she believes that she may have genital warts. What should the nurse teach this client? a) "The drug cannot be administered until further Food and Drug Administration (FDA) testing has been completed" 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) "Gardasil is only given to women between the ages of 9 and 26 years of age"

c) I know that this booster is good for 10 years Pg. 211 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.

2. An elderly client has been given a tetanus-diphtheria (Td) booster after stepping on a rusty nail. Which statements indicate an understanding of vaccine schedules? a) I know that I do not need to worry about infection after getting this injection b) I know that this injection is good for 1 year c) I know that this booster is good for 10 years d) I know that I will need to return in 6 months for another injection

d) Epinephrine pen Pg. 221 Health care providers who are administering vaccines should have aqueous epinephrine 1:1000 readily available to allow immediate treatment of any allergic reaction.

20. A nurse is working at a free vaccination clinic today and expects to give vaccinations to more than one hundred children. Which item is most important to have available? a) Crash cart b) Cold packs c) Oxygen cylinder d) Epinephrine pen

d) CMV-IGIV is routinely administered for prevention of cytomegalovirus after organ transplant Pg. 217 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.

21. 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? a) BIG-IV is routinely administered for prevention of general virus infections after organ transplant b) Imogam is routinely administered for prevention of specific virus infections after organ transplant c) Atgam is routinely administered for prevention of virulent virus infections after organ transplant d) CMV-IGIV is routinely administered for prevention of cytomegalovirus after organ transplant

c) The client takes corticosteroids to treat rheumatoid arthritis Pg. 219 Corticosteroids decrease the normal immune response and could interfere with the intended stimulation of B cells. Recent influenza vaccination does not contraindicate the hepatitis vaccine, nor does type 2 diabetes. Occasional marijuana use would not contraindicate a hepatitis vaccination.

22. A client has come to the clinic requesting a hepatitis A and B vaccination before leaving on a tropical vacation. After assessing the client, the nurse should prioritize what finding to communicate to the provider? a) The client received the annual influenza vaccine seven days ago b) The client has type two diabetes that is controlled by diet c) The client takes corticosteroids to treat rheumatoid arthritis d) The client uses marijuana two to three times per month

d) 30 minutes Pg. 221 The client should be asked to stay in the health care provider's office for about 30 minutes after the injection of immune globulin so the nurse can observe for any signs of hypersensitivity. Reactions usually occur within the first 30 minutes.

23. If a nurse is administering immune globulin to a client in the health care provider's office, the nurse would monitor the client for hypersensitivity reactions for how long after administering the drug? a) 60 minutes b) 15 minutes c) 5 minutes d) 30 minutes

a) Review the procedure for intramuscular injection Pg. 213 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.

24. A nurse is participating in an influenza vaccination clinic on a college campus. What action will best prepare the nurse for this role? a) Review the procedure for intramuscular injection b) Ask participants to identify their blood type, if known c) Review appropriate landmarking for subcutaneous injection d) Prepare to educate each client about serum sickness

b) Shingles vaccine Pg. 211 Vaccine to prevent shingles is available for adults aged 60 years and older.

25. A 65-year-old male client lives in a long-term care facility. The infection control nurse identifies a cluster of clients on the unit diagnosed with shingles. What would the nurse expect the client's prescriber to order? a) Isolation of the client's peers b) Shingles vaccine c) HBV vaccine d) Isolation of the client

a) 3 months after chemotherapy is completed Pg. 219 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.

26. A female client is receiving chemotherapy for breast cancer. She requires a vaccine booster. For when would the health care provider order the administration of the vaccine? a) 3 months after chemotherapy is completed b) 30 days after chemotherapy is completed c) 6 months after chemotherapy is completed d) 1 year after chemotherapy is completed

a) Vaccine Pg. 213 Meningococcal infections would be prevented by a vaccine. A toxoid is a type of vaccine made from the toxins produced by the organism. Immune globulins and antivenin are examples of immune sera.

27. To prevent meningococcal infections, the nurse would administer: a) Vaccine b) Toxoid c) Immune globulin d) Antivenin

b) Chills and fever Pg. 222 Chills and fever are mild adverse reactions observed after administration of vaccines. None of the other options are generally associated with mild adverse reactions to vaccines.

29. The nurse educator is teaching a class of community leaders about immunologic agents. To minimize the concern regarding adverse effects of vaccinations, the nurse should include which mild reactions in the teaching plan? a) Rash and itching b) Chills and fever c) Nausea and vomiting d) Insomnia and hyperactivity

d) It is recommended for all children who have not been exposed to the varicella virus Pg. 211 Measles, mumps, rubella, varicella virus vaccine 0.5 mL Sub-Q. Simultaneous immunization against measles, mumps, rubella, and varicella in children aged 12 months to 12 years.

3. 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 chickenpox vaccine? a) It is recommended only for adults who have not had chickenpox b) It is not recommended for children who have not been exposed to the varicella virus c) It is not recommended for children under the age of 6 d) It is recommended for all children who have not been exposed to the varicella virus

a) People who receive hemodialysis Pg. 212 Pre-exposure immunization against hepatitis B is recommended for high-risk groups. These may include health care workers; clients with cancer, organ transplants, hemodialysis, immunosuppression drug therapy, or multiple infusions of blood products;sexually active gay and bisexual males; IV drug users; household contacts of HBV carriers; and residents and staff of institutions for people with intellectual disability.

30. For what group of adults is pre-exposure immunization against hepatitis B recommended? a) People who receive hemodialysis b) People over the age of 70 c) People with chronic illnesses d) People in their 20s

d) Measure the employee's serum antibody levels Pg. 212 Antibody titers (i.e., levels of the antibody in the serum) can be used to evaluate a client's response to an immunization and to determine the need for a booster dose. This is a more direct assessment than assessing liver enzymes, signs and symptoms or performing palpation.

4. An employee of a long-term care facility has been administered the hepatitis B series prior to beginning employment. How should the employee's therapeutic response to the vaccination be best assessed? a) Attempt to palpate the employee's liver and spleen b) Monitor the client for signs and symptoms of hepatitis B infection c) Monitor the client's bilirubin, AST, ALT, and albumin levels d) Measure the employee's serum antibody levels

c) Tetanus Pg. 210 The vaccine for tetanus is a toxoid. The vaccines for haemophilus influenza B and pneumococcal polyvalent are bacterial vaccines. Hepatitis A is a viral vaccine.

5. What would the nurse identify as a vaccine that is a toxoid? a) Pneumococcal polyvalent b) Haemophilus influenza B c) Tetanus d) Hepatitis A

b) Live vaccines Pg. 219 Clients with active malignant disease may be given killed vaccines or toxoids but should not be given live vaccines. (An exception is persons with leukemia who have not received chemotherapy for at least 3 months.)

6. What type of vaccine is contraindicated in clients who have active malignant disease? a) Attenuated vaccines b) Live vaccines c) Killed vaccines d) Toxoids

a) Infants and people at high risk for contracting the disease Pg. 212 As recommended by the World Health Organization and the CDC, the hepatitis B vaccine should be given to infants and should be given to all children under the age of 18/19 that have not been previously recommended. The vaccine is also recommended in certain high-risk populations among adults. While this population includes children under the age of 15, the vaccine is recommended for all children under the age of 18 or 19. There are not indications to receive the vaccine for people with diabetes or renal disease or all people over the age of 65.

7. 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) Infants and people at high risk for contracting the disease b) People over the age of 65 c) People with diabetes mellitus or renal disease d) Children under the age of 15

c) You should wait at least 3 months after prednisone therapy to obtain a live vaccine immunization Pg. 219 Patients 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.

8. Your client is taking prednisone 40 mg daily. When providing client education about immunizations, which of the following would you include in your teaching? a) You should wait at least 2 weeks after prednisone therapy to obtain a live vaccine immunization b) You cannot be given a live vaccine immunization after receiving prednisone therapy c) You should wait at least 3 months after prednisone therapy to obtain a live vaccine immunization d) Immunizations are not contraindicated when taking prednisone

d) Tetanus-diphtheria-pertussis; hepatitis B vaccine once; influenza vaccine annually Pg. 219 Middle-aged adults should maintain immunizations against tetanus-diphtheria-pertussis. Health care providers should receive hepatitis B vaccine once (if not previously taken). The influenza vaccine is recommended annually for everyone over the age of 6 months. An additional vaccine to prevent zoster infections (shingles) is available for adults aged 60 years and older. Middle-aged adults born after 1956 should get at least one dose of measles-mumps-rubella (MMR) vaccine unless they have had either the vaccine or each of the three diseases.

9. The nurse is providing wellness information to a 50-year-old client who is employed as a paramedic. The client asks what, if any, vaccines the client should get. What is the nurse's best response? a) Tetanus and pertussis b) Hepatitis B once and influenza vaccine annually c) Shingles d) Tetanus-diphtheria-pertussis; hepatitis B vaccine once; influenza vaccine annually