chapter 49: immunizing drugs and biochemical terrorism

menactra is indicated for patients of what ages?

9 months to 55 years of age

A patient has an order for the varicella vaccine. It is most important for the nurse to assess the patient for A) use of high dose systemic steroids in the past month. B) allergy to aspirin. C) allergy to eggs. D) history of hypertension

A) use of high dose systemic steroids in the past month. Varicella vaccine is not to be given to immunodeficient patients or to patients who have received high doses of systemic steroids in the previous month. It is also recommended that salicylates be avoided for 6 weeks after administration of varicella vaccine because of the possibility of Reye's syndrome.

The anthrax vaccine is recommended for which groups of people? (Select all that apply.) A. Military personnel B. Veterinarians C. Workers who process imported animal hair D. Emergency department health care providers

A. Military personnel B. Veterinarians C. Workers who process imported animal hair People at risk for exposure to the anthrax bacterium include military personnel, veterinarians, and workers who process imported animal hair.

Which statement MOST accurately describes the pharmacodynamics of vaccines? A. Vaccines work by stimulating the humoral immune system. B. Vaccines provide IgG antibodies to protect against infection. C. Vaccines prevent the formation of antibodies against a specific antigen. D. Vaccines work by suppressing the amino acid immunoglobulin sequence.

A. Vaccines work by stimulating the humoral immune system. Vaccines work by stimulating the humoral immune system, which synthesizes immunoglobulins. They also stimulate the formation of antibodies against their specific antigen, providing active immunity.

A patient with AIDS was cut by a rusty piece of metal while walking outside. He recalls that his last tetanus booster was over 20 years ago. Which immunization therapy will he receive at this time? A) He cannot receive any type of immunization therapy. B) Tetanus immunoglobulin C) Tetanus toxoid, adsorbed D) Tetanus and diphtheria toxoid (Td) booster

B) Tetanus immunoglobulin Vaccines and toxoids rely on a person's immune system in order to work. Patients who are immunocompromised (as in those receiving immunosuppressive therapy and those with AIDS) may not benefit from vaccines or toxoids because they are unable to mount an immune response. In these situations, passive immunizing drugs such as immunoglobulins are warranted.

Which statement regarding possible bioterrorism agents does the nurse identify as being true? A) Gentamicin and tetracycline are useful in the treatment of botulism. B) Tetracycline and ciprofloxacin are indicated in the treatment of tularemia. C) Vaccination for plague is recommended for public defense personnel in the United States. D) Antibiotics are useful in the treatment of smallpox.

B) Tetracycline and ciprofloxacin are indicated in the treatment of tularemia. Antibiotics are of no benefit in the treatment of botulism. No vaccine currently available in U.S. for the treatment of plague. A vaccine is available for the treatment of small pox and may be effective for up to 3 days after exposure. The antiviral drug cidofovir is possibly effective; however, antibiotics are not effective.

What teaching would the nurse provide to a client receiving tetanus toxoid? A. "You will have lifetime immunity from this injection." B. "Soreness at the injection site is a common reaction." C. "This medication must be repeated weekly for 4 weeks." D. "Increase fluid and fiber in your diet to prevent constipation."

B. "Soreness at the injection site is a common reaction." Soreness at the injection site is a common adverse effect of tetanus toxoid.

The current immunization for tetanus and diphtheria toxoids and pertussis, Tdap, is administered to people in which age range? A. Younger than 6 years of age B. 11 years of age and older C. Any age range D. In the first 2 years of life

B. 11 years of age and older Currently, DTaP is the preferred preparation for primary and booster immunization against these diseases in children from 6 weeks to 6 years of age unless use of the pertussis component is contraindicated. Tdap is the recommended vaccine for adolescents and adults, those over the age of 11 years.

What is the priority nursing assessment to monitor when administering vaccinations? A. Myalgias B. Anaphylaxis C. Symptoms of infection D. Pain at the injection site

B. Anaphylaxis Anaphylaxis is a potential life-threatening adverse reaction to vaccines. Pain and myalgias can occur but are not life threatening.

An allergy to which substance is a contraindication to the administration of an immunizing drug? A. Soy B. Egg C. Corn D. Wheat

B. Egg Contraindications to the administration of immunizing drugs include allergy to the immunization itself or allergy to any of its components, such as eggs or yeast.

Which vaccination is marketed and recommended in the prevention of a virus that is known to cause cervical cancer? A. Herpes zoster vaccine (Zostavax) B. Papillomavirus vaccine (Gardasil) C. Pneumococcal vaccine (Prevnar 13) D. Hepatitis B virus vaccine (Recombivax HB)

B. Papillomavirus vaccine (Gardasil) Human papillomavirus virus (HPV) is a common cause of genital warts and cervical cancer. The HPV vaccine (Gardasil, Cervarix) is the first and only vaccine known to prevent cancer.

After immunizations at a well-baby check-up, a mother notes that her infant has redness and swelling at the injection site, is irritable, and has a fever of 99.9° F. She calls the clinic and is worried about her baby. Which action by the nurse is appropriate? A) Tell the mother there's nothing to worry about and that these symptoms are normal and will go away B) Tell the mother that she should bring her baby in to the office for an examination C) Tell the mother that acetaminophen and rest should help to alleviate these symptoms, which are not unusual after immunizations. D) Complete a Vaccine Adverse Event Reporting System form (VAERS).

C) Tell the mother that acetaminophen and rest should help to alleviate these symptoms, which are not unusual after immunizations. These minor reactions may be treated with acetaminophen and rest. Reactions that are more serious or unusual should be reported with the Vaccine Adverse Event Reporting System (VAERS).

The zoster vaccine (Zostavax) is used in which situation? A) To prevent chickenpox in children B) To prevent chickenpox in children who have been exposed to herpes zoster C) To prevent postherpetic neuralgia in patients who have shingles D) To prevent reactivation of the zoster virus that causes shingles in patients age 60 or older

D) To prevent reactivation of the zoster virus that causes shingles in patients age 60 or older Zoster vaccine (Zostavax) is a vaccine for the prevention of herpes zoster. The vaccine is recommended for patients 60 years or older to prevent reactivation of the zoster virus that causes shingles. The vaccine does not prevent postherpetic neuralgia. It can be given to patients who have already had shingles. The vaccine should not be used for the prevention of chickenpox and should not be given to children.

A patient is admitted to the emergency department with cyanide toxicity. Which antidote drugs does the nurse expect to administer? A) atropine B) pralidoxime C) pyridostigmine D) sodium nitrite

D) sodium nitrite Specific antidote drug therapy for cyanide toxicity includes the chemicals amyl nitrite (by inhalation) and sodium nitrite and sodium thiosulfate (both by injection). Specific antidote drugs for sarin include atropine, pralidoxime, and pyridostigmine.

Which vaccination was developed to prevent bacterial meningitis caused by Haemophilus influenzae? A. Prevnar B. Gardasil C. Hepatitis B vaccine D. Hib conjugate vaccine

D. Hib conjugate vaccine H. influenzae type b (Hib) (HibTITER, ActHIB, Liquid PedvaxHIB) vaccine is a noninfectious, bacteria-derived vaccine. Before this vaccine was developed, infections caused by Hib were the leading cause of bacterial meningitis in children 3 months to 5 years of age.

Administration of which substance provides passive immunity? A. Vaccines B. Toxoids C. Antitoxins D. Immunoglobulins

D. Immunoglobulins Vaccines, antitoxins, and toxoids provide active immunity by stimulating the humoral immune system. Immunoglobulins provide passive immunity by giving the patient substances to fight specific antigens.

does the cell-mediated immune system synthesize antibodies?

NO, it is driven by T cells and works by the release of cytokines (inflammatory and phagocytosis

When planning care for a patient who is receiving interferon therapy, the nurse must keep in mind that the major dose-limiting factor is a. fatigue. b. bone marrow suppression. c. fever. d. nausea and vomiting.

a. fatigue.

minor reactions to immunizing drugs can be treated with what?

acetaminophen and rest

more severe reactions, such as a fever higher than 103 (39.4 C) can be treated with what?

acetaminophen and sponge baths

BCG vaccine, tetanus, pertussis, and diphtheria toxoids, influenza conjugate vaccine, and hep A and B virus vaccines, MMR vaccine, pneumococcal bacterial vaccines, HPV vaccine, and rabies virus vaccine are all examples of?

active immunizing drugs

Tdap is indicated for what ages?

adolescents and adults

immunizing drugs contraindications

allergy to immunization, allergy to eggs or yeast

what are the 3 different interferon groups?

alpha, beta, and gamma

an immunoglobulin with a specific amino acid sequence is known as?

an antibody

what is serum sickness best treated with?

analgesics, antihistamines, epinephrine, and/or corticosteroids; hospitalization may be required

immunizations requiring IM injection are given with particular caution to patients receiving?

anticoagulant drugs such as warfarin

examples of biological antimicrobial drugs?

antitoxins, antisera, toxoids, vaccines

an antiserum containing antibodies against a venom?

antivenin (antivenom)

the influenza vaccine can lose efficacy if given with

antiviral influenza drugs

what are the 3 basic properties of interferons?

antiviral, antitumor, and immunomodulating

term for when the body is exposed to a relatively harmless form of an antigen, thus stimulating the immune system to remember this antigen if a subsequent exposure occurs?

artificial active immunization

During a routine checkup, a 72-year-old patient is advised to receive an influenza vaccine injection. He questions this, saying, "I had one last year. Why do I need another one?" What is the nurse's best response? a. "The effectiveness of the vaccine wears off after 6 months." b. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation." c. "When you reach 65 years of age, you need boosters on an annual basis." d. "Taking the flu vaccine each year allows you to build your immunity to a higher level each time."

b. "Each year a new vaccine is developed based on the flu strains that are likely to be in circulation."

The nurse is conducting a class on drugs for malignant tumors for a group of new oncology staff members. Which best describes the action of interferons in the management of malignant tumors? a. Interferons increase the production of specific anticancer enzymes. b. Interferons have antiviral and antitumor properties and strengthen the immune system. c. Interferons stimulate the production and activation of T lymphocytes and cytotoxic T cells. d. Interferons help improve the cell-killing action of T cells because they are retrieved from healthy donors.

b. Interferons have antiviral and antitumor properties and strengthen the immune system.

When assessing a patient who will be receiving a measles vaccine, the nurse will consider which condition to be a possible contraindication? a. Anemia b. Pregnancy c. Ear infection d. Common cold

b. Pregnancy

why should patients avoid salicylates for 6 weeks after its administration when given the varicella virus?

because of the risk for Reye's syndrome

why are passive immunizing drugs called passive?

because the person's immune system does not participate in the synthesis of antibodies, instead the antibodies are provided by the immunizing drug

in cases where a patient is recovering from a febrile illness or a temporary immunocompromised state, when would you administer the immunizing drug?

best deferred until after recovery, such as following cancer chemotherapy (however this is a matter of clinical judgement)

substances of biologic origin used to prevent, treat, or cure infectious diseases

biologic antimicrobial drugs

The nurse is administering methotrexate as part of treatment for a patient with rheumatoid arthritis and will monitor for which sign of bone marrow suppression? a. Edema b. Tinnitus c. Increased bleeding tendencies d. Tingling in the extremities

c. Increased bleeding tendencies

In caring for a patient receiving therapy with a myelosuppressive antineoplastic drug, the nurse notes an order to begin filgrastim after the chemotherapy is completed. Which statement correctly describes when the nurse will begin the filgrastim therapy? a. It can be started during the chemotherapy. b. It will begin immediately after the chemotherapy is completed. c. It will be initiated 24 hours after the chemotherapy is completed. d. It will not be started until at least 72 hours after the chemotherapy is completed.

c. It will be initiated 24 hours after the chemotherapy is completed.

The nurse is providing teaching after an adult receives a booster immunization. Which adverse reactions will the nurse immediately report to the health care provider? (Select all that apply.) a. Swelling and redness at the injection site b. Fever of 100° F (37.8° C) c. Joint pain d. Heat over the injection site e. Rash over the arms, back, and chest f. Shortness of breath

c. Joint pain e. Rash over the arms, back, and chest f. Shortness of breath

When giving a vaccination to an infant, the nurse will tell the mother to expect which adverse effect? a. Fever over 101° F (38.3° C) b. Rash c. Soreness at the injection site d. Chills

c. Soreness at the injection site

A 28-year-old patient is in the urgent care center after stepping on a rusty tent nail. The nurse evaluates the patient's immunity status and notes that the patient thinks she had her last tetanus booster about 10 years ago, just before starting college. Which immunization would be most appropriate at this time? a. Immunoglobulin intravenous (Gammar-P IV) b. DTaP (Daptacel) (diphtheria, tetanus, and acellular pertussis) c. Tdap (Adacel) (diphtheria, tetanus, and acellular pertussis) d. No immunizations are necessary at this time.

c. Tdap (Adacel) (diphtheria, tetanus, and acellular pertussis)

MMR vaccines can be reduced by?

concurrent interferon therapy

An animal control officer was bitten by a stray dog that showed signs of rabies. Which statement by the nurse is correct regarding the treatment for rabies prophylaxis? a. "You will receive treatment if you begin to show symptoms of rabies." b. "You will receive one oral dose of medication today, and one more in 1 week." c. "You will need to receive 3 subcutaneous injections over the next week." d. "You will need to receive 5 intramuscular injections over the next 28 days."

d. "You will need to receive 5 intramuscular injections over the next 28 days."

The nurse is reviewing the Centers for Disease Control (CDC) recommendations for vaccines. The pneumococcal vaccine (Pneumovax 23) is recommended for which group? a. Newborn infants b. Patients who are immunosuppressed c. Patients who are transplant candidates d. Smokers between 19 and 64 years of age

d. Smokers between 19 and 64 years of age

interferon alpha 2b interacts with drugs that are metabolized in the liver via CP450 resulting in?

decreased metabolism and increased accumulation of these drugs, leading to drug toxicity

live vaccines should be given when if a patient received a Hep B immunglobulin?

defer administration of such vaccines until 3 months after the dose of immunoglobulin is given

before interferons can be given what should you assess the patient for?

drug allergies, AI disorders, hepatitis, liver failure, or AIDS

signs and symptoms of serum sickness?

edema of face, tongue, throat; rash; urticaria; arthritis; adenopathy; fever; flushing; itching; cough; dyspnea; cyanosis; vomiting; and CV collapse

using interferons together with antiviral drugs such as zidovudine does what?

enhances the activity of both drugs but may lead to toxic levels of zidovudine

the bacille Calmette-Guerin vaccine for TB can cause what when taking a TB skin test?

false-positive results on the tuberculin skin test

what is the major dose-limiting factor for interferons?

fatigue

severe reactions to immunizing drugs?

fever higher than 103 F or 39.4 C, encephalitis, peripheral neuropathy, anaphylactic reaction, shock, convulsions, dyspnea, cyanosis

minor reactions to immunizing drugs?

fever, adenopathy, minor rash, soreness at injection site, itching, arthritis, urticaria

adverse effects of interferons

flulike syndrome (fever, chills, HA, malaise, myalgia), fatigue, tachycardia, cyanosis, orthostatic hypotension, neutropenia, thrombocytopenia

interferon alpha 2b indications

hairy cell leukemia, malignant melanoma, follicular lymphoma, condylomata acuminata, Kaposi's sarcoma, chronic hep C and B

what is an example of natural active immunization?

having the disease

an antiserum is usually obtained from what?

horses inoculated with the toxin

a concentrated preparation containing predominantly immunoglobulin G and harvested from a large pool of blood donors?

immunoglobulin

which drug class can potentially reduce the efficacy of immunizing drugs is?

immunosuppressive drugs, including corticosteroids, transplant antirejection drugs, and cancer chemotherapy drugs

passive immunization lasts how long?

it only lasts until the injected immunogloblins are removed from the person's immune system by the reticuloendothelial system

contraindications for interferons?

known drug allergy, AI disorders, hepatitis or liver failure, concurrent use of immunosuppressant drugs, and severe liver disease, AIDS-related Kaposi's sarcoma

interferon alphas are also referred to as?

leukocyte interferons because they are produced from human leukocytes

vaccinations with live bacteria or virus provide what kind of immunity?

lifelong immunity

do active immunizations provide temporary or long-lasting/permanent immunity?

long-lasting/permanent

individuals 65 years of age or older or those with chronic diseases are at risk for what with he influenza vaccine?

mortality

term for when a person acquires immunity by surviving the disease itself and producing antibodies to the disease-causing organisms

natural active immunization

antibodies that are transferred from mother to infant in breast milk is an example of what type of immunization?

natural passive immunizations

should aspirin be given to children?

no

can the meningococcal vaccine, whole-cell pertussis vaccine, and typhoid vaccine be given together?

no because they have an undesirably large bacterial endotoxin content and should not be administered simultaneously

vaccinations with killed bacteria or virus provide what kind of immunity?

partial immunity

antivenins, antitoxins, and immunoglobulins are all what kind of drugs?

passive immunizing drugs

what kind of drugs are used in people who already have the given disease, especially those with diseases that are rapidly harmful or fatal, such as rabies, tetanus, and hepatitis?

passive immunizing drugs

tetanus, diphtheria, and pertussis vaccines are to be used in patients of what ages?

patients 6 weeks to 6 years of age

the MMR vaccine is contraindicated in who?

pregnant women, people with a history of anaphylactic reaction, reaction to egg ingestion, allergic reaction to neomycin with active TB

what is an example of artificial active immunization?

receiving a vaccine or toxoid

is passive immunization temporary or life long?

temporary

in the case of a potentially fatal illness such as rabies, what would you do if the patient is allergic to the immunizing drug?

the drug may still need to be given and any allergic reaction controlled with other medications

when should influenza vaccines be given in relation to antiviral drug therapy?

the influenza vaccine should be given 48 hours after stopping antiviral drug therapy

interferon alpha 2b has a black box warning related to?

the potential to cause of aggravate AI disorders and neuropsychiatric symptoms

any poison produced by a plant, animal, or microorganism that is highly toxic to other living organisms

toxin

bacterial exotoxins that are modified or inactivated (by chemicals or heat) so that they are no longer toxic, but it can still bind to host B cells to stimulate the formation of antitoxin

toxoids

any serious or unusual reaction to immunizing drugs need to be reported to who?

vaccine adverse effects reporting system (VAERS)

suspensions of live, attenuated, or killed microorganisms that can promote an artificially induced active immunity against a particular microorgansim

vaccines

a poison secreted by an animal

venom

Hep B vaccine is contraindicated in patients allergic to what?

yeast

is the use of immunosuppressants a contraindication for immunizing drugs?

yes

are booster shots needed with vaccinations containing killed bacteria or virus?

yes, they are needed periodically