CHAPTER 18: VACCINES AND SERA

A client is seen in the emergency department for a laceration sustained on broken glass. The nurse assesses the client for the last tetanus toxoid received. How often should the client be administered a tetanus toxoid?

"Have you ever received a vaccination for tuberculosis in your home country?"

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?

0.5 mL

The nursing instructor is illustrating the various immunity's the body utilizes to combat disease. The instructor determines the session is successful when the students correctly choose which example(s) to differentiate artificially acquired active immunity from other types? Select all that apply.

1. Administration of the varicella vaccine to an individual who has no immunity to the disease 2. Administration of the influenza vaccine to an individual who has no immunity to the disease 3. Administration of the rubella vaccine to an individual who has no immunity to the disease

Which is an example of artificially acquired active immunity? (Select all that apply.)

1. Administration of the varicella vaccine to an individual who has no immunity to the disease. 2. Administration of the influenza vaccine to an individual who has no immunity to the disease. 3. Administration of the rubella vaccine to an individual who has no immunity to the disease.

Antivenins are used for passive, transient protection from which bites? (Select all that apply.)

1. Black Widow 2. Rattlesnake 3. Copperhead

A nurse is assessing a client's medical record and determines that the client has naturally acquired active immunity. Which example(s) would most likely apply? Select all that apply.

1. Experiencing chickenpox results in immunity to the disease 2. After recovering from pertussis, the client demonstrates immunity against repeat exposures.

Which statements best indicates the client understands recommended vaccines following the 65th birthday?

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

A health care worker has received an annual influenza vaccination and has remained at the clinic after administration so that the nurse may observe for adverse reactions. The worker reports pain at the site of IM injection. What should the nurse recommend?

Acetaminophen

A hospitalized client is about to receive immunological therapy and asks the nurse to explain the difference between passive and active immunity. In order to provide complete information, the nurse knows to include which information during the teaching session?

Active immunity occurs when a client receives a killed or weakened antigen that stimulates antibodies. These antibodies fight the antigen (for example, chickenpox vaccine).

The nurse is assessing a client who is to receive multiple vaccinations. Which nursing diagnosis should the nurse prioritize for this client?

Acute pain

An adult client being treated for breast cancer inquired about required vaccinations. What information should the nurse provide to this client?

Avoid all live vaccines.

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?

Chills and fever

A group of students are role-playing scenarios involving biological weapon exposure. Which medication would the students identify as using for a client with cutaneous anthrax?

Ciprofloxacin

A 1-year-old child will receive a scheduled MMR vaccination shortly. The nurse should teach the child's parents that the child may develop what possible adverse effect related to the administration of this medication?

Cough and fever

A client who was bitten by a pit viper is to receive antivenin. What is the nurse's best action?

Establish IV access.

Administration of the tetanus toxoid in adults involves two initial injections given four weeks apart, a booster injection given six months to a year later, and periodic injections thereafter. What is the recommended interval for the periodic injections for a 66 year old client ?

Every 10 years

The perinatal nurse recognizes that what vaccine can be safely given to a neonate?

Hepatitis B

A 70-year-old client is seen in the family practice clinic. Which vaccine should be administered to prevent shingles?

Herpes zoster vaccine

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?

I know that this booster is good for 10 years.

A nurse is receiving post-exposure prophylaxis for hepatitis B. What would the nurse most likely receive?

Immune globulin

An infant is being administered an immunization. Which statement provides an accurate description of an immunization?

It is the administration of an antigen for an antibody response.

A nursing instructor is discussing the intended populations for various vaccines. Which groups might the instructor mention when discussing the hepatitis B vaccine?

Paramedics and emergency medical technicians.

For what group of adults is pre-exposure immunization against hepatitis B recommended?

People who receive hemodialysis

What is a contraindication to an MMR booster for an adolescent female?

Pregnancy

The school nurse is participating in a program to immunize students against human papillomavirus (HPV). What benefit should the nurse describe to students and their families?

Reduced risk for cervical cancer

The caregivers of a child who is recovering from chickenpox tell the nurse the child was given aspirin for a fever. The nurse would prioritize the assessment for indications of which adverse reaction?

Reye's syndrome

A client develops fever and arthralgia 4 days after the administration of tetanus toxoid. What reaction to the vaccine is this?

Serum sickness

When instructing the parents of a child who has received an immunization in the vastus lateralis, which reaction is most common in the days after the administration?

Soreness and redness at the injection site

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?

Temperature

What would the nurse identify as a vaccine that is a toxoid?

Tetanus

A nurse is teaching a group of clients about immunizations . What benefit of immunization should the nurse describe?

They provide the person with active immunity.

When describing the use of vaccines to a local community group, what would the nurse include?

Vaccines are used to provide active immunity.