Pharmacology Chapter 31: Vaccines

Once a child has received a vaccination, what action is the nurse's priority? A) monitor for possible anaphylaxis B) assess for muscle pain C) treat pain at the injection site D) assess for infection

A) monitor for possible anaphylaxis Anaphylaxis is a potentially life-threatening adverse reaction to vaccines. Muscle pain and pain at the injection site can occur, but assessment and treatment of these is not the primary action. Infection is not likely from a vaccination.

2. A woman who is pregnant tells the nurse she has not had any vaccines but wants to begin so she can protect her unborn child. Which vaccine(s) may be administered to this patient? a. Gardasil vaccine b. Trivalent influenza vaccine c. MMR vaccine d. Varivax vaccine

ANS: B The influenza vaccine is recommended for pregnant women and should be given. Gardasil is given to young women who are not yet sexually active. The MMR is contraindicated because rubella can cause serious teratogenic effects. Varivax is contraindicated during pregnancy.

The patient has been administered a toxoid. The patient is most likely being vaccinated against which disease? A) diphtheria B) human papillomavirus (HPV) C) hepatitis B D) mumps

A) diphtheria Vaccination against diphtheria is performed with administration of a toxoid. Human papillomavirus and hepatitis B both require a recombinant viral antigen vaccine; mumps requires a live attenuated virus.

Which statement about herpes zoster vaccine does the nurse identify as being true? Herpes zoster vaccine: A) is indicated for the treatment of patients at age 40 years B) is a live attenuated vaccine C) should be administered every other year D) prevented zoster in 90% of the people who received the vaccine

B) is a live attenuated vaccine The herpes zoster vaccine is indicated for the treatment of patients at age 50 years or older. It is a one time injection and it prevented zoster in 50% of the people who received the vaccine.

The nurse is preparing to administer the hepatitis A vaccine to the patient. The nurse recognizes that the patient will be receiving: A) inactivated bacteria B) a toxoid C) inactivated viral antigen D) recombinant viral antigen

C) inactivated viral antigen The vaccine against hepatitis A is an inactivated viral antigen.

The patient is scheduled to receive a measles vaccine. The nurse recognizes that the patient will be receiving: A) inactivated viral components B) inactivated virus C) live virus D) live attenuated virus

C) live virus The measles vaccine is a live virus

Before administering the varicella vaccine, it is most important for the nurse to assess the patient for a history of allergy to: A) penicillin B) eggs C) neomycin D) milk

C) neomycin The varicella vaccine should not be given if a patient has an allergy to gelatin and/or neomycin.

The patient has been administered a live virus as a vaccine. The patient is most likely being vaccinated against which disease? A) tetanus B) diphtheria C) smallpox D) anthrax

C) smallpox A live virus is included in the smallpox vaccine. Toxoids are used to immunize against both tetanus and diphtheria. Anthrax requires a vaccine of inactivated bacteria.

Which is the first vaccine developed to prevent cancer? A) rotavirus B) pneumococcal disease C) meningococcal disease D) human papillomavirus

D) human papillomavirus Gardasil is the most widely used vaccine for the prevention of cervical, vulvar, vaginal, and anal cancers caused by human papillomavirus (HPV).

A 38-year-old migrant farm worker is seen in the clinic with a cut to his arm from an old metal drum. The patient has sutures placed, and a tetanus, diphtheria, and acellular pertussis vaccine is given. What is the nurse's most important action after the vaccine has been administered? A) the nurse provides the patient with a vaccine information statement about the tetanus, diphtheria, and acellular pertussis vaccine in the patient's primary language B) the nurse determines the exact date of the patient's last tetanus booster C) the nurse documents that the patient did not experience any side effects immediately following immunization D) the nurse provides the patient with a record of the immunization administered at the visit

A) the nurse provides the patient with a vaccine information statement about the tetanus, diphtheria, and acellular pertussis vaccine in the patient's primary language

3. A 4-year-old child is receiving amoxicillin (Amoxil) to treat otitis media and is in the clinic for a well-child checkup on the last day of antibiotic therapy. The provider orders varicella (Varivax); mumps, measles, and rubella (MMR); inactivated polio (IPV); and diphtheria, tetanus, and acellular pertussis (DTaP) vaccines to be given. Which action by the nurse is correct? a. Administer the vaccines as ordered. b. Discuss giving the MMR vaccine in 4 weeks. c. Hold all vaccines until 2 weeks after antibiotic therapy. d. Recommend aspirin for fever and discomfort.

ANS: A Antibiotic therapy is not generally a contraindication to the use of vaccines. Vaccines may be given in cases of mild acute illness or during the convalescent phase of an illness. All four vaccines may be given. If the MMR or other live virus vaccine is not given the same day as the varicella vaccine, administration of the two vaccines should be separated by at least 4 weeks. Aspirin should not be given because of the increased risk of Reye's syndrome.

9. Which is an example of acquired passive immunity? a. Administration of IgG to an unimmunized person exposed to a disease b. Administration of an antigen via an immunization c. Inherent resistance to a disease antigen d. Immune response to an attenuated virus

ANS: A Passive immunity occurs without stimulation of an immune response. Acquired immunity requires administration of immune globulin. Inherent resistance to a disease antigen describes the state of natural immunity, not acquired passive immunity. The other answers involve stimulation of an immune response.

7. The nurse is preparing to administer rotavirus vaccine to a 4-month-old infant. The nurse notes that the infant received Rotarix vaccine at 2 months of age. The nurse will plan to administer a. Rotarix today. b. Rotarix today and again at age 6 months. c. Rota Teq today. d. Rota Teq today and again at age 6 months.

ANS: A Patients receiving Rotarix receive 2 doses at age 2 and 4 months only.

11. The provider orders Zostavax for a 60-year-old patient. The patient reports having had chicken pox as a child. Which action will the nurse take? a. Administer the vaccine as ordered. b. Counsel the patient that the vaccine may cause a severe reaction because of previous exposure. c. Hold the vaccine and notify the provider of the patient's history. d. Request an order for a Varivax booster instead of the Zostavax.

ANS: A Zostavax is given to boost the immunity to varicella-zoster virus among recipients. It is not likely to cause severe reaction secondary to prior exposure, since the immune response in most recipients has declined. Zostavax, not Varivax, is approved for this use.

1. The nurse is discussing vaccines with the mother of a 4-year-old child who attends a day care center that requires the DTaP vaccine. The mother, who is pregnant, tells the nurse that she does not want her child to receive the pertussis vaccine because she has heard that the disease is "not that serious" in older children. What information will the nurse include when discussing this with the mother? a. If she gets the vaccine, both she and her 4 year-old child will be protected. b. If the 4-year-old child contracts pertussis, it can be passed on to her newborn. c. The vaccine will not be given to her child while she is pregnant. d. Vaccinating the 4-year-old will provide passive immunity for her unborn child.

ANS: B Even though pertussis is not as serious in older children, it is important to vaccinate children to prevent the spread of the disease to infants and others who are not immunized and who are at risk for significant morbidity and mortality from this disease. Vaccinating the mother will not protect the 4-year-old from getting pertussis. The DTaP vaccine may be given to children whose mothers are pregnant. Vaccinating the child does not confer passive immunity to the unborn child.

8. A provider has ordered Gardasil to be given to a prepubertal 9-year-old female. The parent asks the nurse if this vaccine can be postponed until the child is in high school. The nurse will tell the parent that Gardasil a. is less effective in older adolescents. b. is more effective if given before sexual activity begins. c. is more effective if given prior to the hormonal changes of puberty. d. is not effective if given after the onset of menses.

ANS: B Gardasil is most effective when the client is not yet sexually active.

10. The parent of a 12-month-old child who has received the MMR, Varivax, and hepatitis A vaccines calls the clinic to report redness and swelling at the vaccine injection sites and a temperature of 100.3° F. The nurse will perform which action? a. Recommend aspirin or an NSAID for pain and fever. b. Recommend acetaminophen and cold compresses. c. Report these adverse effects to the Vaccine Adverse Event Reporting System (VAERS). d. Schedule an appointment in clinic so the provider can evaluate the child.

ANS: B These are common, minor side effects of vaccines and can be treated with acetaminophen and cold compresses. Aspirin is contraindicated in children because of its association with Reye's syndrome. Since these are not serious adverse effects, they do not need to be reported to VAERS. It is not necessary to schedule a clinic visit.

5. A 48-month-old child is scheduled to receive the following vaccines: MMR, Varivax, IPV, and DTaP. The child's parents want the child to receive two vaccines today and the other two in 1 week. To accommodate the parents' wishes, the nurse will administer a. the DTaP and Varivax today and the MMR and IPV in 1 week. b. the IPV and MMR today and the Varivax and DTaP in 1 week. c. the MMR and DTaP today and the Varivax and IPV in 1 week. d. the MMR and Varivax today and the DTaP and IPV in 1 week.

ANS: D If the MMR or other live virus vaccine is not given the same day as the varicella vaccine, administration of the two vaccines should be separated by at least 4 weeks. In the incorrect answers, the two live virus vaccines are given only one week apart.

6. A young adult patient is in the clinic to receive a tetanus vaccine after sustaining a laceration injury. The nurse learns that the patient, who works in a day care center, has not had any vaccines for more than 10 years. Which vaccine will the nurse expect to administer? a. DT b. DTaP c. Td d. Tdap

ANS: D Persons who work with children should receive acellular pertussis vaccine. The Tdap is given to adults. The DTaP is given to children up to age 6. The DT and Td do not contain pertussis.

4. A patient is preparing to travel with a 4-year-old child to India in 10 days and is in the clinic to receive typhoid vaccines. Which vaccines will be given to the parent and child? a. Four capsules of live, oral vaccine to both patients b. Four capsules of live, oral vaccine for the parent and the IM polysaccharide vaccine for the child c. Four capsules of live, oral vaccine for the child and the IM polysaccharide vaccine for the parent d. IM polysaccharide for both patients

ANS: D While the live, oral vaccine may be given to patients older than 6 years, each capsule must be taken 48 hours apart with the last capsule given 1 week prior to travel. There would not be enough time to complete the regimen since the patients leave in 10 days. Children under age 6 cannot receive the oral vaccine.

The nurse is preparing to administer the tetanus vaccine to the patient. The nurse recognizes that the patient will be receiving: A) inactivated bacteria B) a toxoid C) inactivated viral antigen D) recombinant viral antigen

B) a toxoid The vaccine against tetanus is a toxoid.

Which of the following patients would be eligible to receive the influenza vaccine? A) the patient who is taking care of her son with HIV B) the patient who is pregnant C) the patient with an egg allergy D) the child who is 18 months old

D) the child who is 18 months old

A 14-year-old girl requests a vaccination for human papillomavirus (HPV). After the nurse administers the first dose, which of the following is important to include in the patient's teaching? A) HPV prevents all sexually transmitted diseases B) pap smears are no longer needed after the HPV vaccination C) the patient need to notify the health care provider about pain at the injection site D) the date the patient needs to return to the clinic for the next HPV dose

D) the date the patient needs to return to the clinic for the next HPV dose Typically, a patient receives 3 separate doses of the HPV vaccine. Pain at the injection site is common for many vaccines so the nurse can offer suggestions for the relief of pain such as cold compresses and acetaminophen for soreness or fever. HPV does not prevent all sexually transmitted diseases and pap smears are still needed after the HPV vaccination.